Ten Ways Penn Nursing is Changing the World
(That would be $11.3 million in 2019, the highest level of research funding among nursing schools in the country for three consecutive years.) But in truth, the impact of Penn Nursing is impossible to measure. From revolutionary research and scientific advancements to program development and policy shaping led by the School’s nursing and other interdisciplinary faculty, it is changing the way nurses interact with the world—and helping people lead better, healthier, more fulfilling lives. And there’s never been a better time to celebrate the School: The World Health Organization has dubbed 2020 “The Year of the Nurse and Midwife” to commemorate the 200th anniversary of Florence Nightingale’s birth and honor the vital work and dedication of nurses and midwives. So while it might not be possible to quantify the influence of Penn Nursing, it’s the perfect time to try: Here, 10 ways Penn Nursing faculty are changing the world.
1. THEY’RE WORKING TO STOP PREVENTABLE INJURIES.
Whether its gun violence or texting while driving, many traumatic injuries are preventable. And several Penn Nursing faculty members, including Therese Richmond, Sara Jacoby, and Catherine McDonald, are working tirelessly to understand how these injuries happen, why they happen where they do, how they psychologically affect the victims, and how to prevent them in the first place. Richmond, who founded what is now known as the Penn Injury Science Center 20 years ago, studies trauma recovery—particularly in those from at-risk urban areas—and the importance of concentrating on physical and mental healing. Jacoby, who was a Philly ICU nurse, also focuses on urban communities, and on the glaring inequality between their trauma outcomes and those of other, less vulnerable areas. Her approach: Learn more about where and to whom these injuries are happening (she’s researching the benefit of collaboration between health professionals and law enforcement); and understand how to support these people during recovery (she’s studying the potential of mobile technology). McDonald, meanwhile, is tackling risky behavior in adolescents. She worked with CHOP researchers to develop a driving simulator that assesses how teens react in different crash scenarios, and now she’s studying how to curb risky behaviors—and how to get teens to pay attention to the road instead of their phones.
2. THEY’RE CHANGING THE WAY WE LOOK AT DEMENTIA.
With aging often comes indignities both small and profound: from hearing difficulties and vision problems to disorientation and memory loss. But certain interventions can make life for elderly people not only dignified but fulfilling. These sorts of interventions— and innovations—are all in a day’s work (or, more accurately, a lifetime’s work) for a trio of Penn Nursing faculty members who are seriously advancing elderly and dementia care. Adriana Perez is focusing on older Latinos with dementia, researching how tailored, meaningful physical activity can help behavioral symptoms and improve quality of life, and also evaluating the role of community in ensuring that these elders utilize health care resources. Pamela Cacchione— a clinical educator who also works on life-changing sensory interventions with tools like pocket-sized amplifiers and anti-glare lenses—leads mental health screenings and interventions for older people with a keen awareness of the serious health risks antipsychotic drugs pose for patients with dementia. And Nancy Hodgson, a nationally recognized nurse scientist, co-founded one of the first nursing-home-based palliative care programs in the nation, the Palliative Care Program at the Madlyn and Leonard Abramson Center. Need proof of its success? The program is now a national model.
3. THEY’RE TACKLING THE OPIOID CRISIS HEAD-ON.
Between five and eight million Americans use prescription opioids daily to treat chronic pain. The result? Astounding levels of addiction—and a phenomenon called hyperalgesia, or increased sensitivity to pain. Research from renowned pain expert Peggy Compton has found that in many cases, opioids are actually hindering patient outcomes, making pain (or the perception of it) worse. She’s working with chronic pain patients to determine whether tapering them off opioids improves pain perception, in an effort to understand how opioid abuse affects the human pain system— and how to better assess addiction. She co-teaches a pain course with neuropharmacologist Heath Schmidt, the director of Penn’s Laboratory of Neuropsychopharmacology. With funding from the National Institute of Drug Abuse, Schmidt is also digging into how the brain changes with repeated drug exposure, and working to develop new ways to treat opioid use disorder. Meanwhile, Salimah Meghani’s work has influenced the CDC to make key clarifications in its pain management guidelines, which were inconsistent and unintentionally limiting pain treatment for cancer patients. And her palliative care research has uncovered inequality in pain treatment, with African Americans consistently receiving less care. And Rosemary Polomano was on the committee for a prestigious report from NASEM to build a framework for evaluating and developing clinical practice guidelines for opioid prescription, and coming up with a prioritized research plan for conditions that don’t yet have evidencebased opioid prescription guidelines for treating acute pain— a milestone in tackling the ongoing opioid crisis.
4. THEY’RE SHAPING THE WAY WE MANAGE SYMPTOMS.
When Lee Ann Matura noticed that people with pulmonary arterial hypertension typically showed a common cluster of symptoms— fatigue, shortness of breath, and difficulty sleeping—she began to wonder how much these symptoms affected patients’ daily lives. And so she dived into research on symptom management strategies, such as mindfulness-based stress reduction and cognitive behavioral therapy. Her goal: Improve the lives of those with cardiovascular disease and other chronic illnesses. (And it’s working: These strategies have had a measure of success in some cancer patients.) Barbara Riegel’s work focuses on helping older adults with chronic heart disease and other chronic conditions take better care of themselves—and on working with caregivers to promote and understand best self-care practices. Through her extensive interdisciplinary research into heart disease and selfcare, she’s discovered that patients who understand their symptoms, work to manage them, adhere to treatment regimens, and become actively involved in their care live longer, happier lives. Amy Sawyer’s approach to quality of life, behavioral health, and symptom management is at once simple and incredibly complex: sleep. Her extensive sleep science research focuses on health behaviors as they relate to sleep disorders, and on how to improve our everyday behaviors for optimal, restorative, quality sleep. And Lauren Massimo was recently awarded a pilot grant to develop an app that helps people with frontotemporal degeneration manage apathy, a common symptom among people with FTD. She’s leading a team of Penn neuropsychologists and smartphone app developers to create an app that gives those with FTD a framework for setting, scheduling—and sticking to— meaningful daily activities and goals.
5. THEY’RE LEADING THE MODERN SEXUAL HEALTH REVOLUTION.
Five Penn Nursing faculty members— including Dean Antonia Villarruel— are pioneering the way we talk about, study, and improve sexual health and equality. There are hightech interventions, like the mobile health strategies and biomedical technologies that José Bauermeister uses to help increase health equity for young sexual and gender minority populations; and the geographic information system mapping that Bridgette Brawner uses to develop interventions for urban populations to help prevent HIV and other sexually transmitted infections. There are the social strategies, too: Dennis Flores, who is a national spokesperson for HIV-testing campaigns, is focused on improving the dynamic between parents and sexual minority youth with a framework of inclusive interventions, so that this population won’t engage in risky sexual behavior. And Robin Stevens, the founder of Penn’s Health Equity & Media Lab, is lasered in on social media—specifically on the 56,000 social media posts she and her colleagues have collected from youth between the ages of 13 and 24. Their aim: to study the relationship between platforms like Twitter, Instagram, Snapchat, and sexual risk. And of course there is Dean Villarruel’s lauded ¡Cuídate!, a culturally-based program that promotes abstinence and safer sex for Latino youth. The intervention is a continued success: A randomized controlled study found that participants waited longer to have sex, had fewer sexual partners, and engaged in less unprotected sex. The program is now widely used throughout the US and Puerto Rico.
6. THEY’RE PUSHING NUTRITION TO THE FOREFRONT OF HEALTH CARE.
Despite its vital importance in health care, nutrition has always lingered in the shadow of other sciences. But Charlene Compher, Karen Glanz, Tanja Kral, Ariana Chao, and Bart De Jonghe are driving the field into the limelight with leading-edge research on genetics, biochemistry, and behavioral science. Their studies are wide-ranging and pioneering: Thanks to her research on the links between gut microbiome, diet, and clinical outcomes, Compher has helped countless people who suffer from short bowel syndrome and Crohn’s, an increasingly common disease in the US and around the world. Glanz, who was named one of the World’s Most Influential Scientific Minds of 2015 by Thomas Reuters, is a public health scholar on a global scale. To wit: Her work on improving healthy food environments—like a study on the impact of healthy food marketing in grocery stores—has earned wide acclaim (and replication). Both Kral and Chao direct much of their research at understanding and tackling obesity—Kral from a familial perspective (like how people who are genetically predisposed to obesity are influenced by their surrounding food environment); and Chao from a biobehavioral approach (like studying mechanisms linked to binge eating, food cravings, and other addictive food behaviors). And De Jonghe is working to curb chemo’s awful side effects, namely nausea, vomiting, and appetite loss, with neuroscience. He’s studying brain signals to identify which areas of the brain are connected in an effort to control these side effects—of potential benefit for those undergoing chemo treatments.
7. THEY’RE IMPROVING CARE IN THE HOSPITAL AND AT HOME.
Leaving the hospital doesn’t mean the healing process is over. And for many chronically ill patients, the transition from hospital to home is incredibly difficult. But thanks to the work and innovation of faculty members like Mary Naylor, Karen Hirschman, Margo Brooks Carthon, Pam Cacchione, Linda Aiken, and Matt McHugh, patients and caregivers are better equipped to navigate this vulnerable time, so that patients stay healthier—and stay out of the hospital. Naylor’s pioneering work led to the Transitional Care Model, an advanced practice nurse-led model that supports and guides older adults as they move to home care. Hirschman, a former geriatric social worker and a member of the TCM team who worked to refine and scale the model, is equally dedicated to improving the care of older adults, especially those with cognitive impairments, and to addressing the burden on family caregivers. Brooks Carthon focuses on socially vulnerable and minority older adults whom she found had poorer outcomes than white patients, likely due to a lack of economic resources or access to quality care. Her solution: She spearheaded the development of THRIVE, a program that supports patients with complex social needs (like housing instability and financial insecurity) successfully transition into home care. Meanwhile, Cacchione’s research spans health policy, sensory impairment, and … robots. (Yes, really.) She’s researching the development of affordable mobile service robots to help older adults in assisted living facilities. And Aiken and McHugh have worked to improve nurse-to-patient ratios in hospital settings. Aiken is an authority on nurse shortages, and her research on the importance of these ratios informed safe nurse-staffing mandates around the world, while McHugh’s research influenced nationwide policy, including nurse-staffing legislation, so patients get better care and have better outcomes.
8. THEY’RE HARNESSING THE POWER OF TECHNOLOGY.
Imagine smart homes that passively monitor older adults or people with disabilities to make sure they’re safe, or interactive mobile technology that helps kids with autism who are picky eaters eat healthier. These are very real possibilities, thanks to a group of leaders from Penn Nursing who are utilizing the power of tech to transform the ways in which we understand, care for, and improve patients’ well-being and quality of life. There’s George Demiris, who designs and evaluates smart home technologies and wearable devices for older adults to promote independence, and to ease the burden on family caregivers. There’s Anne Teitelman, who developed two mobile web apps, Everhealthier Women and NowIKnow, to help women track things like cancer screenings, HPV vaccinations, and other reproductive health behaviors to reduce the risk of cervical and other cancers. There’s José Bauermeister, whose pioneering work has helped mHealth apps and other technological interventions (geared toward things like HIV prevention, testing, and care, and the health of racial and sexual minority young adults) reach more people and be more effective. There’s Tanja Kral, who is working on developing an mHealth intervention that will help children with autism spectrum disorder eat more nutritiously, as these children are prone to mealtime problems and obesity. And finally, there’s Kathy Bowles, who along with her research team developed a unique screening tool called the Discharge Decision Support System. They turned it into a software product that has changed the way hospitals assess post-acute care needs and transitional care, so that patients have better outcomes and avoid readmission.
9. THEY’RE ADVANCING THE WAY WE DEAL WITH CHRONIC ILLNESS.
When it comes to chronic illnesses like diabetes, heart disease, and cancer, the stats are staggering. Diabetes affects approximately 30.3 million adults and 200,000 children in the US. Nearly half of all American adults have heart disease. And about 75 percent of head and neck cancer survivors are impacted by lymphedema. At Penn Nursing, renowned experts like Terri Lipman, Barbara Riegel, and Jie Deng are boosting awareness, leading research, and advancing treatments for these chronic conditions in an effort to help people live longer—and better. Lipman, an international expert on diabetes, maintains the only registry of pediatric type 1 diabetes in Philadelphia (which has shown a steady increase of type 1 diabetes across all racial/ethnic and age groups, and a doubling of occurrence in children under five); she pioneered examinations of the prevalence of low vitamin D levels in kids with type 1 diabetes, so that health providers can routinely screen at-risk kids for the deficiency. Riegel works extensively with patients and caregivers to promote self-care for older adults with heart disease. And for good reason: Her comprehensive research found that self-care practices— like diet, exercise, symptom recognition, sleep, and stress management— strongly reduce the risk of hospitalization and clinical events like heart attacks, but aren’t emphasized enough by health care providers. And Deng is leading the charge to tackle health challenges facing cancer survivors, particularly secondary lymphedema, which causes internal and external swelling in the face and neck following treatment for head and neck cancer.
10. THEY’RE REVOLUTIONIZING THE WAY WE ADVOCATE FOR WOMEN AND CHILDREN’S HEALTH.
From Haiti and rural India to Pennsylvania and Appalachia, Penn Nursing is changing the global landscape of health care for women and children. Nurse midwife and failure to- thrive nurse clinician Kim Trout works to improve nutrition during pregnancy, with a special focus on gestational diabetes—particularly on establishing evidence-based diet guidelines for GD patients and addressing the growing disparities in the treatment and occurrence of the disease, which is becoming increasingly common in African American and Latin women. She’s also working to help those in developing countries, like Haiti, develop their midwifery education. Wendy Grube helps underserved women advocate for their reproductive health, especially in places where there are stark inequities in the rates of diseases like cervical cancer. (The widely preventable disease is disproportionally common in rural Appalachia. She takes students there every year to provide free health care and health education for women.) Diane Spatz has transformed the way we approach breastfeeding research, education, and practice. Her 10-Step Model for human milk and breastfeeding in vulnerable infants, which provides breastfeeding information and comprehensive support to mothers, is used by hospitals in the US and worldwide. And Martha Curley’s revolutionary advancements in pediatric critical care have given providers around the world tools to assess critically ill children. (See: The Braden QD scale which predicts pressure ulcers; the State Behavioral Scale which assesses sedation states of infants and young children on mechanical ventilators; the Withdrawal Assessment Tool for opioid and benzodiazepine withdrawal; and the Individualized Numeric Rating Scale to assess pain levels in children with severe intellectual disabilities who cannot speak.)