Feature

Future-Proofing Healthcare

How Penn Nursing’s PhD program is the key to unlocking innovative and equity-focused care and policy.

Before Ellen Munsterman, APRN, AGCNS-BC, MSN even stepped foot onto Penn’s campus, she shared a meaningful connection with the Ralston House Term Chair in Gerontological Nursing, Pamela Z. Cacchione, PhD, CRNP, BC, FGSA, FAAN.

Separately, they had each studied the use of PARO— the small Japanese robot designed like a baby seal stuffed animal—with dementia patients. Could, perhaps, the intervention mitigate agitation? But while Cacchione, thanks to decades of career achievements, is the 2024 recipient of the School of Nursing’s prestigious Norma M. Lang Award for Scholarly Practice and Policy, Munsterman’s contributions to science are just starting to take shape. Still, they have another thing in common: Both belong to the community of nurses who are passionate about addressing real-world health challenges through well-designed research.

Munsterman, now a third-year doctoral candidate, was drawn to the School’s Doctor of Philosophy in Nursing (PhD) program because of impactful research by professors like Cacchione, as well as an enduring eagerness to find evidence-based solutions that will improve patients’ lives. The same goes for fourth-year Lucy Andersen.

“When you’re working clinically, you start to naturally question things and think about how they can be done better. Some of those questions can be answered with your knowledge from a BSN or master’s degree,” Andersen says. “For me, I felt like to answer the questions that I was asking, I really needed to conduct my own research.”

Research is, after all, at the heart of the Penn Nursing doctoral degree pursuit, according to Dean Antonia M. Villarruel. She says a good nurse researcher is “somebody who likes to solve problems. It could be taking care of patients. It could be working in communities. It could be policy related. What’s the problem you want to solve?”

They explore their questions by relying on an array of research methods, always applying a lens of health equity. And, in recent years, the School has strengthened three areas through the recruitment of faculty: precision science (tailoring treatment to individuals), data science (gleaning insights from data to improve health care), and implementation science (putting findings from research into practice).

Whatever their method, doctoral candidates also benefit from the School’s network of clinical and community partners. Alumni go on to everything from leading research that benefits community health to running health systems. They are driven by curiosity. According to the Dean, an interest in taste and smell led Paule Joseph, MS, FNP-BC, RN, CTN-B, GRN’15 to her dissertation topic. Joseph went on to a job at the National Institutes of Health—and when COVID-19 came along, “bingo, her research is elevated,” says the Dean. PhD alumna Regina S. Cunningham, RN, AOCN, FAAN, GR’03 is now Chief Executive Officer at the Hospital of the University of Pennsylvania. Some students even go directly from BSN to PhD, like Stephen Bonett, PhD, MA, RN, Nu’17, GR’21, GRW’21. He is now researching the expansion of equitable access to HIV prevention in Philadelphia.

“What nurses bring to research is a more holistic perspective of the issues that they’re trying to solve,” Dean Villarruel says. “It’s not a disease, but it’s understanding the disease in context of the person, and understanding that the person lives in a family. and the family lives in a community that’s influenced by policy.”

Among our current cohorts of PhD candidates, we talked with five who are using that viewpoint to find health solutions that you may someday see in a setting near you.

a nurse and patient illustration over a yellow background with shapes featuring charts

Helping Dementia Caregivers

Implementation Science

Identifying where tech-enhanced support can help caregivers and spark new policy.

When Hannah Cho, ACHPN, GNU’15 talks to family members caring for a relative with dementia, she brings personal experience to the conversation.

“It’s really challenging. My grandmother had dementia, and my family tried to keep her at home as long as possible. We hired extra help, but still it wasn’t enough,” she says. A desire to drive policy that gives more families like hers the support they need led her back to Penn Nursing for a PhD. After getting her MSN and working as a palliative care specialist, she knew the School’s reputation.

“I was fascinated by Drs. [Nancy] Hodgson and [Laura] Gitlin’s research on COPE, Care of People with Dementia in their Environments. They’ve found some remarkable ways to improve the quality of life for both patients and caregivers,” she says.

black and white portrait of a woman Hannah Cho, ACHPNCho says faculty mentorship and the opportunity to assist George Demiris, PhD, FACMI, Penn Integrates Knowledge University Professor, with his research has been key in designing her own dissertation project. She appreciates that as advisors, Hodgson, PhD, RN, FAAN, Claire M. Fagin Leadership Professor in Nursing, and Demiris have guided her to something practical for a PhD student, yet still innovative.

She plans to examine digital literacy among caregivers of adults with dementia—and how that impacts the social support they get from the community and health care system. Using implementation science and health informatics, she hopes her research will “identify opportunities and needs for technology-enhanced support” and lead to policies that establish financial help for informal caregivers and programming for people with dementia that gives relatives some respite.

She’ll recruit subjects from Demiris’s ongoing study focused on hospices but ask different questions. “I want [to explore] earlier access to palliative care services, so they will have a smoother transition to the hospice services in the future,” she explains.

Health equity is top of mind in her recruiting. “I’m Korean. I think that our nursing school and Dr. Demiris always try to recruit different populations,” she says. She acknowledges, “In my practice, I do not see diversity in hospice services, unfortunately.” But she notes that the agency connected to their research problems is trying to recruit more people of color. Learning how researchers engage such organizations and build productive relationships with them is one of the skills she is honing—even though, Cho jokes, she might not be the typical PhD student.

“Honestly, I do not like studying,” she says with a laugh. But she suggests that even nurses who don’t look back on their school days with fondness should consider a PhD. A big upside, she says, is “being part of a team that can change what we are doing clinically. What we are studying, what we are exploring, it’s going to make a bigger and broader impact on the health care system.”

a line drawing of a hospital linked to shapes featuring DNA, charts, and a home

Supporting Sepsis Survivors

Implementation Science

Discovering how tech can keep sepsis survivors healthy.

The potential of research to change the world has been on the radar for Elaine Sang, RN, MSN since she was an undergrad studying fruit flies (whose genes are similar to those of humans) and triple negative breast cancer. She even spent a summer in Taiwan helping with a study on sleeping disorders among nurses.

Her thirst for science did not abate. Early in her nursing career, at a North Carolina hospital, she was involved with the research committee. There, the patient population was largely rural, and many people she saw had multiple comorbidities, including sepsis. “Many were being readmitted to the hospital because of social determinants of health factors,” she says. Some had to choose between feeding their families and paying for health care. Others had trouble traveling the long distances required to make outpatient appointments.

“All this experience drove me to pursue a PhD,” says Sang, who wanted to determine how technology could be leveraged to improve the health of her patients.

“I knew technology was really growing, especially for patients living in low socioeconomic areas,” she says. She was intrigued by the research of Professor Kathryn H. Bowles, PhD, RN, FAAN, FACMI, GRN’96, van Ameringen Chair in Nursing Excellence, on how health informatics can improve health care for at-risk adults. (Sang is simultaneously pursuing a biomedical informatics certificate.)

black and white portrait of a woman Elaine Sang, MSN, RNFor her dissertation, Sang will explore the quality of patient education given to sepsis survivors. The goal is to ensure they know what self-care and self-monitoring to do at home, and that they have sufficient resources after discharge. She is already conducting a qualitative study that will be part of her dissertation, by interviewing nurses, doctors, case managers, sepsis coordinators, and quality improvement professionals about their perspectives. The next step is recruiting patients who have recovered from sepsis.

“I eventually hope to branch to other interventions, not just education, to improve their self-care and then to improve their well-being and prevent them from having to go back to the hospital,” she says. Sepsis survivors are almost twice as likely to be readmitted within 30 days, and previously, patients have rated their education as very poor. “I hope my research contributes to a new and growing field to really focus on care for this population.”

From a technology and data perspective, Sang wants to examine how technology like telehealth platforms can alleviate transportation barriers, or the potential for artificial intelligence to flag for providers when a patient is a sepsis survivor. “I’m also interested in interoperability between different hospitals’ EHR systems to share patient information, to allow for a more comprehensive care plan,” she says.

Since she has enrolled, Sang says, Bowles and another advisor, Research Professor Karen B. Hirschman, PhD, MSW, SW’96, SWP’01, have been key to her progress.

“They gave me a lot of resources to succeed,” she says. Bowles referred her to a grant opportunity to fund her dissertation. She is also involved in their I-TRANSFER study, which aims to overcome barriers to the effective monitoring of sepsis survivors. “Being involved with that, I have opportunities to learn more about research, about how to work with others and how a research study gets launched.”

Exploring Cancer Insights

Precision Science

Examining how patients tolerate CAR T-cell therapy and their current symptom burden.

Lucy Andersen, OCN, GRN’24 was working at a Washington DC hospital a few years ago when she first saw cancer patients who had received a cutting- edge CAR-T cell therapy. Seeing firsthand the outcomes of a treatment just approved by the FDA in 2017 would be a noteworthy career marker for anyone, and Andersen valued the experience. But soon, something else got her attention: a lack of nursing research.

“I started to have a lot of questions regarding what the long-term outlook for CAR T-cell patients would be,” she says.

“With targeted therapies like CAR T-cell therapy, they’re really a lot more focused on those cancer cells. Patients tend to have much better outcomes, as opposed to our more traditional methods of chemotherapy.”

So Andersen decided to search for her own answers at Penn Nursing—a perfect fit, as Penn has been a pioneer in CAR-T cell therapy. An early interview with Professor Jie Deng, PhD, RN, OCN, FAAN, Evan C. Thompson Term Chair for Excellence in Teaching, influenced her choice of school, too. “She was someone who I really wanted to work with and really wanted to learn from.”

Now, four years into her doctoral pursuit, Andersen is recruiting subjects for a precision science study of this new patient population and their caregivers.

“With targeted therapies like CAR T-cell therapy, they’re really a lot more focused on those cancer cells. Patients tend to have much better outcomes, as opposed to our more traditional methods of chemotherapy,” she says. “It’s exciting for me as a nurse because I want my patients to do well, and I also want them to have minimal impact on their quality of life and minimal symptoms moving forward.”

Specifically, she’ll examine how the patients tolerated the therapy and their current symptom burden. Health equity has also influenced her design and will be integrated into her analysis.

black and white portrait of a woman Lucy Andersen, OCN“We see how someone’s socioeconomic status or their level of caregiver support can really impact their whole illness trajectory,” Andersen says. She will look at the longterm financial impact of receiving such therapy, for patients and their caregivers. Some health insurance covers only part of the cost. “I think ensuring access is one thing, but also ensuring that patients aren’t having other adverse experiences financially after receiving therapy is also important.”

Thanks to a small qualitative study she already conducted, Andersen has found that CAR T-cell therapy patients are doing quite well. However, she says, “most still had some symptoms that they dealt with in their day-to-day life.” Fatigue and neuropathy are common issues. Through her dissertation study, she says, “One goal I have is to develop interventions to address patient symptoms. We can try to offer supportive care and prevention to mitigate those symptoms overall.”

During that initial small study, she cemented relationships with mentors in the Schools of Medicine and Nursing that she believes will be critical to her success. “I have this dream team of scientists who are really passionate about the work I’m doing.”

Her work has continued at the bedside, too, throughout her studies. Andersen still works clinically, to keep her eye on those she wants to help. “I like seeing the patients all the time because it reminds me of why I’m doing this in the first place. It also makes sure that my questions are relevant and the interventions that I’m thinking about are actually useful and could be implemented.”

Addressing Health Inequities

Implementation Science

Utilizing tech to address systemic racism and inequality.

As an ER nurse, Jennifer Gil, MSN, RN saw the return of plenty of patients who had made little progress. Many didn’t have the “resources to connect to preventative care or mental health services,” Gil says.

She wondered, too, about the connection between crowded ERs and nurses’ burnout. The COVID-19 pandemic amplified her inquisitiveness. “I got intrigued in not only patient outcomes, but also the work environment and health care systems’ deficiencies and the inner workings of care delivery models,” Gil says. “I decided that the best avenue to work through those and address those issues was to get my PhD.”

But why stop there? She decided to also enroll in the Master’s for Healthcare Innovation Program. “I really saw an important avenue of integrating innovation into care delivery models … how we can leverage technology to address systemic racism and health inequities for vulnerable populations,” she says.

black and white portrait of a woman Jennifer Gil, MSN, RNNow in her second year, Gil is a predoctoral fellow at the School’s Center for Health Outcomes and Policy Research (CHOPR)—a fitting home since CHOPR research on work environments fueled her advocacy for safe staffing levels when she was at the bedside.

“For that research to be led by nurses was very inspiring,” she says, “that nurses have the power to make an impact on policy and research. And we’re seeing changes in policy.”

Gil, whose family came to the U.S. from Colombia, sees a future in leadership where she can represent “people who look like me.” She currently serves on the ANA’s national board of directors.

Entering the PhD program without much prior research experience hasn’t been a problem, Gil says. She’s been building relevant skills inside and outside the classroom. A course taught by Associate Professor J. Margo Brooks Carthon, PhD, RN, FAAN, GR’08, Tyson Family Endowed Term Chair for Gerontological Research, helped her strengthen her facility for statistics and analysis. She recalls, too, the impact of a class with physician-scientist Meghan Lane-Fall, MD, MSHP, RES’10 FEL’11 GR’13, who Gil refers to as an “implementation science guru.” Gil also works with Brooks Carthon on Thrive, an intervention to support low-income individuals’ transition home after acute care. For her master’s, she did a class project on integrating social determinants of health into an EHR system.

“You get to work with not only great professors and researchers, but these are people who are renowned in our profession. To have that one-on-one experience with them and mentorship is absolutely invaluable,” Gil says. “You have the opportunity to work with people who come from different backgrounds, different expertise, and you get to combine all those things into your curriculum and experience and skill set.”

Creating Dementia-Friendly Hospitals

Implementation Science

Helping to bring dementia-friendly hospitals to the U.S. sooner.

While serving as gerontology coordinator at a Texas hospital, Ellen Munsterman, APRN, AGCNS-BC, MSN jumped at the chance to work with a nurse scientist who was researching hospital care for dementia patients. The experience was rewarding— but she soon realized she wanted to be in the driver’s seat.

“Not that I didn’t enjoy working with her, of course, but I wanted to have the skills to be an independent researcher and to be able to develop those research questions and study on my own,” says Munsterman, now a third-year doctoral candidate with a focus on implementation science.

She was drawn to Penn by faculty with expertise in geriatrics and dementia, and in the acute care space, including Drs. Cacchione and Hodgson. “Between the two of them, really, all of my research interests are covered,” Munsterman says. For her dissertation, she is examining the concept of the “dementia-friendly hospital,” which is more common in Europe than the United States.

black and white portrait of a woman Ellen Munsterman, MSN, APRN, AGCNS-BCFor her, the appeal of implementation science is very much the chance to hasten the adoption of solutions in the real world. “This can be a difficult group of people to take care of, especially when nurses don’t necessarily have the resources that they need to be able to take care of persons with dementia the way that they need to be taken care of,” she says. “My interest in the field of implementation science is a lot about shortening that often perceived length of time in between research being published and research being translated into practice.”

Aware that dementia research has not historically reflected the experiences of all individuals with dementia and their family caregivers, Munsterman chose interview sites “that would give me a more diverse group of people,” she says. “I’ve been thinking a lot about that, especially with the family caregiver inclusion question because I know that there are definite differences in caregiver profiles. Sometimes that caregiver is a spouse and maybe of similar age to the patient, but then oftentimes somebody who is an adult child who is also balancing working full-time, caring for their own children and caring for a parent with dementia.”

The long-term goal for her research, she says, is to develop “interventions specifically for use in the hospital setting that are related to dementia friendly and enhancing the inclusion of family caregivers.” If her research goes as well as she plans, you may start hearing the term “dementia-friendly hospital” much more often in the U.S.

Back to Spring 2024 Issue

More From This Issue