Francesca Behr: Good evening to everybody. We are here for Living Archives. As
customary before starting tonight’s program, I would like to announce the winner of a contest. Of an essay contest that the University of Houston Women’s Studies program in collaboration with the Friends of Women’s Studies and Comerica Charitable Foundation, put together. The applicants had to write an essay about a woman who inspired them and who’s example they would like to follow. The winner will receive $1000 towards – we hope – scholarly [chuckle] pursuits and also a one-year membership of the Friends of Women’s Studies. Our winner today is here. I would like to introduce her to you. She’s Eileen Smith. And Eileen I would like you to come and receive your certificate. And perhaps we can clap.
[clapping from all]
One on panel: You’re very lucky.
F: Okay and on with our program. Today we are here to talk about women and nursing.
This is again in the series called Women’s Archives that is a project sponsored and supported by the Friends of Women’s Studies. The Friend’s of Women’s Studies you may not be aware are highly connected with the so called WARC. Women Research and Archive – I can never say that properly.
[chuckle from group]
F: Women Archive and Center. And this is a wonderful collection that documents, you
know, activities connected with women and women’s lives in Houston. We also collect oral history. So if you want to visit it, it’s sheltered at the M.D. Anderson library at the University of Houston, so this is going to become part of that collection. Today we have some very nice people that have agreed to be here. Our moderator – I’m going to start from the right, my right and continue. And I hope I’m telling these names properly.
[chuckles from group]
F: Adrienne Menicinos, she’s a registered nurse…
One in audience: What are the other persons this way so the students can see them too.
F: Oh, I’m sorry.
F: Oh, I’m sorry. So we’ll have to go back. You know, repeat.
[laughter from all]
F: We also have, I guess, Jenny Hernandez. Why don’t you come? I’m sorry about it.
[clapping from all] & [mumbled talking]
F: Now, from my right on [chuckle] we have Adrienne Medicinos. She’s a registered
nurse at Texas Women’s University College of Nursing. And she will be our moderator for tonight. Following, we have Anne Young. Again you know, professor at Texas Women’s College of Nursing. Sandra Hennaman, Ph.D. and Registered Nurse at UT Houston School of Nursing. Mary-Anne Marcus, Registered Nurse at UT Health Science Center School for Nursing. And finally, Katherine Walsh, you know Ph.D. and Registered Nurse and Methodist Hospital. And they will be telling you all about themselves. Thank you very much for being here tonight.
AM: Thank you very much for that introduction and welcome to all of you. We are very
pleased to be here because I believe this is the first time that nursing has been represented in this living archives and we are grateful for the opportunity to be here with you. The women panelists tonight have varied roles in nursing that you may not be as familiar with as you are with the traditional role as the public tends to think of nursing; providing direct patient care either in the hospital or in a clinic where you may have had your own personal experiences. They have moved from – although I would dare to venture that most if not all of them started out providing direct patient care one place or another as I did myself – and have moved into other non-traditional roles. Although these roles themselves are non-traditional they do compliment in their own way, providing patient care. So what I’m going to ask the panelists is if they could describe their nursing careers and the things that they do, and the work in which they are involved now, and then we will go on to discuss why these roles are important not only for nursing, but for you and the public at large.
Ann Young: Okay. Thank you very much first of all for inviting me to be here. I did
begin my nursing career in a direct patient care role. I worked in an emergency department at St. Luke’s and Texas Children’s Hospital. And did that for several years and found that I wanted to advance my education and that wasn’t something that I was wise enough to foresee when I first went into nursing, but went back and got a Master’s degree. And began teaching in a nursing program. I have done that for the last 29 years. There have been a variety of roles within that. My original teaching roles were working with undergraduate nursing students who wanted to become registered nurses and I did that for a number of years. And then as I continued to advance my education, and I have the good fortune to be an Alumna of the University of Houston –
[chuckles from group]
AY: in their College of Education program, so I feel a little warmth with your group. I
began to work in graduate nursing education where people were preparing themselves to work in advanced clinical practice roles and hospitals, clinic practices, and also in education. And then began to work with doctoral students. And for a number of years I was the coordinator for the nursing doctoral program at the university that I work for. And then had decided to return to my passion which really is teaching so that currently is what I am doing in my role right now.
AM: You, Sandy?
Sandra Hannaman:I’m still trying to get my arms around the Living Archives[chuckle].
[chuckle from all]
SH: There’s something about archives that suggests old.
[laughter from all]
SH: [laughing] That’s been around a long time. And I’m thinking how far back should I
[laughter from group]
SH: Now, I’m also pleased to be here although I’m still not sure about the archive piece
of it. I did get a late start, maybe that’s appropriate that I’m in the living archives.
[chuckle from some]
SH: I started off at the University of Florida in Gainesville. I got a Bachelor’s degree
there. Worked in a pediatric intensive care unit, and that was very tough work because I had too much empathy to take care of sick children and so then I moved to adult intensive care units – critical care units. I was a staff nurse, a nurse clinician, a clinical nurse specialist, advanced practice nurse in Fort Lauderdale, New York, Virginia, Singapore, San Francisco and Houston, when I first came to Houston. I got a Master’s degree at the University of California, San Francisco when I was out working there. Did some consultant work in Singapore to open up – actually, we’re going to start doing heart surgery there in the 70s archive.
[chuckles from all]
SH: But Singapore at the time, they didn’t have hospitals like we have here in the United
States. They didn’t have respirators and if you are undergoing anesthesia you should be on a respirator, at least during the operating room. They didn’t have laboratories where they could test oxygen in the blood, and they didn’t have intensive care units so my job was to set up all of that, so that they could do open heart surgery over there. Then I came to Houston from Singapore, and got a Ph.D. in nursing at Texas Women’s University, in fact, during Anne’s tenure as coordinator of the doctoral program. And then I went on the faculty at Texas Women’s University. And that was probably in my late 30s early 40s, mid 40s.
[chuckle from some]
SH: … in my mid-age years. I went on the faculty at Texas Women’s University and
took me a long time to adjust to the faculty position. Even though I love it, and it has many exciting benefits about it, it’s not the same as being at the bedside and taking care of patients, which I had done for 15 plus years. When you’re taking care of patients, you go to work everyday and you feel like your life truly – you’re making a difference in other people’s lives. Secondly, the gratification is immediate. If you take someone’s pain away, they relax, tension goes out of their body, they smile, they start crying, whatever reasons. If you can unite – especially in the intensive care setting – unite a family who’s very stressed out about their loved one being critically ill, get them together and provide support, you get immediate feedback. It’s not like you work for months on a project, and have to wait to see the results. Everyday you get feedback from human beings and their response to getting through - the patient and the family – a highly vulnerable period of their lives. And so, why did I go into academia? And that is in part to the archive
[chuckles from some]
SH: word because the care work is pretty brutal on the body and the emotions as well,
but the body gave [chuckle] long before the emotions did. And I started have back problems from all the bending and lifting and so forth. And I also had a son who was at the age of needing to be trafficked around to soccer games and piano lessons, and at the time I was a single parent so I needed flexibility. I could not feel on the one hand that I needed to be 24/7 on-call for the patients and their families and meet my own child’s needs as well as my increasing infirmity. So I went into academia and taught in the doctoral program, the research courses at Texas Women’s University. Started my own program of research, and then moved to University of Texas – Houston School of Nursing as Associate Dean for Research. And in that capacity I spent about half of my time as an administrator both setting the research agenda for the School of Nursing, guiding the strategic development of that mission, building the infrastructure to support it, and providing mentoring and counseling – counseling!- consulting to faculty and students. And then I have one day a week where I still do, go into the hospital setting in the critical care units at St. Luke’s Episcopal Hospital, I have one day a week appointment for the purpose of helping the nurses in the critical care units read research and change the care they’re delivering based on the research. And then I teach, Research Methods to our doctoral students and I work with Master’s and Baccalaureate students, those in the honors program who may in the future become nurse researchers. So that’s what I do.
Mary-Ann Marcus: Well I do think archive is appropriate for my case.
[chuckles from all]
MM: Because I just, last year celebrated my 50th reunion at my school of nursing.
[mumbling from group]
One on panel: Wow!
MM: So, start figuring back on that one.
[giggles from some on panel]
MM: I didn’t start out to be a nurse. In fact, that is the last thing I wanted to do. I
planned to be a language teacher and I went to a Catholic women’s college in New Haven, Connecticut, and that was the goal. Guess what? I was terrible at languages.
[laughter from group]
MM: But I was getting all A’s in the sciences. And my mother said, “Well maybe you
would like to be a nurse.” But she was a nurse and I said, “No.” My sister was going to be a nurse. No. Finally, I decided I would try it. So I went to Columbia University in New York and got my Baccalaureate in nursing, and I loved it! The same sort of thing that you’re talking about, being with the patient when they need you most. I never looked back. It was wonderful – wonderful experience. And I still can’t speak Spanish very well.
[chuckles from all]
MM: So, it’s well that I just did that and not try to teach languages. I was head nurse in
men’s medicine and I did that for several years and then got married. And in those days, while one was married, one was home with the children. So I had about 15 years of time when I was on what is now call the “Mommy Track” I guess. Then went back and got my Master’s degrees. I got two Master’s degrees from Teacher’s College, Columbia. And started teaching first at Leeman’s College in the Bronx and then at Columbia University. And then my husband, a physician was recruited here to Baylor. And I had been born in Houston, so it felt right to go back. I was born in Hermann Hospital.
AY: A native.
One on panel: A native.
MM: A native.
MM: So many years ago however.
[chuckles from all]
MM: So I came with him and began on the faculty at the University of Texas here in
Houston. Loved the teaching. Loved undergraduate teaching as well as graduate teaching. But then something happened, in that we were invited - our school of nursing was invited to go and offer care, provide care voluntarily at a substance abuse center. And I thought, “Gee, that sounds like fun. I can go and actually give direct care and bring my students with me.” So I went to Centercore Foundation in 1983 and I realized that I knew exactly how to give primary care. I knew how to do their histories and physicals, but I didn’t have a clue about why they were there. So I became very interested in addiction, how people become addicted, why we don’t know about it as nurses or physicians, or social workers. We do not receive the appropriate training. So that was my mission. And I got a number of grants from the federal government to set up education programs. Most recently for interdisciplinary groups of faculty around the country. We’ve just come out with a new syllabus to train doctors, nurses, social workers, dentists. So every time you step into a primary care setting, that person should be competent and prepared to ask you about addictions, just as a routine part of your exams. Also, I became very interested in the research part of it, so now I’m happily – very happily – in a really, a position that I think is probably the best I’ve ever had. I’m director of the Center for Substance Abuse Education, Prevention, and Research. And there’s a handout, flyer on what our mission is for that, on the table if you’re interested. Essentially, we’re just a fledgling center, we’re getting started. We’re looking for, you know, support and so forth and so on, but it is primarily to train professionals in this field, not to be specialists, but to be generalists and to understand about addictions. I also have a grant from the National Institutes of Drug Abuse to study reducing stress in recovery, so I work on a grant to look at meditation as an adjunct to recovery at Centercore Foundation. And that’s a four-year study, we’re on our second year. It’s like I have a whole other career, this research career. I’m also working with M.D. Anderson on a study looking at meditation as an adjunct to smoking cessation. And then I’m working also with Baylor College of Medicine on another study to look at the role of addictions in elderly self-neglect. So it’s all addictions, but it’s all different facets of addiction that’s researched. We just also finished within the last two years, we finished a community-based study to design and implement a program for prevention for African American middle school students at Windsor Village United Methodist Church. So we’re in the community, we’re in the research endeavor, we’re in the education at the center. And it’s probably the most exciting thing I’ve done in my career.
AM: Thank you.
KW: I’m Katherine Walsh. And I also want to thank you for inviting me to speak today
about my passion and that’s nursing. I became a nurse 27 years ago. And I really wasn’t sure at the time that I wanted to be a nurse. I was in high school. I loved math, I loved science. Wasn’t really sure I knew I’d go to college, but I wasn’t really sure what I wanted to do. And I had an uncle that was critically injured in a car accident, so when I went with my family to visit him out of town – numerous trips as he went through a long recovery- I would watch. And see what people would do, how they cared for him, the machinery and equipment was fascinating, the time that people would spend our family and help us adjust and recover and learn about the accident and learn what to expect. It was very fascinating to me, in a positive sense and that that really impacted me and I really thought, “You know, I’m really good in math and science, and I want to work with people, and I want to feel like I make a difference in the world, so nursing seemed to be a natural path at that point. About midway through however, my nursing schooling, I had a – and I understand this is really common amongst nurses – I decided, “Oh, no. I don’t want to be a nurse. There’s something else I want to do.” And kind of went through a period of time that I looked at other career opportunities, but just came back to it knowing that that’s really what I wanted to do for numerous reasons. I graduated from Texas Women’s University with a Bachelor’s of Science degree and started to work in women and children’s health. And I worked for many years at the bedside, taking care of women, particularly in labor and delivery. So I was there and present for the birth of many, many babies and found that to be very challenging, a very sobering experience that you can really provide care and take care of someone during the extremes of their life from birth to death and suffering, which does occur in women’s health. It’s not as common, obviously, but it’s always a very sad and important thing. I did some work with battered women and also some work with women that have lost pregnancies or lost children. So those things were difficult, but things that I felt like I could really impact to make a difference. I also worked for several years in a teen pregnancy program and found that to be very, very educational for me. I learned so much about the strength of women. The strength that young women have against a lot of obstacles. The faith and the love of families and so forth, really was a very joyful time and I learned so much. That was taxing after a few years. I was fairly young and I thought, “Man, I can really make a difference if I care for them enough, and help them stay in school, I can really change things.” I left that program knowing that I did change some lives, but feeling a little disillusioned, wanting to feel like I’d done so much more and if I were good, I could have made a bigger difference, but that was a very good time of my career. And then I moved from that into administration. I moved back into the hospital and went into nursing management starting with being a charge nurse, and then a unit manager, and then I went in the administrative track and became a director of women and children services at a large hospital. Somewhere along that path I started graduate school. I really wasn’t sure what I wanted to do with my career. I didn’t have a distinct plan in terms of Plan A and Plan B, this step and that step to something there. I just knew that there would be things I would want to do, that further education was important, so I obtained my Master’s from Texas Women’s University, studying education and management and also women and children’s health, and worked for several more years in management at the hospital level, unit based level, and then became a hospital administrator at a large hospital in Houston, and really learned a lot. I learned a lot at that point from the business aspect of healthcare – you know, about budgeting, and marketing, and planning, and measuring outcomes. All of those things that were very interesting and allowed me to use my skills and talents in a little bit different way in terms of creating settings for nurses to be successful. Along the way I went back to school again. It was interesting, when I graduated with my Bachelor’s, I said I would never go into management and I would never go back to school.
[laughter from all]
KW: And I’ve been in management almost all of my career and in school all of my life.
[more chuckles from all]
KW: So I started a doctoral program at University of Texas School of Public Health,
choosing to really study healthcare from a different perspective from a more global perspective; studying health services organization, studying leadership, and became very interested in patient safety. And I became interested in patient safety after a untorn event to the hospital where I was working where there had been a medical error that resulted in the death of an infant. And at the time, I really knew that there were good practitioners and good people, and how did this mistake happen. So I really wanted to know and to learn. And it was around the time in the late 90s, early 2000 when patient safety started to become something that we were much more aware of as an industry. It’s been written about and looking at different high risk industries, and how healthcare compares and so forth. And so I did some research in leadership and patient safety. I was an administrator in a community hospital for about six years and again, really enjoyed a different setting to apply the skills and things that I had learned in terms of healthcare organizations and management and leadership. And recently, the past 6 or 7 months I’ve been at the Methodist Hospital in Houston. I’m the Associate Chief of Nursing, still in hospital administration, and overseeing nursing education and designing nursing educational programs, wanting to help people transition from the student to the nurse in the hospital and easing that role transition, as well as staff development and evidence based practice in terms of looking at nursing education in the hospital setting. And that’s my path, but I’m not sure where it will take me next, and it’s been a very interesting journey and the real value I found in nursing when people said – and it’s very confusing, particularly to my grandmother who’s 95 years old, “You’re a doctor, bur you’re a nurse?” And I’m sure we all have that question. [giggle]
[chuckles from all]
KW: How can you be a doctor and a nurse, because not realizing that there are Medical
Doctors, and Ph.D., and D.R. Ph., and Doctors of Education, and so forth. But that’s been a real interesting path, and one that I think has opened a lot of doors and has been interesting to me. And will continue to lead me into the next steps.
AM: Thank you very much. And a comment that you have just made, Katherine, about
never thinking that where you’re going to be next, and going back to school. I would just like to clarify [chuckle], that I am not on the faculty at Texas Women’s University, I’m actually a student myself. My children have gone off to college and I’ve decided, based much on Mary Anne’s fussing at me over the years to return back to school myself and am enrolled in the doctoral program at Texas Women’s, and what my area of interest is, is nursing history. So yet another venue, a little bit different than hospital based nursing practice.
The next question I would like to pose to the panel. And Mary Anne you did
address this and Sandy you touched on it somewhat, but I wonder if you would talk about your research interests. I suspect maybe and audience would not realize the areas that nurses are involved in, in doing research and that is a very important facet of nursing these days. And Sandy I wonder if you in particular would talk about your lab, because I think that would be something that people are not – tend to be familiar with.
SH: Actually I have – since I am the Associate Dean for Research, I should be doing
research. But I actually started doing research before I had the doctoral degree and all of my research has been in the critical care areas, and it’s always been focused on how to get patients off the respirator as fast as possible. Being on a respirator is not fun – if you know anyone. One in 5 people, before they depart this earth will be on a respirator and it is just not a good experience. We try to keep people sedated most of that time, today, but you can’t talk, you can’t control your breathing, you can’t control your saliva, or swallow. It’s just not a good thing. People don’t like it. They say it’s the worst part of their - worst memory of being in the intensive care unit and their worst memory of being hospitalized, for those who had to be on a respirator. So, all of my research has been oriented, how can we get people off the respirator as soon as it’s feasible and safe to do so. Reading the diverse literatures from across the sciences, suggested a beginning hypothesis that there is this window of adaptation- is what I call it – but that some patients will go down one trajectory/path, which is they’ll do fine, get off of the respirator, move on with the recovery and go home. Other people take a different trajectory, which is not a good one. Being on the respirator is fraught with complications and that trajectory is fraught with one problem after the other – blowing holes in the lung, needing tubes coming out of your chest, getting pneumonia. But the diverse literatures, science literatures suggested that there are very real pathological things that happen at the cellular level and that 72 hours is about the timeframe for the cellular level to start de-compensating and moving down this – what I call – the bad trajectory, the less, not desirable trajectory. So putting those literatures together, I started thinking about this business of getting off the respirator [that it may be] time dependent, and can we identify when is the optimal time. If you try to take people off when they still need it, this is not good [quiet chuckle], they are not going to do well. But if you wait too long, then I think they end up going down this bad trajectory. So about this time, I became familiar with chronobiology. It’s the theory of biological time structures that many people – University of Houston – study at the basic cellular level, but it’s the science of timing of functions, body functions – circadian rhythms, many of you have probably heard of circadian rhythms. That would be within that framework of chronobiology. There are many rhythms some that go milliseconds and some that go years and eons. Circadian rhythms are rhythms that have about a 24-hour or daily period to them. So I started looking into chronobiology, and circadian rhythms in particular and put together a proposal to develop a model that would allow us to test – now remember where I’m going here, getting people off the respirator [chuckle] because we’re going to take a little side path, a little segway away from that for a second - but trying to develop a model where we can pull apart the effects of being in the intensive care unit from the effects of being ill or injured. If you’ve been near an intensive care unit or been in it, you know it’s not a normal environment. You don’t get to go to sleep at your normal bedtime, wake up at your normal bedtime, you don’t get to eat, you don’t get to do anything normal. It’s high tech, lights on, noise all the time, and that kind of an environment can screw up our circadian rhythms. It can make them stop being 24-hour rhythm. Just the environment – if I take anyone of you, healthy, just where you are now and I put you in a room and I start doing the things we do in the intensive care unit in terms of altering your normal routines, the lights the sounds, etc., and measured your circadian rhythms they would be all out of whack. So, one of the things we wanted to be able to do was separate the stuff that happens from being in the intensive care unit, from the rhythms being disrupted when you’re ill or injured. And we can’t do that with humans. Because there is no way you can be critically ill and not be in a modern intensive unit. So I wrote a grant and submitted it to the National Institutes of Health to use a pig model. These are farm pigs that weigh 150 pounds, 150/160 pounds. And, why I selected a pig was not because I knew anything about them – I am a big city girl, New York, San Francisco, Singapore. You didn’t hear Nebraska, or Iowa though, big city, urban. [giggles]
[laughter from all]
SH: Urban animal. [more chuckles] But the pig is remarkably similar to the human in
terms of how it’s body functions. The respiratory system, the lungs, the heart. Any cardiac surgeon has learned their craft by doing heart surgery on pigs. So the heart is very much the same, in terms of how it’s anatomically put together. The physiology of how the body works is the same. How oxygen and carbon dioxide get past back and forth, enzymes, etc. The GI tract, how food is absorbed, even they eat way more than any of us eat. [chuckle]
[Chuckle from one on panel]
SH: And they get rid of a lot more than any of us get rid of. How that whole process
works is the same as in human beings. And then their skin, a lot of the developments in burn grafts, and medications, and treatments used to treat people with severe burns were the result of work done with pigs because their skin is so much like the human skin. So the pig was a very good model. It could be justified based on how close it was to the human model. The other thing is we wanted to make this like an adult ICU. We wanted to use the same equipment that I used to take care of patients one day a week at St. Luke’s hospital, use the same clinical protocols because we were proposing to take the pigs from the farm and put them in an experimental intensive care unit. And so, they had the same sorts of problems that happens to people in intensive care units. It’s one big roller coaster. One day you’re looking at pretty pink, the next day a crisis occurs, something goes wrong and that’s because anybody who’s in an ICU is teetering – teetering in terms of their physiology and the disease processes and trying to balance that with treatment. And so, we were proposing to take the pig from the farm and put him in a bed like any of us would be in and take care of him with those protocols. And the first challenge was, can you do that with a pig? Nobody in this country, nobody in the world has taken a pig and put them in an intensive care unit, had them lie down like we do when we’re in an ICU bed and have them survive. So the very first grant was to demonstrate feasibility. Would the subject survive being put into an intensive care unit and being cared for? Actually, the experiments were wildly successful. Not only were we able to demonstrate that the subjects could survive being in the ICU, we kept him alive for up to seven days. Previously and even to my knowledge currently, 6 hours has been the maximum length of time that people have been able to keep a pig alive under those types of circumstances. And I of course attribute that to….
MM: Good nursing.
AY: Good nursing care.
SH: ….Good nursing care! [laughter]
[laughter from panel]
SH: In fact, the lab next to me, the heart surgeons were trying to create a hemorrhage
model to try to deal with trauma patients and so they were using the pig because the pig is an excellent model for human research. And we were in the lab together one day and he was saying, “Ugh, I just can’t get my pig to stay alive.” And I said, “Well how long are you trying to keep him alive?” And he said, “For 6 hours! (desperate tone) ” and I said, “Six hours? And you’re having trouble?” [giggle]
[chuckles from some on panel]
SH: I said, “You do know that we have a lab, right here next to you, and we’re at five
and a half days now. Would you like a nursing consultation…
[chuckle from one on panel]
SH: on how to keep an organism alive?” Because this is scary! I mean, what if that
translates to the intensive care unit? You better believe that you have nurses taking care of you in the ICU! [laugh]
[laughter from some]
SH: But anyway, the experiment was very successful. We’ve published it in
international journals. We’ve presented it in many, many places. A lot of the techniques we developed to keep them alive are now being used by clinical veterinarians to take care of family pets, and they’re being used by both human and animal researchers as far away as England, and Germany. So, we had many, many wonderful advances in – not so much human, a little bit of human, human monitoring, and veterinarian care as a result of that study. But we were able to establish the fact that we could create this model, it was feasible. And then tropical storm Allison came, and I don’t know how many of you remember but the Texas Medical Center was under water and that lab was totally destroyed. I had no animals at the time, thank goodness! If I had, I would have waded from Rice University, South Hampton wherever, I live over there, I would have waded threw the water, gotten them and brought them into the school of nursing, much to our dean’s chagrin.
[chuckles from all]
SH: But I didn’t have any animals at the time of the flood, but the lab was totally
destroyed and has just now been rebuilt. I use the lab at Texas Heart Institute. In the mean time, you know, I’m not getting any younger. Archive!
[chuckles from all]
SH: Years are marching by. I got things to do! We have a lot of testing to do. We’ve
been able to see what the ICU effects do and we’ve been able to see what the ICU effects with critical illness do. But we have a lot more work to do with that model before we can start using some of these – testing these hypotheses on patients. So we just, last month, got a half-million dollar grant form the University of Texas system, to build the first, in the world, pig ICU in our school of nursing at the University of Texas. And I just thrilled. I told the dean, “That’s it! Whoever’s trying to recruit me to other parts of the country is going to not get me to even talk to them because this has taken so much time to even get to where it is now, and of course the only reason for doing research is to translate it into safer, better, more effective patient care. So we’ve got years of work to do in the lab before we can even begin to impact patient care, and I’m not getting any younger, so I’m thrilled. We’re also going to use the lab for – we’ve got a clinical study going on at St. Luke’s and Methodist and our third site is going to be in Corpus Christi where we’re doing a randomized controlled trial of taking patients who are on the respirator in the intensive care unit and we’re comparing these new special beds that are expensive that turn people from side to side like a rotating spit. You just keep moving side to side in this automatic bed. And turning is good. It’s supposed to prevent pulmonary complications, keep you from getting skin break down and ulcers and so forth, keep the GI tract moving, circulation going. Turning is good. But these beds continuously rotate like a spit, but they are very expensive and one in five patients, 18-20% cannot tolerate it because it feels like you’re falling. And when you’re sick, critically ill, on a respirator, feeling like you’re on a roller coaster at the now defunct AstroWorld is not high on your list of priorities. The old fashion way of turning patients is where two nurses come up to the bedsided and we turn you over. We stuff pillows and blankets around you. We do it manually. You’re lying on your side. You know when you’re there. You stop for a while, two hours – two hours later we turn you to the other side. So we’re comparing these two methods of turning in terms of which is the more effective for reducing pulmonary complications and which is the safest. Because turning is not a benign procedure. You can have problems with blood pressure. You can have problems with all of those tubes that are in the intensive care patients, coming out. So we’re looking at the safety and the efficacy of these two turning interventions and we’re doing it three hospitals; two in Houston and one in Corpus Christi. At any rate, and I am getting to the end so that I’m not hogging the stage here…
[chuckle from some]
SH: but we don’t know what is the best way to turn patients. We don’t know how
frequent – there’s no research saying how often we should turn patients. There’s no research that says how far you should turn somebody. I mean, we turn people on their side, but maybe we should turn them more than on their side, like a semi-prone. I sleep that way. My leg up, half on my stomach, half on my side. And we don’t know how long you should leave somebody in one position in order for the lungs to get the mucus pucus out of the lungs. So having the pig ICU when that’s built, will allow us to test all possible ways of turning people; head up, head down, head really down, allllll the way over, a little bit over, how long you should be there because we can take blood, we can take x-ray after x-ray, after x-ray. We can get stuff up and look at what it does to the pneumonia in the lungs. So we can have a real evidence-based, research-based, understanding of what we should be doing with patients in the intensive care unit. And that will be one other purpose of the ICU experimental lab, the pig ICU, will be to serve as a demonstration and testing project for those of us who are doing studies in the clinical setting. We can work out the protocols, know what we should be doing, should be testing on patients in the animal lab before we bring it to the bedside hospitals or the clinic. And then the third thing is we’re going to use the lab to teach nursing students, and physicians, and respiratory therapists; anyone who’s in a position to take care of patients in an ICU. You don’t just walk in and become an ICU nurse or an ICU physician or whatever. It takes a whole lot of, not just skills, learning how to manage the technology and equipment, and being superman fast with decision-making, but it’s heavy on the critical thinking. You’ve got to size up, in a split second, a gazillion pieces of information coming in from the patient, the family, the environment the data. “Click, click, click.” Working through differential diagnosis. “Is it this? Is it this? Is it this?” And you don’t have time in the ivory halls of academia to think, “Well maybe it’s this. Maybe it’s that.” You have to act quickly. So that the combination of the skill and the critical thinking requires training and so we’re going to use the lab as well for training physicians, nurses, therapists, and so forth in advanced critical care skills. So the three purposes: the circadian rhythm research – again, remember to find out how to get patients off the respirator, quickly and safely; to do demonstration testing of research protocols before we bring them to the clinical setting and thirdly to teach multidisciplinary teams, advanced critical care skills.
AM: Thank you very much. Anne would you address some of the research that either you
or others at TWU have been engaged in?
AY: We actually have several things on-going at TWU. The research that I’ve been
engaged in has primarily been related to the end-of-life area. Because of my role in education my research has not been nearly as active [chuckle] as Sandy’s has. The most recent study that I worked with was a very tiny study, a pilot study looking at family presence during a resuscitation for children at a children’s hospital. And this was an initial pilot study that was to be used by the institution to look and see how they might want to implement a family presence policy. So that some kind of mechanism would be available to invite family members, select family members in during a child’s resuscitation experience. And so that was a small study. The funding came from a fund at Texas Women’s University and so that was what enabled that to happen. And hopefully there will be some thing that can spin off in terms of that. We do have other faculty that routinely engage in programs of research. We have several faculty engaged in research looking at violence against women and very specifically looking at are there measures that can be taken to help women be safer and to prevent on-going violence within their lives. And so that’s a program on research there. And that has reached out to women in the community. Reached out to law enforcement agencies. Have reached out to employers within the Houston region and those studies also have a multi-site studies with partners in Baltimore and some other areas across the country. [brief pause] I’m trying to… [chuckle]
AY: but that’s an example of some of the kinds of things that have been done.
AM: Okay. Thank you. Mary Ann anything else you wanted to add or?
MM: Just, I guess to say that the clients that I work with are people who’ve had many
failures in trying to be sober, in trying to recover. And many of them have come to us from the prison system and so forth and so on, so recovery is a very difficult process. And my research has to do with teaching people to meditate and this is based on program meditation, program mindfulness meditation that was developed by John Cabbot Zen at the University of Massachusetts. It’s not a zoning out meditation. It’s becoming aware in the present moment. And we’ve done two pilot studies that show that this does help people to deal with their impulsive behavior and so forth and so on in addiction. And now we have a 1.4 million dollar grant to study this in much more depth. And we’re looking at stress and we’re looking at physiologic measures of stress using salivary cortisol analysis and also looking at instruments that measure stress psychologically and we’re just really kind of beginning, but the pilot studies were very very positive or we wouldn’t have gotten funded. And if you can imagine, people who have been out on the street, under the bridges everywhere, sitting on cushions meditating. It really is a very heart warming experience for me to see that. I think it has to work, but of course I’m maybe a little biased
[chuckle from one on panel]
MM: which is why I have to let the lab people run it and not me. But it’s a very exciting
SH: This is Dr. Marcus’ lab assistant Kim on the front cover.
SH: We have a brochure over there, but this is the University of Texas’ in Houston but
there’s a little write up about Dr. Marcus’ research in here as well as Center for Substance Abuse. And we just, well just! We opened in November a full wet laboratory for nursing research for both faculty and students. So there’s really no bounds to the kind of research when we have the animal lab, we’ll have that, we’ll have a full wet lab, we have behavioral laboratories with one-way mirrors for if you want to observe children. How they communicate together or spouses, how they communicate together [laugh]
[chuckle from some]
SH: you can do it behind an observation room. We have a sleep lab which allows us to
collect samples while somebody’s sleeping without waking them up. So nursing research really is coming of age and I think you’re getting a sense of the diversity of types of research that can be done and is being done by nurses.
AM: Katherine do you have any comments that you’d like to add to that?
KW: Um, my research was for my doctoral dissertation and I looked at leadership in
patient safety. Really looking at how leaders of organizations, the behaviors they exhibit, the priorities they pay attention to, how they allocate resources. Their own behavior they model in terms of the environments they create for the staff. How that can create a culture where staff are open to reporting errors because its shocking when you read the literature about medical error there are 44-98,000 people that die every year related to medical error and that’s more than breast cancer, more than AIDS. A very prevalent problem but it’s a problem we don’t talk much about because we don’t understand it. And typically we think if people are careful and try hard, and study, and smart, and go to school then they won’t do these things, but we all do these things, but we all make errors. Each one of us, every single day make errors and driving to work, by not being aware of our surroundings to substituting one typing stroke for another. And it’s very prevalent when you take those human behaviors in healthcare and it’s very common to see how that can happen. So, my research studied how leaders can create those environments. They create cultures where people report errors, where people are comfortable to dissect errors and see what there is to learn. And there have been many, many things that have been learned from other industries that leaders can apply in healthcare. Things like two medications that look alike. If the packaging looks alike, they’re very similar and the labels look very similar it’s very common for a nurse, or a pharmacist or a physician to make a mistake. So that was primarily my interest in research and I continue to have interest in patient safety as we look at staff education and blameworthy environments where we address where we have problematic practitioners, but that’s definitely a rare problem and more so it’s a systems problem in the commitment to looking at how we can create systems that are safer so when we’re patients that we rest assured that environments are safer or in our cases when we’re nurses, and doctors and pharmacists and so forth, in those high risk settings that this situation, environments are safer so we’re not as prone to make mistakes and errors.
AM: Thank you. Ann, I wonder if you would be willing to address – I would expect that
most of the people in the audience are aware thru the media about the existence of a nursing shortage and what nursing is trying to do to make sure that there are adequate levels of nurses for the future.
AY: There is a nursing shortage. There is an on-going predicted nursing shortage
because one of the things that has happened is many of our nurses would like to become part of the archive [chuckle]
[loud laughter from panel & audience]
AY: we have a mean age right now of nurses that’s about 45 years old and faculty are
older than that. And we are as a population growing older. Baby boomers are hitting 60 this year and so there is a predicted demand for nurses and the services that they bring to sharply increase. And so one of the things that anyone who’s in an educational institution and also people in service institutions are really, very concerned about where this supply of nurses is going to come from. And so one of the things that we have tried to do is increase capacity for basic nursing education preparation, but there are some limitations to doing that 1) is the number of faculty that you do. Currently the schools that we teach for have a large number of applications every time they take admissions and we take probably about 160 junior and senior level students that want to enter into nursing every year. I think you guys are taking quite a bit. About a hundred…
SH: We turn away 13 qualified, not just people who applied, qualified applicants for
AY: And that’s about average for the medical center area. And so for every student that
we accept we’re turning away individuals. And so not only are we trying to get students into the program, we want them to be successful in the program and clearly have ways who in fact will be successful, but we also want ways to expand our capacity to offer additional nursing education, which means that we need to have adequately prepared faculty so we began to look at our graduate programs to make sure that we have people entering those programs that would like to exit and to be active participants in the nursing education process. And some of that entry level is done at the Master’s degree level and then also people are doctorally prepared and that is the desire to entry level to move into nursing education, and so we try to increase numbers of people that are interested in nursing education as well. And that is very challenging to have those people enter programs at that level and to exit as nursing faculty so that we then can accept a larger number of students. The other part of that is, is that we have to have places for our students to have nursing practice. And so we have to work in very close conjunction with places like Methodist hospital and other hospitals within our community to make sure that we have places where we can send students for clinical education. As a way of increasing those resources you will see a lot of schools of nursing become much more active in the use of simulation and Sandy referred to one of the ways that her lab was going to be used in terms of furthering the education of individuals in practice, but we also have additional kinds of things that we are working to develop simulation packages where students can receive clinical practice some of the critical thinking skills that Sandy was talking about earlier, because it really – sometimes you never think of nursing as being a high thought thing and 90% of what nursing is, is learning how to pay attention, how to organize, how to look at patterns that are going on with patients, and be able to make decisions based on that. And so that is something that has to be incorporated into our nursing education and so we look at different avenues that we can use for that so that we can in fact produce adequate numbers of nurses in the future. And it’s very important also to look at the roles that nursing is moving into in terms of their advanced practice roles. One of the things that came across my desk today, there’s a report that just came out called Code Red. And we in Texas are number one, and it’s because we have the highest rate of uninsured individuals in the nation, in our state and so we need to look at how nursing not only can continue in the roles that they are in now, but also how we can expand to facilitate healthcare for people that are in our state and be able to be able to provide and adequate basic level of healthcare.
KW: I’d like to add from the institutions perspectives about the nursing shortage. It’s
critical that institutions create environments where nurses want to stay at the bedside because it’s very, very hard work and many nurses will leave nursing after a few years and go to less traditional nursing roles or roles outside of the bedside, which is wonderful and great opportunities, but unless we maintain a certain core level at the bedside, then patient outcomes obviously are affected. And there’s some good research that shows the impact that nursing has on patient outcomes. So from the institutions perspective, we’re committed and working very hard to create environments where nurses feel valued, where they can practice their art and their science, that there are opportunities to grow, that pay is adequate, that there’s flexibility in scheduling. There’s a recognition award that recognizes excellence in nursing, by the American Nurses Association, the credentialing center and that’s called the Magnet Award. And that’s a designation for a hospital that has created an environment for nursing excellence. So you’ve probably seen or read something about Magnet Hospitals. There are several in Houston, but that’s one of the things from the institutions perspective that we’re trying to do to help the shortage and partnership with our schools and providing clinical sites, and some part time faculty and so forth, and even some financial support as to create the environment where nurses want to stay at the bed side and take care of patients.
AM: Thank you. I’m not sure how we are on time, are we still okay on time?
AM: I’m sorry?
FB: Let’s open it to questions.
AM: Okay. Does anyone in the audience have a question? Barabara?
Q: This is a silly question.
[chuckles from panel]
[mumbled – audience member too far from mic]
SH: Many people back in the archive days when I was just a baby nurse in the 70s in San
Francisco, we used pig valves to replace the mitral valve in the heart, the tricuspid, all the valves in the heart, we used pig valves to do that. They’re so close that the body doesn’t reject the pig valve in that case like it would from another type of species. They’re not so close that we’re there yet, beyond the valves. There’s a huge resurgence in biotechnology, both with nanotechnology – the development of little microscopic things that can go in and, this is my vision, please, so don’t repeat this! [chuckle]
[chuckles from some on panel]
SH: but this is how I envision it. This is my understanding, you know, you inject it into a
vein and this little robot, if you will, goes zipping around the body, checking out the liver, checking out the brain, checking this, that and the other thing, drop back out of the blood and stick it into the computer and it gives you your health profile. Exactly how things are functioning in the body. That’s nanotechnology and there are many areas in Houston who are actively doing research on that – UT being among them, we’ve got an Institute for Molecular Medicine that’s working heavily in nanotechnology. Rice has a huge program in that and University of Houston, and UTMB, and Baylor; those five institutions together. The genetic work, the unraveling and the understanding of the human genome, has just really shot forward, quantum leaps in – such as organ transplantations.
AY: One of the things that I would like to point out when you talk about these things, if
you look at when most of us entered nursing and the kinds of things that we were taught and what basic patient care was the sorts of procedures and stuff that we had, they are constantly evolving and there’s constantly huge demands being placed on nurses and people that are in that very direct role, and so the knowledge base is constantly expanding and so what you have to learn what to do, if you look at what nursing is like before the advent of critical cares, and then once critical cares became a part of routine nursing care, and then now where those things have advanced to, things really change and so your whole career as a nurse, you’re constantly evolving. When you’re in education and you’re in research, that process is constantly evolving and so what you do is totally different than what you imagined before.
Audience member: Well, I have a dear aunt who went to St. Josephs for nursing school.
St. Joseph’s about ’32 thru ‘36 somewhere there. And you know, her stories – doctors were of course all men. Nurses where of course all women. Doctor’s were gods, to question them, you didn’t even begin to think that they could do anything wrong. Obviously they can do wrong.
[chuckle from one on panel]
Audience member continued: But you guys were talking about nanotechnology and _______. But my question really is can you comment on men in nursing. Are there gender issues. Is it difficult for men? [mumbled comment]
SH: Used to be, not anymore. 37% of our students are male. Now that’s slightly higher
than across the country. I think the average is something like 21-25%, maybe Ann knows the data. But, there is no gender bias for starters and men are finding – you know, when I went into nursing school, I never would have gone into nursing school if were how nursing worked. My mother was a nurse like Mary Anne’s, and she grew up in that age. That would not have suited me. I mean, I’m an independent woman. I’m an independent thinker. I’ve got places to go, people to see. Out of my way. I’m not laying down for any man or any other person. It just wouldn’t have worked for me, but it has changed. I mean, for all of women’s – for what used to be “women’s work” is not women’s anymore. And even if men haven’t discovered some of those areas which nursing is still not gender equality, but it’s definitely moving in that direction. They’re missing out.
MM: I think the other thing you brought out about the doctor being God, I don’t feel that
anymore at all. I mean, my research team is composed of a psychiatrist, a PhD behavioral psychologist. I’m the nurse. We have statistical people. Everywhere I go, I work with physicians. In many cases, it’s an equal thing in the research part. Certainly, in addictions nobody knows all the answers, there’s much more of a sense of being a team. My mother was a nurse. In 1923, she graduated. She was at Hermann Hospital. Dr. Bertner – we’re now on Bertner, the nursing school – picked her as one of his nurses on his panel of people to specialist patients. She thought he was God!
[chuckle from one on panel]
MM: She tells these wonderful stories about “if you got picked by a top doctor, you
really had it made.” No more!
AY: And there really has been a real evolution in nursing. One of the things that I have
taught is ethics in nursing, and if you look at what your aunt had or what her mom had, would be of course in nursing ethics and it was rise when the physician walked in, offering your chair and what that has really evolved into is a real sense that nurses are advocates for the people they care for and that they work with the system and they work to advocate on behalf of those patients. And they can really make all the difference in the world in those patient’s lives. And institutions and I think one of the characteristics of the Magnet institutions that Kathy was talking about, is that they work to support nurses so they can function in the advocacy role. So it really is a lot different. It really, I think there is more parity, that probably didn’t exist when you hear about some of those early years. As a profession, we certainly have evolved and I think have a really wonderful future to evolve into as technology continues to change. But the one element is always still there, and that’s the people you care for and that certainly has been the level where nurses have interfaced with that system.
SH: I think two other things have changed since your aunt became a nurse. One, is the
salaries have gone up for nurses. And that’s in part been spurred on by the nursing shortage. So nurses are making very good money now, compared to a generation ago. The second thing is advanced education. Your aunt and our mothers went to schools of nursing that were hospital based. It was not a college education, but since the late 60s, the mid-60s – TWU’s had a doctoral program since the mid-60s, ‘66 or ’76.
AY: The doctoral program was started in 1972.
SH: ’72. So since, nursing moved into higher education mainstream and more and more
people are getting advanced degrees. I think those two things helped a lot too. We don’t even have any hospitals training nurses in Houston anymore, I don’t think.
AY: We have two in Texas.
SH: Two in all of Texas, but none in Houston.
AY: There’s about 100 diploma programs, hospital-based programs I think across the
country now. And that used to be the mainstay production for all nursing education.
KW: You know, one perspective – I would echo all this, but – other perspective is how
society views nursing, and sometimes there’s still some of those societal issues. For instance, male nurses like where often times the patient will refer the to the male nurse as their physician or refer to the female physician as their nurse. So it’s a comment upon all us to do what we do very, very well, to be able to articulate what we do because you earn your respect, and your place, and your partnership in collaboration based on your credibility and your ability to communicate and work with others and I think that’s key, and often times more in trying to shift some of those societal assumptions is just teaching people to do what they do well and articulate it.
AY: And recognize the importance of all of those players, because everyone is important
as part of that team.
Q: What is the panel’s perception of forming unions for nurses in Texas?
AM: The question is …[question repeated by moderator]
KW: Well, coming from a hospital, as a hospital administrator, I’ll be the first to address
that, and I can’t speak for the panel, but I can guess [chuckle], but nursing is a profession much like other professions – physicians, lawyers, engineers, and the need to form a union to have people speak on behalf of you rather than to be able to speak for yourself is not something that bodes well in a profession. I think in environments where there’s empowerment, where there’s good treatment, where there’s self-governance, where there’s involvement in your profession and your work environment, to union isn’t really necessary because there’s open communications between management, there’s well treatment of people, there’s a positive work environment where people get the satisfaction that they need that they don’t necessarily feel they need to form in a collective way, to have someone else deal with management and bargain for them, that they can do it individually. I don’t know what the rest of the panel’s perception is. [chuckle]
AY: Texas has also been very reluctant to enter in that realm. And part of their strategy,
of the Texas Nurses Association has been to been to try to promote those avenues for communication. And so you have not seen the acceptance of unionization that you may have found in some other states and I think our pro-activity has really paid off.
AM: Anyone else?
[pause from panel]
SH: There’s a lady with a green shirt in the back.
AM: Oh. Did you have a question back there?
Audience member: Yes. [question inaudible]
AM: The question is, is part of the nursing shortage that women are interested in being
doctors now rather than being nurses?
AY: I’ll start with that.
AM: Okay. [laugh]
[laughter from all]
AY: Okay. You know, when I originally chose nursing as a career, I would say that
probably my insight and my options and stuff were a little bit more limited than what my horizon might be now. However, I think we do have people enter into nurses because they look at the horizon and they chose it. Many of our students choose it as a second career. But the other thing also that is creating part of the nursing shortage is that there are a lot more things for nurses to be doing and a lot more ways for them to be interfacing with the healthcare system. So it is true that people do have a lot more options, but on the other hand there are a lot more options within the profession and a much greater demand for nurses as our healthcare system becomes much more complex.
SH: Being an archive person, I feel like I can say this [chuckle] to this group, but I have
two words for you, “Disease Mongers.” There’s a book written by a New York Times writer, oh 10,15 years ago and the whole book is a research-based, fact-based accounting of how in this country in particular, but in many Western civilizations we create disease. We create disease. We create a whole industry about being sick or ill, and that has in part created the need for more nurses. And I’ll just give you a very personal example with my husband, who woke up one day as he’s want to do with a every couple of years with a swollen, aching, inflamed left ankle. Gout. I went into the cabinet and got the gout medicine. Had to listen to him, yell and carry on and sympathize with him because it is very painful, for three days. 72 hours it’s supposed to end, the pain went away. The redness and the inflammation went away, but he still had an ankle the size of a basketball. Couple days later, he had sores in his mouth. And now I’m starting to freak out, sores in the mouth. I kiss that mouth! [chuckle]
[chuckles from all]
SH: And he was participating in a research study for borderline ocular hypertension, glaucoma and they found that he had high blood pressure, so he’s scooted off to his primary care physician, comes home with a medication – prescription for something to decrease his blood pressure, something to reduce the swelling in the ankle, something to get rid the sores in the mouth, and something else for good measure that escapes me at the moment. So he’s sitting there when I get home from work with all these medications lined up on the table and I said, “What are you doing?!” And he says, “I have blood pressure.” I said, “You don’t have high blood pressure! You don’t wake up [snaps fingers] one morning and have high blood pressure! You have high blood pressure today because something else is wrong with your body. [chuckles] It is not normal to have sores in your mouth,
[chuckles from audience]
SH: an ankle that won’t come down when your gout goes away, and your blood pressure
all over the place.” So we started monitoring his blood pressure – those little home models, created an excel file and charted his blood pressure, and because I’m into circadian rhythms we had to do it twice a day, because blood pressure goes up in the morning and down at night. So we did twice a day blood pressure monitoring. And you could see over that excel chart how it took about four days for his blood pressure to come down, but when those sores went away from the mouth, didn’t take any of the medications, sores went away, ankle came down, blood pressure came down. Now I know there is no easy diagnosis for this. You’re not going to pull something out of the PDR that says ankle flu with extension to the mouth and vascular system. There are many strange things that we run into. I mean, there are viruses, mutating and changing all the time. We have stuff in the air around here, who knows, something you ate, who knows what causes some of the things we get. But the American public likes to trot off to healthcare and get something for it. “Give me some medicines so I can sleep. Give me some medicines so my blood pressure comes down. Give me some medicines for my sore throat. Give me some medicines so I can relax.” We are a society addicted to the notion of illness. And this book, Disease Mongers, talks about the whole industry. The pharmaceutical industry, the healthcare industry that has sprung up to create this idea that we have illnesses. Most of us have far less illness than we think we have. Now I’m not talking about people with real high blood pressure. But if you have never had a high blood pressure and you wake up one day with high blood pressure, this requires a little patience and a little investigation. If my husband had gone on those medications he brought home, the high blood pressure reducing medicine would have interacted with the statins to decrease his cholesterol, which would have interacted with the drug to reduce the swelling, and pretty soon he would have been sick! And needed something different to add to that armatory. So this archive lady is in no mood to talk about why we have a nursing shortage, because our society is creating demand and I happen to be of the opinion that that demand exceeds a realistic need when there are many places in this country and abroad that don’t have the basics of healthcare. I’m sorry, I got on my soap box about that. [chuckle]
[chuckles from panel]
AM: Thank you very much.
FB: I would like to take one more minute of your time. Thank you very much to
everybody here tonight. Our third winner in our essay contest has arrived, so I would like to hand to Philip Pieret – I don’t know if I’m pronouncing your name correctly – gift certificate. He placed second in an essay contest. This was open to 10th graders, of course men and women.
[laughter and clapping from all]