More than ever, nurses have the power and potential to improve global and local health care. From HIV treatment in Mozambique to justice for immigrants’ children with asthma in the Seattle area, informed and connected health-care providers improve lives and communities. By harnessing knowledge of population health, global and local networks, technology, and cross-disciplinary data and research, future-focused nurses chart the path toward better health for all.
The nursing profession moves forward thanks to global-minded leaders like Azita Emami. After emigrating from Iran, she went on to study nursing at the Karolinska Institute in Sweden. Emami holds a master’s degree in international health from the Red Cross College of Nursing and a doctorate in medical sciences. She’s an academic leader in both Sweden and the U.S., and she collaborates on research projects with colleagues around the world. As dean of the University of Washington School of Nursing, Emami uses her position to further the critical role of nurses in improving global health care.
A commitment to population health, spearheaded by 18 higher-education leaders (including Emami) from nursing schools throughout Washington state, involves embedding population health into the nursing curriculum in every class and at every level — from preventive health care to chronic disease management, from collaborative practice to policy development.
The UW’s Center for Global Health Nursing, launched in 2016 and co-directed by Drs. Sarah Gimbel and Pamela Kohler, increases the current and future capacity of nurses through global and local research, practice, scholarship and advocacy. A $3.37 million grant from the National Institutes of Health, awarded to Gimbel, supports work that builds on existing HIV-treatment infrastructure in Mozambique to also treat for hypertension, a condition affecting 40% of the adult population. Kohler leads work in Kenya focused on the treatment and prevention of STD/HIV in adolescents. And the UW’s Population Health Initiative has worked with international researchers and practitioners to help launch the Pacific Rim Clinical Emergency Preparedness Research Network, supporting health systems and communities in better preparing for and responding to unexpected events.
A new Population Health building at the UW reflects these joint commitments and a new era of integrated leadership. To be completed in 2020, the space will house the Institute for Health Metrics and Evaluation, the UW Department of Global Health
and the UW School of Public Health. Built with $15 million in funding from the Legislature and a $210 million gift from the Bill & Melinda Gates Foundation, the building is designed to cultivate collaboration, innovation and collective understanding about the many influences on health, locally and globally. Though the School of Nursing will not be located in the new building, nursing faculty and students will be collaborating on many of the projects and research efforts happening there.
In 2018, the University of Washington began offering a new concurrent nursing graduate degree program in population health and global health. The Doctor of Nursing Practice in Population Health and Master of Public Health in Global Health provides a base in advanced nursing leadership and evidence-based decision-making models, and it prepares nurses to be leaders in social-justice and equity frameworks. This cross-disciplinary program encourages partnerships and increases knowledge about health conditions that affect people across borders. The two degrees together offer the skills and training for finding solutions that address social, economic and political barriers.
As nurses are increasingly at the forefront of global and local health care, the world needs to see and understand their potential. The UW School of Nursing has partnered with the University of North Carolina Chapel Hill School of Nursing, the American Nurses Association, and the U.S. Public Health Service to lead Nursing Now USA — the national arm of Nursing Now, a worldwide initiative to advance the nursing profession by raising awareness about the tremendous resource that nurses represent and the urgent task of preparing them well.
The Pacific Northwest has long been an epicenter of global health advancement. So it’s fitting that a large and connected group of nurses — educators, researchers, students and practitioners — continually challenge the status quo here to increase health-care equity and access. By design, this work informs health care both locally and internationally, creating continuous feedback loops for improvement.
Making informed decisions about population health requires a special set of skills. David Reyes, a UW Tacoma assistant professor of nursing and healthcare leadership, focuses on developing this core competency. His community-based participatory needs assessments give voice to communities. It’s an approach centered around careful listening that works.
Uba Backonja, an assistant professor at UW Tacoma and the UW School of Medicine, brings her expertise in identifying, gathering and visualizing data to inform leaders and address care needs. Her work as an investigator on Solutions in Health Analytics for Rural Equity, a five-year project, harnesses the power of data to improve care in traditionally underserved communities. Advanced by an interdisciplinary team and supported by the U.S. Department of Health and Human Services’ Office of Minority Health, this work focuses on the Northwest, with an emphasis on Alaska Native, Native American and Latino groups to better understand disparities in outcomes.
Leaders like Reyes and Backonja understand how this kind of collaborative work can increase the quality of care for everyone. Instead of relying on assumptions or guesses, these approaches create a more complete picture of the health-care realities facing communities.
With more nurses trained in these collaborative, people-focused, data-centered skill sets, individual and community care priorities become evident. This progress lays the groundwork for systems change and a future with more equitable and effective care.
Backonja’s work harnesses the power of data to improve care in traditionally underserved communities.
In 2019, the Washington Global Health Alliance announced the winners of its annual Pioneers of Global Health awards. The collaborative efforts of these groundbreaking professionals illustrate the kind of magic that happens when equity is a top priority.
UW Assistant Professor Jillian Pintye knew from her epidemiologic research that time was of the essence for young women at higher risk for contracting HIV during pregnancy. Plus, her research proved that the HIV prevention drug PrEP was safe to use while pregnant. So she partnered with a team in Kenya and helped build a program that used existing health-care foundations and networks and screened more than 20,000 women.
Pintye’s work required asking the important questions, crossing disciplines, identifying barriers and braving challenging political environments. As a result of her perseverance, more than 4,000 women began using PrEP.
Global Health in U.S. Cities
Typhus and tuberculosis, typically associated with developing countries or places with unsanitary living conditions, increasingly sicken people in the state of Washington and large cities across the U.S. Why? It’s a prime example of health disparities in resource-rich regions.
This work addresses disparities in care, offers hope and health to individuals, and reduces infectious disease risks for the larger community.
Seattle area population-health nurses have stepped up to address this growing public-health crisis by promoting more accessible care to those who most struggle to afford care: families, immigrants, refugees, the elderly, people suffering mental illness or the effects of trauma, and anyone who desperately needs care but may have difficulty getting it. In addition to addressing disparities in care and offering hope and health to individuals, this important work also reduces infectious disease risks for the larger community.
By placing students in clinics all over King County as part of their senior practicum, UW Professor Butch de Castro exposes them to the power and reach of population-health nursing to address these kinds of issues. From Pike Place Market to White Center, Renton City Jail to Summit K–12 School, the experiences of the students — some themselves immigrants — help shape them into a new generation of leaders.
Many established health-care services in Washington exemplify what happens when people, resources and policies come together to promote equitable care. For example, Seattle’s Downtown Emergency Services Center started in 1979 as a homeless shelter and has since expanded to offer mental health, housing, nursing and medical services. Kline Galland Home provides long-term, memory and short-term care and rehabilitation with an emphasis on Jewish traditions and customs. International Community Health Services offers health care for Asian and Pacific Islanders, particularly those who are immigrants and refugees. And the Downtown Public Health Center offers care and support in downtown Seattle, regardless of income.
For children in the state, Best Starts for Kids has more than 220 community partners and over 400 programs that serve families and children in King County, Washington. Nurse-led efforts include Kids Plus, supporting families with medical needs experiencing homelessness in shelters, encampments and hospitals. The Nurse Family Partnership program supports first-time mothers, improving outcomes for both parent and child; research shows that this program provides lasting benefits to vulnerable mothers and children. For example, 9 out of 10 women in the program breastfeed their children, boosting the health of both mother and baby. It’s a result that’s slightly higher than the national average for all mothers. In addition, quarterly collaborative work between agencies ensures that the model continues to thrive.
The grant will help strengthen bonds for children, families and communities today, while policy works to reduce the number of people who begin using opioids in the first place.
Helping Families in Crisis
Over the past 20 years, the U.S. has seen a fivefold increase in overdose deaths from opioid use — from fewer than 9,000 in 1999 to more than 45,000 in 2017. For children and families, the impact has been devastating.
As one way to address this problem, the Washington State Health Care Authority (HCA) has recently awarded the UW School of Nursing a $550,000 grant to better support people with opioid-use disorder who are pregnant and parenting.
Efforts will include training, outreach and assessments grounded in research from the University’s nurse-midwifery faculty and the Barnard Center for Infant Mental Health and Development. The money will be used to train clinicians in trauma-informed services, including the Promoting First Relationships® home-based program, which focuses on improving caregiver sensitivity.
For those caring for infants withdrawing from opioids, training materials will be expanded and updated. For new mothers, support will include prioritizing their questions and the potential for them to stay with their child if he or she has neonatal abstinence syndrome.
By increasing the skills and capacity of both parents and caregivers, the grant will help strengthen the bonds between children, families and communities today, while overarching policy works to reduce the number of people who begin using opioids in the first place.
Schooled in Context
What path led Robin Evans-Agnew, a faculty member at UW Tacoma, from being a school nurse to becoming a health leader in environmental justice? Paying attention to the context of care.
It started with a lot of kids who had asthma. At first, Evans-Agnew didn’t understand all the factors at play for families managing the disease. But after one parent schooled him, he began to ask larger questions — which spurred him to a master’s degree and then a doctorate in nursing. Ultimately, by asking the right questions, he found the education he needed to support and empower people. His work included giving parents and children the tools to study and change things in their own environments. From removing toxins in the home to addressing proper ventilation, these were challenges that people with more privilege, money and power were not experiencing; his efforts sought to empower families in improving their health.
Students worked in real-world contexts and learned to apply their education to realistic solutions.
University of Washington nursing students visiting rural New Mexico, along with New Mexico State University students, had a similar wake-up call when they participated in the Health Disparities Field Experience. The program included shadowing service providers out in the community, traveling the rough roads and seeing firsthand what life was life for local families. Along the U.S./Mexico border region and in remote parts of the Navajo Nation reservation, students worked in real-world contexts and learned to apply their education to realistic solutions.
According to the American Psychological Association, Asian American college students have higher rates of suicidal thoughts and more attempted suicides than white American students. This is one example of a health disparity that needs further study so that the health-care system can provide adequate support. UW School of Nursing Associate Professor Eunjung Kim has spent much of her career understanding the experiences of immigrant families and providing support tools.
Meanwhile, a study conducted by UW Assistant Professor Molly Altman interviewed women of color about their health-care experience during pregnancy. Many of the women described disempowering experiences, exposing inequalities that providers can work to address.
Other examples of health disparities among Americans include higher rates of heart disease among African Americans, Vietnamese American women with higher rates of cervical cancer, and additional disparities based on income, sexual orientation, ability and more.
The disparities between rural and urban Americans is also dramatic; rural residents are 13% more likely to die of heart disease and 33% more likely to die from personal harm. In Washington, the five-year Share-NW project, led by UW School of Nursing Professor Betty Bekemeier (who holds a joint appointment as director of the UW School of Public Health’s Northwest Center for Public Health Practice), is working to address that disparity. Now in its third year, the project results show that increased training in accessing and using data could help better address some of these gaps in outcomes.
Intersection of Interests
Why is Peru’s Academia Familiar del Amazonas loosely based on a similar program in South Seattle, the Graduates of Early Learning and Education Academy? Because UW nursing students participating in an interdisciplinary project in an indigenous community on the edge of the Amazon recognized that one program could inform the other.
Nurses know that poor health and inadequate living conditions interfere with the ability to get an education — and that education is a strong indicator of better health outcomes.
The project in Peru focuses on improving health and living conditions for a community that floats six months of the year and struggles with contaminated food and water. From landscape architects to engineers, microbiome experts to doctors and dentists, a multidisciplinary UW team works together to create sustainable solutions.
Within this group, UW nurses form a crucial care link — partnering with local nurses and caregivers, applying solutions from other settings, and helping with the needs that families have identified as priorities, like diarrhea management and education for their children.
Nurses there know that poor health and inadequate living conditions interfere with the ability to get an education — and that education, in turn, is a strong indicator of better health outcomes. Having a holistic view of health, nurses recognize the importance of both treating acute conditions and profoundly improving quality of life.