The very young and the very old have much to teach about life. And nurses are turning that learning into action. Regionally, nationally and internationally, nurse-led institutions — including the UW’s de Tornyay Center for Healthy Aging and the Barnard Center for Infant Mental Health and Development — are guiding the health-care system to better care for these two special groups. They move the field forward by identifying and addressing access issues, applying practical human and technological solutions, and researching and raising awareness to set the agenda for the future.
Increasing Potential
Kathryn Barnard championed infant health. Like nursing legend Elizabeth Soule, Barnard started young. After getting her first nursing job in 1954 at age 16, she earned her Bachelor of Science in Nursing from the University of Nebraska and her master’s degree from Boston University. In the 1970s, armed with a doctorate from the University of Washington in the ecology of early childhood development, she began demonstrating the significant connection between early care and a baby’s potential. In 2001, she founded the Center on Infant Mental Health and Development, later renamed the Barnard Center.
Barnard contributed to the well-being of individual babies with the invention of a rocking bed with a tape-recorded heartbeat, used by hospital nurseries and neonatal intensive-care units. Her evidence-based models of infant mental health shaped the field of early child development. Over time, the Barnard Center became self-sustaining, with a focus on research, often in the setting of home visits. The center also became a place where people in the child-development workforce could further their knowledge and skills.
In a similar way, Rheba de Tornyay increasingly became a voice for healthy aging. After the UW School of Nursing grew to be the top-rated school
in the country under her leadership as dean,
de Tornyay became a member of the national advisory council of San Francisco’s Institute on Aging and wrote the book “Choices: Making a Good Move to a Retirement Community.” In 1998, she and her husband, Rudy de Tornyay, secured the future of the UW’s Center for Healthy Aging with an endowment. The center would later be renamed in their honor.
Kathryn Barnard, Ph.D., F.A.A.N., international pioneer in the field of infant mental health
The de Tornyay Center for Healthy Aging helps health-care providers and the health-care system support older adults. It’s a center for research on body, mind and community, and it focuses on collecting and analyzing data to spot patterns and trends. Along with offering extensive learning opportunities for nursing students, the center also hosts events and partners with community organizations to advance conversations in the field.
Nurse leaders dropped a metaphorical stone into society’s waters, and the circles expanded outward to meet the future.
In both cases, nurse leaders dropped a metaphorical stone into the middle of society’s waters and then watched as the circles expanded outward to meet the future. Thanks to Barnard’s and de Tornyay’s work, nurses gained additional opportunities for education, research and care delivery — and the profession expanded its impact. The health-care sector became better positioned to address the growing number of people over age 65. And the potential of children, elders and communities increased as they received better and more specialized care.
Nurses Respond
By 2030, nearly 20% of the U.S. population will be over age 65 — and the country’s population is currently 23% children. By anticipating the needs of these two large groups, nurses create a stronger health-care future.
Shedding Light
Weichao Yuwen understands that things aren’t always as they seem. With a Bachelor of Science in Nursing and a UW doctorate in philosophy and nursing science with a concentration in statistics, she’s found that patients benefit when nurses look a little closer, ask questions and then enlist the help of science and technology.
In her work evaluating sleep health in children with arthritis, Yuwen found that parents initially reported few sleep problems — for themselves or their children. Using observation as well as technology similar to the health-tracking devices on the market but much more sensitive, Yuwen put parents’ assertions to the test.
After analyzing the data for patterns, she found that parents had overestimated the quantity and quality of their own and their children’s sleep. By comparing this information to that of families whose children didn’t have a chronic condition, she then assessed the impact of arthritis on a family’s sleep.
No longer in the dark, health-care teams could now see that a problem existed. Since sleep is a central pillar of health and development, identifying the problem paved the way for more holistic and comprehensive solutions. The next step? Developing supports and interventions to better help these families.
Technology Serves Seniors
The University of Washington HEALTH-E research group, led by Alumni Endowed Professor in Nursing George Demiris, helps test and design new technologies that assist with healthy aging. The center works on a range of solutions, from fall-detection devices to robotic pets to smart-home sensors like the one that helped study participant Mary Ruiz discover that her allergies weren’t seasonal but the result of dry air in her home. She fixed the problem by purchasing a humidifier.
At Washington State University, Assistant Professor Shelly Fritz leads a team focused on smart-home research to develop sensors that map daily living and behavior patterns. The goal is to gather data that then gets analyzed by an intelligent machine looking for unusual patterns that warrant a medical alert to a care team.
Both groups use a collaborative approach. At the HEALTH-E lab, the Schools of Nursing and Medicine work together and partner with retirement communities and Microsoft Research. At WSU, with over $2 million in grants from the National Institutes of Nursing Research and the National Institutes of Health, researchers in nursing, computer science and psychology test and work through processes as a multidisciplinary team.
Both efforts have broad applications and keep people, not technology, at the center. The HEALTH-E research team selects technologies that are often simple and readily available; they aim for solutions that are easy for a senior or a family caregiver to understand and use, with the support of a health-care provider.
The WSU effort recognizes the need for diversity among its participants. That’s why its work includes a partnership with Asian Health and Service Center in Oregon and WSU’s College of Nursing in Vancouver, Washington, testing smart homes with older Asian immigrants.
Nontraditional Outreach
In health care, the external factors and context are often just as significant as a population’s internal markers of wellness or illness.
Homeless seniors needed support outside of the typical health-care setting.
For example, consider the socioeconomic issue of housing. As increasingly expensive homes replace affordable ones, and as the price to own or rent a home continues to outpace incomes, the number of homeless people continues to rise in Seattle and other cities. Who specifically becomes homeless as a result of these trends? Lots of people, including seniors trying to pay for costly health care and unable to afford housing as a result.
It also works the other way: After seniors become homeless, they suffer more acutely from exposure-related ailments, like bronchitis or skin infections. In addition, an older adult living on the streets faces a greater risk of being the victim of a crime.
Community health nurse Nikela Harris wanted to address these issues. She knew that this population needed support outside of the typical health-care setting. So, while completing her master’s degree at the UW School of Nursing, she focused her scholarly project on the Pike Market Senior Center. While the senior center gave older adults a place to eat and socialize, it didn’t address the biggest hurdles that half of its members struggled with: homelessness and its related health issues.
Harris established ongoing relationships between the center and area housing agencies. In doing so, she created pathways for homeless seniors to improve their health by securing permanent places to live.
When she completed her project, Harris worked with her mentor to pass the baton to another community health nursing student. That ensured there would be another advocate and leader who could address care in a broader context and support this important population.
Addressing Inequities
Verna Hill was once told by a faculty member, “You do not have the IQ to be a registered nurse.” Despite such discouragement, she completed both her Bachelors and Masters in Nursing at the University of Washington. Even after entering the profession, she faced the fact that some of her patients did not want care from a nurse of color.
Hill’s perseverance set a precedent for others, and the disparities she experienced shaped her approach to care. In 1979, after earning her master’s degree at the UW, she worked as the maternal child health coordinator with Public Health – Seattle & King County. In that role, she began collecting and reviewing data that linked high-quality prenatal care to better outcomes for babies.
Hill noted that African American babies had disproportionately low birth weights and high mortality. She also realized that pregnant women who engaged in high-risk behavior were less likely to seek care. Through education and public-health nursing, she sought to remove barriers that kept people from getting the care they needed.
In the same way, Hill realized that the needs of a diverse public would be better served by more representative leadership. So she worked to increase the number of nurses of color holding leadership positions at the Washington State Nurses Association (WSNA).
Verna Hill’s perseverance set a precedent for others, and the disparities she experienced shaped her approach to care.
Throughout her career, Hill spearheaded many incremental improvements. In 2010, the same year Hill was inducted into the nursing hall of fame, Washington state began soliciting input from African Americans on state board nursing-exam questions, something Hill had requested 25 years earlier as the WSNA chairperson of the Minority Affairs Committee.
Strengthening Communities
Acting on knowledge about individual and community health can be overwhelming. But nurses increasingly have the knowledge, connections and platforms to cut through the noise and lead change.
After a career in nursing diagnosis and management, 97-year-old blogger Doris Carnevali now focuses on healthy aging. Her motto is “If we’re green, we’re growing,” and she brings that perspective, knowledge and gentle humility to her work. Sharing insights into both caregiving and receiving care, she meets her engaged readers wherever they are and helps them get where they need to go.
Meanwhile, UW Alumni Endowed Professor in Nursing Teresa Ward’s years of sleep research told her that tired teens might not reach a ripe old age. Risks of insufficient sleep included diabetes, weight gain and higher cholesterol, plus lower functioning, less motivation, a lack of problem-solving skills, and an inability to control impulses. With modern teenagers getting less and less sleep, the problem added up to a major public-health issue.
As part of a task force that would help the City of Seattle make policy changes to address the issue, Ward and others suggested starting high school later in the morning, giving these developing students the opportunity to get more sleep. Area schools ran with the solution, implementing the change in 2016.
Both Carnevali’s blog and Ward’s advocacy broke new ground, identifying issues and offering solutions. From teenagers to seniors, people benefited from their work, and their efforts offered a path forward for stronger and more resilient individuals and communities.
After a career in nursing diagnosis and management, 97-year-old blogger Doris Carnevali now focuses on healthy aging. Her motto: “If we’re green, we’re growing.”
Engaging Internationally
People learn by sharing information. In health care, international collaboration has the power to dramatically accelerate the quality and pace of progress.
UW Associate Professor Tatiana Sadak witnessed this effect firsthand when she participated in Dementia Forum X, a global forum in Sweden, to discuss and co-author a white paper that would help inform policy decisions about dementia care, support and infrastructure. While there, she presented research to nurse clinicians and researchers from Sweden and Denmark about innovative nurse-run dementia caregiver interventions.
On a professional trip to China, UW Assistant Professor Weichao Yuwen presented about her pediatric sleep research and toured hospital facilities. It was there that she noticed that babies in intensive-care units got only five minutes per day with their families. Yuwen, who’s originally from China, knew that this was at odds with China’s family-centered culture, and so she dug a little deeper. She found that there was worry about infection and that the ratio of health-care providers to infants was 1-to-8, compared with the 1-to-1 ratio in the United States, where Yuwen had been trained. This finding led to a collaboration with a nurse in China, focused on low-cost interventions to promote culturally tailored family-centered care there.
In Seattle, the UW School of Nursing and the Northwest Center for Public Health Practice are using an award of $400,000 from Seattle and King County’s Best Starts for Kids initiative to increase the effectiveness and capacity of home-based programs for young children. To do this, the partners engage staff members, use feedback loops and look at how the programs build on the existing knowledge of the local communities. In addition, they are using the Consolidated Framework for Implementation Research to assess interventions and the World Health Organization’s PROGRESS equity lens as a way to apply global standards to improve local outcomes.
From China to Sweden to Seattle, this type of global knowledge sharing creates connections, expands options and improves care.
Measuring Success
In partnership with researchers at the University of California, Davis, Monica Oxford, director of the Barnard Center for Infant Mental Health and Development, led a home-visiting study focused on safe and sensitive caregiving.
The study looked at the effectiveness of a home-visiting program called Promoting First Relationships®. In addition to showing that families receiving the intervention had fewer foster-care placements and increased sensitivity by caregivers to the needs of the families’ young children, the study also showed a positive impact on the children’s physiological responses.
Families receiving the intervention had fewer foster-care placements, increased sensitivity by caregivers and a positive impact on the children’s physiological responses.
By measuring a child’s heart rate as he or she did a challenging or slightly stressful activity, like completing a puzzle or petting a toy that suddenly jumped, they found that the children who’d participated in the program had milder reactions. The findings offer a groundbreaking example of how to directly correlate a brief family-support intervention with a physical response.
The results also have implications for long-term health, since effectively improving caregiver relationship skills could lead to less maltreatment of children, who then would be at a lower risk for depression and other mental-health issues as adults. In addition, the children’s subdued physical responses to stressors suggest the development of better coping skills.