Data-driven decision making
By Maura Sullivan Hill
Nursing informatics emerged in the early 1980s, even before the widespread use of computers and digital information in medicine, Bobay says. “Nursing research was driving the idea that we needed data to describe what we were seeing in hospitals and nursing units, and then use that data to improve patient care.”
Bobay, who first encountered nursing informatics in the 1990s while working as the nurse educator in an emergency department, is a firm believer in data-driven decision making and evidence-based nursing. “In the past, nurses have often done things because that’s the way we’ve always done them,” she says. “For example, most nurses turn patients in bed every two hours to prevent ulcers, but I have not seen any evidence that two hours is the magic number. Maybe it depends on the patient; maybe it should be three hours. Either way, we need evidence to improve our practice.”
Before nursing informatics, most nurses conducted research with what Bobay calls convenience samples: patients on the floor the nurse was working with, or a small subgroup of patients with the same diagnosis from their hospital. But the increase in data available through electronic health records changed everything.
“Now, here at Loyola, we have data going back to 2007 on every patient that has been seen in the health system. That’s more than seven million patient encounters,” she says. “When we had small samples, it was hard to find statistically significant results. But with larger samples, if there is something there, we can find it with research.”
This year, in the spirit of that research effort, Loyola launched the Center for Health Outcomes and Informatics Research (CHOIR) to educate and engage medical professionals in the fundamentals of health outcomes research and data-driven health care, with a goal of improving outcomes and health equity, as well as lowering health care costs.
“We want to ask questions differently than people are used to,” says Bobay, who is spearheading the project. “We want input from physicians, nurses, public health experts, psychologists, statisticians, economists, computer scientists, and social workers—to ask questions in an interdisciplinary way and work together.”
Their first step is a 25-week lecture series covering topics from clinical trials to grant writing to sample size in research projects. While some other schools have begun to explore informatics in more depth, CHOIR is a unique endeavor, says Bobay. “A few schools have similar centers, but we are leading the way to create something here that includes nurses, which not all schools do.”
Bobay and her CHOIR colleagues are optimistic about the potential and opportunity that this new center provides. “Given the diversity of our community, we certainly can explore some health care disparities and, hopefully, find the most medically effective and cost-effective ways to help people,” Bobay says. “It is a great opportunity to do research and make a difference. This is why most of us went into the field—it’s why I went into nursing, and this center is why I came to Loyola.”
Educating more nurses
By Maura Sullivan Hill
This commitment to providing compassionate, equitable care is the Loyola way, and is evident throughout the initiatives taking place at Niehoff. “[Loyola] provides the community with caring, compassionate, practice-ready nurses educated in the Jesuit tradition,” says Dean Vicki A. Keough (MSN ’91, PhD ’98), RN, FAAN.
The Accelerated Bachelor of Science in Nursing (ABSN) program educates aspiring nurses in just 16 months, enabling them to get into the field more quickly—which is increasingly important these days. With the American Nursing Association estimating that nearly 700,000 nurses will retire or leave the field by 2024, the health care field is confronting a major, nationwide nursing shortage. Sensing this urgency and feeling called to respond to the need, Keough led the efforts to expand the ABSN program to include a hybrid learning option. “Each year, we receive more qualified applications to our undergraduate nursing programs than we can accommodate,” she says. “Expanding the ABSN hybrid option will help us serve more of these students and
will advance our mission of placing more Jesuit-educated nurses in the community.”
Loyola has been helping qualified students earn the ABSN for the past 25 years, and the hybrid learning option will be similar to its successful predecessor. Students will continue to leverage their existing non-nursing bachelor’s degrees towards the accelerated program, and Loyola faculty will teach all the courses.
Now, however, many of these courses will be conducted via an interactive e-learning platform. By offering this hybrid learning option, Loyola can help busy adult learners reduce the amount of time spent commuting to and from a physical location for classes.
Of course, the hybrid ABSN will still require in-person skills labs and clinical simulations, where students learn to put theory into practice. Hybrid ABSN students will participate in these activities at a new ABSN learning center in Downers Grove, Illinois, while students in the existing ABSN program will continue to attend at the University’s Health Sciences Campus in Maywood, Illinois. Both programs include clinical rotations at leading Chicago-area health care facilities.
These highly skilled and well-educated nurses will enter the field and serve in a time of acute need, both in Illinois and nationwide. The Illinois Center for Nursing predicts a statewide shortage of more than 21,000 registered nurses by the year 2020—just three years from now. And across the U.S., more than one million registered nurses are over the age of 50, meaning that nearly a third of the current nursing workforce will reach retirement age in the next 10 to 15 years.
Aid for underserved communities
By Maura Sullivan Hill
In another demonstration of commitment to Jesuit values, Niehoff is focused on providing exceptional health care for the poor and marginalized. Many people living in rural and underserved communities do not have access to much-needed primary care and mental health services. Without this type of care, chronic health problems—like diabetes or high blood pressure—can be fatal when they otherwise would not be.
Across the country, nearly 5,700 geographic areas have a shortage of primary care professionals. That means that the 58 million residents in those areas aren’t getting the annual checkups and mental health exams they need to stay healthy. Jenny O’Rourke, PhD, APN-BC, CHSE, associate dean of graduate programs at Niehoff, wants to change that, and make sure that everyone has access to the same quality of care. In support of these efforts, O’Rourke and the Marcella Niehoff School of Nursing received a grant of
$1.4 million over two years from the Health Resources and Services Administration (HRSA).
This two-year Advanced Nursing Education Workforce Grant will enable O’Rourke to further develop her Mental Health: Providing Access to Health (M-PATH) project, which will educate more primary care nurse practitioners.
“This funding will really give us the resources we need to help our nurse practitioners provide care in geographical areas that don’t have a lot of primary care options,” she says. “It also helps us build relationships with preceptors and the organizations they’re associated with, to give students more options.”
Students enrolled in this program will receive scholarship funding, in light of their commitment to serving the vulnerable populations. The grant will partner nurse practitioner students in training at local sites, including the Hines VA and Proviso School-Based Health Center in Maywood, Cook County Health and Hospital Systems, and Trinity Health System. Students will also have the opportunity to work with nurse practitioners in the Appalachian Regional Health System in eastern Kentucky and West Virginia.
This grant will also help Loyola increase the number of nurse preceptors, who act as teachers and resources to students in the clinical environment. Expanding the already robust network of preceptors within the city and surrounding area to include more rural areas and out-of-state facilities will provide students with a variety of career options when they graduate. “Because these areas have such a high-need level, the connections made between students and preceptors can help them get jobs and serve these communities even further after graduation,” O’Rourke says.
In addition to these varied clinical experiences, the grant will also allow Loyola to launch a mental health nurse practitioner program. In 2016, 82 percent of Niehoff students surveyed indicated that they would be interested in a psych-mental health nurse practitioner program. And 47 percent asked for more mental health classes within the primary care program.
In implementing these types of programs, Loyola will be ahead of the curve once again—and meeting a desperate need. In Illinois, less than 5 percent of working registered nurses are trained to treat mental health issues and nationally, only 5 percent of nurse practitioners are certified in psych-mental health.
O’Rourke is also hoping that this grant will be able to kick-start some telehealth training within Niehoff. Telehealth involves diagnosing and treating patients over a video feed and monitoring health data via smartphone technology. It’s a treatment method that is becoming more common in rural communities, to account for the lack of primary care services or the distance to care providers.
And it also has benefits for Loyola students, especially those in the online ABSN program. Utilizing telehealth will not only better educate Loyola students but also provide increased opportunities for simulation exercises. “This is something we want to implement for our students, and now we have some resources to start doing so,” says O’Rourke.
Together, these new Niehoff initiatives will meet student needs and, in turn, educate better nurses that will meet patient needs. CHOIR, the hybrid ABSN, and the funding for more primary care and mental health training will keep Niehoff students on the cutting edge of medicine, while still staying true to Loyola’s Jesuit identity. Tomorrow’s Niehoff graduates will be prepared to serve marginalized populations and find data-driven solutions that will make health care both more affordable and more efficient.
The impact of early life stress
Growing up in poverty or an abusive or neglectful family environment has been shown to be a strong predictor of poor health in adulthood. Loyola University Chicago scientists Linda Janusek, PhD, RN, FAAN, and Herb Mathews, PhD, are investigating the mechanisms by which childhood adversity predisposes individuals to poor health.
One possibility by which an adverse childhood environment might increase risk for disease is epigenetic embedding. Epigenetics determine how a person’s genes are expressed, that is turned on or off, without changing the actual DNA sequence. Changes in epigenetic regulation of gene expression occur in response to one’s life experiences and environment. The epigenome, a network of chemical compounds that have a role in determining which genes are active in a particular cell, is especially sensitive to experiences in early life, including childhood and adolescence. Such epigenetic changes can become embedded into a person’s DNA and persist into adulthood.
Janusek, professor and the Marcella Niehoff School of Nursing Endowed Chair for Research, and Mathews, a professor of Microbiology and Immunology, recently reported findings in the journal Brain, Behavior, and Immunity that show African American men ages 18-25 exposed to traumatic experiences during childhood produce an exaggerated inflammatory response to stress, termed a “stress-vulnerable phenotype.” A phenotype is visible physical characteristics, such as eye or hair color. In this case, the phenotype is increased inflammation throughout the body.
Janusek and Mathews’ research also showed that the young men, recruited from Rogers Park and Maywood, who exhibited a stress-vulnerable phenotype also had epigenetic changes that resulted in increased expression of inflammatory genes. This suggests that an epigenetic mechanism links childhood adversity to abnormal stress-related inflammation during adulthood. Inflammation is a key component in eight of the top 10 leading causes of death in the United States, including heart disease, cancer, diabetes, and stroke—many of which disproportionately afflict disadvantaged African Americans.
The researchers also identified a specific stress-resilient phenotype within the group of African American men in their study. “This stress-resilient phenotype was found in men who experienced high levels of early life stress and adversity, but who did not produce a heightened inflammatory response to stress challenge,” says Janusek. “A stress-resilient phenotype is consistent with the idea that some individuals who experience a difficult childhood are able to adapt, thrive, and effectively respond to future environmental challenge.”
Their current research project, funded by the health disparities initiative of the University’s strategic plan, is focused on identifying epigenomic pathways impacted by early life stress and adversity. These pathways are hypothesized to result in the two contrasting adult phenotypes: stress-vulnerable and stress-resilient. The stress-vulnerable phenotype produces a greater pro-inflammatory response to stress, while the stress-resilient phenotype promotes a more adaptive stress response despite a difficult childhood.
For that study, Janusek and Mathews are focusing on a group of 74 genes previously shown to be responsive to stress and adversity. In addition, those genes are implicated in the development of heart disease and metabolic disorders, where excess stress exposure and elevations in inflammation play a role. Discovering epigenomic pathways associated with childhood adversity and risk for poor health throughout a person’s life will lead to the identification of biomarkers that can help determine which individuals are at risk for a stress-vulnerable phenotype. This could set in motion preventive measures targeted to people who are vulnerable to adverse early life experiences, but who do not yet have symptoms of inflammatory disease.
The field of epigenetics is rapidly evolving and has the potential to deepen our understanding of how the environment influences the genome and a person’s health over the lifespan.
“Other ongoing research suggests that an unfavorable epigenetic profile can be diminished or even reversed by lifestyle interventions, such as by modifying diet, increasing physical activity, lowering levels of psychological stress, and implementing strategies that enrich the early-life environment,” says Janusek.
Serving where the need is greatest
By Amanda Friedlander
Throughout her 53-year career as a professional nurse and nurse educator, Mary Ann Blackman Noonan (BSN ’64, MSN ’79) has worked to support and assist underserved and minority populations. Her passion for working with underserved populations originated long before entering the nursing profession, beginning when she was in high school.
“I’ve always surrounded myself with people who are interested in offering services for others,” Noonan says. “My family, my parents, and the Sisters of St. Francis in Indiana have all been instrumental in my upbringing and establishing my values.”
After completing an internship at the Indian Health Service (IHS) at the Cheyenne River Sioux Indian Reservation in Eagle Butte, South Dakota, and the Chicago Health Outreach-Primary Healthcare for the Homeless clinic in Chicago, Noonan initiated a two-week primary care clinical experience for Loyola graduate adult nurse practitioner students at the Cheyenne River Indian Reservation. For three years, she accompanied and supervised Loyola nurse practitioner students to deliver primary health care to native Sioux Indians. In 1997, she received the Midwest Alliance in Nursing Award for her contributions toward improving health care needs for rural and minority populations in that area.
It was one of the most impactful experiences I’ve had,” Noonan says. “We had incidents of rattlesnake bites, gunshot wounds, anything you can think of. People would usually come into the clinic because we were the only one within 150 miles. It was very difficult, but very rewarding.”
Following her retirement from the University, Noonan continued to precept Loyola nurse practitioner students at a residential shelter for domestic violence, delivering free onsite health care for women and children. She received the School of Nursing’s prestigious Spirit of Ignatius Award for her service over the years, and this year was honored at Loyola’s annual Founders’ Dinner as Niehoff’s recipient of the Damen Award.
Following her daughter’s passing, the Kim Noonan Memorial Nursing Scholarship was established in memory of Kim Noonan, who died of leukemia in 1990. In order to raise money for the scholarship, Niehoff, along with the Noonan family, established the annual Kim Noonan Walkathon. In addition, Noonan and her husband became active counselor volunteers at One Step at a Time Camp in Williams Bay, Wisconsin, a two-week residential camp for children with cancer, where her daughter had been a camp leader for several years.
It was quite a humbling experience,” she says. “It was very important for myself and my husband to work at this camp. It was fulfilling for us and a way of giving back.
At Niehoff, Noonan taught nursing courses both at the undergraduate and graduate levels. In addition to her teaching responsibilities, she coordinated the RN/BSN and Adult Nurse Practitioner programs. Presently, she is an active volunteer at St. Angela School in Chicago’s Austin neighborhood and at St. Hubert Parish in Hoffman Estates.
It’s all been very uplifting for me,” says Noonan. “All of these have strengthened my role as a nurse practitioner and my role of helping the underserved and less fortunate.”