CU Nursing Fall/Winter 2020

Fall Winter 2020

Superwoman, Superstar and Alumna Loretta Ford Celebrates Her 100^th Birthday!

Post Birthday Greetings on Our Online Message Wall.

https://nursing.cuanschutz.edu/lorettaford

That Unlocks the Future

P. 4-11

Love & Legacy:

How a Blind Date Led to a Major Gift Stethoscope

Brings Tears to Student’s Eyes Labor of Love: Unmasking

Myths About Midwifery, Stigmas About Surrogacy

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Our Programs Pioneered the Past. Our Research Unlocks the Future.

F R O M T H E D E A N

Ford; learn about recent graduates – what they’ve accomplished and their plans for the future; and get to know some of our staff members who know first-hand the quality of nurses and nurse-mid- wives in our clinics. Also, discover groundbreaking research our faculty are conducting that is having an impact on people living with HIV; catch up on classmates, faculty, and students – where they are now and what they are doing; and learn more about how one staff member’s labor of love led her on a special journey of surrogacy with her family.

Make sure to follow the College on our social media channels or download this magazine as a mobile app on your phone or tablet. The mobile app is listed as CU Nursing in the Apple or Google Play stores.

Best,

Elias Provencio-Vasquez PhD, RN, FAAN, FAANP

This College and its people – alumni, faculty, students and staff – have shaped and continue to shape the nursing profession.”

One thing I know from the short time I have been the dean at CU Nursing, the legacy of this institu- tion is truly amazing. As we adapt to a “new nor- mal” of social distancing and working remotely, we celebrate several milestones including 40 years of our Nurse-Midwifery program, 55 years of inventing the Nurse Practitioner program, and Lee Ford’s 100^th birthday! Wow. Can you believe it? This College and its people – alumni, faculty, students and staff – have shaped and continue to shape the nursing profession. Join me in dis- covering how we are boldly transforming healthcare together, and doing it while in the midst of a pandemic.

In this edition of CU Nursing, celebrate the life and legacy of one of the College’s great innovators and educators – Loretta

W E D O N ’ T J U S T T E AC H N U R S E

PR AC T I T I O N E R S . W E I N V E N T E D T H E M .

55 YEARS LATER AND STILL GOING STRONG.

Fifty-five years have now passed since the founding of the nurse practitioner movement at the University of Colorado. With more than 290,000 licensed nurse practitioners in the country – the growth is astounding. Co-founded by Loretta Ford, BS, MS, EdD, FAAN, FAANP, and Henry Silver, MD, FAANP in

response to a physician shortage and a need to provide quality health care, the non-physician role of the nurse practitioner was born. This was a controversial development in health care and not everyone was “on board.” According to Ford, the nurse practitioner idea faced resistance from nursing organizations and nurse educators, as well as some physicians. But 55 years later, the NP role is well entrenched in health care.

CU NURSING MAGAZINE is published twice annually by the University of Colorado Anschutz Medical Campus for the alumni and friends of the College of Nursing.

UNIVERSITY OF COLORADO COLLEGE OF NURSING 13120 E. 19^th Ave., C288-1 Aurora, CO 80045 CONTACT Dana Brandorff, MA 303-724-1698

dana.brandorff@cuanschutz.edu All rights reserved. Contents may not be reproduced without permission. We are usually pleased to extend such permis- sion. The views and opinions expressed in this publication are not necessarily those of the University of Colorado College of Nursing or the CU College of Nursing Alumni Association.

EDITOR IN CHIEF Dana Brandorff, MA ART DIRECTION AND DESIGN Ozzmata.com

PHOTOGRAPHY Susan Baggett Dana Brandorff Debra Melani

Kristi Williams Photography CONTRIBUTING WRITERS Dana Brandorff Debra Melani Katelyn Nolan

CUCollegeofNursing NursingCU CUCollegeofNursing CUCollegeofNursing

ON THE COVER:

Loretta Ford

F A L L / W I N T E R 2 0 2 0

Loretta Ford working as a public health nurse in Colorado.

G E T TO K N OW LO R E T TA FO R D,

B S , M S , E D D, FA A N , FA A N P

Ford grew up during the great depression and learned the value of hard work and education.

She earned her nursing diploma in 1942, lost her fiancé in WWII, and joined the U.S. Army Nurse Corps the following year. After the war, she moved to Colorado to complete her bachelor’s (1949) and master’s (1951) degree in nursing and an EdD in 1959. She met and married William Ford in 1947, gave birth to their daughter in 1952, and worked as a county public health nurse in rural Colorado. This experience convinced her that nurses needed to be able to make clinical decisions in the field.

She co-founded the first nurse practitioner program in the U.S. with Dr. Henry Silver. Seven years after starting the NP program at CU, Ford was recruited by the University of Rochester, where she became founding dean of the School of Nursing and director of nursing for their 800-bed hospital. She retired in 1986, was designated a Living Legend by the American Academy of Nursing in 1999, and is the recipient of numerous awards, and in 2011 was inducted into the National Women’s Hall of Fame.

Today, at 99 years young, Ford remains active. This year, she even Zoomed into CU Nursing classes providing our students with a unique experience and insight.

Mustafa Ozkyanak, PhD. “These all impact anti- biotic prescribing decisions.”

The study of 38 ED providers analyzed these and additional factors to determine how to design a CDS system to assist with antimicrobial stew- ardship in pediatric emergency departments. It discovered that systems are rarely tailored to the context of the ED environment and end-user needs.

“ED clinicians often need to make rapid de- cisions and are frequently interrupted during the decision-making process,” said Ozkaynak.

Current CDS systems do not take this unique set of circumstances into account. “Significant opportunities exist to improve the appropriate- ness of antibiotic prescribing in the ED setting.

Including relevant contextual data, considering the limitations of current CDS systems, and tai- loring the design and implementation could all help in reducing unnecessary antibiotic use.”

Researchers at the University of Colorado College of Nursing at the Anschutz Medical Campus found that a unique set of factors of the emergency department (ED) makes standard Clinical Decision Support (CDS) systems not as effective in helping to reduce anti- biotic overprescribing in that environment.

Antimicrobial resistance is a major public health concern, accounting for 2.8 million infections and 35,000 deaths annually. Hospitals have focused on antibi- otic stewardship programs (ASP) to reduce over prescribing of antibiotics, which is a major contributor to antimicrobial resistance. While this has been effective in reducing unnecessary antibiotic use by as much as 36% in inpatient settings, EDs are an exception where approximately 10 million outpatient antibiotic prescriptions are written annually in the US. Data show that up to 50% of the prescriptions were inappropriate or unnecessary.

The study, published in Applied Clinical Informatics, looked at three pediatric EDs to determine how the unique setting of the ED influences this pattern, and how Clinical Decision Support (CDS) systems can complement professional judgment in the ED setting and potentially reduce unnecessary antibiotic use. “The ED is unique. Several factors are at play – clinical judgment, provider fatigue, the busyness of the ED, workflow, technology, bed availability, social determinants of health of the patient and their families,” said lead author Associate Professor

“ONE SIZE FITS ALL” CLINICAL DECISION SUPPORT SYSTEMS USED IN HOSPITALS NOT EFFECTIVE IN REDUCING THE NUMBER OF ANTIBIOTIC PRESCRIPTIONS ISSUED IN EMERGENCY DEPARTMENTS By Dana Brandorff

R E S E A R C H

Study Suggests How

Emergency Departments Can Reduce Antibiotic Over Prescribing

Mustafa Ozkyanak, PhD

R E S E A R C H

By Children’s Hospital Colorado

Alum earns grant to explore COVID-19’s impact on nurses at Children’s Colorado

In the past few months, the COVID-19 pandemic sent shockwaves throughout the nation’s healthcare facilities. Like many other hospital systems, Children’s Hospital Colorado was left grappling with a once-in-a-lifetime crisis.

Because COVID-19 initially impacted adult popula- tions and organizations caring for adults, pediatric hospitals have been left out of the broader conver- sation. CU Nursing alumna Lindsey Tarasenko, PhD, RN, Magnet Program Director & Nurse Scientist with Children’s Colorado, wants to change that.

On June 10, Tarasenko and her team of researchers earned a $100,000 grant that will help tell Children’s Colorado COVID-19 story, capturing the experi- ence of Children’s Colorado nurses throughout the pandemic. Specifically, the study will outline recently introduced practice changes, unintended consequences and unexpected challenges, and the role of the pediatric nurse in this unusual period.

“The COVID-19 pandemic has significantly impacted our nursing work environments as we have responded to the healthcare needs of our community while

navigating shifts in our professional and personal lives,” says Tarasenko. “This gift is making it pos- sible for us to capture the voice and experiences of nurses during this unprecedented time.”

Tarasenko and her research team stress the importance of studying both the response to COVID-19 and the consequences of decisions that affect nurses, the largest segment of the healthcare workforce. “The knowledge gained from studying responses from current events has the potential to inform future decisions of nursing leaders, hospital administrators, and policymakers to support nurses and the care they deliver to our patients and our community,”

Tarasenko adds.

The COVID-19 pandemic has significantly impacted our nursing work environments as we have responded to the healthcare needs of our community while navigating shifts in our professional and personal lives” - Lindsey Tarasenko

A nurse and pediatric patient at Sheridan Health Services

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PUBLISHED ARTICLES AND STUDIES

Nursing Considerations for Patients with HIV in Critical Care Settings

AACN Advanced Critical Care Volume 31, Number 3, pp. 308-317 © 2020 AACN Lucy Graham, PhD, MPH, RN; Mary Beth Flynn Makic, PhD, RN, CCNS, FAAN, FNAP, FCNS

Maintaining Antiretroviral Therapy (ART) during critical care admissions is essential as it suppresses the virus and is critical for successful management of HIV infection.

Unfortunately, many antiretroviral regi- mens result in drug interactions and ad- verse drug incidents. Stopping ART can have significant consequences, including future resistance to HIV treatment. By recognizing the difficulties of managing HIV along with additional comorbidities, critical care nurses can provide safe, unbiased and compassionate care that promotes health for HIV patients.

Body Composition Changes in Response to Moderate- or High- Intensity Exercise Among Older Adults With and Without HIV Infection

Journal of Acquired Immune Deficiency Syndrome, Nov. 2020

Catherine Jankowski, Samantha Mawhinney, Melissa P. Wilson, Thomas B. Campbell, Wendy M. Kohrt, Robert S. Shwartz, Todd T.

Brown, Kristine M. Erlandson

People with HIV are at an increased risk for obesity and muscle loss, despite effective antiretroviral therapy. Exercise reduced total and visceral fat in older PWH and controls.

Minimal gains in lean mass suggest that greater emphasis on resistance exercise may be needed to more effectively in- crease muscle in PWH.

I

HIV Research

R E S E A R C H

Sensor and Survey Measures Associated With Daily Fatigue in HIV

Journal of Association of Nurses in AIDS Care, 2019

Makic, Mary Beth PhD, RN, CNS; Danielle Gilbert, BA; Catherine Jankowski, PhD;

Blaine Reeder, PhD; Nasser Al-Salmi, RN, CNS; Whitney Starr, NP; Paul F. Cook, PhD*

Fatigue is the most common symptom of people living with HIV and remains a significant concern despite viral suppression.

Studies show that fatigue reduces treatment adherence and in turn efficacy of ART, while increasing the risk of HIV transmission. Causes of fatigue may have many causes. This study used daily smartphone surveys and Fitbit data to characterize fatigue experiences and self-management behaviors. Research that clarifies the co-occurrence of fatigue with other symptoms, and the situations in which fatigue symptoms are most likely to occur can help patients and clinicians discover new options for symptom management. PLWH reported new insights into fatigue from self-moni- toring, an interest in reducing fatigue, and a willingness to use self-moni- toring technology. Thus presenting potential opportunities to improve sleep, activity, or stress management to alleviate fatigue in this population.

Comorbid Mental Health Disorders in Persons Living with HIV: Adherence to Antiretrovial Therapy

Archives of Psychiatric Nursing, 33(4), 364-370. August, 2019 Anna Smith, BS Honors student, Paul F. Cook, PhD

This study looked at factors that hinder and help promote good medication adherence among people who have both HIV and a mental health or sub- stance use disorders. It found that PLWH who had reliable housing were over six times more adherent than those with unreliable housing.

Catherine Jankowski, PhD

Mary Beth Makic, PhD

CURRENT FUNDED STUDY

High Intensity Exercise to Attenuate Limitations and Train Habits (HEALTH) in Older Adults with HIV, R01, National Institute on Aging

Principal Investigators: Kristine Erlandson, MD, A. Webel Co-Investigator: Catherine M. Jankowski, PhD

The global aim of this study is to determine whether high-in- tensity interval training can overcome physical function and mitochondrial impairments in people aging with HIV infection to a greater extent than continuous moderate-intensity exercise and whether biobehavioral coaching promotes long-term adherence to physical activity.

R E S E A R C H

G E T T O K N O W

Paul Cook, PhD

Associate Professor

Dr. Cook studies problems in health behavior change, such as medication adherence, self-management of chronic diseases, and preventing inappropriate opioid use. He brings to his research his background in clinical psychology and training as a psychotherapist. In 2012, he received an R21 grant from the National Institute of Nursing Research (NINR) that led to four papers on people with HIV – their everyday experiences and medication adherence. Published from 2015-2018, the papers also incorporated Two Minds Theory (TMT : http://2mindstheory.org) addressing human behavior and the reasons why people don’t do what’s good for them. In 2018, Cook published an elaboration of TMT that explains health behaviors based on an interaction between two separate mental health systems – intuitive and narrative. The intuitive system is deeply involved in the action of people’s day-by-day lives, reacting to events and actually generat ing behavior in the moment. The narrative system works more like a sports commentator, providing commentary about people’s actions and intentions but not directly influencing the action on the field. Although the intuitive system has a more direct effect on behavior, it’s also harder to modify because it usually operates outside people’s conscious awareness. Cook’s latest research therefore harnesses technology like sensors and in-the-moment text messages to bridge the gap between the two systems, helping change their behavior to improve their health.

The Impact of Moderate or High-Intensity

Combined Exercise on Systemic Inflammation among Older Persons with and without HIV

Journal of Infectious Diseases, August 11, 2020

Kristine M. Erlandson, Melissa P.

Wilson, Samantha Mawhinney, Eric Rapaport, Jay Liu, Cara C. Wilson, Jeremy T. Rahkola, Edward N.

Janoff, Todd T. Brown, Thomas B.

Campbell, Catherine M. Jankowski

Exercise did not exacerbate inflammation and greater intensity and adherence to exercise improves physical function and may be associated with more beneficial changes in inflammation.

Physical Activity and Exercise to Improve Cardiovascular Health for Adults Living with HIV

Progress in Cardiovascular Diseases, 2020

Cemal Ozemek, PhD, Kristine Erlandson, MD, Catherine Jankowski, PhD

Although ART has contributed to a drastic increase in life expectancy for people living with HIV, the side effects of years of ART may contribute to the development of cardiovascular disease (CVD), which is significantly increased in this population and ultimately a major cause of mortality. Higher-intensity exercise appears to result in even greater health benefits without exacerbation of underlying immune dysfunction.

Mounting evidence supports the positive effects of combined aerobic and strength exercise.

Mounting evidence supports the positive effects of exercise on people living with HIV.

R E S E A R C H

Two CU Nursing faculty – Jessica Anderson and Brie Thumm – are members of the Colorado Maternal Mortality Review Committee, which was put into statute in May 2019 through the Maternal Mortality Prevention Act. The committee’s goals are to review causes of maternal deaths in Colorado and recommend ways to prevent such deaths in the future. The committee recently issued its 2014-2016 Morbidity and Mortality report, analyzing causes of maternal deaths during and up to one year after pregnancy. With more than 200,000 babies born in Colorado during that time and 94 pregnancy-associated deaths of pregnant and postpartum people, the top causes of death (in order) were suicide, accidental drug overdose, injury, and homicide.

The rate of homicide was more than twice that of non-pregnant people of reproductive age. People of Native American descent were nearly 5 times more likely to die than non-Native American people who gave birth during the same time period. Education level was significantly inversely related to maternal mortality rate and people who were insured through Medicaid had a higher mortality rate than all other forms of insur- ance. “The findings presented in this report illustrate how structural inequities, specifically structural racism, impact health outcomes.

Maternal mortality is considered a bellwether metric for a region’s health status and these numbers are telling us that in Colorado we must address the systematic discrimination that leads to

marginalized communities dying at higher rates.” said Thumm, PhD, CNM, RN, MAB, an author of the report and the maternal health clinical consultant at the Colorado Department of Public Health and Environment. According to the report, the majority of the top causes of death are preventable.

“It is important to remember that behind these numbers are the lives and the families and communities of the people who died— who we care for as nurses. Nurses have the opportunity to improve maternal outcomes through evidence-based screening, expanding our scope of practice to provide mental and behavioral health services, regardless of our specialty, and, most important, working to change the inequities inherent in the U.S.

healthcare system and our own biases.” said Dr. Thumm.

SUICIDE, SUBSTANCE USE, AND HOMICIDE:

LEADING CAUSES OF MATERNAL DEATH

Recently released Maternal Morbidity Report highlights the causes of death in pregnant and post-partum people.

CU Anschutz – a hub for research and innovation

Propelled by a rich legacy and 120 year history, our research discoveries will transform the future:

• Leveraging the power of collaboration on campus, statewide and nationally

• Training the best and brightest scientists

• Catalyzing thoughtful strategy

• Generating evidence that informs innovative solutions

O U R P R O G R A M S P I O N E E R E D T H E PA S T.

O U R R E S E A R C H

U N L O C K S T H E F U T U R E .

www.nursing.cuanschutz.edu

R E S E A R C H

CUNursing’s July Grand Rounds presentation was a joint effort between Drs. Figaro Loresto and Scott Harpin and highlighted different ways the two harnessed their backgrounds and skills to make a difference during the COVID-19 pandemic. In March, Loresto and Harpin asked themselves what they could do to help in the pandemic – one from a research perspective and the other from a “bedside” and public health perspective. Their unique skill sets have helped and continue to help fight the epidemic in myriad ways.

Dr. Loresto, a biostatistician and nurse scientist at Children’s Hospital Colorado, used his data mining background to develop a searchable repository of the latest articles related to COVID and other epidemics including SARS, Ebola, and H1N1.“It started with 49 articles, it has

grown to 761 — with more than 500 related to COVID,” said Loresto.

His database allows practitioners to conduct robust literature searches differently than before. “Our priority as nurses is to be by the bedside.

Having access to this type of in- formation quickly helps clinicians hone in on treatment therapies and procedures that have worked in the past and might have applications for our current pandemic.”

Loresto’s vision for the repository and application is “to provide tools at your fingertips for clinicians.” Check out his application on Children’s Hospital’s website at: childrenscol- orado.shinyapps.io/RN_COVID_Lit/

Harpin took a different approach to the pandemic by joining the frontlines of the state’s emergency response ef- forts. Having volunteered in Louisiana during Hurricane Katrina, he decided,

“I could leverage those lessons learned to assist with staffing and training needs of the state emergency workforce.”

On March 24, 13 days after Governor Polis declared a state of emergency, Harpin attended his first meeting at the Colorado Emergency Operations Center. “At that time, the experts believed that Colorado would need about 5,000 ventilators and 15-20,000 non-hospital beds to handle the influx of patients if we couldn’t reduce an impending surge,” said Harpin. “We only had approximately 900 venti- lators at the time, a far cry from the anticipated need.” Harpin quickly saw the magnitude of the crisis.

The team assessed Colorado and its capacity, categorizing potential cases across tiers of need from acute to non-acute requiring isolation, but not extraordinary care. “With the anticipated need for many beds for INNOVATIONS UNDER DURESS By Dana Brandorff

G R A N D R O U N D S

COVID-19 Hot Topics

R E S E A R C H

acute patients in hospitals, it became apparent that converting large facilities to make-shift hospitals was a necessity.” The questions became — where will the patients go, who will staff for our needs, what equip- ment do we need to meet the demand, and what kind of training do we need?

As Colorado’s “field hospitals” were built out within days (i.e. the Denver Convention Center and The Ranch in Loveland), Harpin was developing ‘Just in Time Training’ videos and modules for health care providers and the general public. “We trained 15 master trainers, two of whom are CU Nursing alums!”

said Harpin. Those trainers are prepared to train hundreds of first-line responders including health sciences students, retired RNs/MDs, Medical Reserve Corps members, health care workers from other hot zones and community volunteers. It is often said that successful crisis management is planning for the worst and never having to enact the plan because the crisis has been averted or abated. “We hope we don’t have to use the field hospitals, but we have them ready just in case,” said Harpin.

In addition to staffing up for the public, it became clear in late March that Denver’s homeless populations were a special concern for COVID transmission. “Stay at home orders do not work for those with no home,”

said Harpin. So it became imperative to create shelters with social distancing capabilities for this vulnerable population. The City of Denver organized around two facilities – a 750-bed operation at the National Western Complex specifically for men and a second 250-bed facility for women at the Denver Coliseum. “We discov- ered that we needed to make sure that we provide not just masks, socially distanced beds, but also an array of social services to include medical and behavioral care,”

said Harpin.

“These facilities have also provided much-needed clinical opportunities for our students,” said Harpin.

“As well as a great learning opportunity, our current experience might pepper our future curriculum with COVID-19 education.”

At the time of the presentation, the state had 1162 ven- tilators at the ready, and 316 were in use. As of July 17, the number of coronavirus cases and hospitalizations is slowly rising throughout the state. Moreover, the Governor issued a state-wide mask order in response to the increase.

Associate Professor Scott Harpin, PhD, MPH, RN, FSAHM

Nurse Scientist

Figaro Loresto Jr. PhD, RN

C O L L E G E

degree programs, and numerous certificate programs. With 1300 students, CU Nursing is a mid to large size program, but in 2017 was operating as a small school.

“Keeping track of students — how they were progressing as well as clinical placements — was complicated,” said former Associate Dean of Academic Programs Leigh Small, PhD, RN, who arrived at the College in 2016. Dependent on individually-held spreadsheets and key individuals with extensive knowledge about students made it impossible to accurately determine where students were in the pro- grams and to assess when new courses, course sections, faculty, or clinical placements were needed. “We were extremely reactive – man- ually handling placements,” said Director of the Office of Academic Programs Jodi Cropper.

“Time and again, we would be surprised at the last minute that we needed a new section and would have to add faculty or adjunct faculty.

We were frequently caught flat-footed.”

BEING REACTIVE PUT PRESSURES ON THE COLLEGE

With accreditation looming, it became even more apparent that a change was necessary any academic institutions – especially those in the

healthcare field – were caught off guard during the Coronavirus pandemic. The challenge for the University of Colorado College of Nursing wasn’t just a matter of social distancing and moving classes to remote learning. It was ensuring our students also obtained the clinical hours required by the State Board of Nursing to graduate.

For healthcare programs that require on the job prac- tical experience, placements became virtually non-existent. Clinics and inpatient facilities where students typically complete their clinical hours shifted their focus to caring for coronavirus patients and suspended training. Consequently, students were in limbo and in jeopardy of not graduating.

Faced with an internal crisis, CU Nursing faculty and staff retooled its programming and discovered new ways to help students complete the necessary requirements.

“We turned to virtual simulation, nurse-led clinics that we operate, and partnered with Aurora Public School District to help fill our educational void,” said Senior Director Experiential Learning Team Fara Bowler, DNP.

NEW SYSTEM MADE RESPONDING DURING THE PANDEMIC EASIER Not long ago, this rapid response would have been unheard of and more difficult to accomplish. But a system that was implemented three years ago made it possible to respond more swiftly during the crisis. And, the people behind the system are now being recognized by the university for their vision.

During its 120-year history, the College has grown to include a traditional BS degree, an accelerated nursing degree, 12 advanced practice specialties, doctoral

M

Innovative approach leads to university recognition

By Dana Brandorff

Jodi Cropper

C O L L E G E

for future growth. So, the two analyzed the needs of the College and began an overhaul of the in- frastructure. The current system was customized to each student and dependent on advisors’ ex- tensive knowledge of where each student was in each program. “Systems get ingrained and people are used to what they are used to. They knew the system and were adept at thinking on their feet and addressing shortfalls. And for years it worked,” said Small. Being so reactive put pressures and stress on the College.

They knew there had to be a better way. Initially conducting a review of the processes, they dis- covered that it wasn’t simply just a software or tracking problem — moving the system from a spreadsheet to something more automated. “It was much deeper than that,” said Cropper. “We needed to develop a technology-supported structure, fig- ure out a sequential order to our courses, shift to a cohort model for students, and incorporate a series of relational databases integrating numerous soft- ware platforms.”

GAME OF WHACK-A-MOLE

Cropper and Small began tackling this intricate issue. When they uncovered one part, it would lead them to another problem. “We played whack-a- mole. When one issue would pop up, we’d knock it down. Then another would appear. So many parts were inter-related,” said Small. The key was in seeing the bigger picture and realizing that an entire shift in thinking was necessary.

One essential component to building the infrastructure was the addition of InPlace, a relational database system, which could integrate the University’s disparate systems – CUSIS, Typhon, NursingCAS, clinical placements, compliance and ordinary spreadsheets of students. It allowed

CU Nursing to manage the College’s enrollments to determine student’s progression and what future teach- ing needs would be and when.

“Projecting needs allowed us to plan for gaps in a much more proactive fashion,” said Cropper.

Instead of spreadsheets, the team could pull reports that clearly showed specifics, includ- ing current and future needs and gaps.

EDUCATION THE KEY

As with anything new, fear and resistance are a natural bi-product. “Educating our constituents became extremely im- portant,” said Small. The team began an internal PR campaign.

“Helping people understand the capabilities of the technology and how it would be easier for them to facilitate what they do while removing human error became our mission,” said Cropper. “Once we could show how we could generate a report quickly that could keep our students on target for graduation with real-time data and specifics, people became converts.”

“We’ve seen a cultural shift even more so with the pandemic.

Our system helped quickly identify students at risk for not graduating due to lack of clinical placements and where we could shift to accommodate them,” said Small. It provided data that allowed the College’s experiential team to come up with creative solutions to meet students’ needs. Previously, the College would have been reliant on manual data that would have taken much longer to process and might have been inaccurate.

Usually, these types of initiatives are thought of as a “necessary evil.” When completed, there is little fanfare. For Cropper and Small, that is not the case. The team was recognized by the university in September with an Outstanding Achievement Award for improving CU business processes.

“It’s been a challenge to change the infrastructure. We’re proud of what we’ve accomplished. More importantly, we know we’re having a positive impact on the College. To be recognized for the work is the icing on the cake,” said Small.

Leigh Small, PhD

C O L L E G E

“I love being pregnant. When I say that to most women, they look at me as if I’m crazy,” said expectant mother and CU College of Nursing staff member Abby Zamora. For Zamora who is on her fifth pregnancy, having babies is the

“most wonderful experience.” And that’s why she decided to become a surrogate. “I wanted to do this for another family,” said Zamora. When she broached the subject with her husband, he asked her why.

She said, “When we’re done with having our family, I want to make sure that another couple is as exhausted, overwhelmed, underappreciated, irritable, but yet won- derfully overjoyed, excited, rewarded, loved and complete as parenthood makes us.” It was a big decision. “In the beginning, my husband was not as on board with it as I was. A lot of that was because of a lack of information and misinformation. He needed to know how it works.”

Zamora and her husband selected a surrogacy agency that walked them through the process and provided answers to their questions.

QUESTIONS TO ASK YOURSELF

“You must ask yourself many heavy questions – the num- ber one being are you finished having a family?” Because the process can leave the surrogate infertile and unable to have children in the future, “You really need to know that you are done growing your family,” said Zamora. Surrogacy is not impregnation and adoption. It is something very different. It requires In Vitro Fertilization (IVF) and in Zamora’s case embryo transplantation – risky procedures that carry a higher probability of hysterectomy, infertility, and the embryo splitting. A traditional surrogate uses her own embryos. As a gestational surrogate, embryos were donated, retrieved and implanted, and IVF was used to inseminate them. “People are under the impression that as a gestational surrogate it’s the mother’s embryos and her baby. In actuality, you’re a vessel and you are giving over your body for 10 months to grow someone else’s child,”

said Zamora.

Questions and answers surrogates must come to terms with are – if the embryo splits are you prepared to carry multiple fetuses to term or to reduce the number to im- prove survival for the baby and carrier? Other questions:

Can you separate yourself from the fetus you are carrying – knowing that it is not your child, but someone else’s? Will you be able to give the baby up once born? Will you terminate the pregnancy if the baby has a congenital defect and the family wants to terminate? How will you explain the pregnancy to your children? One question stood out for Zamora – “How am I going to feel when the baby doesn’t come home with me?” She needed to know that answer before proceeding.

Zamora said, “I knew I could do it knowing the baby was not ge- netically mine. The father used an embryo donor, so I was literally the oven – that helps.”

MATCHING WITH A FAMILY IS LIKE ONLINE DATING

Zamora described the initial process to match her with potential par- ents as, “Kind of like online dating.” With a lot of sharing of surrogate and parent profiles and Zoom chats to get to know each other, “You have to be on the same page as the parents.” According to Zamora, the agency was amazing. You have to agree to everything upfront or be willing to walk away. Setting expectations is essential. Lawyers get involved, which gets tricky. “They are there to protect both sides,” she said. Sometimes there are things that the family or lawyer require that make the situation potentially untenable. For Zamora, the one contentious requirement that needed to be ironed out before moving forward was the use of a traditional obstetrician over midwives for her care. “I put my foot down. If I can’t see my midwives I’m done,”

she said. The lawyer was unwavering. It had to be an obstetrician.

“I’ve had four babies with these midwives. I asked them, ‘You’re going to make me go to a doctor I’ve never been to before?’” In order to overcome the family’s lawyer’s reticence, Zamora suggested one of the UC Health OBs attend a prenatal appointment. “That did the trick with the Experiential Learning Team

UNMASKING MYTHS ABOUT MIDWIFERY, STIGMAS ABOUT SURROGACY By Dana Brandorff

Labor of Love

C O L L E G E

and seemed to satisfy the lawyer,” said Zamora. In the end, it came down to the family trusting her and her choice of midwife for care, labor, and delivery.

SURROGACY AND MIDWIFERY SHARE SIMILAR STIGMAS

Like surrogacy, the choice of midwifery is very personal.

It is also something that is shrouded in a bit of mystery, which means becoming educated about the experience.

“I’ve seen it before. My husband wasn’t very supportive of midwifery at first. But then we experienced it with our first, and we’ve had great births ever since,” recalled Zamora.

People tend to think it is all-natural, with no doctors, no hospitals, and no drugs. “I think he thought I was going to give birth on the living room floor. His perception was that if it wasn’t a doctor, then it was some sort of medieval practice. He ended up trusting me and my decision,” she said. After they went through it with their first child, he agreed that it was the best experience

for the family.

“The midwives are there to help you however you need, which can include epidurals and pain meds.

And an OB is on call if necessary,”

said Associate Professor Jessica Anderson, DNP, CNM, the director of Midwifery Services at the University of Colorado College of Nursing and one of the midwives Zamora sees. With the UCHealth Center for Midwifery, who are part of the UCHealth University of Colorado Hospital and the University of Colorado College of Nursing, pa- tients give birth at the Hospital on the Anschutz Medical Campus. “All of my children have been born there.

I wouldn’t use anyone else,” said Zamora. Studies show the benefits of midwifery care include fewer instances of complications, reduced use of anesthesia, and higher rates of breastfeeding.

For Zamora, her surrogate family trusted her and her instincts. “You are on a journey with the family. After all, you’re carrying their child,” said

Zamora. So weekly belly bump pictures and Zoom ultrasounds as they happen are part of the process. It’s a lot of communicating.

Her fourth delivery was without complications and delivered with the assistance of a water birth. “I labored in the tub with my other births, but I found it too difficult to get traction, or I got too hot. So would get out of the tub before the births. This time, it worked like a charm,” she recalled.

EACH BIRTH IS DIFFERENT

All of Zamora’s births have been unique. Her first was a breeze, and she had little to no pain. Because her first was so easy, she wanted to feel some pain for the second one because she wanted to know where the baby was in the process of labor and delivery. “Be careful what you wish for. The pain was very intense. After 46 hours of labor, I ended up having an epidural as the pain just got the best of me and I was exhausted,” said Zamora. Then the third was better again. And the fourth, another great experience.

Zamora and her family. PHOTO: KRISTI WILLIAMS PHOTOGRAPHY

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COULD SHE LET GO?

With the birth of her first surrogate son (and her fourth pregnancy), Zamora was able to answer the question she had posed at the beginning of the journey – would she be able to let him go? And yes, she could. “I never felt like I had lost him. He was never mine to lose,” she said.

Because the first surrogacy went so smoothly, her hus- band and family were okay with her doing it again. So, Zamora decided on a fifth. The two “surrobabies” (as Zamora calls the surrogate children) will be 25 months apart. Her fifth required that she travel to California in June for the embryo transfer. “That was a bit unsettling given that I was traveling during the pandemic,” said Zamora. Once she returned, she gave herself daily in- tramuscular injections with the support and help of her children.

“My kids were amazing with both surrogacies. I ex- plained that we were doing this for another family and that the baby was not their brother or sister,”

said Zamora. “They took it in stride.” Others did not.

Zamora and her family lost friends after announcing their first surrogacy. “They couldn’t comprehend why I was doing it and what I was doing to my body,”

she said. There is stigma involved in being a surro- gate. “The second most asked question after they find out I’m a surrogate is ‘how much are you getting paid?’” said Zamora. “I think I get an average of $3 an hour. Believe me, you don’t do it for the money,”

she said. “You do it for the love.” Because there are strict financial requirements to be a surrogate, it can’t be your main source of income, and you can’t be on government assistance.

Now the Zamoras know what to expect for this second surrogacy. And all are on board for another amazing journey.

Continued - Labor of Love

C U N U R S I N G C E LE B R AT E S 4 0 Y E A R S O F E D U CAT I N G N U R S E M I DW I V E S

Certified nurse midwives are registered nurses who complete midwife education programs approved by the national Accreditation Commission for Midwifery Education, and receive certification after passing an exam through the American Midwifery Certification Board. In addition to assisting during childbirth, CNMs provide a range of services encompassing women’s health before, during and after pregnancy. In so doing, they “augment” the care provided by maternal and fetal medicine specialists, obstetricians, and family medicine physicians. This year marks the 40^th year of the midwife education program at CU Nursing, one of the top midwifery programs in the country.

My kids were amazing with both surrogacies. I explained that we were doing this for another family and that the baby was not their brother or sister.” - Abby Zamora

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hospice and death was so important. I learned there were many things you can do to ease suffering – monetarily and emotion- ally. Not talking about death is not one of those things.”

Before her diagnosis, his wife did something that would have a tangible impact on her family after her death. She had the forethought to put insurance in place and raise the limit.

“We didn’t talk about it at that time,” said Simpson. It was fortuitous, as it allowed him to semi-retire, throw himself into school, and pursue a different career.

“As far as I could remember, I wanted to be in healthcare, but had followed several different paths including firefighting, law enforcement, and real estate software.” For Simpson, nothing felt like he wanted it to be until nursing – specifically hospice care. “That’s my path. If it changes, I’m okay with that. But I’m not willing to be sidetracked now,” said Simpson.

REMOVING THE TABOO OF TALKING ABOUT DEATH His personal experience solidified a long-term desire, which led him to CU Nursing’s Bachelor of Science in Nursing pro- gram. Today, Simpson is in his first year at CU Anschutz after completing his prerequisites at the Community College of Denver. Excited by the prospect of being a nurse, Simpson said, “I’m a little older. I’ve seen a lot of things. I want to get rid of the taboo of talking about death.”

I

After undergoing chemotherapy, radiation, sur- geries, and reconstruction, the couple thought she had beaten it. Within months, cancer spread to her brain and spine. The prognosis was grim. She fought hard but realized she wasn’t going to get better.

“During that time, I learned that people deal with these situations very differently, and you need to let them handle it in their way,” said Simpson. His wife’s family did not believe what was happening.

They wanted her to keep fighting and didn’t want to hear that she was dying. “I learned to advocate for her and her wishes,” said Simpson.

FOCUSING ON THE RIGHT STUFF

Consequently, “We tried to plan for the kids and focus on all the right stuff,” said Simpson.

The “right stuff” included making videos for their three young children so they could have them when they got older. The “right stuff” included talking about death, making sure they completed all pa- perwork, and were prepared. The “right stuff” also included Simpson taking Family and Medical Leave from his computer job and becoming his wife’s full- time caregiver.

“We had a lot of time together as a family,” he said.

Juggling her care as well as that of their children was challenging. “But one that I wouldn’t change,” said Simpson. “Being able to be there and openly talk about

The “Right Stuff”

WIFE’S BREAST CANCER DIAGNOSIS LEADS TO NURSING CAREER By Dana Brandorff

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As Liz Phelps opened her book bundle from CU College of Nursing, she began to cry. An unexpected gift from the College and the Alumni Association was included with her books – a stethoscope. “When I opened the stethoscope and saw the note I, to be honest, immediately started to cry.

The fact that nurses who once stood in my shoes would be willing to lend a hand to their future colleagues made me proud of this profession that I am lucky enough to have the opportunity to enter into,” said Phelps.

After working in the field for a while, Phelps soon decided that the pull to healthcare was strong. She quit her job, took a 16-week course and became a certified nurse assistant (CNA), and worked at Denver Health conducting epilepsy monitoring and in the surgical ICU. Sometimes handling acute patients under the age of 18, “That’s when I discovered a love for pe- diatrics. I thought I would hate it. But I really love children’s ability to rebound.”

While working, she went back to school and enrolled at the Community College of Denver. “I stumbled into the Integrated Nursing Pathway program, which offers a unique way to earn a Bachelor of Science degree in nursing.”

Offered through three local community colleges (Community College of Aurora, The Community College of Denver and Red Rocks Community College Arvada), the program pro- vides simultaneous application and admission to the local community college and CU College of Nursing. Upon admis- sion, students take the first two semesters of classes at the community college and receive an associate degree. Then, they complete nursing studies at CU Nursing at the Anschutz Medical Campus where they earn their BSN after two years.

Phelps finished her associate degree this past May and started June 1 at Anschutz where she is one of 58 INP students. She said excitedly, “I have a healthy nervousness. I’m finally in the program and am glad I chose the profession.” As a CNA, Phelps saw and worked with nurses who attained their de- grees from a variety of institutions. “The nurses I have met who have come out of CU are incredibly prepared. Their soft skills are amazing. They appear more centered on the patient.”

If you would like to have an impact on an incoming student and want to contribute to the stethoscope fund, visit:

https://giving.cu.edu/fund/college-nursing-stethoscope-fund

The stethoscope and note Liz Phelps received upon entering the nursing program symbolized her transition into the profession and summed up her journey to nursing.

That journey began years ago when Phelps’ grandmother — a neonatal ICU nurse in Georgia — told her, “You’re going to be a nurse one day.”

Phelps fought it for a long time. Originally pursuing a psy- chology degree, she took a three-year break from school and began working in corporate medical supply sales for a company specializing in internal tube feeding for patients with a variety of conditions from gastrointestinal cancer, to nutrition issues, to chemotherapy and allergic disorders. She discovered a love for patient education. “When families were discharged from hospital I would set up the initial supplies, educate them about kangaroo pumps, troubleshoot and connect them with dieticians,” said Phelps.

Grandmother’s

Prediction Puts Student on Nursing Path

By Dana Brandorff

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BRIDGING THE LANGUAGE GAP WHILE PROVIDING A GREAT CLINIC EXPERIENCE Percival has thrived at Sheridan, helping the pa- tients feel at ease navigating a variety of services including primary care, mental and behavioral health, a dental practice, and pharmacy. “I feel so grateful to work here. It’s such a supportive environment. What separates Sheridan from other clinics is that we truly listen to our patients and their needs.” The patients rec- ognize this special bond. Recalling a patient who needed HIV care, Percival said he first went to a local hospital’s emergency department, which could not provide continuous care for his chronic condition. “He came to us. I coordinated assistance for him. He was so grateful. Those are the moments that make the job rewarding. I know I made a difference in his life,” said Percival.

Her work has made her an invaluable asset providing intangible services for the clinic’s clientele. Making them feel welcome, at home, and cared for. “We can provide the healthcare services, but Ashley sets the stage for a great clinic experience,” said Nurse Case Manager Megan Peek, RN, BSN.

After two-and-a-half years working at Sheridan, seeing the commitment, passion and compassion of the staff and providers, Percival began ques- tioning her role. “Seeing all they do makes me motivated to do more for the community and be more of an advocate,” she said.

NEW PATHWAYS TO NURSING

A year ago, she began thinking about becoming a nurse. Her fellow workers couldn’t be more supportive of her decision to enroll in CU Nursing’s Integrated Nurse Pathway INP) program.

The INP program provides simultaneous application and admission to the local community college and CU College of Nursing.

Percival is taking her courses at the Community College of Denver and will be transitioning to CU College of Nursing in January 2021. Working full-time at Sheridan and going to school full-time is a challenge, “but it’s one I love,” said Percival. With a future goal of being a rural health nurse, Percival has lived the experience that many of her current and future patients will face. “And that’s why she’s going to make an outstanding nurse,” said Peek.

As a child, Ashley Chacon Percival became her family’s interpreter;

helping her Spanish speaking parents navigate the healthcare system. At 8 years old, she was accompanying them to medical appointments, interpreting and translating for them, and when her father suffered a stroke she attended his specialty appointments with him.

CHILDHOOD LEADS TO MEDICAL INTERPRETING

“I think my childhood led me to where I am today,” said Percival. While assist- ing her family, she recognized a gap in services and discovered a calling – medical interpreting for Spanish speaking patients. “I wanted to be the person to fill that gap,” she said.

For six years, Percival was a medical interpreter in different Denver metro area hospitals. “Even though I loved it, it wasn’t a steady job,” recalled Percival.

Three years ago, she began looking for a more reliable position in health care administration. She found it as a referral coordinator with Sheridan Health Services, a nurse-managed health center run by the University of Colorado College of Nursing. “In a sense, it was like going back to my roots. Sheridan reminded me of the community clinics that I attended with my parents when I was a child. I had a true connection and knew I belonged,”

said Percival. As a referral coordinator, she helps patients navigate the clinic, get to their appointments, translates, and make sure paperwork and tests are completed.

Not Lost in Translation

CHILDHOOD EXPERIENCES LEAD TO MEDICAL CAREER

By Dana Brandorff

Sheridan Health Services Referral Coordinator Ashley Percival