During her last rotation as a nursing student at an outpatient program for severely mentally ill patients, Dawn Bounds found her calling as a psychiatric nurse.
“I loved it – to sit and talk with my patients and try to understand the context of their lives and how to support them,” recalls the Chicago native. “It was such an enjoyable experience that I knew specialize in psychiatry from that moment on.”
Pivoting to Psychiatry
Bounds, who planned to go into medical-surgical nursing, took a position in an inpatient child and adolescent psychiatry unit right after graduation.
Being in such a challenging environment came naturally to her – so much so that she used to joke she’d return after she retired. Bounds worked there while earning a master’s degree to become a family psychiatric-mental health nurse practitioner and a Ph.D. in nursing science at Rush University.
As a nurse practitioner, Bounds served in high schools and the county juvenile detention center on Chicago’s West Side. There, she helped at-risk female youths caught in a cycle of running away and getting locked up.
“I had two questions: Who are you running away from – what’s happening in the household that keeps you running? And who are you running to?” she recalls.
“Years ago, I attended a forensic nursing conference. They were talking about sex trafficking and sexual exploitation and all the red flags. I couldn’t help but think, ‘These are the girls I’m already taking care of,’” Bounds says.
“But nobody’s calling it sex trafficking or sexual exploitation. They’re just criminalizing these girls’ behaviors. They had these histories of being traumatized, and then on the other end, I was seeing them in juvenile detention, and I thought, ‘Something needs to change.’”
Supporting the Family Unit
Her research and day-to-day treatment took a fresh focus. Child welfare services often remove youngsters from abusive homes. But teens are more likely to remain in tenuous situations until they flee on their own.
Supporting young people, Bounds realized, meant supporting their entire families, especially those with minimal resources.
“These amazing kids were still going to school despite living in neighborhoods with shootings, violence, and substance use,” she says.
“I was just looking for ways to be of assistance and help them solidify some support networks so that they could not just survive but thrive amid many things beyond our control.”
Psychiatric DNP program
At UCI, where she joined the faculty this summer, Bounds will help establish a psychiatric-mental health nurse practitioner specialization in the Doctor of Nursing Practice program.
But the campus is not the only community that will benefit from her expertise and compassion. She plans to partner with primary care providers across Orange County to create an intervention that supports at-risk youths and their caregivers.
She wants to offer support beyond identifying trauma and suggesting emotional regulation techniques like exercise, yoga, and mindfulness.
“I feel like there’s this healthcare gap in how to make that happen. I think nurses and other health workers can become health coaches in the community,” Bounds says.
“Supporting teens chronically exposed to adversity could also mean connecting them to positive environments.”
This includes school-, faith- or sports-based youth programming, mental health care, housing, and support groups.
Technology’s Role in Helping Vulnerable
Her courses in the Sue & Bill Gross School of Nursing are delivered through Zoom, a tool she thinks could also serve a purpose in treating vulnerable patients. Still, Bounds misses the human connection and hopes her students can feel her warmth and sincerity through the screen.
“Being a psychiatric nurse practitioner, I know that those relationships you build are so important,” she says. “Even when they’re not my patients, students, and colleagues, I want that connection to be there.”
When asked about her proudest accomplishment, Bounds cites her mentoring ability.
“I come from a community that could be considered under-resourced, so I’m proud to be a role model for those I work with. A single mom raised me. I’m a first-gen college student. And now I have a Ph.D. and am working at the University of California,” she says.
“To me, I’m an example of that young person who might have limited resources and support right now. Examples like mine that demonstrate possibilities for young people are so important.”
DNP in hand, he says, “I felt a change. I don’t know if others could see it, but I could see it within myself.”
Patton, the chief nursing executive at UC San Francisco Health, has a well-established and well-earned reputation as a health system leader and change-maker.
Why would someone at a high level pursue another degree? “I did it because I didn’t know what I didn’t know.”
He is grateful that he did.
“It feels different having my degree as a DNP than it did with my MSN,” Patton says.
“Maybe it’s because of the knowledge I gained with social determinants of health, public policy, national policy, quality improvement, or looking at things in a different way.”
UCSF Chief Nursing Executive Pat Patton graduated in June 2021 with a doctor of nursing practice (DNP) degree.
DNP Champions the Evidence Behind Nursing Practice
When it comes to the relationship between nursing research and practice to improve the quality and safety of patient care, “I pay much more attention to the evidence now.”
And if the evidence doesn’t exist, Patton says, his nurses are encouraged to create the evidence through nursing research. Three nurse PhDs from the UCSF School of Nursing work part-time with staff nurses to gain approval for their studies and begin doing research.
As a DNP, Patton’s role is to translate that research into evidence-based nursing care.
“As soon as we find the evidence that something works, we’re going to immediately put it into practice,” he says.
“You don’t have to wait for an average of 17 years between publishing the research and implementation for something to get into practice.”
Proactively pushing for evidence and research is something Patton doesn’t think he would have done before his DNP.
“I would ask people what they thought we should do or wait for someone else to ask ‘What about the evidence?’ instead of me, as the chief nurse, asking about the evidence.”
And it is critical to him that nurses add their voices to the body of evidence in healthcare.
“If we don’t add our voice, knowledge, and power to do research, and what we can prove to what we can do under the scope of our licenses, then we’re failing our profession,” he says.
“We have to do it repeatedly to continue to add to the body of evidence.”
The Social Determinants of Health
Patton says he is also much more attuned to the social determinants of health, the economic and social conditions that influence the health of an individual or a community.
He credits Associate Professor Candace Burton with expanding his understanding via her social determinants of health course.
In particular, Patton saw how those determinants impact the health of various communities, especially the transgender community.
“Because of her, and because I understood the plight, the issues, and the problems that the transgender population have, I can better advocate for them at UCSF.”
While he was a student, he worked with the transgender clinic leadership at UCI to build support for increasing funding for the UCI Health Gender Diversity Program. Doing so enables individuals to remain in Orange County rather than traveling to UCLA for care.
At UCSF, Patton advocates for nurses and nurse leaders to work with GLIDE, a homeless nonprofit in San Francisco. This will better educate faculty and staff leaders on social determinants among the homeless and veteran populations.
His hope is that what they see and learn will lead to a greater understanding of the multifaceted issues that impact the health of the homeless population, then let that inform how they provide care for it.
“The homeless population was a way to continue the work of understanding the social determinants of health and look at things a little bit differently.”
DNP Stresses How Technology Can Lead to Better Care
The role of technology in healthcare is stressed in the DNP Program.
Armed with that knowledge, Patton sees a big opportunity.
One of his major projects is weaving the social determinants of health into the hospital’s electronic medical records system.
Once implemented, staff nurses would be alerted to an individual patient’s determinants via a pop-up, whether they lack access to a car, live in a food desert, or live alone.
“When the nurse sees a pop-up informing them about their patient, that nurse will take different actions when discharging a homeless patient vs. what they were doing before.”
Counsel and Perspective Sought From Peers
Patton is proud to have his knowledge sought by UC system leaders who have asked for his feedback on policies that will affect UC Health Systems so they can advocate for nurses at the state and national levels.
“That made me feel I was using my degree to the fullest. I didn’t realize I was coming across that way. But I think it was because of what I learned in the DNP program around policy and legislation that really helped me look at things.”
In turn, Patton looks at his fellow DNPs much differently.
“I tell them, ‘You got your DNP, so I know what I can hold you accountable for. I know what you learned, so now let’s work on x, y, and z.’”
UCI Sue & Bill Gross School of Nursing Assistant Professor Nakia Best doesn’t tend to exaggerate: When she makes a statement, she has the data to back it up and says kids are healthier when school nurses are in the building.
A self-confessed data nerd with a nursing Ph.D. from the University of North Carolina — Chapel Hill and a post-master’s degree from Johns Hopkins University in health informatics, she is passionate about translating the story that the data-based evidence tells.
“The goal is for kids to have medical access to a nurse every day. Unfortunately, that’s not the case in the United States, where 25% of schools have no nurse,” she says.
An Unexpected Discovery about School Nurses
Best neither expected nor planned to find herself an expert on the relationship between school nurses’ availability and students’ educational outcomes.
This area of research came to her by chance when she was introduced to an exceptionally rich trove of data relating to school nursing in North Carolina, where she grew up and spent two decades of her career.
Best’s practice had been as an ICU nurse in cardiothoracic surgery, but, she says, “I’ve always been interested in how we’re using tech to improve healthcare.”
She had already left ICU nursing for teaching and research when, after her post-master’s, her question became, “Was there a way to marry informatics with critical care?” The initial focus of her Ph.D. was to do with ways to improve nursing information capture in electronic health records.
An Opportunity to Mine ‘Mesmerizing’ Data
Best’s mentor, however, introduced her to North Carolina’s supervisor for school nursing, who had come to a healthcare community meeting looking for help. The state’s Department for Health & Human Sciences had been painstakingly collecting data about school nursing since the 1990s, and no one had ever put it to good use.
Best laughs about her reaction when her mentor first put her forward as a possible candidate: “I knew nothing about school nursing. I hadn’t worked with kids, never worked in paediatrics, and I don’t have kids. My parents said that even when I was a kid, I was a little adult!”
Nonetheless, she recalls, “I left that meeting thinking, ‘I’ve got to do this!’ The data was mesmerizing.”
What that data told Best about school nursing in North Carolina became the subject of her Ph.D.
The Link Between School Nurses and Children’s Success
Looking specifically at children with chronic health conditions of asthma and diabetes, she found that “the presence of the school nurse reduced the number of days missed; it increased children’s ability to manage their own conditions. There’s also evidence of how much of the principal’s and teachers’ time is saved when there’s a nurse around.”
She says, “Schools are charged with providing a safe environment for kids, and nurses help do this.”
Kids missed less school not just because they were less ill but because parents could trust that the school was a safe place for their child to be.
After completing her Ph.D., Best still had questions about school nurses’ experiences and their impact on communities. But changing topic midway through her Ph.D. meant that she’d spent six years researching and writing, and she was exhausted and needed a chance to recharge. So she returned to teaching at the University of North Carolina Greensboro, where she had earned her initial master’s degree in Nursing Education.
UCI Sue & Bill Gross School of Nursing Assistant Professor Nakia Best
Always Ready to Try Something New
“I always liked teaching new nurses,” she says, recalling a childhood trait. “My parents told me, ‘You love teaching!’ So when I was a kid, I would literally sit my sister down, get a blackboard, and teach her math from my grade. She’d be doing fifth-grade math when she was in first grade!”
For someone born educator, researcher, and, increasingly, a leader in her field, Best’s account of her career is full of self-deprecating humor and frequent attributions of her progress to happenstance rather than her own skills and talent.
She’s often frank about the difficulties of retaining confidence and motivation and is quick to credit others — her mentors, colleagues, and family — for her successes.
“I’ll try anything,” she says, “because my parents always said, ‘Try it! If it doesn’t work out, you can always come home and regroup.'” Yet, demonstrably, it is indeed her ability, her approach, and the quality of her output that have created widening demand for her work.
Going to UCI
She wasn’t looking for a new job when Founding Dean and Distinguished Professor Adey Nyamathi, founding dean of the Sue & Bill Gross School of Nursing, contacted her to see if she would be willing to interview for UCI. The Dean was seeking faculty with Best’s specific skills.
“I still don’t know how she found me,” Best recounts.
“It was Sunday, and I was with my family. We’d been to church and were having breakfast when I flipped through my emails. I thought her message was spam! But we’d heard of UCI because of their basketball team. So I looked up Dean Nyamathi and saw what a scientist she is. I thought: I want to do what she’s doing! And I always wanted to go to California.
School Nurses and Pandemic Response
Best took up her position at UCI in 2019, just weeks before COVID-19 — began to make its way across the globe.
“Dr. Dan Cooper, a professor of pediatrics who holds several senior roles at UCI, got in touch,” she says. “He said, ‘We have to help Orange County get ready. No one knows what’s happening, and everything changes daily. The community needs our help. How do we help schools prepare?’ I knew that school nurses needed to be involved.”
Along with “this ragtag group of scientists” who were her colleagues, Best plunged into the emergency, “…trying to help figure out who needed to stay home, how, ultimately we could get the kids back in school. Vulnerable kids. Kids in multi-generational households who have vulnerable older people at home. I was pulling together every piece of research I could find and reading, reading, reading…”
What impressed her most was how “…school nurses never stop nursing. They said, ‘The schools may be closing, but I’ve still got my kids!’ And I thought, ‘I’ve got to tell their story.'”
More than two years into the pandemic, Best is now immersed in that work. “COVID was bad,” she says, “but it was much worse for some people. What I want to look at next [in relation to school nursing data] is overlaying the social determinants of health. Every child has a right to go to school, even with a health condition. Sometimes school nurses are the only access to a child’s healthcare — and nurses can connect them to other resources.”
Harnessing Parent Power to Raise Awareness
She also analyzed qualitative data about school nurses’ experiences during school closures. “People talk about moral distress, moral injury,” she explains. “When you think, ‘I know what needs to be done, I know the right thing to do, but something is stopping me from being able to do that.’ I want to share what it’s been like for school nurses. I want people to know what they’ve been doing.”
In Orange County, school nursing is coordinated under the Department of Education rather than under the Department of Health & Human Sciences as it is in North Carolina; in both instances, as elsewhere across America, funding for school nurses is typically provided by individual school districts.
Best is well aware of the complexities involved in bringing about change, given that “There’s always a nurse shortage! You’ve got to train and hire them…what are the budgets for that?”
“Parents are powerful in getting school boards to make decisions,” she argues. “More affluent schools have a better nursing cover, but they need it less. Do you know if a nurse is in your child’s school building? I’d rather you knew before a tragedy occurred.”
Nurse-leader and health informatics expert Nakia Best doesn’t tend to exaggerate. So perhaps school districts across America should take note — and increasingly, as her work continues, they will.
BSN student Valeria Soria Guzman has been translating for her parents for as long as she can remember. She knows three languages so far – and is learning two more – and she aspires to use her polylingual abilities to increase access and equity for health care patients through the nursing field.
“It’s so hard when you’re sick and when you’re at your lowest point and to not have somebody who understands you,” says Guzman. “To not have somebody who can share that compassion with you in your own language is difficult.”
Guzman moved to the U.S. from Mexico with her family when she was two years old. She is a first-year nursing student at the Bill and Sue Gross School of Nursing at the University of California Irvine (UCI), and she is also the first in her entire family to attend college.
After learning English in the third grade, Guzman found that her background in Spanish made it easy for her to pick up other languages as well. Aside from English and Spanish, Guzman also knows French, is working on American Sign Language and has just begun to dip her toes into Portuguese. As a child, Guzman became her family’s translator at more than just the grocery store – she found herself translating at medical offices, filling out complicated documents with her limited children’s vocabulary of English, and trying to get both her parents and the physicians to understand each other.
“I feel like that’s why I want to go into nursing specifically so that I can walk a patient through the treatment and help them along the way, even if they don’t speak the language,” she says.
Guzman is constantly seeking opportunities at UCI to help those facing a language barrier, especially in the medical field. Currently, she works on the translating team for a research study that is looking for ways to help dementia patients through technology.
“A lot of their patients are lower income and Spanish-speaking only,” Guzman says. “So what I do is translate documents, like ones from the research, into Spanish so the researchers can have focus groups with these Spanish-speaking participants.”
Guzman sees the accessibility of documents in languages other than English as a major point in achieving accessible care. In the future, she plans to use her abilities to serve non-English speaking communities wherever she is most needed. She especially wants to serve areas lacking in non-Spanish speakers, even if it means leaving the large Spanish-speaking community that she values so much behind.
“The thing I’ve missed most since coming to UCI is speaking Spanish in a community setting, and I feel like that’s why I like to seek out a bunch of different Spanish speaking opportunities because I want to have that again,” says Guzman.
For 30 years, E. Alison Holman, Ph.D., professor of nursing at the University of California Irvine Bill and Sue Gross School of Nursing, has focused her research on collective trauma stemming from such climate-related disasters as wildfires and hurricanes, global events like the pandemic and wars, and other human-caused tragedies such as terrorist attacks, mass shootings and bombings. “I’ve always been interested in large-scale events,” she says. “As healthcare professionals, we need to understand how people’s mental health responses impact their physical health in the moment and long-term.”
“Collective trauma” refers to an event that is shared by an entire community, not just an individual. Media – both traditional and social – has expanded community borders beyond a specific geographic location to encompass anyone anywhere in the world who consumes coverage of the crisis. “The role that media plays in the link between mental and physical health following collective trauma is a critical part of my work,” Holman says.
“The healthcare profession has grown to understand that people’s mental health responses to acute stressors are linked to physical health – particularly cardiovascular ailments – down the road. My research has also identified the role that media can play in perpetuating long-term symptomology.”
Her understanding of that is personal as well as professional. The 9/11 terrorist attacks on the U.S. occurred while she was in Nigeria with her family, including two young children. News of this reverberated around the world, and during the six days they waited to return to the States, they experienced the event through media coverage. “I wasn’t there; I didn’t know anyone who was there. And yet it affected me personally, wondering what our country was in for and what it meant for my kids,” Holman says.
Media matters
Back in the U.S., she was a co-principal investigator on the UCI research team that conducted a large, nationally representative study funded by the National Science Foundation on how early reactions to 9/11 (e.g., psychological responses and media exposure) affected participants’ mental and physical health for three years following the attacks. Says Holman: “Because it was such a big event, people were watching it over and over and over, and that was linked to a lot of distress and health problems over time. We realized that we needed to find a way to prevent overconsumption of media.”
Her research into the 2013 Boston Marathon bombings revealed, surprisingly, that media exposure was a more powerful predictor of acute stress symptoms than being at the site of the blasts. “We found that people who were watching hours and hours of media coverage were more distressed soon after the attack than those who had actually experienced the event in person,” she says. “This was a very unusual discovery then.”
After the 2016 Pulse nightclub shooting in Orlando, Florida, Holman was involved in a follow-up survey of participants from the Boston Marathon study, which identified the cumulative effects of repeated exposure. “A cycle of distress can be created over time in which media consumption heightens distress, increases worries about future terrorism, and promotes further media consumption that is again tied to heightened distress,” she says. “We encourage people to limit the amount of exposure they have to traditional and social media after these collective events.”
Providers and personal biases
Over the last 20 years, the healthcare profession has increasingly recognized the link between mental health responses to acute stressors and long-term physical health effects.
“When faced with a traumatized patient, it’s really important that we understand how their trauma may have affected them both mentally and physically. That awareness, particularly with marginalized and underserved populations that generally experience higher rates of trauma, is going to help us be more compassionate and provide more effective care,” Holman says.
“We also need to reflect on our own biases and think about how they may impact our interactions with traumatized patients and, hence, their well-being. We need to learn how to overcome our biases and to support each other as we learn how to change our behavior. None of this is easy, but it’s critical for building a more equitable and effective healthcare system.”
