10 Questions: Therese S. Richmond, PhD, CRNP

10 Questions: Therese S. Richmond, PhD, CRNP

Therese S. Richmond, PhD, FAAN, CRNP , associate dean for research and innovation at the University of Pennsylvania School of Nursing, views nursing as “an exquisite opportunity” to help people when they are at their most vulnerable. There is nothing better than being a nurse, she told MedPage Today, explaining that even during her hardest days she reminds herself to “take a deep breath and be thankful for the honor of being a nurse.”

Richmond received her Masters in Nursing Science from Catholic University of America in the early 1980s, followed by a PhD from the University of Pennsylvania a decade later. Since then, she has spent much of her career using nursing science to prevent injury and violence and improve outcomes, particularly in patients from vulnerable urban populations worldwide.

Richmond was recently elected to the National Academy of Medicine and is also a member of the Federal Advisory Committee to the Secretary for National Health Promotion and Disease Prevention Objectives for 2030.

In this installment of “10 Questions,” Richmond discusses the complexity of the U.S. healthcare system and what she sees as its most pressing issues.

1. What’s the biggest barrier to practicing nursing today?

The complexity of healthcare systems and the rapid movement of patients through acute hospitalization poses a significant challenge. Nurses need to get to know patients and families quickly, predict what their needs will be upon discharge, and prepare patients and families to provide complex care in the home.

As an injury researcher, I have found that psychological consequences surface after injury for a substantial subset of injured patients. Yet the symptoms of psychological reactions to injury do not surface until after discharge. We need to prepare patients to recognize symptoms of disorders such as post-traumatic stress disorder and depression, so that patients and families recognize and attend to symptoms when they arise and know when and how to ask for help.

Nurses need to overcome the barriers erected by increasingly shortened hospital stays and help people know where to go to seek help — which is not easy in complex systems.

2. What’s the most important healthcare issue that nobody is talking about?

We continue to compartmentalize physical and psychological health. Today, we have systems that do not recognize the intersection of psychological and physical health. I am not speaking here about people with chronic serious mental health disorders (e.g., schizophrenia). Instead, I am talking about people who experience an acute illness (e.g., myocardial infarction) or injury (e.g., assaulted with a weapon).

A certain proportion of people with illness or injury will have symptoms of a psychological disorder emerge. While we are effective at treating the MI or the injury, we tend to be blind to the psychological responses — and even when we see these responses — in taking action. This problem is exacerbated by the fact that we predominately focus on a single episode of care. We do not fully take into account previous life experiences and exposures that can directly impact outcomes.

Think about what we know about adverse childhood experiences (ACEs) and the profound impact ACEs have on morbidity and premature mortality. Even though we know this, we don’t typically address previous trauma exposures and consider how that will affect recovery or the emergence of psychological symptoms.

3. What changes, if any, will the Trump administration impose on medical practice?

I am currently a special government employee since I sit on the Federal Advisory Committee to the Secretary of DHHS for Health Promotion and Disease Prevention and thus not in a position to answer this question.

4. What country do you think has a better healthcare system than the United States?

My previous response applies to this question as well, and thus I am not in a position to respond.

5. What is the most important piece of advice for students or providers just starting out today?

Maintain your passion and always remember the reason you entered nursing. Never forget the patient should be at the center of all we do.

6. Have you ever been afraid of a patient?

I have never been afraid of a patient. For the decades I worked in trauma and neurological critical care, there have been times that I have been in situations where behaviors are problematic. I always remind myself that if patients are acting out there is usually a physiologic, psychologic, or medication-related reason and I try to intellectually solve the puzzle of what is driving the behavior. I have found this approach is a useful strategy to address both the needs of the patient and to control any anxiety I may feel about a situation that seems to be spiraling out of control.

7. What is the most memorable research published since you became a healthcare provider and why?

I think in terms of a body of research — not just one study. As an injury and violence researcher, I think the most important is the body of research that has reduced death by motor vehicle crashes. We have learned a tremendous amount through research about cars (e.g., better, safer designs), behavior (e.g., driving while distracted, use of child safety seats, the importance of motorcycle helmets), and environment (e.g., highway design, pedestrian crossings).

As a result, we have been able to decrease death by motor vehicle a significant amount. The CDC counts this reduction in death from motor vehicle crashes as one of the top ten public health successes of the 20th century. This concerted effort required access to data, rigorous design of research studies, and a regulatory body able to institute new policies and standards based on solid science.

I am hopeful that in the future we can build a comparable body of research to reduce death by gun.

8. Do you have a favorite medical-themed book, movie, or TV show?

Can’t think of anything.

9. If you weren’t doing your current work, what do you think you would be doing today?

There is nothing better than being a nurse. Throughout the decades, I have had so many diverse opportunities to impact the lives of people and communities through my practice, my research, and my teaching. If I were not at Penn doing what I love best, I would see myself in a low-resource community trying to improve the health and well-being of those with the highest need. We have such disparities between those who have and those who have-not — it is highly disturbing. I would like to find a way to bring that into a more equal balance, which in the long-run will improve the health of all.

10. What is the biggest difference between your expectations of nursing practice when you graduated from nursing school and the reality?

There is a tremendous difference in what I expected and reality. I expected to provide high quality, knowledgeable, and skilled care to sick people. What I experienced is that at its core, nursing provides me an exquisite opportunity to touch people’s lives at a time that they are at their most vulnerable. This is a privilege afforded to me as a nurse that few others experience. During my hardest days, I take a deep breath and remember to be thankful for the honor of being a nurse.

This story was originally posted on MedPage Today.