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Improving Health at Every Age

Tuesday, May 16, 2017

Duke University School of Nursing (DUSON) has a desire to empower women in caring for themselves. The School developed the Women’s Health Nurse Practitioner major in 2015 to prepare advanced practice nurses with the skills and expertise necessary to provide primary and specialty medical care for women.

In addition to preparing advanced practice nurses, alumni, faculty and students are active in clinical practice and research to improve health outcomes for women from adolescent to childbearing age. Emily Healy, MSN, APRN, one of the first graduates of the WHNP major,  Kathryn “Kathy” Trotter, DNP, CNM, FNP-C, FAANP, associate professor and lead faculty for the WHNP program for DUSON, Rachel Hirschey, RN, PhD student, and Leigh Ann Simmons, PhD, MFT, associate professor for DUSON, talk about their work in women’s health via clinical practice and research.

Clinical Practice

Healy recently became a nurse practitioner in one of the largest women’s health groups in the state of Kansas with three locations, 20 OB/GYN providers, one maternal fetal medicine specialist, two gynecology oncologists, two urogynecologists and five mid-level providers.

“My patient population is primarily obstetrics and well women gynecological care,” she said. “Additionally, I have a strong focus on reproductive planning and contraceptive counseling. I work with a largely adolescent population; I always bring up contraceptive needs, and I work with women to find the best option for them.”

While Healy only recently completed the WHNP program and become a certified nurse practitioner, she’s been working in women’s health for more than three years. “I chose women’s health because I believe that women have very specific health care needs that require individualized treatment and screening by experts in the field,” she said.

“As a woman myself, I am living the experiences of my patients daily. I enjoy going through their health care journey at the same time as I go through my own,” added Healy. Healy hopes her work will improve access to care and health outcomes for all women regardless of circumstances. “My biggest goal is to give women tailored care that provides them with the best life possible,” she said. “I always ask my patients what their goal is for their visit with the hope to accomplish this by the end of our conversation. I also develop a plan we can both agree on.”

She hopes that this will improve mental and emotional as well as physical outcomes for all of her patients. Healy’s current focus is utilizing screening tools with younger women to identify their breast cancer risk and then develop an individualized screening plan based on the latest guidelines and their risk score. Her long-term goal is to adopt the Centering Pregnancy model to her practice to allow for a different way to care for obstetric patients.

“I want to empower women to take charge of their health and know how to get the most out of a healthy life from adolescence to their reproductive years, through the menopausal transition and beyond!"

Advocacy

With more than 37 years in practice, Trotter knew she wanted to be a nurse practitioner during her school days, but she also wanted to be an advocate for women.

“Sometimes you take turns in your career, and you end up there,” said Trotter. “I knew I wanted to be a nurse practitioner, and I started hearing about my friends who were doing different things. One was in midwifery school and another was doing pediatric nurse practitioner. And I was kind of debating it, and then I realized I’m a feminist!”

Trotter said at that moment she wanted to be an advocate for women and their right to have choices in their health care.

After nearly 20 years as a midwife, Trotter went back to school to obtain her family nurse practitioner degree. “I saw it as an opportunity to take care of the whole family,” she said. “Oftentimes it’s the woman in the family that decides when others will see a health care provider, so women are the foundation of the family, and the woman’s health has an effect on the entire family.”

In addition to being the lead faculty in the WHNP program, Trotter still spends 50 percent of her time in clinical practice two days a week. Even with a hectic schedule such as this, Trotter said it’s the response from her patients that keeps her going. “Every day you see it in the patients’ eyes that they are so thankful someone explained the medical concerns or diagnosis to them,” she said. “You see women who have an abnormal mammogram, and they’re only told ‘it’s abnormal, go for a follow-up.’ However, as health care providers, if we would simply take a moment to explain these things, it would eliminate some of the anxiety these patients experience.”

Trotter thinks that women are a vulnerable population that doesn’t always get their fair share of health care, among other things, which is why she’s an advocate for women’s health. “Access to care has improved greatly over the years, but there is still room for improvement,” she said. “Historically, women from various cultures often sacrifice their health to care for their family or advance their career. And it’s important as health care providers and advocates that we find ways to help women see how important they are and why it’s important that they choose their health.”

Trotter encourages more women in and out of health care to become advocates across the country and find innovative ways to help women be empowered in the health system to make good health decisions.

Breast Cancer Survivorship

For more than five years, Hirschey has been working on a research project that will increase levels of exercise among breast cancer survivors in order to improve the quality and duration of breast cancer survivorship.

“My focus is on health behavior change, specifically helping chronically ill women exercise more to improve their health,” said Hirschey. “During my 10 years as a clinical nurse, it was this population that I most enjoyed working with and who inspired me.”

Over the span of Hirschey’s nursing career she worked in a variety of settings, from intensive care units to orthopedics; however, she noticed that the breast cancer patients she took care of were so motivated to do everything they could to improve their health.

“In general, it’s hard for some people to exercise more, and it’s even harder for individuals dealing with cancer treatment side effects such as fatigue,” Hirschey said. “I want to help these women who are really trying to do everything they can to help themselves.”

According to Hirschey, increased exercise is associated with decreased breast cancer recurrence and risk of other cancers. Long-term side effects can also be improved, such as fatigue, pain and concentration.

Childbearing & Health Disparities

Simmons has been involved in women’s health for more than 16 years. She got her start as part of a multi-state study of rural women and their families while she was in graduate school. The motto that drives her research is what keeps the passion fueled – “mask on mom!”

“When flight attendants give the airplane safety talk, they always tell you to put the oxygen mask on yourself before helping your child,” said Simmons. “My research is about helping to put that mask on mom so she can help her children. When we help moms to develop knowledge, confidence and skills to manage their own health, they use this information to manage the health of their children and families.”

Simmons’ research focuses on understanding factors associated with health decision-making and health status among childbearing women who experience health disparities due to rural residence, race or ethnicity and socioeconomic status. She uses this knowledge gained from the research to adapt, design, test and validate personalized behavioral change strategies such as telephonic and digital health coaching. These types of strategies work best in community-based and clinical settings.

“I am particularly interested in obesity and depression because these diseases tend to occur together and have overlapping biological and environmental contributors,” said Simmons. “By targeting a key member of the family system, we can have far-reaching effects on the health of families and ultimately communities. And this will help women to prevent and better manage obesity and depression and more importantly reduce health inequalities among diverse, rural women.”

National Women’s Health Week is an observance led by the U.S. Department of Health and Human Services Office on Women’s Health with the goal to empower women to make their health a priority across the lifespan.