The College of Nursing was founded by pioneers who believed that transforming health care is accomplished by transforming nursing education. As the first of the college’s three missions, teaching is at the heart of what nurses do every day as patient advocates, mentors and lifelong learners. Gator Nursing faculty believe that learning is achieved by promoting open dialogue and accepting differences. Faculty incorporate inclusion principles throughout each course and discuss influences on the individual, family, community and societal levels. In addition, mentorship plays a large role in academic programs.

In 2016, the college established the first cohort of students in the EMBRACE program. EMBRACE, which stands for “Engaging Multiple communities of BSN students in Research and Academic Curricular Experiences,” provides research and leadership opportunities for nursing students from various backgrounds with the goal of creating an inclusive environment for different viewpoints in the scholarly nursing community.

As the program’s faculty director, Jeanne-Marie Stacciarini, PhD, RN, FAAN, is also the college’s assistant dean of diversity, inclusion and global affairs. In EMBRACE, each participant is paired with a nursing faculty member who best matches the student’s research interest.

“EMBRACE has become a national model for engagement programs for underrepresented nursing students,” Stacciarini said. “Our monthly meetings provide an opportunity for our students to dialogue with one another and learn from leaders in our field who serve as guest speakers. This year, we will focus our efforts in the program on social justice and anti-racism as central themes — committing to uphold the college’s core values of engagement, courage and caring, while also modeling acceptance and embracing our diversity.”

Debra Lyon, PhD, RN, FNP-BC, FNAP, FAAN, the college’s executive associate dean and the Thomas M. and Irene B. Kirbo endowed chair, believes that education — and especially nursing education — cannot succeed without mentorship.

She is passionate about expanding the pipeline of minority students who will form the researchers and clinicians of the future and help eliminate health disparities in cancer.

Lyon is the director of the Research Education Core at UF for the Florida-California Cancer Center Research, Education and Engagement, or CaRE², Health Equity Center, and she works with other researchers from this multi-site project to support translational cancer research and training among minority populations.

“Diversity is imperative in health care because individuals always prefer to see providers with shared cultural understanding,” Lyon said. “By building the pipeline of minority researchers and clinicians, we are increasing the multicultural understanding and outcomes in populations experiencing health disparities, and we are accomplishing it in a way that is culturally congruent.”

Major advances in health care have taken place over the past few decades. Yet, racial disparities still exist. While researchers work to address unmet needs when treating certain diseases, one key factor seems to be missing: a racially diverse representation in studies and trials to more accurately ensure meaningful outcomes.

However, the College of Nursing faculty is passionate about combating these disparities and ensuring that when it comes to research, diversity is top of mind to ensure all patient voices are heard, no matter their background.

For Ellen Terry, PhD, an assistant professor, her latest research focuses on determining whether pain catastrophizing, which is the tendency to describe a pain experience in more exaggerated terms than the average person, contributes to differences in pain-related brain function, clinical pain and pain sensitivity among African American and non-Hispanic whites with knee osteoarthritis. Her intervention is designed to teach persons with chronic pain alternative pain-coping skills in order to minimize the use of pain catastrophizing as a pain-coping strategy.

“The significance of this work is that we know that African Americans are at risk for experiencing more severe and disabling chronic pain,” Terry said. “However, few interventions to reduce these disparities have been implemented. I hope that my research will lead to new treatments that will be particularly helpful for African Americans, thereby providing an intervention that may address some of these unacceptable health disparities.”

Racial and ethnic disparities are pervasive in our health care system, and pain is no exception.

Florida has the second-highest prevalence of sickle cell disease, or SCD, in the country. It was first described in the literature over 100 years ago and was the first known molecular disorder characterized at a microscopic level. According to the Centers for Disease Control and Prevention, SCD mainly impacts African Americans/Blacks (1 in 365) and Hispanics (1 in 16,300). The hallmark symptom of SCD is debilitating pain episodes. The CDC also reports that when these patients go to the emergency room, they are often plagued with long wait times before being seen and are often stigmatized and viewed as drug-seeking.

“African Americans are routinely under-treated for their pain,” said Keesha Roach, PhD, RN, a research assistant professor. “The lack of patient-physician relationships, especially in the emergency room, may play a role in patient stereotypes, and the failure to treat pain. Some health care providers tend to believe that African Americans do not feel pain with the same intensity as other racial/ ethnic groups.”

Genetic variability is known to have a role in the perception of pain. To understand pain in the SCD population, it is important to understand associated genetic factors. Genetic polymorphisms — which are a difference in DNA sequence among individuals, groups or populations — and epigenetic mechanisms, heritable changes in gene expression that do not involve changes in DNA sequence, may influence pain severity and frequency and may account for some of the variability of pain in patients with SCD. For Roach and her proposed study of adults with SCD, she will examine the role of genetic and epigenetic mechanisms in SCD pain.

Studying movement-evoked pain is a relatively new concept, but Staja “Star” Booker, PhD, RN, an assistant professor knows it is important in understanding pain-related disabilities. That is why her research focuses on elucidating and understanding movement-evoked pain, or MEP, in older African Americans with knee osteoarthritis. MEP is an emerging concept and represents a shift in assessing pain during movement-based activities rather than simply when at rest.

“The goal of this study is to reduce pain severity, suffering and declines in function — all outcomes that support well-being and healthy aging,” Booker said. “We may not be able to totally eliminate the pain that is associated with movement, but we can certainly identify ways to control it and keep older adults active.”

Booker’s strides in understanding MEP in older adults have earned her recent accolades, including the American Society for Pain Management Nursing Excellence in Nursing Award for Pain Management of the Older Adult and the 2020 Claudia J. Beverly Innovation Award from the National Hartford Center of Gerontological Nursing Excellence.

The concept of “personalized nursing care” focuses on treating each patient as an individual with different needs. For nearly 20 years, the college’s nurse-managed practice, UF Health Archer Family Health Care, or AFHC, has been central to the clinical practice mission of the College of Nursing. AFHC is both a Rural Health Clinic and a Patient-Centered Medical Home recognized by the National Committee for Quality Assurance. These designations mean patients are put at the forefront of care with better experiences and reduced costs.

The practice is located in a rural area just west of Gainesville and treats patients from the surrounding communities who would not otherwise have access to care. Most patients are insured by Medicare and Medicaid, but about 40% are uninsured. Fees are based on a sliding scale and a wide range of primary care services are offered, including labs and procedures.

Denise Schentrup, APRN, DNP, FAANP, is the practice director and the college’s associate dean for clinical affairs. She leads the AFHC team and is also a provider at the practice. She says what is most important in providing care for diverse populations is being a good listener.

“Many of our patients are distrustful of structured health care because they have been let down in the past,” Schentrup said. “I feel honored when an individual comes to AFHC, has a positive experience and comes back again and again. When patients return, it means they are taking an interest in their health, and that is when you know you are making an impact as a provider.”

Schentrup said their patients range across the lifespan, and she is not only proud of their racial diversity — 40% are African American, Hispanic or non-white — but also the diversity among the staff, representing Hispanic, Black, Asian and white ethnicities.

In the area of mental health, Clinical Assistant Professor Michaela Hogan, DNP, APRN, PMHNP-BC, is hopeful that the recent social justice movement will lead to structural changes and positive outcomes for the pediatric mental health patients with whom she works. Hogan maintains a joint clinical practice and teaching appointment within the College of Nursing and the UF Health division of child and adolescent psychiatry. She believes mental health disparities exist among racial and ethnic populations and are perpetuated among marginalized populations, in part due to lack of access. Recent telehealth services have provided better access to clients in rural communities.

In her practice, Hogan sees an opportunity to honor diversity and inclusion almost every day and through various ways. For example, she may serve as an ally for sexual minority youth who are significantly more likely to attempt or complete suicide than their heterosexual peers. Other times, she may advocate for a Black father who wants a concordant provider for his son.

“If we want a social revolution that rights the wrongs of centuries-old oppression, discrimination and racial trauma, we must be more than listeners and speakers; we must be doers,” Hogan said. “Sustainable social change with lasting health and mental health impacts will require coordinated structural changes. I’m looking to emerging generations to lead with passion and the older generations to follow with wisdom. It will be a process requiring the persistent determination of weeding an overgrown garden with deeply rooted injustices waiting to spring up among the tender shoots of equity and equality.”

At the College of Nursing, faculty and administration are constantly evaluating ways to improve racial representation and social justice through the three missions of teaching, research and clinical practice.

“It is easy for an organization to state what they are doing right,” said Anna McDaniel, PhD, RN, FAAN, dean and the Linda Harman Aiken Professor. “At the College of Nursing, it is not enough to accept the status quo. We want to have difficult conversations with our students, alumni, faculty and staff to ensure we are making progress toward improving the experiences and health for all.”