Frontier Nursing University (FNU) named Dr. Paula Alexander-Delpech, Ph.D., PMHNP-BC, APRN, as its Chief Diversity and Inclusion Officer (CDIO).
Previously, Dr. Alexander-Delpech served as the Interim CDIO since January and guided the planning and programming for FNU’s 12th annual Diversity Impact Conference held in June.
Dr. Alexander-Delpech serves as co-chair of the President’s Task Force on Diversity, Equity, and Inclusion (DEI) and the Faculty, Staff, and Preceptor Development and Retention sub-committee of the DEI Task Force.
Performing at the Highest Level
“Dr. Alexander-Delpech has performed at the highest level as our Interim CDIO,” says FNU President Dr. Susan Stone, CNM, DNSc, FAAN, FACNM. “We know she will continue to provide the direction, passion, and leadership necessary to further the essential work of FNU’s Office of Diversity, Equity, and Inclusion. She has tremendous energy and has brought forth a number of new initiatives to build upon our existing DEI efforts, which are so important to the future of healthcare.”
Nurse Educator DEI Faculty Fellowship
Dr. Alexander-Delpech presented “The Development of A Faculty DEI Fellows Program” at the American Association of Colleges of Nursing’s Diversity Leadership Institute. Under her leadership, FNU plans to launch a Nurse Educator DEI Faculty Fellowship program this fall. Eight faculty members will be selected as Fellows and will attend a 12-week DEI training and then be assigned at least four more faculty whom they will coach for 12 weeks.
The Office of Diversity, Equity, and Inclusion oversee the development of five new student interest groups (SIGs), which hold their first meetings in June. The five SIGs are International Students in Nursing, LGBTQIA+ Students in Nursing, Men in Nursing, Military/Veterans in Nursing, and Students of Color in Nursing.
Delivering Equity and Diversity in Healthcare
“It has been a pleasure working with Dr. Alexander-Delpech,” says FNU Dean of Nursing Joan Slager, DNP, CNM, FACNM, FAAN. “She is passionate about creating opportunities for our faculty and our students to grow in their expertise in teaching about and delivering equitable healthcare.”
“I am so honored to accept the role of Chief Diversity and Inclusion Officer at Frontier Nursing University,” Dr. Alexander-Delpech says. “We always think about DEI as it pertains to our curriculum or profession, but when people start talking about it in their personal lives, that means people are making changes. The ripple effect is happening. At FNU, we are ahead of the game. When we talk about DEI work, FNU has surpassed a lot of other universities.”
My nursing education journey began when I received my BSN in Nursing at Rutgers College of Nursing in 2011. During my time there, I met some strong, professional women professors. They took such a personal interest in me that, over a decade later, I think of them with much gratitude. Their strength helped me to see myself as a strong but caring nurse.
A Strong Caring Nurse
My education gave me the confidence to care for my patients competently. I had a tough clinical practice specialist on the Med/Surg/Tele unit I first worked on. When she asked me questions on the spot, I almost always knew the answer. I credit Rutgers and fellow student nurses who supported each other through nursing school.
Prisca Benson, MSN, RN is a a nurse navigator for the neuroscience department at The Valley Hospital
While there was a lot to learn on the job, the education I received provided a foundation I used to excel clinically. It was not long before I started picking up per diem job opportunities to explore and broaden my horizons as a nurse. I worked in home care as an intake nurse, home care nurse, and infusion nurse for different companies.
In 2014, I got a job as a neurology nurse at my dream hospital, NYP-Columbia University Hospital. While per diem there, I joined committees I was interested in and disseminated the information to the staff in my unit to improve our practice.
I also noticed that some patients lacked a basic understanding of their medical history and medication. So I used the principles I learned in school to educate them effectively so they could be more knowledgeable about their health and care.
A Life’s Passion Realized
I soon realized that my passion was teaching.
I began searching for nursing opportunities to give me more time to teach patients. I applied for a position as Neuroscience Nurse Navigator at The Valley Hospital, which allowed me to create and develop the role to support the patients during their admission and help them maintain outpatient follow-up.
This was a dream come true! I finally had the time to sit at a patient’s bedside, teach them about their new diagnosis and answer all their questions.
While working this job, I received my MSN in Nurse Education at Chamberlain University. The modalities taught have allowed me to be a better peer and patient educator. It encouraged me to start with the other person’s understanding as a foundation for effectively educating someone. I participated in my organization’s student nurse externship by teaching skills, theory, and even creating an educational game to increase knowledge retention.
Love and Desire to Educate
My love and desire to educate led me to start a personal finance and health blog, Our Green Life, during the pandemic. The fear and misinformation were very unsettling, so I wanted to provide a reliable but approachable space for information. I use what I have learned through my education and experience to make the information easy to grasp and to demonstrate how it could be applied.
My nursing education helped shape my career, goals, and values, and I will be forever grateful for it.
“To begin, we must acknowledge that from 1916 until 1964, ANA purposefully, systemically and systematically excluded Black nurses…”
The American Nurses Association (ANA) is taking a meaningful first step to acknowledge its own past actions that have negatively impacted nurses of color and perpetuated systemic racism. With the release of a formal racial reckoning statement on July 12, ANA is beginning a multi-phase journey of reconciliation, forgiveness, and healing. The Journey of Racial Reconciliation is the name for ANA’s racial reckoning journey as it seeks to address past racial harms from as far back as the formation of the association in 1896.
From the ANA statement:
“Similar to the concerns raised by Black nurses, in 1974, led by Dr. Ildaura Murillo- Rhode, a group of 12 Hispanic nurses who were also members of ANA came together to consider establishing a Hispanic Nurses Caucus within ANA because ‘ANA was not being responsive to the needs of Hispanic nurses.'”
“We know that ANA’s work to reckon with our historical and institutional racist actions and inactions is long overdue. Racism is an assault on the human spirit, and we want to be accountable for our part in perpetuating it. We have certainly failed many nurses of color and ethnic-minority nursing organizations, undoubtedly damaging our relationship with them and in so doing, diluting the richness of the nursing profession. We ask forgiveness from nurses of color as a first step to mend what is broken,” said ANA CEO Loressa Cole, DNP, MBA, RN, NEA-BC, FAAN.
“ANA recognizes that issues of racism persist today and continue to harm nurses of color. Findings from the Commission’s 2021 national survey on racism in nursing (n = 5,600) noted that racist acts are principally perpetrated by colleagues and those in positions of power. Over half of nurses surveyed (63%) said they had personally experienced an act of racism in the workplace with the transgressors being either a peer (66%) or a manager or supervisor (60%). Fifty-six percent of respondents also noted that racism in the workplace has negatively impacted their professional well-being.”
On June 11, 2022, the ANA Membership Assembly, ANA’s highest governing body, took historic action to begin a journey of racial reckoning by unanimously adopting the ANA Racial Reckoning Statement. Please read the entire statement and stay connected with ANA on its journey.
Nurse-midwives and educators from three prominent research universities have teamed up to improve pregnancy outcomes in Black communities by providing specialized training for doulas, persons who support birthing mothers and families through the entire process of childbirth.
The Alliance of Black Doulas for Black Mamas is led by Vanderbilt University School of Nursing Associate Professor Stephanie DeVane-Johnson, PhD, CNM, FACNM, Duke University School of Nursing Assistant Clinical Professor Jacquelyn McMillian-Bohler, PhD, CNM—both graduates of Vanderbilt’s nationally-recognized Nurse-Midwifery program—and University of North Carolina School of Medicine Assistant Professor Venus Standard, MSN, CNM, FACNM. The project leaders are Black, certified nurse-midwives with a combined 60+ years of midwifery experience.
Doulas offer emotional and informational support for pregnant persons and their families. Unlike nurse-midwives, they are not medically trained; however, their help with things like breastfeeding, acupressure, birth plans and postpartum issues can be critically needed, as can their presence as an advocate for the mother.
The three researchers are addressing the U.S.’s Black maternal health crisis. The U.S. has the highest maternal mortality rate among developed countries—and the crisis is even more pronounced for Black mothers. Centers for Disease Control and Prevention statistics reveal disparities between pregnancy complications and risks across different racial groups. Black women are approximately twice as likely to have a moderately low birthweight child and three times as likely to have a very low birthweight child than white or Hispanic women (https://www.cdc.gov/nchs/products/databriefs/db306.htm). Black women are also more likely than white or Hispanic women to die from pregnancy complications—almost 67 percent of which are preventable.
Having a trained and trusted professional who can help parents-to-be make healthy decisions and choose proper prenatal care can make a difference in maternal health and birth outcomes.
DeVane-Johnson, McMillian-Bohler and Standard worked together to write and fine-tune a plan to train and provide Black doulas to help Black families, with hopes of mitigating the high Black maternal and infant mortality rate. In 2020, the doula project was funded by a $75,000 award from UNC, the Harvey C. Felix Award to Advance Institutional Priorities and the group trained its first 20 doulas. In 2021, they received a $545,000 Duke Endowment grant, which will fund the program for three years beginning in May 2022.
Nurse-midwives Jacquelyn McMillian-Bohler, Venus Standard and Stephanie DeVane-Johnson.
The main program goals are to: decrease Black maternal mortality and morbidity; improve patient experiences; provide doulas for free to families; and help those interested in becoming doulas build critical skills and later use those skills to earn wages. The program’s goals align with the 2021 Black Maternal Health Momnibus Act, which “directs multi-agency efforts to improve maternal health, particularly among racial and ethnic minority groups, veterans, and other vulnerable populations,” states congress.gov (https://www.congress.gov/bill/117th-congress/house-bill/959).
“The training is more than about labor and birth,” said McMillian-Bohler, who teaches the mindfulness curriculum. “We also introduce the doula to general stress-reduction techniques such as mindfulness and acupressure. Although evidence suggests these techniques are helpful, they are often not accessible to the Black community.”
DeVane-Johnson works remotely as the community engagement liaison for the program, which is housed at UNC Family Medicine in Chapel Hill, but the doulas will be serving families in Durham, Wake and Orange counties in North Carolina. Devane-Johnson hopes to receive funding to expand this program to Black pregnant persons in Nashville, TN.
“The strength of the program is the expertise of the entire team and the integration of the expertise,” said Standard, who connects families with doulas from the program and is currently teaching the third cohort of Black doulas. “Although each university could independently support the doula program with its hospital system and academic affiliation, a collaboration between the three universities positively impacts the project as a whole.”
Doula training applicants attend information sessions and are screened to make sure they will be successful in the program and that they will enjoy the work.
According to McMillian-Bohler, the program’s doula/family partnerships offer racial concordance, which can increase trust and understanding.
“I think the fact that we are able to come in and talk about some of these health resources and, I hope, remove some of the stigma, opens up a whole area of health care and wellness to people who desperately need it, who maybe didn’t feel like it was for them,” McMillian-Bohler said.
The doulas recognize that birthing parents have the right and need to speak up for their own bodies and health, and help them build the confidence and ability to do so.
To receive help from a doula in the program, a person must be Black, pregnant and planning to deliver at a University of North Carolina-affiliated hospital.
“By having a culturally concordant doula, the patient has a personal advocate, educator and support person to help guide and navigate the system as a Black person, whose needs are often dismissed or ignored,” Standard explained.
“Our hope is that by selecting doulas, who are gatekeepers into various aspects of the Black community, and by giving them tools to share with families, we create a community project that helps birthing families and doulas, said McMillian-Bohler”
The program offers doula training that is expanded to accommodate the specific needs of Black women, covering topics like reproductive justice and the “superwoman schema,” which says that many Black women care for others at their own expense, increasing stress during a pregnancy.
“The goal is to help mitigate Black maternal and infant mortality rates,” DeVane-Johnson said. “Doulas stand in the gap. Sometimes, Black women bring things up to their health care providers and are not taken seriously, or the provider does not talk at a level that the patient and family can understand. The doula is there to bridge that gap and potentially interpret information.”
DeVane-Johnson also serves as the facilitator for breastfeeding lectures. She studies the history of breastfeeding and presents lectures to doula-trainees to help them understand the hurdles faced by those they are trained to help. The doulas use this training to support Black women who want to breastfeed and connect them with lactation consultants, as research indicates that breastfeeding decreases cancer risks in mothers and improves health outcomes for babies.
“Black women have the lowest breastfeeding rate out of any race,” DeVane-Johnson said. “When variables such as socioeconomic status, education and marital status are controlled for, similar positioned white women still tend to breastfeed at higher rates.”
Doulas help solve communication issues and offer consistent labor support for those who don’t have it, something that has been shown to decrease time in labor and the need for pain medications.
“We hope to create opportunities for Black women to find their voices and be empowered to ask questions,” McMillian-Bohler said.
“Doulas are there to empower, uplift and elevate birthing families,” she continued. “If something doesn’t feel right, the doulas help them recognize that they need to speak up and keep speaking until their voice is heard.”
The doulas are trained to recognize preterm, term and postpartum warning signs that may otherwise go untreated, leaving parent and baby at risk.
They train over the course of seven weekends. While on-call with patients, they assist with birthing plans, help pack bags for the hospital and even attend appointments, depending on how much support the birthing parent needs. Once trained, a doula is paired with three Black families who receive assistance for free.
DeVane-Johnson says program applicants need to be Black, have a passion for birth work and have a desire to support women in labor. In the past, applicants may not have been financially able to secure training, but thanks to the grants, training is free.
Applicants are screened to make sure they have reliable transportation, a job that’s flexible enough to allow them to leave to attend a birth and are vaccinated against COVID-19.
According to DeVane-Johnson, the most important qualification is “a passion to help support Black families in the community.”
“Being a doula often is different than what many people imagine,” said McMillian-Bohler. “They may have a romanticized notion of what the job is like. Babies come all the time, anytime, and doulas have to be able and willing to drop whatever other things they may be doing to come to a birth.”
The program benefits go beyond those received by the birthing family.
“Doulas are marketable and can hire out their services after they work with their first three families through the program,” DeVane-Johnson said. “This training will help them bring in money for their families and provide an important service.”
The program supports workforce development, DeVane-Johnson said, as the new doulas have sustainable jobs and develop entrepreneurial skills.
With many interested in training and families lining up for the service, the program is poised to make a difference in communities and in Black maternal health—and the leadership team envisions it as something that can go even further.
“Our goal with this program is to create a doula training model that can be tailored for birthing people with disabilities, those in the LGBTQ+ community, making things culturally relevant to whatever specific marginalized population that is birthing, because it’s these marginalized populations that have the worst birth outcomes,” DeVane-Johnson said.
At this time, the program has one year of data and the group looks forward to evaluating the incoming qualitative and quantitative data, something the new Duke Endowment grant will help them do over the course of the next three years.
DeVane-Johnson, McMillian-Bohler and Standard also hope to see the program expand beyond the borders of North Carolina.
“We want to disseminate this program throughout the country,” Standard said. “We want to reach out to other academic hospital-affiliated institutions and integrate this program into their maternal care systems.”
If the program receives additional funding, Standard said they plan to increase compensation to the doulas and faculty, and hire additional staff to support an expansion to help more families.
In January 2009, the Maricopa Integrated Health System (MIHS) staged the grand opening of the Refugee Women’s Health Clinic in Phoenix, Arizona with Dr. Crista Johnson, MD, FACOG as the founding medical director. It is believed to be the only such clinic in the U.S. specializing in obstetrics and gynecology for refugee women from Africa, Asia and the Middle East.
“What was striking,” said Dr. Johnson, “was the language, the cultural barriers and the stress the women experienced when they would come to the hospital. The clinic will be an oasis to the community because there will be trained staff, knowledgeable regarding care services, resources, and specialized information who understand the patients better, and are able to facilitate a positive patient experience during their hospital contact and even in their homes.”
“These people,” Dr. Johnson continued, “are called navigators and they include nurses, public health workers, lay workers and others who would serve as a resource guiding, interpreting, communicating, facilitating and helping the refugees through the often times complicated and unfamiliar processes in obtaining satisfactory health care services.”
In the case of the refugee, who most know very little about seeing a doctor, or receiving clinical treatment, or home care of any sort and are also totally lacking in exposure to allied health services. But the engagement of navigators to improve certain service outcomes, and ultimately access to services, added a dimension that has made the service provider a key contributor to the improvement of patient satisfaction.
Duke Health in 2011 launched a robust and credible initiative using a class of employees as navigators who would serve as a resource to patients who because of cultural, economic, historical life experiences, or other reasons needed assistance in facilitating their engagement with the healthcare provider.
“The mission of the intervention,” said Dr. Angelo Moore, PhD, Assistant Director and Program Manager for Community Outreach, Engagement, and Equity (COEE) with Duke Cancer Institute, “was to be part of a highly visible community overall strategy to achieve care delivery that was equitable, culturally appropriate, and timely. The desired result would contribute to improved community health, higher performance outcomes and patient satisfaction.” The mechanism that would be employed is referred to as patient navigation. This is a concept and a process first introduced in 1990 by Dr. Harold Freeman a surgeon who saw the need for a resource for his cancer patients in Harlem Hospital, New York and who were predominantly African American women.
Dr. Freeman, who now oversees the operations of the Harold P. Freeman Patient Navigation Institute in New York, describes navigation as an individual intervention to help overcome barriers due to systemic reasons. “Patient navigation is what a person does,” says Dr. Freeman. However, the type of patient navigation that is employed is based on the education, skill set, scope and who is being served. In the market-place, and since the launching of the concept, several different titles have emerged such as Nurse Navigator, Resource Navigator, Community-Facing Navigator, Clinical Navigator, Non-Clinical Navigator, Lay Navigator. There is now an ongoing effort to harmonize these titles around a common set of descriptors common to the role and purpose of navigation.
Foundational to the role and purpose of navigation is the elimination of barriers or impediments.
What types of impediments are these? Examples of some of the frequently encountered barriers that may be eliminated through patient navigation: Financial barriers (including uninsured and under insured); communication barriers (such as lack of understanding, language and/or cultural competency), medical system barriers (fragmented medical system, missed appointments, lost results); psychological barriers (such as fear and distrust); other barriers (such as transportation and need for childcare).
Dr Freeman’s interest and desire to tackle the high percentage of African American women who were referred to him for diagnosis and treatment, was peaked when he saw that they were in the third and fourth stages of the disease of cancer. He took note that these women were also poor economically and lived very marginal lives, the circumstances that would impact their access to care. Dr. Freeman knew from available data that white women had a lower cancer morbidity rate. He decided to conduct an investigative approach to identify, if possible, the root causes of this phenomenon.
One of the core derivatives of his work was the description assigned to the title “patient navigator.” A patient navigator is a healthcare professional who proactively guides patients through the healthcare process. They are responsible for ensuring that the healthcare provider’s system met the needs of the patient as best as possible. To that end, patient navigators spend their time communicating with patients and their families and as an interface between the patient and the provider. They engage patients by describing the relevant options, the true nature of their illness, what to expect during the treatment process, and what their recovery process will be like. They may also need to identify what are the patient’s legal rights.
It’s important that patient navigators once able to convey the specific impediments that stand in the way of effective treatment, go in pursuit of remedies to overcome the obstacles that they may encounter while pursuing treatment. This means that employees in this role need to be highly knowledgeable of healthcare systems and what can be done to ensure the patient is provided the best possible care. Attributes of compassion, positiveness, trust-building and coaching skills are key to success as a navigator.
To do well in this role, it’s critical that the employee be able to answer patients’ questions as they arise. This means that navigators must have a strong understanding of healthcare systems and how they function. They should also be a compassionate, positive individual who is capable of inspiring confidence in the patients served.
Ultimately the impact of the work of patient navigation is embedded in the social determinants of care. This addresses the social, cultural, environmental, and economic conditions in society that impact upon health. In this regard, colleagues compile and disseminate evidence on what works to address these determinants, build capacities and advocate for accelerated action.
“We’ve come a long way,” remarks Dr. Yvonne Commodore Mensah, Ph.D, MHS, RN. Now an assistant professor at the Johns Hopkins School of Nursing—where she started her PhD study in 2010—she is guiding the next generation of emerging scientists.
With a special interest in mentees of color.
That’s because sheer numbers are not the whole story of diversity, equity, and inclusion. In 2018-2019, about 15,000 Black Americans earned PhDs, about 14,000 Hispanic or Latino Americans, and just 720 American Indians — compared to over 100,000 white Americans.
Mentors guide junior researchers through opportunities with world-renowned nursing faculty, cutting-edge facilities, and opportunities for interdisciplinary collaboration throughout Johns Hopkins University and health care system. Among researchers of color and women, mentors are also critical for sponsorship and in building the fortitude to navigate underrepresented and unfamiliar spaces.
Meet Dr. Commodore-Mensah and her mentees: Dr. Ruth-Alma Turkson-Ocran and Dr. Oluwabunmi (Bunmi) Ogungbe
“Yvonne was always asking me ‘when are you going to come to Hopkins and get your PhD?’” laughs Dr. Ruth-Alma Turkson-Ocran, Ph.D., MPH, FNP-BC, RN.
They’re the same age – they are also both from Ghana, went to the same high school, and came (unknowingly) to the U.S. in the same year to become nurses. Dr. Commodore-Mensah traveled a more direct research path however, while Dr. Turkson-Ocran became a nurse practitioner first. She earned her PhD at the Johns Hopkins School of Nursing in 2019 and was a post-doc at Johns Hopkins School of Medicine until summer 2021, when she became an instructor of medicine at the Beth Israel Deaconess Medical Center and Harvard Medical School.
On the other hand… “I found and reached out to Yvonne when I began to explore doctoral programs,” Bunmi Ogungbe, MPH, RN/BSN says. Bunmi is from Nigeria. “She was one of the first people investigating cardiovascular disease among African immigrant populations.”
The COVID-19 curveball
Heart disease and African immigrant health are interests all three women share. In fact, Bunmi began the PhD program at Johns Hopkins in 2019 intending to investigate cardiovascular disease medication adherence in Ghana, working through an existing study by Dr. Commodore-Mensah. But then COVID-19 threw her work a curveball.
Grounded, with travel unsafe, Bunmi conferred with Dr. Commodore-Mensah and additional mentors, including former dean Patricia Davidson and other faculty internationally recognized for their cardiovascular and chronic care research, to take her research in a new direction: examining biomarkers that indicate an injury to the heart, to determine the long-term cardiovascular effects of COVID-19 among Baltimore City residents.
“Dean Davidson advised me that part of the journey is knowing when to pivot and take advantage of emerging opportunities,” Bunmi says. “Yvonne helped me work through such a big change. She has connected me with so many mentors and sponsors, and brought me into the spaces that matter.”
“It’s really interesting when the mentee takes a slightly different path. There is mutual learning that enhances our skills and knowledge,” says Dr. Commodore-Mensah. “After working with Bunmi I was asked to give a presentation on cardiovascular disease and COVID. And Ruth-Alma is my tech person.”
As faculty at the Beth Israel Deaconess Medical Center and Harvard Medical School, Dr. Turkson-Ocran gets to explore her interest in technology with projects investigating blood pressure at home, ambulatory blood pressure (meaning tracking blood pressure over a 24-hour period), and exploring how to use machine learning to examine blood pressure. Incredibly, information on blood pressure from wearable devices could be actionable in as little as five years.
With the interview process for her faculty position fresh in mind, Dr. Turkson-Ocran reflects on Dr. Commodore-Mensah’s generosity.
“It’s empowering to work on a multicultural team, yet, as underrepresented women in health and academia, there is something to be said for having someone who looks like me there to help raise me up.”
– Ruth-Alma Turkson-Ocran, PhD, MSN, MPH, RN
“Yvonne has constantly sponsored me, encouraged me to take on responsibilities I didn’t realize I was ready for.” She continues, “It’s empowering to work on a multicultural team, yet, as underrepresented women in health and academia, there is something to be said for having someone who looks like me there to help raise me up. It tamps down imposter syndrome and reinforces that this path is truly meant for me.”
“There is this façade of scarcity in academia,” Bunmi says. “People feel the need to hoard resources, opportunities, networks. Yvonne doesn’t do that.”
“You don’t lose anything by being kind.’ Former Dean Davidson used to say that, and I’ve been so fortunate with all my mentors that I can’t help but pass it on,” says Dr. Commodore Mensah.
Read more about graduate and post graduate degrees at the Johns Hopkins School of Nursing: