Kathryn Laughon and Jill Howie-Esquivel will discuss their current research at the School of Nursing's next Faculty Research Showcase this April. Look for an email invitation in early spring or RSVP here to register.

Happy Accidents

By Jill Howie-Esquivel, RN, PhD, ACNP-BC, FAAN
associate professor, American Heart Association, Hillman Foundation, UVA Center for Telehealth, and Virginia Department of Health grantee, and coordinator of the adult gerontology acute care nurse practitioner program

Pretty much every male in my family has died of heart disease. It’s still the number one reason people die. And heart failure—which costs $31 billion each year—is the most common reason Americans age 65 and older are hospitalized. Studies show that exercise is important for patients with heart failure, but alternative types of exercise, like gentle stretching or yoga, may also show important benefits because of the positive impacts they have on physical and psychological function.

But how do we help people to exercise during the pandemic when gyms are closed and social distancing is the rule?

It’s been a surprise—an accident, even—to see how much people value these classes and find others who have similar challenges with their health. Participants often log on early to class to chat together, and stay after, too.

Jill Howie-Esquivel, whose GENTLE: Heart Failure study has received rave reviews from participants

We’ve enrolled 52 people in our "Getting into Light Exercise" (GENTLE:HF) study: half receives written education only on their iPads while the other half has access to live, virtual, gentle stretching exercise classes up to four days a week at home. They’re asked to log in at least twice each week, picking from two of the five classes offered. I ask them questions after they’ve participated for six months, like: what’s beneficial? What recommendations do they have? And have the stretching classes made getting through 2020 better or worse?

I’ve been struck by what people said. One woman told me she can take a deep breath and feel less anxious, having learned in class to pace her breathing. A man told me he felt surprised by how much it meant to him to realize that other men also struggled with this serious illness and wanted to enjoy life, too. At the beginning of the study, he couldn’t stand on one leg. Now he can for a minute and a half. He went fly fishing for the first time in years because he felt better about his balance. He was overjoyed about that.

READ Through Nursing Research, Heart Patients Zoom Toward Better Health

It was certainly my hope that participants would find support from one another, but it wasn’t really built into the study, which was designed more as a way to get physical activity in and improve physical function and relieve heart failure symptoms and improve anxiety. It’s been a surprise—an accident, even—to see how much people value these classes and find others who have similar challenges with their health. Participants often log on early to class to chat together, and stay after, too.

Participants also get their blood drawn at the beginning and end of our study to see whether there’s been improvement in cardiac function. I’m interested to see if they not only feel better, stronger, and better balanced, but whether their biomarkers indicate physiologic improvements, too.

The project’s relevance during COVID has me thinking about other populations these classes might benefit, too. My colleague Maureen Metzger, for instance, is doing a study with people who have end-stage kidney disease who are on dialysis. We’re writing a new grant to see if we can move this intervention into that population because that group is even more socially isolated than most, given how much time they spend managing their condition and going to dialysis. Another possible group to target might be people with heart rhythm problems like atrial fibrillation.

We have lots of opportunities to reach out to others who need physical activity to get better strength, now that people are so used to using Zoom, it doesn’t seem like such a weird thing anymore. It’s totally normalized.

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A Perfect Storm

Kathryn Laughon, PhD, RN, FAAN
Associate professor and National Institutes of Justice-funded nurse scientist

Gender-based violence has always resulted in disease and disability for women around the world, but during a pandemic, the risks are magnified. Even as vaccines deploy, cases plateau, and COVID death rates decline, Phumzile Mlambo-Ngcuka, executive director of UN Women, calls the moment “a perfect storm for controlling, violent behavior behind closed doors.” 

It’s exactly that.

As a working forensic nurse examiner, I see these trends play out in the emergency department where I work. There may be fewer abused women to tend, but the cases we do see are especially severe.

Kathryn Laughon, nurse scientist and forensic nurse examiner

In places that continue to have strict shelter-in-place rules, some women are locked with their abusers, unable to work, go to school, tap child care, or lean on friends. Low-income women in particular  have lost jobs and income—especially Black women—and remain un- and under-employed and without the typical buttressing of their extended social networks. With home-schooling a continued reality for many, wrangling child care and work schedules have fallen largely on women’s shoulders, facts that up both the incidence of intimate partner violence [1] along with less frequent but more serious cases of child abuse.

As a working forensic nurse examiner, I see these trends play out in the emergency department where I work. There may be fewer abused women to tend, but the cases we do see are especially severe.

READ When Staying Home is Dangerous

Nurses have always played an important role in addressing and remediating violence, a role that’s grown even more critical during the pandemic. We must vigilantly screen for abuse at every routine visit, including those conducted via telehealth. We must talk up resources—like the myPlan app, or the National Domestic Violence Hotline—to help all our patients recognize abuse and consider safety planning measures, whether we think they’re abused or not. We must consistently ask about family stress, coping, and be on the lookout for mental health crises that may be bubbling just below the surface. And we must talk up community resources and serve as a conduit for material needs, like rental and food assistance, when it’s needed.

COVID-19 has exacerbated inequity, and stretched our systems thin. But if nurses work at capacity—using all our training and expertise and compassion—we can zero in on the families and individuals who need us most, especially those most victimized by historic racism and inequality. Redoubling our response to intimate partner violence and child abuse can and will literally save lives as we weather this tempest together.

[1] Miller, A. R., Segal, C., & Spencer, M. K. (2020). Effects of the COVID-19 Pandemic on Domestic Violence in Los Angeles (No. w28068). National Bureau of Economic Research.