In the Harold Prince Theater at the Annenberg Center for Performing Arts, Kate Hanselman walks to a microphone positioned in the middle of a performance space. In front of her and to each side are rows of people waiting for this newbie performer, a graduate student in Penn’s School of Nursing, to speak.
“There’s a breath that I want you to listen for, in your conversation with friends, family, patients,” Hanselman begins. “It’s the breath of a moment, it’s a before and after, and it sounds like this.” She demonstrates a deep, chest-heaving aaahhh.
“When you hear it, I want you to wait,” she continues. “And I mean, wait wait. Because that is the sound of a person deciding if you are the person, if now is the time, and if this is the moment that they get to feel a little bit less alone.”
Hanselman goes on to describe Cal, a friend of a friend “built like a fridge” who works in a kitchen. He takes her being a nurse as a cue to share that he’s having a hard time at work, at home. “That’s when I hear it,” she says. The breath. “So, I wait. I wait wait and he tells me, slowly, that sometimes his chest gets tight and his heart starts to beat too fast and he feels hot and shaky and he starts to sweat and he can’t breathe and he feels like he might die.”
In that moment speaking to Hanselman—someone just a few steps removed from stranger—Cal feels less alone.
When she finishes, Hanselman walks back to her seat, number five in a row of 10 people there to share their Nursing stories, like the nurse practitioner (NP) subpoenaed twice or the nurse whose husband suffered a stroke at age 43. Most have not performed in this manner before, yet all captivate the room at the second annual Nursing Story Slam.
The pre-pandemic event, the brainchild of Director of Innovation Marion Leary, speaks to a shift the School of Nursing made several years ago to create an environment that rewards taking chances and supports failures as lessons learned. Beyond Leary’s appointment itself, this includes innovation accelerators, a flipped class focused on design thinking, faculty fellowships with the Penn Medicine Center for Health Care Innovation, enhanced simulation labs, mentorship for students, a podcast, and so much more.
And in 2020, both the World Health Organization’s Year of the Nurse and the Midwife and a year encapsulated by an unprecedented pandemic, taking new approaches to education, health, and health care couldn’t be more apt—or crucial, says Antonia Villarruel, the Professor and Margaret Bond Simon Dean of Nursing.
“Every product and process that touches a patient goes through the nurse. We are the masters of the workaround. We are innovators. You have a problem, we’ll figure out how to fix it,” Villarruel says. “We wanted to create an atmosphere where people weren’t afraid to take risks. It’s now part of our ecosystem.”
Fostering an innovation ethos
Such a mindset wasn’t always pervasive at the School of Nursing. “About five years ago, we made a commitment to consciously think about nursing and innovation and what innovation meant for Penn Nursing,” says Therese Richmond, associate dean for research and innovation.
At the highest level, that entailed securing support from the board of overseers, then talking to people across campus in an effort to outline how such an approach might differ from what was already in place. “One thing I quickly learned was that how people define innovation depends on who you’re talking to,” Richmond says. Penn Nursing opted for the broad view.
Richmond and colleagues decided that innovation should encompass new patient-care methods and unlikely partnerships centered around improving health and well-being for vulnerable populations. It should also integrate seamlessly with research. “We really took in the landscape and decided we were going to embrace all of it, not be specifically technology-oriented or focused on commercialization,” she says.
In an open forum, Richmond and Villarruel presented the idea to the faculty, including Marion Leary, who was then splitting her time between the Perelman School of Medicine’s Center for Resuscitation Science and the School of Nursing. After the presentation, Leary approached them, excited about the new focus. Soon, she was dedicating one day a week to innovation at the School of Nursing, and in February 2019, became the first full-time director of innovation there.
“We are consummate innovators,” Leary says. “This seemed like the exact space we should be in.”
Today, the school takes a threefold approach to innovation. One pillar includes educating nurses and nursing students, often in traditional ways like courses and workshops, including a free open-access platform called Design Thinking for Health, supported by the Rita and Alex Hillman Foundation. The second focuses on increasing collaborations in the innovation space across Penn. The third aims to amplify nurses more broadly and beyond Penn, through projects like the story slam and a podcast, innovation accelerators and hackathons.
“Nurses are not just one thing,” Leary says. “We’re in a plethora of places. We want to show our colleagues, other professionals, and the general public the breadth and depth of what we do.” Luckily, Leary’s not lacking for ideas to do that, and many within the School of Nursing are up for the challenge, like researcher Pamela Cacchione.
Room for faculty to tinker
For older patients with heart failure, regular weight checks can help monitor fluid in the legs, which can indicate when something’s wrong. The problem is, many people dislike weighing themselves daily. Cacchione, a clinician educator on the Penn Nursing faculty and a nurse scientist, wanted a better way to identify symptoms earlier.
So, she created a smart sock prototype that detects symptoms of worsening heart failure, then shares a report with a clinician. The first version, built in collaboration with a group of Weitzman School of Design students, was too bulky, with a large box on the outside and an obtrusive leg band. The team kept tinkering, eventually designing a sleeker, more user-friendly model with built-in electronics that transfer data via Bluetooth to an app.
“We can monitor response to treatment, so when we’ve made adjustments, we can tell if it’s actually helping or making things worse,” Cacchione says. “That was my ‘aha’ moment.”
She entered the socks into what was then the first of its kind: a School of Nursing innovation accelerator with a prize of $10,000 and a year of mentoring support. Cacchione took first place, above a student-designed personalized long-term care app and another app, focused on improving palliative care, created by a pair of NPs.
The victory afforded Cacchione the chance to continue prototyping and she plans to test the socks with 10 patients for three months, generating pilot data that she hopes will lead to a larger study of heart failure patients. She sees applications for the socks in other patient populations, too. It’s exactly the kind of progression the accelerator aimed to foster, and the second annual competition is now underway, with entries being accepted through Oct. 31.
But even researchers just wading into innovation have room to test the waters: In 2017, the dean started an Innovation Fellowship that supports faculty spending up to 20% of an academic year embedded with the Penn Medicine Center for Health Care Innovation. Cacchione did this, as did Penn Nursing researchers Margo Brooks Carthon and Jennifer Pinto-Martin.
And as it became clear that COVID-19 would leave far slower than it arrived, the school moved nimbly into the virtual realm, hosting Twitter chats with nursing innovators and design-thinking experts and participating in an online hackathon with Microsoft, SONSIEL, Johnson & Johnson, and DevUp. Leary, as part of her involvement with a group called Nursing Mutual Aid, also co-organized a Twitter conference where presenters curated six tweets during a 10-minute slot and interacted directly with participants using a specified hashtag. “We had 60 people present over 12 hours,” Leary says. “It was incredible.”
Room for students to grow
The school’s innovation ecosystem doesn’t stop with its faculty. “You can see the energy from our students around innovation,” Villarruel says. Graduate students and undergrads have participated in one-off events, showcasing their creativity and passion each time. Leary experiences these attributes up-close for an entire semester in a class she teaches called Innovation in Health: Foundations in Design Thinking.
“It’s a sequential approach that allows you to fully understand a problem from a human-centered perspective,” Richmond explains. “The design thinking process is rigorous in its own way, and nurses often solve problems with one-off solutions, but we need more than that. We want to train nurses to think about what the real problem is—not what they think the problem is—and how to solve it.”
This is the fifth semester Leary has taught the course, which walks students through the empathize-define-ideate-prototype-test stages of design thinking in a flipped-classroom model. Each time, she’s impressed by what her students create. “One group looked at irritable bowel syndrome and how there’s no real option for young, active people to be protected against accidental bowel movements,” she says. “They designed a prototype of what could eventually be really sleek, comfortable underwear that is absorbent, captures smells, and is waterproof.”
Another group focused on barriers to navigating the health care system for a non-English speaker. Each doctor’s visit, that person may get a different translator, who then has to learn the patient’s history anew and may use slightly different language than the previous translator. “They designed a mobile application where you get matched up with a translator who then stays with you throughout your care,” Leary says. “They built it to integrate with My Penn Medicine, too.”
“These students,” she adds, “they just blow me away with their creativity.”
Like most everything else, the pandemic forced the class online halfway through last semester, but that didn’t stop the juices from flowing. In fact, Leary says the students began building their prototypes using what they had around them at home. It was a glass-half-full approach that she’s carried over to the current semester, which is again running virtually. “When circumstances change,” she says, “if you open your mind, you have the ability to do things you may not otherwise have thought about.”
That, in a nutshell, exemplifies the innovation ecosystem at the School of Nursing. Contemplate new solutions to old problems, don’t be afraid to take risks, and ask for help in the process. “We believe that innovation touches everything: Our education, our practice, our teaching mission,” Villarruel says. “It’s not innovating for innovation’s sake. It’s innovation to improve life and living.”
Antonia Villarruel is the Professor and Margaret Bond Simon Dean of Nursing at the University of Pennsylvania School of Nursing and a senior fellow at Penn’s Leonard Davis Institute of Health Economics.
Therese Richmond is the Andrea B. Laporte Professor of Nursing and the associate dean for research and innovation at the University of Pennsylvania School of Nursing. She is also a professor of nursing in surgery at the Perelman School of Medicine, a senior fellow at Penn’s Leonard Davis Institute of Health Economics, and research director of the Penn Injury Science Center.
Homepage video: In recently enhanced simulation labs like the one here, Penn Nursing students can run through real-life scenarios that they might experience with patients.