Seeing the Whole

It was Aristotle, in the 3rd century BCE, who coined the phrase “The whole is greater than the sum of its parts.” There is surely much about the 21st century that the Greek philosopher couldn’t begin to comprehend. But he would likely not only understand but appreciate the emphasis on holistic wellness that permeates the Columbia University School of Nursing.

The school’s commitment to community wellness is a key element of its mission of advancing nursing to advance health for all. And that commitment (the “whole” part of Aristotle’s quote) is evident in numerous ways throughout the institution (that’s the “sum” part).

Wellness, or well-being, encompasses all aspects of a person’s life, relationships, and environment, in addition to mental and physical health. The World Health Organization defined health in its 1946 charter as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Wellness is now considered in eight dimensions: intellectual, emotional, physical, social, occupational, spiritual, financial, and environmental.

Nursing shares this holistic perspective, aiming to help individuals and communities thrive by seeing the whole patient and addressing social determinants of health as well as clinical needs.

FINDING MEANING IN LIFE

“Well-being is a commitment and a lifestyle that permeates this whole school and building,” says Dean Lorraine Frazier, PhD. Two ingredients essential for wellness are, as it happens, integral to both the profession of nursing and Columbia Nursing as an institution: having meaning and purpose in one’s life and being connected with others.

“You see yourself as part of something bigger,” Frazier explains. “You’re part of a community. You’re part of life. You’re connected to people, to your family. Every day, nursing focuses on patients and our community. Growing and helping and connecting to our patients gives us meaning.”

At Columbia Nursing, Frazier adds, you don’t have to be a nurse to find meaning in your work. “When you’re in this building, and you’re staff, you know that we’re educating students who go out to make a difference in people’s lives. That meaning is a part of our job,” she says.

“I think our community is healthy because we have that meaning. We have that meaning no matter what our role in the school is.”

Living with purpose and being part of something bigger also makes people more resilient, according to the dean, so they’re ready for the next challenge. “It’s saying, ‘You know what, whatever comes, we’ll get through this together,’” she says. “Supporting each other wherever we are, but together as a whole. Coming together as a whole, a united whole, we’ll get through this.”

BUILDING HEALTHY COMMUNITIES

Beyond its walls, Columbia Nursing belongs to multiple, overlapping communities: Washington Heights, Harlem, the Bronx, New York City, New York State, the nation, and even the whole world, through the school’s Office of Global Initiatives.

Assistant Professor Ellen Fahey, DNP ’11, who is the assistant director of the family nurse practitioner (FNP) program, started thinking about ways to connect with local constituencies after attending a webinar that emphasized the importance of medical and nursing schools embedding themselves in their communities to help meet health care needs and address social determinants of health.

Both Fahey and Associate Professor Sabrina Opiola McCauley, DNP ’10, the program director of the pediatric nurse practitioner (PNP) program, participate in the Diversity, Equity, and Inclusion Community Service and Programs committee, which aims to develop community service projects that align with the school’s mission of combating racism, eliminating health disparities, and promoting health equity for underserved communities.

Through her work on the committee, Fahey learned about Fresh Youth Initiatives (FYI), a nonprofit that works with schools across New York City. Among the group’s efforts is an afterschool program at PS 128 that was happy to collaborate with Columbia.

At the same time, Fahey says, “the faculty were looking to provide NP students with an opportunity to work with pediatric patients, because during COVID we didn’t have a lot of access to our community resources for clinical placements.” The venture that grew out of that confluence of interests is called the Brain Health Program.

“What we decided to do was provide clinical hours for the NP students who chose to participate and ask that they look at the students from a clinical lens—from a developmental, social, emotional perspective—which would then allow this opportunity to be considered clinical hours, because there’s faculty supervision. That’s really how it originated. Now it’s taken on a life of its own to a certain degree.”

The number of NP students participating in the Brain Health Program has grown steadily since it was launched in 2022. Second- and fourth-graders participating in FYI’s afterschool program learn about topics that are reinforced in wellness checkups, but framed around brain health. The first four sessions are each devoted to a specific topic—sleep, nutrition, screen time, and exercise—followed by a field trip to Columbia Nursing for the fifth and final session.

FNP and PNP students develop and deliver curricula based on these topics, are briefed before the sessions start and debriefed after they conclude, and are supervised in the clinical setting. The program is offered twice a year.

“We’ve gotten some great feedback through the FYI staff from the parents of the students, which I think we both were a little shocked about,” McCauley says. “The children come home and share the information with the family, and they’re really excited about it and very grateful. I think it’s making a bigger impact than we thought, because it is really going back to the families and deeper into the community and hopefully really making a difference.”

Nowadays, when she passes a Brain Health Program graduate on the street, McCauley adds, “we say hello. . . . It really has made a stronger connection from our school of nursing with the community.”

Adds Fahey: “The other outcome that we didn’t anticipate, which was really awesome, is that when we have the students come to the school of nursing, each and every session there’ll be a student who says, ‘I want to come to this school’ or ‘I’m going to be a nurse.’”

FACING FINANCIAL TOXICITY

Cancer patients and survivors not only face uncertain health risks; they are also at risk of financial toxicity, with resulting negative impacts on their well-being that can persist for years. Adolescent and young adult (AYA) cancer survivors—defined as those aged 15 to 39—are at especially high risk and are more likely to file for bankruptcy and/or to be unemployed than older cancer survivors.

Assistant Professor Melissa Beauchemin, PhD ’19, studies financial toxicity with a focus on AYA patients; she has worked as a pediatric oncology NP for over 15 years, currently at NewYork-Presbyterian.

“We care for families that come from Connecticut and Westchester and New Jersey as well as families from our local community, so you see a lot of different experiences,” she says. But no matter their life situation and experiences, she adds, a child or adolescent’s cancer diagnosis has a major impact on a family.

Even when patients and families are eligible for government resources for financial assistance, Beauchemin notes, they often still face burdensome costs. “They have trouble affording transportation, they have trouble affording rent, and they have trouble affording anything else outside of the health care costs. And sometimes they may sacrifice some health care needs because of the difficulty affording them, but they don’t qualify for additional services or there are no other resources that are available to support these families.”

Beauchemin has received two pilot grants to study needs navigation for 15- to 39-year-old patients and for the caregivers of younger patients who are experiencing financial toxicity. “What I think is most exciting is that we’re partnering with community organizations,” she says. “We’re trying to be thoughtful about existing resources and processes that have been developed to support the community, that folks have relied on for a long time. We are leveraging those.”

The problem, she notes, is that people may not connect with these organizations on their own. “If we can support them in that connection, almost navigate them to the navigation, then maybe we can alleviate some of that burden.”

Beauchemin’s primary partner in her research is the Patient Advocate Foundation, a national organization that helps people with chronic or life-limiting illness and provides case management services in English and Spanish.

“Most of these young people with cancer are going to become long-term survivors, and so the hypothesis is that if we can intervene and identify financial burdens and financial toxicity earlier, can we prevent its longterm negative outcomes?” says Beauchemin.

But truly addressing financial toxicity, especially when it is compounded by structural inequities, will require systemic change, she adds, noting that her research is forming an evidence base to support these policy changes.

“If you’re diagnosed with a cancer that has an 85% to 90% cure rate, we want to give every individual who comes in that same 85% to 90% cure rate,” Beauchemin says, “instead of the current disparities we see, which are striking and unacceptable.”

EXPANDING OUTREACH

ColumbiaDoctors Outreach, a collaboration between the ColumbiaDoctors Nurse Practitioner Group and Columbia Primary Care, was launched in 2022 to expand access to primary care for staff and faculty at Columbia University Irving Medical Center (CUIMC), as well as people living in the surrounding community.

Maura Abbott, PhD, an associate professor and assistant dean of clinical affairs at Columbia Nursing, partnered with Amy McElroy, director of population health at CUIMC; Diana Hernandez, practice manager at NPG; and Kristin O’Meara, director of strategic communications for ColumbiaDoctors, to create the program, which grew out of early efforts to offer breast cancer screening to people working at CUIMC.

Abbott also co-leads the NPG, the original primary care group at the medical center. “We wanted to expand our reach to our community, not just our CUIMC community, but neighboring communities in terms of getting access to care and access to health education and access to understanding preventive health and health maintenance,” she explains. “The idea was to bring the care to them and not for them to have to come to us seeking it.”

Another goal of the program is to help people navigate the CUIMC system when they need specialty care, Abbott adds, “so they don’t drop through the cracks on the way to getting what they need.”

ColumbiaDoctors Outreach began by offering breast cancer screening and prostate cancer screening, and soon began presenting Columbia Health Benefit expos and working with CUIMC specialty services, including ophthalmology, neurology, pediatrics, cardiology, and dermatology, to offer health screenings. A skin cancer screening at Haven Plaza reached 350 people, including 100 who came for free skin cancer screening checks after the event.

Outreach efforts in 2023 included tabling at the Haven Plaza Farmer’s Market from June through October, holding a prostate cancer screening event at Yankee Stadium, partnering with All Hallows High School in the Bronx, and more. Pediatric NP students spoke to parents and students at All Hallows about the HPV vaccine for preventing head and neck and anal and rectal cancers. A breast cancer screening initiative for the school community identified three high-risk women who were referred for mammograms and breast medical oncology, Abbott notes.

“We all kind of own a piece of this and go out and say, ‘Hey, I’m a nurse practitioner and I want you to be healthy, and I’m not here to give you scary information,” she says. “To be able to be a trusted source of information so that people feel empowered to make their own health care decisions, I think is probably the most important piece of the work that we’re doing.”

In the last fiscal year, Abbott notes, the Nurse Practitioner Group saw a more than 308% increase in new visits. “We attribute that in large part to these community events where we’re going out and we’re making ourselves known and that we’re available to these folks. We let them know that we want to work with them and that we’re here to provide them with the best possible care.”

Illustrations by Julia Rose; Photographs by Jörg Meyer

This article originally appeared in the Spring 2024 issue of Columbia Nursing Magazine.