The University of Louisville staff member and alumna is planning to climb Mount Kilimanjaro in Tanzania to raise awareness and support patients with Huntington’s Disease and their families.

“I decided if I was going to make this climb, I wanted to make it count. I want to make a difference for this underserved, underrepresented and often misunderstood population,” Dixon said.

The highest mountain in Africa, Mount Kilimanjaro is a snow-capped dormant volcano that rises 19,341 feet above sea level. After climbing nearby 14,968-foot Mount Meru in February 2022, Dixon set a goal of climbing Mount Kilimanjaro with the added motivation of increasing awareness of Huntington’s Disease and raising funds for the research, education and advocacy of the Kentucky Chapter of the Huntington’s Disease Society of America (HDSA).

Dixon has treated patients with Huntington’s Disease (HD) for more than seven years as a nurse practitioner in the UofL Department of Neurology, co-director of UofL’s HDSA Center of Excellence and director of the Huntington’s Disease Multidisciplinary Clinic at UofL Physicians.

Huntington’s Disease is a progressive, incurable and fatal disease that causes the progressive breakdown of nerve cells in the brain. According to HDSA, approximately 41,000 Americans have symptomatic HD. Symptoms usually first appear in patients between the ages of 30 and 50 and can include involuntary movements, cognition difficulties and psychiatric problems such as depression and irritability. The disorder is caused by a single specific gene.

“After caring for more than 100 people with Huntington’s Disease over the years, it is not lost on me how fortunate I am to have the opportunity and the physical and cognitive abilities needed to make this climb,” Dixon said. “I will be carrying my people with me every step of the way.”

UofL has the only HDSA Center of Excellence in Kentucky. The twice-monthly clinic offers multidisciplinary care for patients and families with HD, providing services in nutrition, mental health, social services. Patients also have access to physical therapy, occupational therapy, speech-language therapy and genetic counseling.

Dixon will start her seven-day ascent of Mount Kilimanjaro on March 1. To support her climb with a donation to HDSA, visit .

UofL News: Please describe some of the health disparities that directly impact the older adult population.��

Harrington: Ageism is a collective result of stereotypes, prejudice and discrimination based solely on age. This is a relevant barrier to health care equity and patient safety. Our mindset of ageism must change. Human life means growing older across the life span without self-exclusion. The burden of preventable disease, mistreatment and inequity in access to and the provision of quality health care impedes opportunities to achieve optimal health. Optimal aging begins in early life and continues across the lifespan.

UofL News: What are some ways to overcome these challenges?��

Harrington: We must take a collaborative all-hands-on-deck approach. There is a strong body of research showing patient outcomes are best when inter-professional teams work together. Our patients are begging for access to high-quality health care.

UofL News: Louisville is home to multiple aging care businesses and city leaders hope we can be innovators for improving quality of life for the growing population of older adults throughout the United States. How do you see your work (both in research and teaching) contributing to this effort?��

Harrington: Ensuring that all our primary care nurse practitioner graduates acquire the knowledge and skill to care for our older adults in the community and long-term care settings is my highest priority as a nursing educator. Disseminating content for student and practicing nurse practitioners on the most complex medical conditions will hopefully help them improve their patients’ outcomes.

I and my medical and computer science and engineering colleagues also are working to change the most confounding social problems affecting older adults with Alzheimer’s disease and their caregivers using artificial intelligence and innovative product design. This exciting research has substantial social and policy implications.

UofL News: As someone with decades of geriatric nursing experience, explain how your research has helped improve the health and well-being of family caregivers of those with��Alzheimer’s disease/Alzheimer’s disease-related dementias (ADRD).��

Harrington: From the 30,000-foot perspective, the gaps are vast in every area of aging. Fifteen million family caregivers of those with ADRD and 12 million ADRD care recipients are potentially impacted by research and innovative practice models adopted by health care professionals. It is difficult to separate research in aging into disease-based categories because they are all interconnected. My defined program of nursing scholarship and creative activity focuses on older adults’ and their caregivers’ health disparities and power inequity in the context of heart failure, Alzheimer’s disease and Alzheimer’s disease related dementias, and ageism.

UofL News: What are some of your significant areas of geriatric research?����Describe for us some of the outcomes.

Harrington: Yes, in the context of the fellowship with the academy, there are several:

• 5 million individuals who reside in long-term care have heart failure. My innovative heart failure evidence-based guideline remains the only nurse-driven practice guideline of its kind since 2006, and has received national and international recognition through citations and inclusion of content. I created the ACE (Assess, Collaborate, Engage) Delirium Superimposed on Dementia practice model to improve how we approach delirium superimposed on dementia that impacts 20 million hospitalized older adults with ADRD yearly. That research recently published in .
• I believe education for quality health care for older adults requires a multi-prong approach that reaches health science students, health science professionals and families in the community. The possibilities for nursing innovation are infinite with inter-professional collaboration and begin with identifying the problems in care provision or care delivery. Redesigning the Medicare Annual Visit process for a 45 office Federally Qualified Health Centers (FQHC), prompted leading an inter-professional team in the development and production of an innovative desktop application for comprehensive geriatric assessment with custom reporting capabilities for FQHCs.
• The outcome of the first population-based study of 1,500 older adults in eastern North Carolina identified family caregivers’ need and desire for the knowledge and skill to be optimal caregivers for those with Alzheimer’s disease. We also realized how unrealistic it is to expect farmers to lose critical daylight hours to seek preventive health care, so we connected them to AgriSafe nursing services who visited them on their farms. The population-based community research led to delivering person-in-context dementia simulation to caregivers as an educational method to improve their understanding of dementia and their family members’ daily challenges and multiple educational workshops in collaboration with area agencies on aging.
• Between 2015 and 2017, I conducted two research studies that successfully eliminated academic silos in inter-professional geriatric education. The outcomes were an innovative and sustained Two-As-One Preceptor Model and the Troika InterProfessional (TIP) Gerontology ����ֱ�� Model impacting over 300 third-year medical, primary care nurse practitioner and physician assistant students. The TIP outcome model was designed for a student team of three primary care professionals who learn and apply gerontology knowledge in a virtual clinic environment. All faculty reported students maintained proficiency in the content over time. These skills impact approximately 8 million older adults these individuals will serve when extrapolated over a 20-year career.

UofL News: What is the future of geriatric health care?��

Harrington: We currently have approximately 680,000 adults over the age of 65 in Kentucky. The majority of the state’s counties, 81 of 120, are medically underserved. This void is compounded by many primary care physicians who are approaching retirement. Nurse practitioners are critical to the care quality of our older adult population and will remain critical for at least the next 30 years. Enacting legislation to remove the practice barriers and allowing nurse practitioner to practice collaboratively at the full scope of our educations, experience and training is growing more so each year. This is imperative to our ability to impact the wide-range of health disparities our older adults experience.

Porter is a student in the University of Louisville’s first (DNP) class, which will graduate in August 2019. On Aug. 16, DNP students participated in a white coat ceremony marking their advancement from didactic courses to patient-focused clinical care and the beginning of their yearlong graduate projects.

After graduation, the 36 students in the program will become nurse practitioners, an advanced practice credential and training for registered nurses who have gained expert knowledge, complex decision-making skills and clinical competencies for expanded practice.

The doctoral program, designed for students with a bachelor’s or a master’s degree in nursing, focuses on creation and implementation of evidence-based care, management of care, leadership in health care organizations and development of health policy.

Porter’s degree concentration is psychiatric-mental health nursing. She works at the Kentucky Correctional Psychiatric Center in La Grange, part of the Luther Luckett Correctional Complex, where she provides nursing care to those facing felony charges.

Her DNP project is a group-based self-esteem enhancement program for girls in an inpatient treatment facility, a group at high risk for engaging in unsafe sex, substance use and delinquency.

“I thought this would be a good population to focus on because they do not get a lot of attention,” Porter said. “Some have been suspended from school, in the juvenile court system or have gone through foster care. If we can intervene now, then hopefully we can give them skills to maintain self-esteem throughout their lives. Increased self-esteem has been found to decrease involvement in high-risk behaviors.”��

Eventually, she would like to work with children who have chronic or terminal health conditions that affect the mental health of them and their families.

“There’s a need for more mental health practitioners,” Porter said. “The UofL DNP program was a great fit for me because a lot of other programs don’t offer the psychiatric-mental health nurse practitioner specialty for those with only a bachelor’s degree in nursing. This is the best way for me to increase access to care and help others.”

Other advanced practice nursing specialties at UofL include adult-gerontology primary care, adult-gerontology acute care, family medicine and neonatal care.

����ֱ�� at the doctoral instead of master’s level for nurses pursuing advanced practice is increasingly becoming the norm.

The American Association of Colleges of Nursing has pushed for this change, pointing to several reasons, including the rapid expansion of knowledge underlying practice, increased complexity of patient care and national concerns about quality of care and patient safety. Also, there are shortages of nursing leaders who can assess, design and evaluate care and quality indicators.

UofL phased out its master’s degree nurse practitioner program and transitioned to the doctor of nursing practice in 2016.

“DNP students will graduate to become advanced practice nursing leaders who will help shape health care and health systems,” said Sara Robertson, director of the DNP program and assistant professor at the . “They are prepared to transform health care by applying the latest in evidence-based research into practice. This will improve population health and health care delivery.”

Heather Raley, a DNP student in the family nurse practitioner concentration, pursued the degree to challenge herself in advancing the nursing profession and provide evidenced-based health care to independently diagnose, treat and manage care for patients with acute and chronic illnesses.

Raley’s graduate project will focus on impacting clinical nursing research on excessive gestational weight gain in pregnant women. She will implement an expedited and individualized education counseling intervention to promote appropriate maternal gestational weight gain through the use of patient risk assessments.

“I hope to increase the discussion of patient-specific needs and addressing potential risk factors for inappropriate weight gain during pregnancy to improve immediate and long-term health outcomes for mother and infant,” said Raley, a critical care float nurse at Norton Children’s Hospital.

A native of Henderson, Kentucky, Raley wants to eventually return to a rural town in the western part of the state to practice in primary care with patients across the lifespan.

“My professional interests have taken shape primarily in caring for and empowering children and families,” Raley said. “I believe health care professionals are in a unique position to influence entire family units by promoting the development of lifelong healthy habits.”

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Hardin will start on Aug. 13, serving as acting dean until the UofL Board of Trustees approves her appointment.

“I am excited to join UofL,” Hardin said. “The School of Nursing has an exemplary leadership team, nationally-renowned faculty and an outstanding cadre of staff, students, distinguished alumni and supporters who are well positioned to impact the health of individuals, families and communities.”

Hardin will replace Marcia J. Hern, who in 2017 announced her plan to retire from the school after an 11-year tenure as dean.

“Dr. Hardin will expand upon the advancement that has occurred in the past decade at the School of Nursing, which has seen growth in programs, learning space and student enrollment,” said Greg Postel, MD, executive vice president for health affairs at UofL.

“Many thanks to Dr. Hern for agreeing to remain as dean during the search process. Under her leadership, the school added two graduate programs, established the only traditional nursing baccalaureate program in Owensboro and underwent significant classroom and clinical simulation lab expansion. Student standards have risen and pass rates on the National Council Licensure Examination for registered nurses exceed the national average.”

Hardin is a nurse practitioner specializing in care for older adults, and her research has focused on symptom management and issues surrounding inpatient critical care of the geriatric population.

While at East Carolina University, she led a three-year, $2.5 million grant from the U.S. Department of Health and Human Services titled the Geriatrics Workforce Enhancement Program, which created a comprehensive approach to caring for older adults in the eastern region of North Carolina. Working with community partners, the initiative established an interprofessional education model, trained primary care providers to meet the needs of older adults and created community-based programs for rural older adults and their families.

Hardin has co-authored more than 50 peer-reviewed articles and three books with topics focusing on geriatric care, critical care for older adults and chronic disease. In 2017, she became a fellow in the American Academy of Nursing, one of the highest honors in the profession.

Incorporating entrepreneurship and technology into practice, Hardin worked with an engineer team at East Carolina University to create a device that quantitatively measures edema in the lower extremity. The group has received a provisional patent on the device.

“Dr. Hardin is an innovative leader with a proven record of providing strategic direction at academic medical centers and nursing schools,” said Toni Ganzel, MD, MBA, dean of the UofL School of Medicine, who led the School of Nursing dean search committee. “She brings a unique skill set to bolster the research mission and visibility of the School of Nursing, build robust partnerships and advance the school in educating the next generation of nurses.”

Hardin joined the nursing college at East Carolina University in 2013, where she started the psychiatric-mental health nurse practitioner program and oversaw accreditation of the doctor of nursing practice, certified registered nurse anesthetist and midwifery programs. She previously had faculty positions at the University of North Carolina at Charlotte and Lenoir Rhyne College. Hardin started her career in 1982, working as a critical care staff nurse in several North Carolina hospitals and earned her adult nurse practitioner license in 2009.

Hardin has a PhD in nursing from the University of Colorado and master’s degrees in business and health administration from Pfeiffer University in North Carolina. She earned master’s and bachelor’s degrees in nursing from the University of North Carolina at Charlotte. She also completed post-doctoral fellowships at Stanford University and the University of North Carolina at Chapel Hill.