Thelma Wells, PhD, RN (in photo on the left) and Carol Brink, MPH, RN were honored on November 23, 2002, as the recipients of the Doris Schwartz Gerontological Nursing Research Award for their joint work on urinary incontinence. Dr. Wells is recently retired from her position as Helen Denne Schulte Professor of Nursing and Nurse Researcher at the University of Wsconsin-Madison School of Nursing. Ms. Brink is Associate Professor of Clinical Nursing and Nurse Researcher at the University of Rochester School of Nursing, Rochester, New York. The award was given by the Clinical Medicine Section of the Gerontological Society of America in collaboration with the John A. Hartford Institute for Geriatric Nursing, part of the New York University Division of Nursing. This national tribute, presented at the annual Gerontological Society of America meeting this year in Boston, is named for Doris Schwartz, a pioneer in gerontological nursing research. It was awarded in recognition of visionary and exemplary contributions advancing the field of geriatric nursing research. After receiving the award, Dr. Wells and Ms. Brink presented a lecture at the nursing special interest group meeting entitled, "Looking Back, Looking Forward." The presentation is featured here.
Thelma: Thank you. We are honored to receive the 2002 Doris Schwartz Gerontological Nursing Research Award.
Carol: We want to thank the Nursing Research Award Committee and the Hartford Institute for Geriatric Nursing.
Thelma: We also want to thank our colleagues at the University of Rochester who put the application together and managed to keep it a secret from me: Nancy Watson, Bethel Powers, Eileen Taille, and Marge Lash.
Carol: We know that many colleagues, near and far, contributed letters. We want them to know rJhat we appreciate that very much.
Thelma: This award has great meaning to us. It is the first to recognize our teamwork and the collaborative essence of our work.
Carol: And it is special to us because we remember Doris Schwartz with great fondness and respect. It is awesome to have an Award which bears her name.
Thelma: Looking back and looking forward - we would like to do that briefly tonight. Looking back 20 years ago, the Gerontological Society of America's (GSA) annual meeting was also held in Boston. Joe Ouslander organized a symposium on urinary incontinence. I believe it was the first ever urinary incontinence themed session at a GSA ing. Carol and I presented a paper, "Nursing Interventions for Urinary Incontinence in the Elderly." It was based on our ROl which had been funded by National Institute on Aging in March of that year.
Carol: I remember that we had been assigned to a rather small room, designed to hold perhaps 50 people. But the attendance was amazing. The room overflowed; people crowded everywhere. The doors were kept open so that people crowded into the corridor outside could hear.
Thelma: We were on to something. But actually there wasn't a whole lot we could say about it then because so little was known.
Carol: Maybe we should tell a little about how we began to work together. I remember first meeting Thelma at the University of Rochester in 1975. She had just returned from England where she had completed her doctorate degree.
Thelma: Yes, I remember not knowing what a nurse practitioner was. I had been away 5 years. Carol, as one of the first nurse practitioners - trained by Dr. Barbara Bates of the famous assessment book (Bates, Bickley, Hoekelman, 1995) - taught clinical nurse specialist me what die nurse practitioner role was all about. I was impressed.
Carol: I was assigned by Dean Loretta Ford to work with Thelma to develop a master's program in gerontological nursing. We were a good team, me with a master's in public healtli and a community background, and Thelma with a new doctorate and an institutional background.
Thelma: I had been interested in urinary incontinence since my master's study at Case Western Reserve. I have told die story often of Sophia, the nursing home patient whose secret was incontinence. And I, who thought everything you needed to know was in the library, was shocked to find nothing there. That was in 1969. It may seem astounding but there really wasn't anything about incontinence in old people in the literature then. Incontinence was considered normal aging and the rule was to treat it kindly.
Carol: Thelma got me involved in urinary incontinence study in the early days at Rochester. We collaborated in a descriptive study at a local nursing home. We moved to the University of Michigan in 1980 and met our urologist colleague, Ananias Diokno. The three of us began a collaborative practice in the first Continence Clinic established in this country.
Thelma: Really Carol ran the halfday-a-week clinic, and Ananias and I were support staff. It was from this joint practice and research design discussion that in 1981 we wrote our first National Institutes of Health (NIH) proposal, Nursing Interventions: Urine Control in Older Women. I was principal investigator and Carol and Ananias were coinvestigators. It was funded in 1982.
Carol: Also in 1981, we published our first joint writing. Irene Burnside's first edition of Nursing and the Aged (1976) had only two thirds of a page on urinary incontinence. We objected to Irene about that, and she invited us to write a chapter for her second edition (Burnside, 1981). We had a horrible time writing together. It was such an awful experience that after we finished the chapter, we decided to try one more joint writing to see if this was a core problem or a learning curve.
Thelma: We discovered it was a learning curve and have continued to write together over the years. I should note that one of Carol's sections in that 1981 chapter was the innovative assessment guide to urinary incontinence. She really was the leader in that.
Carol: In 1987, Irene asked us to revise that original chapter for the third edition of her text. We were amazed to discover how much we had learned. We found that we needed to completely rewrite the chapter.
Thelma: That was published in 1988 (Burnside, 1988) and the difference between the 1981 and 1988 chapters is a real measure of the progress in nursing's understanding of urinary incontinence.
Carol: Our first NIH research grant built on only four to five early nursing papers - efforts to intervene generally in urinary incontinence in old people. Medical research was also very limited.
Thelma: Our early findings were unexpected as we discovered the prevalence of stress urinary incontinence in community living older women. Carol developed a digital scale to measure pelvic muscle strength. That was a major effort to document the effect of pelvic muscle strength training. We linked this to electromyography (EMG) surface measures in adapting vaginal probes used in sexuality research to pelvic strength measurement in urinary incontinence.
Carol: The digital scale-EMG vaginal sensor link was made because Thelma was home with the flu, watching The Phil Donahue Show. Beverly Whipple and John Perry (the two researchers who named the G Spot) were discussing the G Spot and showed an early vaginal EMG sensor. Thelma made the connection and called the show.
Thelma: It was fun. We tackled a complex problem in the only way you could, complexly. We set up research clinics from scratch and ran diagnostic and treatment services. I used to describe the research adventure as a roller coaster ride - ups, downs, curves, fast paced, challenging, exciting!
Carol: Thelma was always eager for problems. She used to say, "If we don't have problems doing this research, we're not paying attention." We paid attention, and we always had a lot of problems to solve.
Thelma: But let's look forward now. I'm looking forward to retiring this May. I've loved my nursing career, but I'm ready to savor my senior years.
Carol: Thelma keeps talking about "graduating" in May. I graduated to retirement in 2001, but I still work with Nancy Watson's team at the University of Rochester 1 day a week. I know Thelma will be working with Chris Kovach's research at the University of WisconsinMilwaukee for a few years.
Thelma: A wonderful thing about looking forward is the certainty that gerontological nursing will thrive. I do recall the early beginnings of this nurse interest group at GSA, San Francisco in the late 70s. Phyllis Michelson from the University of Oregon had the six to eight known nurse attendees to wine and cheese in her bedroom. And now look at this!
Carol: Thelma is looking back again, but I agree. The past gives us confidence and hope for the future. We both look forward to seeing former students continue to develop their work. The next generation of nurse researchers and clinicians in urinary incontinence are a strong and capable group.
Thelma: We've been fortunate over the years to have wonderful friends and colleagues, and we know their good work will continue and grow. This award will be a treasured reminder to both of us.
Carol:A reminder of roller coaster rides of clinical research.
Thelma: A reminder of Doris Schwartz and past recipients.
Carol: A reminder of friends.
Thelma: A reminder of this very special evening.
Thelma and Carol: Thank you.
- Bates, B, Bickley, L.S., & Hoekelman, KA. (1995). A guide to physical examination and history taking/A guide to clinical thinking. Philadelphia: Lippincott Williams & Wilkins.
- Burnside, LM. (J 976). Nursing and the aged (1st ed.). New York: McGraw.
- Bumside, I.M. (1981). Nursing and the aged (2nd ed.). New York: McGraw.
- Burnside, LM. (1988). Nursing and the aged: A self-care approach (3rd ed.). New York: McGraw.