Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing and Health Care Policy

2018 American Academy of Nursing Living Legend – Nancy Fugate Woods

Nancy Fugate Woods is one of the nation’s most distinguished scholars of women’s health and a pioneer of research on the women’s health and wellness, who has received accolades from across disciplinary circles beyond nursing. Her early work as a scientist that spawned her curiosity around the menstrual cycle, reproductive health issues and peri-menopausal health concerns of women were foundational to a career noted by induction into the American Academy of Nursing (AAN), the American Nurses Foundation (ANF) Distinguished Contribution to Nursing Award in 2003, the Pathfinder Award from the Friends of the National Institute for Nursing Research, and elected to the Institute of Medicine, now the National Academy of Medicine. In collaboration with other colleagues, she launched first NIH-funded Center for Women’s Health Research at the University of Washington. Her long tenure with the Center and continuing involvement in the Seattle Midlife Women’s Health Study (click here for “The Seattle Midlife Women’s Health Study: a longitudinal prospective study of women during the menopausal transition and early postmenopause”) continues to be a snapshot of an extensive career that resulted in being selected a “Living Legend” in the American Academy of Nursing, an organization that she served as president.

Dean Woods presided over ten years of the University of Washington’s number 1 ranking in U.S. News and World Report magazine. Her research legacy also involves substantial service to her profession and to federal agencies as a nurse scientist, policy activist, women’s health advocate, and nurse education leader, winning numerous awards and serving in U.S. National Advisory and Washington State Health and Education Committees. We interviewed Dr. Woods, focusing on her extraordinary accomplishments and renowned research on women’s health. As Dean Emerita of the University of Washington School of Nursing, Co-Director of the de Tornyay Center for Healthy Aging, and past president of the American Academy of Nursing (AAN) and other noted societies, we wanted to hear in her own words what wisdom she could share with aspiring nurse leaders and scientists in our “3 Questions” format.

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Nancy Fugate Woods

Dean Emerita, University of Washington School of Nursing and the de Tornyay Center for Healthy Aging

Question 1. Can you tell us more about your recent work related on healthy aging in women and how your early body of research has informed your continuation of research with the study participants from 20 years ago?

Thanks for that great intelligent question. As I look back over the early work that I did and understanding young women’s health, I found myself being very interested in the symptoms that women experienced, and then the episodes of illness – days that were troublesome for them because of their symptoms. I was really looking at this part of a lifespan and what women were doing in the 1970s when women’s roles were changing pretty dramatically. At the time, women were entering the labor force and they were staying employed while they had babies and raised their children. And up to the time of that research there had been very little work at all, very little research on the effects of the kind of work women did. There was much on the health of their husbands, so what was the consequence of women’s work being employed, that is, outside of the home, on the health of their husbands and the health of their children! But there is very little being done to understand the consequence of being employed on the health of women themselves.

So, we were finding at that time that there was a huge untold story! And of course we saw that this was a major oversight, not having looked at the consequences of women’s work in their own lives for their own health. We did find that women’s employment didn’t have a major effect on their health as long as they had support for what they were doing, so as long as they were being supported in their parenting and their employment roles from their partners or spouses, and as long as they believed that they were doing what they should be doing.

The experiences with that study really made me curious about other questions that hadn’t been addressed related to women’s health and I found myself increasingly interested in what was happening with women’s health related to their physiology. In the late 1970s, colleagues and I at Duke University – and then later at the University of Washington School of Nursing – started a study that involved several hundred women both in the Raleigh/Durham area and in the Seattle area that attempted to understand the menstrual cycle in relationship to women’s experiences of symptoms and how the context of their lives – the challenges they were experiencing in daily living, the demands of their roles whether it was parenting or employment and the personal and social resources they had to bring to bear on these  – how these all affected their experiences of symptoms. This was a very revealing project: as it turned out, to my surprise, it was the first large prevalence study of menstrual cycle symptoms that had been done in the United States. It was very much a turning point in some of this work.

We then continued to think more, my colleagues and I, about looking at development of women and their health over the lifespan. And, when we began looking through a feminist lens, we realized that we needed to start with women at the very center of that work with their defining what mattered to them and moving on from there. So at that point we enlarged our lens to look at health during the young adult years, during mid-life and menopause and then eventually, in relationship to aging.

So, for me the study of women as they aged was a natural outgrowth of having studied the younger women, having studied women during midlife, and throughout the entire menopausal transition and then moving on to study women as they aged.

Question 2. Tell us more about the Seattle Midlife Women’s Health Study that was a foundational component of the Center for Women’s Health Research. Did your clinical connections to the research shape its trajectory?

We had the great fortune to have Ellen Mitchell, who is a PhD nurse and who practiced for many years as an Advanced Registered Nurse Practitioner caring for women in a primary care setting, as a collaborator. Ellen’s clinical wisdom as well as her preparation as a scientist with a PhD in nursing science enriched our research. She really ensured the clinical consciousness in all of our studies. For me as a nurse I found the integration of our focus on women’s biology during the menopausal transition, as well as the personal and social context for women’s lives, really clinically relevant as well as intuitively appealing; and one of the things that I was particularly pleased about was when I presented our work at interdisciplinary meetings. People often asked whether I was a physiologist, a psychologist or a sociologist, because of the integrated approach we took to the research we were doing with the midlife women’s health study. When I would tell colleagues that I was a nurse with graduate degrees in nursing and epidemiology, many were surprised and this often gave me an opportunity to talk about nursing science and our discipline’s particular orientation to integrative human health and health ecology. I was certainly flattered by colleagues who asked whether I was a Nurse Practitioner. I’m sorry that I can’t claim that identity. I was not educated as an advanced practice nurse but clearly Ellen Mitchell’s influence rubbed off and really profoundly shaped the kind of research we did.

I would say in relation to that statement about the clinical awareness another kind of awareness that was really an important part of our work was inviting women to advise us, on not only the Seattle midlife women’s health study, but every study that we’ve ever done. At the end of interviewing women we always would ask: was there something else we should have asked you that we failed to ask or is there anything else that you’d like to tell us in relationship to the interview we’ve just done? And often this would be the time when women would contribute incredibly valuable observations by saying “well I was surprised you didn’t ask me about…” (and then fill in the blanks) with what their current concerns were. Often Ellen and I would go through those data, we would talk with the research assistants who might have conducted the interviews after they completed them in a debriefing session, and we would add or modify a research approach to include some of the great ideas that women were suggesting to us.

It was key to me and Ellen that we tried to make sure that the research we were doing was in fact relevant to the concerns of the women who were participating in it.

Question 3. What advice do you have for aspiring nurse leaders and scholars to be able to connect their clinical interests, personal passions and professional goals?

That’s a great question. I think that the passion for the substance of what one is studying is absolutely essential to sustain us in that work. Otherwise, it’s a lot of very hard, very exacting work. But to imbue it with meaning related to really caring about the topic and the population one is studying is extremely important. I was so fortunate in the 1970s to be beginning work as a young nurse and a young scientist at the height of the women’s movement and its intersection with the popular health movement in the 1970s. Together these two events fueled my desire to contribute to work on women’s health that could inform healthcare and the kind of healthcare that would put women at the center of care and also at the center of the inquiry in research.

I have really loved the research that I have done over the course of my career and I still find myself looking forward to taking time to write and think about topics related to women’s health, so that passion continues. For me, it has been a privilege to get to understand, to be privileged to understand the life and health experiences of now thousands of women that our team and in particular Ellen Mitchell and I have talked to over the years to really say there is no substitute for being passionate about what you’re studying.