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 – Jacquelyn C. Campbell

Dr. Jacquelyn Campbell is a widely respected leader in research and advocacy in domestic and intimate partner violence (IPV). She holds a joint appointment in the Bloomberg School of Public Health and is the Robert Wood Johnson Foundation (RWJF) director of the Nurse Faculty Scholars Program. She has received numerous awards and recognitions including: Pathfinder Distinguished Researcher by the Friends of the National Institute of Nursing Research (FNINR); the 2011 Sigma Theta Tau International (STTI) Distinguished Research Award; the 2005 American Society of Criminology Vollmer Award; the IOM/AAN/ANF Scholar-in-Residence appointment for 2005-2006; the Health Care Heroes 2005 Nurse Hero Award; and the Maryland Network Against Domestic Violence 2004 Education Award. In 2018, she was named a Living Legend in the American Academy of Nursing (AAN) recognizing her outstanding contributions to the field of research in violence against women.

Dr. Campbell’s work is extensive and her commitment to supporting victims of domestic violence is ubiquitous. She was appointed by Congress to the U.S. Department of Defense (DOD) Task Force on Domestic Violence and has worked extensively with the DOD, using her research to impact policy including legislation related to gun violence and the Violence against Women Act (WAVA).

Link: To hear her testimony to the United States Senate Judiciary Committee on July 30, 2014, click here).

(Link: To hear her testimony within the full hearing related to domestic violence and child abuse [go to 1:36:45] click here).

Dr. Campbell served on the Board of Directors of the House of Ruth Battered Women’s Shelter and three other shelters. Internationally, she co-chaired the Steering Committee for the WHO Multi-country Study on Violence against Women and Women’s Health. With over 200 published articles, 7 books, and as Principal Investigator on 10 major NIH, NIJ or CDC research grants, she has been a tireless champion for women and an active leader in nursing.

(Link: To hear in her own words about her commitment to the importance of nursing leadership in domestic violence research, click here).

We interviewed Dr. Campbell, focusing on her domestic violence research and its implications in health policy using our “3 Questions” format. She speaks about leadership as an exemplar of how nursing can rise to affect women’s health in general and IPV specifically.

Veronica D. Feeg, PhD, RN, FAAN

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Question 1. Can you talk about the DoD work, VAWA and other domestic violence research in your career that helped you make the policy differences that you have made?

Click here to listen.

I have been very fortunate to be able to work on a number of policy initiatives. One of the earliest national policy work I did was with the Department of Defense (DoD) when I was named to a task force to address domestic violence in the military. There was a number of us, it was an interdisciplinary group, I was the only nurse on board, and we went around the country getting input from both the victims of domestic violence. We also talked to offenders who had been identified as using violence against their partners. We also talked to the military personnel on Marine bases, on Army bases, on Air Force bases. We actually went to Japan and talk to people on the bases from the Navy in Japan.

So, we really got a broad picture and we came together on making some recommendations in terms of how the military could address domestic violence, and how there could be a better coordinated response. The military took us up on a number of those suggestions in terms of doing a better job of coordinating things amongst different parts of the military – doing a better job when a case would come before them – and they would recommend that the offender go to an offender intervention program, and then the offender got deployed to some international post. So what’s supposed to happen then?

We really think we made a difference. We wanted the military to do an anonymous survey every couple of years in all the branches to really determine the prevalence and to see whether or not these new policies were effective. They have never put that part into place. So, the research part, they didn’t do, which we’ve always thought was a shame that it didn’t happen. But it did allow me to see, first of all, that working together with other disciplines, using research to inform what we were talking about to the military. One of the things I was able to do was to make sure that the healthcare providers that served military population did a better job in terms of asking about domestic violence and addressing that in health care settings; used some of my research about the effects of domestic violence on health to inform them about that. That was very important for them to hear the evidence.

And the same kinds of things in terms of my work on the Violence against Women Act (VAWA) (the original one back in the 80s) and the reauthorizations. I haven’t actually testified per se on behalf of the Violence against Women Act, but I have provided research evidence to others who have testified.

And again, you can’t be concerned about you being in the limelight all the time, but rather informing those who do testify what the latest research says.

I especially have research on both risk of homicide in domestic violence cases and I have research on those physical and mental health effects. I was asked to testify on the issue of guns and removing guns from known domestic violence offenders. Not to get too far into the weeds, but closing the boyfriend loophole. People may have heard about it; it’s still an issue that we haven’t been able to do nationally. Many states make orders of protection apply to dating partners as well married or cohabiting partners. And the boyfriend loophole says that unfortunately in many states, those laws in terms of removing guns from known domestic violent offenders don’t apply if it’s a boyfriend rather than a husband or someone that you have children in common with.

So that’s something we’ve been working on for a long time. As I said, many states have passed laws to address that. But there are some states that never will, given their current makeup of their representatives on the state level. And so unless we do some of these things on the national level – the true reduction in domestic violence/homicide with guns – we won’t be able to see nationally.

The work has been very rewarding. I continue to be asked to weigh in on various policies, to educate legislators about some of the laws that are under play, the newest re-authorization of the Violence against Women Act has been passed by the House of Representatives. It has not been passed by the Senate. And that is an area that I continue to work on.

So the work doesn’t end. And, doing the research is very important – to make policy recommendations be informed by research findings be evidence based.

Question 2. Can you talk about the importance about mentoring scholars in violence and trauma in nursing as well as other disciplines?

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One of the things that I’m the most proud of, and one of the things that I love doing the most is mentoring young scholars – especially in nursing but also in any discipline – who are interested in doing violence research and who I can help guide toward doing meaningful research. One of the things I always say when I present is I have hundreds of research ideas – research that needs to be done. I don’t have time. What I love the most is when there’s a PhD student who wants to actually do one of those ideas for a research study I have. And I have been very fortunate to have a mechanism (a T32) which is an NIH funded pre-and post-doctoral training grant. The current version of it is in trauma and violence, and funded by NICHD. And that allows me to not only do my mentoring but also to be able to support with a stipend and with some small additional research funds that students can use to go to conferences etc.

The T32 actually allows me to actually support them to do that work, and attracts them to come to Hopkins. One of the things about Johns Hopkins as with many institutions – we have violence researchers in all of our departments. So our T32, the pre-doctoral fellowship has us supporting three students from the School of Public Health as well as two Nursing doctoral students. They all come together in a seminar – a violence research seminar – that I get to teach and arrange to have other members of the faculty of the T32 to come and present their research to the students. That way the students all learn together, they get to know each other, they work in an interdisciplinary network that they can use for the rest of their careers to support each other – to cheer each other on (which is an important part) as well as that I can provide some mentoring for all of them. But I can also arrange good mentoring, advisor matches, within their own school – within their own discipline.

The other thing I’ve been very fortunate that I was able to be the National Program Director for the Robert Wood Johnson Foundation Nurse Faculty Scholars Program. Now, not all of those scholars were doing research in violence, but some of them were, and some of them had gotten their PhDs in a violence related field, so I particularly reached out to them and said “be sure to apply” – not that I could guarantee them being accepted. But I was able to get a number of them who do violence and trauma work at various stages, to be part of nurse faculty scholars. And that’s another network where people support each other, where people talk about their own area of research and other people seek connections with theirs, and they can do some work amongst different nursing researchers.

The other thing we were able to do with the Robert Wood Johnson Foundation funding in conjunction with the Foundation, and with our wonderful steering committee, executive committee, was to actually do some evaluation of the kind of mentorship we provided. Part of that mentorship was my vision, Angela Barron McBride was my co-leader (she was chair of the national advisory committee). We worked together a lot on providing this mentoring scheme. And of course I used what I had learned in the T32, which I’ve had for a total of now almost 20 years. So I was able to put some of what I had learned into the Nurse Faculty Scholars mentorship model, and was able to learn from that mentorship model for making our T32, the pre- and post-doc program, that much better.

I also mentor other students, other PhD students in nursing as an advisor who are not part of the T32. We just finished the dissertation and one of my mentees, she just graduated. She did research about how strangulation from partners ought to be dealt with in the emergency department. So she’s going to be coming out with some practice guidelines. It’s very exciting work! I’m more than happy to support her, her help get those practice guidelines in good places. She did work, she did the research, and here’s another person who’s been trained to do violence related research from a nursing perspective with nursing outcomes.

I’ve also mentored some of the junior faculty in our School of Nursing who are going toward their own research careers. One of the things I’m proudest of being part of the journey of one of our first – actually our first Native American faculty member in the School of Nursing, who now has a PhD, and she just got her first R01. I’m only a small part of her journey, I’m one of her mentors. But it’s exciting to see. Her research is on historical trauma and Native American children being exposed to ACES (adverse childhood experiences), and what that combination of adverse childhood events plus historical trauma has to do with the suicidal ideation that so many Native American youth are experiencing, and where we see rates of suicide amongst Native American youth being higher any other racial-ethnic group.

So that’s the kind of thing that I’m proudest of – is when the people I have mentored go on and do even better research than I could have ever thought to do. That’s incredibly exciting.

Question 3. How do you describe the big picture visions in your science now?

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I am always amazed at how much there is to learn about violence, how we can prevent violence, how experiences of violence affect people’s brains. We in nursing, I think, come at this in a way that is especially important. We’ve always talked about and done our research from what we call a holistic perspective. And this is, I think particularly relevant in issues about violence and trauma, because we are learning more and more that, especially early experience of violence when you’re a child or adolescent, actually makes changes in one’s brain. That the more traumas and violence that person experiences, the more their brain is affected and the more we see profound mental and physical effects (that’s all in the same brain after all) in those people who’ve experienced violence. And we need to use this new brain science in helping people who have experienced violence heal: designing and testing interventions that can actually make a difference in that traumatized brain. We can think about it from a nursing perspective, as I said from a holistic perspective, and we can work on making those interventions culturally appropriate.

My favorite example is: we have found that yoga, can be helpful for people who have been highly traumatized in terms of doing some of that healing work on their bodies and on their brains. But I always think of the schools that I work with in inner-city Baltimore, and I always have a little chuckle to myself thinking that we could go into those inner city schools, middle schools and say: “would all the young people who have experienced violence in their homes – who have seen their father hit their mother, or their mother hit their father, or have seen a dead body in the neighborhood, or have been abused themselves or sexually assaulted themselves – would you all please report at 3 o’clock for yoga.” And having a little chuckle to myself, thinking nobody wants to do yoga in an inner-city middle school!

We need to design some interventions that do the same kind of good things, but that are culturally appropriate, are relevant, make kids excited to be part of that intervention. I’m sure there are some out there – we just need to develop them and work on them. I’ve done a little bit of work myself with an arts-based intervention for dating violence, but that kind of work needs to continue and we need to test those interventions and really be able to show that it is, indeed, helpful.

As I mentioned, most of the brain science work has been done in terms of mental health responses, that people who have experienced a lot of trauma, as I said, especially as a child or an adolescent. Often times they develop what we say PTSD. In the popular vernacular, we talk about people being triggered, which is really what happens when you have PTSD because you can re-experience events if somebody says something or does something to you that reminds you of when you were horribly afraid in a situation of very serious violence or trauma. And we need to expand that vision to physiological effects, because those happen too and we know that when people have developed PTSD, when they have been highly traumatized, their HPA Axis (Hypothalamic Pituitary Axis), the stress response, gets compromised in various ways, and that the immune system, which is connected to that stress response, also can get compromised.

And when I say compromised, we talk about immune system dysfunction, it can either be over-activated or under-activated. And they can both happen at the same time, as a matter of fact. And if it’s under- activated, they may be more susceptible to infections. If it’s over-activated, we can have the immune system contributing to things like chronic pain (an overactive immune system), or to things like BMI being increased and it being much harder for those people to be able lose weight with normal means.

So it helps you understand why you see certain health problems more often with people who have experienced child abuse. For instance, the Nurses’ Health Study showed that nurses who had experienced child abuse were more likely to have problems with diabetes. We found that women, African-American women who were abused were more likely to develop hypertension early, and find it more difficult to control it.

So these are very important connections that are just beginning to be explored, but they’re being explored in sort of silos in different areas of science. And I think the beauty of nursing is we can see it all together. And we can see things like how the effect on one’s physiology and one’s mental health can contribute to HIV – to people both acquiring HIV and also having trouble keeping their CD4 counts under control, and developing the kind of viral load that disappears over time that makes them no longer infectious. So I’ve been doing some work with other researchers in the HIV world in terms of addressing the kind of cumulative trauma that we see so often in people who contract HIV or acquire HIV, and then have trouble decreasing their viral load to non-detectable, which is the goal now for HIV.

So, it’s this big vision kind of piece that is something that I think I’m particularly good at. Maybe it’s because I’ve done and read so much research by now in many different fields that my own brain is bursting with ideas of ways to apply that and think about things differently. So that we can indeed, and in the end, what we want to do is both prevent violence from happening so much in our country and in the world (there’s also the global vision to think about). But also to help people who have experienced violence, because unfortunately violence in our world is not going to go away in the next few years; to help people who have experienced violence heal so that they don’t, as adults (these children and adolescents) become the ones who are using violence against other people.