The Clinical Advisor spoke with Jennifer Sonney, PhD, APRN, PPCNP-BC, FAANP, the Elizabeth C. Giblin Endowed Professor of Symptom Science at the University of Washington School of Nursing in Seattle, Washington. Dr Sonney will be assuming the presidency of the National Association of Pediatric Nurse Practitioners (NAPNAP) in the summer of 2022. We asked Dr Sonney about what led her into asthma research and the innovative programs she is developing at the Sonney Research Lab.
Q: What led you to asthma research?
Dr Sonney: It has been a bit of a long journey to end up as a researcher. I began my career as a nursing assistant working at Seattle Children’s Hospital, where I primarily cared for children with respiratory conditions. I went on to become a nurse and then a nurse practitioner (NP). During my NP program, I was fortunate to have a funded traineeship in pediatric pulmonary care, which continued to grow my interest in pulmonary care for children.
After completing my NP program, I went on to work as a primary care pediatric NP across a number of community-based settings including one opportunity where I was able to design, implement, and run a pediatric asthma clinic. It was there where I really fell in love with caring for children and families managing asthma and where I became acutely aware of deficiencies in our care. That experience fueled my desire to get a PhD and focus my program of research on caring for children with asthma.
Q: All your research studies include the parent and child and incorporate the children in their own health care (IMPACT and SKIP studies). What brought you to that idea of collaboration?
Dr Sonney: The idea of parent-child shared management of their health is really what fuels me as a clinician-scientist. This is something that nursing brings to the fore: that is, a partnership with the family in managing health. This is especially important when it comes to asthma management. Asthma is the most common chronic condition of childhood and affects over 5 million children. Despite effective treatments, more than half of children with asthma have uncontrolled asthma, meaning that they will have at least 1 exacerbation a year with a litany of poor outcomes.
When I researched solutions to improve patient outcomes, what I found missing from the literature was the voice of the child. The gap in asthma care has been preparing children to start assuming responsibility for their asthma management. So the focus of my research has been to pair a parent and child together as a team in managing asthma. Central to this idea is that asthma management is shared between parent and child; we use technology to provide the opportunity for kids to recognize and report asthma symptoms and for parents to monitor those symptoms.
I am building on the work of my mentor, Gail Kieckhefer, PhD, APRN, PPCNP-BC, and it’s exciting to see that we’re moving past the theoretical into actual solutions aimed at improving parent-child shared management. There are a lot of chronic conditions out there that children are dealing with so I see a broad application opportunity for this model.
Q: Can you explain your research on the role of executive functioning in health care and children with chronic diseases.
Dr Sonney: Executive functioning relates back to self-management potential: our ability to manage our health and make decisions to monitor our symptoms, decide how to respond, and if needed, make a change. What’s fascinating in childhood is that executive functioning is in rapid development. Therefore, I tend to focus on working with school-aged kids, who are developing those executive functions.
When I think about maximizing a child’s asthma outcome, it is natural to question that child’s capacity to assume some of that management responsibility. In a study of the relationship between executive function, asthma, and medication adherence among school-aged children with asthma, we found some deficiencies in executive function in children with asthma. Why executive functioning may be lower in patients with chronic conditions is a big question and there is a lot that we do not know. I can speculate that there may be a cumulative insult occurring in children with asthma in particular.
What we do know is that children have a rapidly developing brain, therefore, their potential is rapidly developing during childhood. This actually may be a new mechanism by which we can intervene and maximize and improve a child’s self-management capacity, which impacts them not only now, but for their lifetime.
Q: You are also examining the use of virtual reality (VR) for stress management of teens with chronic diseases. Can you tell us about that?
Dr Sonney: The overriding theme in my research is to partner with the child to develop solutions alongside them. What we see in adolescents is they have astronomically high levels of stress greater than any other previous generation and they don’t have great ways to manage it. Therefore, we have worked alongside teens to develop a stress management solution designed especially for them. The beauty of VR is that it’s immersive. If you create a soothing environment to help somebody destress, the immersion within VR may enhance the effects. What we found in our study is teens want a nature-based environment; they want soothing audio; they want animal companions; and they want to have a way to explore and destress without any constraints. We’re just in the early stages, but it is a fascinating and promising project.