Health for all: RN fights to level the playing field

By Susan Trossman, RN

It's hard to say what shaped Sally Weinrich's life as a registered nurse more -- nature or nurture. When Weinrich reflects on some of her influences, she talks about tradition, history, justice and even happenstance. But when colleagues and friends consider what makes Weinrich an effective nurse, they refer to innate qualities, like her genuineness, caring, dedication and practicality.

Whatever forces came together in Weinrich, they have served her well in a career that has spanned three-and-a-half decades. Over the years, she has met many challenges head on -- from talking openly about cancer and its prevention long before it was common practice, to reaching out to under-served populations that others deemed "unreachable." For the past several years, Weinrich, a white woman raised in a segregated South, has been working with African American men to lower their historically high incidence of prostate cancer.

Bends in the road

Tradition played a large role in Weinrich's decision to choose a career in nursing.

"It was before the women's revolution, and the only roles for women to pursue were teaching or nursing," said Weinrich, PhD, RN, FAAN. "I knew I liked helping people, and I saw nursing as a great opportunity to do just that."

After graduating from the University of North Carolina, she first worked as a staff nurse in surgical and coronary ICUs, then later in gerontology.

That's where happenstance -- in the form of a serious car accident -- had its effect on Weinrich's nursing career. No longer able to deal with the physical demands of bedside nursing following spinal fusion surgery, she decided to use her knowledge and expertise to pursue a career as a nurse educator and researcher.

Her first foray into nursing research involved breaking the cancer taboo.

"When I went into nursing, RNs were taught to not tell patients their blood pressures, much less about their serious illnesses, such as cancer, because it might 'upset them,'" said Weinrich, a Kentucky Nurses Association member.

But while working with the elderly in the early 1980s, Weinrich realized that older adults routinely attributed their symptoms, like bowel changes, to natural aging as opposed to serious disease. As a result, they were not getting diagnosed and treated in time.

Weinrich decided that talking openly about the benefits of early detection was one way to ensure that older adults could live their lives to the fullest. In a 1984 study at the University of South Carolina, she tackled assessing older adults' knowledge of cancer. Then, with a grant from what is now the National Institute for Nursing Research, she embarked on research aimed at determining the best ways to present information to older adults on colorectal cancer screening so they would become invested in prevention activities.

Ora Strickland, PhD, RN, FAAN, a nursing professor at Emory University and Georgia Nurses Association member who has known Weinrich since 1985, recalls being amazed by Weinrich's practical approach to research and patient education.

Regarding Weinrich's research on colorectal cancer education, Strickland said, "She used peanut butter to show people how to prepare a specimen for stool analysis. It was an educational technique that was so simple, but inventive and practical."

Weinrich believed that simply handing patients a stool occult test kit didn't necessarily mean that they knew what to do with it once they got home. And she knew the statistics -- just over half of patients return the completed test, and among socioeconomically disadvantaged groups, as little as 5 percent do so.

Her interventions, particularly the use of peer educators, proved successful, and Weinrich continued down the path of nursing research.

Real communication

Establishing real communication with people is the backbone of Weinrich's work.

"One of the greatest sources of satisfaction throughout my career has been the one-to-one interactions I've had with people," said Weinrich, who conducted most of her research while on faculty at the University of South Carolina. "Nursing gives you the unique opportunity to interact with people beyond superficial chit-chat and in a meaningful way that can make a real difference in their lives -- and yours."

She claims no magical answer to being an effective communicator, but she believes in some basic principles that have worked for her.

"If you say things in a way that people will understand -- not using medical terminology -- they will do what they need to do because everyone wants their health," Weinrich said.

She also can't overstate the importance of listening and empathy.

"I find that I'm most effective when I'm really listening and when I try to understand what people are thinking -- to view reality from their perspective. I always try to convey caring, empathy -- not that I don't have my bad days. But I believe if you can convey genuine caring and concern, anything is possible."

Howard Barrett, a South Carolina police officer and father of four, knows about Weinrich's ability to connect with people. Now in remission, he met her shortly after being diagnosed with prostate cancer at age 41.

"Years ago, people didn't talk about cancer. But Sally makes you feel comfortable and explains things really well. She was what I was looking for -- someone who let me talk and get things off my chest." Long active in his community, Barrett now helps educate others about prostate cancer.

Life's mission

Over the past decade, Weinrich has focused much of her individual research on fighting prostate cancer in African American men. She also is one of the key investigators in the historic, multi-center African American Hereditary Prostate Cancer Study aimed at identifying the genes responsible for prostate cancer.

African American men traditionally have been less willing to participate in screenings and research studies than other groups, in large part, because of the history of health care discrimination and legacy of the unethical Tuskegee syphilis experiments. But Weinrich has been able to successfully recruit African American men into her prostate cancer studies. In the process, she has been able to create effective methods to educate participants about this disease. Most of her research has been conducted in South Carolina, but she recently started to build a research program on prostate cancer at her new home base, the University of Louisville.

Strickland believes one of the reasons Weinrich has been so successful in enrolling participants is her method: She reaches into the community.

"She goes through organizations that people know and respect, like the black churches, sororities and fraternities," said Strickland. "And she does what she does purely out of a commitment to others. She's highly dedicated to her work and to people, particularly those who are under-served."

Louise Faison Smith, who has worked with Weinrich to recruit South Carolina men for the national prostate study, believes that the registered nurse's personality has won many participants over.

"They see she's a genuine and warm person. People can relate to her immediately," Faison Smith said.

The role of justice

Not only has Weinrich published extensively, she's always been an active participant and organizer of health care events in her community. Her activism has earned her much recognition, including the prestigious Order of the Palmetto, South Carolina's highest award for community service.

When asked about her interest in prostate cancer, Weinrich gives two reasons. One is that she wants to prevent needless suffering and death. The other involves justice.

"African Americans my age and older didn't have the same educational opportunities as whites in the South," she said. "The issues surrounding informed decision-making for prostate cancer screening are very complex -- even for college-educated men. And men with low literacy have more difficulty understanding the abstract concepts of risks and benefits."

Weinrich said she strongly believes "all men have the right to equal education about the facts -- presented in a manner in which they understand and can make important, life-determining decisions about their health and treatment.

"African American men die from prostate cancer at twice the rate of any other ethnic group. I believe they should have an equal opportunity to live and to watch their children and their grandchildren grow up.

"There are a lot of things I cannot change in this world. But as a nurse, I can teach, provide care and conduct research, all aimed at helping more men live."

More information on Weinrich's research and the national African American Hereditary Prostate Cancer Study is available on her website at http://www.mcg.edu/org/prostate.

Trossman, S., (2000, March/April). Health for all: RN fights to level the playing field. The American Nurse, pg. 8 – 9.  Sally Weinrich featured in national American Nurses’ Association magazine. http://www.nursingworld.org/  

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