The Brigham Nurse Scientist Program offers every nurse access to resources and mentorship to help them pursue research and innovative initiatives. This story is the first in a series featuring the Brigham’s nurse scientists.

Annie Lewis-O’Connor, PhD, NP-BC, MPH, FAAN, never thought that she would be a nurse. As a Bostonian raised in a blue-collar family, “I was probably the least likely in my high school class to go to college,” she said.

Lewis-O’Connor is now the founder and director of the Coordinated Approach to Resilience and Empowerment (CARE) Clinic at the Brigham. There, she develops treatment plans with patients using trauma-informed care, an approach that acknowledges that health care organizations and care teams need to have a complete picture of a patient’s life narrative. As the interim director of research in the Center for Nursing Excellence, a senior nursing scientist in the Program of Research, an associate scientist in the Division of Women’s Health, and an instructor at Harvard Medical School, her work encompasses four pillars: research, clinical practice, education and policy. Lewis-O’Connor promotes trauma-informed care practices led by clinicians and leaders throughout the Brigham, while also expanding these practices across health care systems locally and nationally.

An Unexpected Path to Science

College was the furthest thing from Lewis-O’Connor’s mind when she became a mother at 20. Shortly after her pregnancy, she found herself in a very unhealthy relationship. “I knew it was an unsafe situation,” she said.

Although she’d always revered doctors and nurses, she doubted she was smart enough to attend college. But at this pivotal time in her life, her mentors encouraged her to try nursing.

At first, she was hesitant. But in the end, she decided to give healthcare work a go, working as a nursing assistant at a hospital for veterans. “I loved it because I loved the relationship part of it. These patients had such rich life stories,” she said. Soon after, she enrolled in Bunker Hill College as a nursing student. She went on to get her bachelor’s in two subjects, one in health management and the other in ethics and law, at Lesley University. She completed a Master’s in Nursing at Simmons University, a Master’s in Public Health at Boston University, then finally a PhD in Philosophy of Science at Boston College. All the while, she practiced nursing. “I just kept going. I loved learning — there was no shutting it off,” she said.

Lewis-O’Connor said she was attracted to research almost immediately after nursing school, as she was beginning her clinical practice as a child maltreatment clinician. Her curiosity led her to pursue research. “I think as nurses, we all inherently have research in us,” she said. “When you are assessing a patient and you say: I wonder which treatment would be best? That’s research.”

Lewis-O’Connor now has more than 30 years of teaching experience under her belt. In 2014, she was inducted as a fellow into the Academy of Nursing. Then, in 2018, she founded the Academy of Forensic Nurses. These positions, she said, allow her to teach and learn from nurses across the country and the globe who do similar work, particularly in Ireland and Haiti, where she used to travel before the pandemic. “I’ve often learned the most from nurses across the world,” she said.

Establishing the CARE Clinic

After 15 years as a sexual assault examiner, working with patients right after they had experienced a traumatic event, Lewis-O’Connor started itching to know what happened to patients once they left the hospital. Her desire to investigate this topic brought her to the Brigham in 2009. In 2011, she founded the CARE clinic, where she practices and researches trauma-related care.

The clinic’s framework is grounded in trauma-informed care, an approach that considers how a patient’s past experiences may impact their current health. With trauma-informed care, the patient is involved in their care plan, O’Connor said, breaking the barrier between clinician and patient.

Lewis-O’Connor’s work is focused on eliminating structural barriers to care. Her education in public health and her career in nursing have given her firsthand experience with the systemic hurdles that individuals experiencing trauma face when seeking health care. That’s why the model of the clinic is unconventional, she said. Instead of half-hour appointments, she can spend an hour with patients, with a half hour to ground herself in-between visits. To be as accessible as possible, the clinic is reachable via page or email at any time, and patient appointments are booked at times that work for the patient’s schedule. The clinic has used telehealth encounters since 2015.

She’s had a lifelong commitment to racial and social justice, welcomes opportunities to learn, and is committed to life-long learning, she said. She advocates passionately for the importance of inclusive language in medicine. “That means doing away with terms ‘clean’ or ‘dirty’ when talking about addiction,’” she said. “How about Mrs. Jones, who is unhoused and struggling with substance use disorder.”

Looking To the Future

Over the years, Lewis-O’Connor has coauthored more than three dozen studies on best practices in trauma-informed care. Her current research is focused on measuring its effectiveness. “We know anecdotally that people who receive trauma-informed care engage in the health care system in meaningful ways,” she said, and she’s hoping to put hard numbers on these observations, including the cost savings such care provides.

She’s also piloting a trauma-informed care plan based on her research, which provides clinicians with a clear, step-by-step care plan to follow whenever they see a patient who has experienced trauma. These care plans are developed in collaboration with patients and are used in all follow-up visits. “The care plan sits on the storyboard in EPIC and the workflow is that every clinician caring for the patient should read the care plan before seeing the patient.” The pilot for the care plans has been successful at the Brigham, and the plans are currently used by nearly two dozen providers.

Now, Lewis-O’Connor is looking to expand what she’s built. Six hospitals will begin pilot testing the care plans in the coming months.

Lewis-O’Connor said that her favorite part of her work is watching her patients soar.

“I love what I do,” she said. “I see the strength in people, and I lift that up and then watch them soar.”

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