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Nurse’s Innovative App is Giving a Voice to the Voiceless

Nurses Leading Innovation
7 days ago
Nurse’s Innovative App is Giving a Voice to the Voiceless

Rebecca S. Koszalinski, PhD, RN, CRRN, CMSRN, was inspired to become a nurse after experiencing a nurse’s care during her own health journey. Throughout her career as a clinical instructor, researcher, assistant professor, and – most recently – mobile app developer, Rebecca has been committed to improving outcomes for patients with disabilities and/or chronic illnesses who are speech vulnerable. Available for use on iPads and Android tablets, Rebecca’s Speak for Myself® app helps patients communicate pain, fear, anxiety, and loneliness with their healthcare providers, and allows patients to make requests regarding physical needs, such as using the restroom.

Rebecca recently shared her innovation story with us, and her hope that other nurses will be inspired to effect changes in patient care, too.


Johnson & Johnson Notes on Nursing (J&J): Who – or what – inspired you to become a nurse?

Rebecca: Shortly after sustaining an injury, I was studying histology and I thought I would be working in pathology labs for my career. I loved the technological aspects of prepping, cutting, and staining tissue, as well as the chemistry knowledge requirements. However, my injury resulted in disability and required consistent medical care.

At one point, after a two-week hospitalization, I decided I wanted to go home. One of the nurses heard my plans and asked me what I needed to ensure I would stay at the hospital. I told her I wanted to go outside; however, I could not walk and was wrapped in bandages from my hips to my toes. It seemed impossible. She stayed past the end of her shift to help me, bundling me in a wheelchair and propping up my legs to take me outside. It was amazing, and I was interested in nursing from that point forward.

J&J: Can you share a little bit about your nursing career journey and what led you to your current position at The University of Tennessee, Knoxville?

Rebecca: I finished my histology education and worked in pathology briefly, but eventually returned to school to pursue a degree in nursing at the University of Wisconsin Oshkosh in Oshkosh, Wis. After graduation, I worked in rehabilitation, surgery, outpatient oncology, outpatient infusion, and durable medical equipment. Eventually, I returned to school to complete my master of science in nursing (MSN) and doctoral degrees at Florida Atlantic University (FAU) in Boca Raton, Fla., so I could conduct research with the goal of improving life and care for patients who have disabilities. I taught at FAU as a clinical instructor after I rehabilitated out of a wheelchair and onto forearm crutches. Now, I am without equipment and able to ambulate, although my disability remains.

As a result of my personal health journey, I am sensitive to the needs of people who have disabilities and/or chronic illnesses. I accepted the position at The University of Tennessee, Knoxville (UTK) because they are front-runners in innovation and technology. I am a collaborator in the Health Innovation Technology & Simulation Lab and have numerous other opportunities for collaboration across the university.

J&J: What inspired you to develop the Speak for Myself® app?

Rebecca: One of my friends, who was very independent despite living with cerebral palsy and profound disability, was hospitalized while I was working as a clinical instructor. I encountered her after she had been left in an uncomfortable position and exposed to the cold morning air; when I questioned the person caring for her, she told me that my friend “was not all in there, anyway.” It was a devastating comment. My friend asked me to devise a solution for patients who are unable to clearly communicate in a clinical situation, and I agreed. It has been my passion ever since.

J&J: As a nurse, how were you in a unique position to bring this innovation to life?

Rebecca: The specialized knowledge I had as a certified rehabilitation nurse greatly informed my work. Additionally, I was already sensitized to the experience of having a disability given my medical history. My goal as a clinical instructor was to teach as many nursing students as I could about the needs of people with disabilities so any fears would be reduced, if not eliminated – ultimately resulting in better care. This goal has not changed as an assistant professor, nor will it change as I move through other levels of higher education.

J&J: What challenges did you face in developing the app?

Rebecca: At the time, there were few nurses who were learning to program, or engaging in an engineering independent study and producing a proof of concept. The development of Speak for Myself® has not always been met with accolades. At one of the first conferences where I presented my findings, I received feedback that this work “did not belong.” However, all nurses are and have always been innovators who help patients. Any action or solution that demonstrates improved care and patient outcomes belongs in the nursing profession and in nursing literature.

J&J: What has been the most rewarding part of bringing the Speak for Myself® app to fruition for patients?

Rebecca: We are finally at a place where Speak for Myself® is back in the community of persons who have disabilities and/or chronic illnesses and are not able to clearly articulate their needs. There are numerous anecdotal stories about how Speak for Myself® aids communication between patients, family members, and care providers. There have been many unexpected experiences that are exquisitely personal for patients, which has provided much-needed validation. It is these moments that have kept me going!

J&J: What are your goals for the next few years?

Rebecca: I plan to stay at UTK and grow my research in innovation and technology. With the guidance of terrific senior researchers, I am studying cutting-edge techniques for the development of technology, which can be applied to Speak for Myself®. To this end, Speak for Myself® will be further developed in partnership with Smart and Connected Health, a national program working to accelerate the creation and integration of innovative computer, information science, and engineering approaches to support the transformation of health and medicine.

I am also developing a nurse-led delivery model with the East Tennessee Technology Access Center for care of people in the community with disability and/or chronic illness who are communication vulnerable. I am looking forward to what this academic year brings, and to my future contributions to nursing science, technology, and innovation!

J&J: What advice do you have for a fellow nurse who might have an innovative idea, but isn’t sure how initiate change or bring it to life?

Rebecca: Don’t give up. Find fellow experts and engage in dialogue. Share your insights on what nurses do every day to help engage potential funders and experts to help you reach your goal. Document your ideas. Be willing to take risks. Everyone will tell you it takes time and money (often, you use your money until you have funding), so be patient and actively initiate ways to grow your ideas. You cannot wait for someone to deliver your ideas or keep them alive. Be flexible, because the solution to barriers may not be what you expected, and always keep your patient(s) at the center of your solution.

To learn more about innovation in the nursing profession, visit

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