Category Archives: Nursing
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
States that have legalized medical marijuana have seen nearly 25 percent fewer deaths from overdoses involving prescription painkillers than states that have not, according to a study led by Marcus Bachhuber, MD. ABC News reports on it, noting that 23 states and the District of Columbia have such laws. Researchers found that while opioid overdose rates continued to climb, the increase was much slower in states with medical marijuana laws, resulting in 25 percent fewer deaths from opioid overdose. “This study raises the possibility that there is an unintended public health benefit of medical marijuana laws, but we still need to collect more information to confirm or refute what we’ve found,” says Bachhuber, an RWJF/Veterans Administration Clinical Scholar at the Philadelphia Veterans Affairs Medical Center. Outlets covering Bachhuber’s study include CNN, Washington Post, Business Insider, Health Day and Vox.
An infant “sleep pod” designed by Jennifer Doering, PhD, RN, is one of 11 projects funded through new grants from the University of Wisconsin Extension and the Wisconsin Economic Development Corporation, the Milwaukee Journal Sentinel reports. The $25,000 Ideadvance grants are intended to move good ideas more quickly to the marketplace. Doering’s I-SleepPod, developed as a result of her work in the RWJF Nurse Faculty Scholars program, would allow an infant to sleep next to an adult while remaining safe, thanks in part to an alarm that wakes the adult in the event of an unsafe sleeping position. “We designed the sleep pod to minimize hazards because, if we don’t move in that direction of reducing sleep-related infant deaths, then [society] is essentially saying it’s acceptable to have 600 babies die every year that way,” Doering said.
Nutrition rating systems in supermarkets may encourage shoppers to purchase less junk food, according to a study led by John Cawley, PhD, an RWJF Scholars in Health Policy Research alumnus and Investigator Award in Health Policy Research recipient. The study coupled sales data from Hannaford Supermarkets in the northeastern United States from January 2005 to December 2007 with the Guiding Stars nutritional rating system. The ratings system assigns zero to three stars to food items, based on their nutritional value. Researchers found that sales of less healthy foods—such as highly processed snack foods—fell by 8.31 percent when branded with a low nutrition rating, while healthy food purchases rose by 1.39 percent, Medical Xpress reports.
The Robert Wood Johnson Foundation’s (RWJF) LEAP National Program is working to create a culture of health by discovering, documenting and sharing innovations in the primary care workforce. To advance this goal, the program is holding a series of six webinars that highlight best practices. (Read a post summarizing the first of the six webinars.) The second of the webinars in the series focused on team-based care for complex cases. Presenters included leaders from four primary care sites around the country that the LEAP program has deemed exemplars.
Managing Care for the Most Complex Patients
Kathy Bragdon, RN, director of care management at Penobscot Community Health Center in Bangor, Maine, discussed the rapid growth of the health center, and went on to describe its system of care management for the most complex patients.
The center relies on a transitions care manager, who shares information back and forth with the hospital and with patients’ medical homes. In addition, the manager meets with patients when they are in the hospital, looking to identify potential barriers to recovery and to provide any needed referrals.
“One of the big roles—we didn’t realize how big—was that a tremendous number of patients had no primary care at the time of admission,” she said. “We worked really closely with the hospitals trying to provide those services and make that linkage to those patients who needed primary care providers.”
As health reform increases access to care for people with chronic conditions at a time when the supply of primary care physicians is decreasing, one viable alternative is nurse-managed protocols for outpatient treatment of adults with diabetes, high blood pressure and high cholesterol, according to a study published in the Annals of Internal Medicine.
The research team reviewed 18 studies on the effectiveness of registered nurses (RNs) in leading the management of those three chronic conditions. In all 18 studies, nurses could adjust medication dosage; and in 11 studies, they could independently start patients on new medications. The review showed that patients with nurse-managed care had improved A1C levels, lower blood pressure and steeper reductions in LDL cholesterol.
“The implementation of a patient-centered medical home model will play a critical role in reconfiguring team-based care and will expand the responsibilities of team members,” the researchers wrote. “As the largest health care workforce group, nurses are in an ideal position to collaborate with other team members in the delivery of more accessible and effective chronic disease care.”
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the August issue.
More Nursing Schools Preparing Students to Provide Team-Based Care
Several of the nation’s top nursing schools now require students to participate in at least one interprofessional education course or activity, reports the Future of Nursing: Campaign for Action. Experts have called for interprofessional education for decades, but more health professions schools are responding now because requirements are being written into health professions accreditation standards, says Barbara Brandt, PhD, head of the National Center for Interprofessional Practice and Education, a public-private partnership supported by RWJF, the U.S. Health Resources and Services Administration, and other organizations.
Physical Work Environment in Hospitals Affects Nurses’ Job Satisfaction, With Implications for Patient Outcomes, Health Care Costs
A study conducted by RWJF’s RN Work Project finds that a physical work environment that facilitates registered nurses’ efficiency, teamwork and interprofessional communication relates to higher job satisfaction. The study revealed that physical environment affected whether nurses could complete tasks without interruptions, communicate easily with other nurses and physicians, and/or do their jobs efficiently.
The following are among the many honors received recently by Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, grantees and alumni:
James S. Jackson, PhD, a 2009 recipient of an RWJF Investigator Award in Health Policy Research, has been appointed by President Obama to serve on the National Science Foundation’s National Science Board. Jackson is a professor at the University of Michigan School of Public Health, and director of its Institute for Social Research.
Geraldine “Polly” Bednash, PhD, RN, FAAN, will receive the National League for Nursing’s (NLN) highest honor, the President’s Award, at the 2014 NLN Education Summit in mid-September. Bednash is the recently retired chief executive officer of the American Association of Colleges of Nursing (AACN) and director of New Careers in Nursing, a joint initiative of RWJF and AACN focused on increasing diversity in the nursing workforce.
Sally Cohen, PhD, RN, FAAN, has been selected as the 2014-2015 Distinguished Nurse Scholar-in-Residence at the Institute of Medicine of the National Academies. The program provides a yearlong leadership opportunity to participate in shaping health policy. Cohen was also named editor-in-chief of the journal, Policy, Politics & Nursing Practice. She is director of the Nursing and Health Policy Collaborative at the University of New Mexico.
Lainie Ross, MD, PhD, a 2013 recipient of an RWJF Investigator Award in Health Policy Research, has been named a 2014 Guggenheim Fellow. Ross will use her fellowship year to research the relationship between ethics and genetics for a book, currently titled, From Peapods to Whole Genomes: Incidental Findings and Unintended Consequences in a Post-Mendelian World. The fellowship is awarded by the John Simon Guggenheim Memorial Foundation to recipients with “demonstrated exceptional capacity for productive scholarship or exceptional creative ability in the arts.”
The Robert Wood Johnson Foundation (RWJF) has announced the 20 accomplished nurses from across the United States selected as RWJF Executive Nurse Fellows for 2014.
Executive Nurse Fellows hold senior leadership positions in health services, scientific and academic organizations, public health and community-based organizations or systems, and professional, governmental and policy organizations. They participate in a three-year leadership development program designed to enhance the effectiveness of nurse leaders who are working to improve the nation’s health care system. Fellows receive coaching, education, and other support to enhance their abilities to lead teams and organizations. The program is located at the Center for Creative Leadership.
More than 200 nurse leaders have participated in the RWJF Executive Nurse Fellows program since it began in 1998. This will be the program’s final cohort.
Carolyn Montoya, PhD, PNP, is associate professor and interim practice chair at the University of New Mexico College of Nursing and a recent graduate of the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at the University of New Mexico College of Nursing.
Human Capital Blog: Congratulations on your award from the Western Institute of Nursing! The award honors new nurse researchers. What does it mean for you and for your career?
Carolyn Montoya: In addition to being quite an honor, receiving the Carol Lindeman Award for new researchers from the Western Institute of Nursing motivates me to continue to pursue my research. I am sure people can relate to the fact that being in the student mode is so very intense that once you finish you need some recovery time. Then you start wanting to use the research skills you worked so hard to obtain, and this award has helped to re-energize my commitment to research.
HCB: The award recognizes your study on children’s self-perception of weight. Please tell us what you found.
Montoya: I was very interested to see if there was a difference between how Hispanic children viewed their self-perception in regard to weight compared with white children. Seventy percent of my study population was Hispanic, and my overall response rate was 42 percent. I found that Hispanic children, ages 8 to 11, are not better or worse than white children in their ability to accurately perceive their weight status. Most surprising, and a bit concerning, was the fact that one-third of the sample expressed a desire to be underweight.
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Nurse practitioners enjoyed prime time TV coverage when Sunday’s 60 Minutes program ran a segment about the Health Wagon, a mobile clinic serving six counties in an impoverished Appalachian coal-mining region in southwestern Virginia.
The segment, originally broadcast in April, highlighted the work of Teresa Gardner and Paula Hill-Meade, both doctors of nursing practice, who currently see approximately 20 patients a day in a converted RV, while also keeping up with up fundraising responsibilities related to the federal grants and corporate and private donations that keep the organization going.
Their patients “are people that are in desperate need,” Meade told 60 Minutes correspondent Scott Pelley. “They have no insurance and they usually wait, we say, until they are train wrecks. Their blood pressures come in at emergency levels. We have blood sugars come in at 500, 600, because they can’t afford their insulin. ...They have nowhere else to go.”
However, Gardner said, as demanding as the work is, “we get more out of it than we ever give.”
This is part of the August 2014 issue of Sharing Nursing’s Knowledge.
Violence Against Emergency Nurses
For many nurses working in emergency departments, physical violence and verbal abuse is a common occurrence. One survey found that more than half of emergency nurses had experienced such incidents within the previous week. Research suggests a number of contributing factors, including long wait times and patients who have psychiatric problems or are under the influence of drugs or alcohol. According to a study published in the July 2014 issue of The Journal of Emergency Nursing, while data on the frequency of such incidents is readily available, less study has been devoted to nurses’ personal experiences with assaults, including the circumstances and consequences of the incidents.
With that in mind, a research team led by Lisa A. Wolf, PhD, RN, CEN, conducted a qualitative analysis of 46 nurses’ personal accounts of assaults. Several common themes stood out:
- A number of nurses talked about what the researchers described as a “culture of acceptance” of an “unsafe workplace.” For example, hospitals discouraged nurses from pressing charges or prosecutors declined to pursue cases. Some nurses said safety measures such as security or panic buttons were not maintained. Others noted that despite signs being posted that warned that anyone who committed violence, made threats, or acted out in other ways would be ejected from the hospital, such behavior was tolerated.
- Many nurses described the impact of assaults in personal terms, saying they had “lingering psychological trauma that continues to impede their ability to work in the emergency setting.” Some reported chronic pain from injuries sustained during violent incidents, but said they continued to work full time. Others reported having to leave the profession because of the extent of injuries.
- Nurses described what researchers identified as missed cues that violence was about to occur, usually from patients from whom such behavior might have been anticipated. One example is a patient taken to the emergency room for ingesting multiple drugs and placed only in soft restraints. Another example involved individual nurses being left alone with patients brought in for psychiatric evaluation who had been verbally abusive to paramedics.