Category Archives: Human Capital
E. Alison Holman, PhD, FNP, is an associate professor in nursing science at the University of California, Irvine and a Robert Wood Johnson Foundation Nurse Faculty Scholar.
A year ago today, on April 15, 2013, in the first major terror attack on U.S. soil since September 11, 2001, Dzhokhar and Tamerlan Tsarnaev planted two pressure cooker bombs near the finish line of the Boston Marathon. Three people died and more than 260 were injured. For a week authorities searched for the perpetrators, shootouts occurred, and Boston was locked down. As reporters and spectators filmed the mayhem, graphic images were shown repeatedly in both traditional and social media around the world. Like the September 11, 2001 (9/11) terrorist attacks, the population of the United States was the terrorists’ intended psychological target. Yet most research on reactions to such events focuses on individuals directly affected, leaving the public health consequences for populations living outside the immediate community largely unexplored.
Tens of thousands of individuals directly witnessed 9/11, but millions more viewed the attacks and their aftermath via the media. In our three-year study following 9/11, my colleagues and I found that people who watched more than one hour of daily 9/11-related TV in the week following the attacks experienced increases in post-traumatic stress (PTS) symptoms (e.g., flashbacks, feeling on edge and hyper vigilant, and avoidance of trauma reminders) and physical ailments over the next three years (Silver, Holman et al., 2013).
Improvements to Dermatology Curriculum and Residency Training Could Improve Patient Safety, Study Finds
Modifications to curricula, systems, and teacher development may be needed to bring down medical error rates among dermatology residents, according to a study published online by JAMA Dermatology.
The survey of 142 dermatology residents from 44 residency programs in the United States and Canada draws attention to several areas of concern. According to the survey:
- Just over 45 percent of the residents failed to report needle-stick injuries incurred during procedures;
- Nearly 83 percent reported cutting and pasting a previous author’s patient history information into a medical record without confirming its validity;
- Nearly 97 percent reported right-left body part mislabeling during examination or biopsy; and
- More than 29 percent reported not incorporating clinical photographs of lesions sampled for biopsy in the medical records at their institutions.
Also, nearly three in five residents reported working with at least one attending physician who intimidates them, reducing the likelihood of reporting safety issues. More than three-quarters of residents (78 percent) have witnessed attending physicians ignoring required safety steps.
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A year ago this week, the Robert Wood Johnson Foundation (RWJF) convened an unprecedented meeting that brought together diverse leaders from community colleges around the country, the Tri-Council for Nursing, and RWJF’s Academic Progression in Nursing (APIN) initiative, which is fostering collaboration between community colleges and four-year university nursing programs to promote seamless academic progression for nurses. The meeting was organized to address concerns in the community college community about the recommendation in the Institute of Medicine’s (IOM) report, The Future of Nursing: Leading Change, Advancing Health, that 80 percent of the nation’s nurses attain bachelor of science in nursing or higher degrees by the year 2020.
A paper, released today, reports on the proceedings of that meeting, including participants’ shared goal to ensure that community colleges continue their invaluable work to educate a new generation of nurses and diversify the nursing workforce; and to give all nurses opportunities to be lifelong learners who are well-prepared to provide high-quality care and promote health.
The paper includes an addendum that provides news and information about how nursing, health, education, government, business, and other leaders in nine states have made exciting progress in the last year in support of seamless progression for nursing students, as well as for nurses already in the workforce who wish to continue their education.
“While we did not solve every concern, the meeting was tremendously constructive, opening a dialogue, identifying numerous areas of strong agreement, and illuminating issues yet to be resolved,” said John Lumpkin, MD, MPH, senior vice president at RWJF. The Foundation “is determined that last year’s meeting be a beginning for a continuing, constructive dialogue that will advance the goals we all share.”
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:
The California Action Coalition has developed a mentorship program that is helping prepare the next generation of nurses to serve as leaders on health care reform. The state’s mentorship program dovetails with the 2014 leadership focus of the Future of Nursing: Campaign for Action, a national effort backed by RWJF and AARP that is working to transform health care through nursing. “Mentoring is key to strengthening any leader,” Mary Dickow, MPA, tells Nurse Zone. “Having strong mentors in my life helped me think differently and advance. I wouldn’t be where I am today without them.” Dickow is statewide director of the California Action Coalition.
A recent interview in the Atlantic with David Blumenthal, MD, MPP, has generated numerous comments from readers weighing in on the merits of electronic health records (EHRs). Blumenthal is former national coordinator for health information technology at the U.S. Department of Health and Human Services and a recipient of an RWJF Investigator Award in Health Policy Research. He points out in the interview that EHRs offer “substantial” benefits for patients, but notes that in the short-term, providers incur significant costs and that it will take time to make the transition to EHRs. The Atlantic has now published several articles highlighting reader comments, which can be found here, here, and here. FierceEMR published a story about the give-and-take, which notes that many of the commenters who are skeptical about the value of EHRs are physicians.
RWJF Health & Society Scholars program University of Wisconsin-Madison Site Director David Kindig, MD, PhD, appeared on the Kojo Nnamdi Show on Washington, D.C.’s WAMU radio to discuss the “longevity gap,”—the growing gap in life expectancy between the rich and the poor. Kindig and other guests explore how health care reform and policies to address income inequality might affect the gap.
The health care industry is not in the healthiest state when it comes to weight, according to a study published in the American Journal of Preventive Medicine. Analyzing data from the 2010 National Health Interview Survey and adjusting for confounding factors such as race, gender, and smoking, researchers identified two industries—public administration (36%) and health care and social assistance (32%)—as having significantly higher-than-average obesity rates.
Long work hours and hostile work environments were among factors that contributed to higher obesity rates, researchers found. Within the health care industry, obesity rates were lower for health care practitioners and for workers in technical occupations than they were for health care support occupations (such as home health aides and nursing assistants), “suggesting that the impact of working conditions on obesity may be especially harmful for lower-income workers,” the researchers wrote.
Out of 20 industries in the study, real estate workers had the lowest obesity rate, at just under 20 percent.
When workloads increase for hospitalists—the physicians who care exclusively for hospitalized patients—length of stay (LOS) and costs increase, too, according to a study published by JAMA Internal Medicine.
Researchers at Christiana Care Health System, a large academic community hospital system in Delaware, analyzed 20,241 inpatient admissions for 13,916 patients over a three-year period. Hospitalists had an average of 15.5 patient encounters per day, and LOS increased from 5.5 to 7.5 days as workloads increased at hospitals with occupancies under 75 percent.
Each additional patient seen by hospitalists increased costs by $262, although increasing workload did not affect outcomes such as mortality, 30-day readmission rates, and patient satisfaction.
Adam L. Sharp, MD, MS is an emergency physician and recent University of Michigan Robert Wood Johnson Foundation Clinical Scholar (2011-2013). He works for Kaiser Permanente Southern California in the Research and Evaluation Department performing acute care health services and implementation research.
Violence is a leading cause of death and injury in adolescents. Recent studies show effective interventions can prevent violent behavior in youth seen in the Emergency Department (ED). Adoption of this type of preventive care has not been broadly implemented in EDs, however, and cost concerns frequently create barriers to utilization of these types of best practices. Understanding the costs associated with preventive services will allow for wise stewardship over limited health care resources. In a recent publication in Pediatrics, "Cost Analysis of Youth Violence Prevention," colleagues and I predict that it costs just $17.06 to prevent an incident of youth violence.
The violence prevention intervention is a computer-assisted program using motivational interviewing techniques delivered by a trained social worker. The intervention takes about 30 minutes to perform and was evaluated within an urban ED for youth who screened positive for past year violence and alcohol abuse. The outcomes assessed were violence consequences (i.e., trouble at school because of fighting, family/friends suggested you stop fighting, arguments with family/friends because of fighting, felt cannot control fighting, trouble getting along with family/friends because of your fighting), peer victimization (i.e., hit or punched by someone, had a knife/gun used against them), and severe peer aggression (i.e., hit or punched someone, used a knife/gun against someone).
This is part of the April 2014 issue of Sharing Nursing’s Knowledge.
A nurse author is making a grand entrance on the literary scene.
British nurse Nathan Filer, 33, won a prestigious literary prize last month for his debut novel about mourning and mental illness. The book won the United Kingdom’s 2013 Costa Book of the Year award, which carries a prize of nearly $50,000.
Called Where the Moon Isn’t (and The Shock of the Fall in the U.K.), the novel tells the tale of a young schizophrenic who witnessed the death of his younger brother and winds up in a mental health institution.
It draws on Filer’s professional experience as a mental health nurse; he has worked in psychiatric wards for more than a decade.
“For a first novel it is astonishingly sure-footed. ... I think there is genuine excitement about this winner,” chief judge Rose Tremai said, according to a blog post on National Public Radio. “It is not just about schizophrenia—it is about grief.”
Filer has said that he intends to remain active in nursing despite his newfound literary success.
This is part of the April 2014 issue of Sharing Nursing’s Knowledge.
ICU Staffing’s Impact on Patient Outcomes
A nurse-led study from the United Kingdom has found that higher numbers of doctors and nurses in intensive care units (ICUs) have a positive effect on survival rates for high-risk patients.
A research team led by Elizabeth West, PhD, MSc, RN, Director of Research in the School of Health and Social Care at the University of Greenwich, used data on 38,000 patients in 65 ICUs in the United Kingdom, correlating patient outcomes with staffing levels for doctors, nurses, and support staff. They found that “higher numbers of nurses per bed ... and higher numbers of ‘consultants’ [senior hospital-based physicians or surgeons] were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death.”
“It seems reasonable to argue,” the researchers conclude, “that skilled nurses, who have the time to observe patients closely, to intervene or mobilise the team if they begin to deteriorate, would be most important to patients who are at the greatest risk. This study is the first to produce evidence that this is the case.” Their findings are published in the May 2014 issue of the International Journal of Nursing Studies.