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Jan 28 2015
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‘Good Morning, My Name is Aara’: Building Trust in Health Care

Aara Amidi-Nouri, PhD, RN, is associate professor of nursing and director of diversity at Samuel Merritt University in Oakland, Calif. She is a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2014-2017) and has served as a project director for the RWJF New Careers in Nursing scholarship program at Samuel Merritt University since 2009.

Aara Amidi-Nouri

Trust. Our health depends on it, and so do our lives.

Our very first stage of personality development as infants starts with trust, according to renowned developmental psychologist Erik Erikson. A newborn’s basic needs—food, shelter, and clothing—are entirely entrusted to a caregiver, one who hopefully recognizes that he or she does not yet have an ability to shiver, sweat, or shed tears.

When caregivers are attuned to babies’ environments and hunger cues, they are able to meet their needs and build their trust in other human beings. When caregivers hold newborns close, they meet their need for love and affection, building trust with every heartbeat and with every breath. We are social beings, dependent on one another. We must trust one another in order to survive. It’s no coincidence that our pennies—our most basic form of currency—are engraved with that very word.

Health Care in 2015 logo

What happens when, instead of building trust, we createmistrust? What happens when we can’t trust our health care system or our health care providers—our own caregivers, the very people who hold our fate and our lives in their hands? 

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Jan 27 2015
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Diabetes: The Case for Considering Context

At Virginia Commonwealth University School of Medicine, Briana Mezuk, PhD, is an assistant professor in the Department of Family Medicine and Population Health, Division of Epidemiology; and Tiffany L. Green, PhD, is an assistant professor in the Department of Healthcare Policy and Research. Both are alumnae of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program.

Tiffany Green Tiffany L. Green, PhD
Briana Mezuk Briana Mezuk, PhD

Approximately 30 million U.S. adults currently have diabetes, and an additional 86 million have pre-diabetes. The incidence of diabetes has increased substantially over the past 30 years, including among children. Estimates place the direct and indirect costs of diabetes at a staggering $218 billion annually.1 Like many other diseases, disparities on the basis of race and income are apparent with diabetes. Non-Hispanic blacks, Hispanics, Native Americans, and socioeconomically disadvantaged groups are more likely to develop diabetes than non-Hispanic whites and socioeconomically advantaged groups. 

Despite the enormous economic and social costs associated with diabetes, it remains a struggle to apply what we know about diabetes prevention to communities at the highest risk. We have robust evidence from randomized controlled trials that changing health behaviors, including adopting a healthy diet and regular exercise routine and subsequent weight loss, will significantly lower the risk of diabetes. Unfortunately, these promising findings only appear to apply to the short-term. Even worse, results from community-based translation efforts have been much more modest than expected, and show only limited promise of reducing long-term diabetes risk. In response, leaders at the National Institutes of Health have noted that many efforts at translating clinical findings into community settings are “limited in scope and applicability, underemphasizing the value of context.”2

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Jan 26 2015
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Like a Koala Bear Hanging Out in a Tree: Anxiety and Excitement as a Nurse Starts Her PhD Journey

Laren Riesche, MSN, RN, is a nursing PhD student at the University of Illinois at Chicago. With clinical experience in neonatal nursing, her research focuses on the role of the placenta in fetal programming and its effect on health and disease throughout the life span. She is a Robert Wood Johnson Foundation (RWJF) New Careers in Nursing alumna and an RWJF Future of Nursing Scholar

Laren Riesche

I have been extremely fortunate to have had great leadership development opportunities throughout my nursing education, thanks in part to the Robert Wood Johnson Foundation (RWJF). I have been privileged to be selected for two RWJF nursing education scholarship programs which are not only helping build my leadership skills, but also shaping my perspective on the importance of nurse leaders.

I am one of 16 nurses in the inaugural cohort of the Future of Nursing Scholars program, which supports nurses earning their PhDs. This August, we all participated in a leadership development workshop that was part of the very first scholars’ Boot Camp. The event was intended to help us prepare to complete our nursing PhDs in three years.

One of the activities involved choosing and then discussing a picture that represented our fears; we chose from more than 200 picture-cards that bore a wide range of images, from nature scenes to cityscapes, family events to individual athletes, and everything in between. I chose a picture of a koala bear hanging out in a tree. What I saw was a koala, all alone with nothing to hold onto but a single tree branch. It tapped into my fear that I was throwing everything I had into my PhD program, pushing my family and friends away, and losing myself in order to stay focused on finishing in three years—and maybe, in the end, the only thing I would have to hang onto was my degree.  

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Jan 23 2015
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Go Back to Basics, Go Back to Schools

Erin D. Maughan, PhD, MS, RN, APHN-BC, is director of research at the National Association of School Nurses and a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2013 Cohort).

Erin Maughan
Health Care in 2015 logo

If we want to create a Culture of Health in America, a 2015 priority must be to focus on ways to break down the barriers that separate us and keep us from being as effective and efficient as possible. Currently, health care systems, education, housing, and public health work in siloes; they are funded in siloes, and workers are trained in siloes. Yet, people’s concerns and lives are not siloed and a community health culture/system cannot be either.  One of the places to begin coordinated cultural change is in schools.

Schools are a smart choice to target because nearly 98 percent of school-age children, in their formative years, attend school and schools provide access to families and neighborhood communities. The Department of Education’s Full-Service Community Schools Program and Whole School, Whole Child, Whole Community Initiative reminds us that, in order for children to be educated, they need to be healthy and there must be a connection between school and community.

There are many school health initiatives in place, such as healthy food choices, physical fitness, healthy policies, school health services, community support, and after-school programs. The potential is there—but so are the siloes. But when schools are appropriately staffed with school nurses, the nurses help break down the siloes; that is because school nurses are extensions of health care, education, and public health and thus can provide or coordinate efforts to ensure a holistic, resource efficient, healthy school community.

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Jan 22 2015
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'Getting What You Want': Aligning Goals with Actual Care in Patients with Serious Illness

Rachelle Bernacki, MD, MS, is director of quality initiatives in the department of psychosocial oncology and palliative care at the Dana-Farber Cancer Institute, associate director of the Serious Illness Care Program at Ariadne Labs, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (2004-2006).

Rachelle Bernacki
Aging in America

The Institute of Medicine recently released a report entitled Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The news headlines read: “Panel Urges Overhauling of Health Care of End of Life.”

Here’s why: Most Americans wish to die at home and want to avoid heroic measures to keep them alive. Yet most die in institutional settings like hospitals and nursing homes, and 20 percent die in intensive care units.

The transition of death from the home to institutional settings over the past 40 years has been promoted by the advent of new medical technologies. While these remarkable technologies can be life-saving for certain patients, for many others aggressive therapies may simply prolong the dying process and extend suffering. In addition, many patients who die in institutional settings die with undertreated pain and difficult or labored breathing. And many report inadequate communication with their physicians about their end-of-life preferences.

Numerous studies show that patients want to have conversations about their end-of-life care and expect their physicians to initiate these discussions. When these conversations occur, there is greater alignment between patients’ wishes and the care they receive; higher patient quality of life; less frequent use of non-beneficial life-sustaining treatments; more use of hospice care; reduced family distress; and reduced resource use and costs. However, many physicians do not feel comfortable having these conversations and, in fact, identify more barriers to having these discussions than do patients.

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Jan 22 2015
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Preparing Family Caregivers to Provide High-Quality Care for People with Dementia

Tatiana Sadak, PhD, PMHNP, is an assistant professor at the University of Washington School of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2013-2016). She is working to promote “dementia caregiver activation,” a process of preparing caregivers to become ready to manage the multiple needs of loved ones with dementia while caring for themselves.

Tatiana Sadak
Aging in America

The well-documented personal and societal burdens of dementia are the central focus of the National Alzheimer’s Plan, which calls for extensive reforms in the delivery of health care for patients with dementia and their family caregivers. RWJF answered this national call to action by funding several innovative dementia health services research projects and nurturing the careers of junior dementia researchers.

I was fortunate to receive RWJF Nurse Faculty Scholars funding. It will make it possible for me to focus a majority of my time on improving health services for people living with dementia and for their family care partners—or ‘caregivers.’

Dementia patients suffer brain failure that leads to progressive loss of autonomy and the inability to understand and meet personal health care needs. Clinicians conduct health assessments, create care plans, and treat symptoms, but it is dementia family caregivers who deliver the day-to-day care and health management these patients need. There is, however, considerable variation in their capacity to assist care recipients in making health care decisions, for providing daily care, and for navigating health care systems.

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Jan 21 2015
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Restoring Dignity to Those with Dementia

Judy Berry is the founder of Dementia Specialist Consulting and the Lakeview Ranch Model of Specialized Dementia Care in Darwin, Minn., and a 2010 recipient of the Robert Wood Johnson Foundation (RWJF) Community Health Leaders award.

Judy Berry
Aging in America

I live in rural Minnesota, and my passion is to make a significant contribution to improving dementia care in our society and to be an advocate for all seniors with dementia in their quest to maintain their basic human right to dignity, choice, and quality of life until their death.

My mother, Evelyn Holly, passed away 16 years ago. She spent the last seven years of her life being bounced from one nursing home or residential dementia facility to another, and in and out of hospital geri-psych units, all because of her so-called “challenging and aggressive behavior.” She spent the last year of her life strapped in a chair and drugged so she would be “compliant.” I imagine many of you have had similar experiences. Click on this link to view a video about my personal struggle with dementia care—a struggle that has fueled my passion to improve it.

After many years of heartache and frustration in my struggle to find appropriate care for my mother, and after being told repeatedly by others in the health care industry that the kind of dignified care that I visualized was impossible because it was too expensive, I discovered that I could not find any financial support for trying something different. I decided to use my own life savings to try to develop a model of specialized dementia care that would focus on the unmet emotional and spiritual needs of persons with dementia, many of whom are unable to communicate those needs, and to meet their physical needs as well.

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Jan 21 2015
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Nurses Are Leading the Way to Better Health Care for Older Patients

Barbara Bricoli, MPA, is executive director of Nurses Improving Care for Healthsystem Elders (NICHE), an international program based at New York University’s College of Nursing that is designed to help improve the care of older adults. The program was developed by Terry Fulmer, PhD, RN, FAAN, chair of the National Advisory Committee for the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.

Aging in America
Barbara Bricoli

The rapid expansion of the aging population is a national concern. Nearly 20 percent of the U.S. population will be over age 65 by 2030, according to the U.S. Administration on Aging. And our aging population will place a heavy burden on our health care system; older adults, in fact, are hospitalized at three times the rate of the general population.

Yet health care providers lack adequate training in geriatrics and gerontology to care for older patients. Nurses Improving Care for Healthsystem Elders (NICHE) is working to change that.

Based at New York University’s College of Nursing, NICHE aims to better enable hospitals and health care facilities to meet the unique needs of older adults and embed evidence-based geriatric knowledge into health care practice. Hospitals and organizations that adopt NICHE report improved outcomes, decreased lengths of stay, better patient and staff satisfaction levels,  and higher success in building systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice.

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Jan 21 2015
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Quotable Quotes About Nursing, January 2015

This is part of the January 2015 issue of Sharing Nursing’s Knowledge.

“I knew that if something were to go wrong, the nurse was just a phone call away. It made me feel so empowered to take care of my child myself.”
--Camille Wallace, LPN, How Nurses Can Help Low-Income Mothers and Kids, The Atlantic.com, January 14, 2015

“There’s plenty of evidence that there’s a shortage of nursing care, and it’s not solved by anything to do with the hospital supply. All the shortage of care at the bedside has to do with [is] how much hospitals want to pay nurses, and whether they want to use their resources on something else.”
--Linda Aiken, PhD, RN, FAAN, director, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, More Nurses are Better for Patients. Why is it so Hard to Get Hospitals to Hire Them?” The Washington Post, January 13, 2015

“Drivers of the shortage include an aging nursing workforce, increased number of people receiving health care via the Affordable Care Act along with increased number of people living with complex, chronic disease that requires care. Nursing provides a diverse array of opportunities from health care and bedside nursing to advanced practice nursing to positions for nurses in the business world.”
--Laura Rooney, DNP, APRN, director, UT Health Services, University of Texas Health Science Center, Outlook for Nursing Jobs Continues to Look Positive, Houston Chronicle, January 9, 2015

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Jan 20 2015
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Nurses and the Future of Long-Term Services and Supports

Maryjoan Ladden, PhD, RN, FAAN, is a senior program officer at the Robert Wood Johnson Foundation (RWJF).

Maryjoan Ladden / RWJF

By 2050, as many as 84 million Americans will be 65 or older, and most of them will need some sort of help in maintaining their health and well-being. For them, and for the millions of younger Americans who will need similar assistance, it’s essential that we come to grips with the challenge of providing effective and affordable long-term services and supports (LTSS).

As it stands right now, we’ve got a long way to go. But the effort is under way, and nurses are at the forefront. At more than 3 million strong, the nursing workforce will be central to meeting growing demand for LTSS. In addition to providing clinical care, nurses can assess the long-term health prospects of individuals with physical and cognitive impairments, develop customized care plans, monitor individuals’ responses to care, coordinate care across providers and settings, and oversee the quality of the assistance older adults receive.

Aging in America

The latest issue of RWJF’s Charting Nursing’s Future policy brief series highlights a number of trailblazing LTSS efforts in which nurses play a key role. Among them:

  • Transitional Care. The Central New Jersey Care Transitions Program (CNJCTP) is one of a number of sites taking part in the Affordable Care Act-funded Community-Based Care Transitions Program. Six hospitals in the CNJCTP region work with registered nurses (RNs) and social workers, who together act as health coaches to teach self-care strategies to high-risk, chronically ill Medicare beneficiaries. Registered nurses (RNs) focus on beneficiaries’ symptoms and health care needs, including medication management, while social workers attend to socioeconomic needs that may lead beneficiaries to return to the hospital. Coaches visit patients in their homes within three days of discharge, facilitate a follow-up visit with a primary care provider, and follow up by phone for a month after discharge.

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