TAG: "Nursing"

High school students take UCLA researcher’s study to heart

Students participate in study, document experiences in school newspaper.

UCLA's Nancy Pike reviews the results of an MRI scan with a participant in her study.

By Laura Perry, UCLA

You can adopt a child,  a pet or even a stretch of highway. But students at one local high school decided recently to adopt a research project run by UCLA School of Nursing assistant professor Nancy Pike.

Pike has a grant from the National Institutes of Health to study memory loss and brain structural changes in adolescents born with single ventricle congenital heart disease, or, in other words, with only one pumping chamber instead of two. Congenital heart disease (CHD) is the No.1 birth defect in the nation, according to the March of Dimes. Twice as many children die from congenital heart defects each year than from all forms of childhood cancer combined. Children with CHD have an abnormally structured heart and/or blood vessels coming from the heart. These hearts may have incomplete or missing parts.

Since she started studying this disease two years ago, Pike has been searching for two sets of subjects — young people who have a single ventricle due to CHD and others without CHD who can serve as healthy controls. The subjects who have heart disease are, for the most part, referred to her by cardiologists or recruited from cardiology clinics that know about her study. Healthy controls are found via a wide variety of sources — fliers, word of mouth, advertising or siblings of CHD patients.

This past January, Pike tested Allison Houser, a 14-year-old high school student who was born with single ventricle heart disease. As it turned out, Leslie Miller, the girl’s mother and a teacher at an all-girls Catholic high school in La Cañada Flintridge, thought her students might be willing to participate in the study as healthy controls.

Miller told her students at Flintridge Sacred Heart Academy as well as the journalism teacher about the study and how it could really help her daughter. Miller thought students would benefit from understanding that you don’t need to be sick to participate in research and by participating, you are performing a community service.

What happened next was a researcher’s dream come true.

The student experience

Almost immediately, Pike started receiving calls from students asking to be considered for one of two studies where she is enrolling healthy controls. One student, the editor of the school newspaper, wanted to participate in the study and then write an article about the experience. Ultimately, the students decided to make Pike’s research as well as the subject of congenital heart disease their school service project for the month of February, which happened to be Congenital Heart Disease Awareness Month.

“I never expected that the students would get so engaged about a disease they knew so little about,” said Pike. “But seeing how CHD had impacted their teacher really motivated the students to get involved.”

Some of the participating students were asked to take a memory recall test. Others, who served as healthy controls, had both memory testing and a brain MRI scan.

As it turned out, the students got a lot more than just monetary compensation for participating. They recounted their experiences in a two-page feature in their school newspaper, Veritas Shield.

Monica Collins, who was the healthy control matched with Miller’s daughter, had a real sense of pride about being a research subject. She is interested in a career in the medical field and wanted to see how research studies are conducted as well as to learn more about CHD.

“It was interesting to take part in something that is going to help others and further the scientific research of congenital heart disease,” said Collins.

Another participant, who heard about the study from his sister, participated because CHD hit close to home. As it turned out, his older brother was born with single ventricle heart defect and died shortly after birth.

The students also decided to raise funds for CHD and donated more than $300 to Children’s Hospital, Los Angeles, where Allison had her previous heart surgeries.

A school community gives back

Pike said she was very touched by the students’ keen interest in the project and the way they rallied to support a teacher they loved.

“I hadn’t thought of this type of venue for subject recruitment because some schools do not allow study advertisement,” the researcher said. “But what worked for me and this study was the students turning this into a service project.”

What’s even better is that now she has a waiting list of healthy control subjects that she can draw on in the future. But there’s only one problem, Pike said. “It’s an all-girls school, and now I need boys!”

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$2.5M Dignity Health gift to UC Davis nursing school creates endowed deanship

The school’s founding dean, Heather Young, is inaugural holder.

Heather Young, UC Davis

By Jennette Carrick, UC Davis

The Betty Irene Moore School of Nursing at UC Davis announced today (April 3) it received a $2.5 million gift from Dignity Health to create the first endowed deanship at UC Davis. The inaugural holder of the Dignity Health Dean’s Chair in Nursing Leadership is nationally recognized expert in gerontological nursing and rural health care, and founding dean of the School of Nursing, Heather M. Young.

“This is an important moment for UC Davis because it affirms our commitment to teaching and research excellence and our leadership in the future of health care,” said UC Davis Chancellor Linda P.B. Katehi. “We are grateful to Dignity Health for their visionary partnership that has allowed us to realize this moment. We are equally proud that Heather Young, who is such a well-regarded, accomplished and passionate health care leader and a UC Davis alumna, is the first holder of this important endowed position.”

Since its founding in 2009, the Betty Irene Moore School of Nursing at UC Davis has brought forth an unprecedented opportunity to not just improve, but redesign health care. The dean is the visionary leader responsible for developing and enhancing the quality of the school’s faculty and programs.

This endowed deanship provides funds, for use at the dean’s discretion, that support teaching, research or outreach. Ultimately, the endowment provides the dean the opportunity to realize her vision and advance the mission of the School of Nursing. Because endowed gifts are invested so that their earnings can be spent, they provide valuable income, year after year, creating a lasting impact. The Dignity Health Dean’s Chair in Nursing Leadership makes it possible for the school to attract and retain future deans of the highest caliber, who are nationally or internationally renowned, and enables them to innovatively lead a transformation in health care that will last for generations to come.

“As the founding dean tasked with the incredible opportunity to create a school that transforms health care through nursing education, leadership and research, I am filled with appreciation that the Dignity Health team recognizes the importance of investment in our mission. I am also humbled that I am the first named to this deanship,” Young said. “This endowment affirms the value of creating nurse leaders to make a lasting impact on health care.”

Dignity Health President and CEO Lloyd H. Dean said the San Francisco-based health system, which is the largest hospital provider in California, made the financial commitment to UC Davis because of the School of Nursing’s academic focus to develop nurse leaders of the future through high-caliber programs, which will allow health care leaders to leverage the nursing profession to better address the critical needs of health care systems.

“As an organization that was founded by sisters who came to San Francisco and provided nursing care, Dignity Health takes tremendous pride in the nurses who are changing lives in our hospitals every day,” Dignity Health’s Lloyd Dean explained. “The U.S. health care system is at a crossroads and we have a responsibility to support the next generation of nurses and ensure that more exceptional caregivers are entering the profession.”

Dean formally announced the gift Thursday night at a small gathering of Dignity leaders and School of Nursing professors, students, alumni and supporters at the Museum of the African Diaspora in San Francisco.

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Male R.N.s make thousands more in salary than female counterparts

UCSF-led study finds no improvement in earnings gap since 1988.

By Scott Maier, UC San Francisco

Male registered nurses (R.N.s) make more than $5,000 per year than their female counterparts across most settings, specialty areas and positions, according to a UCSF-led study, and this earnings gap has not improved over the last three decades.

The analysis will be published as a “Research Letter” in the March 24/31 issue of the Journal of the American Medical Association.

“The roles of RNs are expanding with implementation of the Affordable Care Act and emphasis on team-based care delivery,” said lead author Ulrike Muench, Ph.D., assistant professor of social and behavioral sciences in the School of Nursing at UCSF. “These results may motivate nurse employers, including physicians, to examine their pay structures and act to eliminate inequities.”

From the research letter background, while the male-female salary gap has narrowed in many occupations since the Equal Pay Act of 1963, it persists in fields such as medicine and nursing. Predominately female, nursing is the largest health care occupation, with salary differences by gender affecting about 2.5 million women, according to the researchers.

To better understand the current pay discrepancy between male and female nurses, researchers led by Muench used data from the last six quadrennial National Sample Survey of Registered Nurses (NSSRN) for 1988-2008. This mail, electronic and web survey selected a state-based probability sample of currently licensed R.N.s from data provided by state boards of nursing with a sample size of more than 30,000 R.N.s per year and response rate of approximately 60 percent.

The NSSRN is ideally suited for analyzing gender differences in the R.N. workplace because of the large amount of employment information available in this survey compared to other surveys that are typically used by social scientists to study pay differences by gender.

The American Community Survey, a household survey with a 90 percent response rate, also was used to extend the time trends to 2013 and establish that unadjusted salary differences by gender were not limited to the national sample survey.

Both surveys showed that unadjusted male salaries were higher than female salaries every year by an average of approximately $10,000. Male adjusted salaries were, on average, higher by $5,148.

Muench notes that the salary gap is affecting most specialty areas and positions and not improved since 1988, the earliest survey year used by the researchers. Specifically, the gap was $7,678 for ambulatory care and $3,873 for hospital settings. It occurred in all specialties except orthopedics, ranging from $3,792 for chronic care to $6,034 for cardiology. Salary differences also existed by position, ranging from $3,956 for middle management to $17,290 for nurse anesthetists.

Muench said over the course of a 30-year career, female R.N.s will have earned about $155,000 less than male R.N.s using the adjusted earnings gap, $300,000 less using the unadjusted gap.

“Given the large numbers of women employed in nursing, gender pay differences affect a sizable part of the population and their families,” Muench said. “We hope that our results will bring awareness to this important topic, which we believe might best be addressed through both private and public efforts.”

The researchers suggest that nurse employers can take important steps towards eliminating pay inequality by increasing transparency in compensation and determining if gender differences in pay exist in their organizations.

“If that is the case, employers should examine whether there are legitimate reasons for paying these men more than women and take action to correct existing inequities,” Muench said. “By increasing transparency of gender differences in compensation, the hiring climate may become more conducive for female nurses to negotiate with their employer for wage parity, which also may help in the closing of the gap.”

Other contributors to the JAMA research letter were senior author Peter Buerhaus, Ph.D., R.N., Vanderbilt University Medical Center Department of Health Policy; and Jody Sindelar, Ph.D., and Susan Busch, Ph.D., Yale School of Public Health Department of Health Policy and Management. Funding was provided by a grant from Sigma Theta Tau, Delta Mu Chapter.

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UCLA, three other universities create National Clinician Scholars Program

New initiative will train physicians, nurses to conduct research with goal of improving health care, health of communities.

By Enrique Rivero, UCLA

UCLA has joined with Yale University, the University of Michigan and the University of Pennsylvania to launch the new National Clinician Scholars Program, which will educate nurses and physicians to serve as leaders, researchers and change agents in health care, community health and public policy.

The innovative program fills the gap left after the Robert Wood Johnson Foundation ended its Clinical Scholars program for physicians. The new program will expand on the RWJF program by including nurse scientists as well as physicians, and will address new and emerging issues related to health care delivery and improving the health of communities.

“This new national program that builds on the over 40-year legacy of the Robert Wood Johnson Foundation Clinical Scholars program will create leaders and change agents with the needed skills to transform health care delivery and ultimately the health of our nation,” said Dr. Carol Mangione, co-director of the RWJF Clinical Scholars Program and of the new program at UCLA.

The National Clinician Scholars Program will partner with organizations sponsoring a number of individual scholar positions and inter-professional training between nurses and physicians. The new program will provide opportunities for nurses and physicians to serve as full partners in health care redesign, improvement and research. It will include fundamental elements from the RWJF program such as high-quality mentoring, a tailored curriculum, clinical work and annual meetings.

“Best patient outcomes require nurses to be full partners in delivering the right care in the right settings,” said Linda Sarna, interim dean of the UCLA School of Nursing and co-director of the UCLA program. “The new National Clinician Scholars Program provides physicians and nurses the opportunity to work together to achieve better health outcomes.”

Partners at each institution will work directly with each scholar to identify and develop projects to solve current real-world problems and to cultivate the scholar’s unique research and leadership skills.

UCLA will work with a consortium of partner institutions called the UCLA Southern California Clinician Leaders Program. In addition to UCLA’s David Geffen School of Medicine and School of Nursing, the consortium includes the Los Angeles County Department of Health Services, Greater Los Angeles Veterans Health System, and Charles R. Drew University of Medicine and Science, among others.

The consortium will identify regional health challenges and recruit scholars to address these challenges with the goal of eliminating health disparities in Los Angeles. It will implement programs to reduce wait times, save resources and improve patient outcomes. Research projects undertaken through the program will be embedded in the community so that scholars will be able to make a meaningful impact locally even as they receive their education.

The community-embedded projects make up the core of the two-year training experience; scholars also will partake in an innovative curriculum to build a robust set of skills in organizational and social change, applied translation research methodology, community engagement, program development and evaluation, team management, communication and leadership.

The RWJF Clinical Scholars Program made great strides in training leaders to serve as the workforce for change toward health improvement. The National Clinician Scholars Program honors that legacy by expanding on its important work.

More information, including instructions for applicants, can be found at www.nationalcsp.org.

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National pain experts discuss care at nursing school annual dean’s lecture

Experts convene at UC Davis to discuss quality pain care for older adults.

By Jennette Carrick, UC Davis

Pain management experts from UC Davis and the nation convened Wednesday to discuss quality pain care for older adults at the 2015 Betty Irene Moore School of Nursing at UC Davis Lecture Series: Leading Change, Advancing Health.

Keela Herr, a nationally recognized expert in elder pain management and health policy, addressed a packed house of current graduate students, faculty and alumni of the school, as well as nurses, physicians, researchers and students of UC Davis Health System and individuals throughout Sacramento. Herr identified the challenges and barriers to quality pain care and highlighted directions for addressing and promoting improved pain care.

“In assessing pain in older people with persistent pain, we must create a larger picture of the pain experience,” explained Herr, associate dean for faculty and professor at the College of Nursing, University of Iowa, and co-director of the John A. Hartford Center of Geriatric Nursing Excellence. “We’re not there with a magic wand yet, but the science is moving quickly in this area. Who knows what the future will hold?”

Herr said the 65-and-over population will nearly double by 2030. Already, older adults make up the largest proportion of patients seeking care in acute care settings and the primary population of long-term care settings. As part of the lecture, “Quality Pain Care for All Older Adults: Progress and Future Directions,” School of Nursing Founding Dean Heather M. Young moderated the panel, who also engaged in conversation with the audience.

“This series is designed to feature topics in line with the school’s vision to transform health care through nursing leadership, education and research,” added Young. “With a condition that affects more Americans than diabetes, heart disease and cancer combined, we know we all have a lot to learn to advance our mission.”

Young collaborated with Scott Fishman, professor and chief of the UC Davis Center for Pain Medicine, to develop pain education competencies across all health care professional schools. That initiative has received international recognition and the center was recently selected by the American Pain Society as a 2015 Clinical Center of Excellence, recognizing pain care teams that provide outstanding, exemplary care for those with chronic pain disorders, acute pain after surgery or trauma, as well as in palliative care settings for pain from cancer and other terminal conditions.

“We took a bold step to commit and try to determine pain competencies for all health professionals,” said Fishman, who was member of the panel. “With a diverse group of experts we created a list of expected skill sets that any graduate from a health professional school should have. And these expectations apply to health care professionals across the spectrum.”

Judy Watt-Watson, professor emeritus at the University of Toronto Lawrence S. Bloomberg Faculty of Nursing, echoed Fishman’s sentiment that educating future providers before they leave school offers the best hope for progress in pain assessment and treatment.

“In clinical practice we work together, but we don’t learn together. If we don’t know what each member of the team can contribute, we are less effective,” said Watt-Watson. “We must focus on interprofessional education, because if we do what we’ve always done, nothing will change.”

Panelists David Copenhaver, pain medicine specialist and faculty member of the Anesthesiology and Pain Medicine Department at the UC Davis School of Medicine, and Timothy Cutler, professor of clinical pharmacy at UCSF, also shared their perspectives with and answered questions from audience members.

The Betty Irene Moore School of Nursing at UC Davis Lecture Series brings nationally recognized leaders to the UC Davis Sacramento campus to illuminate academic, research and clinical topics that advance health, ignite leadership and promote bold system change. This year’s series is sponsored by The Mayday Fund, a charitable organization dedicated to alleviating the incidence, degree and consequence of human physical pain, as well as the Nursing Science and Health Care Leadership Master of Science Class of 2014.

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UC Davis graduate nursing students present scholarship to dean

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Nursing science program ranked among best in West

UC Irvine honored by NurseJournal.org.

UC Irvine’s Program in Nursing Science has been ranked in the top 5 percent of 200 four-year bachelor’s programs in the western U.S. by NurseJournal.org in its annual survey of America’s best nursing schools.

Among comparable programs, it’s 10th in quality, seventh in satisfaction and fifth in value. Overall, it’s the highest-rated nursing program in Orange County.

“These rankings reflect the hard work and investment of our program’s dedicated faculty and staff,” said interim Director Alison Holman, a Robert Wood Johnson Foundation Nurse Faculty Scholar. “We are poised to launch into the next phase of our development with many new, exciting initiatives and programs on our horizon. We have a bright future ahead as we continue to focus on achieving excellence in research and teaching.”

Launched in 2007, the program provides academic and professional education in nursing and offers bachelor’s, master’s and doctoral degrees.

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UC Davis increases efforts to train nursing students to serve in underserved areas

Grant will further develop integrative case-based learning programs for clinical grad students.

By Jennette Carrick, UC Davis

The Betty Irene Moore School of Nursing at UC Davis has received a $150,000 grant from the Office of Statewide Health and Planning to continue developing an integrative case-based learning curriculum for its clinical programs. The school also received an additional $103,650 in one-time, special program funds to provide housing and travel funds for students doing clinical training in underserved areas of central and Northern California.

The granting program, part of the Song-Brown Health Care Workforce Training Act Nurse Practitioner and Physician Assistant Training Program, encourages universities and primary care health professionals to provide health care in medically underserved areas and provides financial support for programs like the School of Nursing’s family nurse practitioner and physician assistant curricula. The School of Nursing’s application ranked first out of thousands of public and private in California that applied for support.

“We were only a handful of schools that focused on the social determinants of health. It tells us that we’re on track with the types of initiatives that are important for the state of California,” said Debra Bakerjian, senior director for the School of Nursing’s nurse practitioner and physician assistant clinical programs. “Providing high quality primary care to the medically underserved are both goals of the office and consistent with the core values of our school.”

In addition to studying health-care concepts, conditions or diagnoses, School of Nursing faculty use case scenarios from real case examples of people living with real conditions that impact their health. The cases are developed so that none of the people are identifiable, yet the details of specific events in a context or situation promote an authentic learning experience. Professors incorporate family relations, regional geography, cultural competence and sociodemographic details, with the hope that students will better appreciate the impact of multiple systems on individual health and well-being.

“By seeing past the chronic condition to explore the bigger picture, students acquire a unique set of knowledge, skills and attitudes that enable them to administer care effectively and lead a team of caregivers,” added Mark Christiansen, director of physician assistant studies. “These cases serve as curricular threads that decrease course isolation and facilitate learning across the curriculum.”

Over the past 40 years, UC Davis graduated 1,800 nurse practitioners and physician assistants, with 67 percent of graduates working in underserved areas. Additionally, nearly 70 percent of graduates work in primary care, compared with significantly lower national averages of between 30 and 40 percent. The new grants will enable faculty to make current integrative case-based curriculum more interactive and more interesting.

“Our philosophy of team-based learning and a flipped classroom creates an environment where our students retain more of what they learn,” explained Virginia Hass, director for the nurse practitioner program. “If we can incorporate videos, short tests and avatars into the program, we can make it more real and more engaging for the students.”

School of Nursing faculty also will use the funding to implement a requirement into clinical rotations mandating students follow people throughout the continuum of care — from office, to hospital, to skilled nursing facility and back to office again.

The Song-Brown Health Care Workforce Training Act was established in 1973 to increase the number of family physicians to provide needed health-care services to the people of California. The program encourages universities and primary-care health professionals to provide health care in medically underserved areas, and provides financial support to family nurse practitioner, physician assistant and registered nurse education programs, as well as family medicine, internal medicine, OB/GYN, and pediatric residency programs throughout California.

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Cuba opens doors to its health care system for visiting nursing students

Cubans embrace UCLA visitors after news of closer ties between two countries.

Students and faculty from the UCLA School of Nursing visit Casa de Maternidad, a maternity home for women with high-risk pregnancies.

By Laura Perry, UCLA

The timing couldn’t have been better for 18 UCLA School of Nursing graduate students and two faculty members headed for Cuba on an educational mission. As they were boarding a flight to Havana from Miami on Dec. 17, big news was breaking: The U.S. was re-establishing diplomatic relations with Cuba, mending a break that has lasted more than 50 years.

One hour later, the UCLA group arrived in Havana, where they were greeted with exuberant hugs, kisses and tears of joy by an excited group of Cuban health leaders over the historic turn of events.

That was the auspicious beginning of a five-day, action-packed visit for the UCLA group. To learn about Cuba’s health care system, they met with physician-nurse teams, engaged in Pan American Health Organization-based discussions on major causes of illness and death, among other topics; and visited community-based consultorios, polyclinics and sex education centers as well as nursing and medical schools.

Eager to see different health care settings, they spent time at a home for seniors and a residence where women with high-risk pregnancies went to live to receive special care.

Ties between Westwood and Havana

This was not the first time that UCLA nurses have connected with their counterparts in Cuba. In 2011, Maria Elena Ruiz, assistant adjunct professor at the school, attended an International Health Conference in Cuba as a member of the American Public Health Association. Through those meetings, she saw firsthand how a first-world, prevention-focused primary health care system functions with third-world economics.

When she returned to UCLA, Ruiz, together with Adey Nyamathi, associate dean for international research and scholarly activities, developed a program that would provide similar experiences for nursing students, who would receive partial credit for a public health course, complete required readings, participate in pre- and post- conferences, and write daily reflective papers.

How do they do it?

Cuba, the UCLA nurses learned during their visit last December, is a third-world country with some impressive health outcomes, including an overall life expectancy that rivals that in the U.S. (78.4 years for Cubans versus 78.6 years for Americans), immunization rates that are nearly 100 percent and low infant mortality. Yet their health care costs per capita are nearly 15 times lower than that of the United States.

Primary care and an emphasis on prevention are key to the success of the Cuban health care system.

“Their system shows how primary care really does work,” said student Vladimir Camarce.  “And when implemented correctly, you can see great outcomes. Historically, the U.S. system has been focused on acute and tertiary care, but we are now starting to see a shift with the Affordable Care Act.”

In Cuba, public service announcements about health are shown daily on television. “They don’t have traditional television commercials like we do here, so the government uses the opportunity to deliver messages about hygiene or reminders on vaccines,” observed student Stephanie Phan.

Another reason for Cuba’s success is its focus on personalized, community-based care. Doctors and nurses work as a team and live in the communities they serve.  They might see patients in a clinic in the morning, said graduate student John Scholtz, and then visit patients who can’t get to the clinic at home “to ensure that they are receiving their checkups and following through with the recommendations.”

The students also noted the personal nature of health care in Cuba. “Patients are referred to by name,” said Phan, “not by ‘the patient in room 11′ …  They told us, ‘They’re not patients, they’re people.”

There is also a strong integration of traditional, herbal and western medicine. It’s all considered good health care. “I believe we should find a way to incorporate that integration into our practices because we do get a lot of patients who use complementary therapies,” said Camarce.

What amazed the students was that the Cubans achieve all this with a scarcity of equipment and health resources. “They don’t have the equipment we have, the technology we have or the pharmaceutical industry,” noted student Jacqueline Marroquin. “They make do with so little, but they are able to accomplish so much.”

“What medical equipment is available resembles a scene from the old MASH television series,” said Ruiz. “And yet we were overwhelmed with the kindness and eagerness of our hosts to share their health experiences with us.”

Also surprising: On average, nurses and doctors make only $20-$30 a month.  But their education and housing are free or subsidized, and they don’t have student loans to pay off.

“In the U.S., you wouldn’t have a lot of people pursuing these professions for that kind of pay,” said Scholtz. “But in Cuba, you have a lot of people interested in being doctors or nurses. They go into it because they want to make a difference in their community.”

Part of the reason why the Cuban system works is the collectivist-based culture and the population perspective, the students said. Many things that have been adapted in Cuba, however, wouldn’t work in the U.S.  “We might be able to integrate some of the ideas in a micro-community,” suggested Marroquin.

Leaving behind impressions — and hand sanitizers

While the students were there to learn, they also taught Cubans something about Americans.  “Our interactions showed them that we were open to ideas and willing to learn from them,” said Scholtz. On a more tangible note, the group left behind hand sanitizers.  And pens. Lots of them.  “There is a real need for basic hygienic supplies, everything we take for granted,” added Ruiz.

But more importantly, the UCLA visitors came away with a new resolve. “As nursing students, as nurses, we really need to understand what is going on across our borders,” said Marroquin.

Nyamathi added:  “These students are now motivated to make a difference, to learn more about other countries and to question our health system, health care costs, disparities, and what we can learn from others to improve health and health care in the U.S.”

It’s also a hope that, with the dawning of warmer relationships with Cuba, the U. S. health care community may be able to learn a lot more from their neighbor, they said.

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UC Davis honors Rising Nurse Leaders

Two-year program builds next generation of nursing leaders.

Joining in for a photo with the Rising Nurse Leader graduates were program manager Kathleen Guiney (seated left) and Chief Nursing Officer Carol Robinson (seated left center).

By Charles Casey, UC Davis

More than a dozen highly accomplished nurses shared the spotlight this week during graduation ceremonies for UC Davis’ Rising Nurse Leaders program. The graduates were honored for completing a two-year, part-time program that provided each of them with the knowledge, skills and mentored guidance necessary to effectively lead and shape the future of nursing at UC Davis Health System.

The graduation event was part of the health system’s Rising Nurse Leaders Institute, which provides nurses with interactive and instructive activities that are focused on decision making, change management, leadership skills and communication techniques. As part of the festivities, the graduates presented their findings and accomplishments about the specific projects they worked on.

“Each of you can help us improve outcomes and build stronger clinical care teams,” said Carol Robinson, chief of patient care services, in her remarks at the event. “We’re going to be following your lead and making your ideas and suggestions a reality.”

The Rising Nurse Leaders initiative is a unique and challenging program that provides participants with career planning, seminars, professional coaching, and peer networking experiences. With its emphasis on mentored training and learning, the program is designed to prepare nurses to be more effective and inspired agents of change in their work environments.

“The goal of our program is to build the next generation of nursing leaders,” said Kathleen Guiney, who serves as the program’s manager. “We want to encourage leadership and change management skills, which are required in order to affect and sustain positive change at the point of care.”

During the first year of the program, participants attend quarterly seminars and a monthly leadership salon. During the second program year, the nurses work on a professional development/patient-related improvement project as well as attend quarterly educational seminars. Coaching and mentorship is offered for both program years.

The Rising Nurse Leaders program is open to all career-nursing employees (CN II, CN III, AN II) who have at least two years of service and meet several other criteria. It is designed for individuals who have demonstrated a long-term commitment and passion to enhance the practice of nursing at UC Davis Health System.

For more information, visit www.ucdmc.ucdavis.edu/cppn/professional_connections/rising_nurse_leaders.html.

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UCSF nursing expands palliative care training

Nursing school starts palliative care minor for advanced practice nursing students.

UCSF School of Nursing professor DorAnne Donesky works with a patient, teaching her to exercise safely without overtaxing her lungs. (Photo by Elisabeth Fall)

By Kathleen Masterson, UC San Francisco

People who live with serious chronic illness often bounce in and out of the hospital, struggle to get the treatment they need and overall experience a poor quality of life.

Now, increasing research is supporting what many health care providers have long known: comprehensive palliative care that treats both symptoms and a person’s emotional needs can significantly improve a patient’s daily life – and in many cases prolong life, too.

These known successes are a big part of why the UCSF School of Nursing started a new palliative care minor for advanced practice nursing students.

The recent push also came from both hospitals looking to hire and nursing students who asked for more palliative care training, said DorAnne Donesky, Ph.D., ANP-BC, a nursing professor who spearheaded the creation of the minor with palliative care physician Wendy Anderson, M.S., M.D.

“Employers also came to us saying, ‘We’re hiring lots of palliative care providers and new graduates who are coming to us are not well prepared,’” said Donesky. Hospital hiring teams told Donesky that they would hire nurses specifically trained in palliative care first if they were choosing between multiple job candidates.

Donesky has seen the benefits of palliative care firsthand with her patients who have chronic lung and heart conditions.

She recalls one patient diagnosed with Chronic Obstructive Pulmonary Disease and heart failure whose doctors gave her a few months to live. The patient was put on hospice, given medication and nonpharmacologic strategies for symptom control and trained with breathing techniques. With this simple but attentive care, she “graduated” from hospice and a year later she’s medically stable, enjoying her family, home and daily gym exercise.

Meeting a growing need

The UCSF palliative care minor is designed to match the national competencies for palliative care so students can take the certification exam.  The minor includes two base courses and an elective, and Donesky also works with students to get them a clinical placement with a palliative care faculty mentor.  For certification students need 500 hours of practice, which they begin to accumulate during the minor.

Palliative care focuses on treating the whole patient with the goal of improving quality of life by addressing everything from symptoms to emotions to family members’ concerns. Research has shown that palliative care improves patients’ symptoms, including pain and depression. And some data suggest that compared to regular care, it prolongs life.

“People are realizing that symptom management and quality of life are really important, separate aspects of care,” said Donesky.

In addition to offering patients standard medications for pain and symptoms, palliative care nurses also teach patients non-pharmaceutical approaches to managing their own health. Donesky said her patients with lung illnesses benefit from learning simple breathing techniques and incorporating exercise into their daily routines. These successes aren’t only good for the patient, it also helps to avoid unnecessary and costly emergency department visits and lengthy hospital stays. While this coordinated care relies on a team of health care providers, in most cases it’s more efficient and more cost effective.

“Palliative care is a team sport,” said Donesky; the core team typically includes a nurse, a physician, a chaplain and a social worker, but varies depending on a patient’s needs. Together these providers work to give patients back some control over their health by training them with techniques to manage pain and self care.   

Donesky said when people hear palliative care, many think of the dying.  While hospice does provide palliative care for end of life patients, palliative care as a whole is really about creating the best quality of life for patients with acute or chronic illnesses or cancer that can be managed, sometimes for years or decades.

Treating the emotional side, too

Oftentimes a big part of treatment is helping patients cope with the emotional distress that their diagnosis brings up.

“A lot of patients are in distress related to relationships that have not been mended, or thinking about where their place is in the world, will their life have meaning, what will be their legacy after they’re gone. Those more spiritual issues are also addressed in palliative care,” said Donesky.

That’s why a big focus of the UCSF palliative care minor is communication skills, from difficult conversations with patients’ families to addressing a patient’s emotional concerns.

Donesky has an extensive background in navigating these kinds of health care communications, including ongoing training with VitalTalk, a highly respected training program that developed out of NIH-funded research. She’s incorporating these techniques in teaching her students.

“As clinicians, it’s scary to talk about these topics, we might be afraid we’re going to open a can of worms,” said Donesky. “But if instead of resisting, we jump in, and say, ‘I suspect you’re having concern with: fill in the blank.’ Often, it just opens the floodgates, and it doesn’t take that long to solve it.”

Donesky said employers specifically want to hire nurses who have advanced training in managing and negotiating these kinds of conversations.

UCSF nursing master’s student Julia Itsikson agrees.

“I believe communication is a cornerstone of this whole program,” Itsikson said. “This is really the bottom line, how do you approach sensitive topics at critical pivotal moment of somebody’s life — it’s not easy.”

Itsikson was accepted into the palliative care minor, which just began this quarter. In addition to coursework, Itsikson is doing clinical work at Laguna Honda Hospital and Rehabilitation Center, where there’s an entire unit that focuses on palliative care.

Itsikson said learning firsthand from an experienced nurse has been invaluable: “I watch my preceptor and it just blows me away every time; the words she finds, her mannerism, her tone of voice – all of this is so critical and important.”

Donesky said as the palliative care minor becomes more established, she’d like to create a multidisciplinary continuing education training that would be open to all kinds of health care providers, including nurses, social workers, chaplains, pharmacists, physical therapists and dentists.

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Bridge builder

Ellen Olshansky excels at forging bonds between university, community health organizations.

“My goal is to build partnerships with community-based groups,” says Ellen Olshansky, professor and founding director of nursing science at UCI. “I want to ask ‘How can we work together?’ It’s the difference between doing research ‘with’ and doing research ‘on.’” (Photo by Steve Zylius, UC Irvine)

Since joining UC Irvine in 2007 to launch the nursing science program, Ellen Olshansky has flourished as a highly respected county leader for community-based research and women’s health policy. And much of it started at her kitchen table five years ago.

There, in her University Hills home, Olshansky brought together Susan Bryant and Karol Gottfredson of UCI and Allyson Sonenshine and Stephanie Kight of Planned Parenthood of Orange & San Bernardino Counties to share ideas about what they could do to champion women’s health issues. Brainstorming over white wine, cheese and crackers, they outlined what would become the Orange County Women’s Health Project.

With aggressive planning and outreach by these five women, the OCWHP kicked off in 2011. In May 2012, it hosted the inaugural Orange County Women’s Health Policy Summit, at which a UCI alumna presented “A Snapshot of Women’s Health in Orange County” – the first-ever such survey.

The project’s partners have since formed task forces for breast and cervical cancer, teen reproductive health, and health and domestic violence. The work is paying dividends: Earlier this year, Blue Shield awarded the OCWHP $2 million to establish a countywide, integrated and collaborative system that will strengthen healthcare response to domestic violence and streamline service.

“Ellen was instrumental in getting the project off the ground – introducing the vision and doing the outreach and creating momentum,” says Sonenshine, OCWHP director. “We’ve developed a wonderful model that’s focused on data analysis, policy and education, and we play an increasingly important role.”

Now Olshansky is applying her bridge-building talents at UCI’s Institute for Clinical & Translational Science.

Supported by a prestigious Clinical & Translational Science Award from the National Institutes of Health, the ICTS is dedicated to advancing efforts to turn scientific discoveries into new methods, treatments and cures to improve public health. One of its most important objectives is community engagement, and that’s where Olshansky comes in.

“My goal is to build partnerships with community-based groups,” she says. “I want to ask ‘How can we work together?’ It’s the difference between doing research ‘with’ and doing research ‘on.’”

ICTS Director Dr. Dan Cooper says Olshansky is the perfect person at the perfect time to lead the community engagement push.

“Ellen has a long history of collaborating with the community, and her work is based upon having real dialogue and understanding among groups that don’t always speak the same language,” Cooper says. “She has remarkable skills in translating and expressing to faculty the community needs that impact health directly. Being a facilitator between these two groups is invaluable to us.”

To boost outreach, the ICTS is a founding partner of the Orange County Alliance for Community Health Research, which consists of the leaders of local, community-based organizations; practicing physicians; healthcare agencies; governmental representatives; community groups; and UCI researchers.

The alliance’s purpose is to create an infrastructure in Orange County that increases the ability of community organizations and universities to engage in health research that’s designed by the community to meet the needs of the community. Olshansky serves on its advisory board.

“At the heart of the alliance is the belief that the community first expresses its health needs, and then university researchers work with these partners to find solutions,” she says. “That’s what community-based research is all about, and I’ll be working diligently to further establish those relationships in Orange County.”

Earlier this year, Olshansky stepped aside from directing UCI’s Program in Nursing Science, where over seven years she oversaw the initiation of the bachelor’s program and the approval and initiation of the master’s and doctoral programs. She also spearheaded the effort to include nurse practitioner concentrations in the master’s program.

And during a recent sabbatical, Olshansky put the finishing touches on her latest book, Women’s Health & Wellness Across the Lifespan. Set for release on Dec. 11, it offers a historical and comprehensive look at women’s health – politically, socially, legally and medically – through contributions from leading experts across the country.

“This book is important because it explains the reasons why it’s necessary to have a focus on the issue of women’s health,” Olshansky says. “There has been such political push-back on sexual and reproductive health services, and we need to be sure that we continue to provide and strengthen these services.

“But many people believe that’s all women’s health is about. In fact, it’s much more than that, and this book goes in depth into the many other important issues women face. It’s written mostly for primary care physicians and nurse practitioners, but I believe anyone interested in women’s health will benefit from reading it.”

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UC Davis recognized for reduction of pressure ulcers

Incidence drops to historic low.

A decrease in the rate of hospital-acquired pressure ulcers at UC Davis Medical Center has earned a Performance Excellence Award from the Collaborative Alliance for Nursing Outcomes (CALNOC).

The award is being presented at CALNOC’s annual conference today (Oct. 28) in San Diego.

Hospital-acquired pressure ulcers (HAPUs) are a national concern due to patient morbidity, treatment cost and reimbursement issues. They are considered among the eight preventable conditions identified by the Centers for Medicare and Medicaid Services (CMS). The cost of treating a hospital-acquired pressure ulcer places a significant burden on health care facilities. Associated expenses potentially include increased supplies, equipment, specialty beds, staffing, nutritional support, laboratory testing and hospital length of stay.

During the third quarter of 2014, only one patient at UC Davis Medical Center had a hospital-acquired pressure ulcer, a rate that is well below the historical level for UC Davis and for hospitals nationwide.

From July through September, the hospital had only one patient with a hospital-acquired pressure ulcer. This gave UC Davis Medical Center a rate of lower than 0.5 percent for the period. Historically, the rate of pressure ulcers at the medical center has been at about 2 percent or higher since 2011, but has been falling, said Holly Kirkland-Walsh, a wound care nurse practitioner.

“Our low rate of pressure ulcers is an outstanding achievement, and reflects the dedication and hard work of many, especially our Wound Care Team,” said Carol Robinson, chief patient care services officer.

The University HealthSystem Consortium has designated a level of lower than 1.1 percent as a rate that’s within the top quartile of all hospitals.

Kirkland-Walsh attributes the improvement of the ulcer rate at UC Davis to the use of a multidisciplinary team to promote prevention, and changes in hospital policy. The team consists of plastic surgeons, nurse practitioners, wound-certified nurses, physical therapists and dietitians.

The hospital policy promotes early intervention and recognition of pressure ulcers by nurses who, together with physicians, stage and document pressure ulcers present at admission. Nurses also intervene early by ordering specialty-bed surfaces and supplies without waiting for a physician order.

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