TAG: "Nursing"

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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Program to reduce hospital readmission doesn’t have impact, study finds


UCSF researchers recommend hospitals evaluate such programs before implementing.

Researchers at UC San Francisco have found that a nurse-led intervention program designed to reduce readmissions among ethnically and linguistically diverse older patients did not improve 30-day hospital readmission rates. Their findings suggest hospitals evaluate such programs before implementing or continuing.

Their study is in the Oct. 7 issue of Annals of Internal Medicine.

“The lack of effect in this population, which was well connected to primary care, suggests reducing readmissions is challenging,” said co-lead author L. Elizabeth Goldman, M.D., M.C.R., associate professor in the UCSF Division of General Internal Medicine at San Francisco General Hospital and Trauma Center (SFGH). “Our findings should give pause to hospitals adopting interventions shown to work in dissimilar populations and settings without evaluating their effect and should prompt consideration of alternate or additional approaches to reducing readmissions in populations with significant medical co-morbidity and language diversity.”

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UC Davis nursing school welcomes its newest grad students


School honors University of Washington nurse scientist with annual leadership award.

(From left) Heather Young, dean of the Betty Irene Moore School of Nursing at UC Davis, presents nurse scientist Brenda K. Zierler with the 2014 Excellence in Leadership Award.

Nutrition, nursing and public health are just some of the fields represented by the 63 new students entering the four graduate programs at the Betty Irene Moore School of Nursing at UC Davis. The students make up is more than professionally diverse, though, said Dean Heather M. Young, as she formally welcomed the group at the annual Welcoming Ceremony on Tuesday evening (Sept. 23).

“You range in age from 23 to 53. Some of you work for local health systems, some of you work in care centers. Others of you work in public health or provide care in our state prisons.” Young said. “Each of you is here because of what you bring to this school. You came here to be transformed as health care leaders, but at the same time, you also transform each other and all of us at the Betty Irene Moore School of Nursing and UC Davis.”

The incoming fall 2014 classes include eight doctoral students, 20 physician assistant students, 25 master’s degree leadership students and 10 nurse practitioner students — moving the school’s total enrollment to 135.

The Nursing Science and Health-Care Leadership Graduate Group prepares nurse leaders, primary care providers, researchers and faculty in a unique interdisciplinary and interprofessional environment. As with other graduate groups at UC Davis, this program engages faculty from across the campus with expertise in nursing, medicine, health informatics, nutrition, biostatistics, public health and other fields. Currently, the graduate group includes more than 45 faculty.

Brenda K. Zierler, a University of Washington nurse scientist, was honored with the Betty Irene Moore School of Nursing at UC Davis 2014 Excellence in Leadership Award. The award is annual highlight at the Welcoming Ceremony.

Nationally recognized for her work examining education systems for health professionals, Zierler’s research explores the relationships between the delivery of health care and outcomes — at both the patient and system levels.

Young said she was thrilled to name Zierler to the award, not only for her national work in interprofessional education, but for her partnership with UC Davis as well.

“Dr. Zierler has worked with both the School of Nursing and the School of Medicine to help us identify how we can improve our curriculum so that students are exposed to more interprofessional opportunities throughout their education,” Young said.

Her primary appointment is in the School of Nursing at the University of Washington, but Zierler also serves in three adjunct appointments at UW — two in the School of Medicine and one in the School of Public Health. Currently, she is a co-primary investigator on a Josiah-Macy-funded grant with physician Leslie Hall to develop a national train-the-trainer faculty development program for interprofessional education and collaborative practice. She also leads two HRSA training grants — one focusing on technology-enhanced interprofessional education for advanced-practice students and the second focused on interprofessional collaborative practice for advanced heart failure patients at UW’s Regional Heart Center.

“I am interested in improving the quality and safety of health care delivery for all,” Zierler said. “Interprofessional education and collaborative practice are a means to meet these goals. Improving communication, coordination and collaboration of care can improve the quality and safety of care.”

Zierler said the future is bright for students of the Betty Irene Moore School of Nursing.

“This is a true learning organization with excellent faculty leadership that takes a student-centered approach to education and a patient-population-centered approach to providing care,” Zierler said. “This school is the model for the future in nursing.”

The school recently opened applications for fall 2015 master’s-degree leadership and doctoral programs. For more information, visit the school’s website at nursing.ucdavis.edu.

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Higher nurse-to-patient standard enhances staff safety


Study finds drop in occupational injuries to nurses after mandated staffing ratios in California.

J. Paul Leigh, UC Davis

A 2004 California law mandating specific nurse-to-patient staffing standards in acute care hospitals significantly lowered job-related injuries and illnesses for both registered nurses and licensed practical nurses, according to a UC Davis study published online in the International Archives of Occupational and Environmental Health. The study is believed to be the first to evaluate the effect of the law on occupational health.

“We were surprised to discover such a large reduction in injuries as a result of the California law,” said study lead author J. Paul Leigh, a professor of public health sciences and investigator with the Center for Healthcare Policy and Research at UC Davis. “These findings should contribute to the national debate about enacting similar laws in other states.”

California is the only state in the country with mandated minimum nurse-to-patient staffing ratios. They are established based on type of service (such as pediatrics, surgery, or labor and delivery) and allow for flexibility in cases of health care emergencies. (The ratios are available on the California Department of Public Health website.)

According to Leigh, some hospitals have argued against extending the law to other states because of the increased costs of additional nursing staff. There is also no consensus that the law has improved patient outcomes, which was its primary intent. Some studies show improvement, while others do not.

“Our study links the ratios to something just as important — the lower workers’ compensation costs, improved job satisfaction and increased safety that comes with linking essential nursing staff levels to patient volumes,” Leigh said.

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Study shows evidence that sleep apnea hurts brain


UCLA researchers find that people suffering from sleep apnea have weaker brain blood flow.

This brain scan shows that the brain blood flow in a subject with obstructive sleep apnea (left) is markedly lower compared to a subject without the sleep disorder.

Employing a measure rarely used in sleep apnea studies, researchers at the UCLA School of Nursing have uncovered evidence of what may be damaging the brain in people with the sleep disorder — weaker brain blood flow.

In the study, published Aug. 28 in the peer-reviewed journal PLOS ONE, researchers measured blood flow in the brain using a non-invasive MRI procedure: the global blood volume and oxygen dependent (BOLD) signal. This method is usually used to observe brain activity.  Because previous research showed that poor regulation of blood in the brain might be a problem for people with sleep apnea, the researchers used the whole-brain BOLD signal to look at blood flow in individuals with and without obstructive sleep apnea (OSA).

“We know there is injury to the brain from sleep apnea, and we also know that the heart has problems pumping blood to the body, and potentially also to the brain,” said Paul Macey, associate dean for Information Technology and Innovations at the UCLA School of Nursing and lead researcher for the study. “By using this method, we were able to show changes in the amount of oxygenated blood across the whole brain, which could be one cause of the damage we see in people with sleep apnea.”

Obstructive sleep apnea is a serious disorder that occurs when a person’s breathing is repeatedly interrupted during sleep, hundreds of times a night. Each time breathing stops, the oxygen level in the blood drops, which damages many cells in the body. If left untreated, it can lead to high blood pressure, stroke, heart failure, diabetes, depression and other serious health problems. Approximately 10 percent of adults struggle with obstructive sleep apnea, which is accompanied by symptoms of brain dysfunction, including extreme daytime sleepiness, depression and anxiety, and memory problems.

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Three UC schools receive grants to prepare doctoral nurses


Part of initiative supporting IOM goal to double number of doctorally prepared nurses.

Three University of California nursing schools are among only 14 nationwide to receive the first grants from a new Robert Wood Johnson Foundation (RWJF) program to increase the number nurses with Doctor of Philosophy degrees.

The recipients of the Future of Nursing  Scholars grants include the nursing schools at UC Davis, UCLA and UC San Francisco. Each UC school will select one student to receive financial support, mentoring and leadership development over the three years of their Ph.D. programs. Some schools will select more than one student, supporting a total of 17 students initially. The Future of Nursing Scholars program expects to support up to 100 doctoral nursing candidates over its first two years.

The Future of Nursing Scholars program is supported by several funders. In addition to RWJF, United Health Foundation, Independence Blue Cross Foundation, Cedars-Sinai Medical Center and the Rhode Island Foundation all provide financial support.

“We are honored to be included as one of the first nursing schools to receive the Future of Nursing Scholars grants, especially as a new school that this year graduated our first Doctors of Philosophy,” said Heather M. Young, associate vice chancellor for nursing and dean of the Betty Irene Moore School of Nursing at UC Davis. “Being a part of the Future for Nursing: Campaign for Action has brought home to me the importance of increasing the number of doctorally prepared nurses in the nation. This effort goes a long way toward promoting that goal. It’s a wonderful way to create community among doctoral scholars who will be our future leaders.”

In its landmark nursing report, the Institute of Medicine recommended that the country double the number of nurses with doctorates; doing so will support more nurse leaders, promote nurse-led science and discovery, and put more educators in place to prepare the next generation of nurses.

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Sen. Boxer highlights efforts to prevent medical errors


She visits UCSF Medical Center.

U.S. Sen. Barbara Boxer (second from right) tours UCSF Medical Center on July 2 to learn how it is working to reduce preventable deaths. Susan Barbour (left), R.N., talks about pressure ulcer prevention. (Photo by Cindy Chew)

Every year, between 210,000 and 440,000 Americans die as a result of preventable errors in hospitals, according to a special report released at UC San Francisco by Democratic Sen. Barbara Boxer.

She presented the updated report detailing the most common and harmful errors at our nation’s hospitals and highlighted what UCSF Medical Center is doing to prevent them.

“We have the opportunity to save not just one life, but to save hundreds of thousands of lives,” Senator Boxer said during her visit to UCSF Medical Center on July 2. “Many people will be shocked to hear this, but medical errors are one of the leading causes of death in America today. These deaths are all the more heartbreaking for families because they are preventable.”

Boxer said she is grateful to UCSF for the steps it has taken to save patients’ lives.

“If we all work together – doctors, nurses, hospital administrators, patients, patient advocates, medical technology pioneers, public health experts and federal officials – we can prevent so much heartbreak for families and stop these tragedies before they occur,” said Boxer at a press conference following a tour of UCSF Medical Center.

Preventable errors in hospitals, such as hospital-acquired infections, adverse drug reactions, patient falls and bedsores, total $19.5 billion annually and that the economic costs of medical errors, including lost productivity, could be as much as $1 trillion a year, according to Boxer’s report.

“We’re one of the nation’s top hospitals,” said Mark R. Laret, CEO of UCSF Medical Center and UCSF Benioff Children’s Hospitals. “But that is meaningful only as it relates to every single patient who walks through our doors, and how we administer their care, follow up and safety. We’re proud of the great strides we’ve made as a leader in patient safety and to partner with Senator Boxer to help all hospitals become places where safe care is offered to every patient, every day.”

While touring UCSF Medical Center, Senator Boxer was shown the interdisciplinary approach UCSF takes to address major hospital issues such as sepsis, ulcer prevention, medication errors and hand hygiene.

As part of its interdisciplinary approach, UCSF creates teams comprised of nurses, pharmacists, doctors and medical center leaders, in addition to staff in medical records and environmental services. Those teams focus on understanding the underlying causes that may have allowed an error to occur and on collaborative problem solving. An open discussion ends with a clear action plan, which might involve implementing a new system, purchasing a piece of equipment, or training doctors and nurses in communication strategies.

UCSF processes and results for sepsis prevention

Sepsis is a potentially fatal, full-body inflammation caused by infection, and one of the main sources of sepsis is hospitals themselves.

“At UCSF we now treat sepsis as a true emergency with a focus on immediate interventions proven to help patients,” said Joshua Adler, M.D., chief medical officer at UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. “This approach has involved innovations in our electronic health record systems, use of rapid response personnel, novel nursing protocols, and continuous evaluation of our performance.”

UCSF’s electronic sepsis surveillance system continuously searches for warning signs, alerts clinicians to the potential presence of sepsis, and provides a means to activate “Code Sepsis”. The Code Sepsis team – a rapid response team, critical care nurse practitioner, and pharmacist – has helped UCSF to treat sepsis as an emergent situation requiring immediate attention and action. “With this approach we have reduced the mortality rate for sepsis by nearly 25 percent since 2012,” Adler said.

Processes and results for ulcer prevention

Ulcers resulting from being bedridden, and thus immobile for a lengthy time, are an ongoing challenge for hospitals. In addition, to training all patient care providers in pressure ulcer prevention, UCSF conducts quarterly pressure-ulcer prevalence study days. On these days, every patient in the hospital is examined for evidence of a pressure ulcer. The total number of pressure ulcers counted is divided by the total number of patients examined to obtain a percentage of patients with pressure ulcers.

UCSF has reduced the rate of hospital acquired pressure ulcers among adult and pediatric patients by 79 percent, from 4.98 percent in fiscal year 2008 to 1.03 percent in fiscal year 2014.

Preventing inpatient medication errors

In 2011, UCSF launched what is believed to be the nation’s most comprehensive automated hospital robotic pharmacy that is designed to prepare and track medications, with the goal of improving patient safety. The pharmacy operation is now linked to the electronic health record system, creating an end-to-end electronic system in which a nurse at the bedside scans the barcode on the patient’s wristband, scans the medication and then scans the bar code on his/her own ID badge. Only after confirming all the information matches is the medication administered. UCSF administers over 10,000 doses of medication daily.

“The barcoding system is a way to minimize the potential for an error at every step of the medication delivery process,” said Laret.

Hand hygiene training and surveillance

Hand hygiene is considered one of the most effective approaches for reducing hospital-related infections. In July 2010, UCSF implemented a hand hygiene education and surveillance program. Since then the rate of hand hygiene has improved from 75 percent to about 92 percent each month. The data are collected and monitored by cameras in some hospital areas, and a daily report is distributed. Some floors even feature real-time monitoring that displays hand hygiene compliance rates.

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Sen. Boxer praises UC efforts to prevent medical errors

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