UCSF students drawn to San Francisco’s legacy of social justice.

“UCSF attracts a special type of student,” says dentistry professor Steve Silverstein, D.D.S., M.P.H., a public health veteran. “They’re drawn to San Francisco for its legacy of social justice, and they give back while they’re here because it’s in their DNA.”

The many ways in which UCSF students reach out to the community are as diverse as the city itself, from combating hepatitis B to hosting radio shows about science careers. These efforts fill a void for the underserved, and can also spark revelations for students about the social determinants of health – the cultural, economic, genetic and behavioral factors that threaten the well-being of entire communities.

Vivian Sha, N.P.C., just completed a full year’s immersion in community health at Glide Health Services, located in the Tenderloin district of San Francisco. Managed by nurses, the federally qualified center provides vital primary care to some of the city’s most impoverished patients – and mentors students like Sha, who seek to treat the underserved as part of their training.

Three years ago, Glide expanded its scaffold for these trainees by partnering with the UCSF School of Nursing in a joint nurse practitioner residency, among 10 programs nationwide to receive a three-year Health Resources and Administration grant. Sha was one of the program’s first two graduates.

“Community health is different. The pace is faster, there are a lot of elements, and there’s not much support,” says Pat Dennehy, R.N., M.S. ’99, D.N.P., UCSF nursing professor and Glide’s director. New graduates often require more mentoring; without it, they tend to leave safety-net practices, she explains. “Our program strives to provide that support.”

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Related links:

• UCSF Magazine
• UCSF Committed to the City

UCLA nursing hosting event April 11-13.

New findings on the role gender plays in the diagnosis, treatment and prevention of heart disease will be among the research topics highlighted by faculty members and students from the UCLA School of Nursing at the annual Western Institute of Nursing Conference, which runs from April 11 to 13 in Anaheim.

At a special state-of-the-science panel on Saturday, April 13, UCLA professor Lynn V. Doering will present a review of gender differences in identification, treatment and outcomes for cardiovascular disease, with a focus on coronary atherosclerosis, heart failure and stroke. During the same panel, UCLA professor JoAnn Eastwood will introduce her novel study in which she is partnering with a community organization and using mobile health technologies to reduce cardiac risk factors among young minority women.

“Cardiovascular disease is the No. 1 killer of women and accounts for more female deaths than all cancers and lung disease combined,” Doering said. “Heart disease — particularly its symptoms — presents differently in women, and it is not so obvious in current testing, so it is harder to diagnose. The cutting-edge work that is being presented will provide critical information on diagnosis, treatment and prevention of cardiovascular disease in women.”

Also during the three-day conference, UCLA School of Nursing faculty and doctoral students will present symposia on health care and nursing education for vulnerable populations and on the behavioral symptoms of dementia.

During the symposium “Cultivating Nurse Leaders: A Framework for Nursing Education in Vulnerable Populations” on Friday, April 12, three UCLA nursing researchers will discuss their work on finding ways to eliminate the cultural, financial and language barriers that impact health care delivery. Health disparities continue to exist among vulnerable populations, the researchers stress, and addressing inequities requires mentoring and guiding new nurse–scientists to conduct research in this important area.

On Saturday, April 13, “Promoting the Health of Vulnerable Populations” will take a look at the challenges of meeting the health care needs of four vulnerable populations: homeless men on parole, homeless men and women who suffer from frailty, methamphetamine users who are mothers, and American Indians suffering effects of abuse.

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These hybrid health care providers are increasingly common — and increasingly critical.

Afflicted with pulmonary arterial hypertension and having great trouble breathing, Carol Volckmann was unable to get much help from the physicians near her home in the Cascade Mountains in Washington State. Desperate, she began consulting physicians elsewhere and ultimately chose UCLA pulmonologist Dr. Rajan Saggar.

Volckmann says the result was “excellent care,” as well as a new and vital member of her health-care team: Kathy McCloy M.S.N. ’96, one of 160 nurse practitioners (NPs) spread across the UCLA Health System.

“Dr. Saggar prescribed very aggressive medication for my treatment. Then Kathy came in and spent a lot of time with me and my husband, making us feel comfortable,” explains Volckmann, who speaks with Mc-Cloy regularly from Washington. “This could all be very scary, but we don’t feel scared because we know she’s right there for us.”

Hundreds of miles south and a world away at the UCLA School of Nursing Health Center at the Union Rescue Mission in downtown Los Angeles, nurse practitioner Hannah Bampton M.S.N. ’11 spends Wednesday nights on the women’s and family floor, where the homeless families stay.

“I’m available all night for families that need to be seen for anything,” she says. “By doing that, we’ve decreased the number of unnecessary urgent-care visits. Someone might call 911 if there was no one there, but with a night nurse there, the kid doesn’t need to go to an ER, because I’m going to help him here. I’m physically there with them.”

McCloy and Bampton are a new breed of healthcare provider that figures to play a pivotal role in health-care reform in this country. Increasingly, it is a nurse practitioner that patients see when they go to their doctor’s office. They visit them at the Minute Clinic at CVS stores and in the hospital. In fact, more than 600 million visits are made to the nation’s 155,000 nurse practitioners every year.

Those visits are going to skyrocket as 35 million new patients enter the system in the next few years via the Affordable Health Care Act. At the UCLA School of Nursing, this vital new front in health care is taking shape.

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Hybrid online and in-person course led by Betty Irene Moore School of Nursing.

Instructor Piri Ackerman-Barger facilitates one of the course's three live class sessions.

For the first time, graduate students in nursing programs across the University of California system learned together as part of a hybrid — online and in-person — course led by the Betty Irene Moore School of Nursing at UC Davis.

Graduate nursing students from UC Davis, UC Irvine and UC San Francisco participated in the course, Methods for Teaching Nursing and Health Sciences: Assessment/Evaluation of Learning, during the 2013 winter quarter. The students and instructor interacted primarily online, through discussion boards, peer- review assignments and other Web-based features. In addition, all students and the instructor took part in three live class sessions, using Web-based video conferencing technology to connect the three participating campuses. The course is considered a hybrid, as it combines elements of online and in-person education.

“This class is breaking new ground for UC nursing education and there is a definite need for it,” said Piri Ackerman-Barger, the nurse scientist and consultant who teaches the class.

The collaboration grew out of the UC Nursing Cross-Campus Task Force, convened by the UC Office of the President and designed to cultivate ideas for collaboration across UC campuses. Together, the nursing programs decided to pilot a collaborative elective course.

This course is also part of a larger movement to expand online education across the University of California system. In January, the UC Board of Regents pledged in the coming years to expand the number of online courses UC offers, as a way to leverage existing resources to enroll more students in the courses they need.

A January UC Office of the President report to the UC Board of Regents states that the potential for cross-campus enrollment is a major benefit of online education.

“Students are able to take advantage of academic expertise or unique course offerings from across the system, greatly increasing the richness of their UC education,” the report states. “For some niche courses, local student enrollment alone may not support the course, but combined online enrollments across UC would enable the offering.”

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UCLA nursing professor co-authors World Health Organization report.

Linda Sarna, UCLA

Nurses and midwives can play a critical role in lessening people’s risk of cardiovascular diseases, cancers, chronic respiratory disease and diabetes, according to a groundbreaking new report issued by the World Health Organization and co-authored by a UCLA nursing professor.

These four non-communicable disease types account for a combined 60 percent of all deaths worldwide.

“The global burden of non-communicable diseases is already high and continues to grow in all regions of the world,” said Linda Sarna, a professor at the UCLA School of Nursing and co-author of the report. “Nurses and midwives have the expertise to help individuals and communities improve health outcomes.”

Sarna points out that since nurses and midwives make up more than 50 percent of all health care providers in most countries, they are the logical candidates to affect lifestyle changes among patients and increase health awareness. Worldwide, there are more than 19 million nurses and midwives, she said.

The 38-page report issued by the WHO highlights evidence-based, value-added nursing interventions that have been shown to reduce such risk factors as tobacco use, alcohol dependence, physical inactivity and unhealthy diets.

“The examples contained in the report are proven activities that nurses can start doing today to make a meaningful impact with their patients and in their community,” Sarna said. “Many of the interventions have been proven to reduce costs and improve the quality of care.”

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U.S. News gives high marks to UC medical schools.

University of California Health ranked among the nation’s best graduate schools in a survey released today (March 12) by U.S. News & World Report.

Five UC medical schools placed in the top 50 nationally for research rankings and four placed in the top 40 nationally for primary care rankings.

In research, UC San Francisco was the top-ranked public school and tied for fourth among all U.S. schools, with UCLA 13th overall, UC San Diego 15th, and UC Davis and UC Irvine tied for 42nd. In primary care, UCSF ranked fourth, UCLA ranked 11th, UC Davis tied for 19th and UC San Diego tied for 39th, with UC Irvine tied for 66th. UCSF has the only medical school ranked in the top five of both categories.

UC medical schools also received high marks in a number of specialty programs. UCSF ranked first for its medical program in AIDS, second in both internal medicine and women’s health, tied for second in drug/alcohol abuse education, fourth in family medicine, sixth in geriatrics, and seventh in pediatrics. UCLA ranked third in geriatrics, seventh in drug/alcohol abuse education, tied for ninth in AIDS and 10th in women’s health. UC San Diego ranked ninth in drug/alcohol abuse education and 11th in AIDS.

U.S. News’ 2014 America’s Best Graduate Schools rankings were released online today (March 12) and can be viewed at www.usnews.com/grad.

The new rankings include previous assessments of a number of other health fields, which U.S. News also surveys but not each year. UCLA ranked first in clinical psychology, UCSF ranked first in pharmacy, UC Davis ranked second in veterinary medicine, UCSF ranked fourth for both its master’s of nursing program (tied) and its nursing-midwifery program, while in public health UC Berkeley tied for eighth and UCLA was 10th. The surveys do not rank dental or optometry schools.

UC Health runs five academic health centers and the nation’s largest health sciences education system with more than 14,000 students and 18 health professional schools and programs in medicine, dentistry, nursing, optometry, pharmacy, public health and veterinary medicine. UC’s sixth medical school, UC Riverside, will enroll its first class this fall.

Related links:

• UC Davis
• UC Irvine
• UCLA
• UC San Diego
• UC San Francisco

An array of obstacles compromise access.

Sally Maliski, UCLA

A combination of financial, cultural and communication barriers plays a role in preventing underserved Latino men with prostate cancer from accessing the care and treatment they need, according to a new study by researchers at the UCLA School of Nursing.

The study, “Barriers to Prostate Cancer Care: Affordable Care Is Not Enough,” is published in the March issue of the peer-reviewed journal Qualitative Health Research.

According to the American Cancer Society, prostate cancer is the most commonly diagnosed cancer among Latino men. Additionally, Latino men are more likely to be diagnosed with later-stage disease than non-Hispanic white men.

“We found that an array of obstacles compromise access and frequently result in negative outcomes,” said Sally L. Maliski, associate dean of academic affairs at the UCLA School of Nursing and senior author of the study. “Sadly, these obstacles disproportionately affect underserved individuals and require a new focus on not only adequate health care coverage but also on the array of hurdles that limit patient access.”

The UCLA study looked at Latino men who were enrolled in Improving Access, Counseling and Treatment for Californians With Prostate Cancer (IMPACT), a state-funded public assistance program. The analysis revealed barriers throughout the entire prostate cancer–care process, including screening, treatment and follow-up care.

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UC Irvine nurse practitioner roots for her charges throughout their treatment journey.

Karen Sommers, UC Irvine

When she was 8 years old, Karen Sommers watched a movie about a young woman struggling with leukemia. It made her realized that she wanted to help people with cancer.

Sommers has been doing exactly that for nearly 30 years, first as a registered nurse and today as a nurse practitioner caring for leukemia patients at UC Irvine Medical Center.

“I see patients from their first diagnosis through their last treatment,” she said. “I  take care of them every day when they are in the hospital, or several times a week if they are outpatients. I help them through their journey.”

Sommers is just one of the more than 1,300 compassionate nurses and nurse practitioners of UC Irvine Healthcare.

“Nurses spend more time with patients than any other member of the health care team,” says Karen Grimley, R.N., UC Irvine Medical Center’s chief nursing officer. “Our nurses approach patient care not only with clinical expertise, but also with an empathy for their patients that is truly inspiring.”

Since 2003, UC Irvine Medical Center has been honored with Magnet recognition, an international designation signifying hospitals’ nursing excellence awarded by the American Nurses Credentialing Center.

“The nurses here treat you like this is your home,” says 20-year-old patient Emmanuel Leon, who spent four weeks in the hospital undergoing treatment for leukemia. “I’ve never been treated so well.”

Leukemia is a cancer that affects the body’s blood-forming tissues, including the bone marrow and the lymphatic system. Some forms of the disease are most common in children, while others occur mostly in adults. Treatment usually involves chemotherapy and may also include radiation, targeted drug therapy and bone marrow transplants.

For Sommers, who works closely with the oncologists at the Chao Family Comprehensive Cancer Center, taking care of leukemia patients means more than performing procedures. She also lifts patients’ spirits, comforts them when they have a tough day, roots for them in their fight against cancer and joins their joy when treatment succeeds.

“I am able to help my patients and their families manage this disease, sometimes for years. I see it as the greatest gift I can give,” explains Sommers. “And I receive so much in return. My patients teach me how to live.”

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High school seniors paired with health education mentors in pilot program.

Registered nurse Darrell Desmond and cardiothoracic surgeon Elizabeth David talk with students.

UC Davis Health System physicians and nurses served as mentors for Arthur A. Benjamin Health Professions High School seniors in a pilot program that allowed the students to interview mentors about their senior project topics and seek one-on-one career advice and guidance.

The first ever Heart2Heart Mentor Morning was hosted recently by the Betty Irene Moore School of Nursing and the School of Medicine’s Office of Student and Resident Diversity. Pediatrician Jann Murray-Garcia, assistant adjunct professor from the Betty Irene Moore School of Nursing and a member of the high school’s Community Advisory Board, partnered with School of Medicine staff in recruiting mentors.

“So many UC Davis Health System employees want to be involved with young people from the community,” said Murray-Garcia. ”Several mentors expressed how touched and re-inspired they were in their conversations with these students who will make up the next generation of health professionals.”

Jann Murray-Garcia, UC Davis

Seven physicians and 10 nurses met with over 20 students in the event, which included breakfast, student interviews and a tour of UC Davis Medical Center’s lobby. Students were prematched with mentors, based on their senior project topics and mentors’ field of expertise. Seniors will continue to work with their mentors through March, as they draft their senior project outlines and seek feedback.

“The students often have to find mentors on their own or they try to get in touch individually with people here. This event has been great,” said Deborah Meltvedt, work-based coordinator and teacher at Health Professions High School.

Health Professions High School senior Brandon Lukwago’s conversation with cardiothoracic surgeon Elizabeth David provided insight, as he continues to explore careers in the field of medicine.

“I’ve learned today that there are lots of careers that I could pursue besides being a cardiologist. I could do lung surgery, chest surgery, stent procedures. There are lots of (career) pathways,” said Lukwago.

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UCSF School of Nursing partners on resource to improve comfort and speed recovery.

Linda Franck, UCSF

When a young child has surgery, parents rely on doctors and nurses for advice on how to prepare and support children during the procedure and immediately afterwards. But once that child gets home, parents are left with little guidance on how to best help their children cope with pain.

A new website aims to fill that information gap and give parents the framework for how to be more effective caregivers for children after surgery.

Created with Linda Franck, R.N., Ph.D., chair of Family Health Care Nursing in UC San Francisco’s School of Nursing, the website My Child is in Pain targets parents of children between the ages of 2 and 6 who want to know how to help manage their child’s post-operative pain.

“There are very few formal resources for parents to learn how to tell if their child is in pain and what they can do to relieve it,” said Franck.

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National recognition, joining three other UCs, signifies outstanding nursing practice.

UCSF Medical Center's team, led by Chief Nursing Officer Sheila Antrum (holding sign), prepares for a video shoot designed to inspire and prepare nursing staff for a five-day site visit by Magnet appraisers.

Last fall, UC San Francisco Medical Center and UCSF Benioff Children’s Hospital achieved Magnet recognition from the American Nurses Credentialing Center (ANCC), a status that has elicited enormous pride throughout the organization from frontline nursing staff to the top leadership in the medical center, UCSF School of Nursing and beyond.

And why not? Magnet recognition signifies outstanding nursing practice, a rewarding work environment for nurses and improvements in patient care, safety and satisfaction. Currently, less than 7 percent of the 5,724 hospitals registered with the American Hospital Association had achieved Magnet status.

UC Irvine Medical Center, Ronald Reagan UCLA Medical Center and UC San Diego Medical Center also have been designated as Magnet hospitals, while UC Davis Medical Center is seeking Magnet designation.

“At two in the morning in the hospital, you want to know you have nursing staff that feels completely capable of making the best possible clinical decisions,” says Karen Drenkard, executive director of the ANCC and a former chief nursing officer at a Magnet hospital. “Magnet recognition helps give you that assurance, because it is a very high, evidence-based bar.”

But for those outside of the process, what constitutes that evidence-based bar can be a little mysterious. Most know little about the standards that Magnet organizations meet and less about how meeting them translates into improvements in patient care.

That was true even for some at UCSF when what everyone involved refers to as “the Magnet journey” began.

The journey to Magnet status

“I think the first Magnet discussion I had with nursing leadership dates back to 2000,” says UCSF Medical Center CEO Mark Laret. “There were some number of hospitals that had achieved Magnet, but at the time, it just wasn’t an institutional priority here.”

By 2005, a UCSF team did put together a Magnet application, but much to a proud institution’s shock, the application was denied.

“That was a watershed moment, because there’s always this fine line between being confident and overconfident,” says Laret. “I worried maybe we were overconfident in where we were relative to having accomplished the goals Magnet sets out, so when we hired Sheila [Antrum] to become chief nursing officer [in 2007], we talked about what it would take to achieve Magnet status.”

By then, the Magnet process had evolved. “Before it was more around anecdotal stories and aggregate data to meet the criteria, but…now you have to demonstrate – by unit and top to bottom – that you’re meeting nursing-sensitive benchmarks of quality and satisfaction,” says Antrum.

“We enhanced the structures and processes that we had in place to demonstrate our outcomes,” says Jody Mechanic, director of professional nursing practice and Magnet program director.

That process began in earnest in 2010, and Antrum believes the collecting of baseline data in and of itself helped demonstrate one value of Magnet: heightened awareness of the need for evidence throughout the hospital and especially among an already outstanding group of nurses who may not have understood just how outstanding they were.

“At UCSF, we don’t rest on our laurels and can even be a little self-flagellating,” says UCSF Medical Center Chief Nurse Researcher Daphne Stannard. “Experts tend to not think of themselves as experts – how can I be an expert if I’m always learning? Our nursing staff epitomizes that, and some didn’t feel we were Magnet worthy.”

Over the next two years – working with Stannard, medical center staff, and faculty from UCSF School of Nursing – Antrum and Mechanic led a team that gathered the baseline data, identified gaps and planned and implemented improvements. They compiled a 3,000-page application that painstakingly documents how the two hospitals, ambulatory care services and home care were meeting Magnet benchmarks – and then the entire enterprise underwent a five-day site visit by Magnet appraisers.

It was a demanding, at times exhausting journey that helped the entire medical center better understand nursing’s contribution to outstanding patient care and set in place the expectation of continuous nursing improvement rooted in Magnet’s five model components – transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation and improvements; and empirical quality results.

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