TAG: "Nursing"

State grants to improve primary care to underserved populations


UC Davis nursing school awarded grants to expand clinical rotations, classroom training.

The California Office of Statewide Health Planning and Development awarded $265,000 to the Betty Irene Moore School of Nursing at UC Davis for the nurse practitioner and physician assistant programs to improve primary care to underserved populations through expanded clinical rotations and simulated learning based on real-life situations.

As part of the Song-Brown Health Care Workforce Training Act Nurse Practitioner and Physician Assistant Training Program, the School of Nursing received $115,000 to create patient case simulations and $150,000 to provide housing and travel funds for students doing clinical training in underserved areas of central and Northern California.

“Primary care providers need to leverage the social, economic and physical conditions that shape health and then better work together as a team,” said Virginia Hass, director for the nurse practitioner program. “The Song-Brown grant enables the preparation of health care professionals to understand the impact of the environment on health outcomes and to deliver care within an interprofessional team.”

As part of the $115,000 one-year grant, the Betty Irene Moore School of Nursing will partner with the UC Davis Center for Virtual Care to develop simulated case scenarios for use throughout the two-year clinical curriculum. Plans call for specific simulations that address culturally relevant care to communities that experience difficulties accessing health care.

The second grant assists students with the costs of travel and housing during clinical rotations in underserved and rural areas. Rotation sites within the California Endowment’s Building Healthy Communities have priority. These 14 geographically diverse communities — ranging from Riverside to Del Norte Counties — are generally low income and rural with a significant proportion of uninsured residents.

“A primary objective of the Betty Irene Moore School of Nursing nurse practitioner and physician assistant programs is to provide student rotations that improve availability of care,” said Mark Christiansen, director for the physician assistant program. “Because many of the designated communities and counties are within the school’s service and recruitment area, the program is a natural extension of current activities.”

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 to significantly lower national averages of between 30 and 40 percent.

The Song-Brown Program partnered with the California Endowment to provide both grants. The California Endowment’s 10-year initiative for Building Healthy Communities invests billions in community-based strategies to prevent chronic illnesses, including obesity prevention, nutrition access and tobacco cessation programs. More information is available at www.calendow.org.

The Song-Brown Program was established in 1973 by the state legislature to assure access to primary-care services for Californians. UC Davis has been one of the largest recipients of the funding, with a total amount exceeding $5 million. More information about the program is available at www.oshpd.ca.gov/HWDD/Song_Brown_Prog.html.

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UC Davis nursing earns Magnet designation


All five UC medical centers now have Magnet recognition.

UC Davis Medical Center joins the ranks of elite clinical-care institutions in the nation with its new Magnet Recognition Program status, which was granted this week by the American Nurses Credentialing Center (ANCC). The designation is the nation’s highest form of recognition for nursing excellence and a benchmark for the quality of care patients receive.

All five UC medical centers now have been designated as Magnet hospitals.

“UC Davis has a long history of demonstrated nursing excellence, and the Magnet recognition is a testament to the dedication and hard work of our nurses and their care-team colleagues,” said Carol Robinson, chief patient care services officer and director of nursing at UC Davis Medical Center.

The Magnet Recognition Program was developed by the ANCC to recognize health care organizations for quality patient care, nursing excellence and innovations in professional nursing practices. To achieve designation, the medical center provided written documentation demonstrating qualitative and quantitative evidence about patient care and outcomes as part of a rigorous certification process that also included a multi-day, on-site visit by ANCC representatives.

Only about 7 percent of U.S. hospitals carry Magnet designation. UC Davis is the 25th organization in California, and the only one in Sacramento, to earn the highly regarded recognition. Studies indicate that Magnet Recognition Program hospitals typically have lower mortality and infection rates, as well as higher patient satisfaction and better work environments for nurses.

“I am proud of our entire team of health-care professionals,” said Ann Madden Rice, chief executive officer of UC Davis Medical Center. “Led by our nurses, this truly was a collaborative effort with our physicians and others in an organization that has always been committed to the highest standards of patient-centered care. Achieving this elite status demonstrates UC Davis’ dedication to continuously improving the health of our patients, our community and our region.”

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Smoking rates drop dramatically among nurses


Significant decline in smoking among RNs found from 2007 to 2011.

Linda Sarna, UCLA

Linda Sarna, UCLA

On the eve of the 50th anniversary of the U.S. surgeon general’s first report alerting the nation to the negative health consequences of lighting up, there is good news about registered nurses who smoke: There are a lot less of them.

A new UCLA study tracking changes in smoking prevalence among nurses and other health care professionals between 2003 and 2011 found that the proportion of registered nurses who smoke dropped by more than a third during that period.

The findings appear in the January issue of JAMA: The Journal of the American Medical Association, which commemorates the surgeon general’s landmark 1964 Report on Smoking and Health.

The study’s principal investigator, Linda Sarna, a professor at the UCLA School of Nursing and oncology nurse who has been committed to tobacco cessation for the past two decades, said she was energized by the results.

“This decline is so important, not just for the health status of nurses but because studies continue to show that smoking by health care professionals sends a mixed message to patients,” she said.

The study used data on health care professionals from the Tobacco Use Supplement for 2003, 2006–07 and 2010–11; the supplement is administered as part of the U.S. Census Bureau’s Current Population Survey.

While the researchers found no significant decline in smoking among registered nurses between 2003 and 2007, the years from 2007 to 2011 witnessed a big drop. The data show that the proportion of registered nurses who smoke dropped from 11 percent to 7 percent — an overall decrease of 36 percent and more than two times the 13 percent decline among the general U.S. population during the same time period.

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UCSF nurse-midwives collaborate with doctors for high-quality maternity care


Changing the culture of childbirth.

Students practice delivery both with "standardized patients" (live actors), as shown above at San Francisco General Hospital, and with robotic "simulated patients" at UCSF's Kanbar Center. (Photo by Elisabeth Fall)

Students practice delivery both with "standardized patients" (live actors), as shown above at San Francisco General Hospital, and with robotic "simulated patients" at UCSF's Kanbar Center.

In the early 1970s, a group of obstetricians at San Francisco General Hospital began discussions with certified nurse-midwives in the local community about starting what would become the first hospital-based midwifery practice in San Francisco. “They recognized that there was an untapped market for women who wanted midwifery care but didn’t want or couldn’t afford out-of-hospital birth,” says CNM Margaret Hutchison, a clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the UC San Francisco School of Medicine, who also chairs the leadership council of the nurse-midwives of SFGH.

It was a time when attitudes toward childbirth were shifting. The enormous safety gains of the previous half century – a product of medical innovations like antibiotics, safer anesthetics and better diagnostic tools – had made survival of the mother and baby seem almost a given, but it moved maternity care into a more “medicalized” model, which sometimes ignored the fact that childbirth is a normal physiological experience for most women. In-hospital midwifery care strikes a balance between preserving the normal aspects of birth and providing rapid access to technology and advanced care when it’s needed.

The midwifery service at SFGH began in 1975 with the opening of an alternative birth center within the hospital, which offered a more homey environment than the traditional labor and delivery unit. Although births at the hospital increased by 50 percent in the first year, maintaining a separate unit proved financially unviable, and midwifery patients were eventually moved to the regular labor and delivery unit, where 46 percent of women now select a midwife for their care.

The move proved fortuitous. Nurse-midwives and obstetricians began working side by side, and over time, a collaborative atmosphere developed.

“I think the early presence of midwifery at SFGH has influenced the culture of childbearing for everybody in our labor and delivery unit,” says Hutchison. Obstetrician Rebecca Jackson, chief of the SFGH division of the Department of Obstetrics, Gynecology and Reproductive Sciences, agrees. “[The midwives] push us [obstetricians] to think more carefully about why we do certain things,” she says.

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Extended viewing of Boston Marathon bombings media coverage tied to acute stress


Six or more daily hours associated with more symptoms than direct exposure to blasts.

E. Alison Holman, UC Irvine

E. Alison Holman, UC Irvine

Stepping away from the television, computer screen or smartphone in the aftermath of terrorist attacks or mass shootings may be beneficial to your mental health. That’s the takeaway from a new study by UC Irvine researchers showing that six or more daily hours of exposure to media coverage of the Boston Marathon bombings in the week afterward was linked to more acute stress than having been at or near the marathon. Acute stress symptoms increased with each additional hour of bombing-related media exposure via television, social media, videos, print or radio.

“We were very surprised that repeated media exposure was so strongly associated with acute stress symptoms,” said E. Alison Holman, associate professor of nursing science at UC Irvine and the study’s lead author. “We suspect that there’s something about repeated exposure to violent images or sounds that keeps traumatic events alive and can prolong the stress response in vulnerable people. There is mounting evidence that live and video images of traumatic events can trigger flashbacks and encourage fear conditioning. If repeatedly viewing traumatic images reactivates fear or threat responses in the brain and promotes rumination, there could be serious health consequences.”

The study challenges key assumptions about how people react to collective traumas, such as the idea that individuals must be directly exposed to an event to be at risk for stress-related disorders. It also raises questions about the latest edition of the Diagnostic & Statistical Manual of Mental Disorders (DSM-5), which specifically excludes media-based exposure as a potential trigger for trauma response among nonprofessionals.

“In our prior work, we found that early and repeated exposure to violent images from the terrorist attacks of Sept. 11 and the Iraq War may have led to an increase in physical and psychological ailments up to three years [later],” said Roxane Cohen Silver, professor of psychology & social behavior, medicine and public health at UC Irvine and the study’s co-author. “Our new findings contribute to the growing body of research suggesting that there is no psychological benefit to repeated exposure to graphic images of horror.”

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HIV plus HPV leads to increased anal cancer risk in men


Researchers also report that smoking increases risk of infection with specific types of HPV.

Dorothy Wiley, UCLA

Dorothy Wiley, UCLA

Human papillomavirus, or HPV, which can cause cervical cancer in women, is also known to cause anal cancer in both women and men. Now, a study led by researchers at the UCLA School of Nursing has found that older HIV-positive men who have sex with men are at higher risk of becoming infected with the HPVs that most often cause anal cancer.

The researchers also report that smoking increases the risk of infection with specific types of HPV among both HIV-infected and uninfected older men by up to 20 percent. This is the first large U.S. study of a group of HIV-infected and uninfected men between the ages of 40 and 69 who have sex with men. Study participants were examined twice a year for up to 25 years.

“Invasive anal cancer is a health crisis for gay, bisexual and other men who have sex with men,” said Dorothy J. Wiley, associate professor at the UCLA School of Nursing and lead author of the study, which was published Nov. 20 in the journal PLOS ONE. “Right now, invasive anal cancer rates among HIV-infected men who have sex with men surpass rates for seven of the top 10 cancers in men.”

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Collaborators in nursing, public health tackle AIDS in China


Part of international effort to limit spread of disease, improve care of those already infected.

Ann Williams (left) and Roger Detels began to collaborate on AIDS research and treatment in China 15 years ago — around the same time that World AIDS Day, every year on Dec. 1, was established to unite people around the globe in the fight against HIV.

Ann Williams (left) and Roger Detels began to collaborate on AIDS research and treatment in China 15 years ago — around the same time that World AIDS Day, every year on Dec. 1, was established to unite people around the globe in the fight against HIV.

Ann Williams, associate dean for research at the UCLA School of Nursing, has traveled the world for nearly 30 years caring for people with HIV/AIDS and conducting research to improve treatment outcomes. Over that same period, Dr. Roger Detels, professor and chair of epidemiology at the UCLA Fielding School of Public Health has taken a similar route, conducting AIDS research and training epidemiologists.

Fifteen years ago, their paths intersected in China, when Detels was looking to include nursing as part of a training program in HIV research for Chinese health care professionals. A professor, Williams signed on, and they have been collaborating ever since as part of an international effort to limit the spread of HIV-AIDS and improve the care of those already infected.

Recently, each received HIV research training grants from the Fogerty International Center at the National Institutes of Health to help scientists and clinicians in developing countries build much-needed research infrastructure.

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The science of nursing


UC Davis Ph.D. candidate shows how data improves patient care.

Rayne Soriano (standing) educates health care professionals in the field of health informatics.

Rayne Soriano (standing) educates health care professionals in the field of health informatics.

Rayne Soriano, nurse and doctoral student at the Betty Irene Moore School of Nursing at UC Davis, immerses himself in patient data — from fall rates to the number of hospital-acquired infections — which he analyzes to improve quality by updating hospital procedures or addressing staffing and resource needs. He also educates nurse managers in the field of health informatics.

“I love being a nurse, but I also love the technology — taking care of people through all methods. My work improves the way we interact with patients and deliver quality care,” Soriano said.

Soriano began his career in the emergency department where he learned the value of data — its capacity to help nurses and nurse managers prioritize and address problems. As he moved quickly through the ranks at Kaiser Permanente, Soriano led a team that introduced the use of a hospital-wide electronic health record system. The system helps health professionals, like Soriano, observe trends to maximize patient safety and quality of care.

As part of Soriano’s research toward his Nursing Science and Health-Care Leadership doctoral degree, he is examining a nurse manager’s role in leveraging technology to improve patient care. He found a gap in how nurse managers utilize these systems.

“How are nurse managers using data to allocate resources and get a pulse on the quality and safety of care?” Soriano asked. “If we get people inspired to use technology, and design it well, we can utilize the systems to build better outcomes.”

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Three decades in the heart of Skid Row


UCLA clinic delivers care where it’s needed most.

Suzette Cardin, assistant dean of student affairs at the UCLA School of Nursing, talks to a patient at the clinic in the Union Rescue Mission about medication. Cardin was one of several representatives who talked to mission guests about health at a 30th anniversary celebration.

Suzette Cardin, assistant dean of student affairs at the UCLA School of Nursing, talks to a patient at the clinic in the Union Rescue Mission about medication. Cardin was one of several representatives who talked to mission guests about health at a 30th anniversary celebration.

Thirty years ago, the Union Rescue Mission in downtown L.A. contacted the UCLA School of Nursing with an intriguing request: Would the school be interested in providing nursing services to homeless adults and children staying at the mission?

Back then, very little was known about the homeless population encamped in the gritty neighborhood of shabby buildings and sidewalks they regarded as “home.” What was a mere 15 miles away might just as well have been a continent away when it came to the distance that separated West Los Angeles from downtown Skid Row. Few health care providers knew how to reach or even treat this forgotten sliver of humanity that remained out of sight and out of mind as L.A. expanded around them.

“At that time, there was little data on the homeless,” recalled Ada Lindsey, who was dean of the School of Nursing when the request was made. “Nobody really knew whether they would come to any clinics for healthcare or whether they would come back for follow-up visits. Nobody even knew much about what kinds of health problems they had.”

But the prospect of reaching out to this underserved transient population and learning from these experiences generated excitement at the school. Soon they realized that there was a need for more comprehensive health services. Could a nurse-managed clinic provide quality primary health care to the homeless and indigent? Would such a clinic be accepted? Could the nursing staff win their trust?

Today, the UCLA Nursing Health Clinic at the Union Rescue Mission has become a national model for its delivery of health care to the poor and homeless. Celebrating its 30th anniversary this month, it is one of the oldest and largest clinics of its kind in the country. And it is also the only shelter-based health clinic in the city that provides health care, not just for homeless men, but women and children as well.

“It means a great deal to me,” said one homeless man staying at the shelter. “People who are homeless — that are down-and-out on their luck, you know — they have medical facilities available to them that help them out.

“It means a great deal,” he reiterated.

Since its founding, the clinic, which manages both acute and chronic illnesses, has provided care in more than 250,000 patient visits. Last year alone, its small staff of six provided comprehensive medical services to more than 2,500 people.

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Related link:
Community impact: Nurse-run clinics

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Free health care clinic


UCLA health care staff help treat thousands at Care Harbor clinic.

A team of more than 200 UCLA health professionals helped staff a free health care clinic last week that provided vital basic medical services to approximately 3,000 uninsured and underserved people in Los Angeles.

They were among the nearly 3,000 medical and general volunteers at Care Harbor’s annual urban health clinic — held Oct. 31 through Nov. 3 at the Los Angeles Sports Arena just south of downtown Los Angeles — who provided more than 5,700 medical, dental and vision exams.

“To me it’s part of the mission of being a physician to care for people,” said Dr. Colin McCannel, a UCLA ophthalmologist. ” It’s part of what I should be doing so doing it makes me feel like I’m doing what I’m supposed to.”

There were 16 volunteers from UCLA Jules Stein Eye Institute, who conducted eye exams, donated 10 free cataract surgeries and prescribed free eye glasses. UCLA’s team also included seven doctors from family medicine, 17 general internists, and one physician from internal medicine/pediatrics, as well as some specialists and medical students.

The Care Harbor clinic provides a wide range of services for people who lack the means to get medical care on a regular basis. The health professionals screened for diabetes and hypertension, administered immunizations, offered mental health counseling and provided teeth cleanings, among many other basic services. For those patients who had more severe problems or conditions that required longer term care, the volunteers provided referrals to followup services.

The UCLA School of Dentistry staffed 10 dental chairs providing oral hygiene services for hundreds of patients.

“Service is part of the core missions and I want to take every opportunity I can to give back,” said Dr. Edmond Hewlett, a professor in the school of dentistry.

In addition to the doctors, UCLA volunteers included nearly 80 nurses from Ronald Reagan UCLA and Santa Monica medical centers; six clinical lab scientists and a pathologist from the department of pathology who interpreted the pap smears; and six nurse practitioners.

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Battling alarm fatigue


UCSF nursing school leads research on rising problem in hospitals.

Hospital room with alarmsTalk about the dangers of multitasking.

“You’re in sterile garb with a patient, and in the next room an alarm goes off. You have to decide if it’s a bed alarm, a ventilator alarm or something else – you need to memorize those sounds and most monitors have multiple sounds. You have to make a decision about whether it’s a technical problem or something more serious, and then you have to decide if and how quickly you need to respond,” says Barbara Drew, R.N., Ph.D., an internationally recognized cardiac monitoring expert who is a professor in the critical care/trauma program at the UC San Francisco School of Nursing and in the Division of Cardiology at the UCSF School of Medicine.

The decision points she describes are disturbingly frequent, especially in intensive care units (ICUs), where nurses might hear over a hundred alarms an hour, many of them false positives.

There is a lot at stake in these complex interactions among people, processes and technology that lead to what has come to be known as alarm fatigue: where clinicians turn down, turn off or tune out the alarms because they are exhausted by their frequency and the number of times they are false. Awareness of the dangers is rising fast around the country.

In one highly publicized case in Pennsylvania, the muting of an alarm cost a teen her life and the surgery center a $6 million malpractice settlement. According to a recent article in the Washington Post, over a three-and-a-half-year period ending June 2012, the Joint Commission had reports of 98 alarm-related incidents, including 80 deaths; in more than 60 percent of the cases, alarms were either inappropriately turned off or were not audible in all areas.

The commission believes the reports, which are voluntary, do not begin to tell the whole story and has established a national patient safety goal on alarms that goes into effect in 2014.

Along with colleagues at UCSF Medical Center and nursing schools that include Johns Hopkins and Yale, Drew is among a small group of nurse scientists conducting research to inform emerging regulations and processes and, ultimately, solve the problem.

At the moment, her collaborative project with GE Healthcare is designed to characterize every piece of clinical information ICU alarms deliver so device manufacturers have the data they need to create better, smarter alarms.

She cautions, however, that the solutions go beyond better technology. “This is a multifactorial problem – technology, nursing practice and systems – and we have to approach it from all of those angles,” says Drew.

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Sleep apnea study uncovers more hidden dangers for women


UCLA researcher: “We now know that sleep apnea is a precursor to bigger health issues.”

Paul Macey, UCLA

Paul Macey, UCLA

There’s more bad news for women with sleep apnea. A new study from the UCLA School of Nursing shows that the body’s autonomic responses — the controls that impact such functions as blood pressure, heart rate and sweating — are weaker in people with obstructive sleep apnea but are even more diminished in women.

Women with obstructive sleep apnea may appear to be healthy — having, for instance, normal resting blood pressure — and their symptoms also tend to be subtler, which often means their sleep problem is missed and they get diagnosed with other conditions.

“We now know that sleep apnea is a precursor to bigger health issues,” said Paul Macey, lead researcher on the study, which appears today (Oct. 23) in the peer-reviewed journal PLOS ONE. “And for women in particular, the results could be deadly.”

Obstructive sleep apnea is a serious disorder that occurs when a person’s breathing is repeatedly interrupted during sleep, sometimes hundreds of times. Each time, the oxygen level in the blood drops, eventually resulting in damage to many cells in the body. The condition affects more that 20 million adults in the U.S. and is associated with a number of serious health consequences and early death. Women are much less likely to be diagnosed than men.

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