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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New program to offer master’s degrees to help increase number of primary care providers.

Klea Bertakis, UC Davis

Already, a majority of UC Davis nurse practitioner and physician assistant graduates go on to work as primary care providers in underserved areas and with hopes of further increasing these rates, the program will offer master’s degrees beginning with classes that enroll this summer.

“UC Davis has a rich legacy of training culturally diverse primary care providers, especially for rural areas of California” said Klea Bertakis, chair of the UC Davis School of Medicine Family and Community Medicine Department, which has housed the program for the past 40 years. “We needed to find a way to continue that and sustain the program. It was clear the program needed to provide its graduates master’s degrees.”

Looming health care reforms, shortages of providers and a growing, aging population combine to create unprecedented demand for primary care providers throughout the nation, especially in rural and underserved areas. Additionally, about 6 million California residents are expected to gain access to health care through national health care reform when it is fully implemented in 2016.

Over the past 40 years, the program 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 much lower national averages of between 30 and 40 percent.

Bertakis said the new master’s-degree programs are the result of a yearlong study of approaches to refine the successful program and meet future educational needs of nurse practitioners and physician assistants. Currently, the program offers graduate certificates to both the family nurse practitioner and physician assistant tracks. Master’s degrees are required to earn a nurse practitioner license and students achieved this through a unique agreement with California State University, Sacramento. This, however, required students to apply and pay fees at both universities.

UC Davis leaders also needed to prepare for accreditation changes that require master’s degrees for physician assistant programs by 2021. Already, 92 percent of the nation’s physician assistant programs offer master’s degrees.

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David Vlahov will begin his two-year term in March.

David Vlahov, UC San Francisco

David Vlahov, Ph.D., R.N., FAAN, dean of the UCSF School of Nursing, has been elected to the board of directors of the American Association of Colleges of Nursing (AACN) as well as its nominating committee.

Votes were cast for the positions by member deans and directors of the nation’s nursing schools with baccalaureate and higher degree programs.

Vlahov, an epidemiologist who specializes in working with community partners to improve community health, is the first male dean of the UCSF School of Nursing. An expert in infectious diseases, substance abuse and mental health, he joined UCSF in 2011.

Vlahov has served as the senior vice president of research and director of the Center for Urban Epidemiologic Studies at the New York Academy of Medicine. He is the founder and first president of the International Society for Urban Health. He was elected to the Institute of Medicine in 2011, one of the highest honors in the fields of health and medicine.

He will begin his new two-year AACN term in March. The organization represents more than 700 members schools of nursing at public and private institutions nationwide.

Read more about the AACN election results on the association’s website.

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Graduates from UC Davis’ nursing school will influence the future of medicine.

Charley Johnston, UC Davis

By the time the Betty Irene Moore School of Nursing’s first commencement ceremony took place, more than one-third of the graduating class had already received job promotions or new positions. That included Charley Johnston, who was promoted in January 2012 from staff nurse in UC Davis Medical Center’s surgical intensive care unit to a newly formed Quality and Safety Nurse Champion position in the burn unit, where he acts as adviser to health care colleagues on how to curb and prevent hospital-acquired infections.

“The graduate program at the School of Nursing strengthened my skills as a leader, a communicator and an educator,” Johnston says. “These enhanced abilities prepared me to act as a multidisciplinary change agent in my new role.”

First graduates

In June 2012, Johnston officially received, with 24 other students, the first Master of Science degrees bestowed by UC Davis’ Nursing Science and Health Care Leadership Graduate Degree Program — one of many educational “firsts” this year for the schools, departments and programs of UC Davis Health System.

The Betty Irene Moore School of Nursing was established with a $100 million commitment from the Gordon and Betty Moore Foundation — the nation’s largest grant for nursing education. The vision is to transform health care through nursing education, research and leadership by preparing nursing leaders who advance health, improve quality of care and health outcomes, and develop bold system change with confidence and creative solutions.

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Mary Woo selected to speak at annual event for nation’s top nurse scientists.

Mary Woo, D.N.Sc., R.N., a professor and researcher at the UCLA School of Nursing, has been selected to give the third NINR Director’s Lecture in May.

“This is an incredible honor for Dr. Woo,” said Courtney H. Lyder, dean of the UCLA School of Nursing. “Her research has and continues to advance the science to find treatments for heart failure mortality.”

Woo is an internationally recognized researcher. Her initial groundbreaking research focused on the brain-heart interactions in relation to sudden death risk, particularly in advanced heart failure patients. She was the first investigator to report specific sites of gray-matter loss (parts of the brain damaged/missing) in heart failure patients and that this gray matter loss/brain structure damage is impacted by the amount of sleep disordered breathing and gender.

Mary Woo, UCLA

Woo has several studies currently funded by the National Institute of Nursing Research/National Institutes of Health including: (1) examining the relationship between sleep and brain structure in heart failure; (2) determining if there is a relationship between short-term memory, thiamine levels (vitamin B1) and brain structure in heart failure; (3) evaluating the impact of a novel treatment (passive foot movement) of sleep-disordered breathing in heart failure; and (4) comparing functional brain responses to autonomic nervous system challenges between heart failure and healthy control subjects.

The NINR Director’s Lecture is an annual event, designed to bring the nation’s top nurse scientists to the NIH campus to share their work and interests with a transdisciplinary audience. The award was initiated as part of the yearlong observation of the institute’s first 25 years at the NIH.

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UC Davis to enhance curriculum, expand community engagement, student recruitment efforts.

Tom Balsbaugh (center) with UC Davis residents

The California Office of Statewide Health Planning and Development (OSHPD) has awarded more than $300,000 to UC Davis training programs that help ensure a robust primary health care workforce in California.

Through the Song-Brown Program, OSHPD provided the university’s Family and Community Medicine Residency Program with $206,460 and its Family Nurse Practitioner and Physician Assistant Program with $135,000. The funding will be used to expand community engagement and student recruitment efforts and to enhance curriculum in the “medical home” concept of team-based, coordinated patient care, an approach that improves outcomes while lowering costs.

“Song-Brown funding helps ensure that we remain at the forefront of state and national efforts to meet the primary care needs of diverse populations and improve access to comprehensive, culturally appropriate care for everyone,” said Tom Balsbaugh, UC Davis associate clinical professor and director of the Family and Community Medicine Residency Program.

While interest in primary care residencies has decreased nationwide, that trend is reversing at UC Davis, Balsbaugh explained. In 2012, the American Academy of Family Physicians ranked UC Davis 12th among U.S. medical schools in the percentage of graduates selecting a career focus in primary care, which includes pediatrics, internal medicine and family medicine. UC Davis was also the only California medical school included among the top 20.

“The increasing number of medical students at UC Davis selecting primary care residencies in recent years is very encouraging, and funding like the OSHPD grants are critical to keeping that momentum going,” said Balsbaugh.

According to the Association of American Medical Colleges, the U.S. is expected to have a shortage of 45,000 primary care physicians by the end of the decade. In California — with current shortages of primary care physicians in most of its counties, the nation’s largest percentage of practicing primary care physicians nearing retirement and more rural, inner urban and fast-growing communities than other states — the deficit is expected to be more pronounced.

To help bridge that care gap, UC Davis also provides top-quality graduate-level education for family nurse practitioners and physician assistants — practitioners who can examine, diagnose and treat patients as part of a health care team.

“These providers are uniquely positioned to improve access to preventive, chronic disease management and acute health care services, especially for vulnerable populations,” said Debra Bakerjian, assistant adjunct professor at the Betty Irene Moore School of Nursing and vice chair for the Family Nurse Practitioner and Physician Assistant Program at UC Davis. “They can also ease the primary care shortage sooner, since their training time is compressed.”

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California Advanced Primary Care Institute launched this week.

Heather Young, UC Davis

Heather M. Young, associate vice chancellor for nursing at UC Davis and founding dean at the Betty Irene Moore School of Nursing, joined more than a dozen health care leaders in San Jose Jan. 15 to launch the California Advanced Primary Care Institute (CAPCI), a multipronged effort to improve the appeal of primary care as a career choice for health professionals and also elevate the performance of primary care teams.

CAPCI emerged from a statewide consensus meeting in April 2012 led by the California Association of Physician Groups. The nonprofit foundation convened its first Steering Council meeting Jan. 15. Young was appointed to the steering council.

“I am pleased to be part of this group. In order to meet the increasing demand for primary care in California, it is essential we prepare a variety of health care professionals,” Young said. “We need nurses, physicians, physician assistants and other team members with advanced skills in understanding complex problems and generating solutions, understanding how health systems and health care works and how to improve quality, lead teams and deal with the business aspects of care.”

“Primary care is the cornerstone for all of California’s health care delivery systems and sets the foundation for every goal of health care reform,” said Wells Shoemaker, the medical director for the California Association of Physician Groups. “Sadly, California faces a serious erosion of primary care workforce at the same time that our state braces for a daunting bulge in chronic illnesses and the long awaited opportunity through health reform to serve millions of previously uninsured individuals and families.”

California’s primary care workforce is expected to shrink by 30 percent in the next five to eight years as a consequence of retiring professionals and fewer new clinicians choosing to work in primary care.

“If we are going to transform primary care to provide superb, patient-centered care to every Californian, we will need to fundamentally change our approach to training the people who work in primary care,” said physician Kevin Grumbach, a professor at the UCSF Department of Family and Community Medicine, and member of the CAPCI executive management committee. “This new coalition represents an unprecedented partnership between practice organizations and training institutions to equip the workforce for the innovative care models that will drive excellence in primary care throughout California.”

CAPCI received startup funding from the California HealthCare Foundation, The California Endowment, CAPG group contributions, and the California Academy of Family Practice.

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Nurse scientists help refine high-tech tools for patients and providers.

David Vlahov and Kylie Grenier, UCSF

A team of engineers and scientists from GE Global Research and GE Healthcare recently huddled with a team of nurse scientists from the UC San Francisco School of Nursing to explore a collaboration to create and refine technology-based clinical interventions that would be fully informed by the real-world needs of patients and providers.

Such collaborations are less common than one might think. Since the early 1990s, some researchers have observed the way health care institutions jump aboard the technology train and have voiced concerns. They worry that the seductive nature of technology and the speed of technological change sometimes outpace the ability and willingness of health care institutions and scientists to appropriately shape the tools or assess and mitigate the risks of adoption.

It’s not that those raising the questions fail to understand the miracles technology has promised and often delivered. New medical technologies like artificial organs and more precise diagnostic tools have saved countless lives and significantly improved the quality of countless others.

Advances in informatics, particularly electronic health records, connect provider to provider, patient to provider and both to essential health research and information. Mobile technology means providers can efficiently extend their ability to help patients far beyond traditional health care settings. A deepening understanding of online learning promises to expand and diversify the health care workforce at a time when both are desperately needed.

But, says David Vlahov, R.N., Ph.D., dean of the UCSF School of Nursing, “Our role in technology adoption has to be that of supportive skeptics. We have to evaluate and mold technology-related tools and interventions so that we optimize the benefits and avoid unintended consequences.”

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