Category Archives: Local or community-based
Comilla Sasson, MD, MS, is an attending physician at the University of Colorado Hospital and Assistant Professor in the Department of Emergency Medicine at the University of Colorado. Sasson was a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Michigan from 2007 to 2010.
I wasn’t even supposed to work that night. I had finished a long day of meetings, and found out at 6:30 pm that my colleague, who had called in sick twice in 40 years, had influenza and he knew it was best not to expose Emergency Department (ED) patients to it. After he called, I remember thinking, “Well, I can just power through until 8 am. Nothing too bad happens on Thursday nights.”
The night began as many other nights do in our ED. Twenty-five of our 50 beds were taken up by inpatients who were waiting for hospital beds to open up. The ED was completely full, with another 10 patients in the waiting room. “Another one of those nights,” I groaned to myself. We were already on “divert” status, meaning that ambulances would bypass our hospital and go to others in town. This should be a relatively easy night, right?
Until we received the call over the dispatch radio at approximately 12:30 am: Shooting at a theater in Aurora. Hopefully the paramedics remembered we were already at capacity and took the patients elsewhere. Nine minutes later, we received a frantic phone call from one of the policemen on scene: Multiple shooting victims and Aurora Police Department just received permission to transport patients to hospitals in the backs of police cars instead of waiting for ambulances. That’s when we realized this was not a gang fight with one or two victims, this was something different.
The first police car showed up at 1:06 am. We raced out to the ambulance bay and started removing patients from the back of the car. The police car looked like a crime scene, with blood splattered throughout. As we were pulling the first two victims out of the car, another police car showed up. And another. And another. In total, we received nine police cars and one ambulance within 45 minutes. Looking out into our ambulance bay with police lights flashing, I realized, this is not like any other shooting I have been involved in. This is radically different.
Roseanna H. Means, MD, is the founder of Women of Means, which provides free medical care to homeless women in the Boston area, a clinical associate professor at Harvard Medical School, and an internist on the attending staff at Brigham and Women’s Hospital in Boston. She is a 2010 Robert Wood Johnson Foundation Community Health Leader.
The prolonged recession of the last four years has hit many people hard. My work is taking care of homeless women, which I have done for the past 20 years. I lead a team of volunteer physicians and part-time paid nurses who provide free walk-in care to women and children in Boston’s shelters. We fill in the gaps left by larger, more bureaucratically rigid systems that put unrealistic and unattainable expectations on those who are disabled by extreme poverty, mental illness, trauma, and cognitive dysfunction.
I designed a program of “gap” care that brings health care to them. We act as the communication and advocacy bridge between the shelter/street world and the hospitals and health centers. Gap care is part of a continuum that I feel has an important role to play in health care access for vulnerable populations.
Here is a glimpse of our work.
Walking into one of the women’s shelters on a recent morning, I see a woman standing glumly in line for coffee, her hands chapped and shaky, her face pale and dry, a blanket heaped around her shoulder, pouring hot liquid into her body before staking out a cot where she can sleep for a few hours, let her guard down, away from the doorway where she was prey to drunk men who jumped her, raped her and stole her stuff.
She is hungover. She drank to escape the horror of having been attacked. She has been on and off the wagon so many times we have all lost count. She’s also been raped and stabbed more times than any of us can remember. She doesn’t go to the police any more. She’s just one more homeless woman who has been raped, a “nobody”; just more paperwork. I give her a hug and remind her that I love her no matter what. I know that she has a library of negative and self-loathing messages in her head. Mine is the one that can break through that chatter and give her a shred of self-respect.
By Adam Pike, BSN, a Robert Wood Johnson Foundation New Careers in Nursing (NCIN) scholar and recent graduate of the Donna and Allan Lansing School of Nursing and Health Sciences at Bellarmine University in Louisville, Kentucky. Read more about second career nurses like Pike in the latest issue of Sharing Nursing’s Knowledge.
I had blown off graduate school for a semester and moved in with a friend living in northern Honduras, ostensibly to spend time developing my Spanish language skills. We occupied a small one—room, key—lime concrete block, completely permeable for a variety of local fauna. A coconut tree was visible from our small stoop on which I sat during many afternoons while rain rattled the metal roof like a snare drum. We washed our laundry with a washboard and cistern in the company of chickens, dogs owned by no one, and playful, kind neighbors who regarded us as a kind of novelty. It was the perfect environment in which to pull back from familiar routine and plunge into academics and artistry. I carried out this mission somewhat anonymously in our austere apartment, with the exception of trips for fruit to the ancient wooden cart at the corner, or perhaps to the pharmacy to remedy the inevitable abdominal maladies that occur for foreigners.
Of the many bouts of illness we fought, only one was potent enough to warrant a hospital stay. On this occasion, as I stood in the dilapidated public ER, looking down at my sick friend in his hospital bed, I saw a young Honduran woman wheeled through the entrance of the ER and immediately placed in a vacant bed adjacent to my friend. In this open room, filled with patients suffering from dengue fever, dehydration, and physical trauma, it was immediately clear this pale, sweating woman, desperately gasping, was far more ill than the rest. As she disappeared in an impromptu room the staff conjured from panels of spare drape, I saw patches of dark bruises climbing her forearms.
As the evening passed, my friend napped, and I ventured behind the white curtains to offer anything I could—really, nothing—to the young woman breathing through a mask and her mother, her only company. For what followed, nothing could have prepared me. We conversed, traded stories, said prayers.
Kynna Wright-Volel, PhD, RN, MPH, PNP-BC, FAAN, an assistant professor at the University of California, Los Angeles and Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar alumna, recently won a five-year, $1.2 million grant funded jointly by the National Institutes of Health’s National Institute of Nursing Research and Office of Behavioral Social Science Research. She will use the grant to work with the Los Angeles Unified School District to launch Project SHAPE LA™, a coordinated school-health program designed to increase physical activity among youth in Los Angeles County schools.
Human Capital Blog: Please share your vision for Project Shape LA™, what its goals are and how many children and teens it will reach.
Kynna Wright-Volel: Project SHAPE LA™ targets 24 middle schools in underserved areas of Los Angeles and will touch nearly 12,000 students. With this grant, we want physical education teachers to ignite a passion for physical activity – to teach kids that by being active, they can be healthy and achieve their dreams. Anticipated outcomes from this program include: increased moderate to vigorous physical activity; increased scores on the California State Board of Education’s FitnessGram Test in the areas of aerobic fitness, body composition and muscular strength/endurance; and increased academic achievement, as evidenced by higher scores on the California standardized test.
HCB: Why is a project like this needed in your community?
Wright-Volel: According to the L.A. County Department of Public Health, one in five children in the Los Angeles Unified School District is considered obese. Health inequities exist as well; children who are racial and ethnic minorities and/or come from families with low incomes have higher rates of obesity.
By Paula Lucey, MSN, RN, Administrator, Milwaukee County Behavioral Health Division, RWJF Executive Nurse Fellows program alumna (1999-2001)
The Robert Wood Johnson Foundation (RWJF) Partners Investing in Nursing program (commonly called PIN) is a wonderful way to address nursing workforce efforts. The Foundation created this program with the concept that nursing workforce efforts needed to become the work of not only nursing but the work of partnership with local foundations and employers.
In Milwaukee, our first PIN grant focused on the impending crisis in public health related to the nursing workforce. We had data that suggested that upwards of 50 percent of the current workforce could retire in the next five years. While not all will do so, this was a wake up call that we needed to begin to work to develop the next generation of public health nurses.
Our program was able to energize some senior nursing students to consider careers in public health. While our numbers were under 20, the students spread the word to their fellow students, and we believe we created a ripple of interest among students at several of the local BSN programs.
As important as the immediate efforts related to these students were, some of the project’s accomplishments will form the foundation for long-term solutions. The most important was increased awareness of the importance of public health and the vital role that nursing plays among our three foundation partners.
Alan M. Garber, M.D., Ph.D., recipient of a 2003 RWJF Investigator Award in Health Policy Research (2003), will become the new provost of Harvard University on September 1. He attended Harvard as an undergraduate and also received his Ph.D. in economics there.
Garber is currently a professor of medicine and economics at Stanford University, where he earned his M.D. He directs the Center for Health Policy and the Center for Primary Care and Outcomes Research at Stanford Medical School, and is a staff physician at the Veterans Affairs Palo Alto Health Care System.
“I think it’s very important to have somebody who has crossed disciplinary boundaries and schools and departments, because that remains an area where Harvard will have to get stronger and stronger,” current provost Steven E. Hyman said at a reception in Garber’s honor on April 15.
Learn more about the RWJF Investigator Awards in Health Policy Research.
Victoria Niederhauser, Dr.P.H., A.P.R.N., P.N.P., of the 2008 cohort of the RWJF Executive Nurse Fellows program, has been named the new dean of the University of Tennessee, Knoxville, College of Nursing.
Niederhauser comes to Knoxville after 10 years in various leadership roles at the University of Hawaii School of Nursing and Dental Hygiene, serving as director of nurse practitioner programs, graduate chair and department chair. Most recently, she has served as associate dean for academic affairs.
Barbara A. Garcia, M.P.A., a RWJF Community Health Leader (1993), began her duties as director of the San Francisco Department of Public Health in January. Garcia had been the Department’s deputy since 1999. “Becoming the director is a really exciting opportunity to continue the work I’ve been doing with the department,” she said.
Her appointment by then-mayor Gavin Newsom was announced in October at the Latino Heritage Month Celebration and Awards ceremony, where Garcia was honored for her contributions to the Latino community in health and medicine.
Garcia received the Community Health Leader award for her work at Salud Para La Gente in Watsonville, California. As the executive director of the small clinic in a rural, predominantly Latino community, Garcia transformed the clinic into a federally-qualified, bi-cultural comprehensive health care center.
February's RWJF Clinical Scholars Health Policy Podcast Focuses on Philadelphia's Fight Against Childhood Obesity
In this month’s RWJF Clinical Scholars Health Policy Podcast former RWJF Clinical Scholar Donald Schwarz, M.D., M.B.A., (University of Pennsylvania, 1985-1987), Philadelphia Health Commissioner and Deputy Mayor for Health and Opportunity, discusses his work combating the childhood obesity epidemic in Philadelphia, touching on that effort’s controversial soda tax. In his conversation with podcast series host, Matthew Press, M.D., Schwarz also talks about the impact of health care reform at the city health level, and the learning curve required to transition from a career in academia to government service.
"We've had classical. We've had rock. We've had country. We've had instrumental. You can see the staff and residents bop their head[s] to different ones," Pam Larimore-Skinner, director of nursing at Signature HealthCare of Trimble County in Bedford, Kentucky, told the Cincinnati Enquirer.
But she’s not talking about a dance party. She’s talking about a unique tool created by RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) grantees. INQRI grantees Tracey Yap, Ph.D., a nurse researcher, and Jay Kim, Ph.D., an engineer, of the University of Cincinnati, are testing a sustainable, system-wide program designed to prevent pressure ulcers and enhance the mobility of long-term care residents.
Every two hours during the day, music is played over a speaker system at nursing homes. The music serves to remind nurses that it’s time to re-position bedridden patients. This subtle reminder prompts busy nurses to stop other tasks and give immobile patients the care they need to prevent bed sores. The music also serves as a reminder to other staff members to invite or encourage patients who are mobile to get up and walk.
The study, which is being conducted at multiple facilities, will conclude in April.
Read more about the project and the INQRI program.