Elizabeth Gross Cohn, PhD, RN, is director of the Center for Health Innovation at Adelphi University, an adjunct professor at the Columbia University School of Nursing, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.
It only took 24 hours for the hospital unit where I work to complete the Ice Bucket Challenge. My colleagues and I were quick to dump ice water on our heads and publicly post a video of it to YouTube. Compare that to the speed at which we adapt other initiatives—even those that benefit our own health.
Why the difference? What is prompting people to action and, more importantly, what can RWJF learn from this campaign as it works to advance a Culture of Health?
In case you’ve been unplugged over the past several weeks, the Ice Bucket Challenge started in golf and baseball but has spread virally. As of today, it has raised $100 million for Amyotrophic Lateral Sclerosis (ALS). Participation begins when you are challenged on social media to—within 24 hours—publicly accept, acknowledge the challenger by name, pour ice water over your head in as dramatic a method as you can imagine or afford, challenge two or three others to participate, and post the results to YouTube. This campaign has been embraced by the general public, celebrities, grandmothers, babies, and teams of teachers, firefighters, nurses, teachers and others.
We public health professionals can learn some important lessons about delivering information and impelling action from this extraordinary cultural phenomenon. Here are five factors that seem most potent to me. Do you see others?
Theresa Simpson, BS, is a 2003 alumna and acting assistant director of Project L/EARN, and a doctoral student at the Rutgers Department of Sociology. Dawne Mouzon, PhD, MPH, MA, is a 1998 alumna and former course instructor for Project L/EARN, and an assistant professor at Rutgers Edward J. Bloustein School of Planning and Public Policy. Project L/EARN is a project of the Robert Wood Johnson Foundation (RWJF), the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.
When we began co-teaching Project L/EARN in the summer of 2006, health disparities was gaining momentum as a field.
At the time, we were both Project L/EARN alumni who shared a background in public health. We were becoming increasingly immersed in disparities through our graduate studies in the health, population and life course concentration of the sociology doctoral program at Rutgers University.
Directly as a result of that coursework, we began significantly expanding the Project L/EARN curriculum in the area of health disparities. Now, every summer, we hit the ground running the opening week of the program.
In the first lecture, an overview of the field of health disparities, Dawne introduces various theoretical frameworks for studying health disparities, followed by data on the social demography on various race/ethnic groups. She concludes with a series of charts and graphs showing race/ethnic, gender and socioeconomic status (SES) inequities in the epidemiology of health and illness.
James Perrin, MD, FAAP, began a one-year term as president of the American Academy of Pediatrics (AAP) in January. A professor in the department of pediatrics at MassGeneral Hospital for Children and Harvard Medical School, Perrin received a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research in 1997.
Human Capital Blog: Congratulations on your new role as president of the American Academy of Pediatrics! What is your vision for the organization?
James Perrin: We are focused on addressing three main areas, which have really driven a lot of our thinking and, more importantly, our activity and change in the last several years.
First, we are working to help pediatric practices take on more community-based interventions to help young families raise their kids more effectively. There is a tremendous growth in the number of chronic diseases among children in four major areas: asthma, obesity, mental health, and neurodevelopmental disorders. We recognize these are not classic health conditions; they arise from and within communities, and both their prevention and their treatment are really community-based endeavors, as opposed to office-based activities.
Our second, and highly related priority, is an increased focus on early childhood development. We have understood the tremendous importance of early childhood for years, but there is now so much more science behind it. We know a lot more about how negative experiences and toxic stress can affect child development and how it can affect brain growth and neuroendocrine function. On the positive side, we also have more knowledge about the importance of reading to children, increasing language in the home, and other early-childhood interventions.
Thirdly, we have a better understanding of the tremendous impact of poverty on child health. Almost a quarter of American children live in households below the federal poverty line, and almost 45 percent live in households with incomes less than twice the federal poverty line. So a large number of American children are poor or near poor, and we know that poverty affects essentially everything related to child health. It makes those four categories of chronic conditions—asthma, obesity, mental health, and neurodevelopmental disorders—more prevalent and more serious, and it affects children’s responses to treatment. Lower-income kids with leukemia or cystic fibrosis, for example, have higher death rates than kids with the same diseases who are middle class. It’s impossible not to see on a daily basis how poverty affects child health.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
States that have legalized medical marijuana have seen nearly 25 percent fewer deaths from overdoses involving prescription painkillers than states that have not, according to a study led by Marcus Bachhuber, MD. ABC News reports on it, noting that 23 states and the District of Columbia have such laws. Researchers found that while opioid overdose rates continued to climb, the increase was much slower in states with medical marijuana laws, resulting in 25 percent fewer deaths from opioid overdose. “This study raises the possibility that there is an unintended public health benefit of medical marijuana laws, but we still need to collect more information to confirm or refute what we’ve found,” says Bachhuber, an RWJF/Veterans Administration Clinical Scholar at the Philadelphia Veterans Affairs Medical Center. Outlets covering Bachhuber’s study include CNN, Washington Post, Business Insider, Health Day and Vox.
An infant “sleep pod” designed by Jennifer Doering, PhD, RN, is one of 11 projects funded through new grants from the University of Wisconsin Extension and the Wisconsin Economic Development Corporation, the Milwaukee Journal Sentinel reports. The $25,000 Ideadvance grants are intended to move good ideas more quickly to the marketplace. Doering’s I-SleepPod, developed as a result of her work in the RWJF Nurse Faculty Scholars program, would allow an infant to sleep next to an adult while remaining safe, thanks in part to an alarm that wakes the adult in the event of an unsafe sleeping position. “We designed the sleep pod to minimize hazards because, if we don’t move in that direction of reducing sleep-related infant deaths, then [society] is essentially saying it’s acceptable to have 600 babies die every year that way,” Doering said.
Nutrition rating systems in supermarkets may encourage shoppers to purchase less junk food, according to a study led by John Cawley, PhD, an RWJF Scholars in Health Policy Research alumnus and Investigator Award in Health Policy Research recipient. The study coupled sales data from Hannaford Supermarkets in the northeastern United States from January 2005 to December 2007 with the Guiding Stars nutritional rating system. The ratings system assigns zero to three stars to food items, based on their nutritional value. Researchers found that sales of less healthy foods—such as highly processed snack foods—fell by 8.31 percent when branded with a low nutrition rating, while healthy food purchases rose by 1.39 percent, Medical Xpress reports.
The Robert Wood Johnson Foundation’s (RWJF) LEAP National Program is working to create a culture of health by discovering, documenting and sharing innovations in the primary care workforce. To advance this goal, the program is holding a series of six webinars that highlight best practices. (Read a post summarizing the first of the six webinars.) The second of the webinars in the series focused on team-based care for complex cases. Presenters included leaders from four primary care sites around the country that the LEAP program has deemed exemplars.
Managing Care for the Most Complex Patients
Kathy Bragdon, RN, director of care management at Penobscot Community Health Center in Bangor, Maine, discussed the rapid growth of the health center, and went on to describe its system of care management for the most complex patients.
The center relies on a transitions care manager, who shares information back and forth with the hospital and with patients’ medical homes. In addition, the manager meets with patients when they are in the hospital, looking to identify potential barriers to recovery and to provide any needed referrals.
“One of the big roles—we didn’t realize how big—was that a tremendous number of patients had no primary care at the time of admission,” she said. “We worked really closely with the hospitals trying to provide those services and make that linkage to those patients who needed primary care providers.”
As health reform increases access to care for people with chronic conditions at a time when the supply of primary care physicians is decreasing, one viable alternative is nurse-managed protocols for outpatient treatment of adults with diabetes, high blood pressure and high cholesterol, according to a study published in the Annals of Internal Medicine.
The research team reviewed 18 studies on the effectiveness of registered nurses (RNs) in leading the management of those three chronic conditions. In all 18 studies, nurses could adjust medication dosage; and in 11 studies, they could independently start patients on new medications. The review showed that patients with nurse-managed care had improved A1C levels, lower blood pressure and steeper reductions in LDL cholesterol.
“The implementation of a patient-centered medical home model will play a critical role in reconfiguring team-based care and will expand the responsibilities of team members,” the researchers wrote. “As the largest health care workforce group, nurses are in an ideal position to collaborate with other team members in the delivery of more accessible and effective chronic disease care.”
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the August issue.
More Nursing Schools Preparing Students to Provide Team-Based Care
Several of the nation’s top nursing schools now require students to participate in at least one interprofessional education course or activity, reports the Future of Nursing: Campaign for Action. Experts have called for interprofessional education for decades, but more health professions schools are responding now because requirements are being written into health professions accreditation standards, says Barbara Brandt, PhD, head of the National Center for Interprofessional Practice and Education, a public-private partnership supported by RWJF, the U.S. Health Resources and Services Administration, and other organizations.
Physical Work Environment in Hospitals Affects Nurses’ Job Satisfaction, With Implications for Patient Outcomes, Health Care Costs
A study conducted by RWJF’s RN Work Project finds that a physical work environment that facilitates registered nurses’ efficiency, teamwork and interprofessional communication relates to higher job satisfaction. The study revealed that physical environment affected whether nurses could complete tasks without interruptions, communicate easily with other nurses and physicians, and/or do their jobs efficiently.
The following are among the many honors received recently by Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, grantees and alumni:
James S. Jackson, PhD, a 2009 recipient of an RWJF Investigator Award in Health Policy Research, has been appointed by President Obama to serve on the National Science Foundation’s National Science Board. Jackson is a professor at the University of Michigan School of Public Health, and director of its Institute for Social Research.
Geraldine “Polly” Bednash, PhD, RN, FAAN, will receive the National League for Nursing’s (NLN) highest honor, the President’s Award, at the 2014 NLN Education Summit in mid-September. Bednash is the recently retired chief executive officer of the American Association of Colleges of Nursing (AACN) and director of New Careers in Nursing, a joint initiative of RWJF and AACN focused on increasing diversity in the nursing workforce.
Sally Cohen, PhD, RN, FAAN, has been selected as the 2014-2015 Distinguished Nurse Scholar-in-Residence at the Institute of Medicine of the National Academies. The program provides a yearlong leadership opportunity to participate in shaping health policy. Cohen was also named editor-in-chief of the journal, Policy, Politics & Nursing Practice. She is director of the Nursing and Health Policy Collaborative at the University of New Mexico.
Lainie Ross, MD, PhD, a 2013 recipient of an RWJF Investigator Award in Health Policy Research, has been named a 2014 Guggenheim Fellow. Ross will use her fellowship year to research the relationship between ethics and genetics for a book, currently titled, From Peapods to Whole Genomes: Incidental Findings and Unintended Consequences in a Post-Mendelian World. The fellowship is awarded by the John Simon Guggenheim Memorial Foundation to recipients with “demonstrated exceptional capacity for productive scholarship or exceptional creative ability in the arts.”
Keon L. Gilbert, DrPH, MA, MPA, is an assistant professor in the Department of Behavioral Science & Health Education at St. Louis University's College for Public Health and Social Justice and a Robert Wood Johnson Foundation (RWJF) New Connections grantee.
In 1999, 28-year-old Demetrius DuBose, a linebacker for the Tampa Bay Buccaneers, was shot 12 times by two officers in his San Diego neighborhood. DuBose was a former co-captain of Notre Dame’s famed football team. His death came after he was questioned and harassed regarding a burglary in his neighborhood. Officers reported they had no choice but to shoot DuBose while he was handcuffed because they feared for their lives.
Many of these details sound similar to those surrounding the death of Michael (Mike) Brown Jr., who was shot at least six times in Ferguson, Missouri, this month. Brown was unarmed. He was reportedly fleeing from a police officer who also felt his life was in danger.
What is missing from this picture is that black males also feel threatened and distrustful of authority figures and are routinely disengaged from contexts such as schools, medical facilities and neighborhoods. The narrative remains the same: Black males who die from excessive force become involuntary martyrs for the sustained legacy of institutional and interpersonal racism that is associated with the health disparities plaguing black communities.
The Robert Wood Johnson Foundation (RWJF) has announced the 20 accomplished nurses from across the United States selected as RWJF Executive Nurse Fellows for 2014.
Executive Nurse Fellows hold senior leadership positions in health services, scientific and academic organizations, public health and community-based organizations or systems, and professional, governmental and policy organizations. They participate in a three-year leadership development program designed to enhance the effectiveness of nurse leaders who are working to improve the nation’s health care system. Fellows receive coaching, education, and other support to enhance their abilities to lead teams and organizations. The program is located at the Center for Creative Leadership.
More than 200 nurse leaders have participated in the RWJF Executive Nurse Fellows program since it began in 1998. This will be the program’s final cohort.