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Aug 12 2014
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Recent Research About Nursing, August 2014

This is part of the August 2014 issue of Sharing Nursing’s Knowledge.

Violence Against Emergency Nurses

For many nurses working in emergency departments, physical violence and verbal abuse is a common occurrence. One survey found that more than half of emergency nurses had experienced such incidents within the previous week. Research suggests a number of contributing factors, including long wait times and patients who have psychiatric problems or are under the influence of drugs or alcohol. According to a study published in the July 2014 issue of The Journal of Emergency Nursing, while data on the frequency of such incidents is readily available, less study has been devoted to nurses’ personal experiences with assaults, including the circumstances and consequences of the incidents.

With that in mind, a research team led by Lisa A. Wolf, PhD, RN, CEN, conducted a qualitative analysis of 46 nurses’ personal accounts of assaults. Several common themes stood out:

  • A number of nurses talked about what the researchers described as a “culture of acceptance” of an “unsafe workplace.” For example, hospitals discouraged nurses from pressing charges or prosecutors declined to pursue cases. Some nurses said safety measures such as security or panic buttons were not maintained. Others noted that despite signs being posted that warned that anyone who committed violence, made threats, or acted out in other ways would be ejected from the hospital, such behavior was tolerated.
  • Many nurses described the impact of assaults in personal terms, saying they had “lingering psychological trauma that continues to impede their ability to work in the emergency setting.” Some reported chronic pain from injuries sustained during violent incidents, but said they continued to work full time. Others reported having to leave the profession because of the extent of injuries.
  •  Nurses described what researchers identified as missed cues that violence was about to occur, usually from patients from whom such behavior might have been anticipated. One example is a patient taken to the emergency room for ingesting multiple drugs and placed only in soft restraints. Another example involved individual nurses being left alone with patients brought in for psychiatric evaluation who had been verbally abusive to paramedics.

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Aug 11 2014
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Quotable Quotes About Nursing, August 2014

“Wearable tech will provide nurses with virtual personal assistants that remind them of appointments and meetings, log professional conversations, maintain notes and serve up data and information in a matter of seconds. If nurses need to perform a procedure, wearable computers will remind them of specific steps and risks via links to videos or instant messages shared by nursing colleagues. Although wearable tech comes with limitations related to power, privacy, interface and connectivity, nurses will benefit from this game-changing innovation.”
-- Susan Sportsman, RN, PhD, ANEF, FAAN, director, Academic Consulting Group, a service of Elsevier, Nurses Will Reap the Benefits of Wearable Tech, AdvanceWeb.com, August 5, 2014

“Nurses save lives and deal with complications every day. It can be a very intense and stressful work environment, which is why humor and a good mood are integral to the nursing profession. As a nurse, it’s an art to keep your smile, which helps ensure an excellent connection to patients. Designing affordable space that is conducive to the work is a smart way to bring positive mood—like laughter— into the workplace.”
--Rana Zadeh, MArch, PhD, assistant professor, Cornell University’s College of Human Ecology, On the Sunny Side, Nurses Dispense Better Care, Cornell Chronicle, July 31, 2014

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Aug 11 2014
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Physician Characteristics Can Affect Prostate Cancer Treatment

Management of low-risk prostate cancer varies widely among urologists and radiation oncologists, with characteristics of the physicians who provide treatment playing a significant role in decisions about care, according to a study published online by JAMA Internal Medicine.

Researchers found that urologists who did not graduate from medical school recently, and who care for patients with higher-risk prostate cancer, are more likely to pursue up-front treatment for patients with low-risk prostate cancer than other urologists, who choose to observe and monitor the disease. In many cases, low-risk prostate cancer does not cause symptoms or affect survival if left untreated.

The prevailing approach in the United States, the study says, for men with low-risk prostate cancer is treatment with prostatectomy or radiotherapy, which can cause complications such as urinary dysfunction, rectal bleeding, and impotence. 

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Aug 8 2014
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Nursing Shortage Offset by Older Nurses Delaying Retirement

Peter Buerhaus, PhD, RN, is the Valere Potter Distinguished Professor of Nursing, director of the Center for Interdisciplinary Health Workforce Studies, and professor of health policy at Vanderbilt University Medical Center. He co-authored a new study in Health Affairs that found more nurses are delaying retirement, which is adding to the supply of nurses at a time when shortages had been projected.

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Human Capital Blog: A decade ago, you forecast large shortages of nurses by the middle of this decade. That isn’t panning out yet. Why?

Peter Buerhaus: When we did the original research, which was published in 2000 in the Journal of the American Medical Association, we were using data that was available at that time, which was up to about 1997 or 1998. At the time, we observed that enrollment in nursing schools had dropped nearly 5 percent each year over the previous five years. Based on that and some other factors, our projections suggested that unless something big happened—namely that we would get a lot of new people to enter nursing to replace the aging and large number of retiring Baby Boomer registered nurses (RNs)—we would run into large shortages and the RN workforce would stop growing by around 2014 or 2015.  

Now we’re seeing two new phenomena: First, there has been a great surge of interest in nursing since the mid-2000s, and this has been reflected in a dramatic increase in the number of graduates from associate- and baccalaureate-degree nursing programs. And second, RNs are, on average, spending more time in the workforce—about 2.5 more years than did their peers back in the 1980s and 1990s.

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Aug 7 2014
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RWJF Scholars in the News: The ACA and mental health treatment, HIV training for nurses, the rise of superbugs, and more.

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:

An Affordable Care Act (ACA) provision that allows parents to keep adult children on their health insurance plans under they reach age 26 has resulted in millions more young people with mental-health and substance-abuse problems getting treatment, according to a study led by Brendan Saloner, PhD. Time reports that over two years, young adults ages 18 to 25 who had screened positive for mental health or substance abuse disorders increased their use of mental-health treatment by 5.3 percent compared to a similar group who were not eligible for their parents’ coverage. Vox and HealthDay were among the outlets to report on the study. Saloner is an RWJF Health & Society Scholar.

Infection Control Today quotes Jason Farley, PhD, MPH, CRNP, on the growing need to train nurses to provide HIV care. An RWJF Nurse Faculty Scholar, Farley developed new HIV curriculum for the John Hopkins School of Nursing, where he is an associate professor. “For many years these specialty training programs in HIV have been available for physicians,” he says. “This is the first time we’re offering them to non-physician providers. It’s quite an important development. When you look at data comparing patient outcomes with physician care and with nurse practitioner care in HIV, whether in the United States or in sub-Saharan Africa, those outcomes are the same.”

Magda Cerdá, PhD, MPH, an RWJF Health & Society Scholars program alumna, explores the stressors that lead to high numbers of returning National Guard soldiers abusing alcohol, reports Science Codex. Cerda is the lead investigator of the study, which examined 1,095 Ohio National Guard soldiers who served primarily in Iraq or Afghanistan in 2008 and 2009, and found that having just one civilian stressor such as job loss, or legal or financial problems, raised the odds of alcohol use disorders. Medical Daily and Medical Xpress also cover Cerda’s work.

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Aug 6 2014
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In the Media: Nursing Champion Calls on Hollywood to Portray Realities of Nursing

This is part of the August 2014 issue of Sharing Nursing’s Knowledge.

The TV is a funhouse mirror—at least when it comes to its portrayals of nurses.

That’s the view of Leah Binder, MA, MGA, president and CEO of the Leapfrog Group, a national organization that promotes quality and safety in hospitals, and a member of the Future of Nursing: Campaign for Action’s Champion Nursing Coalition.

In a recent essay in the Wall Street Journal’s The Experts blog, Binder says television medical shows badly distort everyday life in hospitals and health care facilities. “Tune to your favorite hospital drama and count how many characters are nurses and how many are doctors,” she writes. “More likely than not, you will find about 10 doctors for every one nurse. The reality is roughly the opposite: There are about 10 times more nurses than physicians in the hospital down the street from you. Most of what hospitals do is deliver expert nursing care.”

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Aug 5 2014
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2015 Cohort of RWJF Clinical Scholars Announced

The Robert Wood Johnson Foundation (RWJF) Clinical Scholars program has announced the 31 physician leaders selected as the program’s final cohort. The new Clinical Scholars are physicians who were selected competitively from medical and surgical residencies across the United States. The 2015 cohort includes physicians specializing in primary care, emergency care, pediatrics, surgery, and psychiatry.

This is the program’s largest cohort in more than five years. Clinical Scholars spend two years examining the delivery, impact, and organization of health care.

RWJF will fully fund 10 of the 31 scholars. Through a partnership of more than 30 years, the U.S. Department of Veterans Affairs (VA) will jointly support 13 scholars through VA Medical Centers affiliated with the participating universities. Those universities will fund six scholars, and for the first time, two scholars at UCLA will receive funding support from the Los Angeles County Department of Mental Health.

Read more about the 2015 Clinical Scholars and the funders that are supporting them.

For more information about the program, visit http://rwjcsp.unc.edu/.

Aug 5 2014
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Staffing Mattered: Affordable Care Act Enrollment Got a Big Boost from Assister Programs

Healthy enrollment figures from state and federal marketplaces—topping 8 million sign-ups—during the Affordable Care Act’s (ACA) first open enrollment period got a significant helping hand from 28,000 full-time staff and volunteers in 4,400 assister programs, according to a Kaiser Family Foundation survey.

The survey, which is the first nationwide assessment of these programs and their impact, found that navigators and assisters provided in-person help to an estimated 10.6 million people.  Programs in states running their own marketplaces helped people at twice the rate of programs in states that relied on the federal marketplace.

Around one in eight assister programs reported that consumer demand exceeded capacity, and that share grew to one in four during a surge in March as open enrollment neared its deadline. Among the most difficult challenges programs faced were helping consumers with online technical problems, helping consumers understand plan choices, and helping consumers who had a limited understanding of the ACA.

The survey was designed to capture issues that came up with consumers, assisters’ experiences with the enrollment process, and suggestions for improvements during open enrollment next year.

Read the Kaiser Family Foundation’s Survey of Health Insurance Marketplace Assister Programs.

Aug 4 2014
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Loneliness: A Significant Stressor that Requires Intervention

Laurie A. Theeke, PhD, FNP-BC, is an alumna of the Robert Wood Johnson Foundation Nurse Faculty Scholars program and an associate professor of nursing at West Virginia University School of Nursing.

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The Burden of Stress in America, a new report commissioned by NPR, RWJF, and the Harvard School of Public Health, makes it clear that Americans are experiencing extremely stressful life events that are contributing to poor health outcomes. As a researcher who studies loneliness and how it contributes to poor health, I found the report somewhat alarming. Many of the life events identified by survey respondents are already associated with loneliness in the health and social science literature. Stressful events like new illness and disease, losing a spouse or loved one, or major life transitions can all lead to a personal experience of loneliness. This is very concerning because loneliness is a unique psychological stressor that can be hard to recognize or remedy without professional help.

Loneliness is a significant biopsychosocial stressor that contributes to multiple chronic conditions. We have known since the 1950s that there is an association between loneliness and cardiovascular problems like hypertension (Hawkey, Masi, Berry, & Cacioppo, 2006). More recent studies have identified loneliness as a major predictor of stroke as well.

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Aug 1 2014
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The Imperative to Engage Surgical Residents in Quality Improvement

Charles D. Scales Jr., MD, MSHS, an alumnus of the Robert Wood Johnson Foundation/VA Clinical Scholars program (UCLA 2011-2013), is a health services researcher at the Duke Clinical Research Institute and assistant professor in the division of urologic surgery at Duke University School of Medicine.  He is also assistant program director for quality improvement and patient safety for the urology residency training program at Duke University Hospital.  

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Young doctors training to become surgeons, also called surgical residents, are increasingly caring for patients in an environment that links quality, safety, and value to patient outcomes. Over a decade ago, the Institute of Medicine highlighted the need for improving care delivery in the landmark report, Crossing the Quality Chasm, suggesting that high-quality care should be safe, effective, patient-centered, timely, efficient (e.g., high value), and equitable. Just this week, the Institute of Medicine followed with a clarion call for training new physicians to participate in and lead efforts to continually improve both care delivery and the health of the population, while simultaneously lowering costs of care.

To support this imperative, the Accreditation Council for Graduate Medical Education, which accredits all residency training programs in the United States, mandates that all doctors-in-training receive education in quality improvement. Despite this directive, a number of substantial barriers challenge delivery of educational programs around quality improvement.  Health care is increasing complex, driving residents to focus on learning the medical knowledge and surgical skills for their field.  Patient care demands time and attention, which can limit opportunities to learn about quality improvement within the context of 80-hour duty limits. This barrier particularly challenges surgeons-in-training, who often spend 12 or more hours daily learning surgical skills in the operating room, leaving little time for a traditional lecture-format session about quality improvement. Finally, many surgical training programs lack faculty with expertise in the skills required to systematically improve the quality, safety, and value of patient care, since these skills were simply not taught to prior generations of surgeons.

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