Ilse Wiechers, MD, MPP, MHS is associate director at the Northeast Program Evaluation Center in the Office of Mental Health Operations of the U.S. Department of Veterans Affairs and faculty with the Yale Geriatric Psychiatry Fellowship. She is an alumna of the Yale Robert Wood Johnson Foundation (RWJF)/VA Clinical Scholars Program (2012-2014).
Health and disease are on a continuum. We are at a point in time where we are trying to understand the constituents of health, whereas historically our focus has been on understanding disease. It is important to recognize that veterans have unique determinants of health not shared with the rest of the population, such as exposure to combat and prolonged time spent away from social support networks during deployment.
These exposures can put veterans at increased risk for mental health problems, such as posttraumatic stress disorder, depression, and substance use problems. The U.S. Department of Veterans Affairs (VA) has a health care system uniquely positioned to help improve the overall health of veterans because of its expertise in addressing these unique mental health needs.
I have the privilege to serve our nation’s veterans through my work as a geriatric psychiatrist conducting program evaluation for the Office of Mental Health Operations (OMHO) at the VA. My work provides me an opportunity to directly participate in several of the key components of the comprehensive mental health services the VA provides for veterans.
Lori Escallier, PhD, RN, CPNP, is a professor and associate dean for evaluation and outcomes at the State University of New York at Stony Brook School of Nursing. She is her university’s project director for a program that helps veterans earn baccalaureate degrees in nursing (VBSN) and for New Careers in Nursing, a program supported by the Robert Wood Johnson Foundation (RWJF) and the American Association of Colleges of Nursing (AACN) that supports second-career nurses in accelerated master’s and baccalaureate nursing programs.
Human Capital Blog: Please tell us about your university’s program for nursing students who are veterans.
Lori Escallier: The project is entitled Enhancing the Nursing Workforce: Career Ladder Opportunities for Veterans. The purpose is to increase the enrollment, retention and educational success of veterans in the baccalaureate nursing program at Stony Brook. Our program operationalizes the collaborative efforts of the Health Resources and Services Administration, the Department of Defense, and the Department of Veterans Affairs (VA) by providing opportunities for veterans to transition into nursing careers.
HCB: How is the VBSN program helping to build a Culture of Health that more effectively serves veterans?
Escallier: One of the project’s aims is to enhance the nursing workforce with veterans. Veterans certainly have a good understanding of the needs of other veterans and their families. Who better to promote a Culture of Health for veterans than those who have “walked the walk?”
Erin Krebs, MD, MPH, is the women’s health medical director at the Minneapolis VA Health Care System and associate professor of medicine at the University of Minnesota Medical School. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholars program and the RWJF Clinical Scholars program.
How can we create a Culture of Health that effectively serves veterans? We can put veterans in charge of their pain care.
Chronic pain is an enormous public health problem and a leading cause of disability in the United States. Although 2000-2010 was the “decade of pain control and research” in the United States, plenty of evidence suggests that our usual approaches to managing chronic pain aren’t working. Veterans and other people with chronic pain see many health care providers, yet often describe feeling unheard, poorly understood, and disempowered by their interactions with the health care system.
Evidence supports the effectiveness of a variety of “low tech-high touch” non-pharmacological approaches to pain management, but these approaches are not well aligned with the structure of the U.S. health care system and are often too difficult for people with pain to access. Studies demonstrate that patients with chronic pain are subjected to too many unnecessary diagnostic tests, too many ineffective procedures, and too many high-risk medications.
Tova Walsh, PhD, MSW, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar at the University of Wisconsin in Madison. Her research focuses on the role expectant and new fathers play in the health and well-being of their partners and children, and the influence of parenthood on men's health and well-being. Walsh has used interview, focus group and survey data to examine the experiences of service members returning to family life after deployment.
On Veterans Day, we honor the service and sacrifice of U.S. military veterans. Recognizing that it is not just the individual who serves our country, but his or her entire family, we honor, too, our military families, whose support is essential for our servicemen and women to carry out their duties.
When a service member deploys, partners, children and other family members re-organize their lives to accommodate the physical absence of a loved one. They live each day bearing the burden of separation. When their deployed loved one returns home, they share not only in the joy of long-awaited reunion, but also in the joy and challenges of the extended process of the veteran’s reintegration to home, family and community. The youngest members of our military families are least able to understand or express the impact of these experiences, and yet are deeply affected by these transitions and the accompanying shifts in emotions on the part of the adults who they depend upon for care, love and security.
This is part of the November 2014 issue of Sharing Nursing’s Knowledge.
DNP Programs Increasing
New research by the RAND Corporation, conducted for the American Association of Colleges of Nursing (AACN), finds that the percentage and number of nursing schools offering doctorates in nursing practice (DNPs) has increased dramatically in recent years, but that some schools still face barriers to adopting programs that confer the degree.
Ten years ago, AACN member schools endorsed a call for moving the level of preparation necessary for advanced nursing practice from the masters to doctoral level, establishing a target of 2015. More recently, the Institute of Medicine’s landmark report on the future of nursing called for doubling the number of doctorally prepared nurses in order to help meet the demands of an ever more complex health care system.
According to RAND’s data, nursing schools are following through. Since 2006, the number of schools offering DNP degrees has grown by more than 1,000 percent, from 20 schools in 2006 to 251 in 2013.
The report finds that approximately 30 percent of nursing schools with Advanced Practice Registered Nursing (APRN) programs now offer degree paths in which baccalaureate-prepared nurses move directly to DNP programs, and that such BSN-DNP programs will likely be in another fifth of nursing schools with APRN programs in a few years.
This is part of the November 2014 issue of Sharing Nursing’s Knowledge.
“As a nurse, I understand the risk that I take every day to go to work, and he’s no different than any other patient that I’ve provided care for. So I wasn’t going to say, ‘No, I’m not going to provide care for him. I didn’t allow fear to paralyze me. I got myself together. I’d done what I needed to get myself prepared mentally, emotionally, physically, and went in there.”
--Sidia Rose, a nurse at Texas Health Presbyterian Hospital, Treating Ebola: Inside the First U.S. Diagnosis, 60 Minutes, CBS News, Oct. 26, 2014
“...I grabbed a tissue and I wiped his eyes and I said, ‘You’re going to be okay. You just get the rest that you need. Let us do the rest for you.’ And it wasn’t 15 minutes later I couldn’t find a pulse. And I lost him. And it was the worst day of my life. This man that we cared for, that fought just as hard with us, lost his fight. And his family couldn’t be there. And we were the last three people to see him alive. And I was the last to leave the room. And I held him in my arms. He was alone.”
--John Mulligan, a nurse at Texas Health Presbyterian Hospital, Treating Ebola: Inside the First U.S. Diagnosis, 60 Minutes, CBS News, Oct. 26, 2014
“Someone asked a nurse, what do you make? I make sure your seriously ill father is cared for. I make sure that when you’re incontinent you’re cared for. It’s this everyday, profound yet intimate work that people do. People don’t understand it. It requires incredible cognitive and emotional intellect to do it. You are with someone at the most difficult and challenging and joyous moments of their lives.”
--Diana Mason, PhD, RN, FAAN, professor, Hunter-Bellevue School of Nursing and president, American Academy of Nursing, Nurses Want to Know How Safe is Safe Enough With Ebola, NPR.org, Oct. 14, 2014
RWJF Scholars in the News: Simulating combat conditions for medical and nursing students, enriched maternity care, GMO confusion 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 article on dcmilitary.com describes a recent training exercise conducted for medical and nursing students at the Uniformed Services University of the Health Sciences (USU). The students cared for “patients” under simulated combat conditions that included mock explosions and casualties, operational problems, and reality-based missions. Arthur Kellermann, MD, MPH, dean of the F. Edward Hébert School of Medicine of USU, noted that while the exercise is focused on enhancing leadership and patient care skills, students are also practicing cultural sensitivity and problem-solving abilities. “All of this is wrapped into an incredibly challenging series of unfolding scenarios,” Kellermann said. “They are constantly being thrown problems. They have to adapt and learn to work with one another in a variety of ways and a variety of combinations.” Kellerman is an alumnus of the RWJF Clinical Scholars and Health Policy Fellows programs. Read more from Kellermann on the Human Capital Blog.
A study by Sara Rosenbaum, JD, examines the challenge of maintaining and coordinating “enriched health care” for pregnant women in California who purchase subsidized coverage from Covered California, the state’s health care exchange, and are also eligible for the state’s Medicaid program (Medi-Cal) and the Comprehensive Perinatal Services Program (CPSP) it offers. Science Daily reports that CPSP makes enriched maternity care available to pregnant women facing elevated health, environmental and social risks due to their economic status. Researchers compared maternity care under the two programs and identified a number of care coordination and integration challenges. Rosenbaum is an RWJF Investigator Award in Health Policy Research recipient.
Steven J. Palazzo, PhD, MN, RN, CNE, is an assistant professor in the College of Nursing at Seattle University, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2013 – 2016. ) His research focuses on evaluating the effectiveness of the Teen Take Heart program in mitigating cardiovascular risk factors in at-risk high school students.
Difficult problems demand innovative solutions. Teen Take Heart (TTH) is a program I’ve worked to develop, in partnership with The Hope Heart Institute and with support from the RWJF Nurse Faulty Scholars Program, to address locally a problem we face nationally: an alarming increase in obesity and other modifiable cardiovascular risk factors among teenagers. The problem is substantial and costly in both economic and human terms. We developed TTH as a solution that could, if it proves effective in trials that begin this fall in my native Washington state, be translated to communities across the country.
The State of Obesity: Better Policies for a Healthier America, released recently by the Trust for America’s Health and RWJF, makes it clear that as a nation we are not winning the battle on obesity. The report reveals that a staggering 31.8 percent of children in the United States are overweight or obese and only 25 percent get the recommended 60 minutes of daily physical activity. The report also finds that only 5 percent of school districts nationwide have a wellness program that meets the physical education time requirement.
Earlier this month, the U.S. Department of Health and Human Services (HHS) announced it is investing $283 million in the National Health Service Corps (NHSC), which provides scholarship and loan repayment services to health care providers who work in underserved areas.
The funds were authorized under the Affordable Care Act and will be used to boost the number of health care providers in underserved areas, which will increase access to care.
“Thanks to the Affordable Care Act, programs like the National Health Service Corps increase the primary care workforce in communities that need it most,” HHS Secretary Sylvia Burwell, AB, BA, said in a release. “These investments are another example of how the law is working to deliver accessible, affordable, quality care.”
The NHSC was founded in 1972 and provides care to nearly 10 million people across the nation.
In fiscal 2014, more than 5,100 loan repayment and scholarship awards were made to clinicians and students and 38 states received grants to support loan repayment programs, according to Mary Wakefield, PhD, RN, FAAN, head of the Health Resources and Services Administration.
“Primary care clinicians are the backbone of our health system, and thanks to the Affordable Care Act, programs like the National Health Service Corps increase the primary care workforce in medically underserved urban, rural and Tribal communities,” Wakefield said.
Read the news release.
For more information about NHSC programs, please visit NHSC.hrsa.gov.