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Nov 13 2014
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Addressing the Needs of Female Veterans Who Have Experienced Violence and Harassment

Jacquelyn Campbell, PhD, RN, FAAN, is director of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program and Anna D. Wolf chair and professor at the Johns Hopkins University School of Nursing.  Angela Amar, PhD, RN, FAAN, is an associate professor at the Nell Hodgson Woodruff School of Nursing at Emory University and an alumna of the RWJF Nurse Faculty Scholars program.

Jacquelyn Campbell Jacquelyn Campbell

As two scholars who have worked in research, practice and policy arenas around issues of gender-based violence for years, we honor our veterans this week by paying tribute to the Pentagon and the U.S. Department of Veterans Affairs (VA) for addressing intimate partner and sexual violence among active duty and returning military and their families, and urge continued system-wide involvement and innovative solutions.  

In our work, we’ve heard outrageous, painful stories. One female servicemember explained to Angela why she was ignoring the sexual harassment she experienced. She knew that hearing that she was inferior because she was a woman, being called “Kitty” instead of her name, and having the number 69 used in place of any relevant number was harassing. She knew it was wrong. But she had decided that she would not let it bother her. I can acknowledge that he is a jerk, but I can’t let that affect me.  

Angela Amar Angela Amar

I can’t let his behavior define me as a person. On some level this may seem like an accurate way of dealing with a problem person. However, sexual harassment isn’t just about one obnoxious person. Not telling the story doesn’t make the behavior go away. Rather, it sends the message that the behavior is acceptable and that sexist comments are a normal part of the lexicon of male/female interactions.

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Nov 13 2014
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RWJF Scholars in the News: EpiPens in schools, suicide prevention, financial incentives for wellness, 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:

A study by RWJF Physician Faculty Scholars alumna Ruchi Gupta, MD, MPH, shows that keeping supplies of epinephrine, commonly known as EpiPens, in schools saves lives, Health Day reports. Epinephrine injections are given in response to life-threatening allergic reactions to food or to insect stings. Gupta’s study found that epinephrine was administered to 35 children and three adults in Chicago public schools during the 2012-13 school year. “We were surprised to see that of those who received the epinephrine, more than half of the reactions were first-time incidents,” Gupta said. “Many children are trying foods for the first time at school, and therefore it is critical that schools are prepared for a possible anaphylactic reaction.”  Forty-one states have laws recommending schools stock epinephrine, according to the article.

Matt Wray, PhD, MA, an RWJF Health & Society Scholars program alumnus, writes in Medical Xpress that when it comes to preventing suicides, it’s important to focus some attention on how a person seeks to end his or her life. According to the article, suicide-prevention research has shown that when people who have begun to act on suicidal impulses find that access to their chosen method is blocked, many do not seek out other means. “Most people don’t have a backup plan,” Wray writes. “So when their initial attempt is stalled, the destructive impulse often passes. Moreover, contrary to what many believe, people who attempt suicide more than once are rare. Less than 10 percent of those who survive an attempt ever end up dying by suicide.”

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Nov 12 2014
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Connected Health Approaches to Improve the Health of Veterans

Mitesh S. Patel, MD, MBA, MS, is an assistant professor of medicine and health care management at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania. He is a staff physician and core investigator at the Center for Health Equity Research and Promotion at the Philadelphia Veterans Administration (VA) Medical Center. Patel is an alumnus of the VA/Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at the University of Pennsylvania (2012-2014).

Mitesh Patel

Cardiovascular disease is the number one cause of hospitalizations, morbidity and mortality among the veteran population. Building a Culture of Health could address this issue by focusing on individual health behaviors that contribute to risk factors associated with cardiovascular disease such as physical inactivity, diet, obesity, smoking, hyperlipidemia and hypertension.

The current health system is reactive and visit-based. However, veterans spend most of their lives outside of the doctor’s office. They make everyday choices that affect their health such as how often to exercise, what types of food to eat, and whether or not to take their medications.

Connected health is a model for using technology to coordinate care and monitor outcomes remotely. By leveraging connected health approaches, care providers have the opportunity to improve the health of veterans at broader scale and within the setting in which veterans spend most of their time (outside of the health care system). The Veteran’s Health Administration (VHA) is a leader in launching connected health technologies. VHA efforts began in 2003 and included technologies such as My HealtheVet (serving approximately 2 million veterans) and telemedicine (serving about 600,000 veterans).

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Nov 12 2014
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Improving Mental Health Care for Veterans is Vital

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).

Ilse Wiechers

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.

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Nov 11 2014
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Stony Brook Helps Veterans Become Nurses

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.

Lori Escallier

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?”

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Nov 11 2014
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Let’s Put Veterans in Charge of Their Pain Care

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.

Erin Krebs (Veterans Day)

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.

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Nov 10 2014
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To Honor Our Returning Veterans, We Must Address Their Family Needs

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.

Tova Walsh (Veterans Day)

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.

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Nov 7 2014
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Will Menu Calorie Counts Help Whittle America’s Waistline?

By Sheree Crute

Maricelle Ramirez is a foot soldier in America’s battle against obesity. For three years, Ramirez has politely offered Boston area patrons of McDonald’s, Kentucky Fried Chicken, Burger King, Dunkin’ Donuts, Wendy’s and Subway a $2 gift card in exchange for their estimates of the amount of calories in their fast-food feasts.

“I’ve met all types of people,” Ramirez says, recalling the surprise of encountering a nutritionist who was on her way out of McDonald’s after chowing down on a burger and fries. “She explained that she was just enjoying a meal because she had a craving for something indulgent, but she provided a very careful nutritional analysis of what she was eating.”

At the other end of the spectrum was an older woman leaving Kentucky Fried Chicken with a drumsticks-to-mashed potatoes spread for her family who confessed, “I don’t know much about the calorie content of the food, but it would really make a difference for me and my family if I had more information.”

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Nov 7 2014
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Recent Research About Nursing, November 2014

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.

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Nov 6 2014
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Quotable Quotes About Nursing, November 2014

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

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