Felesia Bowen, PhD, PCPNP-BC, is an assistant professor at Rutgers University School of Nursing, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2014-2017). Her research focuses on community-based pediatric asthma care.
When I first began working as a pediatric nurse in New Jersey 20 years ago, I was committed to getting asthma care right. I worked hard to educate my young patients and their families about the disease, how to avoid the triggers that cause attacks, and how to use their medications. I wrote asthma action plans and prescribed the correct medications to control symptoms.
It wasn’t always enough. One Monday morning, one of my young patients experienced asthma symptoms. The family followed his asthma action plan, “stepping” his medications in an effort to relieve his asthma symptoms. On Tuesday, he wasn’t feeling better, and went to the nurse practitioner (NP) in his school’s health office, who appropriately modified his treatment plan and called the asthma specialist to get a next-day appointment for him.
She remembers the young man telling her that he really needed to feel better, because he was going to his middle school graduation dance Wednesday night. On Thursday morning, he visited the NP again, still with asthma symptoms. He told her that he had missed the appointment with the asthma specialist because his mom couldn’t make it—she had health issues of her own, and three other children to care for. But he’d gone to his dance and proudly showed her his middle school class ring.
Nicole M. Brown, MD, MPH, MHS, is a general pediatrician at Montefiore Medical Center and an assistant professor of pediatrics in the Division of General Pediatrics at Albert Einstein College of Medicine at Yeshiva University in New York City. She is alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program.
Many patients have left an impression on my heart since I began my journey as a pediatrician, but one I cared for early in my career sticks with me. He was a wiry 8-year-old boy exhibiting symptoms of an anxiety and conduct disorder: He was very aggressive, had acted inappropriately with his younger sister, smeared feces around the house, and was difficult to manage. He had been severely and physically abused, and although child protective services had gotten involved, he had fallen out of the system after the case was “closed” and stopped showing up for therapy.
By the time his grandmother brought him to see me, I was the first doctor to see him in about two years. In the hour that I spent with him that day, it became clear that his treatment—or lack thereof—was inextricably bound up in his family’s various other challenges. His family lived in poverty, and faced food insecurity issues, in addition to a long, cyclical history of abuse and child protective services involvement. His grandmother was shuttling between various social service agencies, doing her best to complete forms and meet the requirements for public assistance. Yet despite her best efforts, she wasn’t really able to manage it all and, as a result, the boy’s health care was falling through the cracks.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published nearly 400 posts this year. As we usher in 2015, we take a look back at our ten most-read 2014 posts.
Why Do Deaths from Drugs Like Oxycodone Occur in Different Neighborhoods than Deaths from Heroin? This in-depth look at the role neighborhoods play in shaping substance abuse patterns was written by RWJF Health & Society Scholars program alumna Magdalena Cerdá, PhD, MPH. She compares neighborhoods that have more fatal overdoses of opiate-based painkillers to neighborhoods in which heroin and cocaine overdoses are more likely to occur, identifying characteristics of each. Her piece generated a larger audience than any other post published on this Blog this year, with more than 22,000 visits.
How Stress Makes Us Sick was written by RWJF Health & Society Scholar Keely Muscatell, PhD. A social neuroscientist and psychoneuroimmunologist, Muscatell shares her research into the physical manifestations of stress, its relationship to inflammation, and ways people may be able to reframe their responses to stress in order to alleviate the physical reactions it can cause. Understanding how stress makes us sick, she blogs, “is of extreme importance to the health and longevity of our nation.”
Misfortune at Birth, which drew the third-largest audience among the posts published on this Blog in 2014, asks whether some premature babies are simply born in the wrong place. It reports on nurse-led research that finds seven in ten black infants with very low birth weights have the misfortune of being born in hospitals with lower nurse staffing ratios and work environments than other hospitals. The blog post was written by Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, based on their study funded by RWJF’s Interdisciplinary Nursing Quality Research Initiative.
Mieke Beth Thomeer, PhD, is an assistant professor of sociology at the University of Alabama, Birmingham, and Debra Umberson, PhD, MSW, is a professor of sociology at the University of Texas at Austin and a 2011 recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research. The authors received the 2014 American Sociological Association’s Best Publication Award from the mental health section for an article on marital dynamics and depression that was published in Society and Mental Health.
The Centers for Disease Control and Prevention (CDC) estimates that one in 10 Americans is experiencing depression at any given time.1 Depression is a frequent topic in the media: news reports highlight the toll it takes on the diagnosed person;2,3 celebrities publicly discuss their debilitating experiences with depression;4,5 and researchers investigate biological markers of and cures for depression.6,7
Overwhelmingly, depression is depicted as an individual-level problem, a burden and difficulty for the person with it. Little attention is given to what depression means for her or his loved ones, especially for spouses. Because depression is rarely experienced in isolation, we argue that it is important to ask:
- What is the mental health impact of having a depressed spouse?
- What factors lead to the spread of depression from one spouse to the other?
- How can both spouses be supported during episodes of depression?
Brian D. Smedley, PhD, is executive director of the National Collaborative for Health Equity in Washington, D.C.
Relative to national averages, many people of color have poorer health from the cradle to the grave—beginning at birth, with higher rates of low birth weight and infant mortality; through childhood and adolescence, with higher rates of asthma and unhealthy weight; into adulthood, with higher rates of chronic disease and disability; and at the end of life, with higher rates of premature death and shortened lifespans.
Public health research shows that these health inequities are mostly attributable to factors beyond health care access and quality: As a result of residential segregation, people of color are more likely than whites to live in neighborhoods with a high concentration of health risks, and a relative paucity of health-enhancing resources. Highly-segregated communities of color are too often overrun with environmental health threats brought about by polluting industries, and vendors selling unhealthy products such as tobacco, alcohol, and high-fat, high-sugar, and/or high-sodium products. At the same time, many of these same communities lack access to affordable, nutritious food; safe spaces for exercise, recreation, and play; and high-quality schools that prepare children well for the high levels of education that are often protective of health.
For the 25th anniversary of the Robert Wood Johnson Foundation’s (RWJF) Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Steve R. Martinez, MD, MAS, FACS, a member of the 1992 class.
Washington State has one of the highest rates of breast cancer in the country. Steve R. Martinez, an award-winning surgical oncologist at the Everett Clinic, wants to uncover why.
He zeros in on Snohomish County’s large population of rural poor. Disproportionately higher rates of breast cancer there elicit questions, underscoring the challenges of eliminating health disparities.
Is it radium exposure? Something in the groundwater? Scarcity of vitamin D-rich sunlight?
“Nobody knows—and without delving into it, we’ll never find out,” says Martinez, mindful of the complex factors driving disparities.
Solutions, he adds, require probing beyond race, ethnicity, and socioeconomic status.
Ten nurses who have done outstanding work to improve health for people in their communities were named Breakthrough Leaders in Nursing last month at the Future of Nursing: Campaign for Action summit in Arizona. These emerging leaders, who are helping medically fragile children, low-income mothers, women in rural communities, and many others, hail from ten different states.
The Campaign for Action, a joint initiative of AARP and the Robert Wood Johnson Foundation, created the Breakthrough Leaders in Nursing award to celebrate nurse leadership and the importance of efforts by nurses to improve health and health care.
“It’s amazing to see the difference that these 10 people are making in their communities and the health care system,” said Susan B. Hassmiller, PhD, RN, FAAN, RWJF’s senior adviser for nursing and director of the Campaign for Action. “The lives of the people they care for are better because they fearlessly tackled—or are tackling—daunting health care challenges.”
“These outstanding leaders truly represent the future of nursing,” said Susan Reinhard, PhD, RN, FAAN, senior vice president of the AARP Public Policy Institute and chief strategist at the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation.
For the 13th year in a row, and the 15th time in the 16-year history of the survey, Americans have named nurses the country’s most trusted profession. Health care providers took the top three slots in the survey this year, with medical doctors and pharmacists coming in second and third, respectively.
Gallup has asked Americans to rate the honesty and ethics of various professions each year since 1990, and nurses were first included in the survey in 1999. Every year since, with the exception of 2001 when firefighters were included following the attacks on 9/11, nurses have topped the list.
This year, four in five respondents (80%) said they would rate the honesty and ethical standards of nurses high or very high.
This Gallup poll is based on telephone interviews conducted Dec. 8-11, 2014, with a random sample of 805 adults, aged 18 and older, living in all 50 states and the District of Columbia.
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 December issue.
A Goal and a Challenge: Putting 10,000 Nurses on Governing Boards by 2020
As nurse leaders and champions from around the country gathered in Phoenix last month for the Future of Nursing: Campaign for Action 2014 Summit, a powerful coalition of national nursing organizations launched the Nurses on Boards Coalition, an unprecedented effort to increase the presence of nurses on corporate and non-profit health-related boards of directors. The Coalition will implement a national strategy aimed at bringing the perspectives of nurses to governing boards and to national and state commissions that are working to improve health.
Older Nurses Push Retirement Envelope
A growing number of nurses are continuing to practice in their late 60s and beyond—a phenomenon that has significant implications for the nursing workforce and the health care system. While some nurses have always worked past the traditional age of retirement, the number of older nurses in clinical practice is growing, according to a recent study by Peter Buerhaus, PhD, RN, a professor of nursing at Vanderbilt University and director of the university’s Center for Interdisciplinary Health Workforce Studies.
Pooja Mehta, MD, is a generalist obstetrician/gynecologist and a second-year Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, with support from the Department of Veterans Affairs. Rebekah Gee, MD, MHS, is Medicaid Medical Director for the state of Louisiana, an assistant professor of health policy and management, and obstetrics and gynecology at Louisiana State University and an alumna of the RWJF Clinical Scholars program.*
The theory of disruptive innovation seeks to explain how complicated, expensive systems may eventually be replaced by simpler, more affordable solutions, driven by new entrants into a market who “disrupt” an older, less efficient, and less accessible order.
In the new issue of Current Opinion in Obstetrics and Gynecology, we track the history of the RWJF Clinical Scholars program (CSP) in the field of obstetrics and gynecology, and offer a curated selection of pieces that suggest that our discipline—now peppered with experts in health services research and health policy trained through the CSP—could be teetering at the precipice of an era of such disruptive innovation.
Highlighting the work of nine current and past scholars, among more than 40 Clinical Scholars working in the field of obstetrics and gynecology, this journal issue covers a range of cutting-edge concepts currently being developed and employed to transform our field from the inside out.
Nathaniel DeNicola, MD, (‘11) discusses the potential uses of social media to disseminate and advance new findings and recommendations to broader audiences. Laurie Zephyrin, MD, MBA, (’03) illuminates how efforts to integrate systems, create interdisciplinary initiatives, and how research-clinical partnerships have allowed for rapid organizational and cultural change and have advanced reproductive health care in the Veterans Affairs system.
Elizabeth Krans, MD, (‘09) writes about ways in which new public funding is allowing for disruptive innovation in the delivery of prenatal care—for example, through dissemination of the highly decentralized, patient-driven Centering Pregnancy model. Working from within a city health department, Erin Saleeby, MD, (‘10) writes about how participatory approaches to public health governance can engage community and clinician leaders in the process of redesigning reproductive care and transforming outcomes.