http://www.rwjf.org/en/blogs/human-capital-blog.html Human Capital Blog RWJF’s Human Capital portfolio created its blog to serve as a forum for sharing information and stimulating discussion about the challenges of building a health care workforce that meets the nation’s current and emerging health care needs. Fri, 1 Aug 2014 09:00:00 -0400 en-us Copyright 2000- 2014 RWJF webmail@rwjf.org (RWJF) http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/the_imperative_toen.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/the_imperative_toen.html <![CDATA[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.  

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.

Overcoming these barriers to engaging surgeons-in-training in quality improvement is the focus of my work in resident education. I believe that just as they assume progressive responsibility for patient care during training, surgical residents should also assume progressive responsibility for improving the quality, safety, and value of their care. One model to facilitate progressive responsibility would include early didactic teaching, followed by subsequent integration of residents into the ongoing quality improvement processes of their department or hospital.  Ultimately, residents should have the opportunity to lead meaningful quality improvement projects in the final years of their training.

To create an innovative didactic experience, a team comprised of Jonathan Bergman, MD, (UCLA CSP 2011-13), Tannaz Moin, MBA, MD, (VA Health Services Research & Development fellow), and I have received a grant from the Society of Urologic Chairpersons and Program Directors. Key teaching points will be identified from a review of existing Quality Improvement (QI) curricula and validated as important to urologic surgeons by a stakeholder panel of urologists who have expertise in quality improvement, patient safety, or resident education. Once the key teaching points are identified, urology-specific cases will be developed. The cases and questions will be delivered using a state-of-the-art learning platform that can be accessed by any device with a web browser. Learning interactions are evidence-based and take only 2-3 minutes per day. We anticipate rolling the curriculum out to 40 residency training programs for testing and evaluation in 2015, and if successful may disseminate it nationwide through the American Urological Association.

This method of learning overcomes several barriers to teaching surgical residents about quality improvement. It provides content to training programs that may not have expert faculty in this area, and allows residents to learn in small spaces of time during the day, rather than hour-long lectures. It also averts the need for residents and faculty to gather in the same time and place to learn.

At the end of the program, residents should have improved knowledge of QI methods, and will be able to apply those methods in their local hospitals to improve care delivery and patient outcomes. Based on this foundation of knowledge, future educational research will identify ideal methods to engage surgical residents in ‘hands-on’ QI activities.

Surgeons are different – they work differently and think differently. Thus, innovative programs for engaging surgical residents are required and this grant represents a first step in that direction. Through progressively and meaningfully engaging surgical residents in the ongoing QI process of their institutions, we will help build a surgical workforce that is not only medically knowledgeable and technically skilled, but will also possess the ability to advance the quality of care they deliver.

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Fri, 1 Aug 2014 09:00:00 -0400 Charles D. Scales Patient safety and outcomes Quality of care Education and training Human Capital Clinical Scholars Voices from the Field
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/grants_to_build_amo.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/grants_to_build_amo.html <![CDATA[Grants to Build a More Highly Educated Nursing Workforce]]>

The Robert Wood Johnson Foundation (RWJF) has announced the nine state “Action Coalitions” that will share $2.7 million to advance strategies aimed at creating a more highly educated, diverse nursing workforce. The nine states that are receiving two-year, $300,000 grants through RWJF’s Academic Progression in Nursing (APIN) program are California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas, and Washington state.  For each, this is the second two-year APIN grant and it will be used to continue encouraging strong partnerships between community colleges and universities to make it easier for nurses to transition to higher degrees. 

In its groundbreaking 2010 report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) recommended that 80 percent of the nursing workforce be prepared at the baccalaureate level or higher by the year 2020. Right now, about half the nurses in the United States have baccalaureate or higher degrees.

RWJF is helping advance recommendations in the IOM report by supporting the Future of Nursing: Campaign for Action—a collaborative effort to advance solutions to challenges facing the nursing profession in order to improve quality and transform the way Americans receive health care. The Campaign supports Action Coalitions in all 50 states and the District of Columbia.

Read more about the new Academic Progression in Nursing grants.

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Thu, 31 Jul 2014 15:00:00 -0400 Human Capital Blog Nurses Education and training Education level Leadership development Diversity Human Capital Academic Progression in Nursing Future of Nursing Nursing
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/rwjf_scholars_inthe3.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/rwjf_scholars_inthe3.html <![CDATA[RWJF Scholars in the News: Cesarean sections, hospital readmissions, nurse practitioners, 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:

RWJF Clinical Scholar Chileshe Nkonde-Price, MD, shared her experiences with the medical system  during the last week of her recent pregnancy in a video featured on Nasdaq.com. Despite have given birth via Cesarean section earlier, Nkonde-Price wished to deliver vaginally with this pregnancy if she could do so safely. C-section has become the nation’s most common major surgery, the piece says. It examines some of the factors behind the sharp increase in the number of women delivering via C-section in the United States.

In a Health Affairs Blog, José Pagán, PhD, analyzes Medicare’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excessive 30-day readmissions for conditions such as pneumonia and heart failure. While Pagán says that not all readmissions can be avoided, hospitals can improve their performance through effective discharge planning and care coordination. With more incentive programs on the horizon, Pagán suggests that health care organizations “seek and monitor collaborative partnerships and, more importantly, strategically invest in sustaining these partnerships” so they can survive and thrive. He is an RWJF Health & Society Scholars program alumnus and recipient of an RWJF Investigator Award in Health Policy Research.

A study led by RWJF Nurse Faculty Scholar Lusine Poghosyan, PhD, RN, looks at how Nurse Practitioners (NPs) rate their work environments. It finds that those working in Massachusetts fared better that those working in New York on every topic in the survey: support and resources, relations with physicians, relations with administration, visibility and comprehension of their role, and independence of practice. The survey also found that NPs working in community health clinics and physicians’ offices rated their work experiences better than NPs working in hospital-affiliated clinics. Poghosyan told Science Codex the findings suggest “the practice environment for NPs in New York can improve once the state’s NP Modernization Act,” which will expand NPs’ scope of practice, takes effect.

As the Affordable Care Act is fully implemented, there are growing concerns about shortages of primary care providers, according to a Health Affairs Blog co-authored by RWJF Executive Nurse Fellows program alumna Debra Barksdale, PhD, RN, FAAN. “Physician shortages can be addressed by the rapid growth of nurse practitioners (NPs), trained in primary care, along with the redesign of primary care to include teams that can be led by both physicians and NPs. But our nation’s primary care needs can only be met if states allow NPs to practice to the fullest extent of their training,” Barksdale and her co-authors write, noting that “it is time to remove barriers and support a collaborative dialogue about the needed changes in the U.S. primary care health system.”

A study by Sarah Burgard, PhD, MS, MA, an RWJF Health & Society Scholars program alumna, and colleagues seeks to reconcile previous research that found unemployment increases probability of death, but recessions decrease it. Health Canal reports on the study, which found job loss is associated with a 73 percent increase in the probability of death; however, this increased risk affects only the unemployed and is outweighed by the ways economic slowdowns affect the health of the entire population through such factors as drops in traffic fatalities and reduced pollution. Laboratory Equipment and Red Orbit are among the outlets also covering Burgard’s work.

Seeking mental health care may not help people who are lesbian, gay and bisexual (LGB) who are experiencing depression, Edge News reports, citing a study by Ilan H. Meyer, PhD, that found seeking treatment from a mental health or medical provider did not reduce the odds of a suicide attempt for this population. “Public health officials and health service providers ought to ensure that LGB individuals who seek mental health treatment, whether it is in medical or religious settings, receive competent mental health services that is relevant to their needs,” said Meyer, recipient of an RWJF Investigator Award in Health Policy Research.

How long parents live may be associated with their children’s educational attainment. The Milwaukee Journal Sentinel reports on a study article co-authored by Esther Friedman, PhD, that found parents of college graduates lived about two years longer, on average, than parents of children who did not complete high school. Better-educated children may influence their parents to adopt healthier lifestyles, the authors suggest. Friedman is an RWJF Health & Society Scholars program alumna.

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Thu, 31 Jul 2014 09:40:00 -0400 Human Capital Blog Work environment Workforce supply and demand Nurse practitioners Primary care Nurses Research Scholars and fellows Human Capital Nursing Clinical Scholars Health & Society Scholars Investigator Awards in Health Policy Research Nurse Faculty Scholars Executive Nurse Fellows Research & Analysis HC Website Feature Media Coverage
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/mba_degrees_givephy.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/mba_degrees_givephy.html <![CDATA[MBA Degrees Give Physicians a Career Boost]]>

Physicians who have both doctor of medicine (MD) and master of business administration (MBA) degrees reported that their dual training had a positive professional impact, according to a study published online by Academic Medicine. The study, one of the first to assess MD/MBA graduates’ perceptions of how their training has affected their careers, focused on physician graduates from the MBA program in health care management at the University of Pennsylvania.

Mitesh S. Patel

The MD was more often cited as conveying professional credibility, while 40 to 50 percent of respondents said the MBA conveyed leadership, management, and business skills. Respondents also cited multidisciplinary experience and improved communication between the medical and business worlds as benefits of the two degrees.

“Our findings may have significant implications for current and future physician-managers as the landscape of health care continues to change,” lead author Mitesh S. Patel, MD, MBA, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, said in a news release. “A study published in 2009 found that among 6,500 hospitals in the United States, only 235 were run by physicians. Moving forward, changing dynamics triggered by national health care reform will likely require leaders to have a better balance between clinical care and business savvy. Graduates with MD and MBA training could potentially fill this growing need within the sector.”

The study’s authors include David A. Asch, MD, MBA, co-director of the RWJF Clinical Scholars Program at the University of Pennsylvania; RWJF Interdisciplinary Nursing Quality Research Initiative co-director Mark V. Pauly, PhD; June M. Kinney, MA; Mamta S. Patel, BBA; and Vishal Arora.

Read the study, “The Role of MD and MBA Training in the Professional Development of a Physician: A Survey of 30 Years of Graduates From the Wharton Health Care Management Program,” which will also be published in the September issue of Academic Medicine.

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Wed, 30 Jul 2014 09:00:00 -0400 Human Capital Blog Continuing education Education and training Education level Job satisfaction Jobs Leadership development Human Capital Interdisciplinary Nursing Quality Research Initiative Clinical Scholars
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/remember_the_financi.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/remember_the_financi.html <![CDATA[Childhood Trauma: A Public Health Problem that Requires a Robust Response]]>

Cindy A. Crusto, PhD, is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, an associate professor of psychology in psychiatry, Yale University School of Medicine, and a Public Voices Fellow with The OpEd Project.

Were the findings really a surprise? The recent release of the report The Burden of Stress in America commissioned by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health, highlights the major role that stress plays in the health and well-being of American adults. As a researcher who studies the impact of emotional or psychological trauma on children’s health, I immediately thought about the findings in the context of trauma and the associated stress in the lives of children. That trauma can include violence in the home, school, and community.

Two decades of research has produced clear findings on this significant public health problem: Psychological trauma can have a powerful influence in the lives of children, and if not detected and addressed early, it can (and often does) have long-lasting physical and mental health effects into adulthood. Despite this strong evidence, I have encountered the sheer resistance of some advocates who work with or on behalf of vulnerable children to fully engage in this topic. Perhaps it’s because of the belief that this talk about trauma is a fad—a hot topic that will fade as soon as something “sexier” comes along.

There is also a concern that an emphasis on trauma further stigmatizes children and the cultural groups to which they belong, reinforcing existing negative stereotypes. You can understand their caution that children’s trauma histories could be used against them, that children might automatically be diagnosed with a mental health disorder, or that they would be seen as a danger to society and in need of the highest, most restrictive level of care. That care often takes children away from their families to secure facilities outside of their communities and even outside of their states.

We cannot, however, ignore how widespread trauma is for vulnerable children. It is estimated that among healthy, typically developing children, 26 percent will witness or experience a trauma event before 4 years of age (Briggs-Gowan, Ford, Fraleigh, McCarthy, & Carter, 2010). Among vulnerable children, those who are at risk for poor health outcomes because they live in socioeconomically disadvantaged communities and have fewer health resources, the prevalence of trauma events has been reported to be 49 percent (Briggs-Gowan, Ford, Fraleigh, McCarthy, & Carter, 2010) to 75 percent (Roberts, Campbell, Ferguson, & Crusto, 2013).

Trauma can negatively impact several developmental processes such as attention and learning, memory, emotion regulation, personality development, and relationships—the foundation of all subsequent development and self-regulation.

Furthermore, traumatic stressors activate the stress-response system, which forces the brain to use its resources continuously to ward off perceived or real danger. Children are then at greater risk for mental health problems, though it does not mean that they will automatically have them.

To prevent that from happening, we have to intervene. Rather than pathologize children or families, let’s look at how we can support communities and the educational, medical, juvenile justice, and child welfare systems that serve them. This means support for trauma exposure screening for all children, in-depth assessment, training for caregivers to understand the central role that trauma can play in health and development, provision of interventions to help those who work with children exposed to trauma, and work with parents and caregivers if they, too, have trauma histories. There is a federal program designed to support children experiencing trauma and the systems that serve them: the Child Abuse Prevention and Treatment Act.  

There may be fear at the potential cost of the resources needed. However, if we want to truly make a difference in the lives of children and their families, we have to understand that the annual financial burden to society of untreated childhood abuse—the trauma-encompassing medical costs, mental health utilization, law enforcement, child welfare, and judicial system costs—is approximately $103 billion.

According to Julian Ford, PhD, a child trauma expert, trauma threatens children’s safety and security and thus is a survival challenge. Trauma events evoke stress reactions in children, which are much like those described in the report. If we do not proactively address these experiences, we are jeopardizing children’s health and development, and all of our futures.

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Tue, 29 Jul 2014 09:00:00 -0400 Cindy A. Crusto Behavioral/mental health At-risk and vulnerable people Child welfare Human Capital New Connections Voices from the Field Health Burden of Stress
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/what_protects_ourch.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/what_protects_ourch.html <![CDATA[What Protects Our Children from the Effects of Stress?]]>

Lorraine McKelvey, PhD, is an associate professor of family and preventive medicine and pediatrics at the University of Arkansas for Medical Sciences. She is an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections program (2008-2009) whose work focuses on vulnerable populations.

Lorraine McKelvey New Connections

For children, stress can come from sources inside and outside the family. It was recently documented that nearly two out of every three children in the United States have witnessed or been victims of violence in their homes, schools, or communities. That’s a staggering statistic when we consider the well-established link between children’s exposure to stress and their long-term mental and physical health outcomes.

Indeed, we know that early exposure to adverse experiences can change the way that our brains develop and function. We also know that exposure to adversity increases the likelihood that children will develop psychosocial problems, like depression, aggression, and other antisocial behaviors. There is even evidence that exposure to stressors in childhood increases the likelihood of having heart disease and cancer in adulthood!

But what can happen to interrupt the pattern? What can help children overcome adversity? That’s something that we have been researching for a long time, but it’s often clearer to understand what puts someone at risk for less optimal outcomes than what supports them to overcome. The truth is that understanding what helps someone persevere is difficult to unpack. It depends on many things; the type and number of adversities the child experienced, the developmental period when the exposure happened, and the area of development that you’re trying to understand. An additional complexity is the same variations happen when you look at the protective factors that help support children to achieve optimal outcomes.

For young children, there is evidence that positive family interactions (and even a lack of negative family interactions like family conflict) can be protective against the negative effects of stress on development. For example, when you examine children who grow up in violent communities, studies show that having low levels of family conflict or high levels of family cohesion is protective for psychosocial well-being.  This seems to be true especially for boys, but studies are inconsistent with regard to gender.

Living in the context of violence is also stressful for parents. Empirically, we know that stress has negative impacts on parenting behaviors, including interactions with their children and others in the family. According to recent polling results published by NPR/RWJF/Harvard School of Public Health, The Burden of Stress in America, the most commonly affected area of life when people are under stress is family life.  About four out of every 10 people under great amounts of stress, according to the poll, also reported that stress made it harder to get along with family members and caused arguments. Given that family conflict is an adversity that negatively impacts children’s development, it’s imperative that we support parents to manage their own stress and support their children’s development.

There is evidence that two-generation child and family support programs can help parents achieve optimal parenting in the face of stress. One study of Early Head Start, for example, demonstrated that families in the program, compared to those who weren’t, were able to achieve cognitively stimulating parent-child interaction behaviors that minimized the effects of parenting stress on their children’s emotional development. Two-generation early childhood programs are provided in different ways, through quality early childhood education programs with family support components or in the context of visits made directly to families’ homes. The goals of the programs are to provide services for the child and instrumental and emotional support to parents so they can protect and nurture children to their best abilities.

Fortunately, the federal government is investing funding in early intervention, which has increased the availability of evidence-based early childhood and family support services across the nation. These funds target families at greatest risk, namely those living in poverty or with a child with a developmental concern. While we are making gains, there still aren’t sufficient funds to help all families. It’s important for our nation to continue to invest in our youngest, most vulnerable children and their families; to protect children from stress; and to support a culture of health for future generations. 

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Mon, 28 Jul 2014 09:00:00 -0400 Lorraine McKelvey Research Pediatric care Social determinants of health Children (0-5 years) Adolescents (11-18 years) Human Capital Voices from the Field New Connections Health Burden of Stress
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/working_to_improven.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/working_to_improven.html <![CDATA[Working to Improve Nursing Education and Promote Academic Progression]]>

Juliann Sebastian, PhD, RN, FAAN, is dean of the University of Nebraska Medical Center College of Nursing and president-elect of the American Association of Colleges of Nursing. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (1998-2001).

Human Capital Blog: Congratulations on your recent election as president-elect, and future president, of the American Association of Colleges of Nursing (AACN)! What is your vision for the 2014-2016 term?

Juliann Sebastian: I am honored to have been selected by the members of AACN to serve in this role for an organization that is pivotal to the future of baccalaureate and higher degree nursing education. I support the president and the board in advancing our shared vision of excellence in nursing education, research, and practice.

I look forward to working with the entire board to address issues of concern to AACN’s member schools. Because AACN’s membership encompasses large/small, public/private institutions, we have the special advantage of incorporating diverse voices into shaping the organization’s vision. I am enthusiastic about deepening my opportunity to support the vision AACN has identified for itself and the profession.

  •  AACN’s own vision is: “By 2020, as a driving force for quality health care, AACN will leverage member schools in meeting the demand for innovation and leadership in nursing education, research and practice.”
  • AACN’s vision statement for the profession is: “By 2020, highly educated and diverse nursing professionals will lead the delivery of quality health care and the generation of new knowledge to improve health and the delivery of care services.”

HCB: What issues are at the top of your agenda?

Sebastian: As the president-elect and member of the board of directors, I am focused on the key priorities delineated by the full board. These include raising quality standards in nursing education programs and promoting academic progression for all nurses in keeping with the 2010 report by the Institute of Medicine (IOM), called The Future of Nursing: Leading Change, Advancing Health. Several key issues the board continues to address include advancing doctoral education in doctor of nursing practice (DNP) and PhD programs; further developing and expanding clinical nurse leader programs; addressing the nurse faculty shortage; enhancing diversity within the profession; promoting full scope of practice for all nurses; and promoting post-baccalaureate nurse residencies.

HCB: You have served in various leadership roles with AACN over the years. Why did you decide to run for president?

Sebastian: Public interest in health and health care has been heightened in part by the issues our country is facing in providing affordable, accessible, and quality care as the population ages and as the costs and complexity of care needs increase. I think the public and our interprofessional colleagues are eager to include the unique and important expertise that nursing brings to the table as together we redesign our health care system to include stronger emphases on health promotion, illness prevention, self-management of chronic conditions, and palliative care, to name a few key areas.

Nurse scientists generate the new knowledge to enhance these areas of emphasis, and nursing faculty educate new generations of nurses to lead care improvements for the future. The American Association of Colleges of Nursing is known for the bold and visionary leadership it has provided in moving academic nursing forward, and I was eager to be part of that in this new way.

HCB: You have expertise in a wide range of subjects, including care delivery systems, care for underserved populations, academic nursing practice, and nurse-managed health care centers. Do you think your expertise in these areas will influence your leadership of AACN and, if so, how?

Sebastian: We are each products of our own unique backgrounds and expertise. My hope is that my interests in the importance of partnerships, the value of understanding and changing systems, and the value that academic nursing brings to health care are helpful as AACN’s member schools collaborate to improve health and nursing care for the future. Whether we are engaged in academic-practice partnerships, interprofessional partnerships, or working with health systems, business, or the non-profit sector, I believe a focus on the inherent benefits of collaboration will yield better outcomes for the health of our nation and our world.

HCB: The IOM report on the future of nursing was released four years ago. Can you assess its impact so far and discuss what work remains to fully implement its recommendations?

Sebastian: The IOM report has been effective at mobilizing support for a more highly educated nursing workforce within all sectors of the profession. Since the report was published, AACN has seen a significant growth in baccalaureate nursing programs—particularly in RN-to-BSN degree completion programs—as well as in doctoral programs. To meet the 2020 targets set by the IOM (increase the proportion of nurses with baccalaureate degrees to 80 percent and double the number of nurses with doctorates), all stakeholders must focus on securing funding and federal support for baccalaureate and graduate nursing education programs.

HCB: What are the most pressing challenges facing nurse education? What kinds of solutions are out there to address those challenges?

Sebastian:

  • Shortage of faculty and clinical sites are always at the top of the list when it comes to barriers to expanding capacity in schools of nursing. AACN convened summits in 2013 to address both DNP and PhD education, bringing together leaders from schools of nursing throughout the country to think through ways we can best prepare leaders for nursing education and practice in the future. AACN has created the Advanced Practice Registered Nurse (APRN) Clinical Training Task Force to address some of these issues, as well as the DNP Task Force to look at concerns specific to advancing the DNP.  

  • AACN is committed to working collaboratively with RWJF and other stakeholders to address these issues and other challenges facing the profession.

HCB: You served in the inaugural cohort of the RWJF Executive Nurse Fellows (ENF) program from 1998-2001. Did that experience prepare you for this position and, if so, how?

Sebastian: The RWJF ENF program was invaluable to me in fostering a much deeper understanding of leadership—how it is embedded not only in specific professional contexts such as nursing but also how leadership is most effective when it is interprofessional, bold, and participatory in nature.

I learned much from the program about creativity and thinking through opportunities from new lenses, as well as using one’s strengths to facilitate change and serving from a position of authentic leadership. As a member of the inaugural cohort, I would say that we felt a special responsibility to serve the profession and the public, knowing that we had been given very unique opportunities for learning and developing spectacular cadres of colleagues and friends.

I am grateful for all I learned from this program and to the Robert Wood Johnson Foundation for its generous investment in the program for so many years. RWJF truly has invested in a generation of nurse leaders who are engaged in a wide array of leadership roles in nursing, health care, public health, and policy making. Many thanks to the ENF National Advisory Committee and the program staff at RWJF who made these opportunities possible and to our employing organizations who provided invaluable support to each of us as we did this important work!

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Fri, 25 Jul 2014 09:00:00 -0400 Human Capital Blog Nurses Continuing education Nurse practitioners Human Capital Voices from the Field Executive Nurse Fellows Nursing
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/rwjf_scholars_inthe2.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/rwjf_scholars_inthe2.html <![CDATA[RWJF Scholars in the News: Stereotype threat, hand hygiene, misbehaving science, 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:

Anxiety caused by “stereotype threat” could help explain health disparities that persist across race, suggests research co-authored by Cleopatra Abdou, PhD, an RWJF Health & Society Scholars program alumna. News Medical covers the study, describing it as the first of its kind to empirically test, in the context of health sciences, the impact of the “threat of being judged by or confirming a negative stereotype about a group you belong to.” Abdou’s research offers a possible explanation for ethnic and socioeconomic differences in morbidity and mortality between Black and White women because, as Abdou says, the research goes beyond nature vs. nurture, “bringing situation and identity into the equation.” For example, in the study, Black women with a strong connection to their race had the highest anxiety levels when in waiting rooms filled with posters that displayed negative health-related racial stereotypes dealing with such topics as unplanned pregnancy and AIDS.

Having health insurance improves access to medical care for pregnant, low-income women, and results in long-term health benefits for their babies, according to a study by RWJF Scholar in Health Policy Research Sarah Miller, PhD, and RWJF Health & Society Scholar Laura Wherry, PhD, that was reported by Vox. Miller and Wherry found the expansion of Medicaid in the 1980s made prenatal care much more accessible to low-income women, many of whom would otherwise have been without insurance. The result was improvements in obesity, preventable hospitalizations, and preventable, chronic disease-related hospitalizations among children. 

A new study emphasizes the importance of proper hand hygiene to prevent the spread of health care-associated infections, reports Health Canal. RWJF Health & Society Scholars program alumna Allison Aiello, PhD, MS, and her colleagues offer a series of evidenced-based best practices for optimal hand hygiene in health care settings, encouraging increased availability and acceptability of certain soap and alcohol-based rubs as well as the development of a system to empower health care personnel to create a personalized hygiene system that tracks their progress.

In his book Misbehaving Science, Aaron Panofsky, PhD, an RWJF Scholars in Health Policy Research program alumnus, explores the controversial path by which eugenics, the study of “improving” human genetics, morphed into “behavior genetics” in the years after World War II. The New Scientist raves about Panofsky’s “wonderful insight” into the science, which he describes as afflicted with “persistent, ungovernable controversy.”

MSNBC.com carries a piece exploring the history of health researchers blaming mothers for their children’s diseases. The article touches on Sigmund Freud’s view that “castrating” mothers produced “neurotic” sons, as well as the view held during the 1930s and 1940s that “refrigerator mothers” caused autism among their children by being cold and distant. The article draws a link to current discussions about the ways the “actions, life choices, and genetic patterns” of mothers today “shape the health histories of their offspring.” Amy Non, PhD, MPH, an alumna of the RWJF Health & Society Scholars program, is quoted, making the point that fathers contribute to children’s genetics, as well.

Health & Society Scholars program alumni Amar Hamoudi, PhD, and Jenna Nobles, PhD, continue to receive coverage for their research showing that female embryos are better equipped to survive stressful pregnancies. The result, they conclude, is that people in stressful relationships are more likely to give birth to girls than boys. Time magazine reports on the study.

 

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Thu, 24 Jul 2014 12:30:00 -0400 Human Capital Blog Social determinants of health Medicaid Affordable Care Act (ACA) Research Human Capital HC Website Feature Scholars in Health Policy Research Health & Society Scholars Sharing Nursing's Knowledge Media Coverage
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/sharing_nursing_skn.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/sharing_nursing_skn.html <![CDATA[Sharing Nursing’s Knowledge: The July 2014 Issue]]>

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 July issue.

Nurses Lead Innovations in Geriatrics and Gerontology
As the nation becomes older and more diverse, and more people are living with chronic health problems, nurses are developing innovations in geriatric care. They are finding new ways to improve the quality of care for older adults; increase access to highly skilled health care providers with training in geriatrics; narrow disparities that disproportionately affect older minorities; avoid preventable hospital readmissions; and more. Nurse-led innovations are underway across the nation to improve care for older Americans.

Improving Care for the Growing Number of Americans with Dementia
By 2050, 16 million Americans—more than triple the current number—will have Alzheimer’s disease. RWJF Nurse Faculty Scholars are working now to get ahead of the problem. “We’re all well aware of our aging population and how we’re going to see more individuals with Alzheimer’s disease or some other form of dementia,” says alumna Elizabeth Galik, PhD, CRNP, who is researching ways to improve functional and physical activity among older adults with dementia.

New Degree Program Combines Nursing and Engineering
This fall a new program at Duquesne University in Pennsylvania will offer the nation’s first undergraduate dual-degree program in nursing and biomedical engineering. RWJF Executive Nurse Fellows program alumna Mary Ellen Smith Glasgow, PhD, RN, ACNS-BC, FAAN, came up with the plan in 2012, shortly after becoming dean of nursing. “One of the things that is lacking among biomedical engineers is deep clinical experience,” Glasgow says. Nurses, she notes, are “the ones using the IV pumps and looking at the monitors,” and can offer the engineering industry an invaluable perspective.

High-Achieving Nurse Leader Has No Time for Retirement
At age 67, Aline Holmes, DNP, is no slave to convention. Going back to school “was on my bucket list,” she says. Holmes, senior vice president for clinical affairs at the New Jersey Hospital Association (NJHA), enrolled in a DNP program at age 64. Last year, at age 66, Holmes became co-director of the New Jersey Nursing Initiative (NJNI), which is transforming nursing education in the state. “At NJNI, we encourage nurses to further their education and, as one of its leaders, I felt it was important to walk the walk,” she says.

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Thu, 24 Jul 2014 09:00:00 -0400 Human Capital Blog Nurses Workforce issues Chronic illness Leadership development Seniors (65+) Human Capital New Jersey Nursing Initiative Executive Nurse Fellows Nurse Faculty Scholars Nursing Sharing Nursing's Knowledge HC Website Feature
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/facebook_friend_or.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/facebook_friend_or.html <![CDATA[Facebook: Friend or Foe?]]>

Linda Charmaraman is a research scientist at the Wellesley Centers for Women at Wellesley College and a former National Institute of Child Health and Human Development postdoctoral scholar. She is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, examining the potential of social media networks to promote resiliency in vulnerable populations.

If you were stressed out and wanted to vent to your friends about it, how would you let them know? Would you pick up the phone and talk, or text? Would you set up time to grab coffee or go for a brisk walk? Or would you post to Facebook why your day just couldn’t get any worse?

As I logged into the recent RWJF/NPR/Harvard School of Public Health-sponsored Stress in America discussion, I identified with the panelists who were dispelling stereotypes about “highly stressed” individuals being high-level executives or those at the top of the ladder. Instead of finding work-related stress as a top concern, as is often played out in the media and popular culture, the researchers were finding that individuals with health concerns, people with disabilities, and low-income individuals were experiencing the highest levels of stress. The panelists talked about the importance of qualities like resiliency and the ability to turn multiple, competing stressors into productive challenges to overcome, and the integral role of communities in shaping, buffering, and/or exacerbating stress.

We often consider our communities as living, working, playing in close physical proximity. But what about the online spaces? What about our opt-in networked friendship circles ... our cyber-audience who sign up to read our posts with mundane observations, proud revelations, and the occasional embarrassing photos?

Media coverage about social media has not been kind—often linking its use with cyberbullying, sexual predators, and depression or loneliness. But recent scholarship on new media demonstrates that interpersonal communication, online and offline, plays a vital role in integrating people into their communities by helping them build support, maintain ties, and promote trust. Social media is often used to escape from the pressures of life and alter moods, to secure an audience for self-disclosures, and to widen social networks and increase social capital. The Pew Research Internet Project found that adult Facebook users are more trusting than others, have more close, core ties with their social networks, and receive more social support than non-users.

So what if we asked adolescents the same question: “If you were having a bad day and wanted to let your friends know about it, how would you let them know?”

In our current research on media & identity, we purposively sampled more than 2,300 individuals aged 12 to 25 from 47 states and 26 countries. They took an online survey that investigated how vulnerable populations (such as racial/ethnic minorities, women, adolescents, people who are lesbian, gay, bisexual and transgender, those with low social status) have used the Internet and social media in healthy and unhealthy ways, particularly during times of stress. We wanted to determine how and why supportive communities could exist in personal online networks that could increase one’s resiliency in the face of challenges.

We found that when young people want to talk about a bad day, they mainly preferred in-person (69%), texting (69%), or phone call (51%) methods to reach out for help. Social media was not utilized as often to talk about stressful times—with Facebook (29%) being more popular than Twitter (7%) overall.

The Stress in America poll results found that 19 percent of adults use social media more than usual during stressful times. In our study, adolescents were significantly more likely to post to Facebook networks about their bad days than emerging adults aged 18 to 25, which can indicate that there are generational differences in how new media can be supportive.

African American participants (19%) chose Twitter to report to their networks about a bad day more often, whereas Asian Americans (40%) used Facebook more often than people of any other race/ethnicity during times of stress.

A surprisingly large number of young people (under age 25) reported that they write blogs, from a low of 37 percent of Hispanic respondents to a high of 60 percent of Asian Americans respondents. Incidentally, individuals who have ever written a blog are more likely to report being unhappy or sad than non-bloggers. Perhaps being more public online about private matters helps adolescents to know that they are not alone in their battles with stress.

Further examination of the use of new media may help us develop prevention and intervention programs and tools to guide adolescents, their parents, educators, and health care workers, and to remind ourselves how the adolescent and emerging adult years can be stressful. Perhaps logging onto one’s Facebook community and jotting down one’s thoughts could be just the right kind of coping mechanism whenever the need arises.

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Wed, 23 Jul 2014 10:30:00 -0400 Linda Charmaraman At-risk and vulnerable people Behavioral/mental health Social isolation Scholars and fellows Human Capital Voices from the Field New Connections
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/stay_up_to_date_with.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/stay_up_to_date_with.html <![CDATA[Stay Up to Date with RWJF!]]>

Want to stay on top of the latest news from RWJF? Check out all the ways you can get the latest news delivered to you:

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Wed, 23 Jul 2014 09:00:00 -0400 Human Capital Blog Nurses Research Nurse practitioners Human Capital Nursing
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/a_closer_look_atcon.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/a_closer_look_atcon.html <![CDATA[A Closer Look at Contributors to Stress for Latinos]]>

Gabriel R. Sanchez, PhD, is an associate professor of political science at the University of New Mexico (UNM), executive director of the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at UNM, and director of research for Latino Decisions. Yajaira Johnson-Esparza is a PhD Candidate in the UNM department of psychology and an RWJF Fellow at the University. 

Gabriel Sanchez, PhD

A recent survey conducted by RWJF, NPR, and the Harvard School of Public Health focused our attention on the burdens that stress poses for Americans. We want to focus our attention in this blog post on factors that may be leading to stress among the Latino population. Although the experience of stress is very common, the experience and burden of stress is not uniform across people in the United States. 

One of the main findings that emerged from the recent RWJF/NPR/Harvard survey was the strong role of health problems in stress in the United States, with 27 percent of respondents noting that illness or disease was a major source of stress over the past year. In addition to the direct impact of being sick, the financial burdens associated with needing medical care can generate a lot of stress. We have found support for this finding in some of our own work at the UNM RWJF Center for Health Policy. For example, a recent survey we helped produce found that 28 percent of  Latino adults indicated that because of medical bills, they have been unable to pay for basic necessities like food, housing, or heat, with 40 percent indicating they have had trouble paying their other bills. The financial stress associated with illness can have a devastating impact on Latinos.

Yajaira Pena Esparza Yajaira Johnson-Esparza

Latinos in the United States also face unique stressors from other Americans due to their language use, nativity, and experiences with discrimination. Being followed in a store, being denied employment or housing, and being told that you do not speak English well can all lead to stress for Latinos.

More specifically, the current political climate surrounding immigration politics and policy has led to an increase in discrimination directed toward Latinos, and consequently stress levels. Our Center has been tracking immigration laws passed at the state level over time; we have found a significant increase in passage of punitive laws during the economic recession, with more than 200 immigration laws being passed in 2009 alone.  A June 2011 impreMedia/Latino Decisions (LD) poll reveals that Latino voters are conscious of this tense landscape, as 76 percent of respondents believe that an anti-Hispanic and anti-immigrant environment exists today. 

In addition to anti-immigrant sentiment, stress also exists around fear of deportation and finding safe employment for Latino immigrants and mixed-status families. Immigrants may experience stress at the thought of leaving their home either for work or chores due to fear of being deported, and the children of immigrants are experiencing increased stress due to the fear that their parents will be detained or deported. A research team at our Center is currently developing a survey to be fielded later this summer specifically focused on identifying how the current immigration-driven political climate is impacting the relationship between discrimination and health for Latinos in the United States. 

Addressing Latino stress is important and necessary, as many health problems are directly related to stress. As one of the largest and youngest racial/ethnic minority groups, it is crucial that we focus more attention on stressors that can impact the overall health of the Latino population. 

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Tue, 22 Jul 2014 09:00:00 -0400 Gabriel R. Sanchez Social determinants of health Disparities Latino or Hispanic Voices from the Field Health Burden of Stress Center for Health Policy at the University of New Mexico
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/federal_governments0.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/federal_governments0.html <![CDATA[Federal Government Sets Aside Funds to Boost Access to Primary Care]]>

The federal government announced on July 7 it had awarded more than $83 million to expand access to care by training hundreds of new primary care providers.

The money will be used to support primary care residency programs in family medicine, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, geriatrics, and general dentistry at 60 health centers across the country. The expanded residency programs will help train more than 550 residents in coming academic year—about 200 more than were trained in the previous academic year, according to the U.S. Department of Health and Human Services (HHS). The funds will also be used to boost the number of states with teaching health centers from 21 to 24.

“This program not only provides training to primary care medical and dental residents, but also galvanizes communities,” said Mary K. Wakefield, PhD, RN, head of the Health Resources and Services Administration, a division of HHS. “It brings hospitals, academic centers, health centers, and community organizations together to provide top-notch medical education and services in areas of the country that need them most.”

Also this month, HHS announced the availability of up to $100 million in funding to support community health centers, which provide care to patients regardless of their ability to pay.

Authorized by the Affordable Care Act, the money will be used to support about 150 new health center sites across the country in 2015. Today, nearly 1,300 community health centers provide care to more than 21 million patients across the nation.

The $100 million comes on top of $300 million that was announced in June to support existing community health centers. That funding is intended to allow community health centers to expand service hours, hire more medical providers, and add services in areas including oral and behavioral health, pharmacy, and vision.

“In communities across the country, Americans turn to their local community health center for vital health care services that help them lead healthy, productive lives,” HHS Secretary Sylvia Mathews Burwell, AB, BA, said in a statement. “That’s why it’s so important that the Affordable Care Act is supporting the expansion of health centers.”

Learn more here and here.

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Mon, 21 Jul 2014 09:00:00 -0400 Human Capital Blog Primary care Workforce supply and demand Clinical care Affordable Care Act (ACA) Human Capital
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/building_a_cultureo.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/building_a_cultureo.html <![CDATA[Building a Culture of Health at AcademyHealth Annual Research Meeting]]>
RWJF Leadership Reception at the AcademyHealth RWJF Leadership Reception at the AcademyHealth annual meeting in San Diego in June 2014

At this year’s AcademyHealth Annual Research Meeting, held in San Diego, California June 8–10, the Robert Wood Johnson Foundation (RWJF) hosted “Building a Culture of Health: An RWJF Leadership Reception.” More than 100 RWJF scholars, fellows, and alumni representing 14 RWJF Human Capital programs joined with colleagues and friends of the Foundation for the gathering at the Hilton San Diego Bayfront. There, health providers, clinicians, researchers, and graduate students made and renewed the important professional connections that RWJF facilitates.

Among those attending the reception were RWJF Health & Society Scholars alumnus and RWJF Clinical Scholars Associate Program Director (University of Pennsylvania program site) David Grande, MA, MPA, who presented his paper, “How Do Health Policy Researchers Perceive and Use Social Media to Disseminate Science to Policymakers?,” at the meeting; RWJF Nurse Faculty Scholars Lusine Poghosyan, PhD, MPH, RN, and J. Margo Brooks Carthon, PhD, APRN, who chaired and served as a panelist, respectively, at a health care workforce session; and Clinical Scholars Tammy Chang, MD, MPH, MS, and Katherine A. Auger, MD, M.Sc., who were both chosen as recipients of the AcademyHealth Presidential Scholarship for New Health Services Researchers. This scholarship provides financial support to attend the meeting, and recognizes early-career researchers who demonstrate leadership ability and potential to contribute to the field of health services research.

RWJF Leadership Reception at the AcademyHealth AcademyHealth annual meeting participants gather at the RWJF Leadership Reception in San Diego in June 2014

Foundation staff at the gathering included Senior Program Officer Nancy Wieler Fishman, MPH; Senior Program Officer David Krol, MD, MPH, FAAP; and Vice President for Research-Evaluation-Learning and Chief Science Officer Alonzo Plough, PhD, MPH, who provided the attendees with an update on RWJF plans for evaluating and measuring the Foundation’s new vision for a Culture of Health.

Plough described how the Foundation is beginning to translate the concept of a Culture of Health—as outlined in President and CEO Risa Lavizzo-Mourey’s 2014 President’s Message—into a set of tangible measurements and related action steps. He said that these measurements “will broaden our understanding of the positive steps that individual communities and our nation as a whole are currently taking to build a Culture of Health—and where more help is needed.”

For an overview of RWJF Human Capital programs, visit www.RWJFLeaders.org.

 

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Fri, 18 Jul 2014 09:35:00 -0400 Human Capital Blog Leadership development Scholars and fellows Human Capital Health & Society Scholars Clinical Scholars Nurse Faculty Scholars Building a Culture of Health AcademyHealth
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/rwjf_scholars_inthe1.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/rwjf_scholars_inthe1.html <![CDATA[RWJF Scholars in the News: Gun violence, suicide, ‘structural’ versus ‘cultural’ competency, 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 NPR story quotes RWJF Health & Society Scholars program alumnus Andrew Papachristos, PhD, citing his extensive research on gun violence. Papachristos criticizes the lack of context in media coverage of violence, noting that incidents such as the series of shootings over the Fourth of July weekend in Chicago tend to be treated simply as a long stretch of violent incidents. “Treating Chicagoland violence as merely a tally necessarily dehumanizes its victims, but it also obscures so much of the larger story about that violence. It's data without context.” Not only is the murder rate steadily declining in Chicago, but there is a massive disparity in victims of these crimes: “Eighty-five percent of violence—any shootings—happens among 5 percent of people,” Papachristos says.

In an article about libertarianism and state laws related to guns and other topics, the Economist cites a study about the social costs of gun ownership by RWJF Investigator Award in Health Policy Research recipients Philip Cook, PhD, and Jens Ludwig, PhD. It finds that “more guns empirically lead to more gun-related violence, largely because legally purchased guns somehow end up in the hands of criminals via theft,” gun shows, and online sales, which are largely unregulated. To address these issues, Cook and Ludwig suggest making it costlier to buy guns in high-crime areas, and improving the records used to screen gun buyers by including more information on possible mental-health problems, among other proposals. (Free registration required to view article.)

A study co-authored by RWJF Health & Society Scholars program alumnus Alexander Tsai, PhD, MD, finds that men who are more socially connected are half as likely to commit suicide as men considered loners, NBC News reports. The study looks at data on nearly 35,000 men, ages 40 to 75, and finds that those who are more isolated are at greater risk, even if they are not mentally ill. “Public health practitioners think about things like cardiovascular disease as warranting public health attention,” says Tsai, suggesting that suicide may also need attention.

Instructions that direct parents to use “a teaspoon” to measure liquid medication for children increase the risk of pouring the wrong dose, finds a study led by Shonna Yin, MD, MDS, an RWJF Physician Faculty Scholars program alumna. CBS 8 (San Diego) reports that Yin and her colleagues encourage the use of millimeter-based dosing devices, such as an oral syringe, since 41 percent of parents studied made a mistake in measuring what their doctors prescribed in teaspoons or tablespoons.

Shifting the way medical students are trained, to focus less on “cultural” competency and more on “structural” competency, could help address racial health disparities, according to RWJF Health & Society Scholars program alumna Helena Hansen, MD, PhD. In an interview with ColorLines, Hansen says that the idea behind cultural competency initially was to listen to the patient and learn about her or his world view, but in practice it often reinforces racial stereotyping. Hansen says “clinical training must shift its gaze from an exclusive focus on the individual encounter to include the organization of institutions and policies, as well as of neighborhoods and cities, if clinicians are to impact stigma-related health inequalities.”

Science World Report writes about research from RWJF Health & Society Scholars program alumni Amar Hamoudi, PhD, and Jenna Nobles, PhD, that shows girls may be more likely than boys to survive in the womb throughout the stress of a troubled marriage. The study shows a couple’s level of relationship conflict at a given time also predicts the gender of children born to the couple later. Women reporting higher levels of marital issues are more likely to give birth to girls in later years. “Girls may well be surviving stressful pregnancies that boys can’t survive,” Hamoudi concludes. The findings run counter to previous research that has been interpreted to suggest that female children were actually the cause of more marital stress, the researchers said.

People tend to pick friends who are as genetically similar to themselves as their fourth cousins would be, the Washington Post reports. RWJF Investigator Award recipient Nicholas Christakis, MD, co-authored a study that looks at 1,367 friendship pairs and their genetic markers and variants. He found that friends are more likely than strangers to share many genetic variants. The research suggests friendship could be a significant factor in the recent evolution of the human species, Christakis says, noting that someone’s evolutionary fitness “depends not only on [their] own genotype, but also on the genotype of [their] friends.” The study was also covered by NPR and CNN.

After surveying 5,000 people from 83 countries, RWJF Health & Society Scholar Matthew Killingsworth, PhD, and a colleague offer seven tips to help alleviate a bad mood, reports The Week. In addition to confirming that people are happiest while having sex, exercising, or socializing, the study finds that smiling, comparing yourself to someone less fortunate, performing complex cognitive tasks, and getting adequate sleep are the most effective ways to quickly increase happiness.

Two hundred Medicare patients in Phoenix are set to receive sensors for their asthma inhalers that will track how often they use their medication, and alert physicians or caregivers via a smartphone app when they are in use, reports Crain’s Detroit Business. The device was developed by Propeller Health, a startup company founded by David Van Sickle, PhD, MA, an RWJF Health & Society Scholars program alumnus. HIT Consultant and mHealth News also cover Van Sickle’s research.

In an opinion piece for the Fresno Bee, Edward Walker, PhD, writes that advocacy groups claiming to be grassroots organizations representing individual members are often actually funded primarily by corporations and industry groups. Walker describes this as “opinion laundering,” through which groups present their ideas as those expressed by everyday citizens. “I’ve spent the better part of the last decade investigating campaigns like these and the lucrative consulting firms hired to manufacture grassroots participation. We assume that these strategies are ‘weapons of the weak,’ when in fact even Fortune 500 behemoths—by my estimates, 40 percent of them—frequently find that they need to mobilize the grassroots when facing threatening policy changes.” The issue becomes problematic when “grassroots” organizations begin using fake email addresses or offering financial incentives for participation by “supporters,” writes Walker, an RWJF Scholars in Health Policy Research alumnus.

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Thu, 17 Jul 2014 09:56:00 -0400 Human Capital Blog Community violence Behavioral/mental health Research Scholars and fellows Human Capital Health & Society Scholars Investigator Awards in Health Policy Research Media Coverage Research & Analysis Scholars in Health Policy Research Physician Faculty Scholars HC Website Feature
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/fourteen_schoolsof.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/fourteen_schoolsof.html <![CDATA[Fourteen Nursing Schools to Receive Grants]]>

The Robert Wood Johnson Foundation (RWJF) has announced the first 14 schools of nursing selected to receive grants to support nurses as they pursue their PhDs. Each of the inaugural grantees of the Future of Nursing Scholars program will select one or more students to receive financial support, mentoring, and leadership development over the three years during which they pursue their PhDs.

The Future of Nursing Scholars program is a multi-funder initiative. In addition to RWJF, United Health Foundation, Independence Blue Cross Foundation, Cedars-Sinai Medical Center, and the Rhode Island Foundation are supporting grants this year.

The program plans to support up to 100 PhD nursing candidates over its first two years.

In its landmark future of nursing report, the Institute of Medicine recommended that the country double the number of nurses with doctorates in order to support more nurse leaders, promote nurse-led science and discovery, and address the nurse faculty shortage. Right now, fewer than 30,000 nurses in the United States have doctoral degrees in nursing or a related field. 

“This is a crucial and ambitious endeavor,” said Susan B. Hassmiller, PhD, RN, FAAN, co-director of the program and RWJF’s senior adviser for nursing. “It’s one that everyone in our country should be engaged in and that’s why the Robert Wood Johnson Foundation is inviting other funders to participate in this effort. We believe that working together, we can ensure that we are able to educate the PhD-prepared nurse leaders we need to shape the future of health care education, research, and policy.”

The schools of nursing that will receive Future of Nursing Scholars grants this year are: Columbia University; Duke University; The Johns Hopkins University; Medical University of South Carolina; University of California, Davis; University of California, Los Angeles; University of California, San Francisco; University of Cincinnati; University of Illinois; University of Pennsylvania; University of Rhode Island; University of San Diego; University of Texas Health Science Center at Houston; and Villanova University.

Learn more about the new grants to schools of nursing. Read more about the Future of Nursing Scholars program here and here.

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Wed, 16 Jul 2014 10:44:00 -0400 Human Capital Blog Nurses Continuing education Advanced practice nurses Education and training Education level Human Capital Future of Nursing Scholars Nursing
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/the_impact_of_season.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/the_impact_of_season.html <![CDATA[The Impact of Seasonal Birth-Rate Fluctuations on Measles, Other Vaccine-Preventable Diseases]]>

Audrey Dorélien, PhD, is a 2012-2014 Robert Wood Johnson Foundation (RWJF) Health & Society Scholar studying demography, infectious diseases, and maternal and child health.

Audrey Dorélien

Reoccurring outbreaks of measles and other vaccine-preventable diseases are a major killer of children, particularly in sub-Saharan Africa. In 2012, more than 226,000 cases of measles were reported worldwide, with a little less than half of those in Africa.[1] For the World Health Organization to meet its global measles eradication goal and implement more effective supplemental vaccination programs, public health officials will need a better understanding of the mechanism driving seasonal and episodic outbreaks.

Infectious disease ecologists have demonstrated the importance of human demography, and in particular the influence of the birth rate on the dynamics of acute childhood immunizing (ACI) diseases. For instance in London, in the few years prior to 1950, the city experienced annual measles epidemics, but the dynamics changed to biennial epidemics as a result of a decline in the birth rate between 1950 and 1968.[2] How can the birth rate influence disease outbreaks? An outbreak can only occur when the fraction of the susceptible population exceeds a critical threshold. In the case of ACI disease, the majority of the susceptible population are young children; therefore the birth rate influences the rate at which the pool of susceptibles is replenished.

As a demographer—someone interested in human population dynamics—I wondered whether seasonal fluctuations in human birth rates could influence the epidemics of such acute immunizing diseases as measles, especially in places with both large birth rates and large seasonal fluctuations in the birth rates.  I was also interested in whether there might be important interactions with known factors, such as seasonal changes in transmission. From a policy perspective, seasonal fluctuations in birth rates are predictable, so if indeed they play a role, they should be included in models of ACI diseases.

To get answers, I modified a well-known epidemiological model for measles to allow birth and transmission rates to fluctuate seasonally. I then simulated the effect of varying the birth rate and amplitude (the degree of seasonal fluctuations) based on ranges of measles incidence in sub-Saharan Africa. I found that varying birth seasonality had an effect both on the timing of the epidemic and its magnitude, and seasonality could also influence the periodicity of the epidemics. In addition, I found important interactions between seasonality in birth rates and contact rates—the rates at which people came into contact with the measles virus, whether they contracted the disease or not.

Including seasonal fluctuations in birth rates into epidemiological models may help improve our understanding of the spread of the disease and therefore allow us to better characterize and check measles epidemics in settings where outbreaks still occur regularly. It could also help improve the timing of supplemental vaccination programs, so that they may take into account the large inflow of susceptible infants at certain times of the year.

I am very excited that other researchers are starting to include birth seasonality in their models in both developing and developed countries. A recent paper by colleagues at the University of Michigan, Micaela Martinez-Bakker and Kevin Baker, echoes my findings. Using historical data from the United States, they found that the geographical variation in the timing and amplitude of birth seasonality had the potential to influence the timing and magnitude of measles epidemics.[3]

Learn more and read my paper here.

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Tue, 15 Jul 2014 09:00:00 -0400 Audrey Dorélien Infectious diseases Research Epidemiology Human Capital Voices from the Field Health & Society Scholars
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/breakthrough_leaders.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/breakthrough_leaders.html <![CDATA[Breakthrough Leaders in Nursing]]>

The Future of Nursing: Campaign for Action has announced a new program to honor nurse leaders who are making a difference in their communities and to develop their leadership skills. The Campaign will be accepting nominations for its Breakthrough Leaders in Nursing award through August 15th.

Nominees must be licensed registered nurses engaged in a state Action Coalition of the Future of Nursing: Campaign for Action. Nominations can come from any member of a state Action Coalition, the Champion Nursing Coalition, or the Champion Nursing Council.

The ten nurses selected for this honor will receive national recognition and a Leadership Development Program scholarship from the Center for Creative Leadership, funded by the Robert Wood Johnson Foundation (RWJF).  

The Breakthrough award is designed to:

  • Recognize and elevate the next generation of nurse leaders.
  • Recognize engagement in the Future of Nursing: Campaign for Action’s state Action Coalitions.
  • Provide awardees with a world-class interprofessional leadership development experience.
  • Identify and train Campaign for Action ambassadors.

The Campaign for Action is accepting nominations through August 15.  Learn more and nominate a Breakthrough Leader in Nursing here.

The Future of Nursing: Campaign for Action is an initiative of AARP and RWJF.

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Mon, 14 Jul 2014 13:00:00 -0400 Human Capital Blog Nurses Leadership development Human Capital Awards & Accolades Campaign for Action Nursing
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/study_highlightsrol.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/study_highlightsrol.html <![CDATA[Study Highlights Role for Non-Physicians in Preventing Childhood Blindness]]>

A leading cause of preventable blindness in premature babies can be successfully identified by trained non-physician evaluators working remotely, according to a study published online by JAMA Ophthalmology. The number of ophthalmologists who conduct screenings for the condition, retinopathy of prematurity (ROP), has declined in the United States, while countries in parts of Latin America, Asia, and Eastern Europe have long-standing ophthalmologist shortages that contribute to high rates of childhood blindness caused by ROP.

“This study provides validation for a telemedicine approach to ROP screening and could help prevent thousands of kids from going blind,” lead investigator Graham E. Quinn, MD, MSCE, said in a news release from the Children’s Hospital of Philadelphia, where he is a pediatric ophthalmologist.

The study involved retinal images taken by neonatal intensive care unit nurses and transmitted to trained image readers at a central location. Ophthalmologists had also examined the infants, and the image readers identified 90 percent of the infants the ophthalmologists had flagged as needing further evaluation.

“Telemedicine potentially gives every hospital access to excellent ROP screening,” said Quinn. 

Read the study in JAMA Ophthalmology

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Mon, 14 Jul 2014 09:00:00 -0400 Human Capital Blog Research Pediatric care Clinical research Human Capital Research & Analysis
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/how_stress_makesus.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/how_stress_makesus.html <![CDATA[How Stress Makes Us Sick]]>

Keely Muscatell, PhD, is a social neuroscientist and psychoneuroimmunologist. She is a post-doctoral scholar in the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program at the University of California (UC), San Francisco and UC, Berkeley.

Results from the recent NPR/RWJF/Harvard School of Public Health poll suggesting that Americans are living under high levels of stress probably don’t surprise anyone. In a way, I’ve been taking an informal version of this poll for the last six years, since when I tell people I meet on airplanes or at local bars that I study stress and health, I am unfailingly met with knowing glances and stories about stressors people are facing in their lives. Given that stress is pervasive (and problematic) in modern life, lots of current research in psychology and neuroscience is focused on understanding exactly how stress can get “into our brains” and “under our skin” to make us sick.

When we think of illness, one of the first things that comes to mind is the immune system, with its lymph nodes, white blood cells, and antibodies hanging around to help us fight off infections and heal our injuries. An especially important component of the immune system involves inflammation. If you’ve ever gotten a paper cut, you’ve probably noticed that the area of skin around the cut tends to turn red and warm up shortly after the injury. This happens because proteins called “pro-inflammatory cytokines” swim through your blood stream to the site of the wound, where they call out to other immune cells to come to the area and help heal the cut. In the short term, this is a good thing; those little cytokines are a key part of healing. But if inflammation becomes widespread throughout the body, cytokines can lead to depression and even physical diseases, like arthritis and heart disease.

But what does any of this have to do with stress? A number of studies in a relatively new field called psychoneuroimmunology have shown that stress on its own can cause inflammation. In other words, the immune system can be activated by our thoughts and feelings, even when there aren’t any cuts to heal or infections to fight.

Researchers have found that people who are under a lot of chronic stress, like those living in poverty or caring for a sick parent, have higher levels of inflammation than people living under less stressful circumstances. Even short-term, mild stressors can cause inflammation: When people are asked to come to the lab and give a short speech in front of panel of disapproving strangers, the number of cytokines in their bloodstream increases. In fact, in a recent study I conducted with colleagues at UCLA, we showed that even just being told by a peer that you’re “annoying” or “boring” is enough to increase inflammation.

Maybe it’s time to revise that age-old saying about sticks and stones, as it seems that names can hurt—and fire up the immune system as well. And that, in turn, could be making us sick.

Of course, there are many people in the United States who are faced with stress on a daily basis and still go on to live long, healthy, happy lives. In fact, in the study mentioned above, some participants seemed to just let the negative feedback roll off their backs, while others were visibly upset by it. One participant even asked me two hours after the feedback if I thought she seemed annoying; clearly she was ruminating about the experience and self-conscious about the way she had come across.

This Is Your Brain on Stress

To try and get a handle on why some people are especially sensitive to the negative effects of stress while others are resilient to it, we examined what was happening in the brains of our participants while they received negative feedback from a peer. Using functional MRI scanning (which allows us to track what parts of the brain are being used over time), we measured how participants’ brains responded to being told they were “annoying” and “boring,” in addition to measuring their levels of inflammation. We found that people who showed more neural activity in the amygdala—an ancient, animalistic brain structure involved in emotion and threat—also had bigger increases in inflammation. So it seems that people who responded to stress with more activity in this “emotion center” of the brain also had more reactive immune systems, and therefore may be more likely to develop stress-related illnesses.

If you’re concerned that your amygdala may be firing non-stop and revving up your cytokines, fear not: Just changing the way you think in a stressful situation can calm down the amygdala and hopefully stop inflammation from increasing. A number of studies suggest that reframing the way you think during a stressor (what psychologists call “cognitive reappraisal” and a common technique in cognitive-behavioral therapy) can “turn down” an overactive amygdala. Other research suggests that simply labeling our emotions can help decrease the amygdala’s response, as can thinking about a loved one, writing about stressors in a journal, or even providing help and support to others rather than focusing on our own issues.

While we need much more research to fully understand how stress affects the brain and body, our research and that of many others is beginning to provide answers to the question of how stress makes us sick. Given the tremendous amount of stress that the NPR/RWJF/Harvard School of Public Health Poll revealed that we’re under, answering this question is of extreme importance to the health and longevity of our nation.

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Fri, 11 Jul 2014 11:00:00 -0400 Keely Muscatell Behavioral/mental health Behavior change Chronic illness Health & Society Scholars Voices from the Field Health Burden of Stress Research & Analysis
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/recent_research_abou.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/recent_research_abou.html <![CDATA[Recent Research About Nursing, July 2014]]>

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

Short Rest Between Nurses’ Shifts Linked with Fatigue

New research from Norway suggests that nurses with less than 11 hours between shifts could develop sleep problems and suffer fatigue on the job, with long-term implications for nurses’ health.

Psychologist Elisabeth Flo, PhD, of the University of Bergen in Norway, led a team of researchers that analyzed survey data from more than 1,200 Norwegian nurses, focusing on questions about how much time nurses had between shifts, their level of fatigue at work and elsewhere, and whether they experienced anxiety or depression.

Analyzing the data, they found that nurses, on average, had 33 instances of “quick returns” in the previous year—that is, shifts that began 11 hours or less after another shift ended. Nurses with more quick returns were more likely to have pathological fatigue or suffer from difficulty sleeping and excessive sleepiness while awake—both common problems for night workers.

Flo and colleagues write, “Fatigue has been shown to be higher in nurses who work shifts than in nurses with permanent day schedules. Fatigue in shift workers may be a consequence of circadian misalignment as well as sleep loss. In addition, quick returns may hinder revitalizing spare time activities, which also may affect levels of fatigue.” They go on to warn: “Quick returns may not only bring about immediate sleep and health problems, but possibly also negative long-term effects. Reducing the number of quick returns may represent an important preventive measure for the shift-working population.”

The study was published online in June 2014 in Occupational & Environmental Medicine.

Read an abstract or a Reuters story on the research.

Nurse-Family Partnership Helps Reduce Infant Deaths

New research finds that a long-running program that brings nurses to the homes of economically disadvantaged new mothers helps reduce premature deaths of both infants and mothers. The study of the Nurse-Family Partnership program was conducted by researchers at the University of Rochester School of Nursing and published in JAMA Pediatrics in July 2014.

Beginning in 1990, researchers compared outcomes for 1,138 mothers and their children in Memphis, Tennessee. Most of the mothers were 18 or younger, unmarried, and unemployed. All received standard care before, during, and after giving birth, but while they were pregnant some also received in-home visits from registered nurses. The visits continued for up to two years after those women gave birth.

Researchers conducted 11 interviews with each study participant over the next 20 years. Among mothers who had received in-home visits, the researchers found a significant reduction in preventable child deaths from birth until age 20. The control group of mothers—those who received standard care but no nurse visits—had a 1.6 percent rate of deaths from sudden infant death syndrome and other preventable causes, while the treatment group—those who had in-home visits—had no such preventable deaths at all.

“Our findings add to the body of evidence that the program produces improvements in the short- and long-term,” said study co-author Harriet Kitzman, PhD, RN, FAAN. “Mothers have an innate desire to provide the best care for their babies. When nurses empower mothers with the knowledge and skills to better their families’ lives, it transforms life trajectories.”

The Robert Wood Johnson Foundation was an early and sustaining funder of the Nurse-Family Partnership, providing 12 grants over the course of two decades, more than $26 million in all.

Read an article about the study on the University of Rochester website, or read an abstract of the study.

Read a 2012 Human Capital Blog post by Nurse-Family Partnership founder David Olds, PhD.

More Coverage of Recent Research About Nursing on the Human Capital Blog

Unmet Need for Residency Programs for Acute Care Nurse Practitioners

Keystone State Study Looks at Impact of Worker Fatigue on Patient Safety

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Fri, 11 Jul 2014 08:00:00 -0400 Human Capital Blog Nurses Job satisfaction Shortage of medical or nursing personnel Barriers to care: financial Barriers to care: cultural, gender and racial Child welfare Community-based care Human Capital Nursing Sharing Nursing's Knowledge Research & Analysis
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/quotable_quotes_abou.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/quotable_quotes_abou.html <![CDATA[Quotable Quotes About Nursing, July 2014]]>

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

“We can’t just sit back and wait for things to get created, to be made for a bigger market, to be made just for a patient like that, so we have to make and create what we need ...”
--Roxana Reyna, BSN, RNC-NIC, WCC, skin and wound care prevention specialist, Driscoll Children’s Hospital, MacGyver Nurse and Maker Nurse Program, KRISTV (Corpus Christi, TX), June 30, 2014

“Nurses make up the single largest segment of the health care workforce and spend more time delivering patient care than any other health care profession. Nursing’s unique ability to meet patient needs at the bedside and beyond puts us in a critical position to transform health care.”
--Michelle Taylor-Smith, RN, BSN, MSN, chief nursing officer, Greenville Health System, GHS to Require B.S. Degrees for Nurses, Greenville Online, June 28, 2014

“This country won’t succeed in its implementation of health care reform without more of these types of [nurse-led] clinics in underserved communities.”
--Tine Hansen-Turton, MGA, JD, FAAN, CEO, National Nursing Centers Consortium, At Paul’s Place, Partnership with Nursing School Promotes Good Health, Baltimore Sun, June 22, 2014

“...Despite talk of an impending nursing shortage over the next few years, some believe there is an even bigger crisis looming, one that stems from the very heart of the career—education. Quite simply, nursing students are not as prepared as they should be for the ‘real world of nursing and patient care. ... The decline in nursing skills didn’t happen overnight, and it will take some time to fix. A collaborative effort focusing on a combination of academic instruction and real-life applications—and a focus on both the technical as well as ‘soft’ skills—will be crucial to getting our nurses back on track and ready to properly serve the patients and families that so trust and respect them.”
--Kelly Hancock, MSN, RN, NE-BC, executive chief nursing officer, Cleveland Clinic Health System, Course Correction: Better Preparing Today’s Nurses for 21st Century Health Care Service, Health Affairs Blog, June 20, 2014

“There’s still a lot of work to do to continue to educate the uninsured about new options available under the Affordable Care Act. Too often, even people who have health insurance coverage may not be aware of new benefits, may think incorrectly that preventive services like mammograms are not covered, or may not understand why screening matters. These people need help from you to understand the range of benefits health insurance provides. We’re working very hard to strengthen the competencies NPs [nurse practitioners] will need to practice in redesigned health care systems. HRSA supports initiatives to help transform the present siloed health care system into an integrated system that reflects care coordination and team-based practices.”
--Mary K. Wakefield, PhD, RN, FAAN, administrator, Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services, NPs Expand Access to Care, Educate Patients, The Clinical Advisor, June 18, 2014

“In some states, licensed nurse-practitioners are allowed to provide basic medical treatment within their sphere of competency without oversight from a doctor. In the states where most Americans live, this is illegal. But the state-to-state variation allows us to compare the quality of care provided by NPs to that provided by MDs, and it shows that NPs are just as good on objective outcome measures, and better on subjective accounts of patient satisfaction. If other states acted in line with Institute of Medicine recommendations and let their NPs practice autonomously, patients could get the cheaper health care they provide.” 
--Matthew Yglesias, BA, executive editor, Vox Media, Four Ways to Fix American Health Care that Neither Republicans Nor Democrats Will Touch, Vox, June 11, 2014

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Thu, 10 Jul 2014 13:00:00 -0400 Human Capital Blog Nurses Affordable Care Act (ACA) Scope of practice Health reform Human Capital Nursing Media Coverage Sharing Nursing's Knowledge
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/rwjf_scholars_inthe0.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/rwjf_scholars_inthe0.html <![CDATA[RWJF Scholars in the News: Healthcare.gov, depression and mortality, stress among nurses, 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:

Young adult users of Healthcare.gov, the health insurance marketplace established under the Affordable Care Act, recommend that the site offer better explanations of terminology, more clarity about the benefits various plans offer, and checkboxes and other features that make it easier to compare plans. Those are among the findings of a study conducted by RWJF Clinical Scholar Charlene Wong, MD, along with alumni David Asch, MD, MBA, and Raina Merchant, MD, that looked at the experiences of young adults who used the website. The scholars write about their findings in the Philadelphia Inquirer. Wong told the Leonard Davis Institute of Health Economics blog that these users “may not know what insurance terms mean but they have a lot of expertise and insights about maximizing the usability of the digital platforms that have always been such an integral part of their lives.”

Major depression (also known as “clinical depression”) is associated with an elevated risk of death from cardiovascular disease, according to research covered by Kansas City InfoZine. The study, co-authored by Patrick Krueger, PhD, an RWJF Health & Society Scholars program alumnus, also found that the relationship between depression and early non-suicide mortality is independent of such factors as smoking, exercise, body mass, education, income, and employment status. The authors say the findings indicate that the relationship between depression and mortality is not due solely to the interplay between depression and health-compromising risk factors.

Expanding scope of practice for advanced practice nurses and implementing better management practices could alleviate some stress factors for nurses and improve patient care, Matthew McHugh, PhD, JD, MPH, FAAN, tells Healthline News. For example, in some medical facilities, nurses are empowered to decide if a patient’s urinary catheter should be removed without consulting a doctor, thus preventing delays in care. “Lots of things that don’t require policy change” can have an important impact on patient outcomes and nurses’ job satisfaction, said McHugh, an RWJF Nurse Faculty Scholars alumnus.

While working with low-income children, RWJF Clinical Scholars alumna Nicole Brown, MD, MPH, wondered if misbehaving pediatric patients who had dealt with childhood trauma were being misdiagnosed with attention deficit/hyperactivity disorder (ADHD), reports the Atlantic. Brown analyzed data from a national survey and found that children diagnosed with ADHD also experienced markedly higher levels of poverty, divorce, violence, and family substance abuse. These children may also have ADHD, but unless the emotional damage is treated, it may be difficult to see dramatic improvement in their behavior, she says.

As part of a story about the local impact of the Affordable Care Act’s Prevention and Public Health Fund, the Chicago Tribune describes the work of a new health clinic in one of the city’s low-income, largely Latino neighborhoods. The clinic received a $484,000 grant from the fund, and is overseen by Cynthia Barnes-Boyd, PhD, RN, FAAN, an alumna of the RWJF Executive Nurse Fellows program. One goal of the clinic is to keep families healthy so children can stay in school and parents can hold jobs. “It’s a longer-term view of health,” Barnes-Boyd tells the Tribune. “If people really understood that prevention would improve expenditures on health care, there wouldn't be such opposition. We’re so illness-focused."

In an article for the Washington Post’s Monkey Cage blog, Shana Gadarian, PhD, an RWJF Scholars in Health Policy Research alumna, analyzes the ethics of a Facebook “emotion experiment” that has recently made headlines. Gadarian offers suggestions to Facebook, which experienced backlash from users and criticism in the media after revealing that researchers had manipulated users’ newsfeeds to test reactions. Gadarian maintains that Facebook would have been on higher ethical ground if it had offered study subjects a clearer opt-in message and sent an email to debrief participants after conducting the study.

Registered voters say they want their elected representatives to support action to reduce global warming, according to a study led by Edward Maibach, PhD, MPH, recipient of an RWJF Investigator Award in Health Policy Research. Salon and Pacific Standard cover the study, which finds that 45 percent of respondents say they would be more likely to vote for a candidate who strongly supports taking action on global warming, compared to 17 percent who would be less likely.

Research by Jason Houle, PhD, examines the effects of student debt on the number of young adults seeking to purchase homes, reports Digital Journal. The RWJF Health & Society Scholars program alumnus found that rising student debt serves as a barrier to home ownership, particularly for young African American adults.

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Thu, 10 Jul 2014 09:41:00 -0400 Human Capital Blog Affordable Care Act (ACA) Behavioral/mental health Nurses Scope of practice Research Scholars and fellows Human Capital Clinical Scholars Health & Society Scholars Nurse Faculty Scholars Executive Nurse Fellows Investigator Awards in Health Policy Research Scholars in Health Policy Research Media Coverage HC Website Feature Research & Analysis
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/is_comfort_eatingac.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/is_comfort_eatingac.html <![CDATA[Is Comfort Eating Actually Comforting?]]>

A. Janet Tomiyama, PhD, an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2009-2011), is assistant professor of psychology and director of the Dieting, Stress, and Health (DiSH) Lab at the University of California, Los Angeles. She was recently named the 2013 recipient of the Early Career Investigator Award from the Society of Behavioral Medicine. Her favorite comfort food: potato chips.

What’s your favorite comfort food? Ice cream, pizza, chocolate—everyone’s got a preference, whether they’re from Los Angeles, London, Sao Paolo, or Tokyo. Stress eating is as universal as eating itself; indeed, even Cervantes in his 1605 classic Don Quixote addressed the practice with the line, “All sorrows are less with bread.” Humans seem to reach for food as a way to soothe negative emotions, and that food is often high-fat, high-sugar, and high-calorie. That’s why comfort eating is often blamed as one reason stress is bad for health—because stress causes us to find comfort in a dozen cookies.

A. Janet Tomiyama

If you’re like me, you’ll be surprised but delighted to know it’s not just humans that engage in comfort eating! Eating high-fat, sugary foods in response to stress is a behavior that we see in non-human species like rodents and primates. Under chronic stress conditions, for example, rats will shift their food intake away from standard food pellets to the rodent version of “comfort food” (researchers often use Crisco mixed with sugar).

Even more amazing: it works. These comfort-eating rats showed dampened biological stress reactivity in a stress system called the Hypothalamic-Pituitary-Adrenal (HPA) axis. Sustained over-activity of the HPA axis is associated with poor health, and these studies suggest that comfort eating is playing an important role in managing an organism’s stress levels.

The implications of this are enormous. If comfort eating functions in the same way in humans (the human literature is in its infancy, but my research and that of others offers preliminary evidence that comfort eating is associated with dampened HPA activity), then we need to substantially shift the way we think about stress eating.

Stress eating is currently treated like a villain, a negative health behavior that we should intervene to eradicate at all costs. The science of comfort eating, however, indicates that we may be engaging in this behavior for very good reasons, and that eating that brownie might mitigate the negative health effects of stress hormones—which may be even more harmful in the long-term than a few extra calories.

39047_Philly_070_v2

The upshot of all of this is that we might need to be more nuanced when designing interventions to combat negative health effects of stress. It appears we are evolutionarily wired to use food as a comfort strategy, so our current practice of telling people to stop stress eating might be an uphill battle. Perhaps we can exploit the power of comfort food to help ameliorate in-the-moment stress, and somehow do so without damaging long-term metabolic health. Science has yet to tell us what foods are most effective at comforting, so the door is potentially open for healthy foods to comfort us.

The ultimate goal in our pursuit of a Culture of Health should be sustainable health behavior change, and harnessing the power of comfort eating as a stress-reduction strategy could be a promising—and delicious—strategy.

Learn more about the new NPR/Robert Wood Johnson Foundation/Harvard School of Public Health poll.

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Wed, 9 Jul 2014 09:00:00 -0400 A. Janet Tomiyama Health promotion and disease prevention Nutrition policy Human Capital Health Burden of Stress Voices from the Field
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/transforming_communi.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/transforming_communi.html <![CDATA[Transforming Communities to Reduce Stress and Improve Health]]>

Brita Roy, MD, MPH, MS, is a Robert Wood Johnson Foundation (RWJF)/U.S. Department of Veterans Affairs Clinical Scholar, and Carley Riley, MD, MPP, is an RWJF Clinical Scholar. 

You awake to the sound of your alarm, not feeling as rested as you’d hoped. Hurriedly bathing and dressing, you then grab a breakfast bar and stumble over your long-neglected bicycle to climb into your car, joining other anonymous drivers enduring their morning commutes.

Brita Roy, MD, MPH, MS

Unfortunately, these sorts of mornings, all too common to Americans, create negative stress and worsen health. Under time constraints and other pressures, stressed individuals engage in less healthy behaviors: eating more unhealthy foods, exercising less, smoking more, and sleeping less than their less stressed counterparts. And the persistent assault of low-grade stressors, such as air and noise pollution, constant rush, lack of nature, and social isolation repeatedly trigger our bodies’ stress responses, promote persistent low-level inflammation, and subsequently undermine our cardiovascular and overall health.

Carley Riley, MD, MPP

Beyond these familiar stressors, emerging research is showing how the nature of our communities and our relationships within them—our social environment—also influence our health. We are learning that living in neighborhoods in which residents do not know or trust each other increases negative stress levels. And how living in communities in which residents do not have confidence in their government or do not believe they can affect change to better their lives also creates stress.

We have greater understanding of how people living in neighborhoods with high crime and violence rates experience more chronic stress. And we are finding that living and working in environments in which we feel powerless augments the negative health effects of stress. 

But we don’t have to live like this. We can strategically shape our neighborhoods and our work environments to lower stress, build resilience, and promote health.

Seem like a pipe dream?

Well, while this may, at first blush, seem like a description of an unrealistic utopia as fantastic as The Truman Show, it is actually within reach. Communities can take action and change their environments to reduce chronic stress and promote health.

As an example, back in the 1970s, the residents of San Luis Obispo, Calif., started making changes to their city to promote well-being instead of commercialism. They closed one of their main thoroughfares to create a central plaza for people to gather and festivals to be held. They built large bike lanes and sidewalks, limited the size of signs, deliberately created accessible green space, and banned fast-food restaurants. Today, residents of San Luis Obispo enjoy some of the highest well-being in the country.

Other communities are also starting to transform their environments to make them less stressful and more healthful. Brownsville, Texas, recently rehabilitated old train tracks into an enjoyable trail to run, hike, and bike. Durham, N.C., has opened up streets and created bike lanes to increase physical activity and social connectedness, improve access to healthy foods and health care, improve education, and reduce unemployment. And Williamson, W.Va., has developed programs to promote healthy restaurants, community gardens, and outdoor tourism.

So if these cities did it, why can’t others?  What does it take to create a less stressful and healthier community?

Positive change requires invested leadership and collective action. Collaboration between local policy-makers and community organizations to begin improving environments is key: City or town officials, urban planners, public health officials, and even health care systems can work alongside community members to design neighborhoods that promote routine activity and social connection. State and national governments and organizations can bolster these efforts via financial incentives as well as with information and organizational support.

Imagine transforming communities across America into ones that mitigate stress and promote health. Instead of awakening to car horns, we might open our bedroom windows in the morning to breathe fresh air and hear people chatting. Perhaps it is a priority for one community that the majority of residents may easily walk or bike to work, school, or the market, making physical activity a routine part of the day. Or maybe it is getting residents into common spaces to allow more interaction, fostering friendships, tolerance, and trust, that would matter most. Or it may be that a community would most immediately benefit from better access to healthier foods, space for community gardening, or green space.

To start galvanizing community change, resources are available to guide the process. Communities should choose action items that are important to them and then track what is and what is not working—and share those lessons learned!  If communities across our nation analyze and disseminate the outcomes of these proactive transformations, we can all better understand what works where and why. Then one community may learn from and inspire another to create lasting, meaningful, positive change that allows more residents to live a lower stress, more healthful life. So, how would you start transforming your community?

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Tue, 8 Jul 2014 09:00:00 -0400 Brita Roy Built environment Environmental health Healthy communities Human Capital Clinical Scholars Health Burden of Stress Voices from the Field
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/the_burden_of_stress.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/the_burden_of_stress.html <![CDATA[The Burden of Stress in America]]>

A new NPR/Robert Wood Johnson Foundation/Harvard School of Public Health poll released today finds that about half of the public reported a major stressful event or experience in the past year. Nearly half (43 percent) reported that the most stressful experiences related to health.

More than half of those who experienced a great deal of stress in the past month say too many overall responsibilities and financial problems were contributors. More than a third of those with a great deal of stress say the contributors include their own health problems and health problems of family members. 

“Stress touches everyone. Unfortunately, many of those feeling the most stress get trapped in cycles that can be very unhealthy. If we are going to build a culture of health in America, one big step we can take is recognizing the causes and effects not just of our own stress and the stress of those closest to us, but of others we encounter in our day-to-day lives,” says Risa Lavizzo-Mourey, MD, RWJF president and CEO.

People in poor health are more than twice as likely as the public as a whole to report a great deal of stress in the past month (60 percent).

Interviews were conducted in English and Spanish via telephone by SSRS of Media (Pa.), March 3 – April 8, 2014, among a nationally representative sample of 2,505 adults age 18 and older.

Read the full report, The Burden of Stress in America.

Learn how you can join the live webcast on The Health Burden of Stress on Wednesday, July 9 at 12:30 ET.

The Robert Wood Johnson Foundation (RWJF) Human Capital Blog will carry posts by RWJF scholars and alumni examining the link between stress and health this week, and throughout July.

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Mon, 7 Jul 2014 13:28:00 -0400 Human Capital Blog Data Research Human Capital Health Burden of Stress
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/unmet_need_for_resid.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/unmet_need_for_resid.html <![CDATA[Unmet Need for Residency Programs for Acute Care Nurse Practitioners]]>

A growing demand for acute care nurse practitioners (ACNPs) has created significant opportunity in this field, as well as a significant need for postgraduate residency programs, according to an article in the Journal for Nurse Practitioners.

Faced with issues such as the mandated reduction of work hours for residents, hospitals are turning to ACNPs to boost patient safety and satisfaction, writes Catherine Harris, PhD, MBA, CRNP, director of the ACNP program at Thomas Jefferson University in Philadelphia. Yet ACNP education emphasizes care across the life span instead of focusing on specialties—such as trauma, critical care, and cardiology—that hospital patients count on.

Postgraduate residency programs in specialty areas are “a very popular idea among NP graduates looking for additional mentorship and specialty training,” Harris writes, “but also they are a relatively inexpensive way to recruit and retain new hires.”

The article points out that only around 25 such programs, each with just one or two spots available per year, exist in the United States.

Read “Bridging the Gap Between Acute Care Nurse Practitioner Education and Practice: The Need for Postgraduate Residency Programs” in the Journal for Nurse Practitioners.

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Mon, 7 Jul 2014 09:00:00 -0400 Human Capital Blog Nurse practitioners Nurses Education and training Workforce supply and demand Human Capital Nursing
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/reengineering_medica.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/reengineering_medica.html <![CDATA[Reengineering Medical Product Innovation]]>

Arthur Kellermann, MD, MPH, an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars and Health Policy Fellows programs, is professor and dean of the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. He is co-author of the new RAND report, “Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value.” Here, he shares recommendations for a brave new world of medical technology.

Americans take justifiable pride in our capacity for innovation. From putting the first men on the moon to developing the Internet, we lead the world in developing innovative technologies. Health care is no exception. The United States holds more Nobel prizes in medicine than any other nation.

Novel drugs, biologics, diagnostics, and medical devices have transformed American health care, but not always for the better.

Some innovations have made a big difference. Combination antiretroviral therapy changed HIV infection from a death sentence to a treatable, chronic disease. Before an effective vaccine was developed, Hemophilus Influenze type b, a bacterial disease, was a major cause of death and mental disability in young children. Today, it is virtually eradicated here and in Western Europe.

"What if the policy landscape was changed to promote and reward high value ideas?"

Unfortunately, other health care technologies in widespread use today have driven health care costs higher while doing relatively little or nothing to improve health. For this reason, what Americans get for their health care dollar falls short of its potential.

In most parts of the economy, such as manufacturing, retail sales, computing and telecommunications, innovation boosts productivity and lowers costs. But in health care, the opposite is true. Many groups, from the Kaiser Family Foundation to the Congressional Budget Office, have noted that the introduction of costly new drugs, diagnostics, devices, and clinical procedures is one of the biggest factors driving the relentless growth of health care spending.

Health care behaves differently because inventors, investors, and developers face a very different investment and regulatory landscape from that confronted by other industries. As a result, inventors have weak or even negative incentives to create products that improve health and lower costs. The biggest payoffs come from creating products that can command high prices, whether or not they make a substantial impact on health.

Consider one such example: substantial data indicate that a cardiovascular “polypill” that combines low doses of three generic blood pressure medications and a statin in a single pill could produce a simple, affordable, and near-universal way for adults to reduce their risk of suffering a major heart attack or stroke, two of the biggest causes of death and disability worldwide. Epidemiological studies and limited clinical trials suggest that widespread use of the polypill could reduce the incidence of these deadly diseases by 50 percent or more.

Given the prospect of such enormous benefit, one might think that developers and investors would rush to bring this concept to market. But 10 years after the concept of a polypill was first described, it’s made little progress. Why? Although every ingredient of the polypill has been approved by the Food and Drug Administration (FDA) and doctors can and sometimes do prescribe these medications together, putting them into a single pill is not approved for the U.S. market. And given the low price point of this treatment, investors have determined that they would be unlikely to recoup the costs of mounting the sort of large-scale clinical trials required to secure FDA approval.

As long as the marketplace discourages the creation and testing of cost-lowering innovations, there’s little reason to think that inventors will focus their creative talents in this direction. But what if the policy landscape was changed to promote and reward high value ideas?

Recently, with support from the Bill and Melinda Gates Foundation, a team of researchers from the RAND Corporation examined this question. They synthesized information from scientific, trade, and popular literature; conducted interviews with more than 50 inventors, venture capitalists, CEOs, and health policy experts, and consulted a panel of distinguished experts in policy and product innovation. With the help of a talented group of Robert Wood Johnson Clinical Scholars, they also assembled a set of case studies that illustrate how the development of drugs, devices, tests, and health IT are influenced by the current innovation pathway. Ultimately, the team generated ten policy options, shared in the brief, Healing Medical Product Innovation, to alter the prevailing mix of incentives in ways that could encourage the creation and development of high-value, cost-lowering health care technology:

  1. More creativity in funding basic science.
  2. Offer prizes for inventions.
  3. Buy out patents.
  4. Establish a public-interest investment fund.
  5. Expedite FDA reviews and approvals for technologies that decrease spending.
  6. Reform Medicare payment policies.
  7. Reform Medicare coverage policies.
  8. Coordinate FDA and Centers for Medicare & Medicaid (CMS) processes.
  9. Increase demand for technologies that decrease spending.
  10. Produce more, and more timely, technology assessments.

Several of RAND’s policy options seek to reduce the risks and regulatory barriers associated with bringing cost-lowering products to market. Others seek to alter market signals by encouraging health care providers to favor highly effective cost-lowering technologies over products that are no better but boost costs. Adopted in whole or in part, policies like these could incentivize American inventors, investors, and developers to focus their creative energies toward devising health care technologies that produce better heath at lower cost.

Because the prevailing regulatory and reimbursement landscape is oriented to reward developers who create ever-costlier products; we should not be surprised that they do.  Rather than allowing growing numbers of Americans to be priced out of the health care market, or forcing tax payers and policyholders to underwrite increasingly unaffordable products, policy-makers should consider realigning  the playing field in ways that would encourage inventors and developers to create high-impact, cost-lowering technologies.  If they do that, American ingenuity and competition will do the rest.

The views expressed are those of the authors and do not reflect the opinions of the Uniformed Services University of the Health Sciences, the Department of Defense or the U.S. Government.

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Thu, 3 Jul 2014 09:00:00 -0400 Arthur Kellermann Research Disruptive innovations Public policy Human Capital Clinical Scholars Health Policy Fellows Voices from the Field
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/in_the_media_nurse.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/in_the_media_nurse.html <![CDATA[In the Media: Nurse Fired for Misusing Social Media on TV Series]]>

This is part of the July 2014 issue of Sharing Nursing's Knowledge.

ABC’s NY Med, a documentary series about hospital life, has a lesson for nurses in the digital age: Think before you post.

Katie Duke, RN, an emergency room nurse at NewYork-Presbyterian Hospital who is featured in the series, learned that lesson the hard way.

During the show’s season premiere on June 26, Duke was summarily fired after posting a photo of a messy trauma room on a social media website. She was hired soon after at a different hospital, according to an article about the episode on AOL.com.

“I’ve been in that emergency room for six years ... in a matter of ten minutes, I am no longer,” Duke said, according to the AOL article. “This post that has gotten me fired was a picture of an empty trauma room with a comment underneath.”

Television critic Neil Genzlinger pointed out what he sees as the irony of the situation in a recent blog post in the New York Times. “Given that this hospital is allowing itself to be filmed for prime-time network television, it seems ridiculous” that Duke would be fired for posting a photo to a social media site, he writes.

Still, nurses should understand hospital policies regarding the use of social media and make sure to abide by them, said Maureen Shawn Kennedy, MA, RN, editor-in-chief of the American Journal of Nursing. “If nurses are going to be involved in social media, they have to be very careful in terms of knowing what the hospital policies are,” she said in an interview.

The eight-part series is produced by Terence Wrong and airs on Thursday nights at 10pm Eastern Standard Time.

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Wed, 2 Jul 2014 15:26:00 -0400 Human Capital Blog Nurses Emergency care Work environment Human Capital Nursing Media Coverage Sharing Nursing's Knowledge
http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/rwjf_scholars_inthe.html http://www.rwjf.org/en/blogs/human-capital-blog/2014/07/rwjf_scholars_inthe.html <![CDATA[RWJF Scholars in the News: Menopause and heart disease, nurses and health care finance, 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: 

Changes in hormone levels during early menopause could be linked to an increased risk of heart disease, finds a new study co-authored by RWJF Health & Society Scholars program alumna Rebecca Thurston, PhD. Health Canal covers the study, describing it as a first-of-its-kind evaluation because it used nuclear magnetic resonance spectroscopy to assess the lipoproteins that carry cholesterol through the blood, rather than relying on conventional blood tests. Thurston’s study was published in the Journal of Lipid Research.

For Alice Goffman, PhD, an RWJF Scholars in Health Policy Research alumna, an undergraduate assignment turned into a six-year study of a low-income Philadelphia neighborhood in which, she concluded, “the young men in this community feel hunted.” In the resulting book, On the Run: Fugitive Life in an American City, Goffman says that a “climate of fear and suspicion pervades everyday life” in the community. The New York Times Sunday Book Review calls Goffman’s work “riveting” and her ability to understand her subjects “astonishing.”

The Colorado Department of Health Care Policy and Financing has received a $13.6 million grant from the federal Centers for Medicare and Medicaid Services to integrate and coordinate physical, behavioral, and social-health needs for people enrolled in both Medicare and Medicaid, reports the Northern Colorado Business Report. The story quotes Susan Birch, MBS, BSN, RN, executive director of the department: “This grant allows Colorado to coordinate our members' care, while achieving greater value and health outcomes for our citizens who are on both Medicare and Medicaid.” Birch is an RWJF Executive Nurse Fellows alumna.

Developing hospital finance models that account for the care that is delivered, not simply tasks that are performed, is the next step for U.S. health care, according to Pamela Thompson, MS, RN, CENP, FAAN, as reported in Healthcare Finance News. Thompson spoke recently at the Healthcare Financial Management Association’s annual 2014 conference. She is CEO of the American Organization of Nurse Executives (AONE), which houses the national program office of the RWJF Academic Progression in Nursing program. “Nurses and other frontline providers deliver value to hospitals, but finance professionals often do not have a complete understanding of what they do,” she said, noting that “the value of nursing is beyond the individual task performed ... [it is] in the health outcomes achieved per dollar of cost spent.” 

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Wed, 2 Jul 2014 09:00:00 -0400 Human Capital Blog Research Social determinants of health Medicaid Hospitals Human Capital Media Coverage Academic Progression in Nursing Executive Nurse Fellows Health & Society Scholars Scholars in Health Policy Research Nursing