Category Archives: News

Marilyn Oermann to Receive Award for Excellence in Nursing Education

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Duke University School of Nursing Scholar Dr. Marilyn Oermann to be Honored with

the Elizabeth Russell Belford Award for Excellence in Education

from Sigma Theta Tau International

Durham, NC…Dr. Marilyn Oermann, director of evaluation and education research at Duke University School of Nursing is the recipient of the Elizabeth Russell Belford Award for Excellence in Education by the Sigma Theta Tau International (STTI), the honor society of nursing. The award, named in honor of one of the five founding members of STTI, is awarded every two years and pays tribute to excellence in teaching, significant contributions toward advancing the science of nursing and influencing the professional practice and public image of nursing.

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Interesting Podcast with Jeffrey Beall

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Thanks to Tom Long, who brought this podcast to my attention via the INANE listserv. Stewart Wills of the Scholarly Kitchen interviews Jeffrey Beall, librarian the the University of Colorado, Denver who maintains the blog, Scholarly Open Access. Jeffrey is also going to be speaking at INANE 2014 in Portland, ME next summer.  From the website:

In this episode, we talk with librarian Jeffrey Beall of the University of Colorado, Denver — who maintains a celebrated scholarly publishing “hall of shame,” the list of predatory open access publishers and journals and blogs regularly at scholarlyoa.com — about the inherent vulnerability of gold open access to scams and fraud, the potential pitfalls of article-level metrics, and where his research on the scholarly publishing environment is headed.

Note that near the end of the podcast, Jeffrey mentions doing research on predatory journals in nursing–that is specifically for INANE. He is going to be on sabbatical at the beginning of 2014, doing research on predatory publishers and journals. He will be presenting his findings (among other things) at the conference.

New Editor for International Nursing Review

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Geneva, Switzerland 17 May 2013 – Sue Turale has been announced as the new editor of the International Nursing Review, replacing Jane Robinson who has edited the INR, the official journal of the International Council of Nurses, for the past 11 years.

Dr Turale, previously Editor-in-Chief and Editor of the journal Nursing & Health Sciences, said, “I am delighted to be appointed to work with the International Council of Nurses and the INR Editorial Board, reviewers and authors around the world.  This is a prestigious and historic journal. I have observed it to play an important global role in the dissemination of knowledge to improve nursing and midwifery practices, health, health care and health policy. Since I love working across cultures and countries, sharing ideas, learning from others and developing scholarship, I value this opportunity to build on the significant work of Dr Robinson and others to grow INR as an even more vital resource for the future”.

Dr Sue Turale

Dr Turale trained as a psychiatric nurse, general nurse and midwife, and holds nurse registration in Australia.  She received a Diploma of Applied Science (Advanced Psychiatric Nursing) and a Bachelor of Applied Science (Advanced Nursing) from Phillip Institute of Technology, Melbourne (now RMIT) and a Master of Nursing Studies from La Trobe University, Melbourne.  In 1999 she obtained a Doctor of Education from the University of Melbourne, and is a Fellow of both the Australian College of Nursing and the Australian College of Mental Health Nurses.

After many years working in clinical, management and education roles in psychiatric nursing, Dr Turale became a lecturer at the University of Ballarat, Australia where she later worked as Deputy Head and Director of International Programs, and Associate Professor and Head of the School of Nursing. From 2001-2003 she was the Inaugural General Manager of the Helen Macpherson Smith Institute of Community Health, part of the Royal District Nursing Service in Melbourne.  She then became Director of Nursing and Strategic Planning Consultant at Medea Park Residential Care in St Helens, Tasmania. In 2005, Dr Turale managed the National Indigenous Nursing and Midwifery Education Project at CATSIN, and then became Professor of International Nursing at the Faculty of Health Sciences, Graduate School of Medicine, Yamaguchi University, Ube, Japan – a position she held for seven years. In 2006, she also took on the job of Editor-in-Chief, Nursing & Health Sciences. Currently she works as visiting professor in a number of countries in the Asia-Pacific region assisting in capacity building of the profession and health care systems through education, research, and developing scholarship.

Jane Robinson, who has been editor of the INR since 2003, said: ” I have loved editing INR and working with authors in helping to disseminate so much valuable scholarship across the globe.  It is time to move on, and I am delighted to hand over to the capable hands of Dr Sue Turale.  I know that we share the same values in encouraging nurses to publish from around the world, and the future is bright for INR.  I also thank ICN for this wonderful opportunity to work internationally, and to be a small part of ICN’s incredibly important global mission.”

Notes to editors:

About International Nursing Review

The International Nursing Review (INR) is the official journal of the International Council of Nurses (ICN). It is a quarterly, peer-reviewed journal that focuses predominantly on nursing and health policy issues of relevance to nurses and has an increasing impact factor. INR welcomes original articles that help to forward ICN’s global mission by representing nursing, advancing the profession and shaping health policy. INR also contributes to the ongoing development of nursing internationally with its regular section on International Perspectives. The diverse international readership of INR is located in more than 130 countries. Published both in hard copy and on-line, INR is a key resource for nurses worldwide.

INR encourages unsolicited original manuscripts where nurses describe the policy relevance of their work and document their experience and research. Authors are encouraged to develop a ‘global intelligence’ on nursing and to address INR’s diverse audience by exploring beyond local or national interests to the more general, global application of the principles underlying their work. Background information on the local arrangements for nursing and health care in a country also provides useful context for this global readership. Policy concerns of this journal include: regulation of the profession, workplace issues, innovations in practice, patient safety, quality improvement education, ethics, nurses’ and midwives’ work-life experiences, and the impact of globalization and technology on nursing and health and social policy.

The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations representing the millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality care for all and sound health policies globally.

Scientific Articles Accepted (Personal Checks, Too)

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from the New York Times, April 7, 2013

Scientific Articles Accepted (Personal Checks, Too)

By 

The scientists who were recruited to appear at a conference called Entomology-2013 thought they had been selected to make a presentation to the leading professional association of scientists who study insects.

But they found out the hard way that they were wrong. The prestigious, academically sanctioned conference they had in mind has a slightly different name: Entomology 2013 (without the hyphen). The one they had signed up for featured speakers who were recruited by e-mail, not vetted by leading academics. Those who agreed to appear were later charged a hefty fee for the privilege, and pretty much anyone who paid got a spot on the podium that could be used to pad a résumé.

“I think we were duped,” one of the scientists wrote in an e-mail to the Entomological Society.

Those scientists had stumbled into a parallel world of pseudo-academia, complete with prestigiously titled conferences and journals that sponsor them. Many of the journals and meetings have names that are nearly identical to those of established, well-known publications and events.

Steven Goodman, a dean and professor of medicine at Stanford and the editor of the journal Clinical Trials, which has its own imitators, called this phenomenon “the dark side of open access,” the movement to make scholarly publications freely available.

The number of these journals and conferences has exploded in recent years as scientific publishing has shifted from a traditional business model for professional societies and organizations built almost entirely on subscription revenues to open access, which relies on authors or their backers to pay for the publication of papers online, where anyone can read them.

Open access got its start about a decade ago and quickly won widespread acclaim with the advent of well-regarded, peer-reviewed journals like those published by the Public Library of Science, known as PLoS. Such articles were listed in databases like PubMed, which is maintained by the National Library of Medicine, and selected for their quality.

But some researchers are now raising the alarm about what they see as the proliferation of online journals that will print seemingly anything for a fee. They warn that nonexperts doing online research will have trouble distinguishing credible research from junk. “Most people don’t know the journal universe,” Dr. Goodman said. “They will not know from a journal’s title if it is for real or not.”

Researchers also say that universities are facing new challenges in assessing the résumés of academics. Are the publications they list in highly competitive journals or ones masquerading as such? And some academics themselves say they have found it difficult to disentangle themselves from these journals once they mistakenly agree to serve on their editorial boards.

The phenomenon has caught the attention of Nature, one of the most competitive and well-regarded scientific journals. In a news report published recently, the journal noted “the rise of questionable operators” and explored whether it was better to blacklist them or to create a “white list” of those open-access journals that meet certain standards. Nature included a checklist on “how to perform due diligence before submitting to a journal or a publisher.”

Jeffrey Beall, Librarian at the University of Denver

Jeffrey Beall, a research librarian at the University of Colorado in Denver, has developed his own blacklist of what he calls “predatory open-access journals.” There were 20 publishers on his list in 2010, and now there are more than 300. He estimates that there are as many as 4,000 predatory journals today, at least 25 percent of the total number of open-access journals.

“It’s almost like the word is out,” he said. “This is easy money, very little work, a low barrier start-up.”

Journals on what has become known as “Beall’s list” generally do not post the fees they charge on their Web sites and may not even inform authors of them until after an article is submitted. They barrage academics with e-mail invitations to submit articles and to be on editorial boards.

One publisher on Beall’s list, Avens Publishing Group, even sweetened the pot for those who agreed to be on the editorial board of The Journal of Clinical Trails & Patenting, offering 20 percent of its revenues to each editor.

One of the most prolific publishers on Beall’s list, Srinubabu Gedela, the director of the Omics Group, has about 250 journals and charges authors as much as $2,700 per paper. Dr. Gedela, who lists a Ph.D. from Andhra University in India, says on his Web site that he “learnt to devise wonders in biotechnology.”

Open-access publishers say that the papers they publish are reviewed and that their businesses are legitimate and ethical.

“There is no compromise on quality review policy,” Dr. Gedela wrote in an e-mail. “Our team’s hard work and dedicated services to the scientific community will answer all the baseless and defamatory comments that have been made about Omics.”

But some academics say many of these journals’ methods are little different from spam e-mails offering business deals that are too good to be true.

Paulino Martínez, a doctor in Celaya, Mexico, said he was gullible enough to send two articles in response to an e-mail invitation he received last year from The Journal of Clinical Case Reports. They were accepted. Then came a bill saying he owed $2,900. He was shocked, having had no idea there was a fee for publishing. He asked to withdraw the papers, but they were published anyway.

“I am a doctor in a hospital in the province of Mexico, and I don’t have the amount they requested,” Dr. Martínez said. The journal offered to reduce his bill to $2,600. Finally, after a year and many e-mails and a phone call, the journal forgave the money it claimed he owed.

Some professors listed on the Web sites of journals on Beall’s list, and the associated conferences, say they made a big mistake getting involved with the journals and cannot seem to escape them.

Thomas Price, an associate professor of reproductive endocrinology and fertility at the Duke University School of Medicine, agreed to be on the editorial board of The Journal of Gynecology & Obstetrics because he saw the name of a well-respected academic expert on its Web site and wanted to support open-access journals. He was surprised, though, when the journal repeatedly asked him to recruit authors and submit his own papers. Mainstream journals do not do this because researchers ordinarily want to publish their papers in the best journal that will accept them. Dr. Price, appalled by the request, refused and asked repeatedly over three years to be removed from the journal’s editorial board. But his name was still there.

“They just don’t pay any attention,” Dr. Price said.

About two years ago, James White, a plant pathologist at Rutgers, accepted an invitation to serve on the editorial board of a new journal, Plant Pathology & Microbiology, not realizing the nature of the journal. Meanwhile, his name, photograph and résumé were on the journal’s Web site. Then he learned that he was listed as an organizer and speaker on a Web site advertising Entomology-2013.

“I am not even an entomologist,” he said.

He thinks the publisher of the plant journal, which also sponsored the entomology conference, — just pasted his name, photograph and résumé onto the conference Web site. At this point, he said, outraged that the conference and journal were “using a person’s credentials to rip off other unaware scientists,” Dr. White asked that his name be removed from the journal and the conference.

Weeks went by and nothing happened, he said. Last Monday, in response to this reporter’s e-mail to the conference organizers, Jessica Lincy, who said only that she was a conference member, wrote to explain that the conference had “technical problems” removing Dr. White’s name. On Tuesday, his name was gone. But it remained on the Web site of the journal.

Dr. Gedela, the publisher of the journals and sponsor of the conference, said in an e-mail on Thursday that Dr. Price and Dr. White’s names remained on the Web sites “because of communication gap between the EB member and the editorial assistant,” referring to editorial board members. That day, their names were gone from the journals’ Web sites.

“I really should have known better,” Dr. White said of his editorial board membership, adding that he did not fully realize how the publishing world had changed. “It seems like the Wild West now.”

This article has been revised to reflect the following correction:

Correction: April 9, 2013

An article on Monday about questionable scientific journals and conferences misstated the name of a city in Mexico that is home to a doctor who sent articles to a pseudo-academic journal. It is Celaya, not Ceyala.

This article has been revised to reflect the following correction:

Correction: April 10, 2013

An article on Monday about questionable scientific journals and conferences erroneously included one publishing company among those on a list of “predatory open-access journals,” known as Beall’s list. Although Dove Press was on the list in 2012, it has since been removed.

Why Nurses Need More Authority

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An interesting op-ed piece from The Atlantic. My thanks to Thomas Long, PhD, Associate Professor in Residence at the University of Connecticut for bringing it to my attention.

~~

Allowing nurses to act as primary-care providers will increase coverage and lower health-care costs. So why is there so much opposition from physicians?  

Think it takes a long time to get an appointment with a primary care provider now? Brace yourself: it will likely only get worse. We’re facing a severe shortage of primary care physicians in the nation. The Association of American Medical Colleges predicts a shortfall of 29,800 primary care physicians by 2015, and 65,800 by 2025, mainly because of the anticipated increase in demand for services from the Affordable Care Act (ACA), deterrents to entering the field, such as relatively lower incomes, and growth in the general population and specifically growth in the elderly population. Should the ACA pass muster with the Supreme Court next month, an additional 30 to 33 million previously uninsured Americans will be covered — and even if ACA is not implemented in full, and in the end merely expands Medicaid, it will add 17 million to the insured ranks by 2020.

One of the best ways to alleviate this shortage is to expand the scope of practice for advanced practice registered nurses (APRNs), well-trained registered nurses with specialized qualifications who can make diagnoses, order tests and referrals, and write prescriptions. APRNs could provide a variety of services that primary care physicians now provide.

The definitive word on medical practice in America — the highly respected and impartial Institute of Medicine (IOM) of the National Academy of Sciences — has weighed in on this idea of allowing APRNs to do more, in a landmark 2010 report “The Future of Nursing.” The IOM conducted an exhaustive review of all the available studies of the efficacy and safety of care provided by APRNs and concluded that properly trained APRNs can independently provide core primary care services as effectively as physicians. They can provide wellness and preventive care services, diagnose and manage common, uncomplicated acute illnesses, and help patients manage chronic diseases such as diabetes. In its report, the National Academy of Sciences recommended that “[a]dvanced practice registered nurses should be able to practice to the full extent of their education and training.”

But despite an urgent need and clear evidence that APRNs can complement and extend primary care providers’ roles — without sacrificing quality of care — nurses are only permitted to practice independently to the full extent of their training and competence in 16 states and the District of Columbia. The remaining states impose regulatory barriers that limit their scope of practice. These barriers should and can be removed.

But the turf wars of organized medicine are preventing progress. The American Medical Association, the American Osteopathic Association, the American Academy of Pediatrics, and the American Academy of Family Physicians all oppose expanding the scope of nurse-practitioner responsibilities, despite the IOM report and recent research demonstrating that an expanded scope of practice for APRNs has no impact on primary care physician income.

In Colorado, where there are far too few anesthesiologists available for rural and critical access hospitals, the state’s medical and anesthesiologists societies sued to overturn former Governor Bill Ritter’s 2010 decision to allow Certified Registered Nurse Anesthetists (CRNAs) to provide anesthesia and pain management care in these hospitals. Instead, they prefer to make people travel hundreds of miles out of their communities to have a procedure that a CRNA is licensed and trained to carry out. They are also apparently fine with hospitals being forced to close as a result of a lack of anesthesiologists. This is a classic example of doctor-centric care trumping patient-centric care.

Apparently the physician organizations are threatened by some mix of concerns about lost income and their traditional position as “captain of the ship.” Those opposed to expanding the scope of nurses’ practice also argue that physicians with more years of training under their belts must necessarily know more than an APRN ever could. Of course they know more, but it is well established that they do not know more about providing the core elements of basic primary care.

And why primary care physicians — already overburdened and overworked — wouldn’t want some support with routine care and services is puzzling. Allowing well-trained APRNs to handle routine care frees up physicians focus on diagnostic dilemmas and more complex management issues while dramatically reducing waiting times for care.

Expanding nursing scope of practice not only can help fill the gap in primary care providers, but it can save money as well. RAND estimates that in Massachusetts, using nurse practitioners to their full capacity could save the state between $4.2 and $8.4 billion over ten years. Other studies find sizable savings from care provided by nurses in clinics in retail pharmacies. In these cases, APRNs have the authority to diagnose, treat, and prescribe medications, among other services. Also, tapping nursing’s potential is the fastest and least expensive way to meet growing demand for primary care. Nurses can be trained faster and for a lot less than medical school costs. Between three and 12 nurses can be educated for the price of one doctor.

There is hope. Employers and patients are beginning to clamor for progress in this area and the turf wars may lose steam as we move away from fee-for-service and toward accountable care organizations, in which a team of providers takes responsibility for the well-being of a population in return for global rather than provider-specific payments. The Federal Trade Commission may provide a further nudge. It has weighed in on a handful of states’ efforts to restrict nursing’s scope, finding cause for anti-competitive practices and, in some cases, evidence that the restrictive laws protect professional interests rather than consumers.

The remaining 34 states that restrict APRN’s scope of practice will eventually have to come to terms with a growing shortage of physicians and increasing demands to save money and restructure how we receive and pay for health care. The inconsistent, often punitive, and highly politicized regulatory environment surrounding APRNs must recognize the new horizons in medical care in the United States.

About the Author:   John Rowe is a physician and professor in the department of health policy and management at the Columbia University Mailman School of Public Health.

This article available online at http://www.theatlantic.com/health/archive/2012/05/why-nurses-need-me-authority/256798/

New Editor for Nurse Author & Editor

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Marilyn H. Oermann, PhD, RN, FAAN, ANEF has been appointed Editor of Nurse Author & Editor, a quarterly online newsletter published by Wiley-Blackwell. Nurse Author & Editor was founded  by Suzanne Hall Johnson, MN, RN,C, CNS in 1991. Charon A. Pierson, PhD, GNP-BC, FAANP has served as Editor since 2008.

Dr. Marilyn Oermann is a Professor and Division Chair in the School of Nursing at the University of North Carolina at Chapel Hill. She is author/co-author of 10 nursing education books and more than 150 articles in nursing and healthcare journals. She has edited 6 volumes of the Annual Review of Nursing Education. Her current books are Evaluation and Testing in Nursing Education (2nd ed.), Clinical Teaching Strategies in Nursing Education (2nd ed.), and Writing for Publication in Nursing. Dr. Oermann has written extensively on educational outcomes, teaching and evaluation in nursing education, and writing for publication as a nurse educator. She is the Editor of the Journal of Nursing Care Quality and past editor of the Annual Review of Nursing Education. Dr. Oermann has a Certification in Writing/Editing from the American Medical Writers Association. She lectures widely on nursing education topics and is a facilitator of the NLN Writing Retreat, sponsored by the NLN Foundation and Pocket Nurse. She is a member of the American Academy of Nursing and NLN Academy of Nursing Education.

Each issue of Nurse Author & Editor consists of articles offering advice on writing quality manuscripts, avoiding rejection, finding publishing opportunities, editing and reviewing.  Each issue also has a section containing short articles to update readers on new developments in nursing journals and journal publishing. You can access the publication here. You must register to access the current issue and archives (going back to 2006) but there is no charge.

If you would like to contribute an article to Nurse Author & Editor, contact Marilyn at moermann@email.unc.edu.

The Power of Nursing

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An incredible article from the New York Times–it was buried in the blogs and I suspect a lot of people didn’t see it. The bolding (for emphasis) is mine. LHN

May 16, 2012, 7:00 AM

The Power of Nursing

By DAVID BORNSTEIN

In 2010, 5.9 million children were reported as abused or neglected in the United States. If you were a policy maker and you knew of a program that could cut this figure in half, what would you do? What if you could reduce the number of babies or toddlers hospitalized for accidents or poisonings by more than half? Or provide a 5 to 7 point I.Q. boost to children born to the most vulnerable mothers?

Well, there is a way. These and other striking results have been documented in studies of a program called the Nurse-Family Partnership, or NFP, which arranges for registered nurses to make regular home visits to first-time low-income or vulnerable mothers, starting early in their pregnancies and continuing until their child is 2.

We tend to think of social change as more of an art than a science. “What’s unique about Nurse-Family Partnership is that the program was studied in what’s considered the strongest study design, and it showed sizable, sustained effects on important life outcomes which were replicated across different populations,” explained Jon Baron, president of the Coalition for Evidence-Based Policy, a nonpartisan group. “This is very unusual. There are probably only about ten programs across all areas of social policy that currently meet that standard.”

What that means, notes Baron, is that if policy makers replicate the program faithfully they can be confident that it will change people’s lives in meaningful ways — improving child and maternal health, promoting positive parenting, children’s school readiness and families’ economic self-sufficiency, and reducing juvenile delinquency and crime.

NFP is not a new idea — it’s almost 40 years old — but after decades of study the program, which has assisted 151,000 families, has the potential for broader impact, thanks to the Affordable Care Act’s Maternal, Infant, and Early Childhood Home Visiting Program, which provides $1.5 billion for states to expand such programs.

Done well, it could be among the best money the government spends. Investments in early childhood development produce big payoffs for society. (A 2005 RAND study estimated that NFP provided $5.70 in benefits to society for every dollar spent.) But there’s an important concern: home visiting programs are not all effective. When carefully studied, only a few have been shown to reduce the physical abuse and neglect of children. Among the programs that meet the government’s standard for funding, there are large variations in evidence of impact (pdf). Policy makers and proponents of home visiting would do well to pay attention to the specific elements in the Nurse-Family Partnership’s model that account for its success.

NFP was founded by David Olds, who directs the Prevention Research Center for Family and Child Health at the University of Colorado Health Sciences Center. Early in his career, Olds worked in a day care center in Baltimore because he believed that quality preschool attention would help disadvantaged children succeed in life. What he began to see was that, for some kids, it was already too late to make big gains. If children had been abused or neglected or exposed to domestic violence, or if their mothers had abused drugs, alcohol or tobacco while pregnant, their brains could have been damaged in ways that limited the children’s abilities to control impulses, sustain attention or develop language.

Olds developed NFP in the early 1970s. He conducted his first large study in 1977, in Elmira, N.Y., a semi-rural, mostly white, community with one of the highest poverty rates in the state. The program produced strong results. Follow-up studies would reveal that, by age 19, the youths whose mothers received visits from nurses two decades earlier, were 58 percent less likely to have been convicted of a crime. In the 1980s and 1990s, Olds spread the work to Memphis and Denver and subjected the program to more randomized study with populations of urban blacks and Hispanics. The results continued to be impressive. In 1996, NFP began wider replication; the model is now being implemented by health and social service providers in 40 states.

As Olds published his results, the idea gained momentum, but the imitations did not remain faithful to NFP’s approach. “People adopted all kinds of home visiting models and used our evidence to make claims,” he recalled. In the early 1990s, for example, the federal government, inspired in part by NFP, began a $240 million program to train paraprofessionals, rather than nurses, to make home visits to low-income families with young children. NFP also experimented in Denver, using paraprofessionals (trained from the communities they served) in place of nurses for a subset of families.

In both cases, paraprofessionals didn’t get the same results. When it came to improving children’s health and development, maternal health, and mothers’ life success, the nurses were far more effective. In the federal program, paraprofessionals produced no effects on children’s health or development or their parents’ economic self-sufficiency.

What’s special about nurses? For one thing, trust. In public opinion polls, nurses are consistently rated as the most honest and ethical professionals by a large margin. But there were other reasons nurses were effective. Pregnant women are concerned about their bodies and their babies. Is the baby developing well? What can I do for my back pain? What should I be eating? What birthing options are available? Those are questions mothers wanted to ask nurses, which was why they were motivated to keep up the visits, especially mothers who were pregnant for the first time.

Nurses had more influence encouraging mothers to delay subsequent pregnancies, Olds explained. They could identify emerging complications more promptly, and they were more successful at getting mothers to stop or reduce smoking, drug or alcohol use. This is vital. Prenatal exposure to neurotoxicants is associated with intellectual and emotional deficits. It can also make babies more irritable, which increases risks of abuse. (A mother who was abused herself is more likely to misinterpret an inconsolable baby’s crying as “bad behavior.”)

“A lot of the young mothers have had some pretty terrible early life experiences,” says Olds. “It’s not uncommon for them to have been abused by partners or never have had support and care from a mother. Their lives haven’t been filled with much success and hope. If you ask them what they want for themselves, it’s not uncommon for them to say, ‘What do you mean?’”

A big part of NFP’s work is helping them answer this question.

Consider the relationship between Rita Erickson and Valerie Carberry. Rita had had a methadone addiction for 12 years and was living from place to place in Lakewood, Colo. She found out she was pregnant; a parole officer told her about NFP. “I’d burned bridges with my family,” Rita told me. “I was running around with the wrong people. I didn’t have anyone I could ask about being pregnant.” In the early months, Valerie had to chase her around town, Rita recalled. “I was worried she might say, ‘This is too much hassle. Come back when you have your act together.’ But she stuck with me.”

Over the next two years, they embarked on a journey together. “I had a zillion questions,” Rita recalled. “I was really nervous at first. I had lived most of my adult life as a drug addict. I didn’t know how to take care of myself.” On visits, they discussed everything: prenatal care, nutrition, exercise, delivery options. After Rita’s daughter, Danika, was born, they focused on things like how to recognize feeding and disengagement cues, remembering to sleep when the baby sleeps, how to manage child care so Rita could go back to school. For Rita, what made the biggest impression was hearing about how a baby’s brain develops — how vital it was to talk and read a lot to Danika, and to use “love and logic” so she develops empathy. Once Valerie explained that when babies are touching their hands, they’re discovering that they have two. “To me that was really amazing,” Rita said.

This month, Rita is graduating from Red Rocks Community College with an associate degree in business administration. She’s going to transfer to Regis University to do a bachelors degree. Her faculty selected her as outstanding graduate based on leadership and academic achievement — and she was asked to lead the graduation procession and give one of the commencement speeches. Danika is thriving, Rita said. Recently, she came home from preschool and announced:  “Mommy, I didn’t have a good day at school today because I made some bad decisions and you wouldn’t be proud of me.” (She had pushed another child on the playground.) As for the NFP, Rita says that it helped her recover from her own bad decisions. When Valerie came along, she needed help badly. “I didn’t care about my life. I didn’t care about anything. I never ever thought I would have ended up where I am today.”

“When a woman becomes pregnant whether she’s 14 or 40, there’s this window of opportunity,” explained Valerie, who has been a nurse for 28 years and has worked with more than 150 mothers in NFP over the past seven. “They want to do what’s right. They want to change bad behaviors, tobacco, alcohol, using a seat belt, anything. As nurses, we’re able to come in and become part of their lives at that point in time. It’s a golden moment. But you have to be persistent. And you have to be open and nonjudgmental.”

Beyond the match between nurses and first-time moms, there are multiple factors that make NFP work. (NFP has identified 18 key elements for faithful replication.) The dosage has to be right: Nurses may make 50 or 60 visits over two and a half years. The culture is vital: It must be non-judgmental and respectful, focusing on helping mothers define their own goals and take steps towards them. The curriculum should be rigorous, covering dozens of topics — from prenatal care to home safety to emotional preparation to parenting to the mother’s continuing education. Nurses need good training, close supervision and support, and opportunities to reflect with others about difficult cases. And, above all, data tracking makes it possible to understand on a timely basis when things are working and when they are not.

With the government making such a large investment in home visiting, it’s crucial for programs to get the details right. Otherwise, society will end up with a mixed bag of results, and advocates will have a hard time making the case for continued support. That would be a terrible loss. “When a baby realizes that its needs will be responded to and it can positively influence its own world,” says Olds, “that creates on the baby’s part a sense of efficacy — a sense that I matter.” It’s hard to imagine higher stakes.

Source: The New York Times

Closing the Loop on Dr. Spitzer

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I posted here more than three weeks ago about the letter Dr. Robert Spitzer sent to Dr. Kenneth Zucker, repudiating and apologizing for his 2003 publication on “reparative therapy” for gays. Rachel Maddow did a great piece on it, blogs were all a-twitter (although it’s been a few weeks so they’ve gone quiet) and now, finally, the New York Times has picked up the story.

Leading Psychiatrist Apologizes for Study Supporting Gay ‘Cure’

By BENEDICT CAREY

Dr. Robert L. Spitzer

PRINCETON, N.J. — The simple fact was that he had done something wrong, and at the end of a long and revolutionary career it didn’t matter how often he’d been right, how powerful he once was, or what it would mean for his legacy.

Dr. Robert L. Spitzer, considered by some to be the father of modern psychiatry, who turns 80 next week, lay awake at 4 o’clock on a recent morning knowing he had to do the one thing that comes least naturally to him.

He pushed himself up and staggered into the dark. His desk seemed impossibly far away; Dr. Spitzer suffers from Parkinson’s disease and has trouble walking, sitting, even holding his head upright.

The word he sometimes uses to describe these limitations — pathetic — is the same one that for decades he wielded like an ax to strike down dumb ideas, empty theorizing, and junk studies.

Now here he was at his computer, ready to recant a study he had done himself, a poorly conceived 2003 investigation that supported the use of so-called reparative therapy to “cure” homosexuality for people strongly motivated to change.

What to say? The issue of gay marriage was rocking national politics yet again. The California State Legislature was debating a bill to ban the therapy outright as being dangerous. A magazine writer who had been through the therapy as a teenager recently visited his house, to explain how miserably disorienting the experience was.

And he would learn later that a World Health Organization report, released on Thursday, calls the therapy “a serious threat to the health and well-being — even the lives — of affected people.”

Dr. Spitzer’s fingers jerked over the keys, unreliably, as if choking on the words. And then it was done: a short letter to be published this month, in the same journal where the original study appeared.

“I believe,” it concludes, “I owe the gay community an apology.”

Disturber of the Peace

The idea to study reparative therapy at all was pure Spitzer, say those who know him, an effort to stick a finger in the eye of an orthodoxy that he himself had helped establish.

In the late 1990s as today, the psychiatric establishment considered the therapy to be a nonstarter. Few therapists thought of homosexuality as a disorder.

It was not always so. Up into the 1970s, the field’s diagnostic manual classified homosexuality as an illness, calling it a “sociopathic personality disturbance.” Many therapists offered treatment, including Freudian analysts who dominated the field at the time.

Advocates for gay people objected furiously, and in 1970, one year after the landmark Stonewall protests to stop police raids at a New York bar, a team of gay rights protesters heckled a meeting of behavioral therapists in New York to discuss the topic. The meeting broke up, but not before a young Columbia University professor sat down with the protesters to hear their case.

“I’ve always been drawn to controversy, and what I was hearing made sense,” said Dr. Spitzer, in an interview at his Princeton home last week. “And I began to think, well, if it is a mental disorder, then what makes it one?”

He compared homosexuality with other conditions defined as disorders, like depressionand alcohol dependence, and saw immediately that the latter caused marked distress or impairment, while homosexuality often did not.

He also saw an opportunity to do something about it. Dr. Spitzer was then a junior member of on an American Psychiatric Association committee helping to rewrite the field’s diagnostic manual, and he promptly organized a symposium to discuss the place of homosexuality.

That kicked off a series of bitter debates, pitting Dr. Spitzer against a pair of influential senior psychiatrists who would not budge. In the end, the psychiatric association in 1973 sided with Dr. Spitzer, deciding to drop homosexuality from its manual and replace it with his alternative, “sexual orientation disturbance,” to identify people whose sexual orientation, gay or straight, caused them distress.

The arcane language notwithstanding, homosexuality was no longer a “disorder.” Dr. Spitzer achieved a civil rights breakthrough in record time.

“I wouldn’t say that Robert Spitzer became a household name among the broader gay movement, but the declassification of homosexuality was widely celebrated as a victory,” said Ronald Bayer of the Center for the History and Ethics of Public Health at Columbia. “ ‘Sick No More’ was a headline in some gay newspapers.”

Partly as a result, Dr. Spitzer took charge of the task of updating the diagnostic manual. Together with a colleague, Dr. Janet Williams, now his wife, he set to work. To an extent that is still not widely appreciated, his thinking about this one issue — homosexuality — drove a broader reconsideration of what mental illness is, of where to draw the line between normal and not.

The new manual, a 567-page doorstop released in 1980, became an unlikely best seller, here and abroad. It instantly set the standard for future psychiatry manuals, and elevated its principal architect, then nearing 50, to the pinnacle of his field.

He was the keeper of the book, part headmaster, part ambassador, and part ornery cleric, growling over the phone at scientists, journalists, or policy makers he thought were out of order. He took to the role as if born to it, colleagues say, helping to bring order to a historically chaotic corner of science.

But power was its own kind of confinement. Dr. Spitzer could still disturb the peace, all right, but no longer from the flanks, as a rebel. Now he was the establishment. And in the late 1990s, friends say, he remained restless as ever, eager to challenge common assumptions.

That’s when he ran into another group of protesters, at the psychiatric association’s annual meeting in 1999: self-described ex-gays. Like the homosexual protesters in 1973, they too were outraged that psychiatry was denying their experience — and any therapy that might help.

Reparative Therapy

Reparative therapy, sometimes called “sexual reorientation” or “conversion” therapy, is rooted in Freud’s idea that people are born bisexual and can move along a continuum from one end to the other. Some therapists never let go of the theory, and one of Dr. Spitzer’s main rivals in the 1973 debate, Dr. Charles W. Socarides, founded an organization called the National Association for Research and Therapy of Homosexuality, or Narth, in Southern California, to promote it.

By 1998, Narth had formed alliances with socially conservative advocacy groups and together they began an aggressive campaign, taking out full-page ads in major newspaper trumpeting success stories.

“People with a shared worldview basically came together and created their own set of experts to offer alternative policy views,” said Dr. Jack Drescher, a psychiatrist in New York and co-editor of “Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics, and Culture.”

To Dr. Spitzer, the scientific question was at least worth asking: What was the effect of the therapy, if any? Previous studies had been biased and inconclusive. “People at the time did say to me, ‘Bob, you’re messing with your career, don’t do it,’ ” Dr. Spitzer said. “But I just didn’t feel vulnerable.”

He recruited 200 men and women, from the centers that were performing the therapy, including Exodus International, based in Florida, and Narth. He interviewed each in depth over the phone, asking about their sexual urges, feelings and behaviors before and after having the therapy, rating the answers on a scale.

He then compared the scores on this questionnaire, before and after therapy. “The majority of participants gave reports of change from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation in the past year,” his paper concluded.

The study — presented at a psychiatry meeting in 2001, before publication — immediately created a sensation, and ex-gay groups seized on it as solid evidence for their case. This was Dr. Spitzer, after all, the man who single-handedly removed homosexuality from the manual of mental disorders. No one could accuse him of bias.

But gay leaders accused him of betrayal, and they had their reasons.

The study had serious problems. It was based on what people remembered feeling years before — an often fuzzy record. It included some ex-gay advocates, who were politically active. And it did not test any particular therapy; only half of the participants engaged with a therapist at all, while the others worked with pastoral counselors, or in independent Bible study.

Several colleagues tried to stop the study in its tracks, and urged him not to publish it, Dr. Spitzer said.

Yet, heavily invested after all the work, he turned to a friend and former collaborator, Dr. Kenneth J. Zucker, psychologist in chief at the Center for Addiction and Mental Health in Toronto and editor of the Archives of Sexual Behavior, another influential journal.

“I knew Bob and the quality of his work, and I agreed to publish it,” Dr. Zucker said in an interview last week. The paper did not go through the usual peer-review process, in which unnamed experts critique a manuscript before publication. “But I told him I would do it only if I also published commentaries” of response from other scientists to accompany the study, Dr. Zucker said.

Those commentaries, with a few exceptions, were merciless. One cited the Nuremberg Code of ethics to denounce the study as not only flawed but morally wrong. “We fear the repercussions of this study, including an increase in suffering, prejudice, and discrimination,” concluded a group of 15 researchers at the New York State Psychiatric Institute, where Dr. Spitzer was affiliated.

Dr. Spitzer in no way implied in the study that being gay was a choice, or that it was possible for anyone who wanted to change to do so in therapy. But that didn’t stop socially conservative groups from citing the paper in support of just those points, according to Wayne Besen, executive director of Truth Wins Out, a nonprofit group that fights antigay bias.

On one occasion, a politician in Finland held up the study in Parliament to argue against civil unions, according to Dr. Drescher.

“It needs to be said that when this study was misused for political purposes to say that gays should be cured — as it was, many times — Bob responded immediately, to correct misperceptions,” said Dr. Drescher, who is gay.

But Dr. Spitzer could not control how his study was interpreted by everyone, and he could not erase the biggest scientific flaw of them all, roundly attacked in many of the commentaries: Simply asking people whether they have changed is no evidence at all of real change. People lie, to themselves and others. They continually change their stories, to suit their needs and moods.

By almost any measure, in short, the study failed the test of scientific rigor that Dr. Spitzer himself was so instrumental in enforcing for so many years.

“As I read these commentaries, I knew this was a problem, a big problem, and one I couldn’t answer,” Dr. Spitzer said. “How do you know someone has really changed?”

Letting Go

It took 11 years for him to admit it publicly.

At first he clung to the idea that the study was exploratory, an attempt to prompt scientists to think twice about dismissing the therapy outright. Then he took refuge in the position that the study was focused less on the effectiveness of the therapy and more on how people engaging in it described changes in sexual orientation.

“Not a very interesting question,” he said. “But for a long time I thought maybe I wouldn’t have to face the bigger problem, about measuring change.”

After retiring in 2003, he remained active on many fronts, but the reparative study remained a staple of the culture wars and a personal regret that wouldn’t leave him be. The Parkinson’s symptoms have worsened in the past year, exhausting him mentally as well as physically, making it still harder to fight back pangs of remorse.

And one day in March, Dr. Spitzer entertained a visitor. Gabriel Arana, a journalist at the magazine The American Prospect, interviewed Dr. Spitzer about the reparative therapy study. This was not just any interview; Mr. Arana went through reparative therapy himself as a teenager, and his therapist had recruited the young man for Dr. Spitzer’s study (Mr. Arana did not participate).

“I asked him about all his critics, and he just came out and said, ‘I think they’re largely correct,’ ” said Mr. Arana, who wrote about his own experience last month. Mr. Arana said that reparative therapy ultimately delayed his self-acceptance as a gay man and induced thoughts of suicide. “But at the time I was recruited for the Spitzer study, I was referred as a success story. I would have said I was making progress.”

That did it. The study that seemed at the time a mere footnote to a large life was growing into a chapter. And it needed a proper ending — a strong correction, directly from its author, not a journalist or colleague.

A draft of the letter has already leaked online and has been reported.

“You know, it’s the only regret I have; the only professional one,” Dr. Spitzer said of the study, near the end of a long interview. “And I think, in the history of psychiatry, I don’t know that I’ve ever seen a scientist write a letter saying that the data were all there but were totally misinterpreted. Who admitted that and who apologized to his readers.”

He looked away and back again, his big eyes blurring with emotion. “That’s something, don’t you think?”

Click here to read the original article. I would also suggest perusing the comments. They are very interesting (and if you dig deep enough, you will find one from “you know who”). I am surprised at how many people have absolute faith in the peer review system, believing that if it had been employed properly, this study would never have been published and its subsequent harms would have been prevented. Really? I certainly believe in and use the peer review process in my journal but I don’t have an expectation that it’s perfect. If it was, why would we need a blog like Retraction Watch?

Dr. Spitzer Writes the Letter That He Needed to Write

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I posted last week about Dr. Robert Spitzer and his requested retraction of his work, published in 2003 in the Archives of Sexual Behavior. He wanted the retraction to occur via an online article not related to the original publication. I asked if this was really a retraction or a repudiation. Several commenters suggested that what Spitzer needed to do was write to Dr. Ken Zucker, editor of the journal. Dr. Zucker had even indicated that he would be receptive to receiving and publishing such a letter.

Well, Spitzer’s done what he needed to do. The letter is written to Zucker and has been shared as an exclusive with Truth Wins Out. (For those who might not know, Truth Wins Out is a non-profit organization that fights anti-gay religious extremism. This includes debunking myths about “reparative therapy.”)

The letter starts out:

Several months ago I told you that because of my revised view of my 2001 study of reparative therapy changing sexual orientation, I was considering writing something that would acknowledge that I now judged the major critiques of the study as largely correct. After discussing my revised view of the study with Gabriel Arana, a reporter for American Prospect, and with Malcolm Ritter, an Associated Press science writer, I decided that I had to make public my current thinking about the study. Here it is.

To read the whole thing, click here.

It does not say in the blog if the letter will be be published in the journal but I certainly hope it will be. That will set the matter straight in the scientific indexes (such as PubMed) which needs to be done.

Good for Dr. Spitzer for doing the right thing, at last, but it is unfortunate that 11 years have passed since the original study “results” were presented at the APA annual meeting. As many said in the comments to my first post, this research did not have just scientific implications but also social and political and has been damaging to the LGBTQ community. Let’s hope his repudiation can help to put the nail in the coffin of “reparative therapy,” once and for all.

Comments, as always, are welcome.

More Men Trading Overalls for Nursing Scrubs

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More Men Trading Overalls for Nursing Scrubs

By TESS VIGELAND

Detroit

IN 2007, Kurt Edwards figured he would be stacking and racking 80-pound boxes of dog food and celery in the back of a grocery store for the rest of his working life. And he was fine with that.

But that June, after nine years on the job, layoff notices arrived on the warehouse floor at the Farmer Jack store in Detroit where he worked. His employer, Great Atlantic and Pacific Tea Company, closed the Farmer Jack chain. Today he still does a lot of lifting, but of people, not boxes. Mr. Edwards joined the ranks of former warehouse, factory and autoworkers trading in their coveralls and job uncertainty for nurses’ scrubs.

At 49, divorced with no children, he now tends to patients on the graveyard shift at Sheffield Manor Nursing and Rehab Center, a two-story, gray brick building in a ramshackle neighborhood on Detroit’s west side. Interviewed last month, he says he is making about $70,000 annually, $20,000 more than he did at the warehouse.

The story of how he made the transition is one that men like him appear to be telling with increasing frequency, and the demand for their services is what is setting so many of them on similar paths.

Hard figures are elusive, but the Michigan Department of Energy, Labor and Economic Growth estimates a shortage of 18,000 nurses in the state by 2015 — and the labor force is adapting.

Oakland University in nearby Rochester, Mich., has established a program specifically to retrain autoworkers in nursing — about 50 a year since 2009. And the College of Nursing at Wayne State University in Detroit is enrolling a wide range of people switching to health careers, including former manufacturing workers, said Barbara Redman, its dean. “They bring age, experience and discipline,” she said.

David Pomerville brings a few more years than Mr. Edwards. A 57-year-old nursing student, he spent most of his career as an automotive vibration engineer, including almost 10 years at General Motors. His pink slip arrived in April 2009.

At the time, Mr. Pomerville was earning almost $110,000 a year at the General Motors Milford Proving Ground in Milford Township, Mich.

But having watched another round of bloodletting at G.M. three years earlier, he had already decided on nursing as his Plan B. “I thought, ‘Well, I worked on cars for this long, now I’m going to work on people for a while,’ ” he said.

A married father of two and grandfather of two, Mr. Pomerville had almost no money saved when he was laid off. But the federal Trade Readjustment Act, which aids workers who lose their jobs as a result of foreign competition, paid for nursing school tuition. His wife is a teacher, and he receives unemployment benefits. He hopes to graduate at the end of this year, and he expects his salary will be about half what he used to make.

Timothy Henk ultimately decided not to try to stick it out as long as Mr. Pomerville did. Mr. Henk, 32, worked for eight years at the Ford Sterling Axle Plant in Sterling Heights, Mich., installing drive shafts in the F-150 truck, and was making about $25 an hour by 2007. With overtime, he earned $70,000 a year.

But as he and his wife contemplated having children, he worried that income would not last. So in 2007, he took a buyout, which included $15,000 a year for four years to put toward education. Two friends in nursing — both women — had suggested he look into joining their profession. He researched the demand for nurses in Michigan and used the buyout money to pay his tuition at Wayne State.

The amount of schooling required to be a nurse depends on the level of nursing a student chooses to pursue. Mr. Henk went through Wayne State’s four-year program to obtain a bachelor of science in nursing and then took a licensing exam to become a registered nurse, or R.N. Other levels of nursing include the C.N.A., or certified nurse’s aide, which can require as little as eight weeks of training plus a certification exam, and L.P.N., or licensed practical nurse, which requires one or two years of schooling and a licensing exam.

All of that assumes acceptance in a nursing program. The American Association of Colleges of Nursing said more than 67,000 applicants were turned away in 2010 for lack of faculty or classroom space — not a good sign with a national nursing shortage projected to be as high as 500,000 by 2025.

Mr. Henk now works in the critical care unit at Beaumont Hospital in Royal Oak, Mich. He makes about $50,000 annually for a 36-hour workweek, though Ford’s health insurance was better.

The choice to make this switch was probably least likely for Mr. Edwards, the former grocery worker. He dropped out of college and spent four years in the Army as a paratrooper with the 82nd Airborne Division. He found his unionized warehouse job after a stint working for his father, an accountant.

“You have this plan, this goal,” he said. “I was going to be at this warehouse; all the guys were retiring with great benefits. I was part of the middle class, and I was going to make it.”

When it became clear that he would not make it to retirement there, someone he was dating suggested nursing.

Though he wrote it off as woman’s work at first, he realized he was getting a bit old for manual labor. So he returned to school, living on unemployment checks and occasional groceries from by his mother. He spent the last four months of his L.P.N. training with no electricity because he could not afford to pay any bills except rent.

Once he finished, the Sheffield Manor administrator, LaKeshia Bell, pretty much hired him on the spot. “They are like a hot commodity,” she said. “A male presence actually helps us in the facility.” At 5 feet 9 inches tall and 220 pounds, Mr. Edwards lifts patients as easily as he stacked boxes.

But he still appears to be a rarity. Just 7 percent of employed registered nurses are men, according to a 2008 Department of Health and Human Services survey. It did not count licensed practical nurses. Still, the percentage of people certified in nursing in some way who are men has risen to 9.6 percent since 2000 from 6.2 percent before, according to the department.

Ms. Bell noted that new nurses coming from manufacturing had unusual adjustments to make. When dealing with parts on the factory floor, she said, repetition is a major part of the job. “These are not parts. They’re people, so you can’t just have a set regimen like in a plant setting,” she said.

That cultural shift goes both ways. Mr. Edwards’s supervisor, Yvonne Gipson, provided an example. “I mean Kurt is not an ugly man, O.K.?” she said. “You got all these female workers, and they’re all looking at him like, ‘Oh! Potential husband!’ So, yes, it does change.” Her voice trailed off, erupting into peals of laughter as Mr. Edwards slipped a $20 bill into her pocket.

While these success stories point to opportunity, Michigan’s unemployment rate is still 9 percent. And Nelson Lichtenstein, director of the Center for the Study of Work, Labor and Democracy at the University of California, Santa Barbara, says history is a cruel taskmaster when it comes to struggling industries.

“When one industry goes in decline and another comes to the fore, you don’t have a one-to-one employment replacement at all,” he said. “It takes a decade, two decades. In the meantime, some people find their careers are ended, ruined, and they never get them back.”

For these new nurses, the advantage is the demand in Michigan. Mr. Edwards knows he is lucky. “You know I wake up every day and I’m very proud,” he said. “I’m looking in the mirror. I’m happy. I’m proud. I’m saying, you know, this turned out great. The lights are on!”

Devin Maverick Robins contributed reporting.

Source: New York Times