An Interesting Study from the University of Pennsylvania

I love when nurses do interesting and creative research and to me, this study fits that description to a “T.” This was a press release I received from Penn entitled “Science in Action.”

Food Stamps and Farmers’ Markets

Current food stamp programs at urban farmers’ markets attempting to bring fresh produce to economically stressed city dwellers are so complicated for the shopper and expensive for the farmer that fewer people are taking advantage of the federal program designed to help them, according to research at the University of Pennsylvania School of Nursing.

Record numbers of Americans are receiving Supplemental Nutrition Assistance Program (SNAP) benefits, as food stamps are now known, and many SNAP participants live in neighborhoods with little or no access to healthy food. A study conducted at the Clark Park Farmers’ Market in Philadelphia, Pa., found that making it easier for vendors to collect SNAP payments with electronic point-of-sale systems increased fresh produce sales to SNAP recipients by 38 percent.

However, the costs associated with such systems may put them out of reach for farmers. The study, by Penn Nursing professor Alison M. Buttenheim, PhD, MBA, and colleagues, appears in the Journal of the Academy of Nutrition and Dietetics.

“Our study highlights the need for an equitable approach to subsidizing Electronic Benefits Transfer (EBT) fees at farmers’ markets,” Dr. Buttenheim reported. “Vendors told us, and we confirmed with a cost-benefit analysis, that they would not be able to break even on sales after paying the associated costs.”

SNAP participants access their benefits through EBT cards. To accept the cards at farmers’ markets, vendors must rent wireless POS terminals, pay for wireless service, and cover transaction fees. Because of the associated costs, many market managers operate a single wireless POS terminal for the entire market. SNAP beneficiaries may buy a token that they can exchange for produce, but they can’t receive change. Alternatively, customers can make their selections with a vendor, get a paper receipt for the total amount of the purchase, and present the receipt to the central terminal, where the customer’s EBT card is swiped for the exact amount of purchase. This must be repeated for each vendor the customer wants to visit.

Dr. Alison M. Buttenheim

Instead, Dr. Buttenheim and colleagues provided each vendor at the Clark Park Farmers’ Market with a wireless POS terminal for EBT and credit/debit card transactions. A grant covered all associated wireless charges, transaction fees, and processing fees during a pilot program which ran from June 2008 through February 2009. After the pilot period, the market returned to a single market-operated terminal and receipt system.

Researchers analyzed sales data at the market for four years, beginning 17 months before the pilot project and ending 22 months afterward. There was a 38 percent increase in SNAP/EBT sales during the months with multiple vendor-operated terminals. However, after the pilot project ended, sales to SNAP participants returned to pre-pilot levels, controlling for increases in SNAP participation in Philadelphia.

“Many stakeholders want to increase SNAP redemptions at farmers’ markets,” said Dr. Buttenheim. “We hope this study can inform policymakers about the specific mechanisms driving SNAP redemptions and about the need for subsidies for wireless POS technology at farmers’ markets.”

In an accompanying podcast, Dr. Buttenheim and co-author Allison Karpyn of The Food Trust, a Philadelphia nonprofit working with communities on lasting and stable sources of affordable food, discuss the impact of wireless POS terminals at farmers’ markets on sales to SNAP beneficiaries, and the policy implications of their research. The podcast is available at http://andjrnl.org/content/podcast.

Reference:

Buttenheim AM, Havassy J, Fang M, Glyn J, Karpyn AE. Increasing Supplemental Nutrition Assistance Program/Electronic Benefits Transfer Sales at Farmers’Markets with Vendor-Operated Wireless Point-of-Sale Terminals. J Acad Nutr Diet. 2012 Mar 15. [Epub ahead of print] PubMed PMID: 22425028.

In Memory of Joyce C. Clifford, 1935-2011

I didn’t realize that Joyce Clifford died in October. When I was a student, we practiced primary nursing while the actual staff nurses were all still doing team nursing. It was a tumultuous time. Joyce was truly a visionary and deserves the honor of being a nursing legend.

The following obituary is from The New York Times.

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Joyce C. Clifford, a nurse who advocated a partnership of equals between doctors and nurses in the treatment of patients, and whose ideas were adopted in some of the nation’s best hospitals because they reduced medical errors and improved survival rates, died on Oct. 21 in Boston. She was 76.

The cause was heart disease and kidney failure, said her husband, Lawrence.

Dr. Clifford, who received a Ph.D. in health planning from Brandeis University, was part of the first generation of registered nurses who sought to make bachelor’s degrees a minimum requirement in a field where most held associate degrees. It was a requirement she set for all the nurses she hired at Beth Israel Hospital in Boston, a Harvard teaching hospital, where she worked from 1974 until 1999 as the nursing administrator and later vice president.

Under the “primary nursing” model she introduced in 1975 at Beth Israel, nurses were assigned primary responsibility for four or five patients — caring for each while on duty, being on call when off duty, and acting as an advocate and intermediary with each patient’s doctors.

The idea was to restore the continuity and accountability that were considered casualties of the nursing system then widely in use, known as team nursing. In the team system each nurse had a specialized task, like dressing wounds or managing medication, but no single nurse had a glimpse of the big picture.

“Doctors see a patient for a couple of minutes a day, but nurses are there 24/7,” Margaret Grey, dean of the Yale School of Nursing, said in an interview after Dr. Clifford’s death. “Joyce Clifford put together a system that gave the primary nurse the benefit” of that accumulated round-the-clock nursing information, she said.

Dr. Clifford was not the creator of the primary nursing model, but she was probably the first to put it into practice in a large teaching hospital, said Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, who published research about the work of Dr. Clifford.

Studies showed that the system was good for patients and for hospitals, Professor Aiken added. The increased accountability and higher level of education it demanded were linked to a decline in patient mortality and a lower turnover of nurse staff.

“Beth Israel had a waiting list of applicants,” Professor Aiken said, “even when there were nurse shortages everywhere else.”

Primary nursing has never become the norm. Only about 10 percent of the nation’s hospitals use it in one form or other. In the face of corporate mergers and cost-cutting, some hospitals where it was once in practice — including Beth Israel, now known as theBeth Israel Deaconess Medical Center — have since modified or eliminated it in favor of more decentralized systems.

Dr. Clifford’s achievement was in showing how primary nursing could work, said Dana Beth Weinberg, an assistant sociology professor at Queens College. Professor Weinberg’s Harvard dissertation, published in 2003 as the book “Code Green: Money-Driven Hospitals and the Dismantling of Nursing,” chronicled the dismantling of primary nursing at Beth Israel after its merger with Deaconess Medical Center in 1999 and Dr. Clifford’s departure.

Dr. Clifford went on to found and lead the Institute for Nursing Healthcare Leadership, which promotes research and advanced education in nursing and the primary nurse system.

She was born Joyce Catherine Hoyt in New Haven on Sept. 12, 1935, one of four daughters of Raymond Hoyt, an ironworker, and his wife, Helen. She received a nursing diploma from St. Raphael Hospital in New Haven and a bachelor of science degree in 1959 from St. Anselm College in New Hampshire.

She joined the Air Force in the early 1960s and received a master’s degree in nursing administration in 1968 from the University of Alabama in Birmingham, where she was stationed.

She and her husband met at the university. Besides Mr. Clifford, she is survived by a sister, Rita Brown, of West Haven, Conn.

Dr. Clifford was hired as Beth Israel’s chief nurse by its president and chief executive, Dr. Mitchell T. Rabkin, a member of the Harvard Medical School faculty.

Dr. Rabkin said Monday in an interview that he had had an insight when he was a young intern. “On my very first day of internship,” he said, “I realized that nurses knew a hell of a lot more than I did.”

Dr. Rabkin gave Dr. Clifford carte blanche to put together a nursing staff that would work collaboratively with doctors. There was some resistance at first. Medical doctors complained that instead of talking to one nurse about the patients in a section of a ward, say, they had to contact each patient’s primary nurse, which meant making a number of separate contacts.

“The resistance did not last long,” Dr. Rabkin said. “Because the doctors soon realized that they were getting far better information, and the patients were getting better care.”

RWJF Announces 12 Faculty Scholars

Robert Wood Johnson Foundation Announces
12 New ‘Nurse Faculty Scholars’

Prestigious Program Advances Careers, Health Research of Promising Junior Nurse Faculty

PRINCETON, N.J., Sept. 1, 2011 /PRNewswire-USNewswire/ — The Robert Wood Johnson Foundation (RWJF) today announced the names of the 12 outstanding nursing faculty from across the country who were selected to participate in its prestigious Nurse Faculty Scholars program this year.  The RWJF Nurse Faculty Scholars program is strengthening the academic productivity and overall excellence of nursing schools by developing the next generation of leaders in academic nursing. It is providing $28 million over five years to outstanding junior nursing faculty to promote their academic careers, support their research and reduce the nation’s severe nurse faculty shortage. This is the fourth cohort of RWJF Nurse Faculty Scholars.

Each Nurse Faculty Scholar receives a three-year $350,000 grant to pursue research, as well as mentoring from senior faculty at his or her institution. The award is given to junior faculty who show outstanding promise as future leaders in academic nursing.  The Scholars chosen this year are conducting a range of health studies, from using story-telling to encourage Native American women to get mammograms, to using simulation to help reduce medical errors in hospitals caused by interruptions, to examining the impact of family strength and parenting on reducing risky behavior among teens, to investigating whether home improvements can realize health benefits for disabled, low-income seniors.

“Several Scholars in earlier cohorts have published their research and are already helping to improve health care and advance nursing and nursing education,” said Jacquelyn Campbell, Ph.D., R.N, F.A.A.N., national program director for the RWJF Nurse Faculty Scholars Program.  Campbell is Anna D. Wolf Chair and professor at the Johns Hopkins University School of Nursing, which provides technical direction to the program. “It’s exciting to begin the work with this newest group of Scholars and I look forward to seeing where their work, their enthusiasm and their skills take them.”

This year’s selection comes as the Robert Wood Johnson Foundation is embarking on a collaborative campaign to transform the nursing profession to improve health and health care.  Based on the recommendations from a groundbreaking Institute of Medicine nursing report released last year—The Future of Nursing: Leading Change, Advancing Health, RWJF is spearheading the Future of Nursing: Campaign for Action to engage nurses and non-nurses in a nationwide effort to overhaul the nursing profession. The campaign is working to implement solutions to the challenges facing the nursing profession and to build upon nurse-based approaches to improving quality and transforming the way Americans receive health care.

Supporting junior nurse faculty will help curb a shortage of nurse educators that could undermine the health and health care of all Americans. The Affordable Care Act will vastly increase the number of people who can access health care in the United States. As the number of patients increases, there will be greater demand for skilled nurses and faculty to educate them.  Right now, many schools of nursing are turning away qualified applicants because they lack the faculty to teach them.

The RWJF Nurse Faculty Scholars program is helping to curb the shortage by helping more junior faculty succeed in, and commit to, academic careers. The program provides talented junior faculty with salary and research support as well as the chance to participate in institutional and national mentoring activities, leadership training, and networking events with colleagues in nursing and other fields, while continuing to teach and provide institutional, professional and community service at their universities.

“We are particularly pleased that several of our scholars are reaching a level of achievement recognized by the American Academy of Nursing,” said Campbell. “Three scholars were inducted as fellows of the American Academy of Nursing last year, and this year six more will receive that honor.”

The RWJF Nurse Faculty Scholars Program strives to increase the racial, ethnic, and gender diversity of nursing by fostering leadership skills among scholars to recruit and retain diverse faculties and student bodies at their schools of nursing.  To that end, the program encourages applicants with diverse backgrounds.

The program will also enhance the stature of the scholars’ academic institutions, which will benefit fellow nurse educators seeking professional development opportunities.

To receive the award, scholars must be registered nurses who have completed a research doctorate in nursing or a related discipline and who have held a tenure-eligible faculty position at an accredited nursing school for at least two and no more than five years.

This year’s Nurse Faculty Scholar award recipients and their research projects are:

  • Anna Beeber, Ph.D., R.N., University of North Carolina at Chapel Hill, Developing Best Nursing Practices in Assisted Living;
  • Jennifer Bellot, Ph.D., R.N., M.H.S.A., Thomas Jefferson University, Painting a Portrait of Utilization and Integration: Medicare and Nurse Managed Centers;  
  • Tina Bloom, Ph.D., R.N., The Curators of University of Missouri, Internet-based Safety Planning with Abused Pregnant Rural Women;
  • Alexa Doig, Ph.D., R.N., University of Utah, Simulation Training to Reduce Medication Errors Caused by Interruptions;
  • Jill Esquivel, Ph.D., R.N., N.P.,  University of California, San Francisco, A Self Care Intervention for Hispanic Patients with Heart Failure;  
  • Rosa Gonzalez-Guarda, Ph.D., R.N., University of Miami, Joven (Youth): Juntos Opuestos a la Violencia Entre Novios/Together Against Teen Dating Violence;
  • Nalo Hamilton, Ph.D., R.N., University of California, Los Angeles, Insulin-Like Growth Factor-2, Estrogen Receptors and Racial Disparities;  
  • Emily Haozous, Ph.D., R.N., University of New Mexico, Digital Storytelling and Medical Mistrust in American Indian Women;
  • Tsui-Sui Annie Kao, Ph.D., R.N., University of Michigan, Family Collective Efficacy: An Underdeveloped Mechanism to Minimize Adolescent Risk Behaviors;
  • Matthew McHugh, Ph.D., J.D., M.P.H., R.N., C.R.N.P., University of Pennsylvania, Nursing Care Environment, Neighborhood, and Racial and Ethnic Disparities;
  • Elena Siegel, Ph.D., R.N., University of California, Davis, Leadership Support for Quality Improvement in Nursing Homes; and  
  • Sarah Szanton, Ph.D., C.R.N.P., Johns Hopkins University, Bio-Behavioral Mediators of Enhanced Daily Function in Disabled Low –Income Older Adults.

To learn more about the program, visit www.nursefacultyscholars.org.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change. For nearly 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

 

 

 

Apropos of the social media discussion at the conference last week…

I thought this article might be of interest. From the Washington Post

Drug companies lose protections on Facebook, some decide to close pages

By Christian Torres, Published: August 12

Relationship status: “It’s Complicated.”

Facebook and the pharmaceutical industry have had an uneasy partnership in recent years. Many drug companies didn’t even join the site until Facebook gave them a privilege that others do not have — blocking the public’s ability to openly comment on a page Wall.

But that’s about to change.

In a reversal by Facebook, most drug company pages will have to have open Walls starting Monday.

Companies are worried that open Walls mean open risks, and many are reconsidering their engagement on Facebook. AstraZeneca shut down on Friday a page devoted to depression — the company sells the antidepressant Seroquel. Johnson & Johnson said it will close four of its pages on Monday. Other companies said they will monitor their pages more closely once the changes take effect.

The industry is concerned that users might write about bad side effects, promote off-label use or make inappropriate statements about a product. Aside from poor word of mouth, the comments could raise concerns from government regulators.

Facebook will not say what specifically prompted its change of heart. Andrew Noyes, manager of public policy communications for Facebook, said in an e-mail, “We think these changes will help encourage an authentic dialogue on pages.”

Facebook will allow companies to continue to block Wall comments on specific prescription product pages, but those are a minority of pharmaceutical company pages. Most pages — soon to be open — are focused on companies themselves or on disease or patient-specific communities, which then have ties to the companies’ prescription products.

To read the entire article, click here.

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In nursing news, today is the 101st anniversary of Florence Nightingale’s death. She died in London in 1910 at the age of 90. This stained glass window was restored and rededicated to her memory in October 2010. It is in St. Peter’s Church, Derby. According to Wikipedia:

A remarkable stained glass window was commissioned for inclusion in the Derbyshire Royal Infirmary chapel in the late 1950s. When the chapel was later demolished the window was removed, stored and replaced in the new replacement chapel. At the closure of the DRI the window was again removed and stored. In October 2010, £6,000 was raised by friends of the window and St Peters Church to reposition the window in St Peters Church, Derby. The remarkable work features nine panels, of the original ten, depicting scenes of hospital life, Derby townscapes and Florence Nightingale herself. Some of the work was damaged and the tenth panel was dismantled for the glass to be used in repair of the remaining panels. All the figures, who are said to be modelled on prominent Derby town figures of the early sixties, surround and praise a central pane of the triumphant Christ. A nurse who posed for the top right panel in 1959 attended the rededication service in October 2010.

In Memory: Dr. Luther Christman

Dr. Luther Christman in 1980.

I just learned that Dr. Luther Christman died on June 7, 2011 in Nashville, Tennessee. He was 96.

I first met Dr. Christman when I was in graduate school at the University of Illinois at the Medical Center (now UIC) and he was the Dean at “the college across the street” (Rush University). Years later, I had the honor to introduce him for a presentation at the Biennial Conference for Sigma Theta Tau. My memory is that he was a gracious, warm, and truly genuine man.

His contributions to the profession of nursing are numerous and legendary. Over the past few days, I’ve enjoyed reading various remembrances of his life. I’ll share a few links for all of you:

Obituary from the Chicago Sun-Times
From RushIn Person, a nice tribute from the Rush Archives
From the University of Michigan School of Nursing
Article at Nurse.com

Elizabeth Pittman has written a biography of Dr. Christman; a preview can be viewed here. It can be purchased at the site or as a Kindle book from Amazon.

It seems as if the one thing he didn’t do was serve as an Editor of a journal! Can someone correct me if I’m wrong about that? Thanks!

Seven Decades of Service to Rural and Medically Underserved Families: New Frontier Nursing University Name Becomes Official

HYDEN, Ky., July 6, 2011 /PRNewswire/ — Providing compassionate care for women and families in rural and medically underserved areas for more than 70 years, students and graduates of the Frontier School of Midwifery and Family Nursing have garnered national recognition for their dedication to Frontier’s mission. Proudly, the school has now officially become Frontier Nursing University as of July 1, 2011.

This nationally recognized institution traces its humble beginnings and commitment to service to Mary Breckinridge, a visionary and trailblazing woman who, in 1925, established the Frontier Nursing Service, traveling on horseback through the hills of Eastern Kentucky to serve as a nurse-midwife for mothers during childbirth. Established in 1939, the school was an outgrowth of Mrs. Breckinridge’s dedication, offering the country’s first rural-based nurse-midwifery education program. Over the course of the ensuing decades, students and graduates have expanded her legacy of care by providing health services to women and families in rural communities around the world. In 1970, the school created the first family nurse practitioner program in the United States, and in 2005, the women’s health care nurse practitioner program was added.

Today, Frontier’s educational programs are recognized for their excellence not only across America, but also worldwide. Close to 1,100 students from all 50 states and several foreign countries are enrolled in either Frontier’s Doctor of Nursing Practice or Master of Science in Nursing degree programs, which combine superb online course offerings and real-world practicum.

Dr. Susan Stone, DNSc, CNM, FACNM, President and Dean

Dr. Susan Stone, Frontier’s visionary President and Dean and a certified nurse-midwife, explained: “This new name represents a milestone in the history of our institution: we are a University recognized for our outstanding graduate degree programs, both domestically and worldwide. We’ve just been honored by US News and World Report as being within the top 15 of nurse-midwifery and family nurse practitioner programs in the USA and ranked within the top 50 on their list of graduate schools of nursing nationwide.

“The evolution of the name of our institution reflects both the amazing ‘chronicle’ of our past, as well as the incredible opportunities that lie in our future. All of these milestones are directly attributable to the vision of Mary Breckinridge, the dedication of our board, faculty and staff, and to the increasing worldwide demand for educated women’s and family healthcare professionals.  Combining the Frontier Nursing heritage with our academic excellence as a University, we will more appropriately define the status of our unique institution. As we continue to educate nurses to become nurse-midwives and nurse practitioners, we will fulfill our mission to serve rural and medically underserved communities, while reinforcing our commitment to prepare nurses and midwives for advanced practice both domestically and internationally.”

Click here to learn more about the name change and the mission and purpose of Frontier Nursing University.

From AHRQ: A Resource for Nurses

There are many familiar names on the list of contributors for this book — Leslie

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Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043. Agency for Healthcare Research and Quality, Rockville, MD.

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Nurses play a vital role in improving the safety and quality of patient care – not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes.

Continue reading

From the CMAJ: Perinatal Hospice

I recently received this press release and wanted to share with my colleagues. What an interesting and important issue!

Providing hospice in the womb

Amy Kuebelbeck was 25 weeks into her pregnancy when she received the terrible news. Her fetus had been diagnosed with an incurable heart defect. If she carried through with her pregnancy, her baby’s life would be a brief one.

Kuebelbeck did continue her pregnancy and gave birth to a boy. Her new son, Gabriel, was even sicker than anticipated. He died a few hours after his birth.

“He lived for nine months before he was born,” says Kuebelbeck, “and for two and a half peaceful hours afterward.”

That was in 1999, a time when perinatal palliative care — support for families expecting babies with life-limiting illnesses — was still very much in the concept stage. There was no formal support program at the hospital where Kuebelbeck, a freelance writer from Saint Paul, Minnesota, received care during her pregnancy with Gabriel. There was, however, one person on staff who helped her family though the entire process.

“One person validated for us that we still had a profound opportunity to parent and love this baby,” says Kuebelbeck.

Her experience led to a 2003 memoir, Waiting with Gabriel: A Story of Cherishing a Baby’s Brief Life. It also led to the creation of the website perinatalhospice.org, which lists hospitals, mostly in the United States and Canada, that have perinatal hospice programs. When she started the website, in 2006, there were only 10 programs on that list. Now there are 90.

“My long-term goal is to take the website down because every hospital has a perinatal hospice program, just as every hospital has an emergency room,” says Kuebelbeck.

Continue reading

In Memory: Rose Mary Carroll Johnson

From the INANE Mailing List:

To my colleagues,

It is with a heavy heart that I share the news that Rose Mary Carroll Johnson,
Editor of the Oncology Nursing Forum, passed away very early this morning, February 21st, surrounded by family and dear friends at her home in California. This is sad news and not unexpected – but difficult nonetheless. Rose Mary put up a long and strong fight against cancer – a disease that she also fought on the professional front. Rose Mary celebrated her 20th year as Editor of the Oncology Nursing
Forum this year, in 2011. For her professional and personal friendship, we are
all grateful. She will be missed in so many ways.

No arrangements have been finalized at this time. Her daughter, Elizabeth Mills,
has posted an update on the CaringBridge website
(http://www.caringbridge.org/visit/rosemarycarrolljohnson) and will share
further plans on the website as they become available. I will also share any
information I receive through ONS.

Please remember Rose Mary’s family in your thoughts and prayers. To all of Rose
Mary’s colleagues, we extend a wish for peace, solace and tender memories of a
dear friend.

Sincerely,
Susan Moore RN, MSN, ANP, AOCN
Assistant Editor
Oncology Nursing Forum

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This is very sad news. I was the Editor-in-Chief of The Journal of Hospice and Palliative Nursing from 2001-2009. Prior to my assuming the editorship, Rose Mary was in the editor role. I always enjoyed talking with her at INANE meetings and I appreciated her support in my first months on the job at JHPN. My thoughts and prayers go out to Rose Mary’s family, friends, and professional colleagues.