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New
DNP Degree
Three
faculty members enroll at MCG
Thanks
to a collaboration between Emory and the Medical College of Georgia (MCG),
three School of Nursing faculty members are on their way to completing
their doctorates of nursing practice (DNP). Launched last year, the MCG's
DNP aims to develop clinical leaders and experts in nursing practice.
The program strives to increase advanced competency in clinical, faculty,
and leadership roles; increase knowledge to improve practice and patient
outcomes; and increase the number of clinical faculty.
Carolyn Clevenger, a gerontological nurse
practitioner, was interested in the DNP even before the program began.
When a grant from the Robert W. Woodruff Health Sciences Center Fund became
available to support Emory faculty interested in the DNP, Clevenger was
thrilled. "I thought it was a wonderful opportunity to do something
that I had been investigating for a year prior to that. I'll still
be a nurse practitioner, but the program has forced me to think about
situations very differently. It has given me a different skill set, not
a career change."
Because of the rapid changes in health care
and the need to implement the latest and most effective practice standards,
both academic and nonacademic health care providers are recognizing the
importance of terminal professional degrees that focus on the practice
of health sciences, as opposed to the science behind the practice.
Although
nursing schools will still offer master's programs, they will likely
be redesigned to prepare generalists for the changing health care system.
As certified nurse-midwife Bethany Robertson explains, there is currently
a national movement to admit master's-level nurses to DNP programs.
But by 2015, nurses seeking advanced degrees will move directly from the
BSN into the DNP. This change parallels another national trend that encourages
nurses who are interested in research to enter a PhD program immediately
after receiving a BSN. Both of these trends will mean more PhD- and DNP-
prepared nurses will be able to teach, lead, and conduct research with
much of their careers ahead of them.
Robertson
chose to pursue the DNP "because I saw this wonderful body of knowledge
generated by nursing researchers, and it hadn't been translated
to the clinical arena. I'm now learning to apply that."
She
is currently studying how communication standards can affect patient outcomes
in the delivery room. "They're not going to teach me more
about delivering babies or doing an episiotomy than I already know,"
she says. "This program addresses a much broader context of health
care—how nurses and physicians, and all of the partners in a health
care team, can improve patient outcomes."
For
family nurse practitioner Kathy Matthews, the program's goals have
already bolstered her quest to improve patient outcomes for those who
suffer from a combination of chronic illnesses. Matthews says the program
has helped her delve deeper into the management of chronic diseases. "It
isn't just about increasing the content knowledge, it's really
about increasing communication skills, process skills, and critical thinking."
She is working toward evaluating an intervention program for patients
with diabetes to learn if treating depressive symptoms in those patients
improves not only their mental health but also their physical health.
All
three faculty members emphasize the vital importance of the DNP's
emphasis on keeping up with the latest research. "You have to stay
connected to the evidence. It changes every day," says Robertson.
"That's part of the skills they're giving us in this
program—how to stay connected to the literature so that you can
be at the penetrating point of evidence-based practice and models of care.
That is the charge they're giving us."
Support
for Cancer Patients
Study
targets older African Americans
Years
ago while working as a critical care nurse, Dr. Jill Hamilton noticed
that patients who were more easily weaned from ventilators had something
in common: support from family and friends. Hamilton says the same idea
holds true for cancer patients. Support from family and friends is crucial.
But the type of support patients need differs from culture to culture,
and this difference is often overlooked. That's why the National
Institutes of Health (NIH) has awarded Hamilton, a Georgia Cancer Coalition
Distinguished Cancer Scholar, a three-year grant to study support networks
and coping strategies for older cancer patients within African American
families and communities.
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Talking
about being sick may give the appearance that one is weak, which makes
older African Americans reluctant to talk to their minister or to
the people around them about their fears and doubts. You have to give
these patients a safe place to go. —Dr. Jill Hamilton |
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To
study this population, Hamilton has created a questionnaire developed
from in-depth interviews she conducted during the past 10 years with older
African American breast cancer and prostate cancer patients. The questionnaire
focuses on the distinctive coping strategies and types of support these
patients use to deal with their illness. For example, previous questionnaires
asked whether a breast cancer patient participates in a support group,
and she may answer no. However, this same patient may receive valuable
support from the church, historically a cornerstone of the African American
community.
Yet
even if patients receive support from their church, they may be reluctant
to talk freely with others about their worries and fears. But talking
could be just what they need. "Older African Americans have been
socialized to be strong, to be stoic," says Hamilton. "If
you're very spiritual, very religious, and you talk about being
sick, it goes against your faith. Because the first thing you're
supposed to do when you're sick is have faith that God will take
care of it. Talking about being sick may give the appearance that one
is weak, which makes older African Americans reluctant to talk to their
minister or to the people around them about their fears and doubts. You
have to give these patients a safe place to go."
Where
that safe place is Hamilton does not yet know. But one thing she does
know is that many older African American patients worry about being "cast
aside." They want to stay as active as possible, whether taking
care of grandchildren, teaching classes at their church, or teaching others
what they have learned about cancer. "These things take their minds
off their illness, but most of all they want to feel needed," says
Hamilton.
The
ultimate goal of her study is to develop a coping questionnaire that will
be useful in practice and help others understand what the patient needs.
"It may not prolong their life or help with the severity of the
illness, but it may make them feel good about themselves and the people
around them," says Hamilton. "You know that if they're
feeling good about themselves, they're going to be more motivated
to endure treatments. It'll make them more motivated to do what
they need to do to survive."
A
Leader in Nursing Education
Lewis
named associate dean
The School of Nursing has named a new leader intent on helping
the school fulfill its goal of becoming the best in education. Dr. Marsha
Lewis now serves as associate dean for education.
Lewis comes to Emory from the University
of Minnesota School of Nursing, where she directed the school's
graduate programs and focused her research on interventions for family
caregivers of persons with dementia. In 2003, Lewis was honored as best
director of graduate studies at the University of Minnesota. Among her
colleagues is Dr. Kenneth Hepburn, associate dean for research, who held
a similar position at Minnesota's School of Nursing until he joined
Emory earlier this year.
"I
was drawn to the associate dean for education position because it is meant
to celebrate and take the educational mission of the school to new heights,"
says Lewis, "and because of the school's commitment to equally
valuing both the education and research missions."
In
her new role as associate dean, Lewis is concentrating on collaborating
with administration, faculty, staff, students, and the community to fulfill
the school's potential—providing the best education for nurses,
creating new knowledge, and serving the school's constituencies
across the globe. "Although I have a major responsibility for promoting
a culture that fosters and nourishes the educational mission, all missions
of the school are interdependent," says Lewis. "This makes
the role particularly exciting for me."
For
the past three years, Lewis served on the Board of Commissioners for the
Commission on Collegiate Nursing Education (CCNE) and its Accreditation
Review Committee. "My experiences with CCNE accreditation have provided
me with the tools to guide program and strategic planning and continuous
quality improvement," says Lewis. "It has also given me a
wealth of knowledge regarding creative and innovative means to launch
the nursing school into new dimensions of excellence."
Growing
Interdisciplinary Science
Donaldson
bridges nursing and medicine
Dr.
Sue Donaldson has joined Emory as Distinguished Professor of Nursing and
Interdisciplinary Science. In this newly created position, Donaldson
holds a primary appointment in the School of Nursing and a secondary appointment
with the Department of Physiology in the School of Medicine.
With a research background in physiology,
nursing, and patient care, Donaldson collaborates with Dr. Marsha Lewis,
associate dean for education, and Dr. Kenneth Hepburn, associate dean
for research, to advance interdisciplinary training and research opportunities
in the basic sciences for nurses. She also fosters interdisciplinary research
among the nursing and medical schools and the basic sciences. Specifically,
Donaldson will head a new initiative, "Transforming Nursing's
Engagement in Science," which seeks to advance nursing as an interdisciplinary
and collaborative field with other health sciences, basic sciences, and
biomedical engineering.
"I
look forward to collaborating with my Emory colleagues to facilitate and
develop interdisciplinary science programs across university divisions,"
says Donaldson. "This is a wonderful opportunity to use the resources
from this institution to prepare the very finest scientists to address
health care issues and problems."
Donaldson
is one of an elite corps of nurses who have been elected to the Institute
of Medicine and has received numerous honors and nursing awards. Prior
to joining Emory, she was a professor in both the schools of nursing and
medicine at Johns Hopkins University and served there as dean of nursing
for seven years. As dean, Donaldson created the infrastructure needed
to support the school's developing research program and implemented
its first doctoral programs.
A
Hero to Women and Children
Business
newspaper honors nurse-midwife
Dr.
Maureen Kelley has been bringing babies into the world for more than 20
years. As a practicing certified nurse-midwife, she has cared for hundreds
of women and children, from as far away as Moscow to as close as midtown
Atlanta. Late last spring, the Atlanta Business Chronicle named
Kelley a Health Care Hero for her lifetime commitment to maternal and
infant health.
Kelley, who received the honor in the allied
health category, is a clinical associate professor in the School of Nursing,
where she holds the Independence Chair of Nursing and serves as chair
of the Department of Family and Community Nursing.
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I could
not be where I am today without the support, mentoring, and caring
of the people I have worked with. This award is truly an honor to
them. —Dr. Maureen Kelley |
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"It
was a tremendous honor to have been recognized in this way," says
Kelley. "It is a privilege to be given the extraordinary opportunities
I have had and to be able to work with people all over the world who are
committed to the same goal of making people healthy. I could not be where
I am today without the support, mentoring, and caring of the people I
have worked with. This award is truly an honor to them."
As
part of a team that travels to the Caribbean, Kelley is collaborating
with Dean Marla Salmon to create a centralized accreditation and certification
mechanism for midwives throughout the region and to help midwives improve
care for mothers and babies. Kelley is also a collaborator on the Balashikha
Project, based just outside of Moscow. The project, which helps establish
centers for perinatal care and high-risk mothers and babies, already has
improved the reproductive health of women in Russia.
At
home in Atlanta, Kelley formerly directed the midwifery program at Emory
Crawford Long Hospital. It's there she launched the Centering Pregnancy
program. It provides a group approach to prenatal care, combining three
essential elements of care—health assessment, education, and support—that
every pregnant woman needs.
"I
have been inspired by Maureen and her unflagging dedication to help the
people she serves," says Salmon. "She is crystal clear on
her devotion to healthy moms, healthy babies, and healthy families. We
can get lost in a variety of things that seem important and lose sight
of what really is important, and she never loses track of that."
By the Numbers
Fall
enrollment reflects varied backgrounds
In fall 2006, the School of Nursing welcomed it largest class yet, with
106 incoming juniors. The school also enrolled 88 new MSN students and
three new PhD students. As in recent years, the students have a variety
of backgrounds and interests. Almost 40% of new BSN students are pursuing
nursing as their second degree, with first degrees ranging from biology
to anthropology to dance. Juniors range in age from 19 to 57, and new
master's students from 22 to 63.
Accentuate
the Positive
PEACE trial helps
patients cope with ICDs
Implanted
cardiac defibrillators (ICDs) can shock irregular hearts back to normal
rhythms. But they can also deliver a jolt to patients' psyches when
the lifesaving devices discharge their voltage. Apprehension over if or
when a jolt will come often leads to anxiety, fear, and depression in
some patients.
Dr. Sandra Dunbar, the Charles Howard Candler
Professor of Cardiovascular Nursing, hopes to reduce the emotional side
effects of living with an ICD. Her Psychoeducational Intervention in Internal
Cardiac Defibrillator Patients (PEACE) trial was designed to improve physical
and emotional recovery 12 months after initial ICD implantation.
Specifically,
the PEACE trial examined whether educational and psychological intervention
affects arrhythmic events in patients with ICDs. If patients learn ways
to reduce anxiety, fear, and depression, can the frequency and severity
of the events be reduced?
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Our goal
is to help ICD recipients feel more in control and to shift from a
victim to a survivor mindset. —Dr. Sandra Dunbar |
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Dunbar
says that during the weeks following implantation, ICD patients are usually
keenly aware of the new implant, which is inserted in the pectoral area
and is slightly larger than a pacemaker. In addition to psychological
effects that come with having an ICD, patients may experience pain, sleep
difficulties, and limited arm movement. However, these side effects tend
to subside after the first six weeks.
The
PEACE trial divided patients, ages 25 to 79, into three groups. One group
received education and counseling in group sessions, another received
education and counseling via telephone consultations, and a control group
received standard care from their providers. Counseling sessions focused
on positive self-appraisal and proactive coping skills, such as seeking
social support from family and friends, resuming activities they enjoy,
and turning negative thoughts about their health into constructive ones.
"The
group intervention sessions were interesting because the patients shared
their experiences in detail," says Dunbar. "The telephone
sessions also were informative, and patients received individual assistance
in a convenient, cost-effective manner.
"Our
goal is to help ICD recipients feel more in control and to shift from
a victim to a survivor mindset," she adds.
Study
results to date show the interventions were effective in increasing the
use of positive coping strategies and patients' perception of the
device as nonthreatening. Those groups receiving the interventions had
fewer days on disability and made fewer calls to their health care providers
at the one-year follow-up mark. Trends in gender differences were also
found. Women experienced greater anxiety and depression and less perceived
social support over the course of the year than men.
Dunbar
hopes that further analysis of the data will help identify those patients
for which the intervention will be most beneficial.
Prescriptive
Authority
Georgia law awaits
implementation
More than a decade ago, Georgia's advanced practice nurses (APRNs)
and their supporters began working for the right to prescribe medications
to patients. Last spring, Gov. Sonny Perdue signed SB480 into law, which
expands the authority of APRNs by allowing them to write prescriptions.
Previously, APRNs could only call in prescriptions to pharmacists.
But the law, scheduled to go into effect
this past July, has yet to move forward. Since the bill was signed, Georgia's
Composite State Board of Medical Examiners has proposed rules and regulations
for implementing the law. And there is concern among the law's supporters
that the board's rules and regulations may be too restrictive, impractical,
and costly, in effect, overstepping the law's intent.
Before the law was passed, Georgia was the
only state that did not grant APRNs—nurse practitioners, nurse-midwives,
nurse anesthetists, and psychiatric/mental health nurses—full prescriptive
authority. Such authority would allow nurses to prescribe medications
to treat common illnesses such as colds; chronic illnesses such as diabetes;
and mental illnesses such as anxiety. All prescriptions would be written
in accordance with protocols established by the nurse and the collaborating
physician.
Emory and the Woodruff Health Sciences Center
were among those working behind the scenes to move the legislation forward.
Emory nursing dean Marla Salmon and Lucy Marion, dean of nursing at the
Medical College of Georgia, met with key legislators to advocate for passage
of the law, as did Linda Womack, director of state affairs for Emory.
Maureen Kelley, chair of the Department of Family and Community Nursing,
testified before a House subcommittee in support of the bill. Wright Caughman,
director of The Emory Clinic, also visited the legislature to express
support for the bill on behalf of the Clinic and Emory physician leaders.
Last but not least, Health Sciences Center CEO Michael Johns, School of
Medicine Dean Thomas Lawley, and Dean Salmon sent a joint letter of support
to every member of the Georgia House and Senate.
Proponents of the law say the idea behind
it is to increase access to health care for underserved populatons. It
will also save time for patients, nurses, and physicians by streamlining
the prescription process, as well as deliver more effective treatment
to patients in rural areas where there are few doctors. Opponents state
that granting full prescriptive authority to APRNs will reduce patient
safety and physician oversight and increase the risk of medical liability.
Yet most APRNs say they are not looking
for completely independent prescriptive authority. "We don't
want to be physicians," says Madge Donnellan, associate professor
in the School of Nursing. "We don't want that scope of practice.
What we want is to be authorized to be able to fully practice within our
scope of practice, which is well delineated in this country for every
specialty in nursing. There are no data to show that it is unsafe when
nurses get prescriptive authority."
The Georgia Nurses Association is pursuing
additional legislation in the legislative session in progress at press
time to counteract the new requirements. |
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