When you think of being a nurse, do you envision yourself wearing scrubs and treating patients in a hospital? Perhaps you think of taking patients’ vitals and administering medications, or moving between beds to care for the sick. While nursing often involves this discipline of bedside care, you might not have imagined working in a prison, despite the vital role nurses have in this field.
UConn School of NursingPh.D. student Anne Reeder, BSN, MPH is gaining expertise in this nontraditional area because she says she wants to help reduce inequities in the correctional health care system.
“I worked in a mid-sized jail in Colorado from 2011 to 2015, which was one of the most challenging, yet rewarding, experiences,” Reeder says. “I started asking questions about some of the inequities I saw and realized I wanted to study this topic formally and structurally.”
Reeder has a background in both nursing and public health. She earned her Bachelor of Science in Nursing in 2010 from Michigan State University, and then went on to earn her Master of Public Health in 2014 from the Colorado School of Public Health. Now, she is advancing her studies in both nursing and American Studies through UConn’s School of Nursing and The Graduate School, respectively.
“One of my primary goals is to elevate the voices of people who are incarcerated.”
Reeder’s research focuses on correctional health care, specifically mental health care, health services administration, and quality of care. She says there are often barriers when people who are incarcerated attempt to access health care inside correctional facilities. There is a lack of both physical and human resources, which makes high-quality, community-equivalent health care difficult, she says.
“One of the myriad reasons for the lack of access and quality disparity is the Medicaid Inmate Exclusion Policy, which significantly limits the use of Medicaid dollars for people who are incarcerated,” Reeder says. “Another reason is the stigma and social bias associated with incarceration.”
Reeder’s research aims to expose and decrease inequities in the correctional health care system by centering the material and social needs of people who are incarcerated.
“I am currently working on an integrative review that examines reentry programs for people with mental illness who are leaving U.S. jails,” Reeder says.
She has made two preliminary findings from the integrative review: there is a lack of conclusive evidence regarding the efficacy of existing jail reentry programs for people with mental illness and there is a disconnect between existing reentry models and the implementation research needed to demonstrate model efficacy.
As she continues to study the U.S. correctional health care system, Reeder hopes to implement research-based programs aimed at improving the quality of care for incarcerated individuals within its institutions.
“One of my primary goals is to elevate the voices of people who are incarcerated,” Reeder says, “so that they may more meaningfully direct their health care in correctional facilities.”
A spinal injury that resulted from surgical malpractice changed the course of Sabrina Jamal-Eddine’s life. It first drew her to the nursing field, then drove her desire to make the profession more accessible to disabled students and practitioners.
Jamal-Eddine, RN, is a third-year student in the University of Illinois Chicago (UIC) College of NursingPhD program. She was a sophomore in high school when she underwent posterior spinal fusion surgery to correct a spinal curvature. But the surgery was a failure, and rather than repairing the problem, it created a host of new ones.
“The minute I got out of surgery, it started to hurt to breathe,” Jamal-Eddine recalls. “Every time I inhaled, it felt like someone was cutting me with a knife. That pain didn’t go away.”
Two years later, she had a revision surgery, which successfully corrected the mistakes of the first with the insertion of new, properly-contoured hardware. But two major back surgeries left her with trauma to her spine and a permanent, non-apparent physical disability, entailing lifting limitations, protruding screws, and pain with certain types of movement.
Her experiences with nurses following those two surgeries solidified her desire to be a nurse. She recalls nurses who showed empathy, positivity and caring – as well as those who didn’t. She was determined to be like the former.
“I’ve always been a caretaker and knew that taking care of people and alleviating pain was something that would bring me joy,” she says.
Breaking down barriers for disabled students
But when she entered her undergraduate nursing program as a disabled student, she faced barriers.
Her course syllabus posted a ‘disability statement,’ asking students to come forward if they have a disability. She later learned through research that nearly all nursing programs have “technical standards,” physical requirements to complete the program. Jamal-Eddine knew she would struggle with one of those requirements – lifting a patient in bed – but felt that shouldn’t sideline her entire nursing career.
Nursing is inherently a flexible profession, she says, offering opportunities for nurses with a wide range of abilities and disabilities, including careers in telehealth, administration, informatics and as a nurse practitioner.
“I could do everything that was required in my nursing program besides lifting a patient up in bed,” she says. “That was the only thing I thought I might need help with. I never had any intentions of doing bedside nursing. It was silly that this generic program requirement was posing barriers for future nurses who might never need that skill.”
Despite the deterrent, Jamal-Eddine stayed in the program. She faced resistance from some clinical instructors, who questioned her ability to complete the program, while others showed empathy and support. An instructor on a progressive care unit – which required heavy lifting – was particularly understanding.
Jamal-Eddine recalls the instructor saying: “’Nursing is a team profession. Nurses are always relying on each other. Any time you need to lift a patient up in bed, we have seven other people in this clinical rotation who can help you.’”
Jamal-Eddine is now taking those experiences into her PhD program at UIC to study how she can educate nursing students, instructors and practitioners about ableism – discrimination against disabled people – and disability justice.
For Jamal-Eddine, one of the most powerful ways to do this is through spoken word poetry. She used the format in a 2019 TedX talk about her experiences with Islamophobia and xenophobia.
She sees an important intersection between humanities and nursing and will be exploring this as the first nursing student ever chosen for a prestigious Humanities Without Walls Predoctoral Career Diversity Summer Workshop , hosted by the University of Michigan’s Institute for Humanities.
“Even though I have the inherent experiences as a marginalized person, the humanities provide me with the language I need to articulate these inequities, and they help me advocate to progress beyond those,” she says. “We talk about nursing as art and science, but art isn’t given the space it deserves in nursing curricula. I believe humanities helps us humanize people and often work toward belongingness.”
Karen Giuliano, PhD, MSN, associate professor at the Elaine Marieb College of Nursing and the UMass Institute for Applied Life Sciences (IALS), and Dian Baker, professor emeritus at Sacramento State University, will lead a two-year, interdisciplinary trial in partnership with two Illinois hospitals — the University of Illinois School of Nursing and Hospital and Northwest Community Hospital – and the University of Illinois at Chicago College of Dentistry.
Research has shown that in the first 48 hours after patients are hospitalized, germs can move from the mouth into the lungs, causing pneumonia. Giuliano and Baker have spearheaded NVHAP (non-ventilator hospital-acquired pneumonia) research to investigate risk factors and how to reduce them.
Karen Giuliano, PhD, MSN, MBA.
“Oral health is critical to overall health, and oral hygiene protocols are a key factor in reducing NVHAP,” said Lora Vitek, executive director of Delta Dental of Illinois Foundation. “We work to improve the health and well-being of Illinoisans, and this grant will provide data to help Delta Dental of Illinois Foundation and our hospital partners in the state do just that.”
“We expect that there will be a significant reduction in NVHAP incidence in acute care patients who receive a standardized oral care intervention as compared to acute care patients who do not,” adds Giuliano, co-director of the newly created Elaine Marieb Center for Nursing and Engineering Innovation.
In their ongoing research, Giuliano and Baker have found that NVHAP represents 60% of hospital-acquired cases, affecting approximately one in 100 hospitalized patients and carries an associated crude mortality rate of 13-30%. NVHAP also is associated with increased antibiotic usage, high ICU utilization rates, high readmission rates of 20% for survivors and is the most common pathway to sepsis, an often-fatal infection.
While quality improvement initiatives at hospitals over the past decade have focused successfully on reducing cases of ventilator-associated pneumonia (VAP), there are no regulations requiring hospitals to address NVHAP. As a result, patients, especially those who are non-ventilated and critically ill, remain at significant risk.
“Understanding mechanisms that reduce the incidence of NVHAP remains of paramount importance,” Giuliano says. “In the face of COVID, this issue has assumed an even higher level of importance.”
DailyNurse is inviting nurses in every branch of the profession to share their pandemic experiences and reflections with their peers. Was there a particular experience that you will carry with you for life? Have you been inspired by specific colleagues or a group of nurses? Has Covid significantly changed the way you work, teach, or learn? Did it affect your goals, your role, life? Are you rethinking your ideas about what it means to be a nurse, or has Covid reinforced them? To share your story, submit a 400-800 word post to [email protected].
It is well known that the COVID-19 pandemic has significantly impacted the profession of nursing. Thankfully, there are still nurses who want to be nurses, but many are leaving the profession due to the stress of the pandemic. What’s concerning to me as a nurse scientist is the decrease in nurses who are learning more about, and engaging in, research and evidence-based practice.
When taking care of patients became the one and only priority,I definitely began to question the importance of my role and wondered how, as a nurse scientist, I would be able to contribute during the pandemic.
Understandably, nurse participation in research and evidence-based practice projects declined with the COVID-19 pandemic. As a nurse scientist, it is my goal to assist nurses in conducting research and implementing best evidence to improve practice and patient outcomes. Nurse scientists provide education and opportunities to foster a spirit of clinical inquiry in nurses. But as of early 2020, the level of interest and engagement among nurses in research and evidence-based practice declined significantly. Especially when taking care of patients became the one and only priority, I definitely began to question the importance of my role and wondered how, as a nurse scientist, I would be able to contribute during the pandemic.
Contributing as a nurse scientist in the wake of Covid-19
None of these amazing contributions to the profession of nursing would have been possible without the leadership and colleague support I received in my department. Our work truly made a difference. We proactively identified best practices for working in nursing during a pandemic, rapidly implemented evidence-based education to assist nurses who were caring for COVID-19 patients, contributed to nursing science, and stayed on-call to join in caring for patients if needed. I do miss my team, though. While working remotely is not new to me, the amount of being at home versus being in the office these past two years has been eye-opening. But that’s a different conversation! Especially since this isn’t an option for many nurses.
I am so grateful for the nurses who have been working the front lines during this pandemic. I know you are burnt out. I know you want to leave. Hang in there because this will pass! We need the knowledge and experience you gained from this.
When patients present with a specific type of heart attack (non-ST elevation acute coronary syndrome) or chest pain related to coronary heart disease (unstable angina), they often undergo several tests—many being invasive—and then they may be sent to other facilities for even more procedures.
It’s time-consuming, it can be confusing to the patient, it can be stressful on the patient’s body, and when combined, can lead them to abandon care.
Sarah Slone, DNP, MSN, FNP-BC, CCRN began to address this problem from an implementation science standpoint in her Doctor of Nursing Practice (DNP) project. She aimed to streamline the process of existing care options from acute symptom presentation in the hospital to discharge.
But ultimately that raised a new question:
Can we determine best practices for when patients need catheterization (an invasive procedure) so that we can establish a standardized approach and identify barriers to care that may exist?
“Any invasive procedure carries risk,” Sarah says. “There are non-invasive options like stress tests, information that can be gleaned from a patient’s presentation and previous lab work, and newer options with CT scanners.”
Now she’s pursuing the question from a discovery science standpoint. Her Ph.D. research examines “care pathways” from acute symptom presentation to various methods of invasive and non-invasive testing, to establish best practices for when patients are most in need of these procedures.
From Implementation to Discovery
Sarah Slone graduated from the DNP Executive Track in May 2019, then started the Ph.D. in August 2020. She is in a new Johns Hopkins School of Nursing program that offers an alternative pathway to Ph.D. for nurses who have earned a DNP. Students can transfer credits and earn their Ph.D. in about three years compared to about five years.
The DNP Executive Track is online with on-site immersions, but Ph.D. students must live in Baltimore. So Sarah moved from South Carolina to Baltimore, alone, at the height of the COVID-19 pandemic.
She considered delaying her start but didn’t want to let the time go to waste. And even before the move, the family living situation was complicated.
“My husband is an interventional cardiologist who works in a hospital. At the beginning of the pandemic, we had to decide if we wanted to live together since he would be at risk of being exposed. Our son is in college, but he returned home because of COVID. He decided that he wanted to remain in the house as well,” Slone says.
Now in her second semester, Sarah reflects that the Ph.D. is not harder, but different than the DNP.
“The DNP enriched my perspective as a nurse scientist, but I learned that questions arise from evidence-based practice, and I needed a Ph.D. to explore that further.”
—SARAH SLONE, DNP, MSN, FNP-BC, CCRN
“I’ve already grown a lot in terms of research,” she continues. “I came in with a specific idea of what I wanted to do and was able to develop my research project with my mentors into something not just fundable, but something that can grow into a wider program of research.” Sarah’s DNP mentor was Dr. Deborah Baker, Senior Vice President for Nursing of Johns Hopkins Health System and her Ph.D. mentors are Dr. Cheryl Dennison Himmelfarb and Dr. Kelly Gleason.
Sarah recommends that, if you are considering a Ph.D. and have a DNP, define your research questions early. “The sooner you can do it, the better you can align assignments, so they build and benefit you throughout the program.”
A Passion for Research
Sarah always had a passion for research—from working as a research assistant in a plant pathology lab in high school to initially studying biochemistry in college. She took some time off from undergrad to have a family and later decided to pursue a BSN. Upon graduation, she worked as an ICU nurse for five years, then became a family nurse practitioner, followed by work in general and trauma surgery. She discovered a passion for cardiovascular care when the 36-hour shifts in trauma surgery became too much (especially with a young family!) and the cardiovascular service was hiring.
“It’s fascinating,” Sarah says. “Cardiovascular disease remains the number one cause of morbidity and mortality in the United States. There’s so much opportunity to improve the lives of patients.”
Pressure ulcers—commonly known as bedsores—have been a healthcare challenge for millennia, and researchers continue to seek ways to prevent and treat them. One “rising star” in the study of pressure ulcers is DonnaLee Pollack, RN, MSN, MPH, FNP-C, CWCN-AP, who works as a Family Nurse Practitioner in the Wound Clinic at Olin E. Teague Veterans’ Medical Center in Temple, Texas. Pollack is also working on her PhD at the University of Texas at Arlington College of Health and Nursing Innovation and is a 2018-2020 Jonas-Smith Trust Veterans Healthcare Scholar.
In this interview with DailyNurse, Pollack explains . . . Click here to read the rest of this article.
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