Faculty Research at the School of Nursing

Acupuncture and Moxabustion for Chronic Diarrhea In HIV Patients
Funded by National Center For Complementary and Alternative Medicine
Dr. Anastasi, a licensed acupuncturist, is testing alternative treatment strategies through a randomized clinical trial to reduce the frequency of chronic diarrhea among HIV positive individuals. Sixty percent of patients with HIV disease in the U.S. will have diarrhea at some point in their illness. Although in general many of the opportunistic infections associated with HIV have decreased due to new "drug cocktails," many of these drugs however, have diarrhea as a side effect. In Asian countries, acupuncture (including moxibustion) has been widely used for the treatment of various gastrointestinal disorders. However, there are no published studies that test treatment protocols using acupuncture or moxibustion on patients with HIV experiencing chronic diarrhea. The subjects in the experiment will be 144 men and women with HIV infection who report experiencing 3 or more episodes of diarrhea (non-pathogen related) per 24 hour period for 3 weeks or more.

Center for Evidence-Based Practice in the Underserved
Funded by the National Institute of Nursing Research
Dr. Bakken directs the Center, which has the following aims to:
1. Establish an Administrative Core structure that utilizes information technology and informatics processes to support collaborative, interdisciplinary research related to evidence-based practice in underserved populations
2. Facilitate the building of evidence for practice in underserved populations through the funding of pilot studies, mentoring of investigators, and other Pilot Core activities
3. Develop and implement informatics-based approaches that enable data aggregation, secondary data use, and building of evidence across CEBP studies; these include translation of research protocols into standardized terminologies, creation of electronic data dictionaries and scoring algorithms for standardized research instruments, and development of a common data repository
4. Develop the expertise of CEBP investigators in informatics-based approaches for targeting and tailoring interventions for underserved populations.

Reducing Health Disparities Through Informatics
Funded by the National Institute of Nursing Research
In this project, Dr. Bakken has implemented a research training program that uses information technology and informatics processes for reducing health disparities in the underserved. The overarching premise of the Reducing Health Disparities Through Informatics (RHeaDI) research training program is that information technology and informatics processes are essential components of an infrastructure to reduce health disparities and to facilitate evidence-based practice in the underserved. Through RHeaDI, nurses are being trained in informatics at pre-doctoral (4-5 years) and post-doctoral (2-3 years) levels. Common across both programs is a series of courses on vulnerable populations, theory, and research methods from the School of Nursing doctoral curriculum and informatics courses taught by faculty from the School of Nursing and Department of Medical Informatics. Post-doctoral nurse trainees receive research training tailored to individual interests within the context of the program aims. Currently, 1 post-doctoral fellow and 2 pre-doctoral fellows are supported through this training program.

Maternal and Child Outcomes of a Prison Nursery Program
Funded by the National Institute of Nursing Research
In this project, Dr. Mary Byrne is identifying and exploring the changes in maternal-infant attachment and infant/toddler development as they occur during incarceration on a prison nursery and during the year following release of the infant with and without the mother. The overall goal is to enrich the knowledge base from which prison- and community-based parenting programs can be developed and tested, as well as to improve the lives of incarcerated women and their children during co-detention and following release. The specific aims of this study are (1) to compare the impact of an intervention designed to enhance mother-infant synchrony versus a basic child care intervention on parent-child interaction, parenting competency, and child development; (2) to measure the type of attachment achieved by infants in the prison nursery and maintained during the transition to the community in relation to the inmate mother’s own attachment and to participation in either intervention; and (3) to identify the impact of raising an infant on the prison nursery on subsequent short-term criminal recidivism of the mother. This study proposes to measure bi-directional maternal and infant attachment, parent-child interaction, parenting competency, and child development.

Tailored Web-based Family Education Resources
Pilot project through the Center for Evidence-based Practice in the Underserved
Funded by the National Institute of Nursing Research
In this project, Dr. Choi is developing and evaluating a tailored web-based family education resource that facilitates family-centered decision making in the Neonatal Intensive Care Unit (NICU). The resource is designed to be used by a family member in conjunction with NICU staff responsible for education and decision making support. The specific aims are to (1) design and implement English and Spanish versions of web-based educational materials targeted for families with neonates with Patent Ductus Arteriosus and tailored to parents' coping strategies and health literacy level; and (2) explore the effects of the web-based family education resource on knowledge, decisional conflict. Resources such as this have the potential to improve parental knowledge and participation in decision making and to reduce health disparities through informed, shared decision making.

Partnership to Strengthen Refugee Studies at Bir Zeit University
Funded by the Andrew W. Mellon Foundation
This project establishes a three-way partnership between Columbia University, the London School of Hygeine and Tropical Medicine, and Bir Zeit (BZ) University in Ramallah, Palestinian Territories. The partnership focuses on issues relating to Palestinian refugees, through the development of programs, institutional development at BZ’s department of community medicine, and the development of public health and policy research.

Bioterrorism Training Continuing Education
Funded by Health Resources and Sciences Administration
This project's goal is to develop an expanded program of continuing education in emergency preparedness for key health professionals. In this training grant, funded by the Health Resources and Services Administration, Dr. Gebbie and the Center for Health Policy are working to develop an expanded program of continuing education in emergency preparedness for key health professionals.

Evaluation of Local Public Health Emergency Exercises
Funded by the Centers for Disease Control
This project falls under the rubric of Public Health Ready II. In this project Dr. Gebbie aims to (1) provide a clear description of the level of exercises and drills appropriate to levels of preparedness, purpose of the drill, and the size of agency and community served; (2) provide a standardized method for recording a drill or exercise experience that can be used for evaluation and documentation of public health readiness; and (3) provide a standardized set of criteria for use by local public health agencies or others to evaluate an agency's response during a drill, exercise, or actual emergency event.

Public Health Preparedness and Response for Bioterrorism – NYC
Funded by the Medical and Health Research Association
In this project, Dr. Gebbie is conducting a careful review of Articles 1 through 11 of the New York City Health Code in order to identify ways in which it could be strengthened to assure that it fully supports and protects the health of the City, especially in areas of emergency response and surveillance.

Advanced Education Training Traineeships
Funded by Health Resources and Sciences Administration
This training grant provides the Columbia University School of Nursing with support for its 5 programs of graduate study, including (1) a combined BS/MS program for nurse graduates of associate degree programs; (2) a combined BS/MS program for non-nurses with baccalaureate in other disciplines; (3) a MS for nurses with a baccalaureate; (4) a statutory/post masters University certificate for masters prepared nurses who wish for another area of clinical specialization; and (5) the doctorate in nursing science.

Interdisciplinary Research on Antimicrobial Resistance
Funded by the National Center for Research Resources
Dr. Larson's Center for Interdisciplinary Research on Antimicrobial Resistance (CIRAR) is one of 21 exploratory centers funded as part of the NIH Roadmap for Medical Research. This trans-NIH initiative, managed by the National Center for Research Resources (NCRR), seeks to lower artificial barriers that divide biomedical researchers and impede scientific progress.

While much progress has been made to control preventable infectious diseases, infections remain a major cause of morbidity and mortality.  Many of the traditional treatments for common infections are no longer effective because of the fast-growing problem of antimicrobial resistance, first associated with hospitals, but increasingly widespread in the community.  Antibiotic resistance is now a global problem of major concern.  The ultimate goal of the CIRAR is to develop strategies to implement and evaluate a long term collaborative program of interdisciplinary research on reducing antimicrobial resistance.

The specific aims of the CIRAR are to:

1. Plan, implement, and evaluate outcomes of a core program and curriculum to prepare biomedical researchers to conduct interdisciplinary research;
2. Develop the expertise of CIRAR investigators in interdisciplinary research;
3. Conduct interdisciplinary demonstration projects related to the prevention and control of antimicrobial resistance and evaluate their outcomes;
4. Implement dissemination and implementation strategies that assure the sustainability and expansion of CIRAR's interdisciplinary research projects and programs; and
5. Formalize plans for a sustainable Interdisciplinary Research Consortium for Antimicrobial Resistance.

Impact of Hand Hygiene Guideline on Infections and Cost
Funded by the National Institute of Nursing Research
Healthcare-associated infections (HAl) are one of the most serious complications of health care, yet at least one-third of such infections are preventable. The hands of healthcare personnel frequently serve as vectors for the transmission of organisms between patients and are also a major reservoir for pathogens with antimicrobial resistance. Based on recent research regarding hand hygiene, the CDC released a new evidence-based "Hand Hygiene Guideline for Healthcare Settings" in 10/02, which will vastly change current hand hygiene practices. This presents a unique, one-time opportunity to assess the impact this Guideline on nosocomial infection rates, and to strengthen our evidence-based practice regarding prevention and control of infections. The aims of this study are to: (a) assess diffusion and implementation of the new Guideline on hand hygiene practices in acute care; (b) identify barriers to adoption and implementation of the Hand Hygiene Guideline among patient care personnel; (c) compare HAl rates before and after implementation of the Guideline recommendations; and (d) examine the net medical costs and incremental cost-effectiveness of implementation of the Guideline from the hospital perspective.

Antibiotic Beliefs and Practices in Hispanics
Pilot project through the Center for Evidence-based Practice in the Underserved
Funded by the National Institute of Nursing Research
There is overwhelming evidence of a link between antibiotic use and increasing antimicrobial resistance in the community; nevertheless, inappropriate use of antimicrobials continues to be a global and local problem. In this pilot project, Dr. Larson aims to describe the knowledge, attitudes, beliefs, and practices of Hispanic community members in upper Manhattan with regard to use of antibiotics and to explore the acceptability and feasibility of using web-based interactive health communication to develop an intervention to improve appropriate use of antibiotics. Results will be used to develop a culturally-sensitive intervention using relevant health communications technology to improve the use of antibiotics in newly immigrated Hispanics.

Nurse Anesthetist Traineeship Grant
Funded by Health Resources and Sciences Administration
The purpose of the Columbia University School of Nursing training program in Nurse Anesthesia is to prepare qualified nurses to function as advanced practice nurses in nurse anesthesia. This program provides a solid academic and clinical foundation, enabling graduates to provide a clinical environment that ensures the highest quality anesthesia care for the patient. It is designed to provide the student with continuous opportunities to relate theoretical knowledge with clinical practice by assuming increasing responsibilities for total anesthesia patient care with educational guidance. Students receive intensive educational guidance from both experiences nurse anesthetists and anesthesiologists whose experiences encompass a wide range of anesthetic techniques and procedures including general and regional anesthesia.

Development of the Doctor of Nursing Practice
Funded by the Teagle Foundation
The purpose of this project is to develop the underpinnings of a new terminal degree, the Doctor of Nursing Practice. The project has four distinct pieces: 1) a literature review to assess differentiated practice between nurse practitioners and physicians; 2) a national survey of nurse practitioners credentialed through the ANCC, to assess learning needs and current scope of practice; 3) a survey of health insurance executives to assess barriers to nurse practitioner credentialing, and 4) a content review of syllabi from schools of nursing, to assess if the differentiated practice piece is apparent at the undergraduate level.

Cancer Screening Education for Health Care Students
Pilot project through the Herbert Irving Comprehensive Cancer Institute at Columbia University
Funded by the National Cancer Institute
The aim of this pilot project is to develop an educational module to promote cancer screening among older Afro-Caribbean adults for use with entry-level health care students. It directly addresses the immediate priorities of cancer education and preparation and training of minority investigators. This project will enhance ethnic-specific cancer screening education in the short-term through training health care students as well as producing a culturally-sensitive cancer screening product that can be disseminated to a wider entry-level health care student audience.

The RN Flex Study
Funded by the 1199/League Planning and Placement Fund, Inc.
In this study, Dr. Stone is assessing the relationships between shift patterns (8 hour compared 12 hour shifts) on nursing outcomes, system outcomes and patient outcomes. The specific aims are (1) examine the effect of different scheduling patterns on nursing outcomes: job satisfaction, intention to leave, burnout, absenteeism, and preferences for scheduling; (2) examine the effect of different scheduling patterns on system outcomes: staff turnover, retention, absenteeism, and cost; and (3) examine the effect of different scheduling patterns on patient outcomes: patient safety clinical indicators, length of stay, and patient satisfaction with nursing care.

Economic Evidence of Infections in Vulnerable Populations
Pilot project through the Center for Evidence-based Practice in the Underserved
Funded by the National Institute of Nursing Research
nfectious diseases remain major causes of illness, disability, and death; and racial and ethnic health disparities continue to exist within infectious diseases. Providing rigorous economic evidence on effective strategies aimed at reducing infectious disease in vulnerable populations is one strategy that may assist in the translation of effective and efficient practices into clinical practice and reduce health disparities. In this pilot project, Dr. Stone aims to (1) assess the quality of the economic evidence base of published cost-utility analysis (CUA) aimed at reducing infectious disease and identify gaps in the literature; (2) develop and pilot test and audit form to assess the inclusion of vulnerable populations in the economic CUA evidence; and (3) determine if interventions aimed at reducing infectious diseases in vulnerable populations are more cost-effective than similar interventions targeted to the general public. The results from this study will inform future systematic audits of economic literature and inform the development of an economic model designed to assess the cost-effectiveness of various nursing interventions aimed at decreasing healthcare acquired infectious diseases.

Outcomes of ICU Working Conditions
Funded by the Agency for Health Care Research and Quality
Recent efforts to reduce costs and streamline the delivery of healthcare have led to significant changes in the acute care workplace. In addition, the increased use of technology and an aging population are likely to lead to an increased volume of intensive care unit (ICU) patients in the future. Dr. Patricia Stone is investigating the effect of varied working conditions (workforce staffing and organizational climate) in ICUs on elderly patient safety outcomes (nosocomial infections, length of stay, mortality, and disposition at discharge), and healthcare worker safety (musculoskeletal injuries, blood/body fluid exposure, sick days, and disability days). Through her analysis of Medicare data, data from the National Nosocomial Infection Surveillance, and hospital survey data, she will be able to assess the impact of the changes in ICU working conditions on patient safety outcomes, and healthcare worker safety. Because ICU care and the nursing workforce are expected to continue to experience rapid change, this information is of major importance to those who manage or oversee health care organizations and set policies affecting the working conditions.