Eastern Nursing Research Society Honors Work by Faculty, Students

August 5, 2014

As the Affordable Care Act (ACA), extends health insurance to millions of previously uninsured Americans, advance practice nurses are poised to help meet the increased demand for treatment. The theme of this year’s annual scientific sessions of the Eastern Nursing Research Society (ENRS) recognized nurses’ expanding role:  “Promoting Health across the Lifespan: The Art and Science of Person-Centered Care.”

More than a dozen posters and presentations from Columbia Nursing faculty and students touched on this broad theme, and several efforts were recognized with research prizes at the gathering in Philadelphia. Following are selected highlights of the presentations:

ENRS honored Assistant Professor Rebecca Schnall, PhD, RN, with the Rising Star Award, which recognizes a junior investigator who has shown promise in establishing a program of health or nursing research. Schnall’s work focuses on the use of mobile technology and electronic health records to improve care for patients with HIV. Promoting sexual health and the prevention of HIV and other sexually transmitted diseases (STDs) are among the key goals outlined by the U.S. Centers for Disease Control and Prevention as part of the broader effort to keep people healthy throughout their lives, even as their circumstances and medical needs change over time.

Schnall also presented a poster at ENRS titled: “An Electronic Alert for HIV Screening in the Emergency Department Increases Screening But not the Diagnosis of HIV.” The work, recently published in Applied Clinical Informatics, examined HIV screening in three adult emergency departments in New York City. An electronic alert that reminded clinicians to screen for HIV before discharge led to a statistically significant increase in the percentage of patients who received HIV tests, to 8.7 percent from 5.5 percent.

Research that concentrated on the needs of aging patients was also honored at ENRS. PhD student Catherine Cohen, RN, BSN, won second place for PhD posters for a paper titled: “State Focus on Health Care-Associated Infection Prevention in Nursing Homes.” Co-authors include PhD students Carolyn Hertzig, MS, and Eileen Carter, RN, BSN; as well as Monika Pogorzelska-Maziarz, PhD, MPH, associate research scientist; Elaine Larson, PhD, RN, FAAN, associate dean for research; and Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy. This work was recently published in the American Journal of Infection Control. The study examined state health department websites to learn how each state encourages improvement of infection control practices in different nursing homes. The researchers found wide variation in state laws, infection reduction plans, and the amount of data available to consumers, providers and state inspectors. In stark contrast to laws for acute care, few states require nursing homes to report health care-associated infections, the authors found.

DNP students Brigitte Gordon, RN; Teegan Ogiela, RN; and Lisa Morrow, RN, won first place for MS posters for a project that focused on young women at the onset of puberty was also honored by ENRS. Arlene Smaldone, PhD, RN, assistant dean for scholarship and research, was also an author on the paper, titled: “Childhood Sexual Abuse and Early Menarche: A Systematic Review and Meta-Analysis.” Early onset of menarche associated with early sexual activity may increase the risk for STDs, depression, eating disorders, poor academic performance, substance abuse, breast cancer and an endocrine disorder known as polycystic ovarian syndrome. This systematic review and meta-analysis examined the association between childhood sexual abuse and early menarche. In the pooled analysis of 39,555 women, 17.5percent experienced childhood sexual abuse. Of these, 21.5 percent reported early menarche compared to 12.2 percent of subjects without childhood sexual abuse histories. Early identification of abuse survivors may create an opportunity for clinical intervention before the adoption of risky behaviors that can lead to health complications, the researchers conclude.

Another paper presented by Arlene Smaldone at the meeting focused on pediatric dental health. She was the lead author on the paper, titled: “Utility of childhood salivary culture in predicting 5 year caries increment in young children.” Currently screening for cavity risk in young kids is conducted by asking the parents a series of questions about their living environment, diet and lifestyle. The researchers examined whether pediatricians could instead use a simple saliva swab to test for bacteria that is present in children at risk for developing cavities. They found that the simple test may offer a faster, inexpensive and more accurate alternative to identify kids at risk for cavities.

Diabetes, a chronic condition that can worsen over time without proper management, was another subject of research presented at ENRS. Doctoral student Yoon Jeong Choi, RN, MSN, MPhil was the lead author on a paper written with Arlene Smaldone titled: “Systematic Review of the Determinants of Medication Adherence among Adult Diabetes Patients.” For many diabetics, consistent use of prescription drugs can help to halt the progression of the disease and alleviate symptoms. The study findings suggest that control of depression, simple and affordable access to prescription refills, and support from health professionals can improve adherence to medication. Sacha Ferguson, MS, FNP, was lead author on a poster completed with Melanie Swan, MS, FNP, and Arlene Smaldone titled: “Diabetes Self-Management in the Latino Population: A Systematic Review and Meta-Analysis.” The research evaluated studies on the effectiveness of different forms of diabetes self-management education to determine which efforts were effective among Latino adults. Studies that relied primarily on telephone or telemedicine outreach were generally less successful at helping diabetics manage their blood sugar levels than studies that included in-person individual or group counseling sessions.

 While infections are an acute condition, they also can strike at any point during the lifespan, making it crucial that clinicians develop prevention strategies appropriate for each stage of life and each clinical setting where care may be provided. A team of researchers led by Assistant Professor Jingjing Shang, PhD, examined infection risks for patients treated at home in a paper titled: “The Prevalence of Infections and Patient Risk Factors in Home Health Care: A Systematic Review.” Co-authors included Assistant Professor Lusine Poghosyan, PhD, MPH, RN; Professor Dawn Dowding, PhD; and Patricia Stone, PhD; RN, FAAN, Centennial Professor of Health Policy. Among home health patients, those individuals receiving intravenous nutrition are at the greatest risk for infection, the study found. To minimize the risk, home health clinicians should educate families about proper infection control measures and also assess the home environment for general cleanliness, utility system, availability of running water and toilet facilities, and presence of pets or pests, the researchers conclude. Shang also presented findings from another paper titled: “Hospitalization among Home Health Care Patients – Results from the Outcome and Assessment Information Set (OASIS).” The study reviewed records for 34,432 adult patients from 5,674 home health agencies nationwide over a 60-day period and found that 17 percent were hospitalized during that time. The most common reasons for hospitalization were respiratory infections and other breathing problems, heart failure, dehydration and malnutrition, and wound infection or deterioration. African-Americans, smokers and patients with pre-existing conditions were more likely to be hospitalized, as were individuals with difficulty taking medication or trouble completing activities of daily living.

 Early childhood eating habits can influence health outcomes later in life. PhD student Angela Northrup, presented a paper titled: “Maternal Attitudes, Subjective Norms and Feeding Practices of Young Children.” She examined food selections mothers offered to their children and compared the choices to the U.S. Department of Agriculture recommendations by child’s age, gender and activity level. On average, mothers offered their children more fruit and meat, but less vegetables, dairy and grain than what is recommended, the study found. Maternal health literacy and beliefs about dietary recommendations for children may help identify children at risk for obesity, the study concludes.

One study presented at the meeting focused on the nursing profession, rather than the patients receiving care. Nicole Faerman Geller, PhD, CMN, and Elaine Larson were co-authors on a poster titled: “Examining Bullying, Harassment, and Horizontal Violence (BHHV) in Student Nurses.” Because there is no instrument available to measure bullying, violence and harassment experienced by student nurses, the researchers developed a survey to measure the type and frequency of these unprofessional behaviors during clinical education. The study found that 72 percent of students reported a current experience with bullying, harassment or violence. Most students perceived these behaviors as “somewhat serious” and approximately half of the students reported the occurrence as “sometimes” or “every few clinical days.”

While research should follow patients at all stages of life, the language used to obtain consent for participation should be written at a fifth-grade reading level, concludes a poster presented at ENRS by PhD student Wanda Montalvo, MSN, RN, ANP. Elaine Larson was a co-author on the paper, titled: “Patient Comprehension of Research for which they Volunteer: A Systematic Review.” A major challenge of informed consent is making written materials easy to understand both in terms of the participant’s reading abilities and level of health literacy. Patients also fail to understand many of the concepts included in patient participation materials, such as randomization, placebo therapy and risks and benefits of trial participation, the study found. Researchers should routinely assess comprehension and health literacy to ensure that people understand the implications of volunteering to participate in studies, the authors conclude.  Researchers should use validated tools like Rapid Estimates of Adult Literacy in Medicine (REALM), Quality of Informed Consent (QuIC), Test of Functional Health Literacy (TOFHL) and Teach Back Method in Adults to routinely assess comprehension and health literacy to ensure that people understand the implications of volunteering to participate in studies, the authors conclude.