CNR Newsletter-July 2019

Center for Nursing Research Center for

Center for Nursing Research

NEWSLETTER Nursing Research

Spotlight Center for Nursing Research

Center for Nursing Research Barbara Birriel

Center for Nursing Research Barbara Birriel, PhD, ACNP-BC, FCCM joined the College of Nursing in 2011 to develop the Adult-Gerontology Acute Care Nurse Practitioner Option in the nurse practitioner program. She completed her PhD in Nursing and Bioethics at Penn State in 2017.

Her dissertation work examined family surrogate decision-making during critical illness. Her research interests lie at the intersection of critical care and bioethics, including decision-making and cognitive impairment and recovery following critical illness.

Birriel has recently co-authored papers on family caregiver outcomes regarding left ventricular assist device implantation and on end-of-life care following cardiothoracic surgery. She has been invited to speak on evaluation of cognitive impairment in patients Center for with heart failure by both the Heart Failure Society of America and the Nursing Research American Heart Association in 2019. She is a frequent speaker on multiple critical care topics for the Society of Critical Care Medicine (SCCM). Birriel has been awarded SCCM’s Joseph and Rae Brown Award for advancing regional critical care and the Distinguished Service and Leadership award for work on the leadership Council.

Birriel is a participant of a on a Penn State Strategic Initiative led by Dickinson Law - The Pennsylvania Adult-Fiduciary Project: Developing Statewide Online Education in Support of Aging and Vulnerable Adults.

Her contribution is in development of content related to family member surrogate decision-making. She is working with the Hershey Medical Center’s Nursing Research and Evidence-Based Practice Council, advising clinical nurses on current projects. Birriel is also currently working with Mary Lou Kanaskie on a study using implementation science to evaluate Hershey Medical Center’s program for distress screening in oncology patients. She has just begun to explore potential research opportunities on critical care recovery with Select Medical. Birriel is eager to continue to extend the College of Nursing’s research scope through involvement relevant professional and clinical organizations.

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July 2019

OT! W H AT’ S H Center for Nursing Research

Lisa Kitko Center for Nursing Research Lisa Kitko is very busy on the national front. She is the chair of the ENRS awards committee, current chair of two committees at the American Heart Association: The Complex Care Committee and the Membership and Communications Committee. She will also be chairing the Behavioral and Clinical Science Scientific Review Council. Also, she is an invited preconference speaker at the Society of Critical Care Medicine. Lisa will also be a visiting scholar at both Indiana University College of Nursing and University of Nebraska College of Nursing.

On top of all this Lisa is also the recipient of several new awards, please read further for more information.

Eastern Nursing Research Society

Kiernan Riley won the Early PhD School Selected Poster Award.

The title of her poster is, ”Impact of an Educational Intervention on Organ Donation Attitudes in College Aged Students”.

Liza Behrens is the 2019 recipient of the 2019 ENRS/Council for the Advancement of Nursing Science Dissertation Award by the ENRS Awards Committee. The title of her study was: Nursing Staff Perceptions of Risk When Honoring Nursing Home Residents’ Preferences.

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2019 CONFERENCE

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ENRS The 31st Annual Scientific Session was held in Providence, RI from April 3-5, 2019. Penn State College of Nursing students were in attendance and there were a few notable stars including Elizabeth Thiede who won a travel award as well as 2nd place for her peer-reviewed doctoral student podium presentation. The title of her study was: Using the Area Deprivation Index to Understand the Palliative Care Needs of Individuals with Advanced Heart Failure and Their Caregivers.

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Announcement of CTSI award to Winnie Adebayo & Cara Exten (Rice) Title of the Award: Barriers to Transgender Healthcare in Rural Communities A new award to Oluwamuyiwa “Winnie” Adebayo and Cara Exten (Rice) – College of Nursing from Penn State’s Clinical and Translational Science Institute for their work in health disparities in Rural PA among transgender adults.

Transgender adults living in the U.S. have specific needs, unique risks, and increased vulnerability for multiple negative health outcomes.

A major driver of the health disparities burdening the transgender Winnie Adebayo Cara Exten (Rice) population is poor access to and engagement in healthcare.

This award will address the gap and explore the barriers to healthcare among rural transgender adults in rural Pennsylvania. The proposed project will result in novel pilot data regarding the health needs of rural transgender adults, which, in turn, will inform a National Institutes of Health grant proposal in direct response to NIH’s current call for “Research on the Health of Transgender and Gender Nonconforming Populations.”

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New Awards Elizabeth Thiede, Lisa Kitko and Joel Segel have a new award from the Center for Rural Pennsylvania titled, Availability of Hospice and Palliative Care in Rural Pennsylvania. This award will use a mixed-methods approach to analyze hospice availability and utilization in rural Pennsylvania.

Elizabeth Thiede

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Lisa Kitko and Linda Wray, will be receiving an award from NIH R25 HL147668-01. The project will begin on September 1, 2019. The overall goal of the Improving Access through Research and Education (IMPACT) program is to increase the number of future PhD level scientists from underrepresented backgrounds through participation in an annual 8-week summer mentored training experience that provides critical exposure to the research process and tools necessary to complete a competitive pre-doctoral application and successful admission to graduate school. Long-term, this program aims to increase the diversity of the research workforce that addresses cardiovascular, pulmonary, hematologic, or sleep disordered conditions in particular, and, in turn, reduce health disparities in these areas through education and research skills development.

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Advancing Research on Care Needs and Supportive Approaches for Persons With Dementia: Recommendations and Rationale

J Am Med Dir Assoc. December 2018, Volume 19, Issue 12, Pages 1047–1053

Kolanowski A, Fortinsky RH, Calkins M, Devanand DP, Gould E, Heller T, Hodgson NA, Kales HC, Kaye J, Lyketsos C, Resnick B, Schicker M, Zimmerman S

ABSTRACT The first National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers was held on October 16-17, 2017, at the National Institutes of Health. In this paper, participants from the Summit Session on Research on Care Needs and Supportive Approaches for Persons with Dementia summarize the state of the science, identify gaps in knowledge, and offer recommendations to improve science and practice in long-term care. Recommendations cover 4 areas focused on persons living with dementia: (1) symptoms (behavioral and psychological symptoms of dementia, function, cognition, and sleep); (2) dementia care settings (physical and social environments, home, and residential care); (3) living with dementia (living well with dementia, living alone with dementia, and living with dementia and intellectual and developmental disabilities); and (4) technology as a cross-cutting theme. The participants identify 10 of the most pressing research issues based on the findings from their collective papers. Final Summit recommendations included those presented by session participants and will be used to advise federal agencies and other organizations that fund research.

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Mapping Core Concepts of Person-Centered Care in Long-Term Services and Supports J Gerontol Nurs. 2019 Feb 1;45(2):7-13. doi: 10.3928/00989134-20190111-02.

Behrens LL, McGhan G, Abbott KM, Fick DM, Kolanowski AM, Liu Y, Buck HG, Roes M, Heid AR, Spector A, Van Haitsma K

ABSTRACT Person-centered care (PCC) has a wide range of definitions, most based on expert opinion rather than empirical analysis. The current study used an empirical concept mapping approach to identify core components of PCC used in long-term services and supports (LTSS). The aim is to help providers and researchers develop a unified set of domains that can be used to assess and improve the quality of PCC in real-world settings. Results yielded six domains describing essential elements of PCC in LTSS: Enacting Humanistic Values, Direct Care Worker Values, Engagement Facilitators, Living Environment, Communication, and Supportive Systems; and two underlying dimensions: Intrapersonal Activities and Extrapersonal Services and Social and Physical Environment. Nurses can use the results to enhance clinical knowledge and skills around delivery of PCC. Researchers can use the results to build a comprehensive and unified measure to accelerate adoption of PCC practices shown to benefit older adults, families, and the LTSS workforce.

[Journal of Gerontological Nursing, 45(2), 6-13.]. Copyright 2019, SLACK Incorporated.

Support for Young Black Urban Women After Perinatal Loss MCN, The American Journal of Maternal/Child Nursing. 44(1):13–19, JAN 2019

Fenstermacher KH, Hupcey JE

ABSTRACT PURPOSE: To describe the bereavement support needs of black urban women in late adolescence after perinatal loss.

STUDY DESIGN AND METHODS: Eight black women aged 18 to 21 years who had experienced recent perinatal loss were interviewed in person or by telephone at three points in the 12 weeks that followed their loss to describe their perinatal bereavement experience and support needs. Data from the interviews were analyzed using constant comparative analysis.

RESULTS: Black adolescent women need culturally appropriate bereavement support targeted at key transition points along the bereavement trajectory. They need accurate information, compassionate and respectful communication, and support from their mothers, grandmothers, and other women from their community of faith who have experienced perinatal loss. They value mementos, such as photographs and footprints.

CLINICAL IMPLICATIONS: Nurses are well-positioned to be consistent caregivers and to provide clear, compassionate communication and anticipatory guidance to young black women experiencing perinatal loss. Attending to spiritual needs, harnessing family support, providing mementos, and encouraging reflection through journaling may help adolescent women find meaning and new perspectives on their bereavement experience.

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It Is Not Your Parents’ Long-Term Services System: Nursing Homes in a Changing World J Appl Gerontol. 2018 Dec 21:733464818818050. doi: 10.1177/0733464818818050

Applebaum R, Mehdizadeh S, Berish D

ABSTRACT The long-term services system has changed substantially since the mid-1970s, when the landmark book Last Home for the Aged argued that the move to the nursing home was the last move an older person would make until death. Using detailed nursing home utilization data from the Minimum Data Set, this study tracks three cohorts of first-time nursing home admissions in Ohio from 1994 through 2014. Each cohort was followed for a 3-year period. Study results report dramatic reductions in nursing home length of stay between the 1994 and 2011 cohorts. Reduction in length of stay has important implications for nursing home practice and quality monitoring. The article argues that administrative and regulatory practices have not kept pace with the dramatic changes in how nursing homes are now being used in the long-term services system.

A Machine Learning Recommender System to Tailor Preference Assessments to Enhance Person-Centered Care Among Nursing Home Residents Gerontologist. 2019 Jan 9;59(1):167-176. doi: 10.1093/geront/gny056.

Gannod GC, Abbott KM, Van Haitsma K, Martindale N, Heppner A

ABSTRACT BACKGROUND AND OBJECTIVES: Nursing homes (NHs) using the Preferences for Everyday Living Inventory (PELI-NH) to assess important preferences and provide person-centered care find the number of items (72) to be a barrier to using the assessment.

RESEARCH DESIGN AND METHODS: Using a sample of n = 255 NH resident responses to the PELI-NH, we used the 16 preference items from the MDS 3.0 Section F to develop a machine learning recommender system to identify additional PELI-NH items that may be important to specific residents. Much like the Netflix recommender system, our system is based on the concept of collaborative filtering whereby insights and predictions (e.g., filters) are created using the interests and preferences of many users. The algorithm identifies multiple sets of “you might also like” patterns called association rules, based upon responses to the 16 MDS preferences that recommends an additional set of preferences with a high likelihood of being important to a specific resident.

RESULTS: In the evaluation of the combined apriori and logistic regression approach, we obtained a high recall performance (i.e., the ratio of correctly predicted preferences compared with all predicted preferences and nonpreferences) and high precision (i.e., the ratio of correctly predicted rules with respect to the rules predicted to be true) of 80.2% and 79.2%, respectively.

DISCUSSION AND IMPLICATIONS: The recommender system successfully provides guidance on how to best tailor the preference items asked of residents and can support preference capture in busy clinical environments, contributing to the feasibility of delivering person-centered care.

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The New Biobehavioral Developmental Science of Puberty Journal of Research on Adolescence 2019 March Volume 29, Issue 1 Special Section: Perspectives on The Developmental Science of Puberty

Dorn, Lorah D. and Susman, Elizabeth J.

ABSTRACT This special section is the product of a small-group meeting of those who study puberty and its relevance.

Our aim was to gather information and write manuscripts to inform scientists of advances and continuing obstacles, as well as to stimulate interdisciplinary research on puberty relevant across the lifespan. The themes of the nine position or review papers (and commentary), range from cell to society. We hope this introduction will entice you to read all the papers and consider how they apply or expand your next steps in research or help you synthesize the literature on puberty. We anticipate the papers can embellish your adolescent courses, and, for junior scientists, we hope the many intriguing possibilities for future research on puberty will be apparent.

Heart Failure Care Dyadic Typology: Initial Conceptualization, Advances in Thinking, and Future Directions of a Clinically Relevant Classification System Journal of Cardiovascular Nursing: March/April 2019 - Volume 34 - Issue 2 - p 159–165

Buck HG, Hupcey J, Juárez-Vela R, Vellone E, Riegel B

ABSTRACT BACKGROUND: Heart failure (HF) dyadic self-care science is advancing rapidly, as evidenced by recent theoretical work, literature reviews, and multiple empiric studies. Typologies, once considered archaic, are now viewed as person-oriented classification systems that allow a whole-system view of information patterns. This wholesystem view is particularly needed to understand complex tasks like dyadic HF self-care.

PURPOSE: The purpose of this article is to review the initial conceptualization of an HF care dyadic typology and the present advances in our thinking and suggest future directions for this clinically relevant classification system.

CONCLUSIONS: Development and testing of the typology across 5 studies resulted in a well-characterized, pragmatic and parsimonious, person-oriented classification system for understanding how patients and informal caregivers conduct patients’ HF self-care at home. The 4 types are characterized as 2 individually oriented types—type I, patient oriented; type II, caregiver oriented; and 2 relationally oriented types—type III, collaboratively oriented; and type IV, incongruently oriented. We have devised a single-item measure of typology group that can be assessed in the clinical setting. Once this information is ascertained, the clinician can personalize the plan of care to the realities of the dyad.

IMPLICATIONS: Dyads that disagree on who is responsible for self-care may forego or delay action, resulting in self-care failures with subsequent HF advancement, hospitalization, and mortality. As the HF dyadic self-care science has advanced, we have come to appreciate the complexity that arises when 2 individuals work together on 1 complex task—HF self-care.

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Translating RESEARCH to INNOVATION in Practice 3rd annual Nursing Research and Evidence-Based Practice Symposium More than 100 attended the 3rd Annual Nursing Research and Evidence Based Practice Symposium “Translating Research to Innovations in Practice” on May 10, 2019 at the Nittany Lion Inn, State College, PA.

Hershey Medical Center provided the welcoming remarks.

Judy commented on research initiatives and other scholarly projects being done through the collaborative relationship between the College of Nursing and the Department of Nursing of the Hershey Medical Center.

The annual symposium brings together nurse researchers from both academic and clinical settings to focus on the translation of evidence to health care practices. The intended purpose is to include research and quality improvement activities that provides an understanding of what makes an organization successful in use of evidencebased practice and to provide an opportunity for clinical nurses to network with and share their research with others.

The day is a collaborative effort between the College of Nursing and Penn State Health Hershey Medical Center’s Department of Nursing. Dr. Judith Hupcey, College of Nursing’s Associate Dean for Graduate Education & Research and Dr. Mary Lou Kanaskie, HMC’s Director of the Office of Nursing Research and Innovation, are coordinators of the annual event.

Other invited speakers included faculty and other practicing professionals from the surrounding community who presented their expert ideas in a variety of clinical and professional practice areas. Participants enjoyed the fast pace of the conference. Podium presentations are 15 minutes in length and cover a variety of topics in a short period of time. Breakout sessions provided opportunity for hearing topics from various practice specialties and areas of interest including children’s healthcare. Poster presentations afford the opportunity to connect with others who have similar research interests.

The poster winners were: 1st prize: Matthew Golemboski, Mount Nittany Health, “Changes in Practice Fueled by Staff”

Dr. Hupcey noted that the symposium brings together nurse scientists from both academic and clinical settings to focus on the translation of evidence to health care practices. Keynote speaker, Marie Boltz, PhD, GNP, FAAN, FGSA, spoke about dementia as a family matter and presented perspectives and needs of persons living with dementia and their carers.

2nd prize: Tasha Messmer, Penn State Cancer Institute, “Reducing the Effects of Oral Mucositis and Oral Candidiasis in Stem Cell Transplant Patients through the use of Melaleuca Alternifolia” 3rd prize: Mindy Tait, La Salle University, “Incivility in Nursing Education: A Study of Generational Differences”

“The symposium provides an opportunity for nurses to share their scholarly projects” Kanaskie said. “Topics are included that improve our understanding of what makes an organization successful in use of evidence-based practice.”

Sponsors for this event include Pennsylvania Action Coalition, Mount Nittany Health, Pennsylvania State Nurses Association (PSNA), and Sigma ~ Penn State College of Nursing Beta Sigma Chapter.

Please save the date for next year, May 14, 2020 in Hershey PA.

Judy Himes, MSN, RN, NE-BC, Senior Vice President & Chief Nursing Officer of Penn State Health, Milton S

Student Achievements and Activities Julie Murphy attended the American Heart Association Scientific Sessions, where she presented a poster titled Bereaved Caregivers Perceptions of Supportive Services for Advanced Heart Failure: A Call for Early Integration and Rebranding of Palliative Care. Her co-authors were Judith Hupcey, Lisa Kitko, and Windy Alonso.

Julie was given a travel award and recognized at the dinner.

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Nursing researchers to enhance age-friendly care for older adults in rural PA College receives $3.75 million grant from Health Resources and Services Administration The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, has awarded Penn State’s College of Nursing and its collaborators $3,750,000 to support medically underserved regions throughout rural Pennsylvania. This funding will support the development of educational programming and training for rural-based healthcare providers and caregivers, enabling them to deliver more agefriendly care.

in PA and has over 45 sites (29 are primary care) in 16 counties in PA (13 are rural counties). They employ a medical staff of over 150 physicians, dentists, nurse practitioners, physician assistants, and other health professionals. Annually, they reach over 118,000 patients and families. In addition, we are partnering with the Institute for Healthcare Improvement, Area Agencies on Aging, and the Alzheimer’s Association.”

The partnership’s goal is to improve the availability of the best care possible for older adults, with a focus on the four elements of the “4Ms” Framework of an Age-Friendly Health System: (1) what Matters; (2) Medication; (3) Mentation; and (4) Mobility, and to integrate principles of dementia-friendly care into the care of persons living with dementia and their caregivers.

The Center for Rural Pennsylvania reports that 48 of the 67 counties in Pennsylvania are rural, with growth projections for the entire state population at 5% by 2030. The center also predicts an increase in minority and older adult populations in these rural communities.

People living in rural areas are often faced with limited resources as a result of their location. For example, an older adult in need of specialized care may experience difficulty accessing that care because rural providers are not typically trained to meet their specific needs.

Older adults and people with Alzheimer’s or other forms of dementia, have unique life experiences and equally as unique healthcare related needs.

“The key to age-friendly care is to start by knowing the older adult, to assess and act on mentation (brain health), keep older adults moving and active and avoid high-risk or problematic medications. As we age, too many medications can cause problems with mobility and mentation or interfere with other health and life goals,” Fick said. “The other critical piece with training students and providers is to emphasize how to live well with Alzheimer’s disease and related dementia and document the strengths of the older adult, not just the deficits.”

These healthcare disparities in rural communities provide an opportunity to educate rural providers on age-friendly care, with the potential of improving the quality of life in these communities.

With the funding support of the HRSA, researchers from the College of Nursing in collaboration with the College of Medicine, Primary Health Network and the College of Nursing’s Center for Geriatric Nursing Excellence have created the “PA Collaborative for Age and Dementia Friendly Care.” The collaborative will be led by principal investigators, Judith Hupcey, professor of nursing and associate dean for graduate education and research, and Donna Fick, Elouise Ross Eberly professor of nursing and director of the Center of Geriatric Nursing Excellence; and co-investigator Marie Boltz, Elouise Ross Eberly and Robert Eberly Endowed Chair and professor of nursing.

The Age-Friendly Health Systems Initiative and the 4Ms Framework are national initiatives funded by the John A. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and Catholic Health Association of the United States. The aim of the initiative is to spread the 4Ms Framework to 20 percent of U.S. hospitals and medical practices by 2020, this new funding from HRSA will help make Pennsylvania providers more age-friendly. To learn more about the Age-Friendly Health Systems Initiative, visit the website.

Using these initiatives as a guide, the researchers said they hope to implement a curriculum to educate and support healthcare providers and caregivers, while also providing a valuable resource in these medically underserved regions of Pennsylvania.

“This collaborative partnership with the Primary Health Network (PHN) potentially will impact older adults and their families across PA,” said Hupcey. “PHN is the largest Federally Qualified Health Center (FQHC)

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The Gerontological Society of America - GSA Neuroticism Biases Assessment of Subjective Memory Impairment in Women Authors: Emily Whitaker, Nikki Hill, Jacqueline Mogle, In Young (Iris) Bhang, Sakshi Bhargava

may induce bias when presented to individuals higher in neuroticism who are more sensitive to social threat. This is of particular interest in women, as they have higher levels of neuroticism as well as a unique risk profile for cognitive decline. We examined whether neuroticism influenced SMI and the consistency of these effects across different SMI assessment items. Women (n=1,132; Mage=52.71; SD=13.99) completed the Midlife Development Inventory neuroticism subscale and two SMI items: a self-comparison, and an age-anchored comparison.

Higher neuroticism was associated with poorer ratings on both SMI items, as well as increased consistency in responses to the two items (i.e. closer ratings between the two items). Higher neuroticism in women may influence SMI assessment and reduce the sensitivity of assessment tools.

Subjective memory impairment (SMI) is common in the years prior to objectively identifiable cognitive deficit. Personality traits, specifically neuroticism, may impact SMI report as some assessment items

WE ARE...The CNR! Deborah Thorpe has won this year’s staff appreciation award! Deb works with the faculty on their post award requirements. In a nutshell Deb sets up new awards, monitors their progress, submits invoices for payment, monitors budgets, creates and updates salary sheets, and closes out awards. She does her job so well and never breaks a sweat even under pressure. We are very proud of Deb. She makes our CNR team strong!

Thank you for supporting the Center for Nursing Research!

Penn State is an equal opportunity, affirmative action employer, and is committed to providing employment opportunities to all qualified applicants without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. This publication is available in alternate media upon request. U.Ed. NUR 19-21

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