MU Program Helps Health Care Workers Move Past Tragedy

Program has been recognized nationally

March 26, 2013

Story Contact(s): Christian Basi, 573.882.4430

COLUMBIA, Mo. ­—When a patient dies unexpectedly, whether suddenly or after a long illness, the loss can hit loved ones hard. In some of these cases, health care workers can be affected deeply due to the emotional bonding that can occur between patients and their caregivers. Now, studies have shown that a new program that provides support and training at the University of Missouri Health Care System is helping health care workers get back on their feet and heal both mentally and physically.

“Our staff is here to help patients, but when the care doesn’t lead to a positive outcome, it can take a toll on our staff’s psyche,” said Susan Scott, a registered nurse, patient safety coordinator and director of the forYOU peer support program at MU Health Care and doctoral student in the Sinclair School of Nursing. “The term “second victim” is used to describe health care workers who suffer physically or emotionally following a negative outcome in a medical setting. The ‘first victim’ is the patient and his or her family, but the health care worker becomes the ‘second victim.’”

Situations that can result in an emotional burden for a health care provider include an unanticipated decline in a patient’s condition, caring for young trauma victims, the first death experienced as a health care worker, caring for young victims of violence or neglect, the death of a patient who was starting to recover, violence in the workplace, dealing with elder abuse cases or even a colleague’s death.

“As a caring being, individuals enter into health care to help people; after a while you may become resilient to many situations, but some cases can drill through that armor that builds up over years and can leave an emotional scar,” Scott said.

To support health care providers through these emotional situations, in 2006 Scott and her colleagues established a team that supports caregivers after any adverse event. In the last several years, Scott and her team have conducted numerous studies to determine what is needed to most effectively provide the necessary support for second victims to help them recover from their respective clinical event.

“Following an event, clinicians are willing to review the outcome of the case and determine if any actions could be taken to avoid a negative outcome in the future, but then many of them will immediately start questioning whether they wanted to continue their career in health care,” Scott said.

One such case involved a nurse, “Elaine,” who was attacked by a female patient waking up following a surgical procedure.

“I was in the recovery room with the adult patient, and as I was repositioning a bed pan, the patient took one of the monitoring cords that was attached to her and wrapped the cord around my neck and started to strangle me,” Elaine said. “It only lasted a few seconds, but it seemed like forever.”

Elaine stayed home the following day, but was back at work within 48 hours. When she arrived, her co-workers and the peer support team greeted her.

“Eventually, I was fine, but after something like that happens, you question every move you make; it shakes the core of your foundation as a health care worker,” Elaine said.

According to Laura Hirschinger, R.N., M.S.N., co-investigator and forYOU tam leader, Elaine’s response to the event is very common. The forYOU research team identified eight actions in three tiers of clinician support with action items that should be addressed following an event.

-Tier I (basic, immediate emotional first aid offered by supervisors/colleagues in the same department as the second victim)

  • Address potential second victims to ensure that they are “OK” immediately following a critical clinical event.
  • Provide basic awareness training to unit leaders and colleagues to educate them on key actions to take following an event.

-Tier II (guidance and nurturing of second victims by colleagues specifically trained on the second victim experience)

  • Embed specially trained peer supporters within clinically high-risk departments
  • When necessary, refer second victims to internal resources, such as patient safety experts, for support.
  • Provide long-term assistance for legal action if necessary.
  • Offer group debriefings when an entire team is affected.
  • -Tier III (ensure prompt availability and access to professional counseling and guidance)

    • Provide a fast-track referrals to individuals specifically trained to handle crisis intervention, if necessary.
    • Provide access to additional hospital resources such as chaplains, social workers and clinical psychologists if necessary.

    “Every day, well-meaning health care providers working in clinically complex environments face the harsh reality of unanticipated and sometimes tragic patient outcomes in their chosen professions,” Scott said. “By studying this program that we put in place, we believe we have established a network that can help health care professionals so they know what is available, what to expect, and how to access assistance in the aftermath of unanticipated clinical events.”

    Studies on the program have been published in The Joint Commission Journal on Quality and Patient Safety and BMJ Quality & Safety. The forYOU Team recently received the 2012 Institute for Safe Medication Practice CHEERS award for this patient safety innovation and assistance to countless clinicians.

MU’s Rebecca Johnson to Take on National Advisory Role

March 04, 2013

Story Contact(s): Nathan Hurst, 573.882.6217

COLUMBIA, Mo. — Rebecca Johnson, a professor at the MU College of Veterinary Medicine, director of Research Center for Human-Animal Interaction, and the Millsap Professor of Gerontological Nursing in the Sinclair School of Nursing, has been elected to the National Academies of Practice (NAP) and the Veterinary Medicine Academy (VMA) as a distinguished scholar and fellow. Johnson will be inducted into the NAP in April during the organization’s annual meeting and forum.

The NAP was founded in 1981 to advise Congress in health care practice and delivery. The Academy comprises 10 interdisciplinary organizations: dentistry, medicine, nursing, optometry, osteopathic medicine, pharmacy, podiatric medicine, psychology, social work and veterinary medicine. NAP fellows are considered among the most distinguished in their fields and are chosen only after a rigorous selection process. Membership is limited in order to maintain the Academy’s high standards.

Johnson earned her baccalaureate degree in nursing from the University of Dubuque, Iowa in 1980, her Masters of Philosophy degree from the University of Edinburgh, Scotland in 1982 (as a Rotary Foundation Scholar), and her doctorate from the University of Iowa in 1992. She joined the University of Missouri Sinclair School of Nursing (SSON) in August 1999 as the Millsap Professor of Gerontological Nursing and Public Policy and shortly thereafter was given a joint appointment as associate professor in the College of Veterinary Medicine (CVM) for her research on human and companion-animal interaction. She was promoted to full professor in the CVM and SSON in 2012.

Johnson established the Research Center for Human-Animal Interaction (ReCHAI) in 2005. Her externally funded program of research and community projects merges her work on wellness and relocation of the elderly, assistance of war veterans who have post-traumatic stress disorder and prisoners with the benefits of human-companion animal interaction. Her research shows that companion animals provide a unique source of social support and facilitate motivation for exercise and other wellness-promoting behaviors.

The author of many scholarly publications in peer-reviewed journals and books, Johnson presents her research findings nationally and internationally. She also is called upon as a consultant regarding the relocation of older adults, and human and companion-animal interaction programs. In 2005 she was named the University of Missouri’s William H. Byler Distinguished Professor, an award given for “outstanding abilities, performance and character.” In 2007 she was inducted as a Fellow of the American Academy of Nursing, the highest honor in academic nursing joining only 1,500 nurse academics nationwide to achieve such an accomplishment. In 2011 she had two books published by Purdue University Press: Walk a Hound, Lose a Pound: How You and Your Dog can Lose Weight, Stay Fit, and Have Fun Together, and The Health Benefits of Dog-Walking. Since 2010, she has served as president of the International Association of Human-Animal Interaction Organizations (IAHAIO), a global umbrella association of more than 40 organizations doing practice, education, or research in human-animal interaction. In July, 2013, IAHAIO will hold its triennial conference in collaboration with the American Association of Human-Animal Bond Veterinarians, and the AVMA’s 150th convention in Chicago, Ill.

Johnson’s studies have received funding from the National Institutes of Health, Missouri Foundation for Health, the Waltham Foundation, Pedigree Foundation, Banfield Charitable Trust, and the University of Missouri’s Mizzou Advantage One Health/One Medicine initiative, which facilitates collaborative research projects that benefit human and animal health.

“As a member of the NAP-Veterinary Medicine, it will be my privilege to help this wonderful organization continue to move the importance of the human-animal bond to the forefront with policy-makers nationally,” Johnson said.

The mission of the National Academies of Practice is to promote excellence in practice of health care professionals, and quality health care for all through interprofessional collaboration in service delivery, research, education, and public policy advocacy. To achieve this goal, NAP holds interprofessional healthcare policy forums, Congressional briefings, membership symposiums, and combined conferences. NAP also publishes public policy and position papers, distributing key findings to members of Congress, healthcare planners, public agencies and other interested parties. The Academy publishes the NAP Journal of Interprofessional Healthcare, a free, online journal focused on interprofessional topics in practice, education, research and policy.

Dogs Improve Quality of Life for Families with Children with Autism, MU Study Finds

New social media mapping methods allow MU researchers to analyze posts by families affected by autism

Feb. 25, 2013

Story Contact(s): Nathan Hurst, 573.882.6217

Families who have children with autism spectrum disorders (ASD) are often faced with significant challenges, such as caregiver burden, sleep deprivation, and psychological distress. Because of these difficulties, ownership of pet and service dogs by families with ASD children has received growing attention as a way to provide benefits for these children and their families. However, there has been little research on how dog ownership affects families with ASD children. Now, through a novel method of monitoring social media, interdisciplinary researchers from the University of Missouri have found that families with ASD children regard dog ownership as having a positive impact on their households. Rebecca Johnson, director the MU Research Center for Human-Animal Interaction (ReCHAI) and professor in the MU Sinclair School of Nursing and College of Veterinary Medicine, says these findings further indicate the positive effects animal interactions can have on children with autism.

“We are beginning to learn how companion animals may provide comfort and unconditional love to families of children with autism, and to the children themselves,” Johnson said. “This may be particularly important given the very high stress levels of these families.  Pet dogs can have a calming effect in stressful situation as has been shown widely in research.”

For their paper, which was presented at the 2012 International Communication Association conference, the MU researchers analyzed word clusters such as “family” “pet” and “love” from thousands of Internet forum and social media posts by members of families with ASD children. Based on the researchers’ analysis of these word groups, they concluded that dogs trained to be service or therapy animals can help children with autism in their social and school lives as well as improve the overall quality of life for all family members. Gretchen Carlisle, a former doctoral student in the MU Sinclair School of Nursing, says while dogs can have a positive impact on families, it is important to adequately match dogs with families based on their specific needs.

“Pet dogs are common in families with typically developing children and also among families of children with autism,” Carlisle said. “Most parents reported that their children were attached to their dogs and children said they had closer bonds with small dogs. Considering the special needs of children with autism, selecting the right dog for the right family may be very important for successful family/pet relationships.”

Glen Cameron, the Maxine Wilson Gregory Chair in Journalism Research and professor of strategic communication at the MU School of Journalism, says this newly developed method of mapping social media can be very useful for analyzing Internet content for a wide variety of purposes.

“This study showcases methods and measures for taming the vast content of social media such as blogs, tweets, and Facebook postings that can shed light on internal policies and external communication programs of organizations,” Cameron said. “While this research offers important implications, particularly for health professionals and campaign planners in the autism community about dog ownership in families with children with ASD, our findings and insights regarding social media monitoring and analysis can also be applied to health organizations and companies in the healthcare and public health sector.”

This research is a result of collaboration through the One Health, One Medicine and Media for the Future areas of Mizzou Advantage. Mizzou Advantage is a program that focuses on four areas of strength at MU. The goals of Mizzou Advantage are to strengthen existing faculty networks, create new networks and propel Mizzou’s research, instruction and other activities to the next level.

School launches new DNP program area

Feb. 12, 2013

Columbia, Mo. — The University of Missouri Sinclair School of Nursing (MU SSON) is launching a new online doctoral program area with a $250,000 investment from the university. The new nursing leadership and innovations in health care area of study within the current doctor of nursing practice (DNP) program will allow students to prepare for nurse executive roles.

“The complexity of today’s health care systems demand that top nurse executives receive doctoral preparation,” said Judith Fitzgerald Miller, MU SSON dean. “Nurse executives must be able to manage complex information systems, reimbursement for care and safety challenges and translate best practices into daily care delivery.”

The nursing program area is one of 16 new online programs in which the university has invested in order to respond to the increased demand for online learning opportunities and enhance the number of graduates in specific industries.

“This program will prepare nurse executives by reaching them wherever they work and reside through online program delivery,” Miller said. “The new curriculum provides leadership development coupled with health care innovation and entrepreneurship.”

The school’s RN to BSN and all graduate programs are offered in an online format. The new leadership and entrepreneurship area will be the sixth DNP area of study offered by the school. Other areas of study include adult-gerontology and pediatrics clinical nurse specialist and family, pediatrics and family psychiatric and mental health nurse practitioner.

The university funds will defray startup costs of developing the curriculum, including purchasing any software necessary to offer the courses. Other university programs included in the new initiative include hospitality management, public administration, education, energy efficiency, geospatial intelligence, public health, interactive media, health communication, architectural studies and biomedical sciences. All the programs will be developed and taught by MU faculty.

“We are pleased to begin offering online programs in these in-demand subject areas,” MU Provost Brian Foster said. “Producing graduates with the skill sets and preparation needed to advance these industries is at the core of our mission at the University of Missouri.”

Demand for online education is at an all-time high.

“Mizzou has been offering distance education for more than 100 years as part of fulfilling our land-grant University mission,” said Jim Spain, vice provost for undergraduate studies and interim vice provost for e-learning. “Our offerings have more than doubled and our enrollments have grown 78 percent in the last five years. However, Missourians and distance students everywhere continue to ask for quality, affordable online higher education. These new online programs will not only help students be more globally competitive, but also help meet our state leaders’ goal of having a more highly educated Missouri.”

* The MU News Bureau contributed to this report.

Low-income Pregnant Women in Rural Areas Experience High Levels of Stress; Mothers’ and Babies’ Health at Risk, MU Researcher Says

Jan. 29, 2013

Story Contact(s): Jesslyn Chew

COLUMBIA, Mo. – Stress during pregnancy puts mothers’ and their babies’ health at risk, previous research has shown. Now, a University of Missouri study indicates low-income pregnant women in rural areas experience high levels of stress yet lack appropriate means to manage their emotional and physical well-being. Health providers should serve as facilitators and link rural women with resources, the researcher suggests.

“Many people think of rural life as being idyllic and peaceful, but, in truth, there are a lot of health disparities for residents of rural communities,” said Tina Bloom, assistant professor of nursing and Robert Wood Johnson Foundation Nurse Faculty Scholar at MU’s Sinclair School of Nursing. “Chronic, long-term stress is hard on pregnant women’s health and on their babies’ health. Stress is associated with increased risks for adverse health outcomes, such as low birth weights or pre-term deliveries, and those outcomes can kill babies.”

During interviews with nearly 25 pregnant women from rural communities in Missouri, Bloom and her colleagues learned financial problems plagued the women. Financial stress was exacerbated by the women’s lack of employment, reliable transportation and affordable housing. In addition, the women said small-town gossip, the isolation of their rural communities and the interdependence of their lives with their extended family members also increased their stress levels.

“To the women I talked with, getting jobs was their ultimate solution,” Bloom said. “Self-reliance is a value in rural populations, and I think that’s what these women were expressing—that their circumstances were difficult and stressful, but if they had the ability to support themselves financially, they would be able to lift their families out of poverty.”

Mental illness also affected many of the women, with nearly two out of three showing symptoms of major depression and one in four experiencing moderate to severe Post Traumatic Stress Disorder. Many of the women had significant violent experiences in their lifetimes, and one in five was in an abusive relationship at the time of the interviews.

“Prenatal visits are key opportunities for health providers to talk with expectant mothers about their stressors, especially since many rural areas have fewer or unsatisfactory resources such as mental health care and domestic violence shelters,” Bloom said. “Clinicians making referrals to resources should consider doing warm hand-offs, which involves sitting with the patients and making calls together or introducing them in person to people who can help them. Health providers also should keep in mind that rural woman have increased concerns about confidentiality and gossip and don’t want to feel judged.”

Bloom said rural clinicians need to ask pregnant women about their stress levels and their exposures to violence. In addition, medical providers need to let women know about available resources.

“The rural Missouri women I met have incredible strength and resilience,” Bloom said. “Many of these women were living in very difficult circumstances with minimal resources. Health providers should remember that these women have amazing strengths and acknowledge those strengths when they work with them.”

Bloom cautions that these findings are from a small sample of women who primarily were low-income, unemployed young Caucasian women in partnered relationships and are not necessarily representative of the larger population.

The study, “Rural Pregnant Women’s Stressors and Priorities for Stress Reduction,” was published in Issues in Mental Health Nursing.