Office of Nursing Services (ONS)
Featuring VA Nursing Researchers
Dr. Julius Kehinde Used Paradigm Shift to Broader System-Approach to Improve Falls Prevention
Julius Kehinde, PhD, RN, Chief Nurse for Research and Evidence –Based Practice at Bay Pines VAHCS, chose a system wide approach to his clinical research on patient safety, beginning with fall prevention among older adults living in nursing homes and VA community living centers. Falls and fall-related injuries among older adults lead to serious consequences for Veterans including physical disability including immobility, increased risk of mortality, and enormous health care costs. As traditional individual-centered approaches used for older adults living in long-term care facilities has yielded uneven fall prevention results, a paradigm shift to a broader system-approach is therefore warranted.
Dr. Kehinde was recently appointed as the University of Central Florida College of Nursing Graduate Scholar and he also serves as an affiliate faculty at the Idaho State University College of Nursing. He is the current Bay Pines VAHCS Institutional Review Board (IRB) Chair, a position he has held since fall of 2015. As IRB Chair, he protects the rights of research participants and ensures Bay Pines VAHCS compliance with the 2018 revised Common Rule and the VA human subjects research requirements (VHA Directive 1200.05). In addition to research, he teaches and mentors clinical nurses and graduate nursing students. He received a Translational Science Award from the National Institutes of Health and additional funding from Mountain West Clinical and Translational Research Infrastructure and Idaho State University Office of Research and Economic Development. Dr. Kehinde is a valued member of the VA Nursing Research Field Advisory Committee and he coordinates the bimonthly webinars available to VA staff interested in learning more about nursing research.
Effective Therapy for Post-Concussive Symptoms May Be Right Around the Corner
Judy Carlson, EdD, APRN, FNP, BCN, is a Nurse scientist at the VA Pacific Islands Health Care System. Dr. Carlson is studying the efficacy of neurofeedback in improving post-concussive symptoms of insomnia, chronic headaches and attention disorders in Veterans who have experienced a concussion. Dr. Carlson is board certified in neurofeedback and has utilized neurofeedback in her practice and research for over 20 years. Neurofeedback is like other biofeedback processes in which information about a person’s specific body functioning is relayed back to the person so that he/she will know how that body function is doing. This information can be used to help that person make the specific body function work better through training. The neurofeedback system picks up and interprets the brain waves and sends this information to a special computer game which responds to the Veteran’s brain wave patterns. Neurofeedback has been shown to affect cortical neuroplasticity and contributes to neuro-neuronal rehabilitation by changing connectivities of specific areas of the brain that may have been impaired, and these changes appear to be permanent. The results of Dr. Carlson’s pilot study were overwhelmingly favorable. After 20 sessions, each participants’ post-concussive headaches had resolved, they were able to fall asleep easier and maintain sleep for a 6-8-hour period, and their ability to attend to tasks had improved. In addition, participants experienced enhanced energy levels, mood and perceptions of quality of life as well as significantly decreased stress levels. Dr. Carlson believes the use of the latest infra-low frequency neurofeedback technology and protocols have contributed to the successful outcomes.
Sarah Krein Receives 2019 Distinguished Scientist Award from Association for Professionals in Infection Control and Epidemiology (APIC)
Sarah Krein PhD, RN, received the 2019 Distinguished Scientist Award from the Association for Professionals in Infection Control and Epidemiology (APIC). Krein is a research career scientist at the VA Ann Arbor Center for Clinical Management Research. At the University of Michigan, she is Research Professor of Internal Medicine and the Rensis Likert Collegiate Research Professor, and holds an adjunct appointment in the School of Nursing.
The honor recognizes those who have made outstanding contributions to the science of infection prevention and control. Krein has been an active member of APIC since 2005 and a reviewer for the American Journal of Infection Control since 2008. Using her extensive clinical and research background, Krein focuses on organizational behavior and implementation research to enhance patient safety through the prevention of healthcare-associated complications. Over the past 21 years, Krein’s research has focused on team-based science and the implementation of research techniques to improve healthcare safety, quality, and effectiveness. She has published more than 180 papers based on her research.
She has been widely recognized for her work, most recently as a corecipient of the 2017 HSR&D Health System Impact Award for her efforts to improve Veterans’ care by reducing the risks of unnecessary and harmful urinary catheters, significantly changing the practice across the VA.
Dr. DiNardo Using Mind-STRIDE (Mindful Stress Management In Diabetes Education)
For approximately 5 million Veterans, everyday diabetes self-management can be challenging and for many, burdensome. Nurse Scientist Monica DiNardo, PhD, ARNP, CDE, at the VA Pittsburgh Healthcare system and Center for Health Equity Research & Promotion (CHERP) and her research team are studying whether Mindfulness, an evidence-based stress reduction technique, effectively eases this burden. Diabetes self-management is essential for blood glucose control and prevention of potentially life-threatening and disabling complications such as heart disease, kidney failure, and stroke. Importantly, 40% of individuals with diabetes suffer from diabetes-related distress that interferes with their ability to sustain healthy self-management behaviors; this is particularly problematic for Veterans who are at higher risk for depression and posttraumatic stress disorder. Dr. DiNardo developed a brief stress management intervention known as Mind-STRIDE (Mindful Stress Management In Diabetes Education), which contains mindfulness training and home practice to augment more traditional diabetes teaching. While the team demonstrated the feasibility, patient acceptability, and initial efficacy of Mind-STRIDE in the pilot, its effects on diabetes-related psychological and other health outcomes remain unknown. This randomized controlled trial is enrolling interested participants (2016–2019) to determine if Mind-STRIDE improves diabetes-related distress, diabetes self-efficacy (e.g. confidence), self-management behaviors, and hemoglobin A1C, a marker of diabetes control, among Veterans. The research team also aims to characterize distinctive Veteran experiences with diabetes-related distress and Mindfulness. This research provides evidence-based tools to help bridge the gap between the outpatient clinic and the Veteran’s home.
Dr. Karen Saban Testing Effectiveness of Mindfulness Based Stress Reduction
Evidence demonstrates that chronic stress doubles the risk of heart disease and contributes to inflammation associated with coronary artery disease and stroke. Women Veterans may be at particular risk for experiencing high levels of chronic stress. Mindfulness Based Stress Reduction (MBSR), an 8-week group based stress reduction program, has been demonstrated to improve well-being and reduce stress in a wide variety of individuals. Practitioners of MBSR gain increased awareness and insight into the relationships among their thoughts, emotions, and how their body responds. VA Nurse Scientist Dr. Karen Saban and her team at the Edward Hines VA are completing a clinical trial examining the effectiveness of MBSR in improving psychological well-being and decreasing risk for cardiovascular disease in women Veterans. Preliminary results suggest that the MBSR program is well-received and may lower levels of perceived stress and anxiety in participants.
Dr. Marilyn Lanza Receives the Living Legends in Massachusetts Nursing Award
Dr. Marilyn Lanza received the Living Legends in Massachusetts Nursing Award at the ANA Massachusetts Awards Dinner Ceremony on April 6, 2018. This award recognizes a nurse who has made significant lifetime contributions to the profession of nursing on a state (Massachusetts), national or international level. Dr. Lanza is a nurse researcher and psychotherapist. She has done extensive research, writing and lecturing on patients who exhibit aggressive behavior against healthcare staff. She was one of the first researchers to document staff reactions to these assaults. Dr. Lanza's current research includes factors contributing to blame placement, simulation methodologies to study assault, development of clinical pathways for use of the community meeting as a prevention and/or intervention to assaultive behavior, and a treatment model for psychodynamic group psychotherapy. Most recently she is the principal investigator of two national studies "Violence, Assessment, Mitigation and Prevention" and "Aggressive Behavior: A Multi-Pronged Approach". The Office of Nursing Services congratulates Marilyn on this prestigious award!
HSR&D Post-Doctoral Fellow Explores Link Between Poor Sleep And Suicide In Veterans with PTSD
Dr. Michaela McCarthy completed her PhD in Nursing from the University of Colorado in 2016. Her dissertation research focused on the use of a telemedicine intervention to treat insomnia in rural breast cancer survivors. In addition to working with breast cancer survivors, Dr. McCarthy expanded her research to aid Veterans with PTSD and sleep disturbances in conjunction with the Denver MIRECC.
Dr. McCarthy is currently working as a Health Service Research & Development post-doctoral fellow at the Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Health Care System. Her post-doctoral research is designed to explore the link between poor sleep and suicide in Veterans with PTSD, and to better understand the bidirectional relationship between hypervigilance symptoms and sleep disturbances. Results from her post-doctoral work will inform future studies designed to improve sleep and decrease suicide risk in Veterans with PTSD.
The VA is a reliable resource for post-graduate students looking to develop their careers while building a program of research that improves the health and well-being of the Veterans we serve. Dr. McCarthy reports that her fellowship allows her to build on her earlier research by connecting her with other VA nurse researchers and experts in other disciplines across the country. She reports that the research opportunities within VA have been foundational to her success. For information on VA nursing postdoctoral opportunities, please visit the Office of Academic Affiliations site.
Art as an intervention for chronic illness and pain: a postdoc VA nurse's story
While her enlisted husband and family moved from base to base, Dr. Lisa Wayman took care of their children and worked odd jobs until she completed her nursing degree. She started her nursing career at age 30 and is proud of her work with Veterans. Dr. Wayman is now the VA Nursing Academic Partnership Program Director in addition to serving as the Acting Chief of Nursing Education at the Phoenix VAMC. She completed her PhD at the University of Arizona in 2013 and completed her VA nursing postdoctoral (postdoc) training at Phoenix VAMC. The 2 year VA nursing postdoc was a terrific opportunity to concentrate on her research on art as an intervention for chronic illness and pain. During her postdoc, she worked with national nurse researchers and other leaders in pain management. She developed the Pain Academy for primary care and she is also involved with evidence based practice including hospital acquired infection prevention, safe patient handling (patient falls were reduced by 50%), prevention of pressure ulcers, as well as mentoring new nurses and doctoral and master’s degree students. Prior to joining the VA, she developed a new nursing unit dedicated to preceptors and new graduates; 200 new nurses were trained and hired during her tenure.
Dr. Wayman is also a skilled artist and writer and loves teaching art and incorporating research into her work. She volunteers with several other artists in the Arizona Artist Alliance providing 4 hours of free art instruction for 18-20 Veterans one Saturday each month. She believes that art has cognitive, social, and emotional benefits in addition to increasing Veteran support and socialization. Participating in art programs allow Veterans to concentrate on what they do well. The art engages their mind so they are dedicating brain power to creativity, focus, enjoyment and relaxation, and realize that “life is much bigger.” Veterans who are experienced artists demonstrate their art medium for the classes and participants have a choice to try the new method or work independently. Dr. Wayman says completing a VA postdoc opened many doors for her and provided the opportunity to have dedicated time to pursue her research. Her efforts have flourished into a strong evidence based practice program that has benefitted the lives of the Veterans we serve. If you are a PhD prepared nurse or know someone who would be interested in pursuing VA postdoctoral training, please check out the information available on the OAA website. Photos provided by Mark Woehrle with permissions.
Working with Susan McClellan