Excerpt:
“I will do anything that’s involved with improving cancer care,” says Deborah Mayer, PhD, RN, AOCN, FAAN, associate professor of nursing and member of UNC Lineberger’s Cancer Prevention and Control program. Her work improves cancer care locally and nationally, and nursing was always her career choice. “I wanted to be a nurse since I was five years old,” she says. “I never wavered.”

A journey into refocusing my nursing specialty

By Katie Shattuck

 “So, what do you want to be when you grow up?” We have all been asked this question at various points during our lifetime, in kindergarten during sharing time, in middle school writing class, and then again in high school as we prepare for our entrance into college. I always knew that I wanted to “help people.”  This idea transformed into a solid career path toward nursing after watching my sister go through nursing school and work as a registered nurse in a nursing home.

I applied to graduate school knowing that I wanted to earn my master’s degree in nursing to pursue a career as a Pediatric Nurse Practitioner. At the time, I would have laughed if you said to me that I would find an interest in children with developmental or behavioral disorders. In the fall of my second year in my master’s of nursing program, I was offered the opportunity to participate in NC Leadership Education in Neurodevelopmental Disabilities Fellowship (NC LEND), a yearlong fellowship sponsored by the Maternal and Child Health Branch of the United States Department of Health and Human Services. The purpose of  NC LEND  is to provide training about the complex issues surrounding children with developmental and behavioral disabilities. 

            I started the LEND fellowship unsure of not only what was expected of me but also how I could or would tailor this opportunity to fit in with the care that I was learning to provide as a Pediatric Nurse Practitioner. I had only a cursory knowledge of developmental and behavioral disorders and very limited experience with the community resources set up for these patients and their families. What I have learned over the past eight months has astounded me and made me realize how truly disadvantaged individuals with developmental and behavioral disorders are in terms of the quality of care that they receive.

            Anne (name has been changed) is a perfect example of how common fragmented and ineffective primary care is for individuals with developmental and behavioral disorders. Anne was ten years old with a diagnosis of severe autism spectrum disorder. Her parents came to the behavioral clinic in which I was participating with the hopes that a developmental behavioral specialist would be able to help them with the extreme tantrum behavior that Anne was exhibiting. They were also looking for ways to deal with her lack of self-toileting skills and her repetitive playing of specific clips of television shows.

Anne was also overweight, had a family history of cardiac disease, and during the visit with the behavioral specialist had symptoms of a cough and runny nose that had been going on for ten days. Her parents had not taken her to her primary care doctor for the cough because they assumed that the specialist could take care of anything that may be wrong with her medically. Unfortunately, the specialist addressed none of Anne’s medical concerns; these would have to be discussed with her primary care provider.

At this point during the exam I realized what is missing in our current system. On the one hand, we have great primary care providers who diagnose childhood illnesses. Top-notch primary care providers acknowledge when a child is overweight and start a discussion with the child and family about how to achieve a normal weight. Excellent primary care providers understand that children with chronic conditions like asthma need to have their seasonal allergies under control to help keep their asthma under better control.

On the other hand, we have specialists that know the ins and outs of developmental and behavioral disorders. These specialists have the education to feel comfortable prescribing psychostimulants, antipsychotics, and antidepressants to children when needed. Specialists know how to navigate the world of community resources that the layperson cannot navigate. What we have are two different sets of providers. While each of them performs a necessary function to treat this special population of children and adolescents with developmental or behavioral disorders, they are doing so separately.

In nursing school we spend a great deal of time talking about how we should treat the whole person – we call this holistic care. After eight months as a LEND fellow, I am dismayed to discover that it is a rare thing indeed to find someone who can or will provide both pieces of the puzzle for this population. Some of the barriers prohibiting primary care providers from adequately treating children with developmental or behavioral disorders include lack of insurance company reimbursements, time constraints in busy practices, and being uncomfortable with using screening tools to help diagnose children with developmental and behavioral disorders.

             In order to provide the quality, holistic care that we as nurses and advanced practice nurses have set as our standard, we need to make sure that we have the knowledge to treat these patients. We need to make sure that we willingly embark upon lifelong learning in the area of developmental and behavioral disorders to make sure that we are fighting against the norm of fragmented care in order to provide quality care to a most underserved population.

If you asked me today what I want to be when I grow up, I would still say that I want to “help people.” However, I would just be sure to state loud and clear that my goal is to “help provide cohesive, comprehensive care to children and adolescents with developmental and behavioral disorders.” I encourage you to do the same.

Clinical Assistant Professor Megan P. Williams was excited to see her pediatric clinical students pictured in an article from the N.C. Children’s Hospital. From left to right are Adria Gillespie,  Aaron Parsons, Victoria Neff & of course the star of the show Christian! Read the whole story here: http://www.ncchildrenshospital.org/calendarkids/christian.

Mi-Kyung Song, PhD, RN

Associate Professor Mi-Kyung Song has received a grant ($50K) from the Kornfeld Program in Bioethics and Patient Care, which is administered by The Greenwall Foundation. The grant will support Dr. Song’s research project that  examines management of ethical issues in free-standing dialysis facilities. This prestigious award recognizes the significance and potential impact of individual research projects and researchers in bioethics areas. In the 62 years of the Foundation’s history, only two nurse researchers have been awarded grants.

Deborah Mayer, PhD, RN, AOCN, FAAN

When cancer patients experience medical problems, they may visit emergency departments, but how often and for what reasons, there is little data.

A first-ever study of emergency room use by oncology patients in North Carolina was published in the May 23, 2011 online issue of the Journal of Clinical Oncology. Authors hope the study can give them information so that they can target clinical problems to improve delivery of quality cancer care, thus avoiding emergency room visits.

Deborah Mayer, PhD, RN, AOCN, FAAN, associate professor of nursing in the UNC School of Nursing, study lead author, said, “While some cancer patients develop acute problems that do require a visit to the emergency department, some visits might be avoided with better symptom management.” Mayer is a member of UNC Lineberger Comprehensive Cancer Center.

The UNC team used a statewide database to collect information on over 35,000 Emergency department (ED) visits. They learned that the top three problems that brought patients to the ED were related to pain, respiratory distress, and gastrointestinal issues (mostly nausea and vomiting).
Mayer thinks some of these problems, such as nausea and vomiting, could be managed by the patient and cancer doctors and nurses. Reasons for a problem need to be explored: did the patient not get a prescription? Was the patient able to fill the prescription and take the medication? If it wasn’t working, did they call their doctor or nurse? Mayer concludes by saying that ‘While we have made great strides in cancer care, this study shows we still have room for improvement’.
 
Unlike other people visiting the emergency department where about 15 percent were admitted to the hospital, over 63 percent of cancer patients were admitted.

Debbie Travers, PhD, RN, CEN, FAEN, assistant professor in the UNC School of Nursing and study co-author, believes that “the Study validates the need for emergency department nurses to play an active role in the care and management of acute problems faced by cancer patients.” She said that the study identified additional areas for research, including management of acute symptoms for targeted populations, especially patients with lung cancer.

Other UNC authors are: Annah Wyss, MPH of the UNC Gillings School of Global Public Health; Ashley Leak, RN-BC, MSN, OCN, UNC School of Nursing; and Anna Waller, ScD, UNC School of Medicine. This research was funded by the NC TraCS Institute at UNC-Chapel Hill, one of 55 medical research institutions working together as a national consortium to improve the way biomedical research is conducted across the country. The consortium is funded through the NIH Clinical and Translational Science Awards (CTSA).

Read the press release here: http://news.unchealthcare.org/news/2011/may/cancer-ed-visits.

Maj. Gen. Patricia D. Horoho (BSN '82)

President Barack Obama has nominated Major General Patricia D. Horoho (BSN ’82) as the next Army Surgeon General. Maj. Gen.  Horoho is currently serving as the U.S. Army Deputy Surgeon General and 23rd Chief of the U.S. Army Nurse Corps. The nomination, which must be confirmed by the Senate, includes promotion to the rank of three-star general. Horoho would be the first woman to serve as Army Surgeon General.

Major General Horoho earned her BSN degree from the UNC Chapel Hill School of Nursing in 1982. She was honored  by Time Life Publications, the American Red Cross, and Nursing Spectrum for her care and action as a first responder when Flight 77 crashed into the Pentagon on Sept. 11, 2001.

Read more about the nomination in these stories:

Obama nominates E.E. Smith grad for Army surgeon general
Horoho nominated to be next surgeon general
Horoho Nominated as First RN to Serve as Army Surgeon 

Applications were reviewed by three teams from the Global Nursing Advisory Council (GNAC) joined by faculty who received awards in previous years. Award amounts are primarily based on airfare to the destination. We were still unable to fund all who applied. Through the GNAC we have focused our areas of support so that students and faculty are helping expand our capacity in global health but also are involved in sustainable work, either through service that can be built on from year to year, or in developing scholarship opportunities. We are particularly pleased to award two Cronenwett Global Awards designated for undergraduate students (see Global Study Award Helps Students Gain World Experiences).

We continue our long time relationship with Guatemala through Chris Harlan, Oaxaca through Norma Hawthorne, and Kenya both for Reach Out through adjunct faculty Dr. Pam McQuide and for Carolina for Kibera, which is a non-profit started by a former Carolina student. The Atlantis Project is a campus project in Portugal that through our students has developed ongoing work in health care. We have faculty and doctoral students who were active in the Thai International Nursing Conference and now the International Family Conference, both excellent scholarship development opportunities. We are pleased to have these outstanding Global Ambassadors! Visit the SON Global Health web page http://nursing.unc.edu/globalhealth, primarily built by Graduate Assistant Christina Kim.

 2011 Global Health Awards

The scales she developed to help investigators measure uncertainty in illness are used in 30 countries and have been translated into many languages. Dr. Mishel will be inducted into the International Nurse Researcher Hall of Fame at STTI’s 22nd International Nursing Research Congress in Cancun, Mexico, in July.

In addition, Dr. Mishel was appointed as a permanent member of the Nursing and Related Clinical Sciences Study Section, Center for Scientific Review, National Institutes of Health (NIH). Her term extends from July 1, 2011 through June 30, 2015. This new Study Section reviews funding applications that address the science that underpins clinical practice and is concerned with preventing, delaying the onset, and slowing the progression of disease and disability. It includes nursing as well as other clinical science disciplines such as medicine, social work, psychology, health education, dentistry, and pharmacy.

Members of the study section were selected on the basis of their achievements in their scientific discipline as evidenced by the quality of research accomplishments, publications in scientific journals, and other significant scientific activities and honors. Dr. Mishel says that she looks forward to the sharing of ideas that occurs during evaluation of proposals and being aware of the new techniques included in study designs.

Linda H. Cronenwett (center) with Tina Evans (left) and Rebeca Moretto (right), the 2011 recipients of the Cronenwett Global Study Award.

The Cronenwett Global Study Award was created by a private gift from a SON alumna and her husband to honor the leadership of Linda H. Cronenwett, immediate past dean of the SON, and her passion for improving quality and safety in health care. This year’s recipients are BSN students Tina Evans and Rebeca Moretto. They will both be traveling internationally this summer as part of N489, SON’s Practicum in Nursing Global Health Experience.

Evans will spend four to five weeks in Antigua, Guatemala volunteering at Casa Jackson, an inpatient center for malnourished children. She then plans to spend six to seven weeks in Jutiapa, Guatemala, where she will work on the nursing staff in the maternity department of the Hospital Nacional de Jutiapa. She will also introduce the work of doulas to their maternity care in an effort to increase natural comfort measures in laboring women.

Moretto will be collaborating with two obstetric attending physicians in the high-risk OB/GYN department at the Antigua, Guatemala/Hospital Nacional. She will be assisting them by acting as a doula to the women and helping with deliveries. In addition, she will conduct public health education outreach for the traditional midwives in the area regarding topics including sterile technique and postpartum care of mother and newborn.

You can contribute to the Cronenwett Global Study Award at https://secure.dev.unc.edu/gift/son/.