Faculty Member Receives Nearly $3.2 Million NINR Grant

Assistant professor Mi-Kyung Song received a nearly $3.2 million grant from the National Institute of Nursing Research, National Institutes of Health, for a study entitled, “Representational Intervention to Promote End-of-Life Decision-Making Preparation.”

The randomized, controlled trial will test the effects of the

Assistant professor Mi-Kyung Song received a nearly $3.2 million grant from the NINR, NIH.

Assistant professor Mi-Kyung Song received a nearly $3.2 million grant from the NINR, NIH.

SPIRIT (Sharing the Patient’s Illness Representation to Increase Trust) intervention in improving preparedness for end-of-life decision making among patients with end-stage renal disease (ESRD) and their surrogates. The study also will test the effects of the SPIRIT intervention in reducing surrogates’ conflict during decision making and psychosocial morbidities.

Subjects will be 200 white and black patients with ESRD recruited from outpatient dialysis clinics and their chosen surrogate decision makers. Song’s co-investigators and SON assistant professor Jill Hamilton, School of Medicine associate professor Laura Hanson, UNC biostatistics professor Jason Fine and professor Sandra Ward from the University of Wisconsin-Madison.

Talking With a Nurse Best Helps Couples Grieving a Pregnancy Loss

Although existing research shows that men and women process grief and recovery from miscarriage or early pregnancy loss differently, they are best able to resolve their loss together if they undergo three one-hour long couple-focused nurse-led counseling sessions, according to a study conducted by Kristen M. Swanson, RN, PhD, FAAN, dean of the University of North Carolina at Chapel Hill School of Nursing.

Published in the most recent issue of the Journal of Women’s Health and Gender-Based Medicine, Swanson’s study, funded by the National Institute of Nursing Research, National Institutes of Health, compared three couples-focused interventions to no treatment in order to identify strategies

Dean Kristen M. Swanson recently a study based on her research into how nurse-led counseling helps men and women grieving a pregnancy loss process their emotions.

Dean Kristen M. Swanson recently published a study based on her research into how nurse-led counseling helps men and women grieving a pregnancy loss process their emotions.

to help men and women with the resolution of depression and grief during the first year after miscarriage. This study was the first published randomized clinical trial of interventions to support couples after miscarriage.

“During the study, I found that, while men and women both experience sadness after a pregnancy loss, they are, most often, grieving over different things – while women typically mourn the loss of an unborn child, their husband or partner is more likely to mourn the loss of the relationship he had with the woman as she withdraws into her sadness,” Swanson said. “But even though couples tend to feel distraught over separate aspects of the pregnancy loss, we found that both individuals responded most favorably to an intervention that involved three hour-long counseling sessions with a nurse.”

Existing research shows that 85 percent of couples have limited discussions (if any) about their feelings surrounding miscarriage, even though most women wish to talk about it. In her earlier research, Swanson discovered that at one year after miscarriage, couples are likely to experience decreased emotional and physical intimacy if they have not openly shared their feelings or if the male has not demonstrated his concerns by doing little things to show he cares.

Swanson’s latest study divided 341 couples who were within 12 weeks of miscarrying into three groups – one that received three counseling sessions with a nurse (nurse caring), another that included three video and workbook modules (self caring) and a third that combined one nurse-led session with three self-caring modules (combined caring). A fourth group that received no intervention was included as a control. All interventions were offered at one week, five weeks and 11 weeks after study enrollment.

Each intervention was based on Swanson’s Theory of Caring and Meaning of Miscarriage Model. These frameworks were based on Swanson’s earlier studies with women after miscarriage. The first defines five distinct characteristics of caring relationships and the latter identifies six common issues that confront couples after miscarriage.

Overall, the study showed that while women’s grief  resolution was accelerated by participation in any of the three intervention arms, their resolution of depression was best enhanced through receipt of three one-hour long, couples-focused nurse-led counseling sessions, Men’s responses were more complex. While the men in the nurse caring and control interventions took equally long to resolve their symptoms of depression, men who received either the self or combined caring intervention actually took longer than controls to resolve their depression. Men’s grief resolution, on the other hand, was most rapidly abated among those receiving the combined-caring intervention. Examination of men’s complex responses to treatment suggest that grief (a transitional response to loss) and depression (be it situational or clinical in origin) need to be studied and treated as different emotional responses.

“Through these findings, we saw that the three nursing-led counseling sessions were the most effective way to support the couple as a unit. They provided more time for the nurse and couple to connect and jointly address the meaning of miscarriage in the overall context of their lives,” Swanson said.

All improvements in depression were self-reported. Compared to women in the combined-caring, self-caring, or control arms, women who received three nurse counseling sessions were from 3.0 to 7.9 times more likely to realize a faster decline in their symptoms of depression.

Swanson acknowledges certain limitations to the study: the study sample was predominantly white and all couples were heterosexual. A notable strength of the study was that statistical analysis took into account how each individual’s healing was impacted by their mate’s recovery.

This research was funded by the National Institute of Nursing Research, National Institutes of Health, 5 R01 NR005343.

SON Doctoral Student Studying Feeding in Infants With Congenital Heart Disease

Infants with single ventricle congenital heart disease often experience difficulties with eating, placing them at risk for growth problems and greater morbidity and mortality. School of Nursing doctoral student Britt Pados is conducting a study to determine whether a particular feeding strategy will improve infant development.

In her study, titled “Feeding of Infants with Single Ventricle Heart Disease: Physiology and Behavior, Pados will study seven infants, observing how they react to three different feeding

SON doctoral student Britt Pados is researching the best method to feed infants born with a form of congenital heart disease.

SON doctoral student Britt Pados is researching the best method to feed infants born with a form of congenital heart disease.

methods — breastfeeding, bottle-feeding with a standard-flow nipple and bottle-feeding with a slow-flow nipple. The study has two aims: to examine heart rate and oxygen saturation changes and observe indicators of distress caused by each feeding method and to explore how heart rate variability affects the ability to understand physiological states before, during and after feeding.

The study, supported by a nearly $100,000, three-year Nurse Research Service Award from the National Institute of Nursing Research, National Institutes of Health, is intended to improve quality of life for the patients and help identify the most appropriate feeding strategies for infants with single ventricle congenital heart disease to achieve better growth and avoid complications.

Faculty member Barbara Mark Receives $1.6 Million Grant to Impact Healthcare Quality

Distinguished professor Barbara Mark received $1.64 million from the

Distinguished professor Barbara Mark received $1.64 million from the National Institute of Nursing Research to continue a predoctoral and postdoctoral training program.

Distinguished professor Barbara Mark received $1.64 million from the National Institute of Nursing Research to continue a predoctoral and postdoctoral training program.

National Institute of Nursing Research, National Institutes of Health to continue, for five additional years, a predoctoral and postdoctoral training program designed to improve healthcare quality and patient outcomes.

The new funding will support 12 predoctoral and eight postdoctoral trainees, preparing them to focus on clinical outcomes measurement and research translation/health policy.

Mark’s work is influenced by the Institute of Medicine’s (IOM) existing criteria for quality health care: safety, effectiveness, patient-centeredness, timeliness, efficiency and equity. It also aligns with a new partnership between the IOM and the Robert Wood Johnson Foundation — the Initiative on the Future of Nursing. The new initiative is designed to study, in part, ways to improve healthcare quality through nursing.

SON Faculty Member Helps Lead National Appeal to Congress

Under leadership from SON assistant professor Beth Lamanna, the Public Health Nursing Section of the American Public Health Association joined in the national effort to reform healthcare and ensure patients receive affordable, high-quality care. Lamanna is the chairperson for the Public Health Nursing Section (PHNS).

Along with 17 other national organizations, the PHNS signed a report — “Commitment to Quality Health Reform: A Consensus Statement for the Nursing Community” — that calls on Congress to invest $2 billion in Nursing Workforce Development Programs that will support 400,000 of the 1 million nurses needed by 2016. In addition, the letter calls for the development of recruitment, retention and incentive programs to address the shortage of nurses in the military.

The group also requests fair and equal treatment of all levels of nursing within the healthcare community. Increased funding for nursing science also made the list as the group asked Congress to bump up support for the National Institute of Nursing Research at the National Institutes of Health, the Agency for Healthcare Quality and Research, the Centers for Disease Control and Prevention and the Tri-Service Nursing Research Program.

To view the entire letter with all recommendations: http://www.apha.org/membergroups/sections/aphasections/phn/Resources/

Hypertension in African Americans

The School of Nursing congratulates Debra Barksdale who was notified today that her K23 (Mentored Patient-Oriented Career Development Award) has been funded by National Institute of Nursing Research (NINR). The title of her grant is, “Hypertension in Black Americans: Environment, Behavior, and Biology. Debra’s mentors for the grant are Joanne Harrell (UNC-CH SON) and Susan Girdler (UNC-CH SOM). If you are interested in learning more about Debra’s grant, see below for the abstract from her proposal – or just ask her. I know she would love to tell you about it.

Hypertension (HTN) is a major health problem for Black Americans: as a group they have the highest rate of HTN in the world. HTN develops at younger ages, is more severe, and leads to more adverse clinical outcomes and higher death rates for Blacks than for Whites. Chronic psychosocial stressors (e.g., daily hassles, racial discrimination and financial strain) are believed to contribute to the development of HTN. The purposes of the proposed mentored patient-oriented research career development award are to provide the necessary training experiences so that the candidate can achieve independence as an investigator conducting biobehavioral research and to begin to address the question of why some Blacks develop HTN while other Blacks do not. The training goals are to 1) expand knowledge of cardiovascular physiology and pathological mechanisms leading to HTN; 2) obtain expertise in the assessment of psychosocial stress and the integration of measures of psychosocial stress with physiological indices of stress; 3) obtain expertise in impedance-derived measurement of total peripheral resistance and to become skilled in the assessment of cardiovascular and neuroendocrine responses to acute laboratory-based stressors; 4) become proficient in the design, conduct and analysis of longitudinal studies and associated advanced statistical methods; and 5) disseminate results of research and develop a fundable R01 proposal. The candidate will engage in a 3-year intensive, supervised career development plan that will include: a) formal course work in HTN, stress, and advanced research methods; b) hands-on laboratory experiences with her mentors, consultants, and specialists; c) interdisciplinary experiences such as journal clubs, seminars, and conferences; and d) participation in mentors’ research team meetings. To compliment the training, the candidate will conduct a study to examine factors related to HTN in 128 Black men and women between the ages of 25 and 55. The study will compare Blacks with and without HTN for differences in indicators of allostatic load (sleep blood pressure, sleep total peripheral resistance, cortisol awakening response, and obesity); in chronic psychosocial stressors (daily hassles, racial discrimination, and financial strain); and in the moderating effect of positive and negative emotions, religious coping, and John Henryism active coping on the influence of chronic psychosocial stressors on indicators of allostatic load. A team of experienced researchers will serve as mentors and consultants in the areas of a) HTN and cardiovascular disease, b) physiological and psychological stress, c) biomedical assessment, and d) design and analysis of longitudinal research.

SON Study Shows Stretching May Reduce Preeclampsia Risk For Some

Stretching exercises may be effective at reducing the risk of preeclampsia for pregnant women who have already experienced the condition and who do not follow a workout routine, according to researchers at the University of North Carolina at Chapel Hill School of Nursing.

Preeclampsia, or pregnancy-induced hypertension, is a condition that affects up to 8 percent of pregnancies every year and is among the leading causes of maternal and fetal illness and death worldwide.

The finding is contrary to existing studies and literature that suggest that rigorous exercise is the most effective way to reduce the risk of preeclampsia, said SeonAe Yeo, Ph.D., an associate professor with a specialty in women’s health at the UNC School of Nursing and the study’s lead researcher.

Yeo will present the findings Thursday (May 29) at the annual meeting of the American College of Sports Medicine in Indianapolis, Ind. The results will be published in the spring issue of the journal Hypertension in Pregnancy.

Preeclampsia is characterized by a marked increase in blood pressure during pregnancy and may be accompanied by swelling and kidney problems. It is diagnosed when blood pressure readings taken twice in six hours read 140/90 or higher.

“These results seemingly contradict the conventional wisdom that walking is the best protection pregnant women have against developing preeclampsia,” Yeo said. “But for women who were not physically active before becoming pregnant and who have experienced preeclampsia with a previous pregnancy, that might not be the case.”

From November 2001 to July 2006, 79 women with a previous preeclampsia diagnosis and a sedentary lifestyle participated in this National Institute of Nursing Research-funded study. Women were randomly assigned to either the walking group (41 women) or the stretching group (38 women) during the 18th week of pregnancy.

The walking group was asked to exercise for 40 minutes five times a week at moderate intensity, following the program recommended by the Surgeon General and the American College of Obstetrics and Gynecology. Stretchers were also asked to perform slow, non-aerobic muscle movements with a 40-minute video fives times a week. Frequency and duration of exercise decreased in both groups as the pregnancy progressed.

At the end of pregnancy, almost 15 percent of women in the walking group had developed preeclampsia. Less than 5 percent of the stretching group developed the condition. While the incidence of preeclampsia in the walking group was similar to that reported in high-risk pregnancies, the frequency among the stretching group was similar to rates seen among the general population.

“Clearly, walking does not have a harmful effect during pregnancy,” Yeo said. “But for women who are at high risk for preeclampsia, our results may suggest that stretching exercises may have a protective effect against the condition.”

Stretching could provide protection against preeclampsia because stretchers produced more transferrin than walkers did, Yeo said. Transferrin is a plasma protein that transports iron through the blood and protects against oxidative stress on the body.

Yeo said these results could help prenatal care providers recommend different exercise plans based on an individual pregnant woman’s needs and abilities. Following an active exercise plan is good, she said, but only if a pregnant woman is truly able to do it. For some who already have a risk of preeclampsia, stretching might be a better option.

Co-authors of the study include Sandra Davidge, Ph.D., the University of Alberta; David L. Ronis, Ph.D., the University of Michigan School of Nursing and Veteran Administration Hospital; Cathy L. Antonakos, Ph.D., the University of Michigan School of Nursing; Robert Hayashi, M.D., the University of Michigan; and Sharon O’Leary, M.D., St. Joseph Mercy Health Systems.

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