Health News
UF will talk about the Women's Health Initiative
By John Pastor
The director of preventive cardiology at the University of Florida will talk about the Women's Health Initiative, a national effort to address the most common causes of death, disability and impaired quality of lifein postmenopausal women, at 7 p.m. Tuesday at UF's McKnight Brain Institute.
Dr. Marian Limacher will describe major findings and identify what remains to be done as the multimillion-dollar prevention study nears the end of its 15-year mission. In addition, she will discuss what constitutes a clinical research trial and explain why participation is so important.
Limacher, a professor of medicine, also serves as the principal investigator for the UF Clinical Center for the Women's Health Initiative. Her talk is part of a series called "Topics in Medical Research: Learn how Research in Human Volunteers Improves Medical Practice and Health Care," which UF's General Clinical Research Center is sponsoring.
Other upcoming speakers include Dr. N. Lawrence Edwards, a professor of rheumatology and immunology, who will talk about arthritis and related disorders on March 1. The final presentation will feature Dr. Mark Brantly, a professor of critical care and pulmonary medicine, who will speak on March 8 about advances in chronic obstructive lung disease.
Each talk begins at 7 p.m. at the Deweese Auditorium inside the main entrance of the McKnight Brain Institute and will feature a 30-minute presentation followed by 15 minutes for questions and 15 minutes to meet the presenter. Anyone interested may attend. Parking is free at the east parking garage of Shands at UF medical center. Call (352) 265-0032 for more information.
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University of Florida College of Nursing to implement new
Clinical Nurse Leader track beginning in summer 2005
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By Tracy Brown
GAINESVILLE, Fla. - How do you tackle the nursing shortage and patient care crisis when the number of nurses falls far short of those needed to work in the increasingly complex health care settings of the future? The answer: educate a new kind of nurse.
As part of a national pilot program, beginning in summer 2005, the University of Florida College of Nursing will admit its first class of students to become that new kind of nurse, the Clinical Nurse Leader.
For today's patients, the health care system is often a confusing maze. Fragmentation of patient care, complex technology and severity of illness contribute to patients' frustrations with hospital and health care facilities. A series of reports in the past several years by bodies such as the Institute of Medicine, the American Hospital Association and the Robert Wood Johnson Foundation confirm the need for a better educated nursing workforce and for reforms in health-care delivery overall. The reports state that while there is a need for more nurses to alleviate the shortage, simply increasing numbers of nurses will not address the critical problems in patient care.
National nursing leaders believe that the CNL role can address these issues and make significant contributions to improvements in health care. UF is among 74 participating colleges nationally were chosen to pilot the CNL program.
The CNL provides the link between the patient and the health care setting. CNLs will collaborate with the patient's family members, seek consultation with other members of the health care team and serve as the patient's advocate in the health care system. The CNL will be a source of emotional support, empowerment and knowledge for patients and their families. The CNL will be a resource to other nurses and health care providers.
In short, the CNL focuses on ways for hospitals and other health care facilities to provide the best possible patient care.
"Nursing education must attract and retain the best clinical nurses for our health care settings," said Kathleen Ann Long, Ph.D., A.P.R.N., F.A.A.N., dean of the University of Florida College of Nursing. "The new CNL program will attract nurses who want to advance their knowledge and abilities while retaining a focus on direct patient
care."
The Clinical Nurse Leader will be a master's degree-prepared generalist clinician who effectively coordinates, manages and evaluates care for individuals and groups of patients. The CNL will function as part of the client's health care team and will bring a high level of clinical competence and knowledge to the point of care.
The national CNL pilot program was developed by the American Association of Colleges of Nursing, in consultation with AACN members, nursing practice leaders, regulators and other health professions.
AACN nursing education leaders collaborated with nursing practice leaders to consider models for education and practice that would be patient-centered, cost-effective and quality-driven. They identified the need for a new kind of nursing professional, the CNL.
The CNL is a partnership between nursing education and practice. Currently, the college has one of the largest groups of CNL practice partners in the nation. The five practice partners include Shands at the University of Florida, Shands Jacksonville, Malcom Randall VA Medical Center - part of the North Florida/South Georgia VA Health System - Wolfson's Children's Hospital in Jacksonville and Baptist Medical Center in Jacksonville. The college and its practice partners will participate in a national evaluation project to determine if newly-designed practice units incorporating the CNL role will result in desired improvements in patient care.
"Nursing leaders are seeking innovative and realistic ways to stabilize our workforce and to advance the knowledge, skills and abilities necessary for nurses to remain competent and confident practitioners," said Ginger Campbell, chief nursing officer at Shands Jacksonville. "By focusing on the CNL unit-based and patient-centered model of care delivery, we can expand the scope of nursing practice using credentialed nurses who demonstrate an astute ability to assess and treat patients and evaluate outcomes that are directly affected by nursing practices."
The UF College of Nursing will admit the first class of CNL students this summer on both of its Gainesville and Jacksonville campuses. Potential students are expected to be recent BSN graduates and experienced BSN nurses.
The CNL program is a 15-month full-time graduate program. It will culminate in an intensive residency on model units at each of the college's practice partner sites. These units will provide a new form of client patient care, one in which the CNL role is pivotal. Students will have both faculty members and clinical mentors to guide them through the residency.
Graduates will be eligible to sit for the CNL national certification examination. Future plans for the CNL include a new legal scope of practice and professional license. The American Association of Colleges of Nursing will assume leadership and engage appropriate stakeholders in these activities.
"Those who lead nursing today will determine its future," said Dean Long. "The weight of that responsibility guides our college not only to protect the history and heritage of the profession, but to reach out and envision, shape, and support the next century of nursing on behalf of our patients."
Those interested in the master's CNL track should visit the College of Nursing Web site, www.nursing.ufl.edu or call (352) 273-6366 in Gainesville or (904) 244-5166 in Jacksonville.
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Culture clash: Kids with chronic illness face difficult transition to
adult care
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By Denise Trunk
GAINESVILLE, Fla. - For young patients who grow to adulthood with a chronic illness, leaving behind the pediatrician who may have saved their lives can be a tough transition.
More than half a million children with special health-care needs will turn 18 this year, the first generation to reach adulthood since sweeping medical advances ensured an unprecedented number would survive congenital conditions that until recently would have killed them. The influx is straining an already burdened health-care system, and patients and their physicians are feeling the added stress, according to a study by researchers at the University of Florida's Institute for Child Health Policy appearing in the current issue of Pediatrics.
"We are looking at the very beginning of that wave, because this is the first generation to turn 18 since the technology and treatments have allowed them to survive to adulthood," said lead researcher John Reiss, Ph.D., policy and program affairs chief at UF's Institute for Child Health Policy. "That number will grow, and this will put phenomenal pressure on adult medicine."
Doctors liken it to a culture clash, as adolescents and families adjust to a very different style of health care.
Young patients must say goodbye to the physicians they trust and who often took a team approach to their care by incorporating the opinions of many specialists to optimize a treatment plan for ailments such as cystic fibrosis, sickle cell disease or congenital heart conditions. Many adult practitioners tend to work more independently and are less familiar with how to manage these complex cases because they haven't routinely encountered them in standard practice. The issue can be costly for patients, both physically and financially, said UF research associate Robert Gibson, Ph.D.
"It is like waking up in France one day," Gibson said. "You don't speak French and you have no idea how to get around the city and you say, 'Wait a second. How did I get here?'"
Pediatric hospital systems or practices generally stop serving patients at the ages of 18 or 21, and about 600,000 patients with chronic illnesses are now reaching adulthood every year, Reiss said. Nearly 40 percent of the patients living with childhood-onset cystic fibrosis, for example, are 18 or older, according to the Cystic Fibrosis Foundation's National Patient Registry. As these patients age, their care can be complicated by reproductive issues and other ailments, such as diabetes.
Past studies have shown the transition isn't easy even for the average healthy adult - often because of lack of insurance - and many drop out of the health-care system until they become sick. However, a smooth shift is vital for young adults with chronic illness, who cannot afford to experience a lapse in care, Reiss said. Yet these patients often must switch doctors at a time when they, too, are least likely to be covered by health insurance, in part because of their higher rates of underemployment and unemployment.
Until recently, physicians may have handled one or two such individuals a year, and it was possible to work around the system, Reiss said.
"You didn't need to think about a population-based approach to handling the problem. You could take an individual patient-based approach," Reiss said.
To learn how patients move into adult medical care, UF researchers conducted 34 focus groups, involving 143 patients, families and health providers, to gather information about participants' experiences with health-care transitions. Study participants also answered questions about which factors made transitions successful or unsuccessful.
Researchers said many patients reported differences in care, such as difficulty in receiving adequate pain relief after making the transition into adult practice. Others were concerned about quality and comprehensiveness of care; some were the first patient their adult physician had ever seen with their particular health condition.
Researchers also found that a mutual trust forms among pediatric patients, their families and their health-care providers. Saying goodbye to the doctor who has handled their care since they were diagnosed can be difficult for patients, and that bond can present a barrier to effectively transitioning into adult-oriented medicine. Patients and families surveyed said they perceived pediatric staff to be more available for questions and emotional support.
Patients and families whose outlook focused on the future were more likely to experience a smooth transition, the study showed. Gibson, who conducted the study's data analysis, said it was necessary for patients and their families to look at the change as part of the developmental process.
"The people that we talked to who were most successful understood transition from the moment the child received the diagnosis," Gibson said. "Just like with a healthy child, you anticipate they are going to go to college or live independently in a community. There are things you do developmentally throughout their childhood to prepare them for that early on."
UF researchers say the results suggest the medical community may need to create a more consumer-friendly medical system that would break down barriers to age-appropriate care, improve doctor-patient communication and incorporate a protocol for handling the transition. Internists and other adult practitioners, meanwhile, should talk to pediatricians about patients' conditions and treatment strategies at the time they switch practices, Reiss said.
Elizabeth Tong, M.S., a clinical research nurse at the University of California, San Francisco's division of pediatric cardiology and an associate clinical professor at UCSF's School of Nursing, said Reiss's research spotlights the need for health professionals to tailor specific interventions to this population.
"Young adults with chronic health conditions is an emerging and growing group of patients, and health professionals as a group are still relatively inexperienced in understanding what are the medical, social and financial needs of young adults," Tong said. "Qualitative analysis work by Dr. Reiss and others allows us to directly hear from patients what their needs are and how the current system is or is not meeting their needs. This input from patients provides the necessary groundwork for developing appropriate and meaningful interventions and care."
Educating patients, their families and medical personnel is necessary to address the needs of this growing population of special needs patients, Reiss said.
"It may require the medical system to reorient itself toward the needs of patient, rather than the provider," he said, "to the benefit of everyone."
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