Neonatal/Maternal Child Health
Oxytocin Mechanism During Maternal and Paternal Skin to Skin contact with Preterm Infant
The purpose of this randomized cross-over study is to examine the oxytocin (OT) mechanism during maternal and paternal skin-to-skin contact (M-SSC and P-SSC) with preterm infants in the neonatal intensive care unit (NICU).
Objective: The study will examine oxytocin (OT) mechanism in modulating infants’ behavioral, autonomic, and stress responses and parental stress and anxiety during maternal and paternal skin-to-skin contact (M-SSC and P-SSC) with preterm infants. Infant behavioral states, spectral analysis of heart rate variability (HRV) (sympathetic-parasympathetic balance indicated by the ratio of low frequency [LF] to high frequency [HF] power, LF/HF ratio), and salivary cortisol will be measured as the primary outcome measures of infants’ responses. Parental salivary cortisol and visual analog scales of anxiety will be measured as parental responses.
Our Hypotheses are:
H1. Primary: Infants’ and parents’ salivary OT levels will be higher during- M-SSC/P-SSC, compared to pre- and post- SSC;
H2. Exploratory: Changes in infants’ OT levels, during- vs. pre- and during- vs. post- M-SSC/P-SSC, will be positively correlated with changes in infants’ quiet sleep time, and negatively correlated with changes in LF/HF ratios and cortisol levels; and
H3. Exploratory: Changes in parents’ OT levels, during- vs. pre- and during- vs. post- M-SSC/P-SSC, will be negatively correlated with changes in parents’ cortisol levels and anxiety scores. Funded by American Nurses Foundation, Xiaomei Cong, PI.
Early Life experience imprints gut microbiome in preterm infants
This research project examines the new models of brain-gut-microbiota signaling mechanisms involved in early life stress and prediction of infant neurodevelopment using cutting-edge microbiological and immune-inflammatory biomarker prediction strategies. Three specific research aims are proposed in a prospective longitudinal study to examine: (1) preterm infants’ gut microbiome patterns and mucosal immune-inflammatory responses over the first 3 weeks of NICU stay; (2) the linkage of gut microbiome patterns and mucosal immune-inflammatory responses with early life stress; and (3) the linkage of gut microbiome and mucosal immune-inflammatory responses with autonomic nervous and neurobehavioral outcomes. Study results will provide the preliminary data for an R01 grant proposal and will further contribute to neonatal care in reducing negative consequences of stress in high-risk infants. A Patient-Oriented Career Development Award (K23) Funded by National Institute of Nursing Research, Xiaomei Cong, PI.
Early Life Physiological and Psychosocial Stress Imprints Gut Microbiome in Preterm Infants
Over the past decade, advances in neonatal care have led to substantial increases in survival among very preterm infants (≤ 32 weeks gestation). With these gains, recent concerns have focused on significant increases in neurodevelopment morbidity such as white matter damage in the developing brain and serious diseases such as necrotizing enterocolitis (NEC) linked to immature neuro-immune systems and early life stress. In the neonatal intensive care unit (NICU), premature infants are often exposed to a variety of early life stressors, including repeated painful procedures, daily clustered care, infection, antibiotic treatment, and maternal separation during critical neurodevelopmental windows. Nearly 40% of NICU survivors have at least one neurodevelopment deficit and the resultant costs exceed $26.2 billion per year plus the added burden for families and society. Yet, mechanisms of early life experiences that alter infants’ health outcomes remain largely unknown.
The brain-gut signaling system in conjunction with the composition of the gut microbiome has been found to be remarkably related to life-long stress and health. Recent evidence demonstrates that microbial species, ligands, or products within the developing intestine are crucial to early programming of the central nervous system and regulation of intestinal innate immunity. The central hypothesis driving this translational research is that premature infants subjected to stressful early life experiences develop an altered gut microbiome increasing risk for neurodevelopmental morbidity and gastrointestinal (GI) dysfunction relative to the development of NEC. Using state-of-the-art analytic and computational methods, our study will be the first study to investigate the linkage of early life stress with the brain-gut-microbiota mechanism in human preterm newborns. A prospective longitudinal design will be used to examine:
Aim 1: Preterm infants’ gut microbiome patterns over the first 3 weeks of NICU stay;
Aim 2: The linkage of gut microbiome patterns with early life stress;
Aim 3: The linkage of gut microbiome with autonomic nervous system responses, neurodevelopmental outcomes, and patterns of GI dysfunction related to the development of NEC.
During the 5-year study conducted in the CCMC NICU (Hartford and Farmington), 50 stable preterm infants (28 0/7 – 31 6/7 weeks gestation) will be recruited and followed for 3 weeks. The outcome measurements are gut microbiota (16S rRNA, metagenomic, and metatranscriptomic sequencing), early life stress (NICU Infant Stressor Scale), autonomic responses (spectral analysis of heart rate variability), neurodevelopmental outcomes (NICU Network Neurobehavioral Scale), and GI dysfunction (enteral feeding and NEC incidences). Data collection will begin on day one of life once consent is obtained from parents. Stool samples and autonomic responses will be collected on postnatal days 1 to 5, 7, 10, 14, 18, and 21 (10 data collection points), early life stressors will be measured daily, and neurodevelopmental outcomes will be examined at 36 weeks post-menstrual age prior to NICU discharge. GI dysfunction will be measured throughout the NICU stay. Exploratory data analysis will be conducted with a focus on the evolution in each variable’s distribution over time and linkages among variables. Funded by the Institute for Systems Genomics (ISG), Xiaomei Cong, PI.
Factors Related to Prevalence of Sustained Breastfeeding
Background: The late preterm infant (35-38 weeks gestation) exhibits physiologic risk for less than adequate nutritional intake when exclusively breastfeeding, and therefore may require supplemental feedings. There is little evidence to support the best practice to produce the long term outcome of sustained breastfeeding in this population.
Purpose: The purpose of the proposed pilot, exploratory, correlational study is to determine the prevalence of sustained breastfeeding in the late preterm infant at one and two months of age. In addition, exploring which factors may predict sustained breastfeeding in the late preterm infant will be examined.
Methods: Variables for the proposed study will be breastfeeding self-efficacy, in-hospital lactation consultations, use of supplemental feeding methods, maternal and infant demographic data, characteristics of the birth process, in-hospital feeding practices, and post discharge lactation support. After informed consent, subjects identified through purposive sampling will tabulate their Breastfeeding Self-Efficacy Scores and lactation support, supplemental feeding methods used, and demographic factors will be collected. At one and two months of age, telephone structured interviews will determine the current feeding status and assess post discharge lactation support.
Statistical Analysis: Descriptive statistical and bivariate logistic regression analysis will identify the prevalence of sustained breastfeeding in this population and articulate the predictive capacity of the data collected for sustained breastfeeding at one and two months of age.Impact on Nursing Practice: By determining the prevalence of and identifying what factors are related to sustained breastfeeding in late preterm infants, there will be evidence to support practice guidelines in this population. Funded by Sigma Theta Tau Mu Chapter, Joan Kuhnly, PI
Exclusive Breastfeeding Promotion among HIV+ mothers: A theory-based approach
In 2010 approximately 370,000 children were newly infected with HIV worldwide as a result of mother-to-child transmission (MTCT). Over 90% of these infections occurred in South Africa. HIV represents the main cause of maternal mortality in South Africa and accounts for over 50% of deaths in children under 5 years old.
Exclusive breastfeeding (EBF) has been identified as a key intervention to reduce MTCT of HIV and improve infant health. Although breastfeeding by HIV+ mothers carries a risk of HIV transmission from mother-to-child, that risk decreases from 42% to 2% with the practice of EBF and appropriate antiretroviral therapy. The mechanism by which EBF is associated with lower MTCT is not fully understood, but believed to maintain the gastrointestinal barrier, which is thought to be the primary site of infection. The multiple benefits of EBF in protecting infants from MTCT of HIV and providing optimal nutrition while protecting them against diarrheal and respiratory illness compared to other feeding methods are significant. Given the overwhelming evidence illustrating these benefits, in 2010 the World Health Organization updated their infant feeding guidelines to recommend in limited-resource settings HIV+ mothers engage in EBF for the first 6 months of their infant’s life. However, despite increased resources devoted to promoting EBF within prevention of MTCT of HIV programs, it remains a rare practice. In South Africa, 76% of HIV+ mothers feed their infants a combination of breast milk, cow milk and porridge by 3 months, and approximately 25% introduce water within the first 3 days of the infant’s life.
Using the Information, Motivation, and Behavioral Skills (IMB) model of health behavior change as the theoretical and conceptual framework, the proposed study aims to change prevalent non-EBF practice through a well-targeted IMB-model based intervention. The IMB model is applied to elicit the most prominent IMB barriers inhibiting mothers living with HIV from practicing EBF and using this data to inform the design of an IMB-model based intervention to enhance those IMB determinants influencing EBF behavior using motivational interviewing techniques. Rigorous evaluation will occur to evaluate the efficacy of the intervention on EBF-relevant information, motivation, behavioral skills determinants, and EBF practice at 6 weeks follow-up. The proposed study contributes an innovative and practical approach to help eliminate MTCT of HIV through utilizing a well-established and empirically proven model that has been successfully implemented to eliminate other types of HIV risky behavior in South Africa. A contribution that constitutes a critical step in meeting the 2011-2015 Millennium Development Goals established by the United Nations General Assembly Special Session. (Funded by National Institute of Mental Health, Sigma Theta Tau Mu Chapter, and the Toner Fund, Emily Tuthill, PI, Regina Cusson, Graduate Committee Chair)
Promoting Exclusive Breastfeeding among HIV positive mothers in South Africa: a theory-based approach using the Information, Motivation and Behavioral skills model of health behavior change
Purpose: Using the Information, Motivation, and Behavioral Skills (IMB) model of health behavior change as the theoretical and conceptual framework, the proposed study aims to change prevalent non-EBF practice through a well-targeted IMB-model based intervention.
Background: In 2010 approximately 370,000 children were newly infected with HIV worldwide as a result of mother-to-child transmission (MTCT). Over 90% of these infections occurred in South Africa. HIV represents the main cause of maternal mortality in South Africa and accounts for over 50% of deaths in children under 5 years old. Exclusive breastfeeding (EBF) has been identified as a key intervention to reduce MTCT of HIV and improve infant health. Although breastfeeding by HIV+ mothers carries a risk of HIV transmission from mother-to-child, that risk decreases from 42% to 2% with the practice of EBF and appropriate antiretroviral therapy. The multiple benefits of EBF in protecting infants from MTCT of HIV and providing optimal nutrition while protecting them against diarrheal and respiratory illness compared to other feeding methods are significant. Given the overwhelming evidence illustrating these benefits, in 2010 the World Health Organization updated their infant feeding guidelines to recommend in limited-resource settings HIV+ mothers engage in EBF for the first 6 months of their infant’s life. However, despite increased resources devoted to promoting EBF within prevention of MTCT of HIV programs, it remains a rare practice. In South Africa, 76% of HIV+ mothers feed their infants a combination of breast milk, cow milk and porridge by 3 months, and approximately 25% introduce water within the first 3 days of the infant’s life.
Methods: The proposed project included two phases. In Phase 1 the IMB model is applied to elicit the most prominent IMB barriers inhibiting mothers living with HIV from practicing EBF using focus group discussions and interviews. Phase 2 involves using this data to inform the design of an IMB-model based intervention to enhance those IMB determinants influencing EBF behavior using motivational interviewing techniques. Our IMB intervention will be piloted in a RCT with a control (n=34) and intervention arm (n=34). Rigorous evaluation will occur to evaluate the efficacy of the intervention on EBF-relevant information, motivation, behavioral skills determinants, and EBF practice at 6 weeks follow-up.
Implications: The proposed study contributes an innovative and practical approach to help eliminate MTCT of HIV through utilizing a well-established and empirically proven model that has been successfully implemented to eliminate other types of HIV risky behavior in South Africa. A contribution that constitutes a critical step in meeting the 2011-2015 Millennium Development Goals established by the United Nations General Assembly Special Session and produces a valuable tool that nurses in South Africa can utilize with their patients. Funded by the American Nurses Foundation award, Emily Tuthill, PI, Jacqueline McGrath, Co-Investigator.
Maternal Assessment of Infant Breastfeeding Pattern
Purpose: The purpose is to 1) to describe maternal perceptions of infant breastfeeding behaviors weekly from birth to 1 month of age and 2) to determine how infants’ breastfeeding behaviors and breastfeeding behavior type changes from birth until 1 month after discharge.
Background/Significance: Although the goal for mothers and infants is to exclusively breastfeed for six months, barely half of all mothers exclusively breastfeed their infants beyond two weeks of age. The most commonly reported maternal reasons for breastfeeding cessation, lack of infant satiation, milk insufficiency, and ongoing cracked and bleeding nipples, may actually be an outcome of an infant’s breastfeeding behaviors. Developing a maternal self-report instrument that describes different types of ineffective latch and inefficient breastfeeding patterns would assist mothers to seek professional assistance and clinicians to identify mothers and infants at risk for early breastfeeding cessation.
Methods: A prospective longitudinal study will be utilized to describe mothers’ perception of their infants’ breastfeeding behaviors and their selection of their infants’ breastfeeding behavior type during hospitalization, at 1-, 2-, 3- weeks and 1 month after hospital discharge.
Setting/Sample: Fifty mother-infant breastfeeding dyads will be recruited from the Birthing Center of Duke Hospital, a regional referral center with 3300 births per year. Infants > 34 weeks gestation will be recruited from the Well-Baby Nursery and Special Care Nursery
Procedures: Data will be collected via chart review, maternal self-report instrument, and audio taped semi-structured interview at enrollment in the hospital, and audio taped semi-structured interview telephone calls and maternal self-report instrument at 1-, 2-, 3- weeks, and 1 month after hospital discharge.
Analysis plan: Analysis of research questions will include simple number and percentages to describe infant breastfeeding behaviors and behavior types and a Generalized Linear Mixed-Effects Models applying Generalized Estimating Equations to examine infant breast feeding behaviors over time. In addition, a set of 2 x 2 Fisher’s Exact Tests will be performed to examine the association between the absence (0) and presence (1) of each type of breastfeeding behavior at each assessment point based on maternal perceptions, and a set of bivariate logistic regression analyses will be performed to examine the influence of potential explanatory variables on breastfeeding cessation by 1-month, controlling for maternal and infant characteristics.
Nursing Relevance/Implications: Development of a reliable maternal self-report instrument of infant breastfeeding behavior types will facilitate early identification of mother-infant dyads at-risk for early breastfeeding cessation. The long term goal of this research is to validate the maternal self-report instrument with the physiological parameters of nutritive sucking using the number of sucks, number of sucks per burst to quantify ineffective and inefficient infant breastfeeding behaviors to identify infants at-risk for early cessation of breastfeeding and altered neurodevelopment. Funded by the American Nurses Foundation, Ruth Lucas, PI, Jacqueline McGrath, Co-Investigator.
Maternal Assessment of Infant Breastfeeding Behaviors
Breastfeeding is beneficial to mother and infant. However, in 2011, only half of all breastfeeding dyads are exclusively breastfeeding at two weeks. Research has extensively examined maternal factors contributing to successful breastfeeding initiation and duration. Little research has examined infant factors that contribute to breastfeeding success. Presently, an infant’s breastfeeding success is measured by infant satiation after feeding and normative growth. These two infant outcomes depend on an infant’s ability to create an effective latch, vacuum at the breast, and sustain an efficient latch, adequate milk transfer for satiation and growth. Infant factors that likely contribute to breastfeeding discontinuation are an ineffective infant latch and lack of an efficient pattern. During an infant’s hospital stay, professional tools and breastfeeding support is focused on the infant creating an effective latch. Evaluation of an efficient pattern during hospitalization is by the number of audible swallows and may be difficult to assess as maternal milk is being established. A maternal assessment of effective and efficient feeders would help mothers before and after their milk is established to identify if their infant is at risk for breastfeeding cessation. Currently, observation of breastfeeding behaviors is the gold standard to assess nutritive sucking parameters. The most robust parameters for effective latch is average maximum pressure, and for efficient patterns are visual observation of the number of sucks and the number of sucks per burst during a feeding. Measuring the average maximum pressure does not have readily available apparatus within the United States. However, an infant is not able to sustain an efficient pattern without an effective latch. A recent maternal assessment in a retrospective Japanese study had mothers describe their infant as one of five different categories of breast feeders: barracudas (vigorous), resters, gourmets, excited-inefficient, and procrastinators. Each category of breast feeders was described with different breastfeeding durations and different combinations of effective and efficient breastfeeding behaviors. The purpose of this pilot study is to determine the reliability of weekly maternal assessment of infant breastfeeding behaviors using the categories of breast feeders and to test the feasibility of comparing maternal assessment of categories of breast feeders to observed infant behaviors. My program of research trajectory is to further expand maternal assessment of infant breastfeeding behaviors to be used as a screening tool for atypical neurodevelopment and early identification of infants to refer to early intervention. Funded by the Association of Women’s Health Obstetrics and Neonatal Nurses, Ruth Lucas, PI, Jacqueline McGrath Co-Investigator.
Maternal Descriptions of Late Preterm Infant Breastfeeding Behavior Types
Problem: Although the goal for mothers and late preterm infants is to transition to breastfeeding exclusively, little is known about late preterm infant breastfeeding behaviors during the first month after discharge home. The purpose of this study is to examine maternal descriptions of their infant’s breastfeeding behavior and have mothers categorize their infant’s breastfeeding behavior using a maternal report instrument of infant breastfeeding behavior types. Mother-preterm infant dyads will be followed weekly from enrollment to 1 month after discharge.
Method: A prospective descriptive pilot study.
Sample: A convenience sample of 25 mother-preterm infant (34 – 36 6/7 weeks gestational age) breastfeeding dyads.
Instruments: A semi-structured interview of mothers describing their late preterm infant breastfeeding behaviors and a maternal report instrument of infant breastfeeding behavior types.
Procedure: Mother-preterm infant breastfeeding dyads will be recruited after delivery and before infant discharge for four weekly contacts. At weekly contact, mothers will be interviewed using a semi-structured interview and mothers will also be asked to complete a maternal report instrument categorizing their infant’s breastfeeding behavior type.
Significance: Information from this study will identify infant breastfeeding behaviors that may contribute to early breastfeeding cessation, partial at-breast feeding and exclusive at-breast feeding and thereby assist mothers to seek timely professional assistance. Funded by National Association of Neonatal Nurses, Ruth Lucas, PI, Jacqueline McGrath, Co-Investigator
Oxytocin Mechanism During Maternal and Paternal Skin to Skin contact with Preterm Infant
The purpose of this randomized cross-over study is to examine the oxytocin (OT) mechanism during maternal and paternal skin-to-skin contact (M-SSC and P-SSC) with preterm infants in the neonatal intensive care unit (NICU).
This study develops, implements, and tests the efficacy and feasibility of the Homecare Education, Assessment, Remote-monitoring, and Therapeutic activities (HEART) program. HEART is a nurse-led, multicomponent, home care intervention developed by the principal investigator (PI) that is grounded in the Self-Care in Heart Failure Model (Moser & Watkins, 2008). It combines evidence-based protocols and telemonitoring (TM) to teach heart failure (HF) self-management (Albert, 2006; Naylor et al., 2004; Riegel et al., 2009) and to alleviate depressive symptoms (Bruce et al., 2011; Ell et al., 2007). The goal of this research is to improve quality of life (QOL) and other outcomes for home care patients with HF. (Funded by Sigma Theta Tau International, Colleen Delaney, PI.
Reducing Stress Among Correctional Nurses Through Focus Groups
This pilot study is proposed to evaluate whether participation by correctional nurses in focus groups that elicit their job-related concerns and that are followed, when possible, by administrative response to those concerns will be associated with a subsequent reduction in their levels of stress. The focus groups will be conducted at three correctional facilities over a six-month period. Organizational support for the project and involvement from administrative leadership in it have been obtained along with a commitment to follow up quickly, when possible, on issues discussed in the focus groups. The Harris Nurse Stress Index will be administered prior to focus group participation and, again, 30 days later. Funded by Center for the Promotion of Health in the New England Workplace, Denise Panosky, PI.
Connecticut Collaborative to Promote Mental Health Services Research in Corrections
An existing public-academic research partnership between the Connecticut Department of Correction (CDOC), the University of Connecticut, and the University of Connecticut Health Center seek to continue research infrastructure development to achieve a transformational process where the research mission is consistent, well understood, accepted, and integrated into daily institutional practices of CDOC. Over the past eleven years, the role of research has been gaining attention for its ability to inform the CDOC system, leveraging quality improvement and organizational development for safe institutional environments and safe communities. This progress is impeded by the shifting ecology imposed by the economic and socio-political environment. This partnership seeks to move beyond demonstration projects or singular research projects and move toward a more integrated and widespread use of research findings in the system. Building upon the work of Fixsen, Blase, Duda, Metz, Naoom, and Van Dyke (2008) utilizing an implementation research model, this partnership seeks to create implementation capacity to allow innovations and demonstrations to be deployed effectively. Of particular interest is the deployment of evidence-based practices that have been tested in our clinical settings and are ready for system-wide implementation. In doing this, a new translational research model is proposed that fits the unique and shifting ecology of the Connecticut correctional research environment.
The three objectives include:
a.) Build on existing foundations to create a sustainable environment /capacity for research;
b.) Link existing data from systems between correctional research partner agencies for the conduct of research;
c.) Create opportunities for future correctional researchers to maintain/sustain research infrastructure.
In keeping with Fixsen’s model, a research focused “transformation zone” will be created in which interdisciplinary and cross agency workgroups collaborate on each of the target bjectives. The potential impact proposed by this partnership is to develop a new translational research model that fits the unique and contextually social responsive correctional research environment.
Three strategies for long term sustainability follow suggested essential implementation outcomes: to effect changes in adult professional behavior, changes in formal and informal organizational structures and cultures to support the changes in adult professional behavior; and, changes in relationships to consumers and stakeholders.
By aligning project activities with other agencies that have overlapping organizational strategic goals there can be a synergistic leveraging of resources to maximize quality improvement and organizational development to achieve a safer CDOC institutional environment and a safer Connecticut community. Future opportunities for collaboration with other states would maximize the system’s capacity to transform through dissemination and perpetuating excitement within the research community about achievements. Funded by National Institute of Mental Health, Deborah Shelton, PI.
A Booster Intervention to Sustain Treatment Gains and to Support Community Re-entry in a Connecticut Correctional Institution: A Pilot Study.
The goal of the study is to evaluate the effectiveness of a brief educational program to reinforce self care skills and to provide support as inmates prepare to return to the community.
RUN with LC: Starting with Middle School Students
The University of Connecticut (UConn) School of Nursing (SON) recognizes the need to enhance the diversity of the nursing workforce and is committed to addressing the specific needs of underrepresented and educationally disadvantaged populations in order to increase nursing education opportunities.
UConn preparing tomorrow’s nurse educators: NFLP
Under the auspices of NFLP funding, UConn preparing tomorrow’s nurse educators: NFLP aims to prepare a minimum of 10 graduates from doctoral programs to teach in collegiate programs of nursing education over a multiple year period. We have a combined DNP and PhD doctoral enrollment of more than 60 students. Of these, 50% are interested in education as a career.
UConn School of Nursing (SON), in collaboration with the university’s Institute of Teaching and Learning (ITL), offers a six or nine credit certificate program for Teaching in the Health Professions. This certificate program is intended to provide graduate students with a significant credential on their transcripts in the area of instructional design, understanding and competence. This is an opportunity for graduate students across the campuses to gain teaching instruction, classroom management, techniques using technology, assessment and evaluation, and other pedagogical best-practice expertise in both general and discipline-oriented areas. The objectives of this program are to deliver and document such skills in both a theoretical and pragmatic manner. Three credits are taught by staff of the ITL and six credits are taught by nursing faculty. The expectation is that all NFLP recipients enroll in the six credit certificate program and the nine credit program if they are also a graduate assistant within the School of Nursing.
All new NFLP awardees will be invited to join the existing learning community which meets monthly and addresses the role and responsibilities of nurse faculty, the challenges and opportunities of working with diverse student populations, the benefits and challenges of utilizing varied teaching methods, and the time management skills needed to be an effective educator.
Lastly, the SON will continue to collaborate with the UConn bursar’s office to implement and evaluate systems to manage the interview, “collection, repayment, monitoring, and tracking of the graduates’ employment”.Funded by HRSA Bureau of Health Professions, Nurse Faculty Loan Program, Carol Polifroni, PI.
Developing Tomorrow’s Nurse Educators
The purpose of the Graduate Assistance in Areas of National Need (GAANN) program is to provide fellowships to assist graduate students with excellent records who demonstrate financial need and plan to pursue the highest degree available in their course of study at the institution in a field designated as an area of national need. The award will fund fellowships for four full-time nursing PhD students who are preparing for educational leadership roles over 3 years. Dr. Polifroni designed this competitive proposal to increase enrollment of underrepresented students in doctoral programs with preparation for teaching and research through the award of fellowships, to enhance our learning community of doctoral students, to shorten time to PhD degree completion from 6 years to 4 or fewer years, and to strengthen teaching knowledge, skills, and attitudes. Funded by the Graduate Assistance in Areas of National Need (GAANN) program of the U.S. Department of Education, Office of Postsecondary Education, Carol Polifroni, PI.
Advancing Correctional Nurse Competencies for Quality Care
The aim of this application is to apply for funding is providing managed care, quality improvement, and other skills needed to practice in existing and emerging organized health care systems in order to adequately practice in new and changing interdisciplinary environments. Specifically, this project seeks to assure that the 443 licensed nurses employed by the University of Connecticut (UConn) under its Correctional Managed Health Care (CMHC) contract provide quality nursing care to over 18,000 incarcerated and transitioning to the community men, women and adolescents in the Connecticut Department of Correction (CDOC). When recruiting nurses for correctional health care, even for the mature and experienced nurse, few candidates possess the knowledge and skills in all the related fields required to practice safely in the correctional environment sufficient to meet the challenging nature of the corrections population. This project seeks to meet the goal of NEPQR by strengthening this unique nursing workforce by instituting a nurse competency system supported by a philosophy of life-long learning. This will be achieved by our goal to implement the Corrections Nursing: Scope and Standards of Practice to guide competency in clinical nursing services. Funded by HRSA Bureau of Health Professions, Affordable Care Act Nurse Education, Practice, Quality and Retention, Deborah Shelton, PI.
Pain Management Trajectory Mapping Using Life History Calendar Methodology: A Pilot The purpose of this methodological study is to pilot test use of the life history calendar method to describe and map significant events in the pain management trajectory of people with chronic pain. The sample consists of 20 adults age 65 or older with a history of osteoarthritis pain. An audio-recorded interview with the assistance of the life history calendar will be used to chronicle from the beginning of the osteoarthritis pain to the present all of the significant action events in the pain management trajectory, along with reasons for those actions. Actions include self-treatments, practitioner prescribed treatments, surgery, and treatment outcomes including change in pain and adverse events. Healthcare access factors will also be included. The Brief Pain Inventory and the Center for Epidemiological Studies Depression Scale 10 will be administered to measure current osteoarthritis pain and depressive symptoms upon completion of the life history calendar. Interviews will be transcribed, content analyzed, and compared to the life history calendar constructed during the interview. Individual pain management trajectories will be constructed using the x axis as time and the y axis as pain intensity/pain interference with activity. Nodes will be used to depict factors associated with pain management events. Changes in pain intensity and/or pain interference with activity will be delineated with timeline deflection up for increased pain and down for decreased pain. Timelines for all participants will be superimposed for visual depiction of the pattern of pain management events and outcomes across participants. Exploratory testing of statistical analysis techniques will be conducted to determine optimal analysis methods to prepare for a full study. The research contributes to a greater understanding of pain research methods, and of significant individual and contextual factors that support improved pain outcomes. Funded by University of Connecticut Research Foundation, Deborah McDonald, PI.
Improving Access and Quality of Care for Persons with Disabilities: High Impact, Low Cost Virtual Training for Primary Care Clincians. The project is a collaborative effort of the UCHC Center for Excellence in Developmental Disabilities, Ability Beyond Disability, the UConn School of Nursing and several national organizations, including the American Academy of Nurse Practitioners. The BI Cares grant will support Phase 1 of the development and evaluation of an immersive, interactive computer simulation to improve access to, and quality of primary care of, persons with disabilities by educating teams of primary care clinicians using a computer simulation. Funded by Boeringer Ingelheim Cares, Thomas Van Hoof, PI.
Standardizing the Use of Academic Detailing to Improve Quality through a Systematic Review of the Literature and an Expert Consensus Process
The PI proposed a research project that aligns with SACME’s priority area, “Integration of research into CME/CPD practice.” The proposal aimed to conduct a focused systematic review followed by an expert consensus process to generate a guideline/tool that will inform the ongoing use and study of academic detailing (educational outreach) as an intervention to change clinician behavior and to improve patient outcomes. The guideline/tool will take the form of a peer-reviewed manuscript and a national presentation. Investigators will also disseminate the findings to a wide range of groups and individuals, including those associated with the National Resource Center for Academic Detailing. Funded by the Society for Academic Continuing Medical Education, Thomas Van Hoof, PI.
Peer Reminiscence Intervention for Minority Elders (PRIME)
The overall objective of this application is to secure bridge funding to support the continued development of the Peer Reminiscence Intervention for Minority Elders (PRIME). PRIME utilizes the strengths of oral traditions of older Black adults as well as their informal support networks to mitigate the barriers associated with under-utilization of mental health services and decrease depressive symptoms and prevent major depression.