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Spring 2008  
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There's no 'I' in team

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For the first time in university history, nursing and medical students trained together on lifelike mannequins in their schools' simulation labs one day this past February. More than 200 senior nursing and third-year medical students worked in teams to run through an emergency code—in this case, a 52-year-old man with a leg injury caused by a steel girder.
     "Many people assume that medical and nursing professionals train together as part of their education, but for many, this isn't the case," says Barbara Kaplan, coordinator of the Charles F. and Peggy Evans Center for Caring Skills, the nursing school's simulation lab. "They train independently in their respective disciplines, and their first interactions are typically in the hospital emergency room or clinic."
     During the session, each team gathered around a bed, each with a mannequin, whose voice was supplied by a volunteer via microphone. As one team discussed painkillers, the mannequin piped up, "How about morphine? I heard it was good." Another group, intent on ordering an x-ray, was encouraged by the mannequin to look at his patient chart at the foot of the bed. In it, they found an x-ray.
     After the session, the students debriefed with trained facilitators from across the Woodruff Health Sciences Center. Most students said they found the joint simulation training beneficial.
     "Team work has been shown to avert medical errors," says Assistant Professor of Nursing Bethany Robertson. "It's not the result of simply locating people together."
     Not only does team work take practice, but interdisciplinary training improves patient care, adds Douglas Ander, who oversees the medical school's simulation center.
     "The more time students train together at an earlier stage, the more it will be ingrained in their normal mode of operation,"Ander says. "Typically, students and residents have little to no understanding of how teams function in a real health care environment."
     As a result of its Quality and Safety Education for Nurses grant from the Robert Wood Johnson Foundation, the nursing school is expanding simulation training. Simulation training is one way that students are taught to avert medical errors before they begin practicing on real patients. In the coming school year, students will go through team simulation training to learn how to work in groups more efficiently. Everyone also will learn the "language" of team simulation training—huddling, debriefing, check-back, and call-out are just some of the terms used to encourage seamless team work.
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      International visa: Emory's community nurses attend to Atlanta's immigrants

The Congolese woman, a refugee living in metro Atlanta, was irritated that her two young daughters were showing fear. The girls eyed the seven vaccination needles laid out for each of them on the table warily. The student nurse working with them expected some apprehension from the children; after all, needles make most children wince. And the mother's sternness was only making the children more apprehensive.
     Situations like this are all in a day's work for student nurses in Elizabeth Downes' community health course. The assistant professor is exposing her students to a challenging aspect of community nursing: working with immigrants or refugees who may know little or no English, routinely ingest herbal medicines, and have differing cultural norms. As Atlanta becomes more diverse, student nurses will be called on increasingly to test their communication skills.
     Tristan Pajak, 08N, worked with the Congolese family aboard a mobile health care unit. She talked with the mother, coaching her to release her bear hug-like grip on the girls, thus relaxing everyone involved. She says her experience with health care van clientele is leading her to reconsider her post-graduation plans.
     "I always thought I wanted to work in a hospital, but now maybe I'm a community health nurse," she says. "It's a great experience that many nursing students don't get. In hospitals, patients seem to take health care more for granted. They have information, but they don't use it. People who use the van service see it as such a gift. They are much more receptive to information we give and will use it."
     Downes has achieved her goal with Pajak. She wants Pajak and other student nurses to gain a newfound empathy that can only come from working with vulnerable populations. "It's a powerful position to be in—to be a nurse, to walk up to someone you don't know, especially to someone whose first language is not English," she says. "I love it when our students realize, ‘I can't believe how hard this must be for them.' Having worked with refugees overseas, I understand how hard they work to get here. They have such resilience and strength. Any little show of support has great meaning to them."
     Downes worked with refugees in Mozambique and Zimbabwe, two places she lived because of her husband's job in disaster relief. She also lived in Fiji for four years, establishing that country's nurse practitioner program. Since coming to Atlanta, she has volunteered at the International Rescue Committee (IRC), the Clarkston Community Center, and the International Community School.
     At the IRC, for example, she teaches adults and teenagers about personal hygiene: how Westerners' view body odor, how to use a toothbrush, and what necessitates calling 911. At the International Community School, she concentrates on a more kid-friendly topic: hand-washing. At the community center, she and student nurses recently helped Vietnamese senior citizens understand their medication dosages. And she will answer any question that comes up. One client at the IRC wanted to know what do with a frozen chicken in her freezer.
     She also taps School of Nursing's students to assist immigrants. She matched a French-speaking African student with a woman who needed a translator to talk to doctors about her baby who needed surgery. She sent a Swahili-speaking master's student to a medical center that cared for a number of Somali-Bantu mothers and their babies. Downes hoped the student could translate for the women, but the student thought she would be more effective in clearing up a vexing problem for the nurses. The student explained to the nurses that they needed to teach the Somali-Bantu mothers how to use a disposable diaper, something the women had never seen before.
     One experience, in particular, sticks in her mind. Downes took a pregnant Liberian woman to a community clinic, and she saw a School of Nursing graduate working there. That was the ultimate gratification.
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Deborah Ryan
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h Deborah Ryan's study showed that student nurses let their guard down; only 18 of 267 nursing students got a perfect score on a test designed to see if they could detect incorrect dosages and medications. h
  What does that prescription say?

With more than 4,000 prescription drugs listed in the Physician's Desk Reference and new formulas and dosages of drugs coming out frequently, clinicians can drown in a sea of medication data. Sound-a-like names and similar packaging also can contribute to serious medical errors. Such errors kill approximately 7,000 people each year.
     Raising awareness about the issue begins in nursing school, says Clinical Associate Professor and BSN Program Director Deborah Ryan, whose research for her doctorate of nursing practice from Emory centered on medication errors. She decided an old-fashioned paper and pencil test was in order to find out how savvy nursing students are at catching medication mistakes. While electronic prescription systems are on the market, 95% of the 3 billion prescriptions given each year are handwritten.
     Ryan traveled to eight nursing schools around Georgia to test students in three associate degree and five baccalaureate programs, including the nursing school at Emory. The test had five case studies and associated vignettes, and students had to catch errors in 70 yes/no questions. Had the dosage changed? Was the dosage calculated correctly? Was the patient's name double-checked against the prescription and patient's armband?
     Ryan's test was anonymous in terms of school and student. Of the 267 students who took the test, only 18 had a perfect score. The most frequently missed question was one where students failed to identify that the patient's name on the physician's order didn't match the one listed in the case history.
     "Medication errors are a huge problem in the health care system," Ryan says. "Most instances occur when health care professionals let their guard down. Nurses who don't stop and methodically follow the ‘five rites of medication administration' are at high risk for committing a medication error."
     In fact, one study found that nurses intercepted 86% of medication errors, especially during the ordering, transcribing, and administering of drugs.
     While many health care facilities have policies in place for high-risk medications, drug manufacturers need to do their part, Ryan says. "Avoiding the use of similar sounding names and, for nurses, being diligent in checking dosages and double- and triple-checking every medication is critical," she says.
     Though technology, such as personal digital assistants loaded with PDR software and bar code scanning that double-checks a patient's name and medication, can help reduce errors, it is not infallible; such tools must be programmed by humans and can break down, Ryan points out. Continued diligence by nurses will be needed.
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Amy Parker
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h Treating household water was a crucial component of the Safe Water System, says Amy Parker h
  Liquid gold: Clean water program reduces disease, nets award

Amy Parker, 05MN/MPH, a nurse epidemiologist for the CDC, and School of Nursing adjunct faculty Patricia Riley, a technical adviser for the CDC, have received the 2007 GlaxoSmithKline Circle of Excellence Award for their development of a clean water and hand-washing program. The award is presented by the Henry M. Jackson Foundation for the Advancement of Military Medicine and recognizes projects that promote prevention or enhance the quality of health care.
     Some years ago, the CDC developed a "Safe Water System (SWS)," a program based on teaching how to store water safely, along with the use of water disinfection tablets, and promoting six steps of hand-washing with soap. Parker and Riley, along with Rob Quick, a CDC medical epidemiologist and an adjunct professor at the Rollins School of Public Health, took the program further and put it to use in health care facilities in developing countries.
     "We knew that the SWS had worked in low-income communities for years," Riley says, "but we had yet to take that intervention and integrate it into health care settings."
     Enter Parker, who at the time was working on her master's degrees in nursing and public health.
     "This project was the perfect blending of Amy's course work," says Riley. "She could draw on her nursing training to develop the materials and her public health training to do the fieldwork. She would be building on the strength of both schools to advance a global health intervention."
     Parker developed a health care worker curriculum and resource guide in a semester. Then in the summer of 2004, she trained nurses at a busy maternal and child health clinic in Homa Bay, Kenya, on how to effectively coach their patients. For the nurses, the training was the first of its kind, and for the CDC, the program was the first time it had scientifically measured the impact of a safe water project in a low-resource health care facility.
     "We were thrilled that 71% of patients were treating their household water and more than a third could demonstrate proper hand-washing during our follow-up study a year after they were initially taught the information in the clinic," Parker said. With the success of the program documented, Riley went to the Kenyan government to develop plans for a nationwide expansion.
     "That's so important because fewer than half of Kenyan health care facilities have running water," Riley says. "Showing health care providers how they can treat their water and helping them incorporate that into their patient teaching, along with basic hand hygiene programs, are the first steps in preventing disease and promoting health."
     The program since has expanded to Nigeria, Uganda, Malawi, and Indonesia. Globally, the lack of access to safe drinking water contributes substantially to 2.2 million deaths each year from diarrheal diseases.
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Lynette Wright
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h Lynette Wright h

Lynda Nauright
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h Lynda Nauright h
  Two lifetimes of work

The School of Nursing is saying "happy retirement" to two cherished faculty, Lynette Wright and Lynda Nauright.
     Lynette Wright, the first nurse genetic counselor in Georgia, spent 32 years teaching genetics and working with families on genetic issues. After completing a two-year traineeship in genetics in Emory's Department of Pediatrics, she began working at Emory, establishing the first outreach clinics in Georgia. She was instrumental in expanding a genetic screening program for newborns.
     As a faculty member at Emory's School of Nursing, she developed and taught the first undergraduate and graduate courses in genetics. She didn't limit herself to educating students. After attending a genetic conference, she devised two seminars for Emory faculty: "Applying Basic Genetics to Clinical Practice" and "What's New in Genetics and How do We Use it?"
     "She is a walking, talking encyclopedia of genetics," says Assistant Professor Joyce King, who, along with Associate Professor Michael Neville, has taken over the genetics courses. "We are still one of the few schools of nursing to have a genetics course for undergrads."
     Likewise, Lynda Nauright was not your typical teacher, Eddie Gammill, 01N, 05MSN, recalls. The manager of Emory's wellness programs says he walked into one of his undergraduate classes to find his professor, Lynda Nauright, wearing jeans and a hat. Nauright later became his mentor, and not only did she guide him professionally, she also could keep him in line.
     On one particularly rough day, he says he made a snarky comment to her. She shot back, "Don't be a smartass to a smartass. I'm older and better at it than you."
     Nauright will continue to mentor students in her new position at Kennesaw State University as interim director of the graduate nursing program. She retired from Emory in December after almost 30 years of teaching.
     She began as the director of the School of Nursing's continuing education program. She helped the program flourish, securing $2 million in federal funding for the development of a statewide continuing education program. She later managed nurse practitioner certificate programs in gerontology, family health, and women's health, which became the core content for courses at the master's level.
     Nauright gained national recognition for her "Beads for Books" campaign. She helped collect more than 300 used nursing textbooks for the nursing library at Dillard University in New Orleans after Hurricane Katrina hit. Anyone donating a book received a string of Mardi Gras beads to hang on their office door.
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      Second time around: Fuld fellows look for a higher degree of nursing

No one knew quite what to expect five years ago when the first Fuld fellows walked in the door of Emory's Nell Hodgson Woodruff School of Nursing. The five-year, $5 million endowment from the Helene Fuld Health Trust was the largest single gift in the school's century-long history. There was agreement on how to use the money—to give full scholarships to nursing students who already had a degree in another field. But as faculty selected the school's first Fuld fellows, they felt another imperative as well: to link the fellowship to the school's core values of scholarship, leadership, and social responsibility and to provide opportunity and community for students hoping to do good with underserved populations.
     Now the experiment seems to be paying off. "It has only been a year and a half since our first student graduated, and already good things are happening," says Fuld faculty coordinator Ann Connor, who tracks the fellows' progress from new nursing students to skilled nurses. Already Fuld fellows have published papers, presented research findings at local and international conferences, edited peer-reviewed journals, directed immunization clinics, and presided over the Student Nurse Association of Georgia.
     All the Fuld fellows already had impressive résumés before coming into nursing: A Belizean immigrant with a background in nutritional science. A former world religions major who had done field research in India. A CDC biologist. A woman who created her own program of peace and justice studies in college. A student who has served both as a doula and as a volunteer teacher at a local jail.
     They've all found they have a lot to share at regularly scheduled gatherings where Fuld fellows past and present meet for dinner, for service learning, and for retreats. And these are not exactly typical undergraduate or graduate reunions. Because they happen almost monthly, there's none of the nervousness of people who've been apart for long. The group is small enough—15 current students and 12 alumni—that everyone knows each other well.
     The friendships and diversity of experiences keep alumni coming back. "The fellows in place are always wowed by the people coming in," says Connor. One of the second group of Fuld fellows, Jordan Bell Simcox, agrees. "The recent Fuld fellows are amazing," she says.
     Simcox had already worked in Nepal, Turkey, and Macedonia when she decided to become a nurse. Now, two years after becoming a family nurse practitioner, Simcox works with the nursing school's program at the Gateway Center, which offers services to homeless Atlantans. But she still makes time for the Fuld alumni gatherings. "It's just great to see what people are thinking about and to share ideas," Simcox says.
     That sense of community keeps Simcox grateful for the Fuld and Emory. "I may not have been able to come to Emory without it," says Simcox. But the fellowship's reward includes more than financial support. "What it has provided for me is mentorship, being surrounded by professors like Ann and the other Fuld students, getting their perspectives," she says. "It's an immediate support system, and that's been the greatest gift."
     The work that alumni like Simcox are already doing—and the enthusiasm they do it with—is proof to Connor that the Fuld fellowship is working, for the fellows, for their clients, and for the nursing school. "These students not only enrich the school but enrich the profession," says Connor. "From the emergency room to their work in East Africa, their scope and depth of engagement is amazing. They improve what we do here and sweeten the soup for all of nursing."—Dana Goldman
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      No weighting around: Heart patients need to pump iron

Despite the best medications, heart failure patients suffer such severe fatigue and shortness of breath that many become inactive—definitely not the prescription the nurse ordered. Fatigue hits all heart patients, regardless of their physical conditioning, so many hop onto a stationary bike or treadmill to improve their cardiac endurance. But new research is pointing to the need for heart patients to pump iron.
     Nursing Assistant Professor Rebecca Gary made the connection between strength training and heart failure survival when she saw a study showing that a decline in hand strength in cardiac patients is associated with increased mortality. Hand strength did not decline in patients placed on bed rest for noncardiac conditions. The difference for heart patients, though, is believed to be their body's loss of oxidative fibers.
     "Signs of deconditioning and those of heart failure are similar," Gary says. "But strength training has been shown to partially reverse some of these skeletal muscle changes that contribute to severer symptoms."
     Strength training helps heart patients perform routine daily tasks, such as carrying a weighted bag up the stairs with less fatigue or short of breath, Gary found in a pilot study last year.
     Aerobic exercise, which she tested in an earlier study, improved endurance, reduced depression, and improved sleep time in cardiac patients. They still had loss of muscle strength, though, despite these important gains.
     Gary is conducting a new study this year funded by the Emory Heart and Vascular Center. She hopes it will help make strength training a routine recommendation for future heart failure patients, whose numbers are increasing.
     An estimated 4.8 million Americans suffer from heart failure, and according to researchers, it is the only cardiovascular disease that is rising in occurrence, with 550,000 new cases reported each year. Once diagnosed with heart failure, about 50% of patients die within five years.
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      Salmon appointed to NIH board

Dean Marla Salmon, ScD, RN, has been appointed by the U.S. Secretary of Health and Human Services to serve on the National Advisory Council for Nursing Research of the National Institutes of Health. She will serve a four-year term. The council advises the HHS Secretary and the National Institute of Nursing Research on training, dissemination of health information, supporting research, and other programs with respect to basic and clinical nursing. The council also reviews applications for research grants.
     The council has 15 members, two-thirds of whom are invited from health and scientific disciplines. Of these, seven are professional nurses who are recognized experts in clinical practice, education, or research. The other one-third are from the general public and include people from public policy, law, health policy, and economics.
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      Aurora receives service award

Anjli Aurora, 06N/08MN, has received the 2008 Joseph D. Greene Community Service Award from the Healthcare Georgia Foundation. Aurora is president of HealthSTAT, an organization of health professional students dedicated to education, activism, and service, and has served on its board of directors since 2006. Since joining HealthSTAT, she has increased student nurse involvement by 300%, mobilized advocacy efforts, and raised more than $50,000 in grants. She has organized rallies to lobby for funding for Grady Hospital and has met with legislators to kill provisions that would have prohibited undocumented immigrants from receiving publicly funded health care services. The final bills had most of the health care provisions removed thanks to her and HealthSTAT's efforts. With the award comes a $1,000 donation to the organization of Aurora's choice.
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