Vision for the Future

We are committed to a future of national and international partnerships and inter- disciplinary collaborations in advancing knowledge that will influence healthcare policies and practice. We envision our graduates in positions of leadership in national and international healthcare and as academic faculty who are at the leading edge of developing, transmitting, and evaluating fundamental and translational knowledge in promoting healthy lifestyles, enhancing quality of life, and facilitating living with chronic illness for vulnerable populations and nursing-care providers.

2003-2008 University of Pennsylvania School of Nursing Strategic Plan

School of Nursing Board of Overseers

The Honorable Marjorie Rendell, Chair Mr. Henry P. Baer, Esquire Mr. Mark Baiada The Honorable Phyllis W. Beck Mrs. Carolyn Bennett Mr. Cornelius Bond Dr. Lillian S. Brunner Mr. Gilbert F. Casellas, Esquire Mrs. Eleanor Graham Claus Mrs. Ruth M. Colket Mrs. Eleanor L. Davis Ms. Vernice D. Ferguson Ms. Carol Ware Gates Ms. Rosemarie Greco Mrs. Hannah L. Henderson Mr. Johan Hoegstedt Mr. Stephen J. Heyman, Esquire Mrs. Ellen R. Kapito Mr. Dean C. Kehler Mrs. Norma P. Killebrew Mrs. Sallie G. Korman Mrs. Andrea Berry Laporte Mr. Harvey S. Shipley Miller Mrs. Vivian Weyerhaeuser Piasecki Mr. Robert D. Roy Mr. Robert Ruffolo Dr. Marie A. Savard Rear Admiral Jessie Scott David W. Sweet, Esquire Mr. Alan J. Weber Mr. Michael L. Wert UNIVERSITY of PENNSYLVANIA

F ALL 2004 VOLUME 7 Table of Contents NUMBER 2 From the Dean… 2 The Hospital Workplace 4 4 Ann E. Rogers: Negative Effects of Extensive Overtime 5 Sean Clarke: Injuries from Needlesticks 6 Linda Aiken: Domestic Nursing Shortage 7 Connie Ulrich: Ethical Issues Faced by Nurses Eliminating Needless Childhood Truama 8 8 Edith Simpson: Child Booster Seats 9 Diane Spatz: Breastfeeding 10 Stella Volpe: Childhood Obesity Environmental Threats to Adults 12 12 Therese Richmond: Decreasing the Toll of Gun Violence 14 Linda McCauley: Adolescent Farm Workers/Pesticide Exposure 15 Kay Arendasky: Educating Nurses about Environmental Exposures Influencing Long-Term Care Culture Change 16 16 Kathryn Bowles: Telehealth 17 Karen Schumacher: Quality Improvement 17 Lois Evans and Cynthia Scalzi: Culture Change Exchanging Ideas, Nationally and Internationally 20 20 Dean’s Lecture Series 20 Claire M. Fagin Distinguished Research Award: Barbara Medoff-Cooper 22 U.S. Surgeon General Speaks at Penn Nursing 23 Visiting Scholars Faculty: Stimulating the Intellectual Environment 24 Editorial Advisory Board: Julie A Fairman, PhD, FAAN, 24 School of Nursing Chairs RN,Associate Professor of Nursing, and Class of 25 Loretta Jemmott Named New Assistant Provost 1940 Bicentennial Term Professor;Anne Keane, EdD, CRNP,FAAN, RN,Associate Professor of Nursing, Achievements 26 Class of 1965 25th Reunion Term Professor of 26 Mary Naylor – First Nurse Named a McCann Scholar Nursing, and Associate Dean for Academic Programs; Linda A McCauley, PhD, FAAN, RN, Nightingale 26 Awards Professor of Nursing, and Associate Dean for 27 Presidents Nursing Research;Afaf I Meleis, PhD, DrPS(hon), 28 Selected Publications FAAN. Margaret Bond Simon Dean of Nursing; 34 Grants 2003-2004 Eileen Sullivan-Marx, PhD, CRNP,FAAN, RN, Associate Professor of Nursing, Shearer Term 39 Presentations Professor for Healthy Community Practices, and 41 Changing Penn Nursing’s Environment Associate Dean for Practice and Community Affairs. Design: The Creative Department, Inc. Photography: I. George Bilyk, Felice Macera Editor: Joy McIntyre Contributing Editors: Joyce Brazino, RN, MPH; John Hurdle; Marguerite Miller; Robert Strauss; Debra Wood, RN; Elizabeth Williams

1 FROM THE DEAN…

Our environment at the School of Many decades ago, as Florence lives. In the next few pages, you will Nightingale walked the halls of hospi- sample some of the exciting scholar- Nursing is changing! If you visit us this tals in Turkey caring for Crimean War ship and research conducted by our school year (and we hope you will), pre- victims, she formulated her ideas faculty and students. pare for a surprise. At our front about the vital role surroundings play For example, you will read about in illness and health. She described Dr. Linda McCauley, who is examin- entrance, you will step past piles of the importance of light, ventilation, ing the effects of toxic pesticides on rubble, the first hint that we are dra- aesthetics, and density in understand- migrant farm workers, and Dr. Edith ing and preventing infection and, Simpson, who is creating a safer envi- matically renovating our building. more broadly, in healing and recovery. ronment on the highway for children. Simple in vision, yet profound in Subsequently, science documented While the legal, moral, and physical effect, this renovation will propel our her hypotheses.Today, to understand risks of guns are well-known, Dr. facility – a product of 1970s planning the processes associated with the Therese Richmond’s research on and architecture – into the 21st cen- onset of disease, cell mutations, genet- firearms as a public health issue tury.The new building will meet the ic markers, risk factors, vulnerabilities, explores how we can reduce the neg- growing and changing needs of our productivity, healing, recovery, and job ative impact of guns in our lives. She faculty, students, and staff.The first satisfaction, we must understand the is determined to improve the under- phase of construction revamps the environments that produced them standing of the factors leading to the ground floor to accommodate new and the environments’ biological, epidemic of gun control violence and and more easily accessible offices for social, political, and cultural character- develop ways to curb the problem. student recruitment, admissions, istics.Thus, nurses are trained, educat- Another consistently challenging enrollment, and support services.We ed, and prepared to view health and environment is found in nursing are also upgrading information tech- illness by grasping the dialectical rela- homes for the elderly. In their research, nology by adding wireless internet tionship between a person and his or Drs. Lois Evans and Cynthia Scalzi ask access in the new café and computer her environment, such as a family this pressing question:What are the kiosks in the lobby – plus a striking within the context of individuals, a distinctive characteristics of those insti- glassed entrance bringing in a flood community within a structure, a soci- tutional environments that effectively of light.The second and third phases ety within the world. Nursing science care for the aged? The results of their of our renovation will increase, inte- at Penn continues to have an impact analysis of how nursing homes can grate, and enhance existing lab and on the complex interaction between maximize benefits to the elderly will research space.All of this will trans- environments and well-being by pro- undoubtedly lead to changes in policy form the building into a vibrant and moting health, preventing illness and that retool the culture of institutional- inviting place that maximizes the enhancing recovery – aiming overall ized care to better support the rela- comfort and productivity of faculty, to increase the level of functioning in tionship between the elderly and their students, and staff – properly befitting daily activities for people throughout caregivers. In her research, Dr. Karen our top School of Nursing. their life cycles. Schumacher looks at informal caregiv- Just as the healthier environment Penn Nursing faculty members ing by family members as a set of of our renovated building will better and their research teams are examin- competencies that require coaching by support a healthy School of Nursing, ing the effects of significant environ- nurses.The results of her studies will the practice of nursing and its envi- mental stressors on different popula- also affect caregiving environments for ronment are intrinsically connected. tions to offer models of care that help the elderly. clients lead healthy and productive

2 Dean Meleis is flanked by her husband, Mahmoud (left), and Pennsylvania Governor Ed Rendell with his wife, the Hon. Marjorie O. Rendell, a federal judge and chair of the Board of Overseers. Gov. Rendell has launched initiatives to improve the healthcare environment for Pennsylvania. The hospital is yet another envi- documents the advantages of breast- This issue of Penn Nursing is all ronment that has a dramatic impact on feeding for at least six months to about our relationship with our envi- nurses and patients. Penn’s Center for increase both babies’ and mothers’ ronments. Just as our School is chang- Health Outcomes and Policy well-being. Motivated by the recent ing, our University environment is Research, led by Dr. Linda Aiken, con- dramatic spike in obesity among chil- too.We warmly welcome our new tinues to uncover and document sig- dren, Dr. Stella Volpe examines factors president, Dr.Amy Gutmann, and nificant variables that make hospitals of both nature and the environment interim provost, Dr. Peter Conn, as safe and healthy, enhancing outcomes that define a healthy interaction with we bid sad good-byes to President for patients. Needlesticks and their food for the suckling infant as well as Judith Rodin and Provost Robert prevention are examined by Dr. Sean the developing adolescent. Barchi, thanking them for their con- Clarke; the consequences of fatigue Wherever you look in our School tributions and joyfully wishing them experienced by nurses working over- – or in hospitals, nursing homes, well on life’s journey. time is the subject of pioneering Philadelphia highways, the world at research by Dr.Ann E. Rogers. large – you can see we care about our Florence Nightingale’s admoni- environment and our interaction with tion that environments play a central the world.The science that the faculty role in achieving positive patient out- and students are developing will create comes is also well exemplified in the healthy and safe environments for work of Dr. Diane Spatz. Her research patients and nurses.

3 ses and an increased riskses and an increased of r 143 shifts when nurses said they “coerced” overtime into working

The study found 59 percent of par- The study found 59 percent 199 errors and 213 were There The project, the first a to establish The study, led by Penn School of The study, Penn led by ses reported making at least one nu re re r

orked late at least once,orked and less than times 10 or more overtime orked ork longer shifts with fewer breaks is breaks fewer ork longer shifts with Negative Effects of Extensive Overtime Negative Effects of Extensive error and 32 percent made at least one error and 32 percent near-error. that was in theorythat was voluntary. 12-hour shifts working ticipants were during period.Almost the survey one- 16 sixth of the sample reported working hours at least once consecutive or more during the project.The longest shift was 23 hours and 40 minutes. near-errors dur- reported to researchers period.ing the survey Fifty-eight per- medication; cent of the errors involved others included procedures, charting and transcription.Thirty of the percent nu Ann E. Rogers, Ann E. Rogers, RN PhD, FAAN, on U.S. pressure nurses to Growing w as fatigued patient safety threatening profession- to make likely more staff are al errors, study has found. Penn a new long hours worked clear link between by we overtimeerrors on the job, risk the shows of three-fold increased making a mistake 12.5 consecutive when nurses work hours or more Nursing Associate Ann Professor E. Rogers, PhD, FAAN, RN, all of found the 393 nurses studied for 28 days w of the 5,320 shifts ended on 20 percent time.Almost of the nation- two-thirds sample of nurses ally representative w during the study period, and there we Linda Aiken (left) and Ann E. Rogers study the hospital as a workplace for nurses.

the richest economies. healthcare crisis in countries that lack the resources of es away from the developing world are deepening a and other countries to offset the shortage by hiring nurs- and hazards, including needlesticks. Efforts by the U.S. sive working hours and an increase in professional errors eroded by a growing shortage of nurses, leading to exces- The quality of some U.S. hospitals as workplaces is being The quality of some U.S. hospitals as workplaces

4 THE HOSPITAL WORKPLACE WORKPLACE HOSPITAL THE “The long hours currently being Only four states – California, Injuries from Needlesticks worked by many hospital staff nurses Maine, New Jersey and Oregon – have may have adverse effects on patient banned mandatory overtime, and there Sean Clarke, care,” the study authors reported.“Both are no state or federal regulations PhD, CRNP, CS, RN errors and near-errors are more likely restricting the number of hours a nurse to occur when hospital staff nurses may voluntarily work in a 24-hour or Among the hazards faced by nurses work 12 or more hours.” seven-day period, as reported in the working excessive hours are injuries Although the risk of error didn’t study, which was first published in July. from needles and other contaminated increase significantly until shifts sharps which remain a serious occupa- Rogers, A.E., Hwang, W-T, Scott, LD, Aiken, L.H. & tional health concern for medical pro- exceeded 12.5 hours, it began to rise Dinges, DF. Hospital staff nurse work and patient safety. after 8.5 hours, a conclusion consistent Health Affairs. Vol 23 No. July/August 2004,1-11. fessionals, according to Sean Clarke, with other studies that have found a PhD, CRNP,CS, RN, an assistant pro- link between long hours and increased fessor at the Penn nursing school and mistakes on the job. (continued on page 6) Mealtimes and other breaks were effectively not adjusted to the length of shift, Dr. Rogers said. Nurses working a 12-hour shift had total break time aver- aging 25.7 minutes, little different from the average 23.4needles minutes taken during an eight-hour shift. As hospital managers in the U.S. and abroad struggle to offset a nursing shortage that is expected to worsen in coming years, nurses are not only assigned longer shifts, but are also fre- quently staying at work longer than scheduled, the authors reported. Overtime increased the risk of error regardless of how long the shift was originally scheduled to run, and the risk increases after longer shifts.A work week of more than 40 hours also increases the risk of error, the survey showed. The study, titled “Hospital Staff Nurse Work Hours and Patient Safety,” condemned the use of mandatory overtime as a “controversial and poten- tially dangerous practice.” Many nurses, while not threatened with disciplinary procedures if they do not work over- time, are made to feel that there will be “repercussions” if they refuse to do so, according to the authors.

Dr. Sean Clarke seen with safer sharps. 5 (continued from page 5) Associate Director of the Center for were 50 percent more likely than their and Policy Research Director and Penn Health Outcomes and Policy Research. counterparts in other hospitals to Sociology Professor Linda Aiken, PhD, In studies based on data collected report needlestick injuries in the past FAAN, FRCN, RN, the Claire M. in 1990-91 and 1998, Dr. Clarke year and near-misses in the last month. Fagin Leadership Professor in Nursing. found nurses face the greatest risk of Needlesticks and other sharps Dr.Aiken calls for greater efforts by the needlesticks in hospitals that lack injuries should be seen as a proxy for a developed world to build a sustainable adequate investment in staffing and wide range of safety problems in hospi- domestic supply of nurses, and an equipment, and where the organiza- tals, an analysis that argues for a system- increase in international aid for nurse tional climate is not conducive to a atic approach to the safety issue, Dr. training in developing nations. safe working environment. Clarke said. The United States, with a total of “Nurses on units with less adequate “A systems approach to needlestick some 2.2 million employed nurses, resources, lower staffing, less nurse lead- prevention is warranted, one that relies on foreign nurses for about four ership and higher levels of emotional involves examination of factors such as percent of its workforce currently, and exhaustion were typically twice as likely staffing levels, the mix of clinicians in is expected to face a nursing shortage to report the presence of risk due to terms of experience in nursing and on of 275,000 by 2010, according to the staff carelessness and inexperience, fre- a particular unit, and adequate adminis- study’s authors.The United Kingdom is quent recapping of needles, and inade- trative support for nursing practice,” the twice as dependent on foreign nurses as quate knowledge and supplies,”the first authors found. the U.S. and anticipates being 53,000 study reported. Although federal legislation in nurses short of its requirements by The data in the needlestick studies 1992 reduced the unnecessary use of 2010. Ireland, Canada,Australia and were collected by the Center, directed needles and required the use of safety New Zealand have a similarly high by Linda Aiken, PhD, FAAN, FRCN, equipment with needles, there is room reliance on foreign nurses. RN, the Claire M. Fagin Leadership for further reduction of needlestick The anticipated demand for nurses Professor in Nursing and a professor of accidents, Dr. Clarke said. in developed countries risks blunting sociology, and principal investigator of The data showed that short staffing the efforts of some African countries to the initial research. is one of the biggest modifiable factors fight AIDS despite the availability of Of the 962 nurses in the national that influence exposure to needlesticks, funding for the epidemic, the authors 1990-91 study on AIDS care led by particularly troubling given the antici- argued. Dr.Aiken, 5.5 percent reported an pated U.S. nurse shortage in coming In Botswana, for example, where injury involving a needlestick or sharp years.“For safety issues in general, about a third of the adult population is containing blood, and 23.7 percent staffing is going to be a major barrier,” estimated to be infected by HIV,the reported a near-miss. Dr. Clarke said. government’s commitment to provid- A second paper, written by Center ing free anti-retroviral therapy to its Domestic Nursing Shortage Associate Director Dr. Clarke and citizens is being threatened not by lack based on the original survey of 2,278 Linda Aiken, of financing, but by a shortage of nurs- nurses in 22 U.S. hospitals during 1998, PhD, FAAN, FRCN, RN es and other health workers. found 48 percent of nurses said they Although the proportion of for- had been stuck at least once in their As managers in the U.S. and other rich eign nurses in the total nursing popula- career, 8.6 percent reported a needle- countries contend with a shortage of tion in most developed countries is not stick in the previous year, and 1.2 per- nurses, they are increasingly turning to currently high, the absolute numbers of cent in the last month. developing countries to recruit nurses, nurses being imported from developing Nurses reporting the highest work- exacerbating a shortage of nurses in countries have a significant impact on loads – those caring for more than six those nations. those countries. patients at a time – and those reporting That’s the finding of a paper head- For example, if the United States the worst organizational climate ed by Center for Health Outcomes were to double its proportion of foreign 6 nursing Study Focuses on Nurses’ Ethical Issues Connie Ulrich, PhD, RN Dr. Connie Ulrich investigates ethical decision-making and its stressors. Ethical issues faced by nurses in rela- faced. The researchers are also examin- tion to patient care may lead to low ing the resources available for the dis- morale, dissatisfaction or even depar- cussion and resolution of ethical issues, ture from the profession, according to and how those factors influence job sat- anecdotal evidence that is now being isfaction and retention. Dr. Ulrich systematically researched. believes the study – conducted jointly with the National Institutes of Health, For example, a nurse may disagree with Georgetown University and Inova, a the treatment plan set for a patient by healthcare system based in Fairfax, VA – managers because he or she feels it is the first of its kind in the world. compromises confidentiality or the patient’s autonomy, and yet the nurse is The ethical issues are exacerbated by constrained to implement the plan. This the worldwide nursing shortage which “moral tension” is particularly acute in strains the ability of many nurses to ethical issues were an important con- the case of end-of-life patients who may provide the compassionate care that is tributor to the problem. be intensively medicated at a time an important determinant of patient The current study is designed to “lead when the nurse feels palliative care satisfaction, Dr. Ulrich said. to a better understanding of the impor- would be more appropriate. The project follows earlier work by Dr. tance of ethical problems that nurses Such dilemmas are being studied by Ulrich with nurse practitioners in are facing in the workplace and how Assistant Professor of Nursing Connie Maryland where many were found to these problems influence satisfaction Ulrich, PhD, RN, whose researchers be experiencing ethical conflict in their within the system,” Dr. Ulrich said. began working in April with 3,000 nurs- practices, indicating that their concerns “More importantly, it may help us pro- es and social workers in four U.S. states were not being heard. That research vide interventions to mitigate concerns to identify the ethical problems they also found 40 percent of the NPs were and retain qualified individuals within dissatisfied with their jobs, and that the healthcare system.”

nurses from 4 to 8 percent over the In the U.K. and Ireland, healthcare problem, but so far enforcement has coming decade, that would pull an addi- managers are now dealing with the been uneven, the paper’s researchers tional 100,000 nurses from both devel- legacy of significant cuts in nursing reported. oping and developed countries abroad. education funding during the 1990s. “The world’s nurse supply appears Figures for the number of nurses “Sustained underinvestment in nursing insufficient to meet global needs now relative to population show developed education is a theme across countries and in the future,”the paper’s researchers countries already have a huge advan- that are now turning to aggressive reported.“Countries that use the most tage over less-wealthy nations.The international recruitment,” the authors nurses should make the biggest invest- U.K., for example, has 847 registered said. ment in nursing education in both their nurses per 100,000 people, almost They also argued that the nursing own and developing countries from twice the rate in South Africa and shortage in developed countries can be which they recruit nurses.” some 13 times that of India. eased by a more efficient use of exist- Linda H. Aiken, James Buchan, Julie Sochalski, Barbara Developed countries need to do ing staff.Too many nurses are spending Nichols, Mary Powell. Trends in International Nurse more to grow a sustainable domestic “an inordinate amount of time” doing Migration. Health Affairs 23(3): 69-77, May, 2004. Linda H. Aiken, Sean P. Clarke, Robyn B Cheung, Douglas supply of nurses, the researchers non-nursing tasks such as delivering M. Sloane, Jeffrey H. Silber. “Educational Levels of argued, noting that more than 11,000 food trays and transporting patients to Hospital Nurses and Surgical Patient Mortality.” Journal of the American Medical Association (JAMA) qualified students were turned away tests – practices that contribute to job 290(12):1617-1623, 2003. from U.S. nursing schools in 2003 dissatisfaction, burnout and high Linda H. Aiken, Sean P. Clarke, Douglas M. Sloane, Julie Sochalski, Jeffrey H. Silber. “Hospital Nurse Staffing and because of capacity limitations.The turnover rates, and reduce the quality Patient Mortality, Nurse Burnout and Job U.S. also deters some aspiring nurses of patient care. Dissatisfaction.” Journal of the American Medical Association, 288(16):1987-1993, 2002. because nursing education here is pri- Ethical guidelines on the recruit- Linda H. Aiken, Herbert L. Smith, Eileen T. Lake. “Lower marily financed by students themselves ment of nurses from developing coun- Medicare Mortality Among a Set of Hospitals Known for Good Nursing Care.” Medical Care 32(8):771-787, 1994. or their families, the authors reported. tries have the potential to address the shortage7 ELIMINATING NEEDLESS CHILDHOO

Dr. Edith Simpson investigates parental behaviors Women and Childbearing Nursing regarding child safety seats. Diane L. Spatz, PhD, RN; and Associate Professor of Nursing and Miriam Stirl Te rm Professor in Nutrition Stella Volpe, PhD, RD, LD/N, FACSM.And while probably not gut-wrenching enough to make the evening news, each research effort is nevertheless important. If imple- mented, the suggestions from the studies by Drs. Spatz,Volpe, and Simpson would improve, possibly save, tens of thousands of children’s lives.

Child Booster Seats Edith Simpson, PhD, RN Dr. Simpson was immersed in her dissertation on changing risky sexual behaviors for African American women when her researcher’s eye was drawn to an everyday phenomenon – unrestrained children in motor vehicles. As an emergency and trauma nurse who had seen children without seatbelt protection severely injured in For more information on child There is little as arresting as a child in passenger safety, see TraumaLink’s car accidents,“I became impassioned,” website: www.chop.edu/carseat trauma. While television dramas may said Dr. Simpson.“I needed to know why this was happening.” Her informal use childhood illness or accidents as observations led to structured behav- sentimental heart-string pullers, in reali- ioral studies, where she sought to iden- ty all too many children suffer needless- tify factors that could both explain and predict parental health-promoting ly from injury and disease. And these behaviors that would better protect real stories are often even more children riding in cars. In certain ways, she said, this work wrenching than those on TV. is related to her previous HIV preven- Through separate studies, three tion research.“When you are dealing researchers at the University of with another person, negotiation may Pennsylvania’s School of Nursing are play a key role in whether a healthy trying to limit avoidable childhood trau- behavior will be performed or not per- mas. No complicated, intrusive, or dra- formed,” she said.“Women negotiate matic procedures are required by the with their male sexual partners to use studies being conducted by Assistant condoms. Parents have been found to Professor Edith M. Simpson, PhD, RN; negotiate with their children on safety Associate Professor of Health Care of behaviors’ – such as the use of seat belts car8 safety tors, barriers to booster seat use, and Breastfeeding suggested intervention strategies to Diane Spatz, D TRAUMA increase booster seat use.This study will be conducted using two waves of focus PhD, RN groups.The first battery of 16 focus Dr. Spatz, a clinician educator at Penn groups will elicit beliefs, influencing fac- Nursing, is trying to prevent illnesses in or belt-positioning booster seats.With tors, and strategies.The next 16 groups children around the world by increas- automobile crashes a leading cause of will explore parental insights on strate- ing the adoption of a simple behavior: death and acquired disability for U.S. gies generated by the first wave.This breastfeeding. children, parents should not have to study,funded by the U.S. Department of “There is a plethora of research on negotiate with their children to use Transportation, will be conducted why breastfeeding makes a difference,” proper restraints, said Dr. Simpson. among populations cutting across social, said Dr. Spatz.“The longer women lac- According to the National Highway economic, and ethnic segments. tate, the better it is for both the child Traffic Safety Administration (NHTSA), “We may find that inappropriate and for the mother.” children who weigh more than 40 restraint of these children is due to For the baby, the list of benefits is pounds, are between four and eight years economic barriers that could be solved long, reports Dr. Spatz. Overall there is old, and less then four feet nine inches with parents receiving additional infor- a decrease in infection – ear, gastroin- tall should use a belt-positioning booster mation on how to acquire low or no- testinal, urinary, respiratory and more – seat, said Dr. Simpson. Belt-positioning cost booster seats,” said Dr. Simpson. because human milk contains white booster seats lift children up so that the “Other parents may need training in blood cells that fight infection and dis- shoulder belt fits properly across the the parenting skills needed to promote ease.Also, breast milk is more nutri- shoulder and chest and the lap belt fits the safety of their children.” tional because it is easier to digest, so low and snug across the hips and upper “If we can effectively change par- that each component of the milk is thighs.This type of child restraint should ents’ inappropriate child restraint use readily usable in the baby’s system. In be used until the child can fit properly behaviors – such as the consistent use addition, breast milk contains free-fatty in an adult seat belt. of belt-positioning booster seats for acids, which are a source of nutrition Dr. Simpson conducted her children who should be using them – and act as anti-microbial and anti-bac- research with Associate Professor of we can reduce injuries and even save terial agents. No ready-made formula Pediatrics Flaura Winston, PhD, MD, at lives,” she said. will ever compare, said Dr. Spatz. the University and scientific director of For the mother, breastfeeding Simpson EM, Moll EK, Kassam-Adams N, et al. (2002). TraumaLink, an interdisciplinary pedi- Barriers to booster seat use and strategies to increase decreases risk of post-partum hemor- atric research center located at the their use. Pediatrics 110(4):729-36. rhage, Dr. Spatz said.After a mother has http://www.nhtsa.dot.gov/CPS/ Children’s Hospital of Philadelphia. a baby, her uterus has to contract. Drs. Simpson and Winston have found (continued on page 10) that the highest rate of inappropriate or less than optimal use of child restraints in cars was found among children between the ages of four and eight, children riding with African American and Hispanic parent drivers, and chil- dren riding with parent drivers who had no more than a high school edu- cation.When exposed to an automo- bile crash, these children experienced an increased risk of injury. In order to understand how and why parents decide whether to use belt- positioning booster seats for children, Dr. Simpson is investigating parents’ cul- tural, behavioral, normative, and control beliefs about these safety restraints. She is also investigating other influencing fac- breast milk 9 eecse

time women breastfeed by providing Childhood Obesity research-based support and care. She is particularly concentrating on babies Stella Volpe, with low birth weights and other vul- PhD, RD, LD/N, FACSM nerable infants, such as those born with Dr.Volpe’s research is aimed at making congenital anomalies, since these children healthier, too. She has long infants may benefit most from human been concerned with nutrition and milk.“When we are able to intervene how it affects the health of young peo- and teach how best to continue breast- ple. Since attending the University of feeding, the baby’s stay in the hospital California at Berkeley, she has worked has been decreased,” she said. with mineral metabolism and nutri- Dr. Diane Spatz advocates breastfeeding The profile in the United States of tional supplements, particularly their (continued from page 9) a long-term breastfeeding mother is effects on female athletes. Her research When a mother breastfeeds, her body still a white, well-educated, higher- has been conducted independently produces oxytocin, which contracts the income woman, said Dr. Spatz.“We and with Gary Foster, PhD, an uterus, helping her get back to a non- need to find how to get resources to associate professor at the University of pregnant state. Breastfeeding also low-income women,” she said.“There Pennsylvania School of Medicine and decreases a woman’s risk of later breast are many reasons low-income and Clinical Director of the Weight and cancer and osteoporosis.When a minority women don’t continue. It Eating Disorders Program. woman breastfeeds, her bones become could be cultural – if my mother and Dr.Volpe’s work has led her to less dense, said Spatz, but after she grandmother didn’t do it, I won’t. It study the shocking recent increase in stops, they re-mineralize. could be that they have to go back to childhood obesity, targeting behavior Further, though there is only anec- work in an environment where it isn’t modifications in pre-teen and middle- dotal evidence, Dr. Spatz said she easy to continue.” school children.“It is typically more believes there is a better bond formed Currently, most low-income difficult to change behavior as time between mother and child the longer American women do not have access goes on, so it is very important to do it breastfeeding takes place. to equipment that can extend the time as early as possible,” said Dr.Volpe. The World Health Organization they breastfeed, such as hospital-grade For one thing, she said, when peo- recommends breastfeeding for two electric breast pumps or Baby Weigh ple become obese, physiologically their years, but Dr. Spatz agrees with the Scales, a special scale designed to meas- fat cells increase in number, never to go more modest goal of the American ure milk intake at the breast, important away.Thus, an overweight child is more Academy of Pediatrics, which recom- for vulnerable infants. Such equipment likely to be overweight as an adult mends mothers breastfeed exclusively is not covered by insurance. In addi- because of the development of these fat for six months and part-time for a year. tion, women in the United States often cells early in life. American women breastfeed for a have difficulty finding a healthcare pro- Early childhood obesity is not “the shorter time than others around the fessional trained in breastfeeding. only reason” youngsters become over- world.This is due to a variety of rea- “But if we can just find ways to weight, but it does contribute, she said. sons from cultural and workplace issues make it easier, to get a breast pump, a “Even in children, obesity leads to to lack of knowledge about the advan- scale, some nursing to that population, other diseases, like Type II diabetes.” tages of breastfeeding. Dr. Spatz’s we will impact the health of more chil- Drs.Volpe and Foster are working research is designed to help extend the dren,” she said. with physical education teachers to study whether an increase in vigorous

Marks, J. & Spatz, D.L. (2003). Medications and lactation: What PNPs need to know. Journal of Pediatric Health Care, 17(6), 311-319. Spatz, D.L. (In press). Breastfeeding education and training at a children’s hospital. Journal of Perinatal Education. Spatz, D.L. (In Press). The breastfeeding case study: A model for educating nursing students. Journal of Nursing Education. Milligan, R.A., Low, G., Spatz, D.L., Brooks, L.M., Serwint, J.R., Pugh, L.C. (In Press). Contraception and Breastfeeding: Advising New Mothers. Contemporary Obstetrics and Gynecology. Meier, P.P., Brown, L.P., Hurst, N.M., Spatz, D.L., Borucki, L., & Krouse, A. (2000). Nipple shields for preterm infants: Effect on milk transfer and duration of breastfeeding. Journal of Human Lactation, 16(2), 106-114. Pugh, L., Milligan, R., Frick, K., Spatz, D.L., & Bronner, Y. (2002). Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Birth, 29(2), 95-100. 10 diet exercise

physical activity by children in gym Dr. Stella Volpe works to decrease adolescent obesity. classes will lessen their chances of get- ting Type II diabetes. Dr.Volpe is concerned that chil- dren and adolescents may be develop- ing poor dietary habits.“We see over- weight children, but where it is really striking is with adolescents,” she said. “We need to improve their lifestyles so they don’t gain weight. “We’re not telling kids to run three miles every day, but to do some exercise and eat more fruits and vegeta- bles,” she said.“You can’t take away their choices, but you can help them make better ones.” In another study, Dr.Volpe is look- ing at the infamous “freshman fifteen,” the amount of weight freshmen college students often gain. She will be moni- toring the food eaten by male and female students over the next two years at an unidentified local college where smaller portion sizes will be served by the school’s food service. “We hope the results will show that reducing portion sizes will prevent weight gain often seen during fresh- man year,” Dr.Volpe said. In other words, are the students eating more because they want to or because they are eating what they are served? “You don’t need to become a marathon runner to improve your health and control your weight,” she said.“That’s not what we are out to do. A child, especially, does not and should not need to be on a diet. But eating 100 fewer calories a day or expending 100 calories of energy a day can change a behavior for life. If we can change that behavior, we will have a lot more healthy people.”

A. De Lorenzo, A. Andreoli, P. Battisti, N. Candeloro, L. Iacopino, S.L. Volpe. Assessment of total body potassium in healthy Italian men. Annals of Human Biology, In Press A. De Lorenzo, A. Andreoli, P. Serrano, N. D'Orazio, V. Cervelli, S.L. Volpe. Body cell mass measured by total body potas- sium in normal-weight and obese men and women. Journal of the American College of Nutrition, 22(6): 546-549, 2003. S.L. Volpe, H.-W. Huang, K. Larpadisorn, I.I., Lesser. Effect of chromium supplementation on body composition, resting metabolic rate, and selected biochemical parameters in moderately obese women following an exercise program. Journal of the American College of Nutrition, 20(4): 293-306, 2001. L.S. Pescatello, S.L. Volpe, N. Clark. Which is more effective for achieving a healthy body weight - diet or exercise? ACSM's Health & Fitness Journal, 8(5): 1-6, 2004.

11 ENVIRONMENTAL THREATS TO AD

At the School of Nursing, faculty members are pursuing research projects that promise to improve health and quality of life for victims of violence and workers in hazardous job environ- ments. Faculty members are also edu- cating new nurses to safeguard the health of working populations, includ- ing the health of nurses themselves.

Decreasing the Toll of Gun Violence Therese Richmond, PhD, FAAN, CRNP

As a critical care nurse caring for scores of patients with gunshot wounds, Therese S. Richmond, PhD, FAAN, CRNP,Associate Professor of Trauma and Critical Care Nursing, wondered how she might help to stem ever- mounting gun violence. “We have chosen to live with guns in our society,”said Dr. Richmond. “Given that, how can we reduce the negative impact of guns in our lives? As nurses, it’s not enough for us to simply treat patients; if we don’t prevent the same injury from happening again, we’re not doing our jobs.” Dr. Richmond decided to fight the The profession of nursing has always epidemic of gun violence with a broad- been cognizant of the importance of based program of interdisciplinary research. In 1997, she joined with C. the environment on human health. William Schwab, MD, chief of Penn’s Today, technology, agriculture, popula- Division of Traumatology and Surgical tion growth, urbanization and many Critical Care, to establish the Firearm Injury Center at Penn (FICAP).The other developments have spawned violCenter, funded by the Joyce Foundation, new environmental health hazards. collects data, improves understanding of the factors leading to gun violence, and Fortunately, nursing researchers and will ultimately develop interventions to their multidisciplinary partners are curb the problem. FICAP brings together researchers documenting the nature and impact of in nursing, medicine, epidemiology, these environmental threats to find criminology,demography,and other ways to address them. diverse disciplines that have not tradi-

12 ULTS: Reducing Risk through Research and Education

tionally collaborated.“Gun violence is a “We’re also studying whether our associ- people who become depressed will complex social problem,”said Dr. ates in criminology can keep guns from develop a disability,”she said. Richmond.“We can’t expect to make getting to known perpetrators, or if our “Preliminary findings indicate that progress without all of the disciplines technological colleagues can design per- symptoms of depression frequently involved bringing their specialized sonalized weapons that cannot be used accompany injury – often out of pro- expertise to the table.” by anyone other than the owner.” portion to the severity of the physical According to Dr. Richmond, inter- FICAP data have highlighted the damage suffered.” disciplinary research is “the wave of the predominance of guns in completed sui- The study,now concluding its sec- future” and nurses are uniquely well cides.“Suicide by gunshot is typically so ond year, has revealed that recovery is a positioned to bring diverse disciplines successful that these victims never make complex process.“In the hospital, we together.“Nurses are especially skilled in it to the hospital,”said Dr. Richmond. treat patients who get better and are dis- building relationships and weighing vari- “Because we don’t ‘see’ them, the role charged,”said Dr. Richmond.“But it’s ous points of view,”she said. of firearms in this form of violence not enough to say,‘You’re fine; go back In her research, Dr. Richmond isn’t even on the radar screen for most to your life.’Survival is not synonymous gathers data directly from survivors. healthcare professionals.” with recovery.We’re just beginning to “Being a nurse informs the questions I Dr. Richmond said that her work understand the complex process of ask patients,”said Dr. Richmond.“We with victims of gun violence has recovering from injury.” talk about the day of the injury and the changed her worldview.“It’s easy to Richmond, T.S., Schwab, C.W., Riely, J., Branas, C.C., sequence of events that led to the shoot- judge those involved in gun violence Cheney, R.C., & Dunfey, M. (2004). Effective trauma cen- ing episode.As a nurse, I know these as having made a ‘bad choice.’ But ter partnerships to address firearm injury: A new para- digm. Journal of Trauma: Injury, Infection, & Critical survivors have a wealth of information after hours of interviews with sur- Care, 56:1197-1205. that can help us design interventions to vivors, you begin to understand that Richmond, T. S., Kauder, D., Hinkle, J., & Shults, J. (2003). Early predictors of long-term disability after injury. decrease the impact of gun violence.” not everyone benefits from the same American Journal of Critical Care, 12, 197-205. In their work, Drs. Richmond and array of life choices. Given their life *Richmond, T. S., Kauder, D., Strumpf, N., & Meredith, T. (2002). Characteristics and outcomes of serious traumat- Schwab cast gun violence as a public circumstances, many of these patients ic injury in older adults. Journal of the American health problem, not a political issue. have made the best of all possible Geriatrics Society, 50, 215-222. “Our work is neither pro- nor anti- choices available to them.” *Richmond, T.S., Thompson, H., Deatrick, J., & Kauder, D. (2000). The journey towards recovery following physical gun,”said Dr. Richmond.“We are Because the profession of nursing trauma. Journal of Advanced Nursing, 32, 1341-1347. changing the dialogue about guns by deals with human responses to illness asking people to view this as a health and injury,Dr. Richmond also felt com- matter rather than a political tug of war.” pelled to study the plight of injury sur- Firearm Deaths Using this public health framework, vivors.“Nurses want to know how a United States, 2001* Drs. Richmond and Schwab describe patient’s response to injury affects them Age No. of Deaths the violent event as one in which the long-term and how we can help to pro- 0-9 years 160 environment, the gun, the shooter, and mote an optimal recovery.”She is cur- 10-19 years 2,777 the victim come together to create an rently the principal investigator of a five- 20-64 years 22,253 injury.“Graphing the incident in this year National Institute of Mental Health >65 years 4,364 ence Age unknown 19 way makes it clear that this is a multifac- study entitled “Major Depression Total 29,573 eted problem – not one that can be Following Minor Injury.”The purpose is solved by simply taking guns away,” said to investigate the development of major * Source: Dr. Richmond. depression and related psychiatric disor- CDC National Center for The interdisciplinary team is explor- ders following injury and to examine Injury control and Prevention. ing various approaches to control the their effects on outcomes. Web-based Injury Statistics Reporting System problem.“We’re investigating behavioral Dr. Richmond is enrolling 250 [WISQARS] Available at interventions that might keep the victim injured patients and following them for www.cdc.gov/ncipic/wisqars/default.htm out of high risk circumstances,”she said. one year.“Our hypothesis is that injured

13 rmaueratossc srse,nau- from acutereactions such asrashes, relatedDisorders toexposures range indigent populationisnotknown. medically ness inthisdisadvantaged, sions governing worker safety. the basiccellularlevel topolicydeci- ranged from theeffectsofpesticides at Herresearch inthisarea has ticides. of alltheseworkers are exposedtopes- andmore thanhalf cide-related illness, may forpesti- beatincreased risk ment, vulnerable stageofgrowth anddevelop- ina workers, 17 andunder.Adolescent seven percent are age the UnitedStates, workers in farm seasonal andmigrant Ofthenearly2.5million their families. workers and of pesticidesonagricultural to arecent study onthehealthimpact pesticide andnerve gas. m effects amongdeployed troops from tostudyhealth of Defense, Department of Veterans andtheU.S.Affairs r McCauley undertook the Gulf Dr. War, of Intheaftermath al threats to health. study ofenvironmental andoccupation- tinguished research program inthe hasadis- RN, FAAN, PhD, McCauley, Nightingale Professor Linda ofNursing PhD, FAAN, RN Linda McCauley, 14 Adolescent FarmWorkers/Pesticide Exposure sac,fne yteUS Department fundedby theU.S. esearch, ultiple exposures tohazards suchas pesticidesThe extentofpesticide-related ill- McCauley That work hasledDr. safeguards againstpesticideexposure, Protection Standard toincrease worker Protection Agency revised the Worker McCauley. saidDr. for a ” good,’ ‘greater are willingtoneglecttheirown needs adolescents health consequences.“These which leadsthemtoignore personal f high value onworking their tosupport Central traditionallyplace a America exposure. thatcouldhaveinstruction reduced and information, needed supplies, which prevented themfrom asking for led theyoung workers tofeelpowerless status immigrant McCauley, added Dr. Overall, taking thetimetousethem.” many didnotfeelcomfortable exist, did adequate decontaminationfacilities Even when tive clothingintheheat. we McCauley.“Many saidDr. the job,” sick was viewed asaninevitable of part health practices. andpreventive of occupationalhazards, knowledge attitudes toward work, farm their perceived vulnerabilitytoillness, toelicit usingfocusgroupinterviews ers work- began astudyofadolescentfarm Research, Associate DeanforNursing andfetaldeath. fetal deformity, neurological disease, lems suchascancer, tochronic andeye prob- irritation sea, amilies backintheirnative countries, re n19,theEnvironmental In 1992, natives ofMexicoand In addition, Frteeyugwres getting “For theseyoung workers, whoisalso McCauley, Dr. In 1996,

r eluctant towear layers ofprotec- gr committee of the studyisanadvisory Guiding Child Development Coalition. Education Program andtheOregon suchastheMigrant population, involves this community groupsserving research modelthat participatory-based McCauley employs a Dr. among others. andmolecularbiologists, tural specialists, agricul- community members, chemists, includesneuropsychologists, Sciences, Institute ofEnvironmental Health Safety andHealththeNational National InstituteofOccupational r of theseadolescents.” content tomeettheeducationalneeds we canwork onfine-tuningthe Then, into multiple oraldialects. materials we must alsotranslatethese languages, workers speakindigenous many farm McCauley.“Since saidDr. English,” in Spanishaswell as ing materials challengeistoprovide“Our first train- may notalways bewell understood. thistraining whenprovided, cates that, McCauley’s research Dr. However, indi- safetytraining. mandatory among them, “Nurses have“Nurses abroad educationalback- McCauley. saidDr. to conductit,” r demandinterdisciplinary century m com- providers forthemigrant caring andhealthcare pesticide expertise, sac rga,fundedby the esearch program, esearch are andnurses well positioned unity. owe This nurse-led interdisciplinary This nurse-led “The healthproblems ofthenext rs ,f r okr,scientistswith workers, arm ground, holistic assessment skills and are Educating Advanced Practice Nurses trained to view a problem from many different vantage points.You can’t sim- About Environmental Exposures ply consider policies on the application Kay Arendasky, CRNP, MSN of pesticides when individual risk fac- tors and behavioral factors are also Advanced Practice Nurses are often the malities resulting from exposures involved. Nurses consider all of these first and sometimes the only source of before conception or during prenatal factors and can frame research results to care for those suffering from injury or development. Fetal death, miscarriages, appeal to various audiences such as illness caused by environmental haz- structural anomalies, functional defi- politicians, health professionals, farm ards. As a result, nurses have a major ciencies, and growth abnormalities are workers and others.” role to play in identifying environmen- some of the health consequences.” tal hazards and implementing primary Her latest research project will Chemical hazards (lead, mercury, sol- prevention strategies. focus on “Biomarkers of Oxidative vents), and physical hazards (noise, Stress.”A biomarker is a measurement In her Master’s level Occupational musculoskeletal stresses, extreme tem- that reflects an interaction between a Environmental Health Option, Kay peratures) are addressed in class and biological system (human being) and Arendasky, CRNP, MSN, the School’s clinical experiences. “Often legal stan- environmental agent (pesticide). Dr. Option Director, relates a true story dards are not simply based on health McCauley will look for the presence about a former student, also a nurse, considerations,” she said. “Instead, they can be negotiated using a cost- of metabolites in the urine of those who had given birth to two children with birth defects. Unfortunately, benefit analysis. The resulting stan- exposed to pesticides and compare although the young mother had asked dards can be little more than legal and these to markers of DNA damage. Her pertinent questions connecting her hus- political compromises.” work will also compare effects noted band’s occupational lead exposure to Nurses practicing primary prevention between adolescents and adults.This the congenital defects, she did not must offer adequate environmental will provide new knowledge on the receive accurate information. This exposure information to the public. A ability of pesticides to cause cancer, shows, said Ms. Arendasky, that with- full occupational/environmental history out specific knowledge about environ- neurological diseases, and cardiovascu- is rarely recorded, she noted, potential- mental exposures and their effects, lar disease. ly leading to misdiagnosis, particularly a practitioner is unable to identify an “Pesticide use is worldwide and the if the patient smoked. “When was the environmental exposure health risk. public desire for inexpensive food is a last time your doctor asked you about major driver of their use,”said Dr. Nurses must be alert to threats that all of your previous jobs, exposures or McCauley.“With pesticide use, we can occupational and environmental haz- about the health of pets living in your buy apples for 69 cents a pound. ards pose to women and their repro- household?” she asked. ductive health status. “There is often a Organic farming remains a more “When we study environmental issues, fine line between the therapeutic value expensive alternative to the agricultural we look at air, soil, and water. Humans of work versus the health or toxic via inhalation, ingestion, and absorp- use of chemicals. Research, prevention threat generated by exposures because tion absorb toxins from these sources. programs, and safety standards are of work,” said Ms. Arendasky, noting Risks are present in our daily life so imperative to safeguard both our envi- that 60 percent of women work outside should be our awareness of these risks ronment and the public health.” the home. “Without preventive meas- and specific avenues for prevention.” ures, we can see decreased fertility, McCauley L, Shapiro S, Scherer J, Lasarev M. (In press) congenital and developmental abnor- Assessing pesticide safety knowledge among Hispanic migrant farm workers. Journal of Agricultural Safety and Kay Arendasky on a work site. Health. Salazar M, Napolitano M, Scherer J, McCauley L. Factors Affecting Pesticide Exposure among Hispanic Adolescent Farmworkers. Western Journal of Nursing Research , 26(2):146-166. McCauley LA, Sticker D, Bryan C, Lasarev MR, Scherer JA. (2002) Pesticide knowledge and risk perception among adolescent Latino farmworkers. Journal of Agricultural Safety and Health. 8(4): 397-409. McCauley, L., Lasarev, M.., Higgins, G., Rothlein, J., Muniz, J., Ebbert, C., Phillips, J. Work (2001). Characteristics and Pesticide Exposures among Migrant Agricultural Families: A Community-based Research Approach. Environmental Health Perspectives, 109(5):533-538.

15 INFLUENCING LONG-TERM CARE…

From their origins in the 1880s, home care agencies have grown and become widely “Does the video unit present more opportunities for teaching patients self- accepted options for helping older adults remain independent in their own homes. management skills than the other More than 20,000 home care agencies serve nearly eight million American patients, machine? Or does the patient being according to the National Association for Home Care and Hospice. responsible for using (the second device) daily make him more knowl- Two University of Pennsylvania visits, and could decrease the number of edgeable and interested in managing School of Nursing professors have in-person nurse visits, enabling the pro- his own health?” asked Dr. Bowles. launched research initiatives with fessional caregivers to reach more “We don’t know yet – that is one of Pennsylvania and New York home patients daily.Patients and nurses both the things we hope to discover.” healthcare agencies to improve home viewed the technology favorably. Participating home-care agencies care.The first project is led by Associate Drs. Bowles and Dansky teamed assign patients randomly to the tele- Professor of Nursing Kathryn H. up again on a study funded by the health intervention or control group. Bowles, PhD, RN.With a team of Robert Wood Johnson Foundation to Which telehealth device each patient researchers, Dr. Bowles will measure investigate heart failure patient out- receives depends upon what is available whether telehealth technology can comes, comparing patients using two at each agency. Patients test the tele- increase patients’ ability to stay out of different types of telehealth devices health tools for 60 days.The referring the hospital and if the type of equip- against a control group receiving only physician must agree to the patient’s ment used alters outcomes.The in-home nursing visits.The patients participation in the telehealth research. research takes place at seven home-care using telehealth tools also receive some In a later stage of the study, the agencies throughout Pennsylvania. in-home nursing visits.The team began team will interview the physicians The second research effort is spear- enrolling patients last year and hopes to about their attitudes and intentions to headed by Assistant Professor Karen accrue 700 for this study, which is the use telehealth. In the future, Dr. Bowles Schumacher, PhD, RN, the first first of its kind, Dr. Bowles said. and colleagues plan to conduct a sepa- Beatrice Renfield Visiting Scholar at the “One challenge is getting patients rate cost-efficiency analysis of tele- Visiting Nurse Service of New York to enroll in a research project,” Dr. health used in home care under a (VNSNY). Dr. Renfield, an advocate for Bowles said.“It’s one more thing to prospective payment system. nursing and home care, established the deal with, especially for patients who independvisiting nurse scholar program at the feel very sick.Another challenge has Bowles, K.H., Foust, J.B., & Naylor, M.D. (2003). A multi- disciplinary perspective of hospital discharge referral VNSNY in 2003 to research, develop been patients who really want the decision making. Applied Nursing Research. 16(3), 134- 143. and disseminate new models of home- machine and are not willing to take the Dansky, K.H., Bowles, K.H., & Palmer, L. (2003). Clinical care nursing practice and education. chance of being in the control group.” outcomes of tele-home care for diabetic patients receiv- Both telehealth devices aid in ing home care. The Journal on Information Technology Telehealth in Healthcare. 1(1), 61-74. remotely obtaining vital signs, pulse Bowles, K. H. and Dansky, K.H. (2002). Teaching self- management of diabetes via tele-video. Home Kathryn Bowles, oximetry,and weight.The first device Healthcare Nurse. 20(1), 36-42. PhD, RN has a screen and microphones, allowing Dansky, K.H., Bowles, K.H., Palmer, L. (1999). How the nurse to talk the patient through telemedicine affects patients. Caring, 18(8), 10-14. Dr. Bowles’ original telehealth experi- each step of data collection and to re- Dansky, K.H., Bowles, K.H., & Britt, T. (1999). Nurses’ ence began as clinical coordinator of a responses to telemedicine in home health care. Journal enforce teaching.The second device of Healthcare Information Management, 13(4), 27-38 study with homebound diabetics that prompts the patient to take his or her concluded in 2000.That research, led by Schumacher, K. L., & Marren, J. (In press). Home care blood pressure, oxygen saturation, nursing for older adults: State of the science. Nursing Kathryn Dansky,PhD, from Penn State weight and medications.This device Clinics of North America. University,found that telehealth visits Schumacher, K. L., & Portillo, C. J. (2002). Advanced sends the data back to the nursing improved patients’ self management, practice nursing in home care. In I. M. Martinson, A. G. agency with an alert to the nurse if any- Widmer, & C. J. Portillo (Eds.), Home health care nursing saved money by preventing emergency (2nd ed., pp. 519-534). Philadelphia: W. B. Saunders. thing falls outside prescribed parameters.

16 Quality improvement Karen Schumacher, PhD, RN

Since becoming the VNSNY’s first Visiting Scholar, Dr. Schumacher has collaborated with VNSNY researchers, nursing leaders and frontline clinical staff to identify key issues in home care and to develop goals for the two-year partnership. One aim is increasing nurses’ knowledge about home-care research. With this in mind, Dr. Schumacher and Joan Marren, chief operating officer for VNSNY,wrote a paper about the state of the science of home-care nursing and the clinical implications of recent research.The paper is scheduled for publication in Nursing Clinics of North America. …CULTURE CHANGE Another goal of the Visiting Scholar program is to ease nurses’ entry into home-care practice.VNSNY had For years, nursing homes have provided institutional care focused on completing already established a yearlong internship program for new BSN grads, which tasks – feeding, dressing, medicating and other caregiving activities. Recently, some several Penn graduates have successfully leaders in the nursing home industry have begun to change the culture of their facil- completed. Dr. Schumacher is identify- ities to enhance the residents’ quality of life by providing choices about care and a ing potential new interns and consulting about enhancements to the program. more homelike environment. “Interns in this innovative program In an unusual partnership, a Nursing and Division Chair for Family are gradually brought into the role of University of Pennsylvania team, led by and Community Health, and Cynthia the home-care nurse, receiving a lot of two School of Nursing investigators, Scalzi, PhD, FAAN, RN,Associate guidance from a preceptor,”said Dr. encecollaborated with for-profit nursing Professor in Nursing and the Wharton Schumacher.“It’s very teaching inten- home industry giant Beverly Enterprises School and Director of the sive.They are not making visits on their to evaluate Beverly’s early efforts to Administration and Leadership Graduate own until the preceptor feels they are change the culture at three of its nursing Programs.The two other research team ready.” facilities and compare them to three members were Alan Barstow,PhD, an For the existing VNSNY staff, Dr. traditional Beverly homes, matched for organizational anthropologist in the Schumacher is planning visiting profes- size, location and leadership. School of Arts and Sciences; and nursing sor educational sessions at various loca- graduate student Katie Hostvedt. tions throughout the agency’s wide- Evaluating the Culture Change Model Beverly, one of the largest U.S. spread system. Penn faculty will share Lois Evans, providers of nursing-home care, oper- evidence-based findings applicable to ates 452 skilled nursing facilities and 29 the nurses’ current practice. DNSc, FAAN, RN and assisted living centers in 26 states and “It will be very gratifying to do this Cynthia Scalzi, the District of Columbia. Beverly project,”Dr. Schumacher said.“It will PhD, FAAN, RN began piloting culture change about a help nurses implement research into year before the study began. Beverly daily practice.” The Penn research team was led by Lois funded the study. K. Evans, DNSc, FAAN, RN,Viola (continued on page 18) MacInnes/Independence Professor in

17 Drs. Barstow, Scalzi, and Evans (left to right) seek culture change for elder care.

(continued from page 17) While it is somewhat unusual to partner with a for-profit entity,Drs. Evans and Scalzi viewed the joint effort as a unique opportunity to pilot their research design and instruments and also positively affect nursing-home care. “Resident Centered Elder Care is one of the most important initiatives (at) Beverly,”said Blaise Mercadante, PhD, Beverly senior vice president of market- ing and new business innovation.“We are looking to fundamentally deinstitu- tionalize the nursing-home experience. We needed a credible, outside objective opinion on what we’d accomplished and “Beverly is such a large provider, if Long a proponent of the impor- what we still had to achieve.” they continue to implement Resident tance of values in shaping organization- Drs. Evans and Scalzi found not Centered Elder Care, it will take the al behavior, Dr. Scalzi’s interest in cul- only significant differences between industry by storm, because it will be ture change in nursing homes devel- Beverly’s three culture-change facilities ‘the thing to be doing,’” Dr. Evans said. oped after observing the care of a fam- and the three operating under a tradi- “Normally,it takes 10 to 15 years ily member admitted to a nursing tional approach, but also saw opportu- for research to be put into practice,”said home.Although her aunt lived in a nities for further improvement in the Dr. Evans.“We did this study in seven highly-rated facility, Dr. Scalzi became culture change model.The team rec- months, and they immediately began convinced a better way of caring for ommended changes before the compa- implementing some of our findings.” elders must exist. ny expanded its Resident Centered The professors brought different The Penn research team began its Elder Care program to additional facili- expertise to the project.Twenty years investigation of Beverly’s culture- ties. Beverly began implementing the ago, Dr. Evans’ pioneering research change program by walking through Penn researchers’ recommendations reduced the use of physical restraints in the facilities with clipboards and stan- almost immediately. nursing homes, changed nurses’ percep- dardized instruments, noting quality “The information we provided tion of the practice, altered public policy indicators on the floors, in dietary, was very important, and they definitely and brought international attention to therapy, the bathrooms and common used it,” Dr. Scalzi said.“It is so exciting the physical and psychological harm for areas.They then compared observations to see your research findings translated patients. Once advanced practice nurses and reached a consensus rating for each into actions so quickly.” worked with staff to identify and imple- area. A few nursing homes across the ment alternatives to restraints, previously Next, they gave two instruments country have begun changing their restrained residents began to talk and to all levels of staff and rewarded each culture to empower residents and staff, behave more normally. employee who completed the survey to enable older adults to have choices “It became clear we could improve with a $10 honorarium.They received about their care, and to live in more quality of care by removing restraints, 271 completed questionnaires. home-like environments. Culture but quality of life still had a long way to The researchers followed up in change focuses on relationships, people go,”Dr. Evans said.“Once we began to two-person teams to conduct inter- and personal preferences more than on see what nursing homes really looked views with staff and family members, completion of tasks. Many different like when residents were unrestrained, spending about nine hours at each models of change exist, mostly in inde- other needs came to the forefront.” facility. Staff members seemed quite pendent homes.

18 19 Initially, referred to its tra- Beverly needed as an what was saw “We posi- “While not all findings were Dr. to wait does not want Evans usiness models, rather than a move- eceive needed medical care.eceive Beverly to the actions suggested,eceptive and increase by giving them more opportu- giving them more by increase and fami- with residents nity to work tasks.Theylies rather than just defi- are do to like nitely people who would of them.” than is being asked more as a ditional nursing-home culture “medical model” and called the new “social a approach culture-change recom- researchers Penn model.”The “medical mended that the term model”“institutional by be replaced model,” accu- felt more a phrase they what needed changingrately reflected in the traditional approach, particularly since, model, under any would residents r this has updated the language to reflect site and in internal change on its web documents. integration of the medical, social and b one to another,”ment from Dr. Scalzi said. tive, an objective tried we to provide well working assessment of what was not,”and what was Dr. Scalzi said. very team was executive “The Beverly r since been implemented.” have many for the next major another 20 years in longterm to care improvement nurses will Penn become reality.The change culture researching continue and quantifying its effect on outcomes. 1. Weiner, A. and Ronch, J. (Eds.) (2003) Culture Change A. and Ronch, J. (Eds.) (2003) 1. Weiner, Practice Care. Hawthorne Social Work in Long-Term Co-published simultaneously as Press, New York, 2, Care, Volume in Long-Term Journal of Social Work Nos. 1/2 and 3/4 2003. of L. and Harel, Z. (Eds.) (2001) Linking Quality 2. Noelker, Care and Quality of Life. Springer Publishing Long-Term Canada Company, “They were not aware they had they not aware were “They “Nurses carry in out a vital role strongly team believed The Penn But the Penn researchers also researchers But the Penn that nurses The study also showed orkers on all shifts should eventually orkers ound care – that only they are – that only they ound care be included in preparation for culture be included in preparation team executive change.The Beverly plans to include nurses and others in training sessions. future are behind and now left this group working making an effort through what nursing with nurses to redefine in a resident-centered should look like Dr. environment,” care Scalzi said.“I suspect nurses’ job satisfaction will licensed to provide.They often do not licensed to provide.They and talking the time for sitting have with a resident, enjoy- one of the more in long-term aspects of working able care. a crucial link Nurses also provide and caregivers. executives between the more and are of residents the care educated of the staff, not were yet being utilized to their potential,” Dr. Scalzi said. should be left out of that no one group of the initial training and that all levels w elderto peers as a good place to work.The learning how were management teams to make staff to let go and to empower solve. decisions and problem found opportunities for improvement. effective- time.To change takes Culture for nursing ly alter the environment home residents, be includ- staff must all ed in the training process. During the at Beverly, education initial rollout focused at the leadership level. Nurses, therapists, the and aides did not receive of training in culture-change same level practices. care of their time on tasks – spend much medication administration, treatments, w meeting Beverly’s objectives.” meeting Beverly’s

In one of the homes, however, residents Some families moved had team found that research The Penn “We used a lot of the qualitative used a lot of the “We culture- of Beverly’s In all three re mily members also participated.The esearch goals and at the same time we esearch com- greater physical esidents enjoyed eceptive to participating,eceptive 132 with ecommend their facility to families and acility to tend to personal affairs or to consistent acility because of the more amily were respected and preserved. respected amily were more remarkable progress was noted. was progress remarkable more in vol- There, involved were residents found they unteer jobs and activities satisfying. example, For were residents left the assistance when they provided f visit a hospitalized roommate. a traditional to a culture-change from f and a staffing with the same caregivers sense of community. One daughter months at the two called her mother’s facilityculture-change the best during a nursing in home. years her five staff members the team appreciated facilities. in culture-change environment than likely significantly more were They associates at the traditional homes to r we fort and privacy, choice, had more and with friendstheir relationships and f interview data to substantiate our find- the instruments,”ings from Dr. Scalzi meeting our were explained.“We r change facilities, researchers Penn between found good communication and a calm, and residents employees environment.homelike In addition, r agreeing to interviews.Twenty-one fa short time period receiving between the grant deliv- date and the promised ery obtaining institu- date precluded to talk approval board tional review with residents. r EXCHANGING IDEAS Nationally and Internationally

Dean’s Lecture Series Distinguished Lecture Barbara Friday, September 26, 2003 Medoff-Cooper, Improving Patient Safety: Using PhD, CRNP, FAAN, RN Information Technology?

David W. Bates, MD, MS Second Annual Claire M. Fagin

Distinguished Research Award, Tuesday, December 2, 2003 April 15, 2004 Knowledge Development and Diversity: The Ethics and Art of Dr. Medoff-Cooper’s major accomplish- Creating Disclosive Spaces ments include the development of the Early Infancy Temperament Patricia E. Benner, PhD, RN, FAAN Questionnaire and the development of the Medoff-Cooper Infant Feeding Tuesday, January 20, 2004 Apparatus, potentially providing evi- Claire Fagin, PhD, FAAN, FRCN, RN, is the Leadership dence that early feeding behaviors are Professor Emeritus and Dean Emeritus of the University Healthcare Reform in Pennsylvania: related to developmental outcomes. of Pennsylvania School of Nursing, having received A One Year Retrospective – Lessons numerous honors, including being named a “Living Learned and A Focus Sharpened Major research findings include: Legend” by the American Academy of Nursing in 1998.

Rosemarie Greco 1996: The association between poor feeding and poor developmental outcomes, Excerpts from Monday, March 22, 2004 published in Nursing Research. Dr. Barbara Medoff- Health Disparities and Health Literacy: 2000: Making the Connections, Answering A positive relationship between increas- Cooper’s Presentation the Challenge ing gestational age at birth and feeding It is truly an honor to be the second organization, published in Maternal Vice Admiral Richard H. Carmona, recipient of the Claire Fagin Research Child Nursing. MD, MPH, FACS Award. I will share how this program United States Surgeon General 2001: of research developed and how the A distinct pattern of maturation in findings of each project sparked the feeding behaviors as post-conceptional Thursday, April 8, 2004 next. But mature programs of research age increases, published in Infant can only happen with wonderful teams Unequal Treatment: Does Cultural Behavior and Development. Competency Matter? and great mentors. 2002: Three amazing mentors have Joseph R. Betancourt, MD, MPH Objective measurements and analysis shaped my life, creating new spaces for of feeding behaviors made possible other women and for new knowledge. through development of the Medoff- Claire Fagin developed the idea of the Cooper Feeding Monitoring System, published in Journal of Developmental nurse scholar. Ellen Fuller found new and Behavioral Pediatrics. pathways in cardiovascular basic science, and Maria Delivoria-Papodopolous translated basic science in neonatology into clinical practice. One of the joys of my research is how I feel absolutely in love with

20 children. From the first time I cared (NMR) spectroscopy and, second, with ly, from the early studies we showed for them, specifically premature a daily clinical neurobehavioral assess- that we could reliably measure feeding infants, I wanted to make a difference ment.We were able to demonstrate behaviors in both very immature in their lives, particularly those born that healthy preterm infants had signifi- preterm and full term robust infants, less than 1,000 grams or about two cantly different brain metabolism than establish norms for feeding behaviors, pounds at birth. Just one decade infants who had experienced an intra- and lastly, that both maturation and before my practice began, these infants ventricular hemorrhage who also experience mattered. often did not survive. showed a specific pattern of abnormal In behavioral investigations, we Frustrating for me as the primary neurological findings. introduced the Early Infant care provider, as well as for their fami- Feeding behaviors in young infants Temperament Questionnaire (EITQ) lies, was our lack of knowledge of how seemed associated with brain integrity, to measure behavioral style in very these high risk infants would develop but there was little information linking young babies. Since those early days, or why they presented such parenting feeding to developmental outcomes. the EITQ has been published quite a challenges.Those questions led me to Those early days of research supported few languages and used internationally. frame my doctoral program. by small pilot funds have since been fol- With additional NIH funding we dis- Determined to know more about lowed with three National Institutes of covered that all preemies are not the the antecedents of both the difficult Health (NIH) grants, which have gen- same.The most immature preterm temperament and slow development, I erated many important clinical findings. infants – those born between 24 weeks looked for underlying causes, the neu- Feeding was very different and 27 weeks – were different from rodevelopment of these most at-risk between the two preterm and full term those more mature, even if preterm, infants in their earliest days. In the infants. Measuring sucking behaviors and did not “catch up” to term infants Robert Wood Johnson Clinical across gestational ages produced empir- when they reached 40 weeks. In addi- Scholars program, we studied the brain ical data that demonstrated infant feed- tion, those infants with more organized in two ways: first, brain metabolism ing patterns changed with both matu- feeding skills at 40 weeks reached with nuclear magnetic resonance ration and experience. Most important- higher developmental markers at 12 months of age. Giving infants earlier feedings and more frequent bottle feedings had an influence on feeding behaviors at term. With funding from the National Heart, Lung, and Blood Institute, I fur- ther developed norms on a sucking machine to discern these behaviors by looking at both healthy and sick infants.Those infants with congenital heart defects were both full term but not feeding or growing well.We did not know whether poor feeding failed to sustain growth or whether these infants needed more calories. Other factors confounded the investigation, such as length of time on cardiopul- monary bypass, or the complexity of the defect. (continued on page 22)

21 (continued from page 21) These questions served as the basis for the third major research grant.This project is the first to measure both feeding skills and energy requirements in a large group of infants with very complex heart disease (CHD).We are measuring total energy expenditure, sleeping energy expenditure, and body composition with the most up to date, high tech monitoring system, available at only a very few institutions. Our study is the first of its kind to provide U.S. Surgeon General a comprehensive picture of how new- Speaks at borns grow following CHD surgery. We have provided evidence that Penn Nursing infants can safely feed as early as 32 weeks post-conception, that matura- The nation’s top doc, U.S. Surgeon “This is not just an academic discussion tion of feeding behaviors is a way to General Richard Carmona, brought his to me,” he emphasized, exhorting the evaluate maturation of preterm infants, message of health promotion and standing-room only Penn Nursing crowd and that feeding behaviors should help health literacy to Penn Nursing. What to shift the emphasis in healthcare from direct discharge plans. Infants that do might be less well known is that Vice treatment to prevention. Noting that the not feed well should not be sent home Admiral Carmona, MD, MPH, FACS, is poverty of his own childhood prohibited before we discover the reason for poor the nation’s top nurse, too. doctors’ visits except in dire emergen- cies, Dr. Carmona said his grandmother feeding. Dr. Carmona’s medical career began in cooked with lard, thinking it was the For the infant with CHD, our the unlikeliest of ways when he dropped right thing to do, and used home health goal is to find ways to help them grow out of high school to join the Army. remedies, thinking this was her only in order to prevent insertion of a per- Becoming an Army medic, Dr. Carmona option to care for her family. Many peo- later went on to become a paramedic, manent feeding tube and a diagnosis of ple today behave similarly, he said, urg- nurse, physician, and surgeon, before “failure to thrive.” If we can figure out ing students and professionals to con- being tapped by President George W. the puzzle of why they do not eat and sider cultural imperatives and reduced Bush to the nation’s top medical post. what are their energy demands post- finances when talking with patients surgery, we may be able to have a Noting that medicine and nursing have about preventing disease. “We have a major impact on care for future gener- different approaches to the patient, Dr. world within our world that is represent- ations of infants with complex heart Carmona noted of himself, “You’re ed by health disparities,” he said. never a former nurse. It stays in your defects.We know that CHD is not This means that many preventable prob- fabric.” He credited nurses for being going away, but we can improve the lems continue to increase. The incidence “tenacious patient advocates.” quality of growth and development of of obesity is growing rapidly, particularly these vulnerable infants. In his own career, Dr. Carmona now among the nation’s youth, quickly over- advocates for the nation’s most vulnera- taking smoking as the leading cause of ble patients by using his post as a “bully illness. Currently, 15 percent of the gross pulpit” to push heath promotion for the national product is spent on healthcare poor and disenfranchised. He noted that with nine million children already classi- this current emphasis on health promo- fied obese. “If we don’t do something to tion across the varied cultures in the break that cycle, it’s going to break the United States springs from his own bank,” Dr. Carmona said. impoverished upbringing in a housing What is needed, he said, is cultural com- project in the South Bronx in New York petence among purveyors promoting City where he was greatly influenced by healthy lifestyles. That produces health his tiny Spanish-speaking grandmother literacy for all Americans, regardless of who reared a flock of children. cultural imperatives. “The legacy we as health professionals want to leave this country is prevention,” said Dr. Carmona.

22 Visiting Scholars Dr. Stewart’s recent research into incidence of heart failure indicates that

Since coming to the School of Nursing in heart failure remains “a common and 2002, Dean Afaf I. Meleis, PhD, DrPS deadly disease, but survival rates are (hon), FAAN, has increased the interna- actually improving.”Maintaining a sta- tional visibility of the school with visiting ble population of heart failure patients international scholars and increased inter- may strain the healthcare system in the national cross-fertilization through more future, Dr. Stewart noted, but currently keynote addresses abroad. Here is a brief disparities in care typify the disease. look at some of the views expressed by Indeed, according to recent research Dr. De Geest the 2003 International Scholars in Residence, Simon Stewart of Australia on case fatalities in Scotland, Dr. Stewart Unimaginable only a few decades and Sabina De Geest of Switzerland, as found that the more affluent were less ago, kidney and liver transplants have they addressed Penn Nursing. likely to have an acute fatal event.“This become increasingly common as the presents a challenge to all countries,”Dr. incidence of chronic kidney and liver Simon Stewart Stewart said.“These are socio-economic disease has continued to rise globally. Simon Stewart, PhD, FESC, FAHA, differences and we must do something The intersection of the human psyche RN, the National Heart Foundation of about that.” and behavior with medical advance- Australia’s Professor of Cardiovascular Dr. Stewart posed a vexing ques- ments such as transplants provides a Nursing at the University of South tion:Are symptoms overlooked when vast new area for research. Australia and Professor of Health exhibited by a more youthful person? “Our program of research is one Research at the University of “Do younger men ignore symptoms?” that looks into the behavioral dimen- Queensland,Australia has focused his Dr. Stewart asked.“Do younger sion of transplantation, specifically . . . research on developing new models of women come into hospital and their reviewing patient adherence,” said Dr. care for patients with congestive heart symptoms are missed? Sex-based differ- De Geest.“We are focusing on looking failure and is particularly interested in ences and socio-economic-based gradi- at the magnitude of noncompliance investigating the effect nursing has on ents are evident.” with immunosuppressant drugs.” the patients. Dr. Stewart has designed a Investigating effective models of One surprising finding of the Dr. home-based program of care for these care, Dr. Stewart looked at heart failure De Geest’s research was that compli- patients and helped to establish the teams dealing with high-risk patients ance extends the average life expectan- world’s first city-wide Heart Failure with clinic care, community-based care, cy by four years, but it also increases Nurse Liaison Service in Scotland. telephone support and interactive healthcare costs.“Non-adherence is less “Where should nurses be most monitoring, providing different modes expensive than adherence due to differ- active?” Dr. Stewart asked.Answering his of management depending on the age ences in life expectancy,” she said. question, Dr. Stewart exhorted the and situation of the patient. In the end, Dr. De Geest pointed out that crowd of standing faculty to take action nursing made the difference. patient non-compliance with a drug when conventional strategies fail and “Nurse intervention had an effect regimen is substantial: one in five health outcomes are poor, arguing that over and above drug therapy.There is patients is non-compliant.While some as the “most trusted” healthcare profes- something that we do that adds value. of the drugs produce uncomfortable sionals, nurses should be the facilitators Caring for other people is the founda- side effects, she said there is no one of achieving healthcare for everyone. tion of our profession,” he concluded. reason for non-compliance.Thus, to Sabina de Geest increase compliance, healthcare practi- Dr. Stewart Sabina De Geest: Professor of Nursing tioners need to tailor individualized and Director of the Institute of approaches to immunosuppressant Nursing Science at the University of drugs for each patient. Basel in Switzerland Dr. De Geest concluded that “a Sabine De Geest, PhD, RN, spe- major opportunity to improve out- cializes in investigating patients’ comes is to invest in behavioral factors responses to one of the more stunning for transplantation” and make sure that medical achievements of the century: people who work with transplants are human organ transplantation. trained in behavior modification in order to best mediate interventions.

23 FACULTY: Stimulating the Intellectual Environment

Drs. Sullivan-Marx, Keane, and McCauley (left to right)

Shearer, is intended for a nurse facul- ty member who will provide leader- ship and faculty support for the school’s community-based initiatives. Dr. Sullivan-Marx meets that intent with distinction. She is responsi- ble for expanding the School’s Healthy in Philadelphia (HIP) Initiative. She is conducting an ongoing evaluation of reimbursement mechanisms and policy related to quality of care and cost of services for vulnerable, older popula- tions. Dr. Sullivan-Marx is also partici- pating in developing Penn Home Care and Hospice Services.

Linda McCauley, Associate Dean for Research, has been named the Nightingale Professor in Nursing.The Nightingale Chair is funded by a gen- erous gift from Margaret R. Mainwaring and was established to honor nurses who served their coun- try during times of war and is dedicat- School of Nursing Chairs ed to their memory. Dr. McCauley’s work with mili- Anne Keane, Associate Dean for the different components of nursing tary personnel makes her particularly Academic Programs, has been named programs. In addition, Dr. Keane is suitable for appointment as the the Class of 1965, 25th Reunion extending her research on stress and Nightingale Professor.A distinguished Te rm Professor in Nursing.The Class healing following home fires, testing researcher, scholar, teacher and mentor of 1965 Chair is one of five created intervention models of caring for with a top national and international in 1990 by the Class.This unprece- children and adolescents following reputation, Dr. McCauley conducts dented 25th Reunion class gift fund- fires, and using these models for dif- innovative and influential research, ed a chair for each of the four under- ferent levels of education. publishes in prestigious journals, has graduate schools and one in honor of Eileen Sullivan-Marx, Associate Dean received many awards, and is frequent- the College for Women. Dr. Keane for Practice and Community Affairs, ly selected to consult with govern- will be the first to hold the Class of has been named to the Shearer ments and universities. Her research on 1965 Chair in the School of Nursing Endowed Term Chair for Healthy the outcomes of exposure to antineo- due to her initiative in developing Community Practices.This chair, plastic drugs on nurses contributed to and testing innovative educational funded by a generous gift from the 1988 development of work-prac- models, given the shortage of faculty Miriam Stirl (HUP ’20, Ed ’23) in tice guidelines for safe handling of in nursing, and building on her earli- memory of her mother Helen M. drugs that became occupational health er work on educational evaluation of

24 administration policy.As a result of her Dr. Loretta Jemmott Named research on chemical exposure experi- enced by military personnel, she was New Assistant Provost invited to give congressional testimony With primary responsibility for University-wide faculty gender and to provide expert advice on the and minority equity issues, Loretta Jemmott, PhD, FAAN, RN has threat of bioterrorism. Her most cur- been named the new Assistant Provost for Gender/Minority rent work on injuries among children Equality Issues. of migrant farm workers is likely to "For me as an African American woman, scholar, nurse, educator, provide an impetus to reform U. S. parent, community leaders, and human being, the importance of labor law. equity and fairness for all people has been and continues to be one of my core life values. As an advocate and ally for gender and Stella L. Volpe, PhD, RD, LD/N, minority equity, I hope to continue the work that is presently FACSM,Associate Professor of Nursing, being carried out here at Penn in terms of recruitment, retention, has been named to the Miriam Stirl education, and celebration of women and people of color," said Endowed Term Chair in Nutrition. Dr. Jemmott. This chair is funded by a bequest Dr. Jemmott, also van Ameringen Professor in Psychiatric Mental from Miriam Stirl (HUP ’20, Ed ’23). Health Nursing, and Director of the Center for Urban Health Ms. Stirl developed an interest in nutri- Research, is seen here with Elias Zerhouni, MD, Director of the tion during her nursing career and National Institutes of Health, discussing “Challenges, Facing the made this gift posthumously in 1989 Nation’s Research Enterprise” at a national forum con- for the study and teaching of nutrition. ducted by Research! America. Dr. Zerhouni is the archi- Dr.Volpe will be the second holder of tect of the “roadmap initiative” to accelerate progress the Stirl Chair. Dr. Linda Brown across the NIH. Dr. Jemmott is one of the leading AIDS researchers developing curricula to increase safer brought distinction to the Stirl Chair sex behaviors among at-risk youth nationally and during the period 1997-2002. internationally. Dr.Volpe’s research in physical activity and nutrition intervention is well recognized and fits well with the donor’s intent. Her research focuses on cross-cutting themes – the relationship of mineral metabolism and body com- position, nutrition and physical activity education in low-income schools, and obesity prevention through environ- mental change. Dr.Volpe is an emerging leader in the growing fields of nutrition and fit- ness/sports medicine, which have tremendous potential for discovery and where there is a great need for con- sumer education. Dr.Volpe has under- taken media efforts to enhance public knowledge about nutrition and Dr. Loretta Jemmott (left) with Elias Zerhouni, MD, Director of the National Institutes of Health at a Research! America forum. increase awareness of the need for healthy eating habits.

25 ACHIEVEMENTS

Awards Ivo Abraham Gerontologic Nursing Book of the Year Award (co-editor), American Journal of Nursing

Linda Aiken Media Award,American Academy of Nursing

Nurse Researcher Award, American Organization of Nurse Executives

Debbie Becker Provost’s Award for Distinguished Teaching, University of Pennsylvania

Compher, Charlene Chair, Dietitians in Nutrition Support, Dietetic Practice Group of the American Dietetic Association

Valerie Cotter Elected Fellow, American Academy of Nurse Practitioners

Janet Deatrick Best of the Journal of Nursing Scholarship Award, Mary Naylor – First Nurse Named Sigma Theta Tau International a McCann Scholar Research Paper of the Year (co-author), Maternal Child Nursing Members of the faculty of the School of Nursing have recently received many of the highest awards in healthcare: the Episteme, the Codman, and a MacArthur fel- Claire Fagin Honorary Doctorate of Jurisprudence, lowship.And for the first time, a faculty member was named a McCann Scholar by University of Toronto, June 2004, the Joy McCann Foundation. Commencement Speaker As the MacArthur fellowship, the McCann award seeks to reward originality Julie Fairman and verve with a no-strings-attached financial award.The McCann award is 2003 Barbara Lowery DSO Faculty Award, $150,000.The McCann Scholar criteria are demonstrated success as an educator Doctoral Student Organization and mentor in teaching, research or patient care, leadership in the Scholar’s institu- Susan Gennaro tion or profession, and recognition as a role model. AACN Helene Fuld Leadership Fellow The award citation said:“Dr. Naylor has garnered a national and international Ellen Giarelli reputation as a geriatric scholar, combining her humanistic concern and respect for Quality of Life Award, Publishing Division of vulnerable elders with rigorous science to create innovative models to enhance the the Oncology Nursing Society care and health outcomes of this population. She has also earned the respect of her Rosemary Gillespie students and peers as an outstanding teacher and mentor. Especially noteworthy is 2004 Academic Support Staff Teaching Award, the leadership Dr. Naylor has demonstrated in promoting educational and research School of Nursing collaborations among scholars and students from various disciplines. Colleagues at the University of Pennsylvania say,‘she is a mentor, collaborator, clear thinker, and a real leader in her University and her field.’ ”

26 Loretta Sweet Jemmott Therese Richmond Robert E. Davies Award,Association of Women 2004 Teaching Award, School of Nursing Presidents Faculty and Administrators, University of Pennsylvania Diane Spatz Penn Nursing has long been known for Phi Sigma Sigma Order of the Sapphire Award its tradition of producing nurse leaders. Named University Assistant Provost for Gender This year, several members of the facul- and Minority Equity Issues, Carrie Stricker ty and teaching staff are or will become University of Pennsylvania International Research Utilization Award, Sigma Theta Tau International presidents of major nursing organiza- Clifford Jordan tions, including: Distinguished Lifetime Service Award, Marilyn Stringer School of Nursing Alumni Society 2004 Chiron Mentor, Sigma Theta Tau Wendy Grube, lecturer, is President of International Honor Society the Philadelphia Coloposcopy Society Sarah Kagan 2004 Barbara Lowery DSO Faculty Award, Neville Strumpf Dr. Kathleen McCauley, PhD, FAAN, Doctoral Student Organization University of Pennsylvania Senate Chair-Elect RN, CS, Associate Professor of for 2004-2005 Mary Ann Lafferty-della Valle Cardiovascular Nursing, and Class of 2004 Undergraduate Advisor’s Award, First Grace Tien Visiting Professor at Hong 1942 Endowed Term Professor, is School of Nursing Kong University, Feb. 2004 President of the American Association of Critical Care Nurses. Terri Lipman Jacqueline Sullivan Best Research Abstract Award, International Research Utilization Award, Dr. Ann O’Sullivan, PhD, FAAN, CRNP, Pediatric Endocrinology Nursing Society Sigma Theta Tau International Professor of Primary Care Nursing, is Erme Maula Eileen Sullivan-Marx President of the National Organization 2004 Teaching Assistant’s Award, 2004 Primary Care Fellow, of Nurse Practitioner Faculties. School of Nursing U.S. Department of Health and Human Services Judy Verger, MSN, CRNP, CCRN, RN, is Kathleen McCauley Primary Healthcare Policy Fellow, Chair-elect of the Association of Critical President, Department of Health & Human Services Care Nurses Certification Corporation. American Association of Critical Care Nurses Lorraine Tulman Vicky Weill, MSN, CRNP, clinical coordi- Barbara Medoff-Cooper Member, U.S. Food and Drug Administration 2004 Claire M. Fagin Advisory Committee on Reproductive Health nator/lecturer, just turned over the Distinguished Researcher Award, gavel as President of the Pennsylvania- School of Nursing Judith Verger Delaware Valley Chapter of the National Chair-Elect,Association of Critical Care Nurses Association of Pediatric Nurse Afaf I. Meleis Certification Corporation 2004 Book of the Year Award, Practitioners. American Journal of Nursing Karen Buhler-Wilkerson Sigma Theta Tau International Pinnacle Award 2004 Commonwealth of Pennsylvania for 2004 for Nursing Media (ART) for region Commission for Women Celebration of 12 for RN:The Past, Present, and Future of the Women’s History Month Award Nurse’s Uniform.

Mary Naylor Ruth York McCann Scholar Award, Best of the Journal of Nursing Scholarship Award, Joy McCann Foundation Sigma Theta Tau International

Ann L. O’Sullivan President, National Organization of Nurse Practitioner Faculties

27 Sinha, D., Badellino, K.O., Marchinkiewicz, M., Clarke, S.P.(2004). International collaboration in Selected Publications & Walsh, P.N. (2004).Allosteric modification of nursing research:The experience of the factor XIa functional activity upon binding to International Hospital Outcomes Study.Applied Linda Aiken polyanions. Biochemistry, 43(23), 7593-7600. Nursing Research, 17(2), 134-136. Aiken, L.H. (2004). RN education:A matter of degrees. Nursing 2004, 34(3), 50-51. Jane Barnsteiner Clarke, S.P.& Connolly, C. (2004). Nurse educa- Barnsteiner, J.H., Kurlowicz, L., Lipman,T.H., tion and patient outcomes:A commentary poli- Aiken, L.H., Buchan, J., Sochalski, J., Nichols, B., Spatz, D., & Stringer, M. (2004). Establishing an cy. Politics and Nursing Practice, 5(1), 12-20. & Powell, M. (2004).Trends in international evidence base in academic practice:The role of nurse migration. Health Affairs, 23(3), 69-77. the clinician-educator faculty. In L.K. Evans, & Clarke, S.P., & Aiken, L.H. (2003). Failure to res- N. Lang (Eds.),Academic Nursing Practice: cue: Measuring nurses’ contributions to hospital Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, Helping to Shape the Future of Healthcare. performance.American Journal of Nursing, 103, D.M., & Silber, J.H. (2003). Education levels of (205-218). New York: Springer. 42-47. hospital nurses and patient mortality.Journal of the American Medical Association, 290, 1617-1623. Christine Bradway Vahey, D.C.,Aiken, L.H., Sloane, D.M., Clarke, Bradway, C. (2003). Urinary incontinence S.P. ,& Vargas, D. (2004). Nurse burnout and Clarke, S.P., & Aiken, L.H. (2003). Registered among older women: Measurement of the patient satisfaction. Medical Care, 42(2), Suppl: nurse staffing and patient and nurse outcomes in effect on health related quality of life. Journal of II-57-II-66. hospitals:A commentary. Policy, Politics, & Gerontological Nursing, 29(7), 13-19. Nursing Practice, 4, 104-111. Clarke, S.P.(2004). Introduction to research. 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B.P. (2004). Harris Benedict equations do not adequately predict energy requirements in eld- Aiken, L.H. (2003).Workforce policy perspec- Sean Clarke erly hospitalized African Americans. 96(2), 209- tives on advanced practice nursing. In M. Mezey, Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, 214. D. McGivern, & E. Sullivan-Marx (Eds.), Nurses, D.M., & Silber, J.H. (2003). Education levels of nurse practitioners: Evolution to advanced prac- hospital nurses and patient mortality. Journal of Spencer, C., & Compher, C. (2003).Total par- tice (4 Ed.). New York:Springer. the American Medical Association, 290, 1617- enteral nutrition, an ally in the management of 1623. patients with intestinal failure and malnutrition: Aiken, L.H. (2004).Academic practice:A rich A long-term view. J. Parent. Ent. Nutr., 27(5), laboratory for nursing research. In L.K. Evans, & Clarke, S.P.(2004). Failure to rescue: Lessons 374-381. N.M. Lang (Eds.),Academic nursing practice: from missed opportunities in care. Nursing Helping to shape the future of health care. New Inquiry, 11(2), 67-71. York: Springer. This and the three pictures that follow were produced by frail elders participating in the art therapy program at LIFE Cooper, R.A., & Aiken, L.H. (2003). Human (Living Independently for Elders), a two-site clinical practice serving frail elders in the community and run by the School inputs:The health care workforce and medical of Nursing. Two such pictures are hanging in the offices of Pennsylvania Sen. Arlen Specter and Rep. Jim Greenwood. markets. In P.J. Hammer, D. Haas-Wilson, M.A. Peterson, & W.M.Sage (Eds.), Uncertain times: Kenneth Arrow and the changing economics of health care. Durham, NC: Duke University Press.

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Karen Badellino Badellino, K.O., & Rader, D.J. (2004).The role of endothelial lipase in high-density lipoprotein metabolism. Current Opinion in Cardiology, 19(4), 392-395.

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29 Kagan, S.H. (2004). Shifting perspectives: Gero- Mitchell, P.H.,& Lang, N.M. (2004). Nurse Orlov, B., Evans, L.K., Lang, N.M., & Mershon, oncology nursing research. Oncology Nursing staffing:A structural proxy for hospital quality? K.M. (2004). Strategic planning for academic Forum, 31(2), 293-299. Medical Care, 42(1), 1-3. nursing practice:The consultants’ view. In L.K. Evans, & N.M. Lang (Eds.),Academic Nursing Krouse, H.J., Rudy, S.F.,Vallerland,A.H., Hickey, Mitchell, P.H.,& Lang, N.M. (2004). Framing Practice: Helping to Shape the Future of Health M.M., Klein, M.N., Kagan, S.H., et. al. (2004). the problem of measuring and improving Care. (66-91). New York: Springer. Impact of tracheotomy or laryngectomy on healthcare quality: Has the quality health out- spousal and caregiver relationships. ORL- Head comes model been useful? Medical Care, 42 Ter r i Lipman and Neck Nursing, 22(1), 10-25. (Suppl.), 4-11. Lipman,T.H. (2003).Toward evidence-based practice.American Journal of Maternal Child Kagan, S.H. (2003).The work of a gerontology Swan, B.A.,Al-Gasseer, N.H., & Lang, N.M. Nursing, 28, 214-215. clinical nurse specialist. (Eds.), International (2003). Global partnerships to strengthen the Nursing Review (Japanese Version).Tokyo: evidence base for nursing. Nursing Economics, Lipman,T.H. (2004).Toward evidence-based Japanese Nursing Association Publishing. 21(5), 247-252. practice.American Journal of Maternal Child Nursing, 29, 52-54. Kagan, S.H. (2003).The advanced practice nurse Vahey, D.C., Swan, B.A., Lang N.M., & Mitchell, in our aging society. (Eds.), Lippincott APN P.H. (2004). Measuring and improving health Lipman,T.H., Hench, K.D.M., Benyi,T., Source Book. Philadelphia: Lippincott Williams care quality: Nursing’s contribution to the state Delaune, J., Gilluly, K., Johnson, L., et. al. (2004). and Wilkins. of the science. Nursing Outlook, 52(1), 6-10. A multicenter randomized controlled trial of an intervention to improve the accuracy of linear Anne Keane Evans, L.K., & Lang, N.M. (Eds) (2004). growth assessment.Archives of Disease in Keane,A., & Becker, D. (2004). Emerging roles Academic nursing practice: Helping to Shape Childhood, 89, 342-346. of the advanced practice nurse. In L. Joel (Eds.), the Future of Health Care. New York:Springer. Advance Practice. Philadelphia, PA: F.A.Davis. Barnsteiner, J.H., Kurlowicz, L., Lipman,T.H., Evans, L.K., Lang, N.M., & Medoff-Cooper, B. Spatz, D., & Stringer, M. (2004). Establishing an Lenore Kurlowicz (2004). Integrating research and practice. In L.K. evidence base in academic practice:The role of Evans, L.K.,Talerico, K., & Kurlowicz, L.H. Evans, & N. M. Lang (Eds.),Academic Nursing the clinician-educator faculty. In L.K. Evans, & (2003). Behaviors associated with dementia. In Practice: Helping to Shape the Future of Health N. Lang (Eds.),Academic Nursing Practice: n/a (Eds.), Eldercare at Home. (n/a). New York: Care. (183-204). New York: Springer. Helping to Shape the Future of Healthcare. American Geriatrics Society. (205-218). New York: Springer. Evans, L.K., McCausland, M.P.,& Lang, N.M. Norma Lang (2004). Making academic nursing practice work Kathleen McCauley Evans, L.K., Swan, B.A., & Lang, N.E. (2003). in universities: Structure, function, and synergy. Naylor, M.D., Brooten, D.A., Campbell, R.L., Evaluation of the Penn Macy initiative to In L. K. Evans, & N. M. Lang (Eds.),Academic Maislin, G.M., McCauley, K.M., & Schwartz, J.S. advance academic nursing practice. Journal of Nursing Practice: Helping to Shape the Future (2004).Transitional care of older adults hospital- Professional Nursing, 19, 8-16. of Health Care. (92-120). New York: Springer. ized with heart failure:A randomized clinical trial. Journal of the American Geriatrics Society, Lamb, G.S., Jennings, B.M., Mitchell, P.H.,& Lang, N.M., & Evans, L.K. (2004).A vision and a 52(5), 675-684. Lang, N.M. (2004). Quality agenda: Priorities for plan for academic nursing practice. In L.K. action recommendations of the American Evans, & N.M. Lang (Eds.),Academic Nursing Jessup, M. & McCauley, K. (2003). Heart Failure: Academy of Nursing conference on health care Practice: Helping to Shape the Future of Health Providing Optimal Care. Monograph Series. quality. Nursing Outlook, 52(1), 60-65. Care. (3-19). New York:Springer. Elmsford, NY: Futura/Blackwell.

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Sarah Kagan Anne Keane Lenore Kurlowicz Eileen Lake Norma Lang Terri Lipman Zoriana Malseed

33 How Nursing Affects the Volume-Outcomes Kathryn Bowles Grants 2003-2004 Relationship Factors to Support Effective Discharge Decision- National Institutes of Health (5-R01-NR- Making Linda Aiken 04513-06) National Institutes of Health (5-RO1-NR- Advanced Training in Nursing Outcomes Research 8/15/2001-7/31/2005 07674-01) National Institutes of Health (2-T32-NR- Principal Investigator: Linda Aiken 9/15/2001-8/31/2005 007104-06) Co-Investigators: Sean Clarke, Douglas Principal Investigator: Kathryn Bowles 6/1/1999-3/31/2009 Sloane, Julie Sochalski Co-Investigator: Mary Naylor Principal Investigator: Linda Aiken Co-Investigators: Sean Clarke, Loretta Sweet International Comparisons of the Impact of Nursing Nurse Researcher for VNA Jemmott, Julie Sochalski on Hospital Quality of Care and Patient Outcomes Visiting Nurses Association of Greater The Commonwealth Fund Philadelphia Beyond Quick Fixes: Evidence Based Policy Analysis 6/1/2003-5/31/2004 7/1/2001-6/30/2004 The Robert Wood Johnson Foundation Principal Investigator: Linda Aiken Principal Investigator: Kathryn Bowles 2/1/2004-1/31/2005 Principal Investigator: Linda Aiken International Nurse Shortages and Nurse Migration Promoting Self-Management of Congestive Heart The Commonwealth Fund through Health E-Technologies Center for Nursing Outcomes Research 4/1/2003-3/31/2004 Pennsylvania State University National Institutes of Health (5-P30-NR- Principal Investigator: Linda Aiken 9/1/2003-8/31/2004 005043-03) Principal Investigator: Kathryn Dansky 2/15/2000-1/31/2005 Study of Outcomes of Neutrapenia Patients Co-Investigator: Kathryn Bowles Principal Investigator: Linda Aiken Oncology Nursing Society Co-Investigators: Susan Gennaro, Loretta 10/1/2003-9/30/2005 Karen Buhler-Wilkerson Sweet Jemmott, Barbara Medoff-Cooper, Principal Investigator: Linda Aiken Albert Einstein Medical Center Nursing Collection Julie Sochalski Co-Investigator: Christopher Friese Processing Project Pennsylvania Historical and Museum Doctoral Degree Scholarship in Cancer Nursing Nursing Intervention for HIV Regimen Adherence Commission American Cancer Society among the Seriously Mentally Ill 10/12/2002-10/31/2003 8/1/2003-7/31/2005 National Institutes of Health (1-R01-NR- Principal Investigator: Karen Buhler-Wilkerson Mentor: Linda Aiken 008851) Fellow: Christopher Friese 9/1/2003-5/31/2008 Living Independently for Elders (LIFE): Improving Principal Investigator: Michael Blank Quality of Life of Frail Elders in West Philadelphia Evaluating a Hospital Quality Improvement Model Co-Investigator: Linda Aiken Pew Charitable Trusts for Developing Countries 1/1/2002-12/31/2003 Population Studies Center Mellon Program Kay Arendasky Principal Investigator: Karen Buhler-Wilkerson 7/1/2002-12/31/2003 Occupational Health Nurse Internship at OSHA Co-Investigator: Mary Naylor Principal Investigator: Linda Aiken U.S. Department of Labor (909400) 5/17/2004-7/9/2004 Master’s Education in Occupational Environmental Evidence-Based Nurse Executive Program on Mentor: Kay Arendasky Health Solutions to Nursing Shortage Fellow: Lynda Nolan Center for Disease Control and Prevention The Robert Wood Johnson Foundation (T01/CCT310445-09) 6/15/2002-12/14/2003 Fran Barg 7/1/2002-6/30/2005 Principal Investigator: Linda Aiken Preserving Physical and Mental Health and Social Principal Investigator: Karen Buhler-Wilkerson Functioning among Elderly Hospice Caregivers Co-Investigator: Kay Arendasky Health Disparities Supplement-Center for Nursing Wissahickon Hospice Outcomes Research 1/1/2000-12/31/2003 Sean Clarke National Institutes of Health (5-P30-NR- Principal Investigator: Fran Barg Organizational Climate and Hospital Patient/Nurse 005043-02S1) Co-Investigator: Deborah McGuire Safety 2/15/2000-1/31/2005 National Institutes of Health (1-K01-NR- Principal Investigator: Linda Aiken Jane Barnsteiner 07895-01A1) Co-Investigators: Susan Gennaro, Loretta State of the Science on Safe Medication 7/1/2002-6/30/2005 Sweet Jemmott, Barbara Medoff-Cooper, Agency for Healthcare Research and Quality (1- Principal Investigator: Sean Clarke Julie Sochalski R13-HS-014836-01) 5/10/2004-5/9/2005 Charlene Compher Hospital Restructuring: Implications for Patient Principal Investigator: Jane Barnsteiner Nutritional and Immune Parameters in Home Outcomes and Workforce Policy Co-Investigator: Kathleen Burke Parenteral Nutrition Patients The Robert Wood Johnson Foundation University of Kansas Medical Center 9/1/1999-8/31/2004 3/1/2003-3/31/2004 Principal Investigator: Linda Aiken Principal Investigator: Charlene Compher

Kathleen McCauley Linda McCauley Maureen McCausland William McCool Deborah McGuire Barbara Afaf Meleis Medoff-Cooper

34 Oleic Acid Effects on Transit and Absorption in SBS Lois Evans Violence in the Dating Experience of College Women National Institutes of Health (5-R03-DK- Attributes of Organizational Culture in Nursing American Nurses Foundation 062841-02) Homes 11/1/2002-11/1/2003 7/1/2003-6/30/2005 Beverly Enterprises, Inc. Mentor: Susan Gennaro Principal Investigator: Charlene Compher 8/1/2003-4/30/2004 Fellow: Angela C. Frederick Principal Investigator: Lois Evans Prevention of TPN-Associated Hepatic Steatosis:A Co-Investigator: Cynthia Scalzi Ellen Giarelli Placebo Controlled Trial Participating in Life-Long Surveillance: Families with Northwestern University Delaware Valley Geriatric Education Center F.A.P. 5/1/2002-8/31/2004 U.S. Department of Health and Human Services Oncology Nursing Society Principal Investigator: Charlene Compher (5-D31-HP-070144) 5/15/2003-5/15/2005 7/1/2001-6/30/2006 Principal Investigator: Ellen Giarelli Margaret Cotroneo Principal Investigator: Mary Forciea Myers Health Annex Men’s Health Outreach Co-Investigator: Lois Evans Arlene Houldin Program Experiences of Colorectal Cancer Patients and Their Jesse Ball Dupont Foundation Julie Fairman Caregivers 9/1/2001-9/15/2004 Gendered Domain: Medicine and the Nurse Oncology Nursing Society Principal Investigator: Margaret Cotroneo Practitioner Movement, 1960 to the Present 9/15/2003-9/15/2005 National Endowment for the Humanities Principal Investigator: Arlene Houldin Norma Cuellar (FA3722302) A Comparison of Type 2 Diabetes with/without RLS 1/1/2003-9/30/2003 Factors Affecting the Negotiation of Cancer Pain American Association of Diabetes Educators Principal Investigator: Julie Fairman Treatment among African Americans 5/1/2004-5/1/2005 Oncology Nursing Society Principal Investigator: Norma Cuellar Nurse Practitioner Legislation and Access to Healthcare 3/15/2004-3/14/2006 National Institutes of Health (1-F31-NR- Mentor: Arlene Houldin Patricia D’Antonio 008302) Fellow: Salimah Meghani Nursing History Review 8/1/2003-7/31/2006 American Association for the History of Mentor: Julie Fairman Graduate Education in Oncology Nursing for Nursing Fellow: Deborah Ann Sampson Minorities 1/1/1992-12/31/2006 National Institutes of Health (5-R25-CA- Principal Investigator: Patricia D’Antonio Susan Gennaro 56689-10) Ethnic Identity and Hispanic Adolescent Sexual 5/1/1998-6/30/2004 Nursing in the US:A History of People and Places Behavior Principal Investigator: Arlene Houldin National Institutes of Health (1-G13-LM- Franklin Health Trust 008199-01) 9/10/2001-8/31/2003 Helping the Mother with Breast Cancer and Support 6/1/2004-5/31/2007 Mentor: Susan Gennaro Her Child Principal Investigator: Patricia D’Antonio Fellow: Aida Egues University of Washington 6/1/2002-5/31/2005 Who Is a Nurse:The Mormon Experience Mechanisms for Preterm Birth in African American Principal Investigator: Frances Lewis Sigma Theta Tau, Xi Chapter Women Co-Investigator: Arlene Houldin 5/1/2003-4/30/2004 National Institutes of Health (1-R03-NR- Principal Investigator: Patricia D’Antonio 008548) Master’s Degree Scholarships in Cancer Nursing 8/15/2003-7/31/2005 American Cancer Society Janet Deatrick Principal Investigator: Susan Gennaro 8/1/2002-7/31/2003 Assessing Family Management of Childhood Chronic Mentor: Arlene Houldin Illness Renovation of Nursing Doctoral Student Computer Fellow: Lynne Reilly Yale University Lounge Workspace 5/1/2003-2/28/2006 Franklin Health Trust Supporting Mothers with Breast Cancer:A Pilot Principal Investigator: Kathleen Knafl 5/1/2003-2/29/2004 Study Co-Investigator: Janet Deatrick Principal Investigator: Susan Gennaro University Research Foundation 2/1/2003-1/31/2004 Family Experiences Withdrawing Life Sustaining Research on Vulnerable Women, Children and Principal Investigator: Arlene Houldin Therapy Families National Institutes of Health (5-F31-NR- National Institutes of Health (5-T32-NR- Mary Katherine Hutchinson 07558-02) 07100-05) Dyadic Ecological Analysis of Adolescent Sexual Risk 9/27/2000-7/25/2003 5/1/1998-2/29/2008 National Institutes of Health (5-R03-MH- Mentor: Janet Deatrick Principal Investigator: Susan Gennaro 063659-02) Fellow: Debra Wiegand Co-Investigators: Linda Brown, Janet 7/1/2001-6/30/2004 Deatrick Principal Investigator: Mary Katherine Hutchinson Co-Investigator: Loretta Sweet Jemmott

Mary Naylor Ann L. O’Sullivan Freida Outlaw Jennifer Pinto-Martin Therese Richmond Barbara Riegel Ann E. Rogers

35 Loretta Sweet Jemmott South African Adolescent Health Promotion Project Neutropenia in Older Adults with Hematologic Cam’s Adherence in Adult Minorities with Asthma National Institutes of Health (5-R01-MH- Malignancy National Institutes of Health (1-F31-AT- 065867) The John A Hartford Foundation through the 001149-01) 9/20/2002-7/31/2007 American Academy of Nursing 7/1/2002-12/23/2003 Principal Investigator: John Jemmott 7/1/2003-6/30/2005 Mentor: Loretta Sweet Jemmott Co-Investigator: Loretta Sweet Jemmott Mentor: Sarah Kagan Fellow: Maureen George Fellow: Margaret Crighton The Generalizability of HIV Risk Reduction Church-Based Parent-Child HIV Prevention Project Strategies Smoking Program for Head and Neck Cancer Patients National Institutes of Health (5-R01-MH- National Institutes of Health (5-R01-HD- Fox Chase Cancer Center 063070-02) 039109) 6/1/2002-6/30/2004 7/1/2001-6/30/2006 9/30/1999-8/31/2005 Principal Investigator: Peter Gariti Principal Investigator: Loretta Sweet Jemmott Principal Investigator: John Jemmott Co-Investigator: Sarah Kagan Co-Investigators: Mary Katherine Co-Investigator: Loretta Sweet Jemmott Hutchinson, Freida Outlaw Anne Keane Helping Families Reduce HIV in African American Advanced Education Nursing Traineeships Hampton Penn Center to Reduce Health Disparities Youth Health Resources and Services Administration National Institutes of Health (1-P-20-NR- National Institutes of Health (1-R01-MH- (2-A10-HP-00072-) 008361-01) 63459-02) 7/1/2003-6/30/2004 9/30/2002-6/30/2007 9/30/2000-9/2/2003 Principal Investigator: Anne Keane Principal Investigator: Loretta Sweet Jemmott Principal Investigator: Larry Icard Co-Investigators: Janet Deatrick, Susan Co-Investigator: Loretta Sweet Jemmott Nursing Education Grant Program Gennaro, Mary Katherine Hutchinson, Pennsylvania Higher Education Foundation Barbara Medoff-Cooper, Lorraine Tulman HIV Prevention Trial Unit 9/1/2003-6/30/2004 National Institutes of Health (5-U01-AI- Principal Investigator: Anne Keane Empowering Women Drug Users to Reduce HIV 048014) Risk 7/1/2000-6/30/2005 Eileen Lake National Institutes of Health (5-R01-DA- Principal Investigator: David Metzger Nursing Expertise Measures for Outcomes Research 013901) Co-Investigator: Loretta Sweet Jemmott National Institutes of Health (5-K01-NR- 6/20/2001-11/30/2004 000166) Principal Investigator: Erica Gollub AIDS Clinical Trial Unit 7/1/2000-6/30/2004 Co-Investigator: Loretta Sweet Jemmott National Institutes of Health (5-U01-AI- Principal Investigator: Eileen Lake 032783) HIV Sexual Risk Reduction for Black Drug-Using 1/1/2000-12/31/2004 Norma Lang Women Principal Investigator: Pablo Tebas Measuring and Improving Health Care Quality National Institutes of Health (1-RO1-MH- Co-Investigator: Loretta Sweet Jemmott Agency for Healthcare Research and Quality 64407-01) (1-R13-HS-12058) 9/25/2001-8/31/2006 Sarah Kagan 9/30/2001-9/29/2003 Principal Investigator: John Jemmott Advanced Cancer and Decision-Making in African Principal Investigator: Norma Lang Co-Investigators: Mary Katherine American Families Co-Investigator: Beth Ann Swan Hutchinson, Loretta Sweet Jemmott Oncology Nursing Society 3/15/2002-3/15/2005 Collaborative Programs in Nursing and Peace and HIV/STD Prevention Interventions for Black Mentor: Sarah Kagan Conflict Studies with the University of Ibadan Adolescents Fellow: Joanne Reifsnyder The John D. and Catherine T. Macarthur National Institutes of Health (5-R01-MH- Foundation 062049) Doctoral Degree Scholarship in Cancer Nursing 1/1/2004-6/30/2005 9/10/2000-8/31/2005 American Cancer Society Principal Investigator: Peter Conn Principal Investigator: John Jemmott 8/1/2002-7/31/2004 Co-Investigator: Norma Lang Co-Investigator: Loretta Sweet Jemmott Mentor: Sarah Kagan Fellow: Margaret Crighton Terri Lipman HIV/STD Risk Reduction for African American Management of Pediatric Type 2 Diabetes Couples Geriatric Nursing Knowledge and Experience in Long The Children’s Hospital of Philadelphia National Institutes of Health (5-U10-MH- Te rm Care Facilities 9/20/2001-2/28/2009 064394) Health Resources & Services Administration (1- Principal Investigator: Charles Stanley 4/1/2002-1/31/2007 D53-HP-00520) Co-Investigator: Terri Lipman Principal Investigator: John Jemmott 7/1/2003-12/31/2004 Co-Investigator: Loretta Sweet Jemmott Principal Investigator: Sarah Kagan

Cynthia Scalzi Karen Schumacher Edith Simpson Julie Sochalski Diane Spatz Marilyn Stringer Neville Strumpf

36 Linda McCauley Barbara Medoff-Cooper Physician-Nurse Co-Management of Elders with Biomarkers of Pesticide Toxicity Among Teen Energy Expenditure, Energy Intake, Growth and Heart Failure Farmworkers Body Composition in Infants with CHD National Institutes of Health (5-R01-NR- Centers for Disease Control and Prevention American Nurses Foundation 007616) (RO1-OH-008057) 11/1/2003-11/1/2004 9/30/2000-8/31/2004 1/1/2004-9/29/2006 Mentor: Barbara Medoff-Cooper Principal Investigator: J. Schwartz Principal Investigator: Linda McCauley Fellow: Judy Verger Co-Investigators: Mary Naylor, Kathleen McCauley Genes and Environment: Education to Involve Feeding Behaviors and Energy Balance in Infants Communities with CHD Ann O’Sullivan National Institutes of Health (R25-ES-12089) National Institutes of Health (2-R01-NR- Moms on the Move 4/1/2004-8/31/2007 002093-01A1) William Penn Foundation Principal Investigator: Linda McCauley 9/6/2002-5/31/2007 1/31/2001-1/30/2004 Principal Investigator: Barbara Medoff-Cooper Principal Investigator: Donald Schwarz Neurotoxic Superfund Chemicals and Biomarkers Co-Investigator: Ann O’Sullivan Oregon Health Sciences University Infant Functional Status and Discharge 4/1/2004-3/31/2005 The Children’s Hospital of Philadelphia Jennifer Pinto-Martin Principal Investigator: P.Spencer 9/1/2001-8/31/2004 Center of Excellence for Autism Epidemiology Co-Investigator: Linda McCauley Principal Investigator: Jeffrey Silber Centers for Disease Control & Prevention Co-Investigator: Barbara Medoff-Cooper (U10/CCU320394-01) Reducing Pesticide Exposure in Minority Families 9/30/2001-9/29/2006 National Institutes of Health (R01-ES-08707) An Export Center of Excellence for Inner City Principal Investigator: Jennifer Pinto-Martin 4/1/2004-7/31/2005 Health Co-Investigator: Ellen Giarelli Principal Investigator: Linda McCauley National Institutes of Health (5-P60-MD- 000209) Epidemiology of Early CNS Injury & Anne McGinley 9/30/2002-9/29/2007 Psychopathology at 13 Evaluation of the Accuracy of Height Assessment of Principal Investigator: Shiriki Kumanyika Research Foundation for Mental Hygiene, Inc. Pre-Menopausal and Memopausal Women Co-Investigator: Barbara Medoff-Cooper 2/1/1999-1/31/2004 Hartford Center for Geriatric Nursing Principal Investigator:Agnes Whitaker Excellence Mary Naylor Co-Investigator: Jennifer Pinto-Martin 1/1/2002-12/31/2004 Assessing Health- Related Quality of Life Among Principal Investigator: Anne McGinley Frail Elders Therese Richmond Co-Investigator: Terri Lipman Ralston House Disparities in Clinical Care Outcomes for Older 7/1/2002-6/30/2004 Adults: Influence of Age, Race and Gender Deborah McGuire Principal Investigator: Mary Naylor American Academy of Nursing Biobehavioral Interventions for Oral Pain and Co-Investigator: Kathryn Bowles 7/1/2003-6/30/2005 Mucositis Mentor: Therese Richmond National Institutes of Health (R01-NR-03929- Building Interdisciplinary Geriatric Health Care Fellow: Michele Balas 06) Research Center 9/30/1999-8/31/2003 Rand Corporation Major Depression Following Minor Injury Principal Investigator: Deborah McGuire 1/1/2003-12/31/2004 National Institutes of Health (R01-MH-63818- Co-Investigator: Susan Nolte Principal Investigator: Mary Naylor 01A1) 4/1/2002-3/31/2007 Doctoral Degree Scholarship in Cancer Nursing Coordinating Care Between Hospital and Home: Principal Investigator: Therese Richmond American Cancer Society Translating Research Into Practice, Phase I 9/1/2001-8/31/2003 The Commonwealth Fund Project Safe Neighborhoods (PSN) Research Partner Mentor: Deborah McGuire 2/1/2004-4/30/2005 U.S. Department of Justice, Bureau of Justice Fellow: Sadie Neureuther Principal Investigator: Mary Naylor Assistance (2003-GP-CX-0110) 4/7/2003-9/30/2006 Doctoral Fellowship Living Independently for Frail Elders Principal Investigators: Therese Richmond, American Cancer Society Franklin Health Trust Charles Schwab 9/1/2000-8/31/2003 1/1/2003-12/31/2003 Mentor: Deborah McGuire Principal Investigator: Mary Naylor Case-Control Study of Alcohol Outlets & Firearm Fellow: Susan Nolte Violence Clinical and Economic Effectiveness of a Technology- National Institutes of Health (5-R01-AA- Driven Heart Failure Monitoring System 013119) Health Care Financing Administration (18-C- 8/1/2002-4/30/2006 91172/3-03) Principal Investigator: Charles Branas 9/20/2000-9/19/2004 Co-Investigator: Therese Richmond Principal Investigator: Mariel Jessup Co-Investigator: Mary Naylor

Eileen Sullivan-Marx Nancy Tkacs Lorraine Tulman Connie Ulrich Stella Volpe Terri Weaver Karen Buhler-Wilkerson

37 Reducing Firearm Injury through Interdisciplinary and Community Partnership The Joyce Foundation 5/1/2001-10/31/2005 Principal Investigators: Therese Richmond, Charles Schwab

Barbara Riegel Effectiveness of Telephonic Case Management in Hispanics With Heart Failure American Heart Association 1/1/2002-12/31/2004 Principal Investigator: Barbara Riegel

Enhanced Education to Improve Heart Failure Self- Care University Research Foundation 6/30/2003-6/30/2004 Principal Investigator: Barbara Riegel

Nurse-Delivered Focused Education and Counseling Intervention to Decrease Delay in Seeking Treatment University of California, San Francisco 9/1/2002-2/28/2005 Principal Investigator: Kathleen Dracup Nursing students assisted Philadelphia Mayor John Street's Office of Health and Fitness by providing cholesterol and Co-Investigator: Barbara Riegel glucose screenings with baseline assessments of flexibility, endurance, strength, and cardio fitness in April 2004.

Ann E. Rogers International Mobility of Nurses and Globalization The Program for North American Mobility in Higher Staff Nurse Fatigue and Patient Safety World Health Organization Education Agency for Healthcare Research and Quality (1- 8/1/2002-12/31/2003 University of New Mexico RO1-HS-11963-03) Principal Investigator: Julie Sochalski 2/15/2000-2/14/2005 9/30/2001-9/29/2004 Principal Investigator: Karen Carlson Principal Investigator: Ann E. Rogers Nurse Assessments of Process and Outcomes for Co-Investigator: Diane Spatz Co-Investigator: Linda Aiken Hospitalized Cancer Patients Oncology Nursing Society Marilyn Stringer Karen Schumacher 5/1/2004-4/30/2005 Cultural Sensitivity of Instruments Used in Women Family Caregiving Skill Measurement and Evaluation Principal Investigator: Julie Sochalski Experiencing Preterm Labor National Institutes of Health (5-R01-NR- Hampton University 05126-03) Nurse Staffing and Patient Outcomes in the VA 9/30/2002-6/30/2004 9/1/1999-8/31/2004 U.S. Department of Veterans’Affairs (663- Principal Investigator: Marilyn Stringer Principal Investigator: Karen Schumacher D36020) Co-Investigator: Sarah Kagan 10/1/2002-9/30/2005 Neville Strumpf Principal Investigator:Anne Sales Building Academic Geriatric Nursing Capacity- Edith Simpson Co-Investigator: Julie Sochalski Administration Scholars Building on the Findings of the Partners Study- American Academy of Nursing Identifying Interventions That Promote Child Predicting Pediatric Risk of Death After 7/1/2002-6/30/2004 Restraints Hospitalization Mentor: Neville Strumpf The Children’s Hospital of Philadelphia The Children’s Hospital of Philadelphia Fellow: Elizabeth Miller 3/1/2004-5/31/2004 8/1/2003-7/31/2006 Principal Investigator: Edith Simpson Principal Investigator: Julie Sochalski Care at the End of Life in a PACE Program The John A. Hartford Foundation through Rand Julie Sochalski Diane Spatz Corporation Decision-Support Tools for Improved Nurse Workforce An Innovative Program for Breastfeeding Education 6/1/2003-5/31/2004 Management: Exploring Data on the International and Training Principal Investigator: Mary Naylor Migration of Nurses to the United States The Foederer Fund Co-Investigator: Neville Strumpf School of Medicine 7/1/2002-6/30/2004 6/1/2003-5/31/2004 Principal Investigator: Diane Spatz Center for Gerontologic Nursing Excellence Co-Investigator: Julie Sochalski The John A. Hartford Foundation Support for Low-Income Breastfeeding: Cost and 1/1/2001-12/31/2006 Improving the Outcomes of Care for Hospitalized Outcomes Principal Investigator: Neville Strumpf Cancer Patients Johns Hopkins University Co-Investigators: Lois Evans, Mary Naylor Oncology Nursing Society 3/1/2003-2/28/2007 2/1/2003-6/30/2004 Principal Investigator: Linda Pugh Development of a Palliative Care Minor Principal Investigator: Julie Sochalski Co-Investigator: Diane Spatz Arcadia Foundation 6/1/2003-5/31/2006 Principal Investigator: Neville Strumpf

38 Geriatric Nursing Education Project Visting Nurse Service of New York Scholars Program Stella Volpe American Association of Colleges of Nursing Visiting Nurse Service of New York Changing Cafeteria Portion Sizes to Prevent Weight 7/1/2002-6/30/2005 9/1/2003-8/31/2005 Gain Principal Investigator: Neville Strumpf Principal Investigator: Eileen Sullivan-Marx National Institutes of Health (1-R03- Co-Investigator: Karen Schumacher DK063991-01) John A. Hartford Fellowship: Building Academic 1/1/2004-4/30/2005 Geriatric Nursing Joyce Thompson Principal Investigator: Stella Volpe The John A. Hartford Foundation through the Forming the Building Blocks of Leadership for American Academy of Nursing Nursing Students Across Academic Levels School-Based Prevention of Type 2 Diabetes in 9/1/2002-2/28/2005 Helene Fuld Health Trust Children Mentor: Neville Strumpf 7/31/2001-12/31/2003 George Washington University Fellow: Cheryl Monturo Principal Investigator: Joyce Thompson 3/1/2004-8/31/2004 Co-Investigator: Linda Carrick Principal Investigator: Gary Foster John A. Hartford Foundation Geriatric Nursing Co-Investigators: Terri Lipman, Stella Volpe Scholarship Nancy Tkacs The John A. Hartford Foundation through the Counterregulatory Failure and the Arcuate Nucleus Ter r i Weaver American Academy of Nursing National Institutes of Health (5-R21-DK- Complementary and Alternative Medicine Adherence 8/10/2001-8/31/2003 059754) in Asthma Mentor: Neville Strumpf 9/29/2000-8/31/2003 American Lung Association Fellow: Anna Beeber Principal Investigator: Nancy Tkacs 7/1/2001-12/23/2003 Mentor: Ter r i Weaver The Cancer Experience of Israeli Elders Hypoglycemia-Associated Autonomic Failure and the Fellow: Maureen George Oncology Nursing Society Brain 3/15/2002-3/15/2004 National Institutes of Health (1-KO1-DK- Impact of CPAP on Functional Outcomes in Milder Principal Investigator: Neville Strumpf 02899-02) OSA Co-Investigator: Cathy Musgrave 8/15/2001-6/30/2005 National Institutes of Health (1-R01-HL- Principal Investigator: Nancy Tkacs 076101-01) Eileen Sullivan-Marx 9/1/2003-6/30/2007 Building RN Training Skills for Geriatric Education Menstrual Cycle and Insulin Sensitivity in Diabetes Principal Investigator: Ter r i Weaver Excellence National Institutes of Health (1-F31-NR- Health Resources & Services Administration (1- 008179-01) Predictors of Adherence in CPAP Treatment for OSA D62HP01912) 9/1/2002-8/31/2005 U.S. Department of Veterans’Affairs 9/1/2003-6/30/2006 Mentor: Nancy Tkacs 6/1/2003-9/30/2004 Principal Investigator: Eileen Sullivan-Marx Fellow: Kimberly Trout Principal Investigator:Amy Sawyer Co-Investigators: Kathleen Burke, Linda Co-Investigator: Ter r i Weaver Carrick, Rebecca Phillips, Rosalyn Watts Lorraine Tulman Exploration of Safe Sex Practices for HIV Prevention SCOR in Neurobiology of Sleep and Sleep Apnea. Hospital Staffing, Physical Restraint and Patient Among Rural Thai Women in Northern Thailand: National Institutes of Health (2-P50-HL- Outcomes Comparison of 1933 and 2003 060287) National Institutes of Health (1-K01-NR- Sigma Theta Tau International 9/15/2003-8/31/2004 00157-02) 6/1/2003-5/31/2004 Principal Investigator:Allan Pack 9/1/2000-8/31/2004 Co-Investigator: Lorraine Tulman Co-Investigator: Ter r i Weaver Principal Investigator: Eileen Sullivan-Marx Co-Investigators: Linda Aiken, Neville Strumpf

Friese, C.The Nurse Work Environment in Kagan, S. Merging Nursing and Business Presentations Magnet Hospitals:A Comparison between Education for Nurse Managers of the Future. Oncology and Medical-Surgical Units. Sigma 2nd International Nursing Management Clarke, S. Challenges and Successes in Theta Tau International, 14th International Conference, November 2003, Belek,Turkey. Collaborative Nursing Research across Borders: Nursing Research Congress, July 10, 2003, St. The International Hospitals Outcome Study. Thomas,Virgin Islands. Kagan, S. Karolinska Institute, Department of Sigma Theta Tau International, 14th Nursing, September 2003, Stockholm, Sweden. International Nursing Research Congress, July Friese, C. International Differences in Nurse (Invited Visiting Researcher). 12, 2003, St.Thomas,Virgin Islands. Practice Environments: Findings from the International Hospital Outcomes Research Kagan, S. Nursing Intervention with Older Cuellar, N. Diagnosis and Treatment of Restless Consortium [Co-Author: Eileen Lake]. 5th Cancer Patients. School of Health & Social Legs Syndrome. Boston National Advanced International Conference on the Scientific Basis Care, Oxford Brookes University,August 2003, Practice Conference, November 6-8, 2003, of Health Services, September 22, 2003, Oxford, UK. Boston, MA Washington, DC. Kagan, S. Language Lessons Learned from Older D’Antonio, P.Women and Nurses: Rethinking Gennaro, S. Evidence-Based Nursing, November Adults with Cancer: Merging Grounded Theory Educational Achievement in the 20th Century 2003, Milan, Italy. and Practice. University of Nottingham School America. International Nursing History of Nursing, Faculty of Medicine and Health Conference, September 4-5, 2003, Oxford, UK. Kagan, S.Visiting Professor, University of Hong Sciences,August 2003, Nottingham, UK. Kong, February 2004, Hong Kong SAR. Fairman, J. Consultation. Dublin University, March 2004, Dublin, Ireland.

39 Reale, B. Midwifery Education. International Confederation of Midwives,Trinidad/Tobago, April 2004.

Richmond,T. Psychiatric Profiles of Individuals Sustaining Minor Injuries. 7th World Injury Conference, June 2004,Vienna,Austria.

Riegel, B. Psychometric Testing of the Self-Care of Heart Failure Index.American Heart Association Scientific Sessions, November 11, 2003, Orlando, FL.

Riegel, B. Computing CPR and AED Skill Assessment Score. Poster at the AHA Resuscitation Science Symposium, November 8, 2003, Orlando, FL.

Simpson, E. Sub-Optimal Restraints for Children among Diverse Groups of Drivers. 7th World Injury Conference, June 2004,Vienna, Austria. Outgoing University of Pennsylvania President Judith Rodin (seated) and Provost Robert Barchi (sixth from left) are pictured here with the deans of Penn’s 12 schools. Sochalski, J. Merging Nursing and Business Education for Nurse Managers of the Future. Lake, E. International Differences in Nurse Medoff-Cooper, B. Neonatal Nursing and 2nd International Nursing Management Practice Environments: Findings from the Research Utilization. Karolinska Institute, May Conference, November 2003, Belek,Turkey. International Hospital Outcomes Research 2004, Stockholm, Sweden. Consortium [Co-Author: C. Friese]. 5th Spatz, D. Protecting Breastfeeding in International Conference on the Scientific Basis Medoff-Cooper, B. Quality Improvement in Marginalized Population. IWK Grace Perinatal of Health Services, September 22, 2003, Neonatal Nursing. Karolinska Institute, May Conference, March 31, 2004, Halifax, Nova Washington, DC. 2004, Stockholm, Sweden. Scotia. (Invited Keynote Speaker).

Lake, E.A Validation Study of the Practice Medoff-Cooper, B. Study Abroad Program with Strumpf, N. Building the Evidence Base for Environment Scale of the Nursing Work Index Penn Nursing. Hadassah Hebrew University, Individualized Care for Frail Older People. [Co-Author: L.S. Leach]. 37th Biennial March 2004, Israel. University of Hong Kong, February 2004, Hong Convention of Sigma Theta Tau International, Kong SAR. November 2003,Toronto, Canada. Medoff-Cooper, B. Program of Research. University of Hong Kong, October 2003, Hong Strumpf, N. Shifting Policy and Practice in Lake, E.A Good Place for Nurses to Work: Kong SAR. Acute Care: Restraint Free Care for Hospitalized Examining the Nursing Practice Environment of Elders. Medical and Health Research Network, a Broad Set of Hospitals [Co-Author: C. Friese]. Meleis,A. Penn’s Nursing’s CRISP-5 Report February 2004. Sigma Theta Tau International, 14th [Co-presenters: N. Lang and B.A. Swan].WHO International Nursing Research Congress, July Collaborating Centers Global Network Swan, B.A. Closing the Gap between Evidence 2003, St.Thomas,Virgin Islands. Meeting, March 2004, Johannesburg, South and Practice:An Overview.World Health Africa. Organization, December 2003, Geneva, Lang, N. Strategic Advisory Group for the Switzerland. International Classification for Nursing Practice. Meleis,A.Theory as a Source and a Resource:A International Council of Nurses, October 2003, Map for Nursing Future.Advancing Knowledge Swan, B.A. Breastfeeding and HIV/AIDS Geneva, Switzerland. through Education, Practice and Research; 1st Transmission. Global Forum for Health Ministry of Health International Nursing Research, December 4, 2003, Geneva, Lang, N. Directors’ Meeting. Pan American Conference,August 2003, Singapore. (Keynote Switzerland. Nursing and Midwifery Collaborating Centers, Speaker). September 22-23, 2003,Washington, DC. Swan, B.A. Poster. Global Network Meeting, Meleis,A. Developing and Analyzing Theories, March 2004, Johannesburg, South Africa. Lang, N.Translation of the Science of Nursing Defining Theory and Defining Nursing, and Informatics and the Validation of the ICNP.10th Our Theoretical Journey and State of Nursing Swan, B.A. Improving Health through Research: Academic Conference on Nursing Diagnosis Discipline. Lectures to Graduate Students, Implications for Evidence-Based Practice. and the Japanese Society of Nursing Diagnosis, University of Singapore,August 2003, Singapore. Multidisciplinary International Health Care June 2004, Osaka, Japan. Conference, March 2004, Johannesburg, South Pinto Martin, J. NINDS,August 2003, Norway. Africa. McCauley, K. Merging Nursing and Business Education for Nurse Managers of the Future. Postmontier, B. State of the Science:The Weaver,T. How much is enough CPAP? 7th 2nd International Nursing Management Treatment of Postpartum Depression. World Congress on Sleep Apnea, July 3, 2003, Conference, November 2003, Belek,Turkey. Collaborative Conversation Conference, Institute Helsinki, Finland. of Health and Community Studies at McCauley, K. Baccalaureate Nursing Education. Bournemouth University, September 10, 2003, CGFNS, January 12, 2004, Beijing, China. Bournemouth, UK.

40 Changing Penn Nursing’s Environment

The new construction at the School of Nursing will reflect the School’s stature as a nationally-ranked institution with a vision for the future that will sustain its position at the cutting edge of nursing education, research, and practice. But perhaps even more significantly, the renovations demonstrate how much the School values stu- dents, faculty, and staff by providing an improved environment to better support and enhance their ongoing work.

Those entering the building’s new, beautiful glass-front entry will be greeted person- ally at a reception desk and offered information and direction to better welcome and guide visitors, students, and family members. A new café on the ground floor will provide not only a place for nursing students to socialize over coffee between class- es or meet with study groups, but will be also be a fully equipped wireless web environment to support the use of laptops, cell phones, and hand-held devices.

Now, also on the ground floor, students, prospec- tive applicants, and their families will find the Offices of Student Services and Enrollment Management, relocated more conveniently from the 4th Floor. On the opposite side of the ground floor, a new entrance will be constructed to the developing health sci- ences campus, benefiting both the School and the University by creating a practical passageway for students. Throughout the ground floor, there will be display cases to highlight the work and history of the School, as well as interactive com- © Susan Maxman & Partners Architects puter kiosks providing students and visitors information about the School, upcom- ing events and other featured programs.

Important infrastructural changes include significant upgrades to the elevators and the construction of an open stairway to connect the lobby with the first floor classrooms.

Completion is scheduled for August 2005.

On the back cover: Penn Nursing faculty and staff greet the new University of Pennsylvania President Amy Gutmann during her procession.

41 Non-Profit Org. U.S. Postage PAID Permit #2563 Phila., PA UNIVERSITY of PENNSYLVANIA

420 Guardian Drive Philadelphia, PA 19104-6096 http://www.nursing.upenn.edu