Nursing Reports Almanac October 4, 1988 Shown at left is a portion of the mural which hangs in the lobby of the Nursing Education Building. Past achievements are symbolized by the double helix of the DNA molecule which transmits an active blueprint for future generations. It also portrays the leading figures in the history of nursing and individuals peopling the first half century of the University's School of Nursing. Designed for the School's 50th anniversary in 1985, the mural is the work of Samuel Gallo. Caring For The Future Through Nursing Research Nursing research contributes to the body of Contributions of nursing research to the health Care Delivery thatguides nurses in their practice of care industry are crucial to the development of the knowledge Early Hospital Discharge and nursing and enhances the quality of patient care as discipline of nursing and improvement of patient Nurse Specialist Transitional Care new technology and service systems emerge. care. Current research shows that patient survival in The University of Pennsylvania School of Nurs- intensive care units depends primarily upon well- Research on the benefits of early hospi- and transitional ing is nationally recognizedfor its leadership in educated professional nurses practicing independently, tal discharge follow-up nursing research. Its faculty represents one of the with excellent communication between physicians care in the home by master's prepared strongest cadres of nursing researchers in the coun- and nurses. This research has fostered the develop- nurse specialists has been the focus of a try, and this was a major factor in the School's earn- ment of creative programs to recruit and retain such seven-year research effort by a team of ing its designation as a World Health Organization nurses in hospitals. Thus, the work of nurse investi- nursing school faculty headed by Dorothy Collaborating Center. gators is particularly important as the nation faces a Brooten, PhD, FAAN, professor and chair Thefaculty includes nurses who are prepared to severe shortage of nurses and a decline in enrollments of Health Care of Women and the Child- study nursing and health care questions from qualit- to undergraduate programs. bearing Family. ative, quantitative, and historical perspectives. In Research, such as that described below, demon- The group's efforts were furthered this addition, faculty investigators have developed strong strates that nurse specialists providing quality care spring when the School of Nursing collaborative relationships with other schools on can we consumers health care dollars. Such studies received a research program grant to campus including Medicine, Engineering, Arts and have encouraged legislators to increase funds for extend their work. Sciences and the Wharton School. advanced nursing programs and to establish the The newly awarded $1.3 million Opportunities for research development have been National Center for Nursing Research at the National Institutes of Health grant studies are greatly enhanced by the School's Center for Nursing National Institutes of Health. three patient groups who, nationally, Research, initially funded in 1980 by the Mabel Research into clinical problems helps nurses being discharged early from the hospital- Pew Myrin Trust. The Center, directed by Barbara maintain and enhance the quality of care they pro- women with unplanned cesarean births, Lowery, EdD, FAAN, provides consultation on vide to patients, despite the unprecedented demands childbearing diabetics, and hysterectomy proposal writing, research methods, statistical analy- for their services. The following examples of nursing patients. sis, computer use, and preparation of manuscripts for faculty research at Penn were selected to show the Using the team's quality-cost model of publication. It is one of three sites selected nationwide range of research that is shaping the health care of early discharge and transitional follow-up for training of Robert Wood Johnson Post-doctoral today and tomorrow. -Claire M. Fagin care, nurse specialists begin working with Clinical Nurse Scholars. Margaret Bond Simon Dean of Nursing patients while they are hospitalized, pre- paring them for discharge. Following early discharge, nurse special- ists make a series of home visits and tele- phone calls. They are also on call for patients seven days a week to answer their questions and concerns. Using the model, patient outcomes such as rehospitalization, morbidity, affect, self- esteem, satisfaction with care and cost of care are compared between patients dis- charged early and those discharged routinely. The study is timely and important for several reasons, Brooten noted. Because the high cost of health care has caused hospitals to reduce the length of time patients are hospitalized, transitional follow-up care in the home is needed in some groups to assure that patients Doctoral students Susan Bakewell-Sachs and Lauren Arnold meet with Dr. Ruth McCorkle and Dr. Ann receive all care necessary for recuperation. O'Sullivan in the School of Nursing's Center for Nursing Research. The research also provides a model of student, School of Nursing; and John A. Carlson Jr., MD, associate director gyneco- logic oncology, associate professor obstet- rics and gynecology, HUP. Barbara Munro, PhD, RN, associate pro- fessor at the School of Nursing, is asso- ciate program director of the research effort. Barbara Jacobsen, associate profes- sor in the School of Nursing, will conduct the statistical coordination among the three study groups. Steven Finkler, PhD, of New York University, who worked with the team on the earlier research, is the economist on the study. Follow-up Home Care for Patients With Cancer The effects of follow-up home care on cancer patients is the focus of a study undertaken by Ruth McCorkle, PhD, FAAN, professor, School of Nursing and co-investigator Karen Buhier-Wilkerson, PhD, RN, associate professor, School of Nursing. The study, funded by the National Institutes of Health National Center for Nursing Research, involves 400 Dr. Dorothy Brooten consults with Dr. Ruth York. Dr. Linda Brown and other investigators on the research patients with lung, breast, prostate, head team about the nurse specialists who will work with the three patient groups on the study-women with and neck, gastrointestinal, colorectal or unplanned cesarean births, childbearing diabetics and hysterectomy patients. gynecological cancer. The investigators targeted people at transitional follow-up care using master's These women are also at risk of infection, high risk for problems after discharge prepared nurses who have advanced prac- hypoglycemia, anxiety, depression, and from the hospital and are looking at a cul- tice skills in the care of the patient groups poor infant outcomes. They are often hos- turally mixed group, including blacks, His- they are following. pitalized during pregnancy for blood glu- panics and Asians. The patients and cose elevation, stabilization and control. are interviewed on three The team's model of spouses being quality-cost early Education the effects occasions over a six-month to see and nurse regarding interacting period hospital discharge specialist of and diabetes and how their to illness and treat- transitional home care was deve- pregnancy potential responses follow-up is a of their ment over time. at Penn in 1981. It was used in 1982 complications necessary part change loped home care. To date, the have enrolled with home visits to risk infants who follow-up investigators high The of women 96 recruited from six area were from the group having hysterec- patients discharged early hospital. than 600,000 Fox Chase Cancer Cen- That headed Brooten tomy surgery-more hospitals-HUP, original study, by at risk for com- ter, Univer- with a team of Penn nurses and annually-is postoperative Presbyterian Hospital, Temple physi- infection, tract Thomas cians, was in the New plications including urinary sity Hospital, Jefferson University published England and alterations in Medical Center, and Graduate Medicine and established a national dysfunction, depression, Hospital. Journal of self and the will look at the model for transitional care programs. image sexuality. During study, they The overall research on the three differences in referral patterns across hos- Each of the patient groups in the pres- ent with cesa- patient groups will be headed by Brooten pitals, including the type and duration of study-women unplanned and she will also be a member of the team home care services and reasons home rean births, diabetics, and why childbearing the cesarean On this team care is initiated and terminated. McCorkle hysterectomy patients-is beginning to studying group. earlier as with Brooten are: Marianne Roncoli, PhD, and Buhler-Wilkerson will use this infor- experience discharge hospitals RN, associate School of mation to and inter- attempt to control costs. While earlier professor, Nursing plan develop nursing has and clinical director, Obstetrical/Neonatal ventions to maximize the patients' ability hospital discharge potential advantages HUP; Lauren Arnold, MSN, RN, to their illness and the for these three groups, it also has many Nursing, manage improve and lecturer and doctoral candidate, School of quality of life while living with their potential disadvantages-physical psy- and Michael Mennuti, MD, disease. chological complications may go unde- Nursing; pro- tected at home unless there is fessor and chairman, Department of McCorkle recently completed a