When Carolyn Yucha accepted the post of dean of the UNLV School of Nursing in 2004, she knew that building research would be one of her most pressing priorities.
At the same time the state legislature had just issued a mandate to double nursing school enrollments. Nursing research might have easily moved to the back burner as faculty focused on meeting the mandate if the right actions weren’t taken.
It was a challenging time for research in the school.
“We had faculty conducting research, certainly, but they didn’t have the support and infrastructure needed to really be successful,” says Yucha, who was determined to make the changes necessary both to build research and produce more graduates. “At the time, developing creative ways to address the growing statewide nursing shortage was the top priority for the school and its faculty. But we were committed to research as well.”
To produce more nurses, the school streamlined its curriculum and extended its calendar to accommodate more students, enabling them to enter the workforce faster. Additionally, a Ph.D. program in nursing education was approved, and several new faculty were hired.
While the new faculty supported the school’s classroom goals, they also incubated what would soon become a brisk and dedicated research endeavor.
“Nursing education was and still is a primary focus, but research is absolutely necessary to move the school to the next level,” says Yucha, who previously served as associate dean for nursing research at the University of Florida. “Building a research program, as we’re doing in nursing, benefits the entire school. The new knowledge created through research improves our teaching efforts. Also, faculty members engaged in research are able to obtain external funding, which in turn supports the programs we offer.”
In the years that followed Yucha’s arrival, the school’s research effort was bolstered with the hiring of five research-active faculty members, including an associate dean for research, a full-time research coordinator to support new projects, and an editorial liaison to assist faculty with grant applications.
The scholarly productivity of nursing faculty began to climb dramatically: Total publications nearly tripled from 2004 to 2007, and scholarly presentations jumped from 11 to 101. Funded grants climbed from just three to 14 during that time. Given the school’s relatively small research faculty of only 14, the results are impressive, Yucha says. Yucha herself contributes to the school’s scholarly reputation by publishing, presenting at professional conferences, and serving as editor of the respected journal, Biological Research for Nursing.
Understanding Nursing Research
While nursing research continues to grow at UNLV, nursing faculty invariably face a challenge associated with perception: Casual observers tend to overlook nursing as an academic endeavor that benefits, as all do, from the performance of research. Nursing is often perceived as a professional or clinical program rather than a scholarly one; as a result, nurse researchers often encounter a lack of understanding from colleagues in the scientific community about what they study.
“Most people picture nurses in a hospital or clinic because that’s what they’ve been exposed to,” says Barbara St. Pierre Schneider, associate dean for research. “While we’ve all benefited from the care of nurses in these frontline positions – be it in a clinic, emergency room, or even at school – nurses are also working behind-the-scenes, through research, to answer the questions that will lead to improved quality of life.”
According to St. Pierre Schneider, many scholars and researchers outside of nursing aren’t aware that nursing professors and students conduct research. After all, it was only a little more than 20 years ago that the National Institutes of Health formally established what is now the National Institute for Nursing Research.
“Nursing is a venerable profession, but nursing research developed only recently,” says St. Pierre Schneider. “It evolved because there are questions nurses ask that no one else does.”
For example, physicians tend to focus their research on the cause and cure of disease. Nurse researchers, on the other hand, study the physical, psychological, and social response to health and illness; that is, nurse researchers holistically address health both for the individual and the larger population. They also study patient comfort and care, effective nursing practices, and the profession of nursing itself.
“Nursing researchers don’t just look at illness, but wellness as a whole. In the end, the total health of the person is at the core,” says St. Pierre Schneider.
The changing climate of health care in America is making nursing research more important than ever, according to Nancy York, UNLV assistant nursing professor. Nurses, with their unique positions on the frontlines of care, both in hospital settings and in the community, are perhaps in the best position of all health care professionals to identify problems and test theories.
“Whether it’s health promotion, patient or worker safety, or disease prevention, health care delivery has changed,” says York. “In many ways, nurses offer a unique perspective in the scientific inquiry process. And it’s that unique perspective that has and will continue to allow nurse researchers to play an even greater role in the scientific research community.”
UNLV Nursing Research
Nursing research at UNLV incorporates many perspectives, all with a similar aim: to improve human health and wellness. Through work in the classroom, in the clinic, and in the community, nurse researchers are not only effectively educating future health care leaders, they are also improving understanding of significant health issues related to diabetes, obesity, stress, and aging. In addition, UNLV’s School of Nursing boasts one of the nation’s few dedicated nursing research efforts related to biological and biobehavioral issues. Below are just a few examples of the research projects currently under way in the school.
Preventing Caregiver Depression
Michele Clark, Associate Professor
Michele Clark is looking for ways to prevent the alarming rate of depression among caregivers of the elderly.
A clinician with more than 30 years clinical experience in the home health care setting, Clark developed an interest in this area during her many interactions with the families of dependent elders in her practice. Through time, she began to notice how the complex physical and emotional needs of elders placed their family members at risk for burnout and depression.
“More than 50 percent of caregivers are at risk for depression,” Clark says. “The common pharmacological treatments for depression can take weeks to months to show therapeutic effect, if they do at all. So, instead of treating caregivers once they become depressed, it seems much more appropriate to prevent depression before it occurs.”
In order to develop appropriate treatments, Clark seeks to understand the underlying psychological and physiological factors that place caregivers at risk for depression. Specifically, she is investigating how and why the act of caregiving affects mood, and how a caregiver’s individual personality factors increase depression risk. She has also begun evaluating clinical stress assessment tools for their applicability to caregivers, with the ultimate goal of developing a novel instrument to measure stress patterns specific to this population.
“The stress associated with caregiving – beyond leading to depression – places caregivers at risk for heart disease, diabetes, and dementia,” she says. “Preventing stress not only improves the health of caregivers, but also enables them to continue providing adequate care for their loved ones without relying solely on an already strained health care system.”
Foreign-Trained Nurses and the American Workforce
Yu (Philip) Xu, Associate Professor
As the nationwide nursing shortage persists, health care facilities across the country are becoming increasingly likely to rely on foreign-trained nurses to fill staffing needs, says UNLV nursing professor Yu (Philip) Xu.
Xu is one of only a few researchers in the nation who study how this population adjusts in the American workforce.
Xu, a foreign-trained nurse himself, notes that foreign-trained nurses comprise more than 15 percent of Nevada’s nursing workforce, and that number is expected to grow.
According to Xu, most foreign-trained nurses are very capable of succeeding here, but many have trouble adjusting to American culture.
“Hospitals spend upwards of $10,000 per individual to recruit foreign nurses, yet most often there is no specific orientation or cultural training for them,” says Xu. “Many do not succeed and are sent back to their home countries – a blow for hospitals, nurses, and ultimately patients. In a field where good communication is a necessity, there has to be a better way.”
To address this problem, Xu and a team of UNLV researchers developed “Speak for Success,” the nation’s first research-based, comprehensive language and communication training program for currently employed foreign-trained nurses.
The program, which is funded by a $300,000 grant from the National Council of State Boards of Nursing, is based on Xu’s past and current research. It consists of two interrelated components: a 10-week course with a certified speech pathologist, followed by a series of interactive workshops on practical communication skills, including language use and language variations in the American health care setting.
“Nursing requires constant communication with doctors, co-workers, patients, and families, making communication-focused transition programs for foreign nurses vital for improving both patient safety and quality of care,” says Xu.
“With the nursing shortage expected to continue, we need to find ways to reduce turnover among the nurses we already have in the profession and to make certain that all nurses entering the American workforce are adequately prepared to succeed.”
Sustainability and Community Health
Nancy Menzel, Associate Professor
Associate professor of nursing Nancy Menzel believes that a healthy community is a sustainable community.
“Without healthy people, a city is not sustainable,” says Menzel. “A city’s most valuable resource is its people. Government and business leaders must view public health as an investment in the future.”
For this reason, Menzel studies a variety of health issues, seeking to ascertain if the community and state are sustainable environments for their citizens. She has explored such subjects as health care services and access, work-related injuries, and the relationship between low-back pain and disability.
Recently, Menzel has focused on workplace health and safety for nurses. Her research has proved that instructing students on the use of safe lifting equipment positively affects the likelihood that care facilities will adopt safe lifting programs, reducing both workplace injuries and employee turnover.
“Many injured nurses leave the field forever,” says Menzel. “It’s not an effective or sustainable practice to invest funding and time to produce more nurses only to have them leave the field due to an injury through unsafe manual handling of patients. It’s obviously harmful to the nurses themselves, and it’s detrimental to the profession.”
Menzel, who also serves as the current president of the Nevada Public Health Association, not only conducts research on the subject of safe handling of patients, but also serves as an advocate for nurses.
In 2006, she promoted legislation to require Nevada hospitals to provide safe patient handling equipment, and she developed a research-based curriculum on safe patient handling principles. Her curriculum project won the Award of Excellence in Public Health Training from the Centers for Disease Control and Prevention.
Helping Combat Obesity
Sally Miller, Associate Professor
With the growing obesity epidemic in the U.S., associate nursing professor Sally Miller is interested in helping obese people lose weight and keep it off.
To achieve that end, Miller conducts research on the incidence of and attitudes toward obesity across the lifespan, with a particular focus on long-term maintenance of weight loss.
“As a clinician, I found that a great number of patients in my practice have struggled with obesity and suffer from both physical and psychological issues,” says Miller, who has received grant funding from the American Academy of Nurse Practitioners. “From a nursing perspective, I focus my research efforts on both treatment and prevention by emphasizing the health implications as well as the emotional issues surrounding obesity.”
In addition to these areas, Miller has recently investigated a physiological aspect of weight loss: She is currently examining how levels of ghrelin, a hunger stimulant hormone produced in the gastrointestinal tract, fluctuate in people who have lost weight.
Ghrelin was first identified as a growth hormone less than a decade ago, and there is some suggestion that ghrelin levels rise disproportionately after someone loses weight. This increase leads to increased hunger and subsequent weight gain in some people.
“The practical implication is that you work hard to lose weight, have to adjust to diet and lifestyle changes, and then have to live with a hormone that makes you hungry all the time,” says Miller. “It’s as if you’re being punished for losing weight. There has to be a solution to this, and we’re working to find it.”