Research studies
The Path for Women of Color (WOC) to Ascend in Healthcare: Stakeholder Perspectives in Nursing
Study Team: PI- Larissa Morgan MSN, RN, NPD-BC; Co-Is- Rebecca Trotta PhD, RN, Jaya Aysola, MD, MPH; Interviewers – Andrea Blount, MPH, BSN, RN; Georgian Green, MSN, CRNP, FNP-C, RN-BC; Felicia Morrison, MBA, MSN, RN-BC
Summary: This qualitative study aims to understand the nuanced personal, interpersonal and organizational experiences of Black/African American women, as a representative group of WOC, in one of the largest industries (healthcare), inside one of the largest occupations within that industry (nursing). We seek to understand the pathway for advancement along this trajectory from pre-nursing positions to executive leadership by gathering the stakeholder perspectives. The results of this pilot study will inform strategic interventions designed to mitigate barriers and create opportunities for advancement of WOC along this pathway from pre-nursing positions to executive leadership.
Funding Source: Wharton Center for Leadership and Change Management Diversity and Inclusion Initiative Grant $5,600 2022 Funded Research | Center for Leadership and Change Management
Status: Dissemination
Development of a Palliative Care Screening Tool (PCST) for use in Neurology Critical Care
Study Team: PIs – Julia Valenziano, MSN, RN, CCRN; Co-Is - Rebecca Trotta, PhD, RN; Robin Hermann, MSN, RN, CCRP; Barbara Riegel, PhD, FAAN FAHA; Caroline Dougherty, MSN, AGACNP-BC, FACC; Interviewers: Erin Marturano, MSN, MBE, RN
Summary: Although screening tools to identify palliative care (PC) needs for critically ill patients exist, none fully captures the unique needs of neurocritical care patients. This multi-phase study aims to develop a PC screening tool for use by nurses in neurocritical care to help them identify patients’ PC needs. In Phase I, a national Delphi approach was undertaken to determine indicators of potential PC needs for neurocritical care patients, yielding a neurocritical care palliative care-screening tool (NCPCST). In Phase II a mixed methods approach will evaluate the feasibility, acceptability, and utility for integration of the NCPCST into nursing practice and understand nurses’ perspectives on the barriers and facilitators of PC in neurocritical care.
Funding Source: $4,000 – Southeastern Pennsylvania Chapter of AACN (SePA); $5,000 – Agnes Marshall Walker Foundation
Status: Data analysis
An Exploratory Analysis of Factors Associated with Falls Among Neutropenic Hematologic Malignancy Patients Undergoing Autologous Stem Cell Transplant or Induction Chemotherapy
Study Team: PI - Danielle Pollock, BSN, RN, OCN; Co-Is – Rebecca Trotta, PhD, RN; Robin Hermann, MSN, RN, CCRP; Rosemary Polomano, PhD, RN, FAAN
Summary: Neutropenic hematologic malignancy patients hospitalized for stem cell transplant or induction chemotherapy are at high risk for falls. Studies of oncology patients suggest that a cancer diagnosis and receipt of chemotherapy increases fall risk compared to other hospitalized patients. Standard risk factor assessments do not account for these oncology-specific characteristics and therefore may not accurately reflect an oncology patients’ risk of falling. In this exploratory retrospective study, we will review records of oncology patients hospitalized for stem cell transplant or induction chemotherapy to identify likely predictors of falls in this vulnerable oncology population. This will be a foundational step for further research aimed at testing an oncology-specific fall risk prediction scale.
Funding: 2021 Daisy Foundation $7,500 Grants Funded | DAISY Foundation
Status: Dissemination
Adaptation of Heart Failure Self Care and Somatic Perception Instruments for Use with LVAD Patients
Study Team: PI-Lisa Joy Klein MSN, RN; Co-Is Rebecca L. Trotta, PhD, RN, Robin Hermann, MSN, RN, CCRP, and Barbara Riegel, PhD, RN, FAHA, FAAN
Summary: The SCHFI is an instrument created by Dr. Barbara Riegel that measures heart failure patients’ self-care practices. Self-care is defined as a naturalistic decision-making process that influences actions that maintain physiologic stability, facilitate the perception of symptoms, and direct the management of those symptoms. This theoretically grounded instrument has undergone extensive psychometric testing for use with heart failure patients, but does not fully reflect the self-care experience of heart failure patients with VADs. This study was initiated using Delphi methodology to gain consensus on content, and will be validated for use with VAD patients as part of a larger randomized controlled trial.
Status: Dissemination
Establishing the Validity and Reliability of the Self Care of Heart Failure Index for VAD Patients (SCHFI-VAD) and the Heart Failure Somatic Perception Scale for VAD Patients (HFSPS VAD)
Study Team: PI- Lisa Joy Klein MSN, RN, AGPCNP-BC, Co-I- Rebecca Trotta PhD, RN, Robin Hermann MSN, RN, CCRP. Additional team members- Michele Feil MSN, RN, WCC, Carmela Garcia-Alonzo BSN, RN, Robyn Strauss ACNS, BC, RN, MSN, WCC
Summary: The number of patients with advanced heart failure is growing rapidly. Patients with LVADs must engage in multiple daily self-care practices involving their device, health, and lifestyle. Two instruments specific to the heart failure population are The Self Care of Heart Failure Index (SCHFI) and the Heart Failure Somatic Perception Scale (SPS). Although the SCHFI and SPS are specific to the heart failure population, they are not specific to LVAD patients. The purpose of this study is to establish the reliability and validity of the Self Care of Heart Failure Index for VAD Patients (SCHFI-VAD) and Heart Failure Somatic Perception Scale for VAD Patients (HFSPS-VAD).
An Exploratory Analysis of Risk for Central-Line Associated Blood Stream Infections (CLABSIs) in the Adult Acute Myeloid Leukemia Population
Study Team: PI- Theresa Gorman, MSN, RN, AOCNS, BMTCN; Co-Is – Robin Hermann, MSN, RN, CCRP, Rebecca L. Trotta, PhD, RN Rosemary Polomano, PhD, RN, FAAN; Sarah Cutrufello MSN, RN, OCN, Amy Moore, MSN, RN, ACNS-BC, AOCNS, WTA-C; and Rachel Mea MSN, RN, OCN
Summary: Oncology patients with central lines are at high risk for blood stream infections. Those infections can have devastating effects. This study will uncover unique early predictors of central line-related blood stream infections (CLABSI) in hospitalized patients with acute myeloid leukemia. These predictors can be used to identify patients at high risk for CLABSI and ensure proactive prevention.
Funding Source: 2017 The Daisy Foundation $5,000. Grants Funded | DAISY Foundation
Status: Dissemination
An Implementation Science Study of Kangaroo Care Practices in a Neonatal Intensive Care Unit
Study Team: PI –Saritha Vangala, MSN, RNC-NIC, Co-Is - Rebecca L. Trotta, PhD, RN, Robin Hermann, MSN, RN, CCRP
Summary: Kangaroo Care (KC), also known as skin-to-skin care, is a decades old practice of holding a newborn directly against a mother (or parent’s) skin. There are well-established benefits of this practice, especially for critically ill neonates, such as promotion of breast feeding, improved neurological development, decreased need for neuroleptic medications, and shorter length of stay, and decreased mortality. Despite the benefits, KC is not fully integrated into practice. This study will focus on understanding and addresses neonatal nurses’ behaviors with regard to KC implementation, and subsequently improve outcomes. Completed Phase I involving baseline practice assessment and use of a behavior change theory to implement interventions. Kangaroo Care rates improved from 10% to 32%.
Status: Dissemination
Validation of the Secondary Traumatic Stress Scale (STSS) for use in Labor and Delivery Nurses
Study Team: Rosemary Polomano, PhD, RN, FAAN; Rebecca L. Trotta, PhD, RN; Robin Hermann, MSN, RN, CCRP; Erika Nicholls, MSN, RN, C-EFM
Summary: Secondary Traumatic Stress is a phenomenon experienced by health care providers who witness patient trauma that can have lasting negative physical and psychosocial effects. The Secondary Traumatic Stress Scale (STSS) was developed to quantify this trauma, and has been validated for use with populations such as social workers, emergency nurses, and first responders. We completed a study of secondary traumatic stress among labor and delivery nurses across Penn Medicine in 2019 (see manuscripts) and are now embarking on validating the instrument for official use in this population of nurses.
Status: Analysis
Contact the Abramson Family Center for Nursing Excellence at HUP.CenterforNursingExcellence@pennmedicine.upenn.edu
Interested in supporting the center?
Other scholarly projects
How do Palliative Care Screening Tools Perform?: A Systematic Review
Project Team: Julia Valenziano MSN, RN, CCRN; Matt Mitchell, PhD; Robin Hermann, MSN, RN, CCRP; Rebecca Trotta, PhD, RN
Summary: Use of a palliative care-screening tool improves timeliness of and access to palliative care consultation in critical care. However, there was inadequate use of valid and reliable screening tools. The tools in this review lacked consistency across criteria to assess appropriateness of palliative care consultation. This heterogeneity prevented completion of a meta-analysis to determine effectiveness of one scale over others. Future research is needed to determine which criteria are most effective in identifying the need for palliative care consultation in the critical care population.
Status: Dissemination
How do Oncology Fall Risk Scoring Systems Perform? A Systematic Review
Project Team: Danielle Pollock, BSN, RN, OCN; Matt Mitchell, PhD, Robin Hermann, MSN, RN, CCRP, Rebecca Trotta, PhD, RN
Summary: Patient falls are a serious adverse hospital event. Consequences of falls include unintended injury, additional unnecessary treatment, and increased costs. Fall risk assessment is a mainstay of nursing practice. Despite this, oncology patients experience falls at higher than desirable rates. Limited evidence exists regarding oncology-specific fall risk assessments, and these assessments lack agreement regarding the risk factors they evaluate. Despite this, an oncology specific assessment may improve risk identification in this population. More evidence is needed to determine the factors that contribute to fall risk for oncology patients specifically.
Status: Dissemination
Nurse Driven Protocols for Antibiotic Initiation in Febrile Neutropenia: A Systematic Review
Project Team: Cristina Lusardi BSN, RN; Rian Mills BSN, RN, OCN; Samantha Schad BSN, RN, OCN; and Matt Mitchell, PhD
Summary: Neutropenic patients are immunocompromised and highly vulnerable. When they become febrile, they are at high risk for developing sepsis and other serious complications. Clinical guidelines recommend the timely initiation of broad-spectrum antibiotics. Delay in antibiotic initiation can lead to unnecessary negative consequences. Nurse-driven protocols are effective in improving the timeliness and efficiency of multiple clinical pathways in oncology care. However, the evidence for nurse-driven protocols related to antibiotic initiation in febrile neutropenia is not well understood. Implementing nurse-driven protocols to improve time to antibiotic initiation for febrile neutropenic patients can positively impact patient and organizational outcomes. They can also promote nurse autonomy to practice to the fullest extent of licensure and empower nurses to lead interprofessional care. As such, organizations should consider investing in implementation of such protocols in their clinical environments. Future work should evaluate the effects of implementation of such protocols on nurses and the practice environment. Given the evidence base has established the relationship between timely antibiotic initiation and reduction in sepsis, more research is needed to directly test the effects of nurse-driven protocols on sepsis reduction as a clinical outcome.
Status: Dissemination
Communication Strategies for Patients Who Are Non-Vocal Due to Artificial Airways: A Systematic Review
Project Team: Elizabeth (Beth) Bass MSN, RN, CCRN; Stephanie Maillie MSN, RN, PCCN, CCRN, CCNS, WCC; Robin Hermann MSN, RN, CCRP; Matt Mitchell, PhD
Summary: Hospitalized patients with impaired communication experience frustration, helplessness, anxiety, and are at high risk for adverse events. The Joint Commission endorses communication as a key aspect of quality care and advises hospitals to provide communication support during non-vocal episodes caused by mechanical ventilation or tracheostomies. However, the range of strategies to support communication and their effectiveness is unknown. The purpose of this systematic review was to summarize the evidence on communication strategies for non-vocal patients with artificial airways. There is wide variation in types of communication aids and strategies, and insufficient evidence to conclude that any one approach is more effective than another. Overall, most communication strategies had some positive effect, but given the variation in outcomes (e.g., patient satisfaction, anxiety, ability to communicate), evidence on their comparative effectiveness is inconclusive. Clinical trials are needed to test the effectiveness of standardized interventions and conduct evaluations using comparable outcomes.
Status: Dissemination
Kangaroo Care in the Neonatal Intensive Care Unit
Project Team: Saritha Vangala MSN, RNC-NIC; Michelle Ferrant DNP, CNS, RNC-NIC; Matt Mitchell, PhD
Summary: The purpose of this project is to Identify and summarize evidence from clinical guidelines/ protocols/pathways on use of kangaroo care and implementation strategies for the uptake and sustainability of Kangaroo care (KC) in neonatal intensive care units.
Status: Analysis
Boomer Esiason Cystic Fibrosis Nurse Education Project
Project Team: Matt Walker MSN, RN, PCCN, NE-BC
Summary: This program is intended to support nursing scholarship and enhancement of the nursing workforce for the care of the cystic fibrosis patient population. Nurses can receive funds to support professional development through conference attendance, non-degree course work, and scholarly presentation or by achieving a specialty certification. Funds are also available for nursing support staff who are committed to advancing their education through enrollment in a nursing degree program.
Funding: Boomer Esiason Foundation $85,000
Status: In Development
Food for Health Project
Project Team: Sofia Carreno MSN; RN, Jessie Reich MSN, RN, ANP-BC; Terri Lipman PhD, CRNP, FAAN; Celeste Durnwald MD
Summary: Food insecurity of marginalized under-resourced communities in Philadelphia has risen since the start of the pandemic from 16.3% to 18.8% due to unemployment, poverty, and decreased access to healthy food. To help address this problem, a sustainable food delivery, education, and resource program for inpatient postpartum women at the Hospital of the University of Pennsylvania who are experiencing food insecurity has been developed. The program is called the HUP Food Farmacy for Women’s Health and the program will leverage existing technology and partnerships with community-based organizations (Philabundance and Food Connect) and Penn School of Nursing students to help combat food insecurity in this vulnerable patient population.
Funding: $10,000 Penn School of Nursing Innovation
Status: In progress
Nurse-Driven Antibiotic Initiation for Febrile Neutropenic Patients- Evidence-based Practice Project
Project Team: Samantha Schad MSN, RN, ONC, WTA-C, Rian Mills, BSN, RN, OCN, Cristina Colella BSN, RN, Rebecca Trotta PhD, RN, Robin Hermann, MSN, RN, CCRP, Daniel Landsburg, MD, Colleen Kucharczuk DNP, AGACNP-BC
Summary: The purpose of this project is to design and implement an evidenced-based nurse-driven antibiotic initiation protocol for hospitalized patients who experience their first neutropenic febrile event with the goal of ensuring antibiotics are administered within 60 minutes of their febrile event.
Funding: The Daisy Foundation $2500 Grants Funded | DAISY Foundation
Status: In progress
Contact the Abramson Family Center for Nursing Excellence at HUP.CenterforNursingExcellence@pennmedicine.upenn.edu
Interested in supporting the center?