Funded Research Highlights
- Nursing professors lead R01 studies on family functioning after the loss of a child - read more...
- Late-life depression: A concern for vulnerable older populations - read more...
- Clinical biomechanics: Analysis of normal and pathological movement - read more...
- Pediatric research in intensive rehabilitation training - read more...
- FIU CNHS participates in landmark national multi-site study on use of simulation in nursing education - read more...
- Peer education promotes HIV/STD awareness and prevention for college students - read more...
- Studying physical and mental effects of immigrant/refugee women’s transition to the U.S. - read more...
- Investigating methods to improve senior mobility after driving cessation - read more...
- Research aims to advance culturally sensitive rehabilitation efforts for amputee victims of Haiti earthquake - read more...
Nursing Professors Lead NIH Studies on Family Functioning After Loss of a Child, Assessing Risk and Intervention for Grieving Families
For most parents the birth of a child signifies the beginning of a new set of hopes and dreams. But what happens to parents when these hopes and dreams are cut short by the untimely death of their child? FIU CNHS nursing professors Dr. JoAnne M. Youngblut and Dr. Dorothy Brooten are fielding a unique R01 class study on this subject titled, Death in the PICU/NICU: Parent & Family Functioning. Backed by a $2.15 million grant from the National Institute of Health’s (NIH) National Institute of Nursing Research, the five-year study focuses on how families function and relate with one another (i.e., mother-to-father, parents-to-surviving children) after the death of a child in a pediatric or neonatal intensive care unit (PICU/NICU).
The goals of the study are to (1) understand why some family members are more at risk than others to function less well, (2) recognize what the signs of declining functionality are, and as a result (3) identify which families may be at greater risk to deteriorate as a unit after such a loss.
“Research in this area is crucial so that NICU/PICU healthcare professionals and primary care providers can identify parents and families at risk for poor outcomes and target them for early intervention,” says Youngblut, Principal Investigator of the study. “By knowing what signs to look for in someone’s behavior that point to a potential for deterioration, NICU/PICU team members can take the necessary and appropriate steps, both in and out of the hospital setting, to help these parents and families deal with a child’s death before they have significant difficulty functioning,” added Brooten, the study’s Co-Investigator.
Unlike other studies of this nature, the project includes interviews with families soon after a child’s death and at subsequent time points to study their bereavement process, mental health and daily functioning so as to identify factors that are important to a family’s recovery. Also, it is the first study to provide data on cross-cultural similarities and differences in the aftermath of a child’s death. The research team is studying more than 70 families from the NICU and PICU units of Miami Children’s Hospital and Jackson Memorial Hospital in Miami-Dade County, and Broward General Medical Center and Joe DiMaggio Children’s Hospital in Broward County. Because the families are equally representative of White, Black and Hispanic descent, the study will also serve to detect racial, ethnic and cultural differences and similarities that may play a role in the success of a family’s recovery process.
In fall 2010, Dr. Youngblut and Dr. Brooten received a second NIH R01 award for $2.5 million for their study titled, Children’s Responses to Sibling Death in NICU/PICU in 3 Racial/Ethnic Groups. Building from the parent study, they seek to understand the impact of the loss of a sibling among living sibling who have lost a playmate, friend, peer and confidante.
The death of a sibling is a double loss to a surviving sibling. It includes playmate, confidante, role model, and loss of parents whose grief leaves them with little to no emotional energy to reach out to their hurting surviving children. This area of research has evolved from having the children get over their sibling’s death to recognizing that children may need to continue a relationship with their deceased sibling. There is a great need for healthcare providers to understand the responses to sibling death from the child’s perspective at different ages with different family and support systems, and responses of children from different racial/ethnic groups where the meaning and traditions around death differ.
The goals of the study are to (1) examine children’s mental health, physical health, personal growth, and functioning after the death of a sibling in the NICU/PICU and (2) identify factors related to outcomes in three racial/ethnic groups. Identifying surviving siblings at risk for poor outcomes, and targeting these children and families for early treatment, holds potential to maximize health and functioning to potentially reduce healthcare costs.
This project builds on the parent study and includes contacting families and interviewing siblings after a child’s death at subsequent time points to study their bereavement process, mental health, and daily functioning. This is among the few studies that examines the bereavement process and functioning of siblings and provides data in cross-cultural similarities and differences in the aftermath of a child’s death.
With this growing body of work, Dr. Youngblut and Dr. Brooten are solidifying their impact in the field of nursing and healthcare in relation to death, dying and bereavement, and the impact on the family unit.
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Through funding from the National Institute of Mental Health (NIMH), Associate Nursing Professor Dr. Ellen Brown, FIU mounted a series of studies to address the public health problem of inadequate late-life depression care. Dr. Brown's work transformed the way in which homecare nurses learn to detect and manage depression in older adults, a vulnerable and under-treated population. In 2011, Dr. Brown was recognized by the American Academy of Nursing “Edge runner” Award for the Training in the Assessment of Depression (TRIAD) program. TRIAD is an intervention providing information about depression, patient interviewing techniques and instruction in how to facilitate referral of a positive depression screen. The goal of the program is to ensure that home healthcare nurses working with patients in their homes better identify symptoms of depression and direct patients to further evaluation. The web-based version of TRIAD is now being used in a NIMH national multi-site randomized trial.
Dr. Brown authored one of the most popular (more than a thousand printed and electronic copies disseminated in the U.S. and abroad) evidence-based guidelines, “Detection of Depression in Dementia,” developed under the aegis of the NINR-funded Gerontological Nursing Interventions Research Center (P-30) at the University of Iowa. This evidence-based guideline is the foundation for Dr. Brown's Pfizer, Inc. funded study currently underway at Miami Jewish Health Systems. Dr. Brown is leading (PI) a multidisciplinary team (Psychiatry, Psychology, Nursing, and Social Work) to implement an intervention to improve depression care in older adults with dementia living in a nursing home.
In another project with colleagues across disciplines (Computer information and Sciences, Physical Therapy, Social Work) at FIU and in partnership with United HomeCare, Inc. Dr. Brown has led in the development of the Home Continuation Care Dashboard (HCCD). The HCCD is designed to promote care transitions, service coordination, and exchange of client information for seniors living in the community with disabilities, declining health, and coexistent medical conditions. The impetus for the development of the HCCD was Dr. Brown's previous research that found inadequate exchange of patient information and poor care transitions placed older adult homecare patients at risk for adverse events, rehospitalizations, and substandard care. A HCCD field test is planned with key stakeholders in a community setting: physicians, case managers, and patients as well as their caregivers.
Dr. Brown has been selected as a Fellow of the American Academy of Nursing (FAAN), one of the most prestigious honors in the field of nursing. She is one of 142 to receive this honor in the nation in 2011, and one of two in the state of Florida. In 2011, Dr. Brown was recognized as a “Top Scholar” by Florida International University. Dr. Brown’s research-based publications appear in both nursing literature and interdisciplinary journals.
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An eight-camera motion analysis system housed in the Human Performance Laboratory at FIU CNHS is the springboard for some important research on how we move. This system, together with force plates and electromyography, allows for exceptional capture and analysis of human movement. The research of Physical Therapy professor and department chair, Dr. Denis Brunt, has utilized these tools to measure functional movement in healthy populations, including sit-to-stand, the initiation of gait, stepping, postural perturbation and gait.
This research addresses the biomechanics of both normal and pathological movement as well as outcomes to explain the neurological control of movement. In addition, Dr. Brunt has published research on patients with Parkinson’s disease, stroke, and diabetes and children who are idiopathic toe-walkers. In collaboration with Dr. Mark Rossi, Physical Therapy associate professor, motion analysis is being used to identify movement problems in patients before and after knee replacement surgery. This research will provide important objective data on functional outcomes.
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Techniques to improve physical therapy programs for children and the value of motion capture and other emerging technologies in physical rehabilitation is the research focus of Physical Therapy Associate Professor Dr. Leonard Elbaum. In collaboration with faculty colleague Dr. Martha Bloyer, Dr. Elbaum is currently investigating the effect of intensive therapy training in children with cerebral palsy on functional skill performance. The CNHS Physical Therapy department has also established a mobile motion analysis system which has allowed Dr. Elbaum to conduct this study in collaboration with health facilities such as Miami Children’s Hospital. Dr. Elbaum’s research has also focused on functional electrical stimulation and developmental assessment.
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The FIU Nursing program was one of only ten in the country chosen by the National Council of State Boards of Nursing (NCSBN) to participate in a landmark, national, multi-site study that will determine the optimal use of, and time spent in, simulation education scenarios by pre-licensure nursing education programs.
Beginning in the fall of 2011, FIU CNHS Associate Dean of Administration Dr. Helen Cornely and Clinical Assistant Professor/STAR Center Coordinator Henry Henao will lead FIU’s faculty team – Ali Marie Galindo, Daniel Little, Elizabeth Azutillo and Mark Fonseco, a recent FIU BSN alumnus – to evaluate the learning and competencies of more than 100 incoming BSN nursing students; they will be evaluated from their first day of class through the end of their first year of practice after graduating. The students will be randomly assigned to one of three groups representing different amounts of simulation – <10%, 25%, 50% – replacing traditional clinical experiences.
The goal is to determine how and to what extent simulated clinical education, as compared to traditional clinical experiences, enhances nursing comprehension, competence and clinical judgment as an RN. FIU joins four other baccalaureate nursing programs from John Hopkins University, Washington State University, University of South Carolina and the University of Southern Mississippi in the groundbreaking NCSBN study.
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SENORITAS AND SALSA: Peer Education to Promote HIV/STD Awareness and Prevention Skills for College Students
The Centers for Disease Control and Prevention (CDC) estimates 25% of all new cases of HIV infection are in persons under the age of 25. With Miami continuing as one of the top metropolitan areas in the U.S. for AIDS case rate, HIV prevention is a priority concern for community health, and for the health of young adults at FIU. That is why FIU CNHS Associate Nursing Professor Dr. Sandra “Sande” Gracia Jones and faculty colleagues Dr. Katherine “Kitty” Chadwell, clinical assistant professor and Dr. Carol A. “Pat” Patsdaughter, clinical professor, are conducing various research initiatives to address this fast-growing public health issue.
The SENORITAS project -- which stands for Student Education Needed in Order to Reduce Infection and Transmission of AIDS/HIV and STIs [sexually transmitted infections] -- was piloted at FIU in 2003 by Dr. Jones, who is widely recognized for her decades of research and work related to HIV/AIDS-specific nursing care. SENORITAS at FIU is an innovative approach to lowering the incidence of HIV/AIDS contraction among college-aged Hispanic women through use of female nursing students as campus-based HIV prevention peer educators. The project was initially funded by a grant from the U.S. Department of Health & Human Services Office on Women’s Health as part of its national Prevention of HIV/AIDS among Young Women Attending Minority Institutions Program. The project had two major aims: (a) to provide age-appropriate, gender-specific, and culturally tailored HIV/STI prevention education for Latina college students through the use of peer education and (b) to improve the competence, comfort level, and skills of multiethnic nursing students as HIV prevention educators.
The SENORITAS peer educators are junior and senior undergraduate FIU nursing students, who teach a class on HIV prevention for FIU’s Hispanic female students in an effort to help decrease new cases of HIV infection. SENORITAS is now being expanded due to a grant from the U.S. Department of Health & Human Services Office of HIV/AIDS Policy through its Minority-Serving Institutions HIV Prevention Sustainability Initiative. The single-session SENORITAS intervention will be expanded into a multi-session program focused on safer-sex practices for minority women students at FIU ages 18-25. The SENORITAS study will explore whether a multi-session intervention is effective in decreasing unsafe sexual practices for the young women who participate in the intervention.
Other research has revealed that substance abuse, particularly alcohol, is a major risk factor for college students’ unsafe sexual practices. Substance abuse awareness education, along with prevention education for HIV, hepatitis and other sexually transmitted infections, is being addressed on campus through the SALSA initiative.
SALSA, which stands for Student Awareness of the Link between Substance abuse and AIDS, is being funded through Dr. Jones’ OHAP grant, in combination with a grant from the U.S. Department of Health & Human Services Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration (SAMHSA). As part of SALSA, male and female FIU nursing students attend a two-day workshop to become certified as collegiate peer educators through the BACCHUS (Boosting Alcohol Consciousness Concerning the Health of University Students) network. After achieving certification, the students then serve as SALSA campus-based prevention peer educators.
One of their activities is to teach freshman students about HIV, substance abuse and STI education and prevention. The SALSA peer educators teach a 50-minute class to freshman students during the FIU Freshman Experience course. The SALSA class addresses contemporary issues and provides education relating to substance abuse, HIV, hepatitis and other sexually transmitted infections. Additionally, SALSA has provided campus-wide events for HIV prevention and for substance abuse awareness. In October 2010, SALSA sponsored the first-ever “Paella Block Party” for National Latino AIDS Awareness Day, which is held annually during Hispanic Heritage Month. More than 400 students attended the event, and nearly 150 students received a free HIV test.
The SALSA team works collaboratively with FIU’s Student Health Services. This collaboration has resulted in several campus-wide FIU events highlighting safer sex prevention and substance abuse awareness education for students. SALSA has also collaborated with FIU sororities, fraternities and residential life. SALSA has also successfully increased access to free HIV testing for students through community partnerships with HIV mobile testing vans. These vans come to the events at FIU and are parked in areas that are convenient to both residential and commuter students.
The SALSA team has been aided in research data collection activities by MSN students during their Research Practicum class. In 2010, the MSN students assisted SALSA in surveying over 900 FIU students to explore students’ knowledge, attitudes, beliefs and practices in relation to substance abuse, HIV and other sexually transmitted diseases. The results of this study are being used to tailor the SALSA curriculum to meet the identified needs of FIU students.
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Addressing the Physical and Mental Health Needs of Refugee and Immigrant Women During their Transition to the United States
Refugee and immigrant women experience a plethora of challenges before, during, and after their resettlement to a novel environment. Refugee and immigrant women in general and especially, Arab women whose cultural values, norms, and lifestyles are dramatically different and sometimes in conflict with the values and norms of the host countries, experience greater challenges than those who come from countries with similar cultural and religious orientation.
Consequently, women who come from traditional patriarchal family norms experience additional challenges such as ethnic and gender discrimination among other issues while trying to rebuild their lives, and access social and healthcare services. The physical and mental health of these vulnerable women are therefore, compromised due to the multitude of barriers they experience in accessing services that are designed to help them and their counterparts.
Professor Dr. Anahid Kulwicki, is studying the issues of refugee and immigrant Arab women who are victims of political, family, or intimate partner violence and developing culturally appropriate community education and intervention programs that will assist women who are at risk or are victims of violence. Dr. Kulwicki is a multi-lingual nurse scientist with a strong research background in health issues of Arab American immigrants and refugees.
Dr. Kulwicki’s focus of research is to develop and test a culturally appropriate intimate partner violence intervention program for refugee and immigrant Arab women that is evidence based, cost effective, and theory driven. The overall goal of her research is to extend the application of the intervention program to other minority women who have similar challenges and empower women in overcoming barriers in service utilization and improve their quality of life.
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How can we reduce seniors’ dependence on the car and ensure continued mobility after driving cessation?
Young and old alike, Americans rely on the personal automobile as their primary form of transportation. However, as seniors age, normative age-related changes, as well as a greater likelihood of acquiring medical conditions may impede the ability to drive safely. This is why Dr. Dennis McCarthy, assistant professor of Occupational Therapy, is studying mobility issues among seniors.
As a group, seniors are among the safest drivers and self-limit their exposure, avoiding driving conditions in which they no longer feel confident (e.g., night driving, rush hour). Many seniors, however, continue to drive past the time they are able to do so safely. Often, this is due to a lack of acceptable alternatives to the automobile: seniors may not be able to obtain groceries, medications, heath services or participate in desired activities. Even when public transportation is available, few seniors transition to its use.
Dr. McCarthy’s specialty is in the research of safe mobility for seniors, which includes driving performance and the development of transportation programs that provide acceptable alternatives to the car. With better access to transportation option other than the car, seniors are able to live independently in their communities with continued access to needed goods and services.
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Research to Advance Culturally Sensitive Rehabilitation for Post-Amputation Victims of Haiti Earthquake
FIU CNHS Department of Physical Therapy professors are leading a pilot study funded by the National Institutes of Health (NIH) focused on the impact of traumatic and surgical amputations on earthquake victims in Haiti.
During the rescue efforts after the catastrophic earthquake in Haiti on January 12, 2010, an unprecedented number of amputations were performed on children and adults in a country where post-amputation care and rehabilitation were practically non-existent. What is the impact of the traumatic event and the perception of disability and the quality of life of so many amputees in a cultural and economic environment that offers very little in terms of accommodations for the disabled?
Dr. Marilys G. Randolph and her colleagues, Dr. Leonard Elbaum, Dr. Denis Brunt and Dr. Anahid Kulwicki, are conducting this pilot study in collaboration with a clinical center in Port-au-Prince, Haiti. The aims of the study are two-fold: 1) to develop the socio-demographic profile of individuals (adults) who had a lower-extremity amputation after the earthquake, and 2) to assess the amputees perception of their level of disability, their functional status and quality of life post-prosthetic fitting.
This study is expected to generate important information about factors likely to impact the rehabilitation of individuals with lower limb amputations in Haiti. The demographic component and the perception of disability by the amputees themselves in their cultural environment will provide important information to develop a culturally sensitive rehabilitation model.
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