complete issue - School of Nursing - University of Pittsburgh

N U R S I N G R E S E A R C HCritical AndEnd-of-Life CareMi-K yung Song,assistant professor,Department of Acuteand Tertiary CareCritical care nurses direct patientcare from the acute event, throughpalliative care, to the end of life.Researchers at the School of Nursingare studying health disparities, neurology,genetics, oncology, and pulmonarydysfunction across the continuum ofacute care services.How do outcomes compare whenadvanced care nurse practitioners(ACNPs) manage patient care in a criticalcare setting? In a study funded bythe National Institutes of Health (NIH),Leslie A. Hoffman, PhD, RN, FAAN,professor and chair of the Department ofAcute and Tertiary Care, compared outcomes between ACNPand housestaff (physicians who are completing a fellowship inpulmonary or critical care medicine) who managed patient carein a medical intensive care unit. Hoffman’s study showed thatpatient outcomes were equivalent with one exception—morepatients required reintubation (replacement of the breathingtube) under care of housestaff. Hoffman and her team believethe greater continuity of care under ACNP care may explainthis outcome. In companion studies, her research team documentedthat ACNPs and housestaff require a similar amountof time to manage patient care, and a qualitative analysis of theperceptions of intensivists, respiratory therapists, and nursingstaff concluded that ACNPs are valued for their contributionsto medical management in critical care settings.Approximately 13,500 Americans die each year from subarachnoidhemorrhage (SAH), a form of stroke where blood entersthe space surrounding the brain. SAH affects 30,000 Americanseach year and has a mortality rate of 45 percent. The primarycause of this high mortality rate is cerebral vasospasm (CV),a condition where the cerebral blood vessels contract forprolonged periods, causing a decrease in delivery of bloodand nutrients to the brain. In a second study funded by theNIH, Hoffman is testing whether a biomarker (20-HETE)influences development of CV after SAH and whether theextent of CV during the first 14 days after injury predictsfunctional recovery.Sheila Alexander, PhD, RN, assistant professor in theDepartment of Acute and Tertiary Care, also is interestedin SAH. In a study that combines genetics research withcritical care research, Alexander is examining the influence ofApolipoprotein E genotype (common variations in gene) andphenotype (differences in amounts and forms of proteins) onboth short- and long-term recovery after SAH. The abilityto identify individuals at risk for CV and poor outcomes willenable intensive care unit nurses and other healthcare professionalsto provide individualized interventions to maximizerecovery and focus resource utilization on individuals at thegreatest risk. Alexander also is exploring other genetic influenceson recovery from SAH as well as traumatic brain injury.Coronary heart disease (CHD) is the second leadingcause of hospitalization in America. More than 12 millionpeople in the United States have CHD, but the death ratefrom this disease is higher among African Americans than forany other racial or ethnic group for which data are recorded.Coronary artery bypass grafting (CABG) is a common invasiveintervention used to treat CHD, but African Americans areless likely to undergo CABG than Caucasians with equivalentseverity of disease, and they experience higher postsurgicalmorbidity and mortality.Marilyn Hravnak, PhD, RN, CRNP, associate professorin the Department of Acute and Tertiary Care, is studying12 u n i v e r s i t y o f p i t t s b u r g h