Spring 2002 - UCLA School of Nursing

WEB-BASED DIAGNOSTIC PROGRAMENHANCES CLINICAL LEARNINGFranco Dombkoski, a 71-year-oldman, has come to the clinic complainingof shortness of breath. TheUCLA School of Nursing student who seesDombkoski under the watchful eyes of apreceptor is being put to the test, with theopportunity to take a history, conduct aphysical exam and order labtests where necessary. Thestudent will receive feedbackfrom the preceptor for howthorough and efficient he orshe is in the encounter.It sounds like thesame process advancedpracticenursing studentshave gone throughfor years in their clinicaltraining. But this is different.Mr. Dombkoskiisn’t a flesh-and-bloodpatient, but a case presentedas part of a Webbasedinstructional computersoftware programcalled DxR Clinician,which enables students,from the comfort of their home computer,to learn about clinical decision-making anddiagnosis in a way that simulates the clinicalenvironment to the extent that lecturesand textbooks can’t.“Nothing is going to replace workingwith actual patients and an actual preceptor,”says Dr. Colleen Keenan, associateprofessor at the UCLA School of Nursing,who is leading the effort with Dr. LynnDoering. “But our clinical faculty are parttime,and with changes resulting from managedcare, our preceptors are very busy.They can’t take all the time it takes to doclinical teaching with beginning students.”So the school has purchased DxR DevelopmentGroup’s software and, beginninglast fall, integrated it into the courseworkfor all clinical graduate students. The DxRClinician program, which was designed toteach both medical and nurse practitionerstudents, simulates real cases such as Mr.Dombkoski’s. In “interviewing” patients,students can choose from more than 250questions in 20 categories, ranging frompresent illness to questions about the patient’shistory. Eighteen exam tools that produce morethan 425 physical and neurological exams areavailable, presenting real heart and breath“A lot ofinstructionalapproachesdon’t reflectclinical realities.This will helpour studentsbe even betterprepared tostart seeingpatients.”Dr. Colleen Keenansounds with each case and, in some cases, digitalvideo presentations. Thirty-two common labswith more than 400 other labs and proceduresare available for each case, including X-rays,magnetic resonance imaging, nuclear imaging,and electrocardiograms. (Sample cases can befound at DxR Development Group’s Web site,www.dxrgroup.com.)All along, students report theirhypotheses and interpretations asthey collect data that lead to a finaldiagnosis. Later, the instructor candownload the student’s work andtrace the clinical decision-makingprocess, providing evaluation andfeedback on how it might be improved.DxR Clinician is the latest andmost extensive adoption by theschool of the teaching methodologyknown as problem-basedlearning, which has gained favoramong clinical educators. “A lot ofinstructional approaches don’t reflectclinical realities,” Keenan says.“When students see a real patient,the patient comes forward with asymptom and a set of complaints, and it’s up tothe student to ask the appropriate questions andselect the appropriate diagnostic tests in order toreach the correct diagnosis. That’s very differentfrom the way things are presented in textbooks,where the diagnosis is already assumed and thenyou backtrack and learn about how you gotthere.”In addition to giving students a more realisticexperience than would be possible in a lecture ortextbook, the program offers the additional advantageof being accessible to students any timeand anywhere as long as they have a computerwith an Internet connection. “Students canspend as much time as they want on the case,and it’s very convenient to be able to do it athome,” Keenan says.Keenan points out that the school is still evaluatingthe program’s impact on the curriculum,but so far the signs are positive. “Our students alreadyhad an excellent reputation among ourpreceptors,” she says, “but this will help them tobe even better prepared to start seeing patientswhen they walk into the clinical sites.”

UPDATE:CENTER FORVULNERABLEPOPULATIONS RESEARCH AT UCLAThe Center for Vulnerable Populations Research(CVPR) was established at theUCLA School of Nursing in 1999 with a$1.48 million National Institute of NursingResearch grant award. The center, directed byDr. Deborah Koniak-Griffin and co-directed byDr. Adeline Nyamathi, brings together faculty atthe school, from other parts of the UCLA campusand from the community, with the goal of improvingthe health of social groups that are atincreased risk for health problems. Partnershipsare established with communities through mutualdefinitions of needs and the identificationof strengths and resources. Based on this assessment,interdisciplinary scientists, research participants,and community collaborators developand implement research to eliminate health disparities.Study results are then disseminatedwithin the communities of research participants,scholars, ethicists, and policy-makers.Three years after its establishment, the centeris thriving, with regular presentations and anumber of ongoing studies and community projects,including:Lay Health Advisors and Health EducationObesity, lack of physical exercise, and exposureto tobacco smoke – health problems that contributeto chronic disease and decreased life expectancy– are on the rise in Southern California,and affect some community groups more thanothers. Particularly vulnerable are those groupswith limited resources to deal with these problems.A joint project by the CVPR, the Los AngelesCounty Department of Health Services, andthe local community seeks to address this concernwith an educational community outreachproject conducted by lay health advisors, whopromote health in the areas of nutrition, physicalexercise, and smoke-free living environments.Lay health advisor outreach programs offer aresource to communities with unmet needs, andhave been shown to be successful.HIV Vaccine TrialsMore than a dozen HIV vaccine products are beingtested in clinical trials in the United Statesand the developing world. But little is known ofthe challenges that will confront researchers interestedin assessing the efficiency and efficacy offuture clinical trials in individuals targeted forthe large-scale trials – racial and ethnic minorities,the impoverished, and substance-usingpopulations. These groups have been historicallymarginalized and disenfranchised, and maintaina high level of distrust of the federal governmentand public health research. Thus, Nyamathi andKoniak-Griffin have received funding from theUCLA AIDS Institute to conduct a series of “thinktanks” to stimulate research and collaborative endeavorsto advance knowledge and skills inpreparing for these challenges.Boron in ChinaAs detailed in the last issue of UCLA School ofNursing News, Dr. Wendie Robbins, with colleaguesin China and the United States, is implementinga study of the relationship betweenworkplace exposure to boron-containing compoundsand adverse male reproductive effects.Exposures of workers and persons living in communitiesnear the boron mines and processingplants in certain areas of northeast China were ofconcern to local environmental officials and thesurrounding communities. This fostered a collaborativeresearch relationship between the U.S.and China researchers.Latino Health Demonstration ProjectThis proposed project, a community partnershipbetween the CVPR and the Venice Family Clinic,is based on a request from nurses at the clinicwho designed and implemented a unique programin diabetes education. The study tests theeffects of this bilingual, bicultural communitybaseddiabetes education program through medicalrecords review, interviews with patients andproviders, and participant observation. Membersof randomized and control groups are monitoredfor measures such as HbA1c, weight, blood pressure,and diabetes knowledge at the beginning ofthe program and four months into it. This is aparticularly important issue for the Venice FamilyClinic given that diabetes disproportionately affectsMexican Americans, who represent a largeportion of the clinic’s population.Lay health advisors (promotoras de salud)exercise as part of the health promotiontraining sessions run by the Center for VulnerablePopulations Research and Los AngelesCounty Department of Health Services.CENTER FOR VULNERABLEPOPULATIONS RESEARCHCONTINUING PILOT STUDIESJANNA LESSER,R.N.,Ph.D.“Perceptions of HIV Risk and ViolenceRisk Among Young Parents Living in orAround Housing Projects”MARY WOO,R.N.,D.N.Sc.“Cystic Fibrosis Education for HispanicPatients”NEW STUDIESJANET MENTES,R.N.,Ph.D.“Characterizing Pain in CognitivelyImpaired Nursing Home Residents”DOROTHY WILEY,R.N.,Ph.D.“Anal Cancer Screening:Knowledge,Attitudes, Beliefs”JILL BERG,R.N.,Ph.D.“Latino Families and AsthmaManagement:An Exploratory Study”

School Bids Farewell to Renowned Faculty Flaskerud, AndersonDrs. Jacquelyn Flaskerud (left) andNancy Anderson (right), two outstandingand popular faculty members,have retired from the UCLASchool of Nursing.Flaskerud began her nursingcareer in 1962 as the graduate ofa diploma program. She went on to obtain a bachelor’s in nursing andthen a master’s in community mental health nursing.And, at a timewhen there were few Ph.D. nursing programs in the nation, she was thefirst graduate of the University of Illinois College of Nursing to finish adissertation and receive a Ph.D., with a minor in anthropology.Throughout her 40-year career in nursing, Flaskerud’s research focushas been on the relationship between culture and various illnesses indifferent ethnic groups. In the early 1980s, with encouragement fromDr. John Fahey, director of the Center for Interdisciplinary Research inImmunology and Diseases at UCLA, Flaskerud began AIDS researchwith a focus on ethnically diverse low-income women.In 1994, Flaskerud received a grant to train pre- and postdoctoralscholars in research on the health-related problems of vulnerable populations.Work with these scholars and interested faculty led her to developand publish a conceptual model for vulnerable populations researchin 1998.This model is used for the school’s Center for VulnerablePopulations Research, in which Flaskerud continues to play a vital role asa participatory researcher.Flaskerud is proud of the numerous professional nursing organizationsand university committees on which she has served during hercareer, particularly those dedicated to ethnic diversity and equal opportunity.She has taught theory development in nursing at UCLA since 1987,and developed the Neuropsychiatric Nurse Practitioner Program,established at the school in 1996.The author of many articles, Flaskerudalso wrote an AIDS textbook for nurses that has generated four differenteditions with translations in French, Portuguese and Japanese.Anderson was inspired to go into nursing by her father, “a wonderfulnurse.” She found a way to combine a career in nursing with her childhoodpassion of anthropology and her fascination with other cultures.Like Flaskerud,Anderson began as a “diploma nurse,” graduating froma New York state program and going on to work at a Boston hospital.In 1973 she became a UCLA student, receiving a master’s degree in1975 and becoming a lecturer at the school.Anderson went on to obtaina doctoral degree in anthropology from UCLA in 1987. In 1989, shebegan her second tenure at UCLA, combining teaching, research andclinical practice as a member of the school’s full-time faculty.Although she has enjoyed all facets of her career,Anderson says thatteaching has been the most rewarding.“A teacher, like her students, is alwayslearning,” she says. She feels fortunate to have been able to watchher students’ careers develop,and has stayed in touch with many of them.Anderson’s interest is in the partnership between nurse/researcher and patient/research participant, and the role of cultural competenceand sensitivity.As a master’s student, she created a nursingmodel that was adapted for use in the undergraduate program as well asin participatory research as a qualitative method of collecting data. Muchof Anderson’s research has focused on adolescents in community-basedand juvenile detention settings, particularly their risk-taking behaviors.Working with the Venice Family Clinic,Anderson is co-director withFlaskerud of the Social Policy and Dissemination Core of the Center forVulnerable Populations Research. Even though “officially” retired, bothwill continue to consult for the center.Please send any changes of address, as well as professional or personal updates for use in future issues, to: Editor, UCLA School of Nursing News,Box 951702, Los Angeles, CA 90095-1702.You may also fax to (310) 206-7433, or e-mail to lapointe@support.ucla.edu.UCLA School of NursingBox 951702Los Angeles, California 90095-1702Nonprofit Org.U.S. Postage PaidUCLAAddress Service RequestedNU17