One year later: UF College of Nursing, UF Health Shands transform nursing practice

Clinician and faculty teams at UF Health and the UF College of Nursing can proudly claim that they have charted a new frontier in nursing innovation.

More than one year later, the inaugural cohort of nurses and nurse faculty from UF Health and the UF College of Nursing’s joint demonstration project initiative has completed the pilot phase of each of their funded research projects. Ranging from efforts create to inspire the next generation of nurses to research aimed at improving wound treatment for COVID-19 patients, all of these projects used ideas taken from the nursing bedside, as well as the community, to make a lasting difference in health care

The next cohort of Demonstration Projects comprises nine interdisciplinary teams — with the opportunity now including four groups from UF Health Jacksonville for the first time. In advance of the new project year, the previous cohort of teams provided some of their latest updates to share insights on what the future may have in store for their projects:

A closer look

While working with infant patients UF Health Shands nurse and current UF College of Nursing PhD student Alexandria Owens, BSN, RN, CCRN noticed that some babies from specific locations, all appeared to have something in common:  complex heart lesions.

maymi owens
Michael Maymi (left) and Alexandria Owens await the analysis of their blood bank samples.

“On my unit, we noticed that infants from certain areas of Florida frequently came in with similar cardiac defects,” she said. “It led me to start to question what all of these babies shared to make this the case.”

Her own personal research took her to the Florida Panhandle, where she knew chemicals called per and polyfluroalkyl substances, or PFASs, existed in high concentrations. Commonly used in non-stick cookware and fast-food containers, PFASs are ‘forever chemicals’ that are known to remain in the human body for an extended period of time. These chemicals can cause a variety negative of health effects, according to Owens. This led her to hypothesize that these substances could potentially be in blood samples of the patients on the Pediatric Cardiac Intensive Care Unit.

To solve the mystery, Owens partnered with UF College of Nursing Clinical Assistant Professor Michael Maymi, DNP, APRN, CPNP-AC, CCRN, CNE. Through their collaboration, she was able to analyze blood from babies whose families had previously consented to store material from their infants in biobank for future research. Owens identified 120 critically ill, neonatal patients who met research criteria of requiring an open-heart surgery within their first month of life.

Thanks to their efforts, Owens has now completed the very first step of her research, concluding that PFASs are present in these infants’ blood. The next phase of her work involves reviewing the electronic medical records of these patients to find correlations with PFAS

 “These babies and their families deserve answers,” Owens said. “I hope that my research will be helpful in discovering and uncovering what factors can lead to an embryo to have a malformed heart, and take action against, what is responsible.” 

Support from a distance

When working with patients with cognitive impairments, safety comes first.

But for nurses on ‘fall-risk’ units, working with vulnerable patients can prove to be a challenge, especially when moving on their own, despite limitations.

raga with unit 64
Raga Bjarnadottir (second from right) meets with unit nurses to discuss the monitoring system.

According to UF College of Nursing Assistant Professor Raga Bjarnadottir, PhD, MPH, her decision to partner with the nurses of Unit 64 at UF Health Shands, as well as her coinvestigator, UF Health nurse Kelly Jacobitz, RN, BC, was driven by a desire to improve the floor’s fall response workflow, as well as create a reassuring environment for patients.

 “Falls are a common issue on this inpatient unit, but a constant response can take a toll on the nursing staff, as well as disturb patients, she said. “Our ultimate goal was to reimagine fall procedures in the most efficient way possible.

To help reimagine fall-prevention, the team created a remote, video surveillance program for at risk patients. Through this initiative, nurses and support technicians assigned to a command station can watch patients in real time on a video monitor, removing the need for disruptive bed alarms, as well as reducing the likelihood of false alarms.

After trialing this system on the unit, Bjarnadottir and her team plan to collect surveys from the floor’s nurses to observe whether the new process had any effect on fatigue caused by frequent bed alarms. Now in the analysis period of their research, she hopes that their findings reveal that this response system can be implemented across all fall risk floors at UF Health, as well as beyond.

Research roundup

During the COVID-19 pandemic, acute skin failure, or the breakdown of the body’s largest organ, was a common problem among COVID-19 positive patients seen by the UF Health Shands units, including the Wound Care Unit. Although they were initially classified as pressure wounds, after observing these injuries, clinicians at UF Health began to theorize that a mysterious culprit, not pressure, may be behind their development.

Jennifer Bart and Meghan Bailey present a poster on their research at the FNA Annual Conference in Orlando, Florida.

These unique wounds also had a very different look: Characterized by a “beehive-like” pattern, these injuries progressed rapidly and were often not located on pressure points.  According to UF Health nurses Jennifer, Bart, MSN, RN, CWOCN and Cristina Phillips, MSN, RN, CCRN, the number of “pressure injuries” with these distinct characteristics, which did not respond to typical treatments, increased during the pandemic to an alarming level on the units.  

Following a yearlong partnership with Interim Dean Debra Lyon, PhD, RN, FNP-BC, FNAP, FAAN, the team sourced a dataset of over 500 patients collected over a three-year span. To fully understand this acute skin failure, this group collected a large body of literature to determine whether how current research described this phenomenon.

Although their patient data is still being analyzed, the team concentrated their work on reviewing nearly 1,000 articles. Thanks to their efforts, the pair of nurses now have several literature review publications to their name, setting the stage for future research on what these wounds are and how they are caused.

“This was an amazing experience; coupling clinician and researcher was the magic formula,” Bart said. “I have confidence that better outcomes for patients, supported with evidence, will be the fruits of this labor. Knowing this makes me appreciate being a nurse, especially a nurse at UF.”

Next steps

Spanning seven disciplines of nursing, the 2022-2023 Demonstration Projects cohort pioneered the first incarnation of a lasting collaboration. Now in their post study periods, each group hopes that their dedication will serve as a source of inspiration across UF Health, as well as inspire new study teams to answer the call to create their own research.

Four additional projects, which sought to improve mentorship in the community, stroke care, gratitude in the health care setting and psychiatric care strategies, will continue to investigate and share their project findings at conferences within the coming months.