Building urban community resilience through university extension: community engagement and the politics of knowledge.

Many land-grant universities are examining approaches to community engagement to better align with the US land-grant mission of knowledge democratization. With a growing majority of the United States' population living in urbanized spaces, it is a societal imperative for university engagement initiatives to devise strategies for engaging people on the complexity of urban issues central to individual and community wellbeing. Effective urban engagement demands collaboration and strong relationships with urban organizations and residents to co-create approaches to urban concerns. Through narrative-based inquiry, we explore urban engagements within Penn State Extension (PSE) across the Commonwealth of Pennsylvania (USA). PSE, located administratively in the College of Agricultural Sciences, is charged with carrying out Penn State's land-grant commitment to serve Pennsylvania's citizens through community engagement and nonformal education in the agricultural and food, human, and social sciences. We examine extension educator and faculty practices, program development, community engagements, and experiences, and those of community stakeholders. This work draws upon democratic methods to uncover the undergirding philosophies of engagement within PSE and how communities experience those engagements. This project offers an entry-point to longer-term applied research to develop a broadly applicable theory and praxis of translational research, engagement, and change privileging urban community resilience.

Lessons learned from study of depression in cardiovascular patients in an acute-care heart and vascular hospital.

Depression is highly prevalent in patients with cardiovascular disease, but questions about the effectiveness of screening and intervention remain unanswered. To evaluate the effects of proactive intervention at an acute-care heart and vascular hospital, patients who reported depressive symptoms on admission were randomized to an active, counseling-based depression intervention plus standard care (referral to a primary or psychiatric care physician) or to standard care alone. Despite early termination of patient enrollment because of lower-than-expected recruitment rates, the project had a positive impact. By involving and educating staff, the investigators raised awareness and improved the process of identifying and helping depressed patients. The lessons in study design and execution gained from this experience will help ensure success in future studies of this condition.

The preadmission packet: a strategy that benefits patients and nurses during the admission process.

At Baylor Jack and Jane Hamilton Heart and Vascular Hospital, we developed a preadmission packet that is given to patients before their procedure date, enabling them to complete much of their paperwork in advance. The results of our subsequent study revealed that nurses save time during the assessment interview when patients arrive at the hospital with their admission database forms completed. In a busy facility with a large number of patients admitted daily, the nursing time saved can translate into a substantial economic benefit. Even more important, however, is the benefit to patients, who feel less rushed and provide a more thorough and accurate medical history when they can fill out the admission database form at home.

Implementation of an informational card to reduce family members' anxiety.

For surgical patients' family members, the wait during surgery can cause anxiety that can be exacerbated if staff members provide inadequate or inconsistent information about the patient's status. Educational interventions and other staff-intensive measures to help reduce family members' anxiety can be time consuming for staff members and impractical in a high-volume facility. To improve communication with patients' families, nurses at a heart and vascular hospital in Dallas, Texas, designed and distributed a card containing estimated procedure times, helpful telephone numbers, and other information. A survey of family members indicated that receiving the card reduced anxiety in a significant proportion of the respondents.

Glucose control and opportunities for health care improvement in a hospital setting.

We initiated a study at Baylor Jack and Jane Hamilton Heart and Vascular Hospital to compare the sliding scale insulin (SSI) protocol used in 2006 with the SSI protocol currently used to treat diabetic patients admitted for procedures or surgery. An audit of patients' records revealed greater variation in staff compliance with the current protocol than with the previous one. In addition, it seemed that more patients were refusing insulin coverage under the current protocol than under the prior version. Although the study was aborted, the initial findings motivated us to identify obstacles to glucose control and to launch a health care improvement initiative to increase compliance with the SSI protocol. As a result of this process, the hospital has made several changes, including re-educating staff nurses, initiating competency checks of protocol interpretation, promoting patient education, and implementing early identification of inconsistent glucose control.