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Papers by tanya friese

ABSTRACT Background: In 1991, Rush University Medical Center (RUMC) chartered the ADA Task Force ... more ABSTRACT Background: In 1991, Rush University Medical Center (RUMC) chartered the ADA Task Force with a charge to implement policies for individuals with disabilities, champion inclusion, and educate people on how working with and hiring persons with disabilities enriches our global village. Methods: The Task Force meets monthly with members including administrators, staff, faculty, and inter professional students. Purposefully the task force includes decision makers in human resources, patient services, transportation, building and maintenance, and curriculum, among others, in order to facilitate implementation of solutions to issues with access, discrimination, and accommodation. Results: The Rush ADA Task Force has generated a list of accomplishments including: 24 programs for improved access and services, with two components that have 19 improvements between them, as well as 35 disability training, outreach, and education programs. Our new hospital tower has over 45 instances of accommodations and accessibility. Our patients and their significant others experience an inclusive culture supported by proactive hospital policies. Currently the Task Force is identifying and training veterans, increasing employment for people with disabilities, acting on requested student and staff accommodations, and using online training for nurses who care for our adult patients with intellectual/development disabilities. We have annually celebrated people with disabilities. We have won national awards for disability advocacy. Conclusions: RUMC signature programs have included training for those inside and outside of our institution, in areas that cross all of our fourteen protected classes. The ADA Task force is successful due to its empowered membership and policy adaptations.

Journal of Child and Adolescent Psychiatry

In 1979, a study conducted by Ehrhardt et al. retrospectively examined childhood behavioral patte... more In 1979, a study conducted by Ehrhardt et al. retrospectively examined childhood behavioral patterns of 30 adults; 15 identified as lesbian women and 15 identified as transmen. All 30 adults had been assigned female at birth, and, as children, all were regarded as “tomboys.” The study found several key factors that distinguished the two cohorts. The goal of this study was to replicate and extend the 1979 study, utilizing a larger sample size and including a reference group of heterosexual women. Given the major social, technological, medical, and legal paradigm shifts that have occurred over the past four decades, we sought to determine if the previous findings still differentiate the cohorts. In light of the exponential rise in the number of gender diverse and dysphoric youth who request treatment, providing optimal, affirmative care and education is paramount, especially since many of these young people seek social and/or medical transition. Exploration of the early behavioral ind...

Journal of Global Health Reports

Psychological trauma : theory, research, practice and policy, Jan 3, 2018

Moral injury is a nascent construct intended to capture reactions to events that violate deeply h... more Moral injury is a nascent construct intended to capture reactions to events that violate deeply held beliefs and moral values. Although a model of moral injury has been proposed, many of the theoretical propositions of this model have yet to be systematically studied. We conducted semistructured interviews with eight veterans who reported experiencing morally injurious events during war zone deployments. Using narrative thematic analysis, five main themes and associated subthemes emerged from the data. The main themes capture the timing of the event, contextual factors that affected the decision-making process during the morally injurious event, reactions to the moral injurious event, search for purpose and meaning, and opening up. The findings from the present study supported an existing model of moral injury, while extending it in several important ways. Preliminary clinical recommendations and directions for future research are discussed based on the study findings. These include...

JONA: The Journal of Nursing Administration, 2016

Administrators at Rush University Medical Center have made a commitment to diversity, including a... more Administrators at Rush University Medical Center have made a commitment to diversity, including accommodating disabilities in the workplace and for students. This article explains extensive multilevel accommodations instituted by Rush University Medical Center that promote organizational growth and a healthier work environment and improve patient care.

Individuals with intellectual disabilities (IWIDs) are moving from family homes due to the aging ... more Individuals with intellectual disabilities (IWIDs) are moving from family homes due to the aging and deaths of family caregivers. Residential care in small group homes increased by >300% over 20 years. Already high rates of aggressive/challenging behaviors among IWIDs (45-60%) are exacerbated in residential care. Consequences include emergency room visits, hospitalizations, more restrictive environments, and incarceration. Reducing aggressive/challenging behaviors is important for promoting the health and well-being of this vulnerable population and in supporting caregivers. Social problem-solving (SPS) programs have shown success, but have not been delivered within the natural support system of the group home. The purpose of our work was to modify an existing research-based SPS program Attitude, Define, Alternatives, Predict and Tryout (ADAPT) for the group home environment. Input was sought from supervisory staff responsible for behavior programs for IWIDs, IWIDs, and residenti...

Problem behaviors (behaviors considered aggressive or challenging), such as destruction of proper... more Problem behaviors (behaviors considered aggressive or challenging), such as destruction of property and threat of or real personal injury, are a major public health issue for individuals with intellectual disabilities (ID) and their support systems. Social problem solving (SPS) training programs for individuals with ID have had positive behavioral results, but most were conducted in clinical settings among clinical and forensic populations. We modified a widely used research-based SPS skills program with the input of individuals with ID and their support staff as a community-based health promotion program and piloted the program among individuals with ID and their staff. The 2002 Surgeon General’s report Closing the Gap: A National Blueprint for Improving the Health of Individuals with Mental Retardation (now called ID) called for evaluating the use of assistive technology and different media for promoting healthy behaviors among individuals with ID and their supports.We report on w...

Background: In 1991, Rush University Medical Center (RUMC) chartered the ADA Task Force with a ch... more Background: In 1991, Rush University Medical Center (RUMC) chartered the ADA Task Force with a charge to implement policies for individuals with disabilities, champion inclusion, and educate people on how working with and hiring persons with disabilities enriches our global village. Methods: The Task Force meets monthly with members including administrators, staff, faculty, and inter professional students. Purposefully the task force includes decision makers in human resources, patient services, transportation, building and maintenance, and curriculum, among others, in order to facilitate implementation of solutions to issues with access, discrimination, and accommodation. Results: The Rush ADA Task Force has generated a list of accomplishments including: 24 programs for improved access and services, with two components that have 19 improvements between them, as well as 35 disability training, outreach, and education programs. Our new hospital tower has over 45 instances of accommod...

Intellectual and developmental disabilities, 2015

People with intellectual disabilities (ID) represent a small but important group of hospitalized ... more People with intellectual disabilities (ID) represent a small but important group of hospitalized patients who have higher rates of complications than do patients without ID hospitalized for the same reasons. Complications are potentially avoidable conditions, such as healthcare-acquired infections, healthcare-acquired skin breakdown, falls, and medication errors and reactions. Addressing factors related to complications can focus efforts to improve hospital care. The purpose of this exploratory study was to analyze data from reviews of academic medical center charts (N = 70) about complications and to examine patient and hospitalization characteristics in relation to complications among adult patients (age ≥ 18 years) with ID hospitalized for nonpsychiatric reasons. Adults with ID tended to be twice as likely to have complications (χ(2) = 2.893, df = 1, p = .09) if they had a surgical procedure and were nearly four times as likely to have complications (χ(2) = 6.836, df =...

Nursing management (Harrow, London, England : 1994), Jan 25, 2015

Individuals with intellectual and developmental disabilities (ID) represent a small but important... more Individuals with intellectual and developmental disabilities (ID) represent a small but important group of patients who have high levels of hospitalisation, and who are likelier to have more complications and spend more days in intensive care than those without ID admitted to hospital for similar problems. However, nursing and medical staff lack training in the care of people with ID. To address the needs of this patient group, an academic medical centre in the mid-western United States has developed specific standards of nursing care. This article describes the standards, which cover nursing interventions to enhance communication, the provision of safe and accessible environments, and collaboration with and support for caregivers; it also outlines the online educational programme that was developed for nurses to support their implementation and use of the standards.

Intellectual and Developmental Disabilities, 2014

Individuals with intellectual disability (ID) represent a small but important group of hospitaliz... more Individuals with intellectual disability (ID) represent a small but important group of hospitalized patients who often have complex health care needs. Individuals with ID experience high rates of hospitalization for ambulatory-sensitive conditions and high rates of hospitalizations in general, even when in formal community care systems; however, no research was found on the common reasons for which this population is hospitalized. Academic medical centers often treat the most complex patients, and data from these centers can provide insight into the needs of patient populations with complex needs. The purpose of this study was to analyze descriptive data from the UHC (formerly known as the University Healthsystem Consortium; an alliance of 115 U.S. academic medical centers and 300 of their affiliated hospitals) regarding common reasons for hospitalization, need for intensive care, and common hospitalization outcome measures of length of stay and complications for adult (age ≥ 18) pa...

ABSTRACT Background: In 1991, Rush University Medical Center (RUMC) chartered the ADA Task Force ... more ABSTRACT Background: In 1991, Rush University Medical Center (RUMC) chartered the ADA Task Force with a charge to implement policies for individuals with disabilities, champion inclusion, and educate people on how working with and hiring persons with disabilities enriches our global village. Methods: The Task Force meets monthly with members including administrators, staff, faculty, and inter professional students. Purposefully the task force includes decision makers in human resources, patient services, transportation, building and maintenance, and curriculum, among others, in order to facilitate implementation of solutions to issues with access, discrimination, and accommodation. Results: The Rush ADA Task Force has generated a list of accomplishments including: 24 programs for improved access and services, with two components that have 19 improvements between them, as well as 35 disability training, outreach, and education programs. Our new hospital tower has over 45 instances of accommodations and accessibility. Our patients and their significant others experience an inclusive culture supported by proactive hospital policies. Currently the Task Force is identifying and training veterans, increasing employment for people with disabilities, acting on requested student and staff accommodations, and using online training for nurses who care for our adult patients with intellectual/development disabilities. We have annually celebrated people with disabilities. We have won national awards for disability advocacy. Conclusions: RUMC signature programs have included training for those inside and outside of our institution, in areas that cross all of our fourteen protected classes. The ADA Task force is successful due to its empowered membership and policy adaptations.

Journal of Child and Adolescent Psychiatry

In 1979, a study conducted by Ehrhardt et al. retrospectively examined childhood behavioral patte... more In 1979, a study conducted by Ehrhardt et al. retrospectively examined childhood behavioral patterns of 30 adults; 15 identified as lesbian women and 15 identified as transmen. All 30 adults had been assigned female at birth, and, as children, all were regarded as “tomboys.” The study found several key factors that distinguished the two cohorts. The goal of this study was to replicate and extend the 1979 study, utilizing a larger sample size and including a reference group of heterosexual women. Given the major social, technological, medical, and legal paradigm shifts that have occurred over the past four decades, we sought to determine if the previous findings still differentiate the cohorts. In light of the exponential rise in the number of gender diverse and dysphoric youth who request treatment, providing optimal, affirmative care and education is paramount, especially since many of these young people seek social and/or medical transition. Exploration of the early behavioral ind...

Journal of Global Health Reports

Psychological trauma : theory, research, practice and policy, Jan 3, 2018

Moral injury is a nascent construct intended to capture reactions to events that violate deeply h... more Moral injury is a nascent construct intended to capture reactions to events that violate deeply held beliefs and moral values. Although a model of moral injury has been proposed, many of the theoretical propositions of this model have yet to be systematically studied. We conducted semistructured interviews with eight veterans who reported experiencing morally injurious events during war zone deployments. Using narrative thematic analysis, five main themes and associated subthemes emerged from the data. The main themes capture the timing of the event, contextual factors that affected the decision-making process during the morally injurious event, reactions to the moral injurious event, search for purpose and meaning, and opening up. The findings from the present study supported an existing model of moral injury, while extending it in several important ways. Preliminary clinical recommendations and directions for future research are discussed based on the study findings. These include...

JONA: The Journal of Nursing Administration, 2016

Administrators at Rush University Medical Center have made a commitment to diversity, including a... more Administrators at Rush University Medical Center have made a commitment to diversity, including accommodating disabilities in the workplace and for students. This article explains extensive multilevel accommodations instituted by Rush University Medical Center that promote organizational growth and a healthier work environment and improve patient care.

Individuals with intellectual disabilities (IWIDs) are moving from family homes due to the aging ... more Individuals with intellectual disabilities (IWIDs) are moving from family homes due to the aging and deaths of family caregivers. Residential care in small group homes increased by >300% over 20 years. Already high rates of aggressive/challenging behaviors among IWIDs (45-60%) are exacerbated in residential care. Consequences include emergency room visits, hospitalizations, more restrictive environments, and incarceration. Reducing aggressive/challenging behaviors is important for promoting the health and well-being of this vulnerable population and in supporting caregivers. Social problem-solving (SPS) programs have shown success, but have not been delivered within the natural support system of the group home. The purpose of our work was to modify an existing research-based SPS program Attitude, Define, Alternatives, Predict and Tryout (ADAPT) for the group home environment. Input was sought from supervisory staff responsible for behavior programs for IWIDs, IWIDs, and residenti...

Problem behaviors (behaviors considered aggressive or challenging), such as destruction of proper... more Problem behaviors (behaviors considered aggressive or challenging), such as destruction of property and threat of or real personal injury, are a major public health issue for individuals with intellectual disabilities (ID) and their support systems. Social problem solving (SPS) training programs for individuals with ID have had positive behavioral results, but most were conducted in clinical settings among clinical and forensic populations. We modified a widely used research-based SPS skills program with the input of individuals with ID and their support staff as a community-based health promotion program and piloted the program among individuals with ID and their staff. The 2002 Surgeon General’s report Closing the Gap: A National Blueprint for Improving the Health of Individuals with Mental Retardation (now called ID) called for evaluating the use of assistive technology and different media for promoting healthy behaviors among individuals with ID and their supports.We report on w...

Background: In 1991, Rush University Medical Center (RUMC) chartered the ADA Task Force with a ch... more Background: In 1991, Rush University Medical Center (RUMC) chartered the ADA Task Force with a charge to implement policies for individuals with disabilities, champion inclusion, and educate people on how working with and hiring persons with disabilities enriches our global village. Methods: The Task Force meets monthly with members including administrators, staff, faculty, and inter professional students. Purposefully the task force includes decision makers in human resources, patient services, transportation, building and maintenance, and curriculum, among others, in order to facilitate implementation of solutions to issues with access, discrimination, and accommodation. Results: The Rush ADA Task Force has generated a list of accomplishments including: 24 programs for improved access and services, with two components that have 19 improvements between them, as well as 35 disability training, outreach, and education programs. Our new hospital tower has over 45 instances of accommod...

Intellectual and developmental disabilities, 2015

People with intellectual disabilities (ID) represent a small but important group of hospitalized ... more People with intellectual disabilities (ID) represent a small but important group of hospitalized patients who have higher rates of complications than do patients without ID hospitalized for the same reasons. Complications are potentially avoidable conditions, such as healthcare-acquired infections, healthcare-acquired skin breakdown, falls, and medication errors and reactions. Addressing factors related to complications can focus efforts to improve hospital care. The purpose of this exploratory study was to analyze data from reviews of academic medical center charts (N = 70) about complications and to examine patient and hospitalization characteristics in relation to complications among adult patients (age ≥ 18 years) with ID hospitalized for nonpsychiatric reasons. Adults with ID tended to be twice as likely to have complications (χ(2) = 2.893, df = 1, p = .09) if they had a surgical procedure and were nearly four times as likely to have complications (χ(2) = 6.836, df =...

Nursing management (Harrow, London, England : 1994), Jan 25, 2015

Individuals with intellectual and developmental disabilities (ID) represent a small but important... more Individuals with intellectual and developmental disabilities (ID) represent a small but important group of patients who have high levels of hospitalisation, and who are likelier to have more complications and spend more days in intensive care than those without ID admitted to hospital for similar problems. However, nursing and medical staff lack training in the care of people with ID. To address the needs of this patient group, an academic medical centre in the mid-western United States has developed specific standards of nursing care. This article describes the standards, which cover nursing interventions to enhance communication, the provision of safe and accessible environments, and collaboration with and support for caregivers; it also outlines the online educational programme that was developed for nurses to support their implementation and use of the standards.

Intellectual and Developmental Disabilities, 2014

Individuals with intellectual disability (ID) represent a small but important group of hospitaliz... more Individuals with intellectual disability (ID) represent a small but important group of hospitalized patients who often have complex health care needs. Individuals with ID experience high rates of hospitalization for ambulatory-sensitive conditions and high rates of hospitalizations in general, even when in formal community care systems; however, no research was found on the common reasons for which this population is hospitalized. Academic medical centers often treat the most complex patients, and data from these centers can provide insight into the needs of patient populations with complex needs. The purpose of this study was to analyze descriptive data from the UHC (formerly known as the University Healthsystem Consortium; an alliance of 115 U.S. academic medical centers and 300 of their affiliated hospitals) regarding common reasons for hospitalization, need for intensive care, and common hospitalization outcome measures of length of stay and complications for adult (age ≥ 18) pa...