'She lights the way'
Building a tool to help veterans with spinal cord injuries
By Tim Bannon
Photo by Erik Unger
Keith Aguina, who suffered a spinal cord injury in 1981, serves on the veteran engagement panel at Edward Hines, Jr. VA Hospital and has worked with Lisa Burkhart for 10 years.
“She sees a problem and figures out a way to fix it,” said Aguina, an Army vet. “She’s given me and many others at the VA a lot more information about ways to improve our lives.
“She lights the way. And she has the heart of an angel.”
As a research health scientist in the VA’s Center of Innovation for Complex Chronic Healthcare and as a professor at the Marcella Niehoff School of Nursing, Burkhart’s expertise is in health systems research, mixed methods, interprofessional collaborative practice, and patient-centered care.
As part of her joint appointment with Hines, Burkhart recently completed a study as principal investigator to develop a tool to prevent community-acquired pressure injuries in veterans living with spinal cord injury (SCI) for use in ambulatory care, called the Community-Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT).
This summer, thanks to a $1.6 million grant, she began a four-year research study to assess implementation of that tool at seven VA sites across the country.
“As a nurse, I understand clinic workflow and community health challenges,” she said. “It is so important to create positive, collaborative environments to integrate the CAPP-FIT into clinical practice with provider input while adapting the tool to meet veteran need. Process is as important as outcome.”
Burkhart’s early work focused on bridging gaps between spirituality and informatics to measure the effect of the spiritual dimension of care on patient outcomes, particularly using the electronic health record (EHR).
“Spirituality is not a piece of a human being but a reflection of our humanness,” she said. “It is the dimension that unites physical, psychological, and social dimensions.”
The first step was to integrate whole person terms in standardized health terminologies into the EHR. Specifically, she authored NANDA International diagnoses related to spirituality, religiosity, and moral distress and further developed Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) terms related to spirituality and religiosity.
Building bridges
She mapped narrative parish nurse documentation into the NIC system to determine how well the NIC captured a spiritually focused, community-based nursing practice.
“The beauty of what I try to do is build bridges between entities to maximize wins,” Burkhart said. “I love win-wins.”
Burkhart also led an interprofessional team to create spiritual care documentation for chaplains, nurses, and physicians in the Epic electronic health record at Loyola University Health System.
That is now part of the Epic product and communicates patient spiritual distress among nurses, chaplains, and physicians. This helps integrate spiritual care in health care using the EHR.
Her research trajectory expanded to veteran health care, in particular preventive care in veterans living with spinal cord injury, which is a permanent condition affecting every aspect of life including health, daily activities, participation, and quality of life.
SCI is among the most complex, chronic conditions, costing the VA an estimated $2 billion annually.
“It’s a horrible thing to endure,” Burkhart said. “And it’s expensive.”
People with SCI are at high risk of pressure injury, also known as pressure ulcers or bedsores, due to loss of sensation, motor denervation, and immobility. They can occur when too much pressure, friction, and shear is applied to the skin, reducing blood flow and damaging the skin and underlying tissue.
“These injuries can be devastating,” she said. “Once you have a pressure injury it becomes a hot spot, and it can recur for years.”
Valuable tool
The CAPP-FIT tool is a veteran survey available as an email link to assess a patient’s risks, issues at home, equipment needs, and other vital factors. Results of this survey appear on a provider report highlighting individualized preventive care needs, with recommended actions immediately available to the nurse and primary care provider during a clinic visit.
That information is then integrated into a systematic, primary prevention, and evidence-based strategy in SCI clinics that can prevent devastating and costly injuries.
“Things happen really fast with these patients, so it’s important that we try to catch some of these issues early,” she said.
For Burkhart, working with veterans has been a remarkable experience. “Veterans are very cool people with strong work ethics, and very dedicated,” she said. “The population is amazing and resilient. It gives me goosebumps thinking about how resilient they are.”
The VA provides care to more than 27,000 veterans with SCIs, making it the largest health care system in the world providing lifelong spinal cord care.
“The VA has strength in its research,” said Lorna Finnegan, dean of Loyola Nursing. “And it’s an opportunity for us to partner with them and for our faculty to conduct research there.
“It’s important to us because our students get clinical experiences at the VA and many of the patients there have complicated illnesses, and it’s right there in our backyard. The VA is a great system to work in.”
Burkhart also serves on the Nursing Research Field Advisory Committee for the VA Office of Nursing Services to facilitate mentoring, education, and policy at the national level for nurse researchers.
“Throughout this journey, it is so critical to not only receive mentoring, but to also mentor those who continue to expand knowledge through research and translate that research into practice toward improving the health of our people,” she said.
In 2022, Burkhart won Loyola’s Faculty Member of the Year Award.
Burkhart said what guides her as she moves forward is her commitment to spiritual care, and the whole person mission that unites physical, psychological, and social dimensions.
“My passion is preventative care in the community, empowering people to embrace their own care,” she said. “And to live healthy lives.”
Building a tool to help veterans with spinal cord injuries
By Tim Bannon
Photo by Erik Unger
Keith Aguina, who suffered a spinal cord injury in 1981, serves on the veteran engagement panel at Edward Hines, Jr. VA Hospital and has worked with Lisa Burkhart for 10 years.
“She sees a problem and figures out a way to fix it,” said Aguina, an Army vet. “She’s given me and many others at the VA a lot more information about ways to improve our lives.
“She lights the way. And she has the heart of an angel.”
As a research health scientist in the VA’s Center of Innovation for Complex Chronic Healthcare and as a professor at the Marcella Niehoff School of Nursing, Burkhart’s expertise is in health systems research, mixed methods, interprofessional collaborative practice, and patient-centered care.
As part of her joint appointment with Hines, Burkhart recently completed a study as principal investigator to develop a tool to prevent community-acquired pressure injuries in veterans living with spinal cord injury (SCI) for use in ambulatory care, called the Community-Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT).
This summer, thanks to a $1.6 million grant, she began a four-year research study to assess implementation of that tool at seven VA sites across the country.
“As a nurse, I understand clinic workflow and community health challenges,” she said. “It is so important to create positive, collaborative environments to integrate the CAPP-FIT into clinical practice with provider input while adapting the tool to meet veteran need. Process is as important as outcome.”
Burkhart’s early work focused on bridging gaps between spirituality and informatics to measure the effect of the spiritual dimension of care on patient outcomes, particularly using the electronic health record (EHR).
“Spirituality is not a piece of a human being but a reflection of our humanness,” she said. “It is the dimension that unites physical, psychological, and social dimensions.”
The first step was to integrate whole person terms in standardized health terminologies into the EHR. Specifically, she authored NANDA International diagnoses related to spirituality, religiosity, and moral distress and further developed Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) terms related to spirituality and religiosity.
Building bridges
She mapped narrative parish nurse documentation into the NIC system to determine how well the NIC captured a spiritually focused, community-based nursing practice.
“The beauty of what I try to do is build bridges between entities to maximize wins,” Burkhart said. “I love win-wins.”
Burkhart also led an interprofessional team to create spiritual care documentation for chaplains, nurses, and physicians in the Epic electronic health record at Loyola University Health System.
That is now part of the Epic product and communicates patient spiritual distress among nurses, chaplains, and physicians. This helps integrate spiritual care in health care using the EHR.
Her research trajectory expanded to veteran health care, in particular preventive care in veterans living with spinal cord injury, which is a permanent condition affecting every aspect of life including health, daily activities, participation, and quality of life.
SCI is among the most complex, chronic conditions, costing the VA an estimated $2 billion annually.
“It’s a horrible thing to endure,” Burkhart said. “And it’s expensive.”
People with SCI are at high risk of pressure injury, also known as pressure ulcers or bedsores, due to loss of sensation, motor denervation, and immobility. They can occur when too much pressure, friction, and shear is applied to the skin, reducing blood flow and damaging the skin and underlying tissue.
“These injuries can be devastating,” she said. “Once you have a pressure injury it becomes a hot spot, and it can recur for years.”
Valuable tool
The CAPP-FIT tool is a veteran survey available as an email link to assess a patient’s risks, issues at home, equipment needs, and other vital factors. Results of this survey appear on a provider report highlighting individualized preventive care needs, with recommended actions immediately available to the nurse and primary care provider during a clinic visit.
That information is then integrated into a systematic, primary prevention, and evidence-based strategy in SCI clinics that can prevent devastating and costly injuries.
“Things happen really fast with these patients, so it’s important that we try to catch some of these issues early,” she said.
For Burkhart, working with veterans has been a remarkable experience. “Veterans are very cool people with strong work ethics, and very dedicated,” she said. “The population is amazing and resilient. It gives me goosebumps thinking about how resilient they are.”
The VA provides care to more than 27,000 veterans with SCIs, making it the largest health care system in the world providing lifelong spinal cord care.
“The VA has strength in its research,” said Lorna Finnegan, dean of Loyola Nursing. “And it’s an opportunity for us to partner with them and for our faculty to conduct research there.
“It’s important to us because our students get clinical experiences at the VA and many of the patients there have complicated illnesses, and it’s right there in our backyard. The VA is a great system to work in.”
Burkhart also serves on the Nursing Research Field Advisory Committee for the VA Office of Nursing Services to facilitate mentoring, education, and policy at the national level for nurse researchers.
“Throughout this journey, it is so critical to not only receive mentoring, but to also mentor those who continue to expand knowledge through research and translate that research into practice toward improving the health of our people,” she said.
In 2022, Burkhart won Loyola’s Faculty Member of the Year Award.
Burkhart said what guides her as she moves forward is her commitment to spiritual care, and the whole person mission that unites physical, psychological, and social dimensions.
“My passion is preventative care in the community, empowering people to embrace their own care,” she said. “And to live healthy lives.”