Research Spotlight Archive – Fall 2015
Research Spotlight
Over the last 18 years, Dr. Elnitsky has focused her work on health care systems, access to health care services, and health disparities, with an emphasis on deployment health, transitions in care, and self-management for military service members and veterans of Iraq and Afghanistan, older adults with chronic illnesses, and multidisciplinary health care teams. Her principal contributions are in the following areas:
Processes of access- Guided by her findings across projects, Dr. Elnitsky has developed a model of barriers to care that may be applied across military and veteran populations. Specifically, she has examined and is disseminating a model that frames access as a dynamic patient-centered process. Her work has clarified definitions and processes of access to care in at-risk groups (Elnitsky et al, 2013).
Reintegration of veterans- Dr. Elnitsky’s work in health care systems provided direct insights regarding service integration and coordination, leading her to collaborate on several efforts focusing on access, integration of services and reintegration of veterans. These efforts are breaking new ground in reintegration. A new work (Elnitsky & Fisher, 2014 in review) delineates types of reintegration, health disparities and services and describes a conceptual model of reintegration of veterans, military and their families; work emerging from these findings is informing and guiding targeted interventions.
Implementation science- Dr. Elnitsky’s work has enhanced understanding of the role of internal facilitation (i.e., process of implementing interventions to help people and organizations change) in empowering nursing staff in healthcare organizations to adopt new evidence-based clinical practices. Her efforts have resulted in a theoretical extension of The Promoting Action on Research Implementation in Health Services (PARIHS) framework to clarify the role of the internal facilitator; this innovation will impact the conceptualization of facilitation.
Gender differences- Dr. Elnitsky examined the deployment exposures and mental health service needs, barriers, and stigma among military veteran women and men. This ground-breaking work resulted in a book chapter, Gender Differences among Combat Medics and Implications for Healthcare Services in Women at War (in press) and a journal article (Elnitsky, Chapman, Thurman, Pitts, Figley, & Unwin, 2013). In addition, she explored experiences and preferences for rehabilitation services and prosthetic device features among a panel of women with major limb amputations resulting in both a journal article and a clinical continuing education product (Elnitsky, Latlief, Andrews, Adams-Koss, & Phillips, 2013). These works have raised awareness of women’s exposures and given voice to their barriers, preferences and concerns, contributing to broader system efforts to meet their healthcare needs.
Mixed methods- Dr. Elnitsky has written about applying mixed quantitative and qualitative methods and has implemented them, often using an ethnographic approach and including multiple methods such as interviews, focus groups and photo-voice. Recent work is using qualitative findings to drive the quantitative analysis in a concurrent mixed methods study of organizational culture and its impact on implementation of evidence-based practice in nursing.
Elnitsky Examines Health Care Systems for Community Reintegration of Service Members, Veterans, and Families Returning from Iraq and Afghanistan.
Dr. Elnitsky is currently extending her work in health care systems to examine the Veterans Affairs (VA) Traumatic Brain Injury/ Polytrauma Individualized Rehabilitation and Community Reintegration Care Plans being implemented in the VA Polytrauma System of Care (PSC). The PSC is an integrated nationwide system of specialized rehabilitation programs for returnees with TBI and polytrauma. The Individualized Rehabilitation Community Reintegration Care Plans are a statutory requirement of the US Congress in 2008 (38 US Code § 1710C).
Providing coordinated care to over one million injured returnees from Iraq and Afghanistan is difficult due to complex polytraumatic injuries (that is, two or more injuries affecting multiple body parts or systems that result in physical, cognitive, psychological, or psychosocial impairments and disabilities). In polytrauma, TBI often occurs in combination with amputation, spinal cord injury, Post Traumatic Stress, auditory and visual impairments or other injuries such as chronic pain. These complex injuries require new health care systems to provide integrated and coordinated interdisciplinary services, goals, and plans to help injured service members and veterans reintegrate. Reintegration refers to the individual’s return to roles in the home, community, work or school with the goal of maximizing their independence.
According to Elnitsky, “We have a large population of military service members and veterans returning from conflicts in Iraq and Afghanistan who receive rehabilitative care for functional and behavioral health needs related to polytraumatic injuries, including traumatic brain injury (TBI). Examining the effect of new service systems on reintegration in a catchment area that includes urban center city to rural regions will inform recommendations for service system change and implementation of reintegration care planning processes across the VA in ways that serve rural and urban service member and veteran needs, thereby facilitating reintegration.”
Dr. Elnitsky has researched, consulted, published and presented nationally and internationally about health care systems for community reintegration of service members and veterans. Her goals are to continue her research identifying reintegration risk factors and developing effective interventions to reintegrate service members and veterans to their roles in communities.
Dr. Elnitsky earned a BS degree in Nursing, a MS degree in Community Health Nursing, and a PhD in Urban Services- Health Services Research from Old Dominion University. She completed post-doctoral study in pharmacoeconomic methods measuring patient preferences. Dr. Elnitsky came to UNC Charlotte in 2013 from the Health Services Research and Development/ Rehabilitation Research and Development Center of Excellence, James A. Haley Veterans Hospital and the Tampa FL site of the Uniformed Services University of the Health Sciences where she served as the Site Director of the Doctoral Program in Nursing and VA Research Health Science Specialist. Prior to her service in Tampa, Dr. Elnitsky served as senior program analyst in the Office of the Assistant Secretary for Policy and Planning, and Assistant Director in Health Services Research and Development Service, at VA headquarters in Washington, D.C. Dr. Elnitsky received a Certificate of Appreciation from the Secretary, Department of Veterans Affairs, for work with the Presidential Task Force on Returning Global War on Terror Heroes to enhance the delivery of services and benefits to returning military personnel and veterans. She has also presented her work on the National Guard- VA Transition Assistance Advisor Program at the Department of Defense Centers of Excellence (and VA.org cover Story) 3rd Annual DoD-VA NIH Trauma Spectrum Conference in Washington DC. Currently, Dr. Elnitsky Chairs the CHHS Academy for Veteran and Military Health. Additionally, Dr. Elnitsky is affiliated with the Health Services Research Doctoral Program and the Health Psychology Program at the University of North Carolina at Charlotte. She continues to support VA research at the VA Medical Centers in Salisbury, NC, Portland, OR, and Tampa, FL.
Dr. Elnitsky comes from a patriotic family dating back to the Spanish American War. She is the daughter of a 20 -year US Air Force veteran of WWII, Korea and Vietnam and the wife of a 27 -year US Navy veteran of Desert Shield, Desert Storm and the Operation Iraqi and Enduring Freedom war era.
Relevant Publications:
Elnitsky C, Lind J., Rugs D., Powell-Cope G. (2014) Implications for patient safety in the use of safe patient handling equipment: A national survey. International Journal of Nursing Studies. Published online 22 May 2014 at doi:10.1016/j.ijnurstu.2014.04.015.
Elnitsky C.A., Andresen E.M., Hall C., McGarity S., Kerns R.W., Clark M.E. (2013) Access to the U.S. Veterans Affairs Health System: Self-reported Barriers to Care Among Afghanistan and Iraq Returnees. BMC Health Services Research 13, 498.
Elnitsky C., Chapman P., Thurman R., Pitts B., Figley C., Unwin COL. B. (2013) Gender Differences in Combat Medic Mental Health Services, Barriers, and Stigma. Military Medicine 178(7) 775-84.
Chapman, P., Elnitsky, C., Barnett S.D., Lapcevic A., Spehar A., Kayo R., Baker M. (2013) Exploring Combat-Related Loss and Behavioral Health Among OEF/OIF Veterans with Chronic PTSD. Traumatology 19(2): 154-157.
Elnitsky, C., Latlief, G., Andrews, E., Adams-Koss, L., Phillips, S. (Jan/Feb 2013) Preferences for Rehabilitation Services Among Women with Major Limb Amputations. Rehabilitation Nursing Journal 38(1):32-36.
Elnitsky, C., Gavin-Dreschnack, D., Latlief, G., Harris, M., Campbell, R. (Dec 2012) Lessons Learned in Pilot Testing Specialty Consultations to Benefit Individuals With Lower Limb Loss. International Journal of Telerehabilitation 4(2):3-9.
Chapman, P., Baker, M., Cabrera D., Varela-Mayer C., Elnitsky C., Figley C., Thurman R.M., Mayer P. (2012) Training, Deployment Preparation, and Combat Experiences of Deployed Health Care Personnel: Key Findings From Deployed U.S. Army Combat Medics Assigned to Line Units Military Medicine 177(3): 270-277.
Besterman-Dahan, K., Barnett, S., Hickling, E., Elnitsky, C., Lind, J., Skvoretz J., Antinori, N. (2012) Bearing the Burden: Deployment Stress Among Army National Guard Chaplains. Journal of Health Care Chaplaincy, 18 (3-4) 151-168.
Latlief, G., Elnitsky C., Hart-Hughes S., Phillips S.L., Koss L., Kent R., Highsmith M.J. (2012) Patient Safety in the Rehabilitation of the Adult with an Amputation. Physical Medicine and Rehabilitation Clinics of North America 23(2):377-92.
Fisher, M. and Elnitsky, C. (2012) Health and Social Services Integration: A Review of Concepts and Models. Social Work in Public Health, 27(5):441-468.
Scholarship and research at the School of Nursing is concentrated in two major areas:
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Vulnerable Population
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Symptom Management
For areas of faculty research interest, please see the link below.