Research by nurses at UCSF is changing care for the sickest patients, from helicopter transport of newborns to diabetes treatment
Clinical nurses are often the first to see where the treatment system gets stuck, what patients are missing, and at which moments outcomes can be improved faster than official protocols suggest. It is precisely from such practice at the University of California, San Francisco, better known as UCSF, that research emerges which does not remain at the level of theory, but is turned into concrete changes in care. The latest examples come from two very different fields: emergency air transport of critically ill babies and children, and education and support for adults living with diabetes. What they have in common is that they were initiated by nurses directly involved in working with patients, with mentoring and scientific support from university researchers. According to official UCSF data published on March 5, 2026, such projects show how frontline experience can be transformed into a scientifically grounded model for improving health care.
From the helicopter cabin to new training for the most vulnerable patients
Charles Hood works as a paramedic and critical care transport nurse, and his job takes place where there is the least room and where mistakes must not exist. In the Bear Force One helicopter, which UCSF Benioff Children’s Hospitals uses for emergency medical transport, he cares for newborns, children, and adolescents who need highly specialized care during transport to the hospital. These are patients whose condition can change from minute to minute, so every step, from catheter placement to drug administration and vital signs monitoring, resembles work in an intensive care unit, only in a much more confined space and with the added challenges of flight. UCSF states that its pediatric specialists and transport teams are available 24 hours a day, and transport is organized as needed by ambulance, airplane, or helicopter. In addition, the hospital system now has two dedicated neonatal transport teams, one in San Francisco and the other in Oakland, serving the wider Bay Area and Central Valley.
In such circumstances, equipment that enables breathing support for the most critically endangered newborns and children is especially important. Hood noticed that using a high-frequency ventilator during transport required more specially trained staff, but also that no formalized training program for that device existed. In other words, there was a need, there was equipment, there were patients for whom such support could be crucial, but there was no single, standardized, and verifiable education model that everyone could rely on. This opened the door for a research project that did not arise from an abstract academic question, but from a very practical problem in working with the sickest patients. In a system where seconds are decisive, and transport lasts until arrival at a specialized center, such a gap in training can have serious consequences.
How a clinical problem becomes a scientific project
To develop and test the new training program, Hood received support through the Clinical Nursing Research program, or CNR grant, jointly led by UCSF Health’s Center for Nursing Excellence & Innovation and the UCSF School of Nursing. According to the official program description, this is a model that connects nurses from clinical practice with doctorate-prepared researchers so that they can jointly conduct clinically relevant research within the health system. The goal is not only to publish a paper, but to create new knowledge that can be returned to everyday practice, improve treatment outcomes, and strengthen the partnership between the academic community and the hospital. The current grant cycle provides funding of up to 30,000 U.S. dollars per project over a period of 12 months, and the program itself has been operating for decades and has dozens of research projects behind it.
UCSF’s nursing research and professional development team states that such projects cover all phases of the work, from refining the idea and preparing the research proposal to data collection, analysis of results, and publication of conclusions in professional journals. This is an important detail because many clinical nurses have deep experience in working with patients, but do not necessarily have formal research routines, knowledge about applying to an ethics board, or experience in writing scientific proposals. That is exactly why the role of mentors and researchers is not secondary, but crucial. Maria Yefimova, lead nurse scientist at UCSF Health and associate professor at the School of Nursing, pointed out that this is research that arises from everyday work with patients and therefore has a direct impact on care, rather than remaining at the level of theory.
Simulations, video modules, and mandatory training for transport teams
In Hood’s case, the collaboration included Sandra Staveski, a professor and pediatric complex care scientist, and Mandeep Chadha from the pediatric intensive care medicine department. Together, they designed video materials and simulation modules for working with the high-frequency ventilator in transport conditions. The essence of such training is not only to familiarize staff with the device, but to prepare them for concrete scenarios that occur on the way: changes in the patient’s condition, limited access to equipment, time pressure, and decisions that must be made without delay. According to UCSF, these simulation modules are now a mandatory part of training for pediatric medical transport teams working in ambulances, helicopters, and aircraft.
Such an outcome shows why small, targeted clinical studies are important for the health system. They often do not result in spectacular headlines about a new drug or a revolutionary device, but they can change procedures that directly affect patient survival and safety. In this case, it is about standardizing knowledge in a segment of care in which the most severe neonatal and pediatric cases are treated. UCSF emphasizes that transport involves critically ill newborns, including children with severe heart and lung conditions or with hypoxic-ischemic encephalopathy, and that this is why transport is not just logistics, but a continuation of intensive medicine in motion. When such work is supported by research and training, the possibility increases that the same level of care will be available consistently and in every team.
Diabetes and a burden that is not always visible in laboratory findings
The second project from the same program is focused on a problem that is less dramatic at first glance, but affects a far larger number of people and often remains insufficiently recognized. Esther Rov-lkpah, a diabetes education specialist at UCSF Helen Diller Medical Center, tried to answer the question of why some patients repeatedly return after emergency admissions due to dangerously high or low blood sugar, cardiac complaints, or other serious symptoms related to diabetes. The classic clinical answer is often sought in therapy, diet, or discipline in taking medication. But practice showed that behind these deteriorations there is very often something else: the psychological and emotional burden of everyday life with a chronic disease.
This burden is described in the professional literature as diabetes distress. It is not the same thing as depression, but a specific emotional strain that arises from constant disease monitoring, concern about diet, exercise, travel, intimate life, treatment costs, and fear of hypoglycemia or long-term complications. Rov-lkpah, in collaboration with Professor Elena Flowers, launched research in which patients are surveyed precisely about this form of burden. The idea is simple but important: if the health system does not recognize the source of worries that hinders the patient in self-managing the disease, the same problem will return, regardless of how formally correct the medical instructions are.
What the official data and previous research say
According to the latest National Diabetes Statistics Report by the U.S. Centers for Disease Control and Prevention, published on January 21, 2026, an estimated 40.1 million people in the United States are living with diabetes, which represents 12 percent of the population. Of these, 29.1 million are diagnosed cases, while an estimated 11 million adults have diabetes without a diagnosis. Such figures show that this is one of the biggest public health challenges in the country, and the consequences are not limited only to disease complications, but also to the organization of care, treatment costs, and the burden on emergency services. That is why every tool that can help with earlier recognition of problems and reduce the number of acute deteriorations has both clinical and systemic value.
In its project report, UCSF also cites data from a study led by Professor Emeritus Lawrence Fisher, according to which so-called significant diabetes distress was recorded in about 42 percent of adults with type 2 diabetes and in about 43 percent of adults with type 1 diabetes. These data further explain why some patients, although they have prescribed therapy and contact with the health system, still struggle to cope with the disease in everyday life. Earlier research also showed that some patients reduce insulin doses because of cost, skip medical check-ups because of exhaustion from numerous obligations, or independently change therapy out of fear of blood sugar levels that are too high or too low. Such decisions may in the short term seem like attempts to cope, but in the long term they increase the risk of emergency admissions and serious complications.
Why talking about fear can be just as important as changing therapy
The central message of the research led by Rov-lkpah is that a patient cannot be treated well if their experience of the disease is ignored. A patient who fears nighttime hypoglycemia may consciously maintain glucose levels that are too high. A patient who cannot bear one more examination may postpone a check-up until the problem becomes urgent. Someone else may abandon the recommended diet or therapy because the disease spills over into every part of private and professional life. When a health professional recognizes such a pattern in conversation, the possibility opens up for targeted education and an adjusted approach, and with that a real chance to reduce the number of deteriorations that end in the emergency department.
The project is still ongoing, but the plans are already clear. If the results are solid enough, the team intends to publish the findings in a peer-reviewed journal in the field of diabetology and consider the possibility of introducing the diabetes distress questionnaire into hospital departments as part of standard care. According to available information, the next phase should be the development of concrete solutions for the problems that cause the highest degree of burden among patients. In this way, the research would take another important step: from recognizing the problem toward interventions that can be built into the hospital’s routine work.
A broader message: nursing research as a tool for changing the system
UCSF states that other projects from the CNR program were also focused on very concrete issues, such as earlier recognition of hearing loss in older patients, reducing the number of needle sticks during blood draws by finding better strategies for identifying accessible veins, and simplifying hospital discharge. At first glance, these are different and unrelated topics, but they actually share the same logic. All of them begin at the point where the patient or health worker encounters an obstacle, and then try to determine through evidence whether that part of care can be made safer, faster, less painful, or more effective. This is especially important in large hospital systems where changes in practice rarely come only from above, from management or regulators, but often start with the people who work with patients every day.
The value of such an approach is not only in one successful project. When clinical nurses are enabled to turn their observations into research questions, and then receive mentoring, methodological, and financial support, the health system gains a mechanism for permanent internal improvement. Such studies may be smaller in scope than major pharmaceutical studies, but they are often more direct in their effect because they deal with precisely defined procedures, communication with patients, and work organization. In practice, this means that innovation does not always have to look like a new device or a new therapy; sometimes it is standardized training in a helicopter, and sometimes a timely question to a patient about how they are truly coping with their own disease.
At a time when health systems in many countries are looking for ways to simultaneously raise the quality of care, ease the burden on emergency services, and retain patients’ trust, examples like these show that an important part of the answer can come precisely from nursing. From the transport of critically ill newborns to work with adults who carry the burden of diabetes every day, the message is the same: when frontline experience is connected with scientific method, the result is not only new knowledge, but also a very concrete benefit for the patient who needs help immediately, and not only in some future reform.
Sources:- UCSF – report on the research of nurses Charles Hood and Esther Rov-lkpah and the role of the Clinical Nursing Research program
- UCSF Center for Nursing Excellence & Innovation – official description of the CNR grant, program goals, and the collaboration model between clinical nurses and researchers
- UCSF Center for Nursing Excellence & Innovation – data on the Research & Scholarship team and institutional support for nursing research
- UCSF Benioff Children’s Hospitals – official information on pediatric and neonatal transport, team availability, and modes of transport
- CDC – National Diabetes Statistics Report with the latest estimates of diabetes prevalence in the United States
- UCSF Diabetes Teaching Center – profile and publications of Lawrence Fisher on diabetes distress and the emotional burden of living with diabetes
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