The nursing care that an infant in the neonatal intensive care unit (NICU) receives influences a myriad of outcomes including risk of preventable harm, development of chronic conditions, and achievement of key developmental milestones prior to hospital discharge. Dr. Tubbs Cooley’s research focuses on understanding factors that both impede and enhance the quality and reliable delivery of core nursing care in the NICU and other pediatric settings, with a goal of redesigning systems to better support the critical work of front-line clinicians. By combining classical health services research approaches with emerging methods such as intensive longitudinal matching of data from nurses and patients and data visualization, Dr. Tubbs Cooley and her team are discovering new insights about patterns of nursing care delivery that impact neonatal outcomes.
Dr. Tubbs Cooley teaches in the undergraduate and PhD programs.
Engagement in clinical care, whether through practice or research, is a priority for Dr. Tubbs Cooley. Formerly a pediatric inpatient and private duty nurse, she remains connected to practice through her appointment as a Principal Investigator in the Center for Perinatal Research at Nationwide Children’s Hospital and as an affiliated nurse scientist at Cincinnati Children’s Hospital Medical Center. Through these appointments she routinely interacts with clinicians, administrators, patients, and families who inspire her to make health care better through science.
Enhancing reliable delivery of core nursing care in NICUs
Reliable delivery of high quality nursing care is essential for positive patient outcomes during and after hospitalization. Dr. Tubbs Cooley’s recent study, the Neonatal Nursing Care Quality Study, focused on evaluating relationships between nurse workload, missed nursing care, and adverse events in neonatal care. Her current project, Systems Analysis of Guideline Adherence in Neonatal Intensive Care, funded by the Eunice Kennedy Shriver National Institute for Child Health and Human Development, takes a human factors approach to understand why NICU nurses have difficulty adhering to evidence-based patient safety guidelines. This work considers adherence as an indicator of nursing care reliability with a goal of identifying work system factors that can be modified to better support the complex work of nurses.
Pediatric healthcare reutilization
Dr. Tubbs Cooley’s research career began by studying the effect of nurse staffing ratios on 14- and 30-day hospital readmission in children. She continues to study pediatric healthcare utilization as a co-investigator on a Patient Centered Outcomes Research Institute funded trial of nurse home visits and phone calls to reduce unplanned reutilization after routine pediatric discharge. Additionally, she is a co-investigator on a study funded by Cincinnati Children’s Hospital to evaluate utilization outcomes of nurse telehealth triage in pediatric primary care.
Opportunities to Learn at Ohio State Nursing
Students at all levels with interest in health care quality and safety research are invited to apply to join the Tubbs Cooley lab. Students are integral study team members and will learn to develop research ideas, interact with participants, collect, manage, and analyze data, and disseminate knowledge through publications and presentations.
Dr. Tubbs Cooley mentors PhD students in an embedded model, where students are integrated into active projects to give maximum exposure to the research process. This model provides students with unique opportunities to construct dissertation research from larger studies that are funded by federal agencies such as the National Institutes of Health. Prospective PhD students are strongly encouraged to discuss their research interests with Dr. Tubbs Cooley prior to program application.
- Tubbs-Cooley HL, Mara CA, Carle AC et al. Association of Nurse Workload With Missed Nursing Care in the Neonatal Intensive Care Unit. JAMA Pediatr. 2018 Nov 12. doi: 10.1001/jamapediatrics.2018.3619. [Epub ahead of print] PubMed PMID: 30419138.
- Auger KA, Shah SS, Tubbs-Cooley HL et al. Effects of a 1-Time Nurse-Led Telephone Call After Pediatric Discharge: The H2O II Randomized Clinical Trial. JAMA Pediatr. 2018 Sep 1;172(9):e181482. doi: 10.1001/jamapediatrics.2018.1482. Epub 2018 Sep 4. PubMed PMID: 30039161; PubMed Central PMCID: PMC6143054.
- Auger KA, Simmons JM, Tubbs-Cooley HL et al. Postdischarge Nurse Home Visits and Reuse: The Hospital to Home Outcomes (H2O) Trial. Pediatrics. 2018 Jul;142(1). pii: e20173919. doi:10.1542/peds.2017-3919. PubMed PMID: 29934295.
- Tubbs-Cooley HL, Mara CA, Carle AC, Gurses AP. The NASA Task Load Index as a measure of overall workload among neonatal, paediatric and adult intensive care nurses. Intensive Crit Care Nurs. 2018 Jun;46:64-69. doi:10.1016/j.iccn.2018.01.004. Epub 2018 Feb 12. PubMed PMID: 29449130.
- Melton KR, Ni Y, Tubbs-Cooley HL, Walsh KE. Using Health Information Technology to Improve Safety in Neonatal Care: A Systematic Review of the Literature. Clin Perinatol. 2017 Sep;44(3):583-616. doi: 10.1016/j.clp.2017.04.003. Review. PubMed PMID: 28802341.
- Tubbs-Cooley HL, Gurses AP. Missed Nursing Care: Understanding and Improving Nursing Care Quality in Pediatrics. Hosp Pediatr. 2017 Jul;7(7):424-426. doi: 10.1542/hpeds.2017-0083. Epub 2017 Jun 13. PubMed PMID: 28611145.
- Tubbs-Cooley HL, Pickler RH, Mara CA et al. Hospital Magnet® Designation and Missed Nursing Care in Neonatal Intensive Care Units. J Pediatr Nurs. 2017 May - Jun;34:5-9. doi: 10.1016/j.pedn.2016.12.004. Epub 2016 Dec 9. PubMed PMID: 27955957.
- Tubbs-Cooley HL, Pickler RH, Younger JB, Mark BA. A descriptive study of nurse-reported missed care in neonatal intensive care units. J Adv Nurs. 2015 Apr;71(4):813-24. doi: 10.1111/jan.12578. Epub 2014 Nov 27. PubMed PMID: 25430513.
- Tubbs-Cooley HL, Pickler RH, Meinzen-Derr JK. Missed oral feeding opportunities and preterm infants' time to achieve full oral feedings and neonatal intensive care unit discharge. Am J Perinatol. 2015 Jan;32(1):1-8. doi: 10.1055/s-0034-1372426. Epub 2014 Mar 28. PubMed PMID: 24683073.
- Tubbs-Cooley HL, Cimiotti JP, Silber JH et al. An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions. BMJ Qual Saf. 2013 Sep;22(9):735-42. doi: 10.1136/bmjqs-2012-001610. Epub 2013 May 7. PubMed PMID: 23657609; PubMed Central PMCID: PMC3756461.
- Funded Research Grants
- 1R21HD084863-01A1 Tubbs Cooley, HL (PI) 07/01/16 - 06/30/19
Systems Analysis of Guideline Adherence in Neonatal Intensive Care
Role: Principal Investigator
- No grant # Hutzel-Dunham, E. (PI) 07/01/18 – 06/30/19
Cincinnati Children’s Hospital Medical Center
Effects of Telehealth vs Telephone Triage in Pediatric Primary Care
- IHS-1306-00811 Shah, SS (PI) 02/01/14 – 06/30/18
Patient-Centered Outcomes Research Institute (PCORI)
Improving Post-Discharge Outcomes by Facilitating Family-Centered Transitions from Hospital to Home
- ANF SPR115707 Tubbs Cooley, HL (PI) 09/01/15 - 08/31/16
American Nurses Foundation
Nurse Certification and Infant Outcomes in Neonatal Intensive Care
Role: Principal Investigator
- 1R21HD084863-01A1 Tubbs Cooley, HL (PI) 07/01/16 - 06/30/19
- Degree Certifications
- Post-doctoral fellowship, Cincinnati Children’s Hospital Medical Center, 2013
- PhD, University of Pennsylvania, 2010
- MS, University of Pennsylvania, 2006
- BS, Western Michigan University, 2003
- Fellow, American Academy of Nursing, 2018
- Finalist, March of Dimes Ohio Nurse of the Year (Research Category), 2018
- Scholar & Grantee, American Nurses Foundation, 2015
- Council for the Advancement of Nursing Science Brilliant New Investigator Award, 2014
- Inaugural recipient, Cincinnati Children’s Research Scholars in Patient Services Award, 2012
- AcademyHealth Interdisciplinary Research Group on Nursing Issues New Investigator Award, 2011
- Outstanding Alumni Award, Western Michigan University College of Health and Human Services, 2010
- Professional Activities
- Peer reviewer, National Institutes of Health, 2017 – present
- Peer reviewer, American Nurses Foundation Nursing Research Grant program, 2018 – 2020
- Editorial board, Hospital Pediatrics, 2018-2020
- Membership committee, AcademyHealth, 2018-2020
The need for human touch is universal among critical care patients and is an important component of the nurse–patient relationship. However, multiple barriers to human touch exist in the critical care environment. With little research to guide practice, we argue for the importance of human touch in the provision of holistic nursing care.
The five-year, $3.13 million grant will deploy social-assistive robots at Ohio Living Westminster-Thurber and Chapel Hill Community in Canal Fulton near Canton for an eight-week trial. The study is aimed at curbing loneliness and apathy in older adults, especially for those with dementia.