Faculty

Daniel David headshot

Daniel David

PhD RN

Assistant Professor

1 212 992 5930

433 First Avenue
Room 422
New York, NY 10010
United States

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Professional overview

Daniel David, RN, PhD, is an assistant professor at NYU Rory Meyers College of Nursing and National Palliative Care Center Kornfeld Scholar. His research investigates older adults and their informal caregivers in the context of serious illness. He is particularly interested in technology-based interventions that improve caregiving, communication, palliative care, and advance care planning.

David is the principal investigator of the PC-CRAFT Assisted Living Project (Palliative Care – Connecting Residents And Family through Technology), which uses video technology to support palliative care consultation between providers, residents of assisted living, and their informal caregivers.

Prior to joining the faculty at NYU, David was an adjunct assistant professor in the Department of Community Health Systems at the University of California, San Francisco (UCSF) School of Nursing and a postdoctoral fellow in the VA Quality Scholar Program in the UCSF Division of Geriatrics.

David received his PhD in nursing from Northeastern University, MS from the University of Colorado, and BSN from the University of Virginia.

Education

PhD - Northeastern University
BSN - University of Virginia
MS - University of Colorado

Specialties

Gerontology
Palliative care

Professional membership

American Geriatrics Society
Gerontological Society of America
Hospice and Palliative Nurses Association
Palliative Care Research Cooperative
Sigma Theta Tau

Honors and awards

Faculty Honors Awards

Junior Investigator, Palliative Care Research Consortium (2018)
VA Quality Scholar, VA Medical Center, San Francisco (2018)
Scholarship, End of Life Nursing Education Consortium (2017)
Sigma Theta Tau, Scholar Research Award, Northeastern University (2016)
Kaneb Foundation Research Award, Regis College (2015)
Scholar, Summer Genetics Institute, NINR, National Institute of Health (2014)
Scholar, Jonas Center for Nursing Excellence (2014)
Sigma Theta Tau, Rising Star Award, Northeastern University (2013)
Sigma Theta Tau, Beta Kappa (2004), Gamma Epsilon Chapter (2013)
Distinguished Nursing Student Award, University of Virginia (2005)
Raven Society, University of Virginia (2005)

Publications

Publications

Anxious, Depressed, and Planning for the Future: Advance Care Planning in Diverse Older Adults

McMahan, R. D., Barnes, D. E., Ritchie, C. S., Jin, C., Shi, Y., David, D., Walker, E. J., Tang, V. L., & Sudore, R. L. (2020). Journal of the American Geriatrics Society. 10.1111/jgs.16754
Abstract
OBJECTIVES: To determine whether depression and anxiety are associated with advance care planning (ACP) engagement or values concerning future medical care. DESIGN: Cross-sectional. PARTICIPANTS: English- and Spanish-speaking patients, aged 55 years and older, from a San Francisco, CA, county hospital. MEASURES: Depression was measured by the Patient Health Questionnaire 8-item scale, and anxiety was measured by the Generalized Anxiety Disorder 7-item scale, using standardized cutoffs of 10 or more for moderate-to-severe symptoms. ACP engagement was measured using validated surveys of ACP behavior change (e.g., self-efficacy and readiness; mean five-point Likert score) and ACP actions (e.g., ask, discuss, and document wishes; 0- to 25-point scale), with higher scores representing higher engagement. In addition, we asked a question about valuing life extension (“some health situations would make life not worth living”). We used adjusted linear and logistic regression. RESULTS: Mean age of 986 participants was 63 years, 81% were non-White, 39% had limited health literacy, 45% were Spanish speaking, 13% had depression, and 10% had anxiety. After adjustment for demographic and health status variables, participants who were depressed versus not depressed had higher ACP behavior change scores (0.2 points; 95% confidence interval (CI) = 0.06–0.38; P =.007), higher ACP action scores (1.5 points; 95% CI = 0.51–2.57; P =.003), and higher odds of not valuing life extension (odds ratio (OR) = 2.5; 95% CI = 1.5–4.3; P <.001). Results were similar in participants with versus without anxiety (ACP behavior change: 0.2 points; 95% CI = 0.05–0.40; P =.01; ACP action scores: 1.2 points; 95% CI = 0.14–2.32; P =.028; odds of not valuing life extension: OR = 2.3; 95% CI = 1.3–3.9; P =.004). CONCLUSION: Depression and anxiety were associated with greater ACP engagement and not valuing life extension. Although the direction of association between ACP engagement and values with anxiety and depression cannot be determined in this cross-sectional study, these conditions may influence ACP preferences. Future studies should assess whether changes in anxiety or depression affect ACP preferences over time.

“They Don’t Trust Us”: The Influence of Perceptions of Inadequate Nursing Home Care on Emergency Department Transfers and the Potential Role for Telehealth

Stephens, C. E., Halifax, E., David, D., Bui, N., Lee, S. J., Shim, J., & Ritchie, C. S. (2020). Clinical Nursing Research, 29(3), 157-168. 10.1177/1054773819835015
Abstract
In this descriptive, qualitative study, we conducted eight focus groups with diverse informal and formal caregivers to explore their experiences/challenges with nursing home (NH) to emergency department (ED) transfers and whether telehealth might be able to mitigate some of those concerns. Interviews were transcribed and analyzed using a grounded theory approach. Transfers were commonly viewed as being influenced by a perceived lack of trust in NH care/capabilities and driven by four main factors: questioning the quality of NH nurses’ assessments, perceptions that physicians were absent from the NH, misunderstandings of the capabilities of NHs and EDs, and perceptions that responses to medical needs were inadequate. Participants believed technology could provide “the power of the visual” permitting virtual assessment for the off-site physician, validation of nursing assessment, “real time” assurance to residents and families, better goals of care discussions with multiple parties in different locations, and family ability to say goodbye.

The quality of family relationships, diabetes self-care, and health outcomes in older adults

David, D., Dalton, J., Magny-Normilus, C., Brain, M. M., Linster, T., & Lee, S. J. (2019). Diabetes Spectrum, 32(2), 132-138. 10.2337/ds18-0039
Abstract
The purpose of the study was to investigate the relationship between family support, diabetes self-care, and health outcomes in older, community-dwelling adults. Using the theoretical framework of the Self-Care of Chronic Illness Theory and a cross-sectional design, 60 participants completed questionnaires related to diabetes self-care activities of the individual, supportive and nonsupportive diabetes behaviors of the family, and the quality of family relations. Participants indicated that diabetes self-care behaviors were performed frequently, with exercise reported as the least-performed behavior. Multiple regression analyses revealed that the quality of family relations as measured by the Family Relationship Index contributed significantly (26.0%) to the variability in A1C levels (R2 = 0.260, F(1, 40) = 14.037, P = 0.001). Neither family supportive behavior nor the quality of family relations contributed to diabetes self-care. It is recommended that health care providers include family members to assess diabetes family support and family relationships in the care of older adults with diabetes.

Rehabbed to Death: Breaking the Cycle

Flint, L. A., David, D., Lynn, J., & Smith, A. K. (2019). Journal of the American Geriatrics Society, 67(11), 2398-2401. 10.1111/jgs.16128
Abstract
Many older adults transfer from the hospital to a post-acute care (PAC) facility and back to the hospital in the final phase of life. This phenomenon, which we have dubbed “Rehabbing to death,” is emblematic of how our healthcare system does not meet the needs of older adults and their families. Policy has driven practice in this area including seemingly benign habits such as calling PAC facilities “rehab.” We advocate for practice changes: (1) calling PAC “after-hospital transitional care,” rather than “rehab”; (2) adopting a serious illness communication model when discussing new care needs at the end of a hospitalization; and (3) policies that incentivize comprehensive care planning for older adults across all settings and provide broad support and training for caregivers. In realigning health and social policies to meet the needs of older adults and their caregivers, fewer patients will be rehabbed to death, and more will receive care consistent with their preferences and priorities. J Am Geriatr Soc 67:2398–2401, 2019.

Patient Activation: A Key Component of Successful Advance Care Planning

David, D., Barnes, D. E., McMahan, R. D., Shi, Y., Katen, M. T., & Sudore, R. L. (2018). Journal of Palliative Medicine, 21(12), 1778-1782. 10.1089/jpm.2018.0096
Abstract
Background: Patient activation - or knowledge, confidence, and skill managing overall health - is associated with improved health behaviors such as exercise; it is unknown whether it is associated with advance care planning (ACP). Objective: To determine whether patient activation is associated with ACP. Design: This is a cross-sectional study. Setting/Subjects: A total of 414 veterans (≥60 years) with serious and chronic illness enrolled in an ACP trial. Measures: Patient characteristics and self-report surveys included the validated 13-item patient activation measure (PAM, five-point Likert) (e.g., "Taking an active role in your own healthcare is the most important factor⋯") categorized into four levels (e.g., Level 1: "disengaged and overwhelmed" to Level 4: "maintaining behaviors"). ACP was measured with the ACP Engagement Survey including 57-item process scores (i.e., knowledge, contemplation, self-efficacy, readiness, 5-point Likert scale) and 25-item action scores (i.e., surrogate designation, yes/no items). Associations were determined with linear regression. Results: Participants were 71.1 ± 7.8 years of age, 43% were non-white, 9% were women, and 20% had limited health literacy. Higher PAM levels were associated with higher finances, having adult children, lower comorbidity, and more social support (p < 0.05). After adjusting for these characteristics, higher PAM (Level 4 vs. Level 1) was associated with higher ACP engagement (ACP process scores, 2.8 ± 0.7 vs. 3.8 ± 0.7 and action scores 9.7 ± 4.4 vs. 15.1 ± 6.0, p < 0.001). Conclusions: Higher patient activation to manage one's overall healthcare is associated with higher engagement in ACP. Interventions designed to foster general patient activation and self-efficacy to engage in health behaviors and disease management may also improve engagement in the ACP process.

Self-care in Heart Failure Hospital Discharge Instructions—Differences Between Nurse Practitioner and Physician Providers

David, D., Howard, E., Dalton, J., & Britting, L. (2018). Journal for Nurse Practitioners, 14(1), 18-25. 10.1016/j.nurpra.2017.09.013
Abstract
Patients with heart failure (HF) are at risk for frequent readmission potentially due to self-care deficits. Medical doctors (MDs) and nurse practitioners (NPs) both provide discharge instructions. However, each type of provider may emphasize different elements of care. The aim of this study was to analyze and compare the content of the documentation of 50 discharge instructions of heart failure patients written by NPs and MDs. Compared with MDs, NPs placed greater emphasis on symptom identification, and were more likely to advise and schedule follow-up appointments with primary care and cardiology providers rather than advising an appointment was needed without scheduling one.

Behavioral Interventions in Six Dimensions of Wellness That Protect the Cognitive Health of Community-Dwelling Older Adults: A Systematic Review

Strout, K. A., David, D. J., Dyer, E. J., Gray, R. C., Robnett, R. H., & Howard, E. P. (2016). Journal of the American Geriatrics Society, 64(5), 944-958. 10.1111/jgs.14129
Abstract
Objectives: To systematically identify, appraise, and summarize research on the effects of behavioral interventions to prevent cognitive decline in community-dwelling older adults using a holistic wellness framework. Design: Systematic review of randomized controlled trials that tested the effectiveness of behavioral interventions within each of the six dimensions of wellness: occupational, social, intellectual, physical, emotional and spiritual. Databases searched included PubMed MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, ALOIS, and The Grey Literature Report through July 1, 2014. Setting: Community. Participants: Individuals aged 60 and older (N = 6,254). Measurements: Consolidated Standards of Reporting Trials Checklist. Results: Eighteen studies met the inclusion criteria. Interventions in the physical dimension of wellness were most common (11 studies); interventions in the spiritual dimension were least common (0 studies). Fifty-nine different measures were used to measure multiple cognitive domains, with memory being the most commonly measured (17 studies) and language being the least commonly measured (5 studies). Fifty percent of the interventions examined in the 18 studies demonstrated statistically significant outcomes on at least one cognitive measure. Interventions in the intellectual dimension that examined cognitively stimulating activities using pen and paper or a computer represented the greatest percentage of statistically significant outcomes. Conclusion: Intellectual and physical interventions were most studied, with varied results. Future research is needed using more-consistent methods to measure cognition. Researchers should include the National Institutes of Health Toolbox Cognition Battery among measurement tools to facilitate effective data harmonization, pooling, and comparison.

Implementation analysis of a nurse-led observation unit

Murphy, G., Willetts, K., Duphiney, L., Dalton, J., & David, D. (2016). Journal of Nursing Administration, 46(4), 187-192. 10.1097/NNA.0000000000000324
Abstract
OBJECTIVE: This implementation analysis of a nurseled observation unit describes the development process and analyzes patients- characteristics, patient satisfaction, and provider perceptions. BACKGROUND: A nurse-led observation unit was developed to createmore inpatient bed capacity and place patients in the clinical area best suited to their needs. METHODS: Descriptive statistics and content analysis were used for analysis. RESULTS: The average length of stay of 467 patients was 1.1 days; 68.1%(n = 318) were female. Elective surgery was the most frequent reason for admission. All of the patients rated the observation unit patient feedback survey factors favorably except for noise. All healthcare providers (n = 64) reported that they communicated well with each other and had resources to provide quality care but rated the environment less favorably. CONCLUSIONS: A nurse-led observation unit was found to be an effective and efficient approach to providing postoperative and postprocedure care, which was generally well received by patients and healthcare providers.

Strategies to reduce the risk of falling: Cohort study analysis with 1-year follow-up in community dwelling older adults

Morris, J. N., Howard, E. P., Steel, K., Berg, K., Tchalla, A., Munankarmi, A., & David, D. (2016). BMC Geriatrics, 16(1). 10.1186/s12877-016-0267-5
Abstract
Background: According to the CDC, falls rank among the leading causes of accidental death in the United States, resulting in significant health care costs annually. In this paper we present information about everyday lifestyle decisions of the older adult that may help reduce the risk of falling. We pursued two lines of inquiry: first, we identify and then test known mutable fall risk factors and ask how the resolution of such problems correlates with changes in fall rates. Second, we identify a series of everyday lifestyle options that persons may follow and then ask, does such engagement (e.g., engagement in exercise programs) lessen the older adult's risk of falling and if it does, will the relationship hold as the count of risk factors increases? Methods: Using a secondary analysis of lifestyle choices and risk changes that may explain fall rates over one year, we drew on a data set of 13,623 community residing elders in independent housing sites from 24 US states. All older adults were assessed at baseline, and a subset assessed one year later (n = 4,563) using two interRAI tools: the interRAI Community Health Assessment and interRAI Wellness Assessment. Results: For the vast majority of risk measures, problem resolution is followed by lower rate of falls. This is true for physical measures such as doing housework, meal preparation, unsteady gait, transferring, and dressing the lower body. Similarly, this pattern is observed for clinical measures such as depression, memory, vision, dizziness, and fatigue. Among the older adults who had a falls risk at the baseline assessment, about 20 % improve, that is, they had a decreased falls rate when the problem risk improved. This outcome suggests that improvement of physical or clinical states potentially may result in a decreased falls rate. Additionally, physical exercise and cognitive activities are associated with a lower rate of falls. Conclusions: The resolution of risk problems and physical and cognitive lifestyle choices are related to lower fall rates in elders in the community. The results presented here point to specific areas, that when targeted, may reduce the risk of falls. In addition, when there is problem resolution for specific clinical conditions, a decreased risk for falls also may occur.

Using Kotter's change model for implementing bedside handoff

Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Journal of Nursing Care Quality, 31(4), 304-309. 10.1097/NCQ.0000000000000212