Johns Hopkins Nursing Research News--May-June 2013

Promoting Heart Health in Vulnerable Populations. Heart health messages and interventions simply don’t resonate for every traditionally underserved group. In the Journal of Cardiovascular Nursing, Johns Hopkins University School of Nursing (JHUSON) researchers Benita Walton-Moss, FNP-BC, DNS; Sarah L. Szanton, PhD, RN CRNP; and recent doctoral graduates Laura Samuel, RN, FNP; Yvonne Commodore-Mensah, RN, BSN, and Tam H. Nguyen, RN, MSN/MPH, report on the results of an extensive literature review to tease out the most promising ways to promote more heart-healthy behavior among the most vulnerable: people of limited income, education, and English skills. While general heart health education was the most common intervention, the most promising emphasized blood pressure—an understandable, measurable risk factor. In contrast, behavior change like smoking cessation and following a proper diet were among the most challenging to achieve. [“Community-based health interventions in vulnerable populations: A systematic review,” Published online on April 22, 2013, DOI: 10.1097/JCN.0b013e31828e2995]

Abusers’ Career Can Suffer. A male perpetrator of intimate partner violence, so intent on controlling a woman that he misses work or uses company time or equipment to harass her, can not only harm her ability to get or hold a job but can sabotage his own employment standing. Professor Nancy Glass, PhD, MPH, RN, and colleagues identify five types of work-related, intimate partner violence (IPV) by abusive men—low-level tactics; job interference; job interference with threatened or actual violence; extreme abuse without jealousy; and extreme abuse—and look at how demographics like race/ethnicity, education, and income factor into the types of work-related IPV. By further isolating different “clusters” or patterns of abusive behaviors, the authors hope to “inform the development of work-related IPV screening, training, and prevention programs in the workplace that are based in culturally and linguistically competent strategies.” [“Patterns of work-related intimate partner violence and job performance among abusive men,” Journal of Interpersonal Violence. Published online on May 21, 2013, DOI: 10.1177/0886260513488681.] Caregiving: It’s About Readiness. Caring for a family member with dementia can be a challenge, particularly when it comes to managing difficult behaviors like rejecting help, agitation, repetitive questions, wandering or sleeplessness. Some caregivers, according to a study by Laura N. Gitlin, PhD, and a colleague, may not be ready to take action to better manage or modify these behavioral challenges without resorting to medication. The authors found that readiness can be limited by factors like their own emotional and financial states, and the severity of their family member’s symptoms. But that same readiness can be modified by ensuring caregivers have the tools and skills to help change the social and physical environments for a partner or parent with dementia. Gitlin says, “By understanding a caregiver’s readiness and the factors associated with it, we glean important clues about that person’s ability to use [non-medication] strategies in daily dementia care.” [“Factors associated with caregiver readiness to use nonpharmacological strategies to manage dementia-related behavioral symptoms,” International Journal of Geriatric Psychiatry. Published online on May 7, 2013, DOI: 10.1002/gps.3979. ] Bridging the Classroom-to-Bedside Gap. A team of JHUSON faculty, Pamela R. Jeffries, PhD, RN; Linda Rose, PhD, RN; Anne E. Belcher, PhD, RN; Betty T. Jordan, DNSc, RNC; Jo M. Walrath, PhD, RN; Linda Gerson, PhD, RN; program staff Jo Fava Hochuli, BSN, RN, and clinical nursing colleagues from the Johns Hopkins Hospital system created a mechanism to help resolve an identified gap between nursing student preparation and readiness for actual practice. In the Journal of Professional Nursing, they describe a clinical/academic practice partnership at JHUSON that has created nursing unit-type clinical experiences that immerse students in mentored nursing practice. According to Jeffries, “Linking each student, one-to-one, with a clinical nurse preceptor enhances students’ clinical experiences, builds preceptor leadership and teaching experience, and produces graduates with improved practice readiness.” [“A clinical academic practice partnership: A clinical education redesign,” May/June 2013]

Rare Good News on HIV-TB. In South Africa, comorbid HIV and drug-resistant tuberculosis have reached pandemic status. The dual diagnosis complicates the treatment of each. Fortunately, according to assistant professor Jason Farley, PhD, MPH, CRNP; and former JHUSON student Jeanne Garcia Davis, RN, MSN/MPH, and colleagues, HIV status alone does not appear to increase the risk for severe reactions to often-toxic drugs needed by patients with multidrug-resistant tuberculosis. Nonetheless, better monitoring and evaluations for adverse drug reactions by nurses and elsewhere in the health system remain essential to prevent life-threatening complications, regardless of HIV status. [“Serious treatment related adverse drug reactions amongst anti-retroviral naïve MDR-TB patients,” PLOS One, April 2013.]

In Other Nursing Research News. Doctoral candidate Katia Garcia Reinert, MSN, CRNP, and a colleague propose separate definitions of “spirituality,” one for use in clinical care and another for research on spirituality and mental health outcomes. [“Re-examining definitions of spirituality in nursing research,” Journal of Advanced Nursing, published online: April 18, 2013, DOI: 10.1111/jan.12152.] In a heads-up for clinicians, associate professor Elizabeth Sloand, PhD, PNP-BC, and a colleague discuss hallmark distinctions between childhood Kawasaki syndrome and streptococcal scarlet fever to help clinicians make rapid, accurate diagnoses that lower the risk for heart complications. [“Kawasaki syndrome and streptococcal scarlet fever: A clinical review,” Journal for Nurse Practitioners, May 2013.] In a case study in the Journal of Pediatric Nursing (May 2013), Sloand and Vanessa B. Waldrep, MSN/MPH, CPNP, discuss ways to make sense of often ambiguous symptoms of complicated pneumonia before complications arise. [“A case study of pediatric pneumonia with empyema.”] In two separate publications, professor Douglas A. Granger, PhD, and others examine stress responses related to young couples’ interpersonal conflict and to roles in a competitive friendship group. [“Refining the multisystem view of the stress response: Coordination among cortisol, alpha-amylase, and subjective stress in response to relationship conflict,” Physiology and Behavior. Published online on May 18, 2013, DOI: 10.1016/j.physbeh.2013.05.019; “Friendship network position and salivary cortisol levels,” Social Neuroscience. Published online on May 18, 2013 DOI:10.1080/17470919.2013.795500.]