Johns Hopkins Nursing Research News—August 2012

Newswise — Better Behavior, More Success through Positive Parenting. Improved parenting skills—particularly how parents treat their preschool children—can help prevent problematic behavior in school and with peers, and affect children’s learning and long-term success, according to Johns Hopkins University School of Nursing (JHUSON) professor Deborah Gross, DNSc, RN, FAAN. In an assessment of the Chicago Parent Program (CPP), a 12-week parenting program for low-income, urban-Latino and African-American parents of young children in childcare centers, Gross and colleagues found that, when compared with a control group, school and home problematic behavior was reduced among children of participating parents. Generally, positive effects were sustained for up to a year. According to Gross, “Parenting programs like CPP are an important tool for agencies serving low-income families with preschool children… its cost is small compared with its potential benefit in improved family life and school performance.” [“The Chicago Parent Program: Comparing 1-year outcomes for African-American and Latino parents of young children,” Research in Nursing and Health, online, May 24, 2012.] Gross and Johns Hopkins Hospital nurse specialists Karin Taylor, MS, RN, PMHCNS-BC, and Kristine Mammen, MSN, A, RN-BC, published additional research in “Characteristics of patients with histories of multiple seclusion and restraint events during a single psychiatric hospitalization.” [Journal of the American Psychiatric Nurses Association, May/June 2012.]

When Knowledge May Not Be Sufficient. Self-care, a challenge for many with heart failure, is too often not included in the education of patients with both heart failure and mild cognitive issues such as problem solving, concentrating, and remembering. Working to change that dynamic are Johns Hopkins Hospital (JHH) nurse and recent doctoral graduate Karen K. Davis, PhD, RN; JHUSON associate professor Cheryl R. Dennison Himmefarb, PhD, RN, ANP, FAAN, and professor Jerilyn Allen, ScD, RN, FAAN, and colleagues who have developed and tested an in-hospital, education program for these doubly challenged patients. Although their intent was to improve self-care—thus reducing hospital readmissions, lowering health care costs, and potentially improving quality of life—their findings showed that while heart failure knowledge improved at 30 days after discharge, patient readmissions did not decrease. Davis suggests, “Heart failure patients with mild cognitive impairment may need more intense at-home follow-up and ongoing self-care education to lower readmission rates.” [“Targeted intervention improves knowledge but not self-care or readmissions in heart failure patients with mild cognitive impairment,” European Journal of Heart Failure, June 2012.]

Combining Technology and Schools to Boost Asthma Care. Asthma, affecting nearly 10% of U.S. children under age 18, can be well controlled with medications—if children use them. To improve use of preventive meds, JHU professor Arlene Butz, ScD, RN, MSN, joined other nursing colleagues to create, test, and refine the School-based Preventive Asthma Care Technology (SB-PACT) program that combines computer technology with in-school health staff. The well-received web-based intervention focused on high-risk, urban preschool and elementary school children in an upstate New York test community and was found to improve asthma care compliance. Butz says “This research shows SB-PACT’s promise as a preventive asthma care program that can improve children’s lives and help hold the line on health care costs.” [“Working toward a sustainable system of asthma care: Development of the school-based preventive asthma care technology (SB-PACT) trial,” Journal of Asthma, May 2012.]

Not Just Spitting in the Wind. Learning to manage stress is critical for nurses and other first responders working in combat environments to save lives of wounded soldiers. With a key element—spit—JHUSON professor Douglas A. Granger, PhD, postdoctoral fellow Dorothée Out, PhD, and colleagues are now identifying the triggers and modifiers of front-line stress among army nurses. Using a combat casualty simulation, the noninvasive collection of saliva (spit), and tests of stress response-related saliva components, they assessed nurses’ stress rates, their ability to make complex decisions, and stress recovery. Granger says, “By understanding the stress, being experienced, and having the tools to manage those stresses, nurses and others working as first responders or treating critically wounded patients can improve their performance under very challenging conditions.” [“Nature, correlates and consequences of stress-related biological reactivity and regulation in Army nurses during combat casualty simulation,” Psychoneuroendocrinology, June 2012.] In the same journal (July 2012), Granger, Out, and others also explore causes of daily fluctuations in the stress-related protein in saliva. [“Disentangling sources of individual differences in diurnal salivary alpha-amylase.”] Other recent articles published by Granger and Out include “Incorporating salivary biomarkers into nursing research” [Biological Research for Nursing, May 2012], with assistant professor Sarah L. Szanton, PhD, CRNP, and others, and “Focus on methodology, salivary bioscience and research on adolescence.” [Journal of Adolescence, August 2012.] In Other Nursing Research News — Parents should be warned that bed-sharing with their infants may be linked to sudden infant death according to assistant professor Sarah (Jodie) J.M. Shaefer, PhD, RN. [“Review finds that bed-sharing increases risk of sudden infant death syndrome” Evidence Based Nursing, May 2012.] She also co-edited Voices from the Community: Cross-cultural Expressions of Grief at the Loss of an Infant [American College of Obstetrics and Gynecology, May 2012.] Doctoral student Janna Stephens, RN, and professor Jerilyn Allen, ScD, RN, FAAN, found that text message or smartphone prompts may help patients lose weight and get active. [“Mobile phone interventions to increase physical activity and reduce weight: A systematic review, Journal of Cardiovascular Nursing, May 2012.] Assistant professor Nancy A. Hodgson, PhD, RN, and colleagues found that complementary therapies— reflexology and Swedish massage—can help lower cancer patients’ pain, depression, and stress. [“Reflexology vs. Swedish massage to reduce physiologic stress and pain and improve mood in nursing home residents with cancer: A pilot trial.” Evidence-Based Complementary and Alternative Medicine, online, June 2012.] Writing in the Journal of Cancer Education [online, July 2012] Hodgson and others explore needed cultural adaptations for effective cancer care programs [“Lessons learned in developing culturally adapted intervention for African-American families coping with parental cancer.”] In “What can I do? Recommendations for responding to issues identified by patient-reported outcomes assessments used in clinical practice,” Elizabeth Hughes, RN, BSN, CHPN, and colleagues suggest how clinicians can better respond to cancer patient-reported questionnaires about symptoms. [Journal of Supportive Oncology, July 2012.] Assistant professors Hayley Mark, PhD, MPH, RN; Nicole E. Warren, PhD, MPH, CNM; and Elizabeth T. Jordan, DNSc, MSN, RNC, FAAN and nursing student Jomarie Cruz, BA, present updated sexually transmitted disease management guidelines. [“What’s new in sexually transmitted infection management: Changes in the 2012 guidelines from the Centers for Disease Control and Prevention,” Journal of Midwifery and Women’s Health, May-June 2012.] Johns Hopkins University School of Medicine (JHUSOM) senior research nurse Sandra M. Swoboda, RN, MS, FCCM, and colleagues offer ways to improve palliative care and the healing environment of intensive care units in “Meeting standards of high-quality intensive care unit palliative care: Clinical performance and predictors,” [Journal of Critical Care Medicine, April 2012] and “Guidelines for intensive care unit design” [Critical Care Medicine, May 2012]. In A Human Factor Guide to Enhance EHR Usability of Critical User Interactions when Supporting Pediatric Patient Care, [National Institute of Standards and Technology, June 2012.], associate professor Patricia Abbott, PhD, RN, FACMI, FAAN, and colleagues craft a guide to improve EHR usability by pediatric clinicians.