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Posted: 11/10/2008

Best Practices Can Help Prevent Transmission of Drug-Resistant Bugs - Johns Hopkins University School of Nursing (JHUSON) faculty member Jason Farley, PhD, MPH, ARNP, is a man on a mission. His goal:  To identify, seek, and destroy potentially lethal, treatment-resistant infections in hospitals and in the community.  In "Epidemiology, clinical manifestations, and treatment options of skin and soft tissue infection caused by community-acquired methicillin-resistant Staphylococcus aureaus," a clinical overview published in the Journal of the American Academy of Nurse Practitioners, Farley observes that the spread of methicillin-resistant staphylococcus aureus (MRSA) is no longer a concern only in hospitals. It has become a complex community and public health concern about which clinicians, including nurse practitioners, must be increasingly cognizant. In a review of 40 years of research, Farley provides nurse practitioners and other clinicians a unique roadmap to understand, recognize, and potentially prevent transmission of MRSA as he highlights current thinking about MRSA risk factors, the skin and soft tissue infections hallmark of community-acquired MRSA, and the current best methods of diagnosis and treatment.

Farleys literature review also emphasizes the role clinical and surveillance research play in MRSA prevention, a focus on  prevention that has led him to undertake research to determine which  specific MRSA diagnostic tests can help identify resistant bugs more quickly and accurately. He and colleagues at the Johns Hopkins Hospital and JHU School of Medicine assessed the relative effectiveness of two rapid MRSA screening tools in correctional facilities as part of a larger study of MRSA nasal colonization among newly arrested men. Their findings, "Comparison of the BD GeneOhm Methicillin-Resistant Staphylococcus aureau PCR Assay to Culture by Use of BBL CHROMagar MRSA for Detection of MRSA in Nasal Surveillance Cultures from an At-Risk Community Population," published in the Journal of Clinical Microbiology, suggest that, in contrast to earlier reports, currently available rapid MRSA tests need to be more closely examined before they are used as screens to guide either infection control or clinical decisions.

Heads Up to ERs to Identify Those At Risk for Lethal Domestic Partner Violence - Emergency room nurses and doctors can save lives by being on the lookout for signs of attempted strangulation among women victims of intimate partner violence (IPV). Based on an analysis of medical examiner, police, and emergency room (ER) records spanning 11 cities over a 6-year period, attempted strangulation common injury suffered by female IPV victims was found to increase sevenfold the risk of becoming a subsequent homicide victim. In "Non-Fatal Strangulation is an Important Risk Factor for Homicide of Women," in the October 2008 issue of the Journal of Emergency Medicine, JHUSON nurse researchers Jacquelyn C. Campbell, PhD, RN; Nancy Glass, PhD, RN; and Phyllis W. Sharps, PhD, RN; and colleagues report that women "victims of completed or attempted homicide [by a partner] were far more likely to have a history of strangulation" compared to abused women in a control group. In fact, prior non-fatal strangulation was reported in 45% of attempted homicides of IPV victims and 43% of homicides. Because strangulation associated with IPV has been under-assessed in the clinical setting, the authors call not only for further research focused on this high-risk group of abused women, but also for ER nurses and physicians who are better skilled to recognize, document, and treat the soft tissue injuries associated with attempted strangulation. It is also important that they accurately document this potentially lethal act for possible future court action, and know how to appropriately refer the abused women to domestic violence services for an improved clinical response to high-risk abused women.

Discussing Medication "Rights" Helps Prevent Drug "Wrongs"- On average, one medication error occurs each day for each patient hospitalized in the U.S. That translates to 1.5 million preventable negative drug effects each year. These errors most often occur at the point of drug administration the last line of defense with responsibility falling squarely on nurses and the patients in their care.  JHUSON faculty members Jo M. Walrath, PhD, RN, and Linda E. Rose, PhD, RN, in The Medication Administration Process, published in the Journal of Nursing Care Quality, recommend ways in which nurses can better work with patients to strengthen their partnership to halt medication errors. In a descriptive, exploratory study the first to examine the role of hospitalized patients in the medication administration process Walrath and Rose found that, while aware of nurses role in the medication process, acute care patients vary widely in their understanding of and involvement in assuring the safety of their medication regimen. Nurses are well-versed in administering medications using the five "rights" (right drug, right patient, right dose, right route, and right time). By taking this process one step further verbalizing the five rights to the patient during drug administration, nurses can raise patients awareness and encourage their ongoing engagement in the process. Walrath and Rose agree that nurses need to really hear and act on their patients concerns about their medication regimens and continuously encourage participation. By adopting their outlined strategies, the authors posit that nurses are uniquely positioned as the safety net to catch medication errors before they become potential patient tragedies.

Lowering Blood Pressure for Heart Health: More Work Needed  - Affecting over 73 million Americans, high blood pressure, hypertension, increases the risk for heart attack, stroke and kidney disease. The introduction of evidence-based guidelines, new medications, and beneficial behavioral changes have given patients and clinicians tools to control blood pressure and lower cardiovascular risk. But the tools aren't being used widely or well, says JHUSON researcher Cheryl R. Dennison, PhD, RN, ANP. In "Raising the Bar to Lower Blood Pressure," published in the Journal of Cardiovascular Nursing, she warns against complacency, noting a significant gap between what is known about hypertension and what is being done to control it. Because the prevalence of hypertension is expected to rise as much as 25% by the year 2025, it not only puts millions more at risk but also represents what Dennison calls a national "public health imperative" for action. "We must raise the bar to lower blood pressure," she asserts. To that end, she urges patients, health care professionals and systems, and communities to join together to help lower blood pressure nationwide, and identifies specific steps - from screening to education, to ongoing monitoring and follow-up care - that each can take to reduce high blood pressure and its damaging health effects.

Birth Companions Program Promotes Nursing Touch in Technology Era - In a program unique to the Hopkins School of Nursing, students are given a body of skills to help them balance the human touch with today's increasingly high-tech health care environment. Now in its eleventh year, "Community Perspectives on the Childbearing Process" has offered 525 students the skills and opportunity to serve as doulas, birth companions, and provide informal emotional, physical and informational support to women in labor. Under the leadership of JHUSON faculty Elizabeth T. Jordan, DNSc, RNC, and Shirley E. Van Zandt, MS, MPH, CRNP, the program enables young nurses to work at the interface of the technology touch screen and the human touch in obstetrical nursing practice. Their recent article in the Journal of Professional Nursing, "Doula Care:  Nursing Students Gain Additional Skills to Define Their Professional Practice," describes the theory and practice underlying the birth companions program and its significant value to both patient and nurse. "We have found that, whether they continue to work as doulas or not, our students carry the patient-focused skills gained from the experience into their nursing practice," Van Zandt and Jordan concur. They also agree the curriculum warrants further replication and evaluation in other nurse training environments.