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Posted: 11/9/2009

Mom's Mood Matters in Childs Asthma Care
Depression is significant among mothers of chronically ill children.  And, when mom is depressed, she may not attend as carefully as she should to that child's treatment needs.  With over 9 million asthmatic children in the U.S. today, the public health implications are significant.  Johns Hopkins University School of Nursing (JHUSON) associate professor Joan Kub, PhD, APR, BC, and colleagues are exploring factors implicated in depression among these moms in the first place.  In "Life events, chronic stressors, and depressive symptoms in low-income urban mothers with asthmatic children," Public Health Nursing [July/August 2009], they highlight the role poverty, unemployment, limited education, and the stress of caring for a child with asthma play in maternal depression.  Kub notes, "These findings remind nurses and other health professionals that it is as important to be aware of a mother's depression as it is to help her manage her child's asthma or other chronic illness."

Transmitting Knowledge and Practice, not TB
Catchy public service announcements are helping prevent disease transmission by reminding people to cough and sneeze into their sleeves and wash their hands.  That's a good start.  However, health care professionals could benefit from a refresher on the rights and wrongs of infection control, too, according to PhD candidate Carrie Tudor, MPH, RN, and assistant professor Jason Farley, PhD, MPH, CRNP.   In a presentation at the First African Conference on Infection Prevention and Control, they report early findings that, despite high rates of drug-resistant tuberculosis (TB) in South Africa, nurses and other health providers do not routinely engage in appropriate infection control practices to safeguard against the spread of the disease.  Moreover, regular health provider TB screening is not widely available.  While final study results are under review, Farley notes, "The broader implications of these findings cannot be lost on the global public health community.  With the growth of highly resistant infections and drug-resistant tuberculosis, application of sound infection control practices should be high on everyone's list of activities."

Breaking Through Health Disparities
Many racial and ethnic groups face formidable barriers to needed health care services, from prevention to chronic care.  Hopkins nurse researchers are working to help bring those barriers down.  Writing in "A meta-analysis of interventions to promote mammography among ethnic minority women" [Nursing Research, July/August 2009], associate professor Hae-Ra Han, PhD, RN, professor Miyong Kim, PhD, RN, FAAN, and post-doctoral students Jong-Eun Lee, PhD, RN, Jiyun Kim, PhD, RN, and Heejung Song, PhD, delineate keys to improved use of mammography by minority women, among them outreach by trusted community partners and locally available, affordable mammography screening for breast cancer.  The same team found that recent Korean American emigres with high blood pressure have limited access to care due primarily to economic factors (e.g., no health insurance), competing priorities that trump personal health, and cultural and language barriers.  Culturally sensitive interventions can help overcome these factors ["Does access to care still affect health care utilization by immigrants?" Journal of Immigrant and Minority Health, August 2009]. In other research, Kelly Bower, MSN, MPH, RN, and colleagues describe how racial disparities in diabetes prevalence disappear when African Americans and whites live in similar social and economic environments.  They found that rather than race itself, issues such as poverty and segregation may place people at risk for diabetes without regard to racial or ethnic background ["Environmental and socioeconomic factors as contributors to racial disparities in diabetes prevalence," Journal of General Internal Medicine, August 2009]. 

What to Say,When to Say It
In two recent articles, bioethics and palliative care expert Cynda Rushton, PhD, RN, offers clinicians specific ways to work through often difficult communications with patients and families in the critical care setting. In a column "Asking ourselves and others the right questions," [AACN Advanced Critical Care, July-September 2009], associate professor Rushton suggests strategies such as active listening, humility, proactivity and mindfulness about ones own judgments and feelings to change confrontation to collaboration when working with families of patients with serious medical conditions.  She and colleagues suggest a framework to discern when silence can be therapeutic and healing presence rather than a "technique" that may undermine communication and relationships in difficult clinical conversations ["Compassionate silence in the patient-clinician encounter," Journal of Palliative Medicine, online, August 2009]. In a third article, "Distress and burnout among genetic service providers" Rushton and others examine underlying reasons for and suggest possible ways to reduce dissatisfaction and burnout among nurses and others providing genetic counseling and similar services [Genetics in Medicine, July 2009]. 

Preventing Intimate Partner Violence (IPV) and its Repercussions
IPV, domestic violence, is hard to prevent, but professor Jacquelyn Campbell, PhD, RN, FAAN, and others have a program with promise to do just that for young new mothers, a group at high risk for IPV.  They have built a three-part IPV intervention into a home care program for pregnant, low-income, young women that promotes healthy pregnancies, mothers, and children.   The specialized program includes a structured assessment, curriculum, and intervention for those experiencing IPV ["A multicomponent intervention to prevent partner violence within an existing service intervention," Professional Psychology: Research and Practice, June 2009].  In other IPV-related research, associate professor Nancy Glass, PhD, MPH, RN, FAAN, explores why many female victims of IPV appear less aware of or knowledgeable about the availability of emergency contraception to avoid IPV-related pregnancy.  In "Knowledge, awareness, perceptions, and use of emergency contraceptives among survivors of intimate partner violence," she outlines ways in which nurses can help educate about emergency contraception with accuracy and sensitivity [Obstetrics and Gynecology International, online August 2009]. 

In Other JHUSON Research News
Professor Campbell, postdoctoral student Jamila Stockman, PhD, MPH, RN, and others examine ways sexual coercion may result in risky behaviors that increase risks for HIV risk ["Sexual violence and HIV risk behaviors among a nationally representative sample of heterosexual American women," Journal of Acquired Immune Deficiency Syndrome, September 2009].  Associate professor Cheryl R. Dennison, PhD, RN ANP, continues her progress in prevention column ["Reforming cardiovascular care," Journal of Cardiovascular Nursing, September/October 2009], exploring the possible impact of growing attention to cost and quality on patient cardiovascular health outcomes.  In "Thoughtful reading for thoughtful leaders," Journal of Nursing Administration, September 2009, professor Maryann F. Fralic, DrPH, RN, FAAN, describes six volumes to help nurse managers hone their leadership skills.  Assistant professor Sarah L. Szanton, PhD, CRNP, professor Jerilyn K. Allen, ScD, RN, and colleagues have found that, without regard to race or ethnicity, both low education and poverty respectively triple and double a woman's risk of late life frailty ["Socioeconomic status is associated with frailty," Journal of Epidemiology and Community Health, August 2009].