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Posted: 8/3/2009

Helping Patients "Get with the Program" to Better Manage Illness
People with high blood pressure or diabetes are urged to change their diet, quit drinking and smoking, and get more exercise, yet many find it hard to make these important changes to help keep them healthy. Researchers at the Johns Hopkins University School of Nursing (JHUSON) are exploring factors that may thwart or promote self-care by people with these illnesses. Writing in "Strategies for implementing and sustaining therapeutic lifestyle changes as part of hypertension management in African Americans" [Postgraduate Medicine, May 2009], Associate Professor Cheryl R. Dennison, PhD, RN, ANP and colleagues suggest answers to why - despite both awareness of and treatment for high blood pressure - fewer than one-third of African Americans with the condition undertake the lifestyle changes known to help control it.  Dennison and colleagues outline specific ways for health care providers to help patients be more receptive to adopting a heart-healthy lifestyle, such as encouraging small, ongoing steps toward change and making recommendations consistent with an individuals heritage, beliefs, and behaviors. "By working one-on-one and building individualized plans for patients, nurses have a major role to play in helping patients overcome barriers to heart-healthy living," says Dennison.
 
While diet also plays a role in controlling type 2 diabetes an illness affecting over 18 million people other health issues also are at play.  How those factors may interact to promote or complicate diabetes control can help save pain, suffering, and lives. According to Assistant Professor Deborah E. Jones, PhD, RN, "The connection of mind to body - depression to diabetes - is one that warrants closer attention in both research and diabetes treatment. In a study of 55 adults with type 2 diabetes seen at an inner city clinic, Jones and colleagues found that depression - even at low levels - is associated with poor self-care and diabetes management, particularly among women and younger people. While suggesting the need for further study, "Depression, quality of life, and glycemic control in individuals with type 2 diabetes," [Journal of the American Academy of Nurse Practitioners, April 2009] also emphasizes the importance of depression screening in improving the quality of life for many with type 2 diabetes.

Staying Current: Nursing Education on the Cutting Edge
In addition to disseminating new research findings, the nursing literature provides a forum for nurse educators to communicate new principles and best practices in clinical care far beyond the classroom walls. Serving as guest author and lead commentator in the April 2009 Johns Hopkins E-Neonatal Review, neonatal and pediatric nursing expert and Assistant Professor Mary Terhaar, DNSc, RN, helps update practicing nurses, nurse educators, and students on new skin care guidelines for premature infants. She highlights the body of research underlying practice guideline changes that promise to better protect the immature skin of preemies from potential infection often leading to longer hospital stays and physical discomfort. "Science changes practice," Terhaar says. "By writing and teaching about those changes, nurse educators help continuously update the fields capacity to meet the needs of patients of all ages."
 
Sometimes what needs to be taught cannot be learned in a classroom, in a journal, or even at the clinical bedside. That's where Associate Dean for Academic Affairs Pamela Jeffries, DNS, RN, FAAN, ANEF, enters the picture. A national expert in the use of new technology for experiential learning and nurse education, Jeffries is an unabashed advocate for the use of simulation to help nursing students problem solve in situations not routinely encountered in clinical settings. Simulation has come a long way from the plastic manikins on which millions practiced CPR; it is now the realm of high-tech robotics and web-based international collaborations, thanks in large measure to Jeffries. The March-April 2009 Nursing Education Perspectives focuses exclusively on the topic. In "Creating simulation communities of practice: An international perspective," she describes how nursing faculty from around the world created the virtual Simulation Innovation and Resource Center (SIRC), that provides worldwide access to web-based knowledge on the use of simulation in nursing education.  Jeffries' commentary in the same publication, "Dreams for the future of clinical simulation" explains how this technology can provide a safe environment for rich, often challenging, clinical experiences for students.  "Simulation isn't just the wave of the future," she says. "It's already here as a viable, vital part of nursing education."

Nursing in the Public Health: Intimate Partner Violence at Home; HIV/AIDS Abroad
HIV/AIDS and intimate partner violence can be lethal and each is burdened by silence and stigma. Yet, both are preventable. The challenges in preventing IPV and HIV/AIDS and in helping survivors, at home and abroad, have not been lost on Associate Professor Nancy Glass, PhD, MPH, RN. In "Leveraging the role of public health nursing in managing HIV/AIDS in Thailand: A Journey of international collaboration," [Collegian, April 2009], Glass describes an international collaboration among governments, academic institutions, and nursing educators to help reduce rates of HIV/AIDS transmission and death in Thailand, where the illness is the first or second leading killer of both women and men ages 15-44. The primary weapon:  Nurses, who represent nearly 60% of health care providers in Thailand. "It's a model with great potential for use in other countries," Glass notes. She hopes that, when it comes to victims of intimate partner violence (IPV), another model she has begun testing will prove equally valuable. With findings expected in 2011, the longitudinal study compares outcomes for groups of female IPV survivors, one getting rent assistance and advocacy services, another receiving only advocacy services. ["An innovative approach to serving the needs of IPV survivors: Description of a CDC-funded study examining the Volunteers of America home free-rent assistance program," Journal of Womens Health, June 2009.] And Glass' 50-state review of laws on strangulation, including public policy and public health recommendations about this most common injury suffered by female IPV victims, appears in the June 2009 Evaluation Review.

In Other News: 
Reports by other JHUSON faculty also have implications for clinical care, education, and policy. In "Effects of estrogen on postischemic pial artery reactivity to ADP," [Microcirculation, July 2009], Associate Professor Marguerite Littleton-Kearney, PhD, RN, FAAN, explores how estrogen may help reduce stroke-induced brain damage. A state-of the-science review of intimate partner violence screening tools by Professor Jacqueline Campbell, PhD, RN, FAAN, suggests current tools are not yet ready for routine  use in health care settings. [American Journal of Preventive Medicine May 2009]. In "Health IT-enabled care for underserved rural populations: The role of nursing" [Journal of the American Medical Informatics Association, March 2009], Associate Professor Patricia A. Abbott, PhD, RN, BC, FAAN, FACMI, explores the challenges facing rural health care and how nurses, using new health information technology, can help rural communities improve residents' health. Associate Professor Cheryl R. Dennison, PhD, RN ANP, continues her Journal of Cardiovascular Nursing (May/June 2009) column by delineating the key elements of an individualized, patient transition plan to help nurses smooth patients transitions from hospital to home. In the same journals July/August 2009 issue, her review, "Patient, provider- and system-level barriers to heart failure care," identifies key deterrents to successful outcomes for people with heart failure and ways to overcome them.