ResearchHopkins Nursing researchers focus on stress, parenting programs, diabetes, and more in the January issue of research news.

Managing Stress: It’s More than Mind over Matter—People respond to a threat consciously with behavior, and automatically with the body’s biological fight-or-flight stress response. The ability to manage both kinds of response can affect long-term health and adjustment.  According to Professor Douglas A. Granger, PhD, the capacity to manage stress may help explain why some children are resilient and others are unable to cope, with markedly different life outcomes. Writing in Child Development (November/December 2011), he and several colleagues report on findings from a study of over 1,200 young children. Granger notes, “When you add the biology of stress to the child/environment equation, it can act as a tipping point toward health and resilience, or in the other direction. The implications for early preventive interventions are tantalizing.”  By collecting information on a child’s behavior, environment, and stress biology, it may be possible to match that child to specific, beneficial prevention programs, saving healthcare dollars and possibly lives. [“Salivary cortisol mediates effects of poverty and parenting on executive functions in early childhood.”]  But what gives rise to the differences in stress response in the first place? Might long-term health and adjustment issues associated with poorly managed stress responses be avoided? In a ground-breaking study, Granger and colleagues explored how infants learn to manage and coordinate behavioral and biological responses to stress. The answer, in part, lies in the behavior of an infant’s parents.  Granger says “It appears likely that one important function of parenting is to model, teach, and enable children to appropriately coordinate the behavioral and biological components of their response to stress, threat, and challenge.” [“Interparental aggression and infant patterns of adrenocortical and behavioral stress responses,” Developmental Psychobiology, November 2011.]

Increasing Participation in Parenting Programs: Do Incentives Work?—Programs that promote good parenting skills can help lower young children’s risks for later emotional problems.  But, getting and keeping parents engaged in these programs is a challenge.  Financial incentives sometimes are introduced as an inducement to participate. Do they work? According to Professor Deborah Gross, DNSc, RN, FAAN, the jury is still out. For parents, cost trade-offs, such as those associated with attending sessions, the size and prompt payment of the financial incentive, and potential lost work income, all matter. Agencies running the programs need to administer a financial incentive program, but lose income when parent turnout is low. According to Gross, more work is needed.  “We need to keep searching for cost-effective ways to support parents’ abilities to participate in these important programs for their young children, especially when they have so many demands on their time and energy,” she says. Gross notes that the most important message is “parents from low-income communities participate in parenting programs because they want to be better parents. Their love for their children, not a daycare discount, remains the most important incentive for getting help.”  [“Cost-effectiveness of childcare discounts on parent participation in preventive parent training in low-income communities,” Journal of Primary Prevention, December 2011]

Lowering ‘Multiplier Risks’ for Patients with Diabetes and Chronic Kidney Disease—Adults with type-2 diabetes are at increased risk for both chronic kidney disease and high blood pressure. The good news is that controlling high blood pressure for patients with all three problems can slow the progression of diabetes-related chronic kidney disease. The not-so-good news is that best practices in diagnosing and managing both chronic kidney disease and blood pressure in these patients often are not followed by primary care providers.  Doctoral candidate Bernadette Thomas, DNP (c), MPH, APRN, reports in Advances in Chronic Kidney Disease (November 2011), that the use of individualized action lists and computer-based, electronic health record (EHR) technology help boost provider awareness of and screening for high blood pressure and chronic kidney disease among diabetic patients. The study found electronic record-based scorecards and real-time feedback increased doctor and nurse practitioner adherence to best practices in screening and treatment for chronic kidney disease and hypertension among type-2 diabetes patients. According to Thomas, “Making these reminders and action lists part of electronic medical recordkeeping puts them on providers’ radar screens and more likely to be remembered and used in patient care.” [“Improving blood pressure control among adults with CKD and diabetes: Provider-focused quality improvement using electronic health records.”] 

Other Nursing Research News—In “Inflammation and traumatic stress: The society-to-cells resiliency model to support integrative interventions” [Journal of the American Psychiatric Nursing Association, December 2011], assistant professor Sarah Szanton, PhD, CRNP,  and an NIH colleague suggest a stress-response model to explain the interplay of six social, behavioral and biological risk factors on the onset of posttraumatic stress disorder (PTSD).  Professor Laura N. Gitlin, PhD, and a colleague explore the growing role of families as informal caregivers for older relatives, highlighting the importance of timely, ongoing family communication with health providers when the older adult is faced with a care-related or personal transition. [“Family involvement in care transitions of older adults: What do we know and where do we go from here?,” Annual Review of Gerontology and Geriatrics, 2011.]   Professor Miyong Kim, PhD, RN, FAAN; associate professor Hae-Ra Han, PhD, RN; research scientist Hee-Hung Song, PhD; and postdoctoral fellow Soohyun Nam, PhD, examine how community-based diabetes testing can help recruit research participants from hard-to-reach ethnic communities.  [“Utility of a point-of-care device in recruiting ethnic minorities for diabetes research with community partners,” Journal of Health Care for the Poor and Underserved, November 2011.]  According to Professor Cynda Hylton Rushton, PhD, RN, FAAN, Maryland’s Council on Quality Care at the End of Life is a catalyst for change in both palliative care and end-of-life policymaking and a model for adoption. [“A legislatively mandated council: A model for palliative care policy integration,” Journal of Palliative Medicine, November 2011.] Associate professor Joan Kub, PhD, APHN, BC, explores the career of Mary Ryan Woods as a nursing leader in addictions medicine in “Innovative Roles: An interview with Mary Ryan Woods.” [Journal of Addictions Nursing, October 2011.]