From sexual violence among displaced women and girls to natural health products and children’s healthcare, to self-care protocols, VAP, and asthma: the Johns Hopkins Nursing Research News (part one of two):

About 1 in 5 refugee or displaced women and girls will experience sexual violence. And because of social stigma, widely varied accounting, lax justice systems, and lack of access in war-torn regions, among other barriers to reporting such crimes, that figure might be far too low, say Nancy Glass, PhD, MPH, RN, FAAN, and colleagues in “The Prevalence of Sexual Violence Among Female Refugees in Complex Humanitarian Emergencies: a Systematic Review and Meta-analysis.” Many survivors will find the climate too inhospitable to disclose their experiences and seek help. “The negative health impacts of the experience of sexual violence are significant and long-term and may include serious physical injuries, sexually transmitted infections and HIV infections … chronic pain, unwanted pregnancies, and myriad psychological health consequences, including suicide.”

They suggest developing strategies for improving identification of survivors (such as standardizing screening for gender-based violence), predicting where violence is most likely, and expanding prevention efforts. “More vigorous action is needed to prevent and to respond to sexual violence among refugees and displaced populations, identify methods to assist survivors, and hold perpetrators accountable.” The authors say sexual abuse of men in similar situations should be studied as well. [PLOS Current Disasters, March 2014]

Bigger Dose of Information

The Food and Drug Administration recently reported that there are over 85,000 natural health products (NHPs--vitamins, minerals, herbals, homeopathic and traditional medicines) already on the market, with more coming. About 31 percent of U.S. children take them as supplements. In “the first known review to synthesize pediatric NHP clinical management guidance in primary care,” doctoral student Emily Gutierrez, RN, MSN, CPNP, Assistant Professor JoAnne Silbert-Flagg, DNP, CPNP, IBCLC, and a colleague examine the literature and suggest guidelines for ensuring the safety of young patients in “Natural Health Product Use and Management in Pediatrics: An integrative review.” [European Journal of Integrative Medicine, April 2014]

The Heart and the Lungs

Poor self-care in those with heart failure contributes to more frequent hospital readmissions and is a drain on the U.S. healthcare system and Medicare. Add the mild cognitive impairment (MCI) frequently associated with heart failure (and often unrecognized), and the challenge of self-care is exacerbated. In “Predictors of Heart Failure Self-care in Patients Who Screened Positive for Mild Cognitive Impairment,” Karen Davis, PhD, RN, MEA-BC (Director of Nursing at the Johns Hopkins Hospital), Associate Professor Cheryl Dennison Himmelfarb, PhD, RN, ANP. FAAN, Associate Professor Sarah Szanton, PhD, CRNP, Associate Dean for Research Jerilyn Allen, RN, ScD, FAAN, and a colleague suggest screening for MCI in all heart failure patients. They look at factors that contribute to better self-care and how interventions could be adapted for such patients. [Journal of Cardiovascular Nursing, published online ahead of print]

“Muscle weakness is common after acute lung injury, usually recovering within 12 months. This weakness is associated with substantial impairments in physical function and health-related quality of life that continue beyond 24 months,” Dennison-Himmelfarb and colleagues write in “Physical Complications in Acute Lung Injury Survivors: A Two-Year Longitudinal Prospective Study.” Their prescription: “Evidence-based methods to reduce the duration of bed rest during critical illness.” [Critical Care Medicine, April 2014]

Studies show that cardiac patients with moderate to severe depression are far more likely to die than non-depressed patients. Since individual preferences and culture are undeniable elements in treatment of depression, understanding these factors can lead to recommendations that are culturally acceptable and thus more likely to be adhered to by the patient, Dean Patricia M. Davidson, PhD, MEd, RN, FAAN, and colleagues suggest in “Heart Disease and Depression: Is Culture a Factor?” [Journal of Transcultural Nursing, published online ahead of print]

Dennison Himmelfarb and doctoral student Yvonne Commodore-Mensah, BSN, RN, discuss recent guidelines focused on assessment of cardiovascular risk, and lifestyle management and treatment of blood cholesterol to reduce that risk in “New Cardiovascular Prevention Guidelines Offer a New Approach and Effective Strategies,” [Journal of Cardiovascular Nursing, March/April 2014]

Ventilator-associated pneumonia, or VAP, occurs in 9 percent to 27 percent of intubated patients in intensive care units. It can be deadly, so suspected cases are treated quickly and aggressively with antibiotics. Diagnosis of VAP is challenging, though, and misdiagnosis can lead to prolonged and unnecessary antimicrobial therapy (and legitimate worries over antibiotics resistance), Senior Research Nurse Sandra Swoboda, RN, MS, and colleagues suggest in “Ventilator-Associated Pneumonia: Overdiagnosis and Treatment Are Common in Medical and Surgical Intensive Care Units.” [Infection Control and Hospital Epidemiology, March 2014]

An intensive clinician and caregiver asthma feedback intervention, one that included home and nurse facilitated follow-up primary care provider (PCP) visits, was no more successful than a home-based nurse education intervention in improving the number of preventive care visits for inner-city children with persistent asthma. Although the intervention targeted clinician decision support by providing timely asthma symptom information and controller medication recommendations, there was a high level of non-adherence to PCP visits in a subset of families. Arlene Butz, ScD, MSN, CRNP, Joan Kub, PhD, MA, PHCNS, BC, and colleagues report that more targeted interventions for caregivers of high-risk children with asthma, delivered in the clinic or in the context of their home, may be necessary to engage caregivers who have substantial barriers to preventive asthma care. [“Improving preventive care in high risk children with asthma: lessons learned,” Journal of Asthma, February 2014]

A reliable, valid, culturally acceptable instrument is needed to develop and test self-care interventions in Iran, according to Davidson and colleagues in “Translation and Validation of the Self-care of Heart Failure Index into Persian.” The authors translated the Self-care of Heart Failure Index, or SCHFI, a well-known scale for assessing self-care. Dennison Himmelfarb helped do the same for the Chinese version: “Construct Validity of the Chinese Version of the Self-care of Heart Failure Index Determined Using Structural Equation Modeling.” [Journal of Cardiovascular Nursing, both published online ahead of print.]

In Other Nursing Research News

Untreated child behavior problems are costly, affecting the long-term health and well-being of the child, the family, and society. But how best to reach, and serve, low-income families? Professor Deborah Gross, RN, DNSc, FAAN, Assistant Professor Chakra Budhathoki, PhD, and colleagues have set out to compare the effectiveness, cost, and “social validity” of the Chicago Parent Program, a group-based program developed in collaboration with a community advisory board of African-American and Latino parents, and Parent-Child Interaction Therapy, an individualized parent-child coaching model considered “the gold standard” for parents of children with behavior problems. Gross is a founder of the Chicago Parent Program. [“Study protocol for a comparative effectiveness trial of two parent training programs in a fee-for-service mental health clinic: Can we improve mental health services to low-income families?” [Trials, March 2014]