Spirituality is a central tenet of 12-step recovery programs like Alcoholics Anonymous. Its value, particularly regarding alcohol addiction, has been recognized by many health care practitioners as well. But what does research science say about the role spirituality plays in the prevention and treatment of and recovery from addictions? A special issue of the Journal of Addictions Nursing [December 2013], co-edited by associate professor and addictions expert Joan Kub, PhD, PHCNS, BC, is dedicated to that very topic.
The issue seeks to clarify whether spirituality and religiosity are synonymous concepts; whether spirituality is as relevant to recovery from substance dependence as factors such as age, sex, environment, and genetics; and whether spirituality has a role to play in the prevention of addictions. As attested to by the articles, including several by Kub and Johns Hopkins colleagues Benita Walton-Moss, DNS, RN, CRNP; Ellen M. Ray, DNP, RN; and Kathleen Woodruff, MSN, CRNP, answers to those questions are not always readily available. Kub’s lead editorial underlines the dearth of ongoing research at the intersection of addictions and spirituality and the absence of common, consistent definitions of spirituality and religiosity across research efforts. Says Kub, “With more information, practitioners in the addictions field can gain a better understanding of spiritual resources and provide information about them to patients at risk for or trying to overcome an addiction.”
New Blood Pressure Guidelines … and a Caveat
In December 2013, JAMA published an article detailing guidelines for managing high blood pressure. The advice to clinicians about when patients should receive active treatment for hypertension was developed by a panel of 17 experts, among them associate professor Cheryl Dennison Himmelfarb, PhD, RN, ANP, FAAN. Based on a detailed review of the current evidence base, the panel made nine recommendations specifying blood pressure levels at which treatment is appropriate for individuals of different ages and health status. The first, and the lone recommendation on which the panel was divided, changes the target level for people 60 and older: The systolic target rate for individuals with no risk factors such as diabetes was modified upward to 150mm Hg from 140mm Hg.
Dennison Himmelfarb and several others expressed concern that the change could affect medication use, insurance coverage, and, above all, individual health and wellness. They shared their concern in an editorial in the January 2014 Annals of Internal Medicine that “increasing the goal may cause harm by increasing the risk for [cardiovascular disease] and partially undoing the remarkable progress in reducing cardiovascular mortality in Americans older than 60 years.” [“2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth joint national committee,” JAMA, Clinical Review and Education, published online December 18, 2013; “Editorial,” Annals of Internal Medicine, January 2014.]
High blood pressure and excessive weight place Ghanaians and Nigerians at significant risk for heart disease whether they live at home or abroad, according to a comprehensive literature review by PhD candidate Yvonne Commodore-Mensah, BSN, RN, and Laura J. Samuel, PhD, RN, CRNP, Dennison Himmelfarb, and a colleague from the Netherlands. (“Hypertension and overweight/obesity in Ghanaians and Nigerians living in West Africa and industrialized countries: A systematic review." Journal of Hypertension, January 2014.)
TB Risks for People with HIV
In South Africa, tuberculosis has become the leading cause of death among those with HIV, whose compromised immune systems leave them at greater risk of co-infection. In the January 2014 Journal of Acquired Immune Deficiency Syndromes, assistant professor Jason Farley, PhD, MPH, CRNP, FAAN, and colleagues suggest steps to lower TB risks to both HIV patients and researchers. Some mirror those Farley has recommended in clinical treatment settings, such as opening windows, segregating patients, and using paper masks and respirators. Farley insists that while such protocols take time and attention, “Implementing every possible means to prevent TB transmission in this particularly vulnerable population is both responsible and an essential part of safety for research subjects.” [“Optimizing the protection of research participants and personnel in HIV-related researcher where TB is prevalent: Practical solutions for improving infection control.”]
In Other Nursing Research News
While depression is known to compromise physical health, the causes are less clear. Associate professor Sarah L. Szanton, PhD, CRNP, and colleagues have found that people with depression have reduced levels of antioxidants that help ward off problems like diabetes, cancer, and heart disease, implicating a specific type of antioxidant-linked stress in the depression-disease equation. [“Depression and oxidative stress: Results from a meta-analysis of observational studies,” Psychosomatic Medicine, January 2014.] ProfessorLaura Gitlin, PhD, and colleagues at the Ann Arbor (MI) Veterans Administration program suggest how an evidence-based approach called DICE--for describe, investigate, create, and evaluate—can help those involved in dementia care better manage behavioral problems like wandering and aggression in patients. [“The role of the occupational therapist in the management of neuropsychiatric symptoms of dementia in clinical settings,” Occupational Therapy in Health Care, January 2014.] Associate professor Kathleen M. White, PhD, RN, and colleagues describe the increased diversity of Federal Health Resources and Services Administration-trained nurses as the result of workforce development programs. [“The Health Resources and Services Administration Diversity Data Collection,” Public Health Reports, January/February 2014.] Doctoral program graduate Jeanine Frumenti, DNP, RN, and a colleague assess the effectiveness of a specialized leadership training program for medical-surgical nursing staff to help reduce the incidence of sores among patients in “Addressing hospital-acquired pressure ulcers: Patient care managers enhancing outcomes at the point of service.” [Journal of Nursing Administration, January 2014.]