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Johns Hopkins Nursing Research News—August/September 2011


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Posted: 9/9/2011

Clearing the Air for Kids with Asthma—Smoking is off limits in many public places, but it isn’t prohibited in private spaces where children live, play, andResearch sleep.  While smoking rates are down, as many as two-thirds of inner-city children with asthma live in a household with at least one smoker, increasing risks for asthma-related symptoms, trips to the ER or doctor, and anti-inflammatory asthma medication.  In a six-month, randomized controlled study of asthmatic children living with smokers reported in the Archives of Pediatrics and Adolescent Medicine, August 2011, Johns Hopkins University School of Nursing (JHUSON) professor and School of Medicine faculty member Arlene Butz, MSN, CPNP, ScD, and others found that regular use of indoor air cleaners can greatly reduce household air pollution and lower rates of children’s daytime asthma symptoms. While improving overall air quality in homes, the air cleaners neither reduced air nicotine levels nor cotinine levels, a biomarker of second-hand smoke, in these children. Butz notes “Air cleaners are a temporary tool on the road to smoking cessation, not a replacement for a smoke-free home. As nurses, we recognize that while total home smoking bans are hard for inner city families to sustain, such bans are good for the public’s health and for child and family health, too.” [“A Randomized Trial of Air Cleaners and a Health Coach to Improve Indoor Air Quality for Inner-City Children with Asthma and Second-hand Smoke Exposure”]

Shiftwork Danger Potential for Tiny Patients of Neonatal Nurse Practitioners—Work shifts of 17 hours or more can be as dangerous as drunk or drugged driving. Even medical residents are limited in the consecutive hours they may be on call in the hospital. Yet, neonatal nurse practitioners (NNPs) on the front line of 24-hour care for sick newborns are not subject to similar shift limits. Writing in Advances in Neonatal Care, June 2011,  JHUSON doctoral candidate Donna LoSasso, MSN, RN, NNP-BC, asks “Are We Really Doing What is Best for Our Tiny Patients?” in her article of the same title. She says that while “good evidence about shift lengths is needed to make good recommendations,” that evidence doesn’t yet exist for NNPs.  Based on her exploration of existing work-shift data for flight nurses and others, LoSasso observes that shift intensity and the acuity of patient needs may be as much a factor in maintaining patient safety and quality of care as shift length itself. She urges more research, coupled with ongoing professional education about issues surrounding shiftwork, but cautions that “given broad variation in the intensity of shiftwork based on facility size, staffing patterns, and patients served, it may be impractical to set specific shift standards for NNPs.”

Abused, Pregnant, and Poor: Coping Strategies of Rural Women—Pregnant women aren’t immune from intimate partner violence (IPV), but their decisions about how to manage the abuse may differ from those of other abused women. In fact, they may be even more complicated for abused and pregnant women living in depressed rural areas where shelters or other safe havens from abuse are limited. Those very decisions are the focus of a small, but important, first-of-its-kind study by professor Phyllis W. Sharps, PhD, RN, CNE, FAAN, and others, “Pregnancy and Intimate Partner Violence: How Do Rural, Low-Income Women Cope?” [Health Care for Women International, September 2011]. Interviews with 20 rural, low-income, pregnant or post-partum women in abusive relationships revealed the need to protect their unborn or newborn babies was the seminal factor in virtually uniform decisions to leave the abusive relationships.  These findings contrast to those among non-pregnant rural women, the majority of whom choose appeasement or bargaining with their abuser over quitting the relationship. According to Sharps, “The women saw their babies as a ray of hope for a new beginning, enabling them to walk away as mothers who were protecting and loving their infants.”  She cautions, however, that these women have very real needs for social, economic, and environmental support that remain in short supply in rural areas.

Was Sex Forced or Consensual? Evidence Equivocal—Medical histories taken by sexual assault nurse examiners (SANEs) often become evidence in legal sexual assault cases. Such nurses, part of sexual assault response teams, are the first line of care for most of the one in five women reporting such an attack. But can a SANE’s finding of genital injury be held as a definitive sign of forced sex? According to associate professor Daniel J. Sheridan, PhD, RN, FAAN, and JHUSON doctoral student Jocelyn C. Anderson, MSN, RN, CNRN, today, the answer is equivocal at best.  Their in-depth literature search found that female genital injuries are seen in both forced and consensual sex, leading the authors to urge SANEs to exercise “extreme caution” in their reports about the cause of the injury. Sheridan notes, “There is no way to tell by the actual examination if the trauma was from consensual or non-consensual sex.”  Anderson adds, “To provide the most complete care, SANEs must thoroughly document patient histories as well as physical findings, including, but not limited to genital injury status. [“Female Genital Injury Following Consensual and Nonconsensual Sex:  State of the Science.”  Journal of Emergency Nursing (2011, in press; online, April 2011, doi:10.1016/j.jen.2010.10.014.]

Other Nursing Research News—Associate professor Nancy Glass, PhD, MPH, RN, FAAN, and colleagues report on a partnership to improve the lives of female Congolese victims of sexual violence that focuses on enhancing perceptions of such women’s worth through “Pigs for Peace,” a microlending program. [“A Congolese-US Participatory Action Research Partnership to Rebuild the Lives of Rape Survivors and Their Families in Eastern Democratic Republic of Congo, Global Public Health, July 2011, online] The relative benefits and dangers of supplemental oxygen therapy for newborns are explored and future research and clinical care directions are proposed by JHUSON assistant professor Mary Terhaar, DNSc, CNS, RN, and a colleague in “Hyperoxia in Very Preterm Infants” [Journal of Perinatal and Neonatal Nursing, July/September 2011.]  In “Outcomes of Multi-Drug Resistant Tuberculosis among a Cohort of South African Patients with High HIV Prevalence, assistant professor, Jason E. Farley, PhD, MPH, RN, and others demonstrate the need to integrate care for HIV when treating patients with TB in a country in which HIV-related TB deaths are as high as 53%.  [PLoSONE 6(7): e20436. Doi: 10.1371/journal.pone.0020436.]  A  Journal of Aging Research editorial by assistant professor Nancy Hodgson, PhD, RN, and others highlights the complex end-of-life issues affecting families, providers, and patients discussed in four journal articles on the topic. [End of Life Research, 2011, doi:10.4061/2011/716231.]