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Johns Hopkins Nursing Research News–January 2011


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Posted: 1/12/2011

Bound by Law: Making the Call on an Endangered Child
When it comes to detecting child abuse in preschool children, nurses are on the front lines. Yet, just over 8 percent of reports to child protective services are from nurses. According to Johns Hopkins University School of Nursing (JHUSON) post-doctoral fellow and clinical mental health nurse Shelly S. Eisbach, PhD, RN, most nurses say making the required call is a “no brainer” when a child has obvious signs of abuse. But, when the signs are more subtle, the decision becomes more difficult and more critical. In a descriptive exploration, [“Am I Sure I Want To Go Down This Road? Hesitations in the Reporting of Child Maltreatment by Nurses,” Journal for Specialists in Pediatric Nursing, October 2010] Eisbach and a colleague asked how nurses handle these less definitive cases of child abuse.  Do they report it, hesitate or seek additional information before contacting protective services?  Do they engage the families immediately or watch the situation over time? Based on their interviews with pediatric nurses and nurse practitioners, Eisbach found no one path is always the right path to detecting and reporting child abuse. Sometimes, when a nurse engages a family, they reach out for help; other times, delay can result in heartbreak. She advised nurses to “follow their knowledge, experience, and ‘gut feeling’ to save a child from harm.” Further, Eisbach called upon everyone “to be as public and outspoken about child maltreatment in this country as we are about animal abuse.”

Insurance No Deterrent to Breast Cancer Cost Concerns
For many women, the challenges of breast cancer treatment are heightened further by today’s difficult economic and employment climate.  While health care costs have long been known to increase stress and deter treatment for uninsured women with breast cancer, JHUSON PhD candidate Rachel Klimmek, BSN, RN, OCN, and assistant professor Jennifer Wenzel, PhD, RN, CCM, have found economics also affect women with breast cancer who are insured by managed care organizations. Women reported considerable stress related to the loss of personal control over treatment, care, and cost decisions; and to the dearth of speed and transparency in managed care decisions, resulting in delayed treatment and unanticipated patient-borne costs. According to Klimmek, “Many women find managed care processes dehumanizing, time-consuming, and demoralizing at the very time they may be struggling with body image, the impact of cancer on work and family, and survival itself.” Wenzel adds, “As unthinkable as it might seem, some patients report financial uncertainties can be harder to manage than the disease itself.” Yet, most women don’t raise their concerns about coverage and cost with healthcare providers.  That’s where nurses can help by anticipating cost concerns, encouraging dialogue about them, and helping to identify solutions.  Klimmek notes, “While patients can feel overwhelmed, nurses can act as navigators through the experience, an approach we’re now testing with older African-American women.   [“Insurance-related and financial challenges reported by managed care enrollees with breast cancer,” Clinical Journal of Oncology Nursing, October 2010.]

Knowledge, Motivation Are Power in Successful Heart Care
Hopkins Nursing associate professor Cheryl R. Dennison Himmelfarb, PhD, RN, ANP, FAAN, believes that patient knowledge and motivation is essential for the one-third of American adults living with cardiovascular disease. To ensure health education is well-received and heeded, Dennison and a colleague encourage clinicians to engage their heart patients by using motivational interviewing, a collaborative, non-confrontational technique encouraging patients positive lifestyle and behavior change. [“Motivating our Patients to Adopt and Maintain Healthy Lifestyles,” Journal of Cardiovascular Nursing, January-February 2011.] In the November 2010 issue of the same journal, she and others also describe the role health literacy–the ability to understand and manage knowledge about an illness and its treatment–can play in self-care among people hospitalized with heart failure. [“Adequate Health Literacy Is Associated with Higher Heart Failure Knowledge and Self-Care Confidence in Hospitalized Patients.”] Finally, Dennison and others report on a test of an automated telemanagement system to help clinicians and patients with congestive heart failure collaborate to manage home treatment and monitor progress. “While technology cannot replace the care management team,” Dennison notes, “Given the broad use of computers in the home as well as cell phones and hand-helds, this system adds a new tool to boost patient self-monitoring and improve heart failure outcomes.” [“Exploring Feasibility of Home Telemanagement in African Americans with Congestive Heart Failure,” Studies in Health Technology and Informatics, October, 2010]

Making Sure HIT Isn’t a Miss
Electronic health information technology (HIT) has been heralded in national policy, statute, and regulation as healthcare’s future, improving quality of care and patient safety, and saving precious time and dollars. Yet, fallacies, fears, and frustrations have made real-world adoption of HIT slow going. Writing in the November 2010 Journal of the American Medical Informatics Association, JHUSON associate professor Patricia A. Abbott, PhD, RN, BC, FACMI, FAAN and colleagues both debunk HIT myths, such as the misguided belief that if you build it, providers will use it and the assumption that a one-size HIT system can fit all. Abbott is quick to point out that neither premise is accurate and argues for a rapid course correction that directs HIT development toward the safest and most meaningful design and use for clinicians and patients alike. [“Health information technology: Fallacies and sober realities.”] 

In Other JHUSON Research News
Linda Gerson, PhD, RN
, and Johns Hopkins Hospital nurse practitioner Gail Hefter, DNP, MS, RN, found that nurses can help reduce cancellations for important cardiac tests that could delay needed treatment by giving heart patients a checklist and reminder tool. [“Increasing adherence to scheduled outpatient dobutamine stress echocardiograms,” Journal for Nurse Practitioners, November/December 2010.] Resilience–the ability to bounce back from adversity–is a powerful foundation on which positive health outcomes and nursing excellence can and should be built, according to Sarah L Szanton, PhD, CRNP. [“Facilitating resilience using a society-to-cells framework,” Advances in Nursing Science, October/December 2010.] Writing in Oncology Nursing Forum (November 2010), doctoral recipient Barbara A. Biedrzycki, PhD, CRNP, explores the factors that can help motivate a cancer patient’s decision to participate in treatment-related research. [“Decision-making for cancer clinical trial participation: A systematic review.”]  Center for Interdisciplinary Salivary Bioscience Research director Douglas A. Granger, PhD, and colleagues examine if and how co-rumination–excessive negative discussion about problems among teen or young adult friends not only can increase social bonds but also can heighten anxiety and stress as measured by changes in  cortisol and alpha-amylase, chemicals found in saliva. [“Stress reactivity to co-rumination in young womens’ friendships: Cortisol, alpha-amylase, and negative affect focus,” Journal of Social and Personal Relationships, October 2010.]