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Johns Hopkins Nursing Research News–November 2011


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Posted: 11/10/2011

ResearchABLE Spells Better Living, Likely Lower Health Costs for at-Risk Elders—Older adults with chronic illnesses often have disabilities that make it hard to do simple, everyday activities. For many, disability leads to nursing home placement or premature death. According to Laura N. Gitlin, PhD,  professor and director of the Johns Hopkins University School of Nursing (JHUSON) Center for Innovative Care in Aging, “Today’s health system does not focus on the disabling consequences of late-life illness, even though disability is implicated in higher health costs from hospitalizations and long-term care.” Most older adults would rather live at home—“age in place”—than move to an assisted living or nursing facility. But, do the costs of in-home help outweigh the benefits?   Gitlin and colleagues undertook a retrospective, cost assessment of the known-effective Advancing Better Living for Elders (ABLE) program that provides brief, in-home occupational and physical therapy, and low-cost assistive devices to at-risk elders.  Gitlin observes, “Small changes in the home and how older adults conduct everyday activities can have a substantial positive effect on quality of life. Outcomes of ABLE and its cost study show that by these innovations to improve function can help extend lives and can do so in a cost effective way.” [“Cost effectiveness of a home-based intervention that helps functionally vulnerable older adults age in place at home,” Journal of Aging Research, [online version; January 2012 print publication.]  

Patient Knowledge is Power—A solid understanding of their illness helps people with high blood pressure or heart failure understand the value of reducing fat and salt intake, of taking medications exactly as prescribed, and of curbing other risk factors like tobacco or alcohol use. To ensure patients are taking the right steps to manage their illnesses, researchers are developing patient knowledge assessment tools and exploring the of role health literacy in patient self-care confidence. Professor Miyong T. Kim, PhD, RN>; associate professor Hae-Ra Han, PhD, RN>; doctoral student Tam Nguyen, MS, MPH/RN>; and post-doctoral student Heejung Song, PhD, are working on a simple, self-administered knowledge assessment for Korean Americans with high blood pressure. The questionnaire identifies areas in which patients would benefit from added education. Kim and Han agree the questionnaire may have wider application in other populations with high blood pressure.  [“Development and evaluation of a hypertension knowledge test for Korean hypertensive patients. The Journal of Clinical Hypertension, October 2011.]  In an exploration of heart-failure patients, associate professor Cheryl R. Dennison, PhD, RN, ANP, FAHA>; doctoral student Laura Samuel, MSN, FNP>; and research assistants Mindy L. McEntee, MA, Brandon J. Johnson, and Alexandra Keilty, BSN, found health literacy is a key to self-care capacity among patients with heart failure. According to Dennison “Inadequate health literacy affects patients’ ability to understand and follow instructions for self care. Clinicians must pay particular attention to health literacy level when preparing and delivering health education information, especially to older adults.” [“Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients.” Journal of Cardiovascular Nursing, September/October 2011.]

Simulation Helps Hone Heart Assessment Skills—Today’s advanced practice nurses (APNs) often manage patient care and other tasks once reserved for physicians. To provide top quality care, APN cardiovascular assessment skills need to be kept sharp. Associate dean Pamela R. Jeffries, DNS, RN, ANEF, FAAN, and others use a simulation tool named Harvey and a learning technique called deliberate practice, to develop and test a curriculum specifically designed to buttress APN heart assessment skills.  Hands-on practice with the Harvey simulator has been shown to increase student motivation, bedside assessment and diagnostic reasoning, when compared with other teaching methods alone. Jeffries notes, “While it takes a strong advocate for change to introduce new teaching concepts like this, the Harvey/deliberate practice model has application to other areas of nursing practice and diagnostic reasoning.”  [“Multi-center development and testing of a stimulation-based cardiovascular assessment curriculum for advanced practice nurses.” Nursing Education Perspectives, September/October 2011.]

Undiagnosed Herpes Potential Danger for People with HIV
– Most people with HIV in the U.S. are living longer, more symptom-free lives.  Yet, as many as 70-90% are also living with genital herpes (HSV-2), another sexually transmitted, viral infection known to increase HIV transmission risk. Together, the two disorders can affect overall health and HIV progression. In a survey of 110 people with HIV,  Hayley D. Mark, PhD, MPH, RN, and Jason E. Farley, PhD, MPH, CRNP>; and postdoctoral student Marguerite Lucea, PhD, MPH, RN, looked at whether clinicians are alerting their HIV positive patients to HSV-2 risks. Most surveyed (57%) said they were not tested for genital herpes. Over 75% of those tested for HSV-2 did so based on a doctor’s or nurse’s recommendation. Mark notes that genital herpes testing and counseling among people living with HIV can help reduce the risk of transmission both through education about the added risks pose by HSV-2 and through the adoption of preventive behaviors. [“Genital herpes testing among persons living with HIV, Journal of the Association of Nurses in AIDS Care, September/October 2011.]

Other Nursing Research News— In “The health of women and girls determines the health and wellbeing of our modern world,” Health Care for Women International, (October 2011) professor Jacquelyn C. Campbell, PhD, RN, FAAN, and other members of the International Council on Women’s Health Issues delineate strategies to meet key health needs of women and girls around the globe, arguing for the role of health equity in worldwide human rights. Professor Marie T. Nolan, PhD, RN, and colleagues identify specific core caregiver needs to which nurses should be attuned when checking in on the heart failure patients. [“Informal caregivers’ experiences of caring for patients with chronic heart failure, Journal of Cardiovascular Health, September/October 2011.] Writing in Communication Monographs (September 2011), Douglas A. Granger, PhD, Director of the JHUSON Center for Interdisciplinary Salivary Bioscience Research, and colleagues evaluated levels of the stress hormone alpha amylase to discern how actual and perceived parent communication skills may affect their teens’ emotional well-being. [“Parents’ communication skills and adolescents’ salivary alpha-amylase and cortisol response patterns.”]