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Johns Hopkins Nursing Research News — April/May 2010


Posted: 5/7/2010

Promoting Collaborative Healthcare through Simulation
Nursing and medical students most often learn separately. When they graduate, they may be less than fully prepared to work collaboratively in the high-risk healthcare environment. The need for interdisciplinary education — an issue of concern to the Institute of Medicine — is a problem for which Johns Hopkins University School of Nursing (JHUSON) Associate Dean Pamela R. Jeffries, DNS, RN, FAAN, ANEF, has a suggested solution: the use of simulations. In “Learning together: Using simulations to develop nursing and medical student collaboration” [Nursing Education Perspectives, January 2010], Jeffries describes assessing the impact of a surgical collaborative care simulation on medical and nursing students. The simulation, based on her Nursing Education Simulation model, appeared effective as a learning tool in interdisciplinary settings. Students said the simulation gave them a chance to experience a high-risk situation safely, to interact with other disciplines, and to test skills. Some expressed surprise by the intensity the experience. The simulation also marked the first time most were able to observe, first-hand, the knowledge and skills each discipline brings to patient care. Jeffries suggests, “Simulations can help bridge the artificial educational divide between nursing and medical students before they enter clinical practice. In doing so, we can better prepare them for real-world clinical situations in which they can provide safe, high-quality care in a complex healthcare environment.”

Can What Hurts Actually Make You Stronger?
Intimate partner violence (IPV) most commonly affects women in their child-bearing years.  While 95% of women seek prenatal care, few seek medical care following IPV. Even fewer reach out for emotional support, despite two to three times the rates of depression and post-traumatic stress disorder (PTSD) than other women. Until now, little research has examined the emotional toll of IPV, particularly on pregnant women and young mothers. In “Impact of intimate partner violence on pregnant women’s mental health [Issues in Mental Health, February 2010], JHUSON professor Phyllis Sharps, PhD, RN; associate professor Linda Rose, PhD, RN; and colleagues assess IPV’s impact on emotional well-being and coping. Their qualitative study of 27 abused, pregnant women affirms not only the pervasive and intense emotional distress caused by IPV but also the equally intense maternal instincts to deflect abuse from their children. Both can affect emotional well-being. Sharps explains, “When women become mothers, the depression and anxiety of IPV victimization is amplified by the emotional changes associated with the transition to maternal roles.”  The study amplifies the value of early recognition and attention to the emotional aspects of IPV and the need for mental health services to be included among the services for IPV victims and their families. Rose observes, “We were also struck by the incredible mental strength evidenced by these victimized pregnant and parenting women, as well as their commitment to protect their children, and their desire to be good parents. It makes the need for early intervention all the more compelling.”

What Makes a Nurse Leader?
Long-time nursing administrator  and JHUSON professor Maryann F. Fralic, DrPH, RN, FAAN, knows nursing leadership today demands flexibility, agility, creativity, and efficiency in ways never before imagined. Approaches, skills, and behaviors that worked yesterday may not be applicable to today’s challenges. In “Contemporary Nurse Executive Practice: One Framework, One Dozen Cautions,” [Nursing Clinics of North America, March 2010], she suggests what it takes to be a nurse leader in the rapidly changing healthcare landscape and how to avoid the hazards and dangers associated with it. Fralic urges careful strategic planning, attention to “bottom line” issues, cultivation of solid predictive skills, and an outlook that embraces the new and selectively discards the used. “Nurse leaders,” she says, “must pay careful attention to ‘cash register’ issues. To succeed, one needs to be research-savvy and become bilingual, speaking both clinical and financial languages.” She further stresses that the pursuit of excellence must be tempered by personal energy management. In a recent interview in the March 2010 Journal of Nursing Administration [“Inspiration Point,”], Fralic also shares insights on how nurse executives can build engaged, effective leadership teams.

Attitude Matters in End-of-Life Care
When treatment no longer alleviates patient suffering, many clinicians are unsure how to proceed. They know how to heal better than how to care for the dying patient. In “Impact of a contemplative end-of-life training program: Being with dying” [Palliative and Supportive Care, December 2009], associate professor Cynda H. Rushton, PhD, RN, FAAN, examines the impact of the “Being with Dying” training program on clinicians’ capacity for more connected and compassionate care. “The program,” Ruston notes, “helps demonstrate that providing compassionate care requires both openness and active engagement, and that caring for patients, particularly those who are dying, is also about caring for oneself, too.” In another recent publication, “Learning that leads to action” [Archives of Pediatric and Adolescent Medicine, April 2010], Rushton and colleagues report how an intensive clinician retreat helped catalyze improvements in pediatric palliative care and family clinician interaction.

In Other Nursing Research News
Age, low stipend rates, and limited mentoring are impediments to nursing research careers, according to associate professor Nancy E Glass, PhD, MPH, RN, FAAN, and postdoctoral student, Veronica Njie-Carr, PhD, SPRN, BC. Writing in “The new nurse investigator” [Journal of the Association of Nurses in AIDS Care, April 2010)], they suggest why surmounting these and other factors is critical to cultivating the next generation of nurse researchers.

Writing in “Implementation fidelity in community-based interventions,” [Research in Nursing and Health, March 2010], Professor Deborah E. Gross DNSC, RN, FAAN, and colleagues explain why even the best research results can be confusing or misleading because the evidence-based practice or intervention under investigation is not delivered to patients as intended  — a concept called fidelity.