Recent School of Nursing faculty publications include results of blood pressure studies among young urban African Americans, health care communications, new approaches for electronic health records, and designs for the ideal hospital medications system.
Hypertension Clinical Trial of High Risk Group Yields Promising Blood Pressure Results-Controlling hypertension among African American men living in urban areas has long posed a challenge, a perception that may have discouraged researchers from studying that high risk group. Now, a hypertension clinical trial specifically targeting high risk, underserved young, urban African American men has yielded encouraging blood pressure results but high mortality rates.
In “Underserved Urban African American Men: Hypertension Trial Outcomes and Mortality During 5 Years,” published this month in the American Journal of Hypertension, Johns Hopkins University School of Nursing (JHUSON) researchers Cheryl R. Dennison, PhD, CRNP; Miyong T. Kim, PhD, RN; Martha N. Hill, PhD, RN; and others report the results of a randomized clinical study that compared two interventions for treating hypertension. A more intensive approach provided one group of participants with an array of high blood pressure treatment and support services delivered by a nurse practitioner, community worker, and physician team. The less intensive approach offered education information and referral to hypertension care sources in the community. Both approaches succeeded in reducing blood pressure; however those in the more intensive group showed superior improvements in both systolic and diastolic blood pressure.
The study was conducted among a group of very high risk urban African American men facing a host of social and economic challenges. Unfortunately, during the study 17% of participants died, over half due to narcotic or alcohol intoxication or cardiovascular and cerebrovascular disease. The researchers note that the alarmingly high mortality rate among the study participants exposes “a major societal and public health problem.”
Health Care Patient, Provider Communications: Easier Said than Done-Improving communications between patients and health care providers, especially nurses on the front line, and facilitating provider-to-provider communications are seen as key avenues to reducing medical errors and improving the quality of patient care. In support of these goals, initiatives such as Speak Up, aimed at creating patients who are active in their own care, and Silence Kills, designed to enhance communications among providers, have been launched throughout the country.
However, in “Breaking the Silence-Bridging the Communications Gap Between Healthcare Professionals,” published recently in Nursing Leadership 2006, JHUSON faculty members Jo M. Walrath, PhD, RN, and Cynda H. Rushton, DNSc, RN, find such efforts face real obstacles in daily medical practice. The authors note that “a ‘quality chasm’ exists in health care-the lack of skills, competency, or confidence of many nurses to engage in open and effective communication with one another, other providers, and patients.”
In one study reviewed by Walrath and Rushton, fewer than one in ten providers who had seen coworkers make mistakes, cut corners, or break rules fully discussed their concerns with the coworker and most felt it was not their responsibility to do so. In response, Walrath and Rushton ask, “If only one in ten providers have the communications skills to raise a red flag in their hospital setting when problems are witnessed-or believe it is their professional responsibility to call attention to the issues-how can anyone be confident that the patient who chooses to speak up will be heard and have issues resolved?”
Banking for the Future: A New Approach to Electronic Health Records-The fragmented U.S. health record system-where many different providers maintain and access patient information-is seen as cumbersome, inefficient, and not serving patient needs or privacy. New and better systems for documenting, storing, and sharing information electronically are now evolving and are expected to be maintained in the future by regional health information organizations supported by a national health information network.
According to JHUSON faculty member Marion J. Ball, EdD and colleagues, such a system would encounter many challenges, including adequate financing without a heavy reliance on public funding. In “The Health Record Banking Imperative,” published in the IBM Systems Journal, the authors suggest an alternative approach, a Health Record Banking (HRB) system, and a unique method of financing. The proposed HRB system would function as a sustainable institution independent of long-term government funding and, the authors write, provide “uninterrupted access to patient records, maintenance of the rights of the consumer to control his or her personal health data, and…storing all electronic health records and data in fail-safe, readily accessible, secure and restricted repositories.”
To fund the system, Ball and colleagues propose substantial underwriting through the sale of “deidentified” health data (data that does not identify individuals) that would allow industry, government, and medical researchers to “reap great value from data mining and researching enormous [HRB] databases.”
What Would the Ideal Hospital Medication Use System Look Like?-Medication use systems (MUS) in hospitals are complex and prone to error. They often depend on intricate organizational systems and subsystems. According to JHUSON faculty member Jo M. Walrath, PhD, RN and nursing colleagues at the Johns Hopkins Hospital, “This complexity, along with the sheer volume of medications given to patients, opens the way for error and reinforces the need for a major redesign of MUS within hospital settings.”
In “Quest for the Ideal, A Redesign of the Medication Use System,” published in the January-March issue of the Journal of Nursing Care Quality, Walrath and colleagues describe efforts to redesign the MUS for Johns Hopkins Hospital, one of the nation’s largest hospitals. The redesign effort-now in the implementation stage-used idealized design methodology as a starting point for preventing patient harm from medication errors. The interdisciplinary team directing the effort identified systems properties, proposed and gathered feedback on an ideal design, and established a structure to plan changes in the system and to monitor the impact of changes.
In Other Nursing News:
Robin P. Newhouse, PhD, RN has been awarded a two-year $100,000 grant by the Maryland Cigarette Restitution Fund Grant at The Johns Hopkins Medical Institutions to conduct four studies related to smoking cessation interventions and counseling efforts by nurses in Maryland hospitals.