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Johns Hopkins Nursing Research News–March 2011


Posted: 3/8/2011

Workplace Violence: Nurses Risks Surprising
Hospitals and other healthcare facilities are not immune from workplace violence. But why are nurses the victims of physical and psychological violence twice as often as others in healthcare? That’s what JHUSON researchers Jacquelyn C. Campbell, PhD, RN, FAAN, Joan Kub, PhD, APHN, BC, and Daniel Sheridan, PhD, RN, FAAN, wanted to know. Their survey of over 2,160 nurses, one of the largest U.S. studies to examine the risk factors for workplace violence among nurses, yielded both important and unexpected findings. Not surprisingly, where you work–particularly emergency rooms and psych units–elevates the risk for workplace violence. Surprisingly though, facilities for older adults generate particularly high levels of verbal abuse.  Further, male nurses run a greater risk for violence than female nurses, which Sheridan thinks may result from the assignment of male nurses to more risky, potentially abusive patients and environments.  Perhaps most unexpected, one-fourth of physical violence and almost one-third of psychological violence is directed at nurses by patients’ relatives. Campbell says, “This is a type of workplace violence we don’t expect and don’t give our students and employees the tools to prevent or de-escalate. Identifying this and other risk factors for workplace violence against nurses is a first step toward reducing and, hopefully, eliminating the danger.” [Workplace Violence: Prevalence and Risk Factors in the Safe at Work Study, Journal of Occupational and Environmental Medicine, January 2011.]

A Spoonful of Nursing Helps the Medicine Go Down: Coaching Patients on Medications
Hospital discharge marks a transition from care by an expert health team to home-based self-care.  From a nursing perspective, discharge of a patient with multiple chronic illnesses and a virtual arsenal of medications is a step into the unknown.  Will the patient manage medications adequately or be caught in a revolving door of chronic discharge and rehospitalization?  According to JHUSON faculty and Johns Hopkins Hospital nurse Linda L. Costa, PhD, RN, NEA-C, “As the population ages, this reality can affect growing numbers of Americans. If patients with chronic illnesses don’t understand how and when to take their medications, they can’t manage their illnesses.”  That’s why Costa partnered with hospital colleague Stephanie S. Poe, DNP, RN, and doctoral student Mei Ching Lee, MS, BSN, to compare the value of telephone check-ins and home-based drop-ins to coach proper medicine use by recently discharged patients taking 8-10 medications daily. Their findings?  Being there matters.  Two-thirds more medication discrepancies were uncovered in home visits than in phone interviews. Patients were better at taking their meds when nurses had provided in-person tips and coaching on managing the drug routine. Costa hopes that studies like this will help improve medication compliance that not only will foster better health, but also will reduce the risks for rehospitalizations and unnecessary healthcare costs. [Challenges in Posthospital Care: Nurses as Coaches for Medication Management, Journal of Nursing Care Quality, January 2011]

Putting Baby “Back to Sleep”: Nurses as Models for Mothers
When babies sleep on their backs, not their tummies, they are at lower risk for sudden infant death syndrome (SIDS). Yet, SIDS still accounts for over 2,500 U.S. deaths each year. Adoption of “back to sleep” has been slow in hospital-based, newborn care and in the behavior of new mothers and families. Why? Getting new medical knowledge like this adopted in regular practice can take seven to 20 years. Too long, according to JHUSON assistant professors Sarah J.M. Shaefer, PhD, RN, and Mary Terhaar, DNSc, RN, and colleagues from Michigan’s statewide SIDS program.  Since nurses provide visible, hands-on newborn care that is watched and trusted by new mothers and families, they reasoned that what nurses do can influence parental behaviors. According to Shaefer, “If nurses model putting babies to sleep on their backs, parents will observe and learn to do the same thing.” She and Terhaar agree, that the challenge is promoting nurses to model that critical new behavior. Using a model by the Michigan SIDS program, a 4-year demonstration to help nurses embrace this research found a way to do just that. Terhaar notes, “If you want nurses to change how they usually do something, we found it helps to ask them to be a part of the change process itself.” The demonstration engaged nurses, administrators, and entire facilities in the job of making the practice part of routine infant care. And it worked in seven urban Michigan hospitals.  Nurses adopted and practiced safe sleep techniques that, in turn, were learned by parents and brought home to communities to keep infants safer. [Translating Infant Safe Sleep Evidence into Nursing Practice, Journal of Obstetric, Gynecological and Neonatal Nursing, November/December 2010.]

In separate research, Terhaar explores ways to improve nurse job satisfaction and retention in “Using Maslow’s Pyramid and the National Database of Nursing Quality Indicators to Attain a Healthier Work Environment.” [Online Journal of Issues in Nursing, December  2010.]

In Other Nursing Research News
With focus groups being used increasingly in nursing research, assistant professors Jennifer Wenzel, PhD, RN, and Elizabeth E. Hill, PhD, RN, and an international colleague present a data-derived approach to planning and conducting these groups with nursing staff in “Planning and Conducting Focus Group Research with Nurses” [Nurse Researcher, January 2011.] Jane C. Shivnan, MScN, RN, AOCN, executive director of the Institute for Johns Hopkins Nursing, advocates nurse managers as champions in the adoption of evidence-based practices in nursing care [“How do you support your staff? Promote EBP,” Nursing Management, February 2011.]  Jacquelyn C. Campbell, PhD, RN, FAAN and associate professor Nancy Glass, PhD, MPH, RN, FAAN, focus attention on interpersonal violence (IPV) in separate research reports.  In “Responding to the Needs of Culturally Diverse Women who Experience Intimate Partner Violence,” Campbell and colleagues present findings of perceptions and responses to IPV among cultural groups in Hawaii [Hawaii Medical Journal, January 2011]. In Field Methods (January 2011), Glass and colleagues describe tested strategies to both protect the safety of IPV victims and engage them in long-term research studies [“The SHARE Project: Maximizing Participant Retention in a Longitudinal Study with Victims of Intimate Partner Violence.”]  Finally, Glass and colleagues explore how research on IPV can benefit from an integrated approach that melds both cultural and community perspectives. [“Interdisciplinary Linkages of Community Psychology and Cross-Cultural Psychology: History, Values and an Illustrative Research and Action Project on Intimate Partner Violence,” American Journal of Community Psychology, January 2011.]