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Summer Nursing News and Research Briefs


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Posted: 7/31/2007

Prior Domestic Violence is the Major Risk Factor for Intimate Partner Homicide
Based on a review of research conducted over the past ten years, Johns Hopkins University School of Nursing (JHUSON) researchers and colleagues have determined, the major risk factor for intimate partner homicide, no matter if a female or male partner is killed, is prior domestic violence.  In the July 2007 issue of  Trauma, Violence & Abuse, faculty members Jacquelyn C. Campbell, PhD, RN; Nancy Glass, PhD, RN; and Phyllis W. Sharps, PhD, RN>; and other researchers report that while intimate partner homicides have decreased in the past 30 years, women are still nine times more likely to be killed by an intimate partner than by a stranger. Most intimate partner homicides were preceded by intimate partner violence.  In 83% of cases, either the victim or the perpetrator had contact with justice, victim assistance, or health agencies in the year prior to the homicide. Among the risk factors authors cited in Intimate Partner Homicide in addition to prior domestic violencewere gun access, estrangement, threats to kill and threats with a weapon, nonfatal strangulation, and a stepchild in the home of a female victim. Unemployment by the male partner was also an important factor.

Acute Injury Patterns Help Identify Intimate Partner Violence
Also writing in the July issue of Trauma, Violence & Abuse, JHUSON nurse researchers Daniel J. Sheridan, PhD, RN and Katherine R. Nash, MSN, RN describe, as previously reported in forensic literature, the mechanisms, locations, and types of injury sustained by women who have survived intimate partner violence (IPV). According to Sheridan and Nash, each year several million people, mostly women, receive acute physical injuries from IPV. The injuries vary from minor abrasions and bruises to multisystem trauma that can result in death. The information they have compiled in Acute Injury Patterns of Intimate Partner Violence Victims is aimed at helping health care providers to better differentiate injuries that may have occurred accidentally from those inflicted intentionally.  Their review indicates that the most common mechanism of IPV injury is being struck with a hand and the head, neck, and face are the most common locations for such injuries. They also observe that strangulation is under-assessed–it is experienced by over half of IPV victims–and that soft tissue injuries are the most common type of injury suffered by IPV victims.

New Study Identifies Strategies for Retaining Participants in Health Care Research
Losing participants in a clinical study can compromise the validity of the research project if the rate of attrition is too high.  Despite its importance, little research has focused on ways to limit participant attrition and maintain participants in studies. JHUSON faculty member Cheryl R. Dennison, PhD, ANP and others conducted a comprehensive literature review and found there is sparse evidence concerning strategies aimed at maximizing retention of study participants–and no study that explicitly evaluated retention strategies. In their review, the researchers examined 21 studies culled from over 3,000 citations and identified 368 retention strategies. Their findings are reported in Systematic Review Identifies Number of Strategies Important for Retaining Study Participants, in the online Journal of Clinical Epidemiology.


Systematic Strategy Improves Adherence to Treatment Guidelines for Coronary Artery Bypass Patients
In a pilot study conducted to assess adherence to recommendations that reduce secondary risk, researchers found a systematic approach can help improve utilization of strategies that have been shown to increase survival, reduce recurrent events, and diminish the need for interventional procedures.  In “Use of the ABC Care Bundle to Standardize Guideline Implementation in a Cardiac Surgical Population: A Pilot Study,” published online this summer in Journal of Nursing Care Quality, JHUSON Associate Dean for Research Jerilyn Allen, ScD, RN and other Hopkins nurse researchers describe their study comparing post-operative coronary artery bypass surgery patients cared for after implementation of the systematic ABC Care Bundle approach and a similar group who received treatment prior to the new approach.  They found more positive outcomes with the ABC approach, which features reminder systems to promote the prescription of recommended medications and lifestyle counseling, including adhering to drug therapy and following medical advice on smoking, diet and weight management, exercise and diabetes control.  The authors concluded the study provided evidence supporting the effectiveness of a systematic strategy to improve adherence to guidelines. The study was funded by a grant from The Dorothy Evans Lyne Fund, which supports pilot studies of nursing interventions designed to improve patient care and outcomes and which are conducted by teams of nurses from JHUSON and Johns Hopkins Hospital, and their interdisciplinary colleagues.

Conceptual Model Assesses Cancer Patient Fatigue Reduction Intervention
In a recent clinical trial, JHUSON nurse researchers including Victoria Mock, PhD, RN; Christine St. Ours, MS, RN; Sue Hall, MS, RN; Anne Belcher, PhD, RN>; and Sharon Krumm, PhD, RN employed a conceptual model to test the effects of a nurse-directed exercise intervention to manage fatigue in cancer patients.  Fatigue, an almost universal symptom in cancer patients undergoing chemotherapy, radiation therapy, or other intensive treatment, is viewed by patients as the most distressing symptom of treatment, one that can persist long after treatment ends.  Researchers used the Levine Conservation Model to guide their development and implementation of a randomized study of patients being treated with radiation therapy or adjunctive chemotherapy following a cancer diagnosis. In the theoretical paper “Using a Conceptual Model in Nursing Research: Mitigating Fatigue in Cancer Patients,” featured in the recent Journal of Advanced Nursing, they report the model proved to be a useful organizing framework for their study.  The authors note, Our experience, applicable on an international level, strongly supports the value of using a conceptual model as a framework for nursing research.

Nurse Researcher Explores Chronic Heart Failure Fatigue, Unexplained Chest Pain, and Recurrent Breast Cancer
In another study focusing on fatigue, which also is a common symptom in patients with chronic heart failure (CHF), JHUSON researcher Fannie Gaston-Johansson, PhD, RN and associates from Goteborg University and Sahlgrenska University Hospital, Goteborg, Sweden, sought to better understand the phenomenon. Gaston-Johansson and colleagues used three different key measurement scales to conduct a study among CHF diagnosed patients.  Their findings, presented in “Fatigue is a Prevalent and Severe Symptom Associated with Uncertainty and Sense of Coherence in Patients with Chronic Heart Failure,” appear online in the European Journal of Cardiovascular Nursing. Gaston-Johansson and other Goteborg University associates also recently examined unexplained chest pain (UCP), the diagnosis received by more than half the people complaining of chest pain who seek care in emergency departments. The researchers sought to learn more about its characteristics and also to compare pain/location descriptions of patients admitted with UCP with those admitted for ischemic heart disease (IHD). The study appears in “Pain Characteristics in Patients with Unexplained Chest Pain and Patients with Ischemic Heart Disease,” online now in the August European Journal of Cardiovascular Nursing. In a third study by Gaston-Johansson and Swedish colleagues, the team looked at postmenopausal women with recurrent breast cancer. In “Coping with Recurrent Breast Cancer: Predictors of Distressing Symptoms and Health-Related Quality of Life,” Journal of Pain and Symptoms Management, they report, to help women manage recurrent breast cancer, it is important to use multidimensional measurement to identify, evaluate, and treat distressing symptoms, and not assess single symptoms only.

In Other News
JHUSON faculty member Shari J. Lynn, MSN, RN is the author of two Drug Watch columns in summer issues of the American Journal of Nursing.   In the May and June issues, Lynn focuses on over-the-counter availability of the obesity medication Orlisit, a black box warning for an asthma drug, new medications for ulcerative colitis among children and teens and for schizophrenia, further labeling revisions for the antibiotic Telithromycin, ADHD medication risk warnings, off-label use of Rituximab, and approval of a product for treatment of Von Willebrand Disease.