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Johns Hopkins Nursing Research News – Winter 2010


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Posted: 1/28/2010

Bridging a Cultural Healthcare Gap
Like other new immigrant groups, Korean Americans’ health risks — diabetes, high blood pressure, and cancer — increase after arriving in the U.S. Unfortunately, too many also miss out on needed healthcare services until they are seriously, often chronically ill. Johns Hopkins University School of Nursing (JHUSON) researchers, professor Miyong T. Kim, PhD, RN, FAAN, associate professor Hae-Ra Han, PhD, RN, and post-doctoral students Jong-Eun Lee, PhD, RN, and Jiyun Kim, PhD, RN, have found that older Koreans with a traditional diet use too much salt and get too little fiber and calcium — risky behaviors when it comes to high blood pressure, colon cancer, and osteoporosis [“In-depth assessment of the nutritional status of Korean American elderly,” Geriatric Nursing, September 2009]. They also note that despite rising breast cancer rates, only half of age-appropriate Korean-American women report having mammograms. [“Do cultural factors predict mammography behavior among Korean immigrants in the USA?,” Journal of Advanced Nursing, November 2009]. “Language, culture, and a work ethic that emphasizes earning over personal health can lead to delayed diagnosis and treatment,” notes M. Kim. Our research to break through these and other barriers shows change starts by sharing health knowledge in a common language and with sensitivity to the immigrant culture. When the team found self-care confidence is a key to successful management of high blood pressure among Korean Americans, they also found a low-cost way to boost confidence: a monthly hypertension counseling phone call by a bilingual nurse. With an 80% success rate, this technique markedly increased medication compliance and exercise and reduced alcohol use. [“Implications and success of nurse telephone counseling in linguistically isolated Korean American patients with high blood pressure,” Patient Education and Counseling, November 2009; and “Correlates of self-care behaviors for managing hypertension among Korean Americans,” International Journal of Nursing Studies, December 2009]. Han notes, “Nursing interventions well-matched to Korean culture and habits help improve outcomes for Korean Americans with type 2 diabetes, just as they do for hypertension.” Reporting in the Diabetes Educator  [November/December 2009], her team found culturally relevant local interventions also stabilize diabetes and reduce the emotional fallout from diagnosis of this chronic illness.  [“A community-based, culturally tailored behavioral intervention for Korean Americans with type 2 diabetes.”]

Staff Behaving Badly
Hospitals aren’t immune from disruptive clinician behaviors; nor are the nurses or other healthcare team members that work there, whether victims or perpetrators.  Disruptive behavior can affect not only the safety of patients but also the cohesiveness of the healthcare team and the long-term health of the nursing workforce.  In “Hospital RN’s experience with disruptive behavior,” Journal of Nursing Care Quality [online, November 2009], JHUSON assistant professor Jo M. Walrath, PhD, MS, RN, and Johns Hopkins Hospital’s Deborah Dang, PhD, RN, NEA-BC, and Dorothy Nyberg, MS, RN give voice to nurses experiences with these behaviors. Based on nurse focus group findings, the research team created taxonomy of disruptive behaviors ranging from incivility to psychological aggression to physical violence.  The most frequent adverse behaviors are triggered by issues related to personal characteristics, stress, fatigue, or competency.  Whatever its source, disruptive clinician behavior can affect quality of care, patient safety, and the quality of a nurse’s work life. Surprisingly, when confronted by rude, insulting, or condescending behavior from peers, staff, physicians, or administrators, many nurses choose not to speak up, despite their longstanding role as patient advocates. Some hunker down; others choose to leave. These findings underscore the Joint Commission on the Accreditation of Healthcare Organizations standard that bad behavior warrants immediate attention. Walrath notes, “Much can be done to promote more emotionally healthy workplaces for nurses. Disruptive behavior should be recognized, openly discussed and equitably addressed for the safety of all, particularly for that of our patients.”

When the Real World is Risky, Simulations Teach Skills Safely
Nursing students manage a limited number of patients under supervision. After graduation, their patient loads can triple or quadruple; supervision may be minimal. How well-prepared are these new nurses to juggle multiple competing demands requiring attention to detail such as critical patient assessments and complex pain management? By assessing the use of educational simulations from manikins and role-play to interactive media and standardized patients — JHUSON associate dean Pamela R. Jeffries, DNS, RN, FAAN, ANEF, and colleagues are working to ensure new nurses can meet high-risk situations and safeguard their patients from adverse events. Writing in “Fostering patient safety competencies using multiple-patient simulation experiences” [Nursing Outlook  November/December 2009], Jeffries describes the results of a study testing a simulation that helps assess nursing students ability to manage complex, even ambiguous, patient safety-related decisions while juggling a large patient load. “The value of simulations cannot be overstated,” Jeffries observes. “We can expose students to high-risk nursing situations that they may not see in their clinical education rotations. Simulations help students safely hone skills and problem-solving that, down the road, can help them save lives.”  

In Other JHUSON Research News
Associate professors Marie T. Nolan, PhD, RN and Joan Kub, PhD, APR, BC, and others describe a simple way to check the readiness of family members to make difficult decisions for terminally ill loved ones in “Development and validation of the family decision-making self-efficacy scale,” [Palliative and Supportive Care, August 2009]. In “Public health and nursing: A natural partnership” [International Journal of Environmental Research and Public Health, November 2009],  Kub urges nurses to stay true to the profession’s historic public health focus and to the principles of health promotion and disease prevention, despite growing workforce and economic challenges. Reporting in Academic Emergency Medicine [November 2009], professor Jacqueline Campbell, PhD, RN, FAAN, and others show how a brief set of questions help identify victims of intimate partner violence (IPV) at greatest risk of reinjury [“Intimate partner violence: Development of a brief risk assessment for the emergency department”]. Kub, Han, and Campbell explore the effects behaviors like exclusion and social rejection can have on the emotional and physical health of inner city youth [“Relational aggression and adverse psychosocial and physical health symptoms among urban adolescents,” Public Health Nursing, November/December 2009]. When clinicians work with women victims within the context of their culture and belief systems, IPV can be reduced, according to associate professor Nancy Glass, PhD, MHP, RN, FAAN, and colleagues [“Research and action on intimate partner violence in Quad Erat Demonstrandum,” Pedio Books, 2009]. In a study of African-American twins, assistant professor Sarah L. Szanton, PhD, MSN, CRNP, and others found younger twins, in contrast to their older counterparts, experience greater educational diversity and attainment, in part as a result of broadened opportunities since the 1960s. [“Education in time:” PloS One, October 2009].