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Johns Hopkins Nursing Research News — September 2010


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Posted: 9/9/2010

Open Wide: Clues to Stress Through Saliva
The eyes may be windows into the soul, but for Douglas A. Granger, PhD, director of the Center for Interdisciplinary Salivary Bioscience Research at the Johns Hopkins University School of Nursing (JHUSON), the mouth is the window into the effects of adversity on health and illness. Simple saliva tests can yield clues about stress and exposure to contagious disease or environmental chemicals. With several research teams, Granger has studied chemicals in saliva, like alpha-amylase and cortisol, that are linked to stress, a well-known factor in health problems ranging from high blood pressure to reduced fertility to depression. In one just-published study, Granger and colleagues explored the physical and emotional impact of relocation on youth following Hurricane Katrina. Alpha-amylase levels in saliva, and, in turn, stress levels, were higher in the Katrina group than in a matched control group. [“Sex differences in salivary cortisol, alpha-amylase, and psychological functioning following Hurricane Katrina” Child Development, July/August 2010.] Another study reveals links among bullying, physical aspects of stress, and problem behavior in school-aged children. [“Peer victimization and aggression:  Moderation by individual differences in salivary cortisol and alpha-amylase” Journal of Abnormal Child Psychology, August 2010.] Granger and the teams also have reported the “what, when, where, and why” of saliva collection and analysis to promote both accurate research findings today and effective prevention and intervention tomorrow. [“Salivary flow and alpha-amylase: Collection technique, duration, and oral fluid type.” Physiology and Behavior, September 2010]. Granger says, “The potential implications are phenomenal. The rubber will really meet the road when we translate our basic research to practice.” Eventually, in the wake of natural and man-made disasters, a simple saliva test could help healthcare workers identify those at greatest risk of stress-related illnesses.

Where Clinical Notes Meet CPUs: Nursing in the Electronic Era
Healthcare is getting wired; handwritten notes and charts are being replaced by keyboards and CPUs. Because nurses are the 24-hour, frontline healthcare managers at patients bedsides, their notes that help guide treatment need to be accurate, complete, timely and, today, digital. That’s where JHUSON assistant professor Laura A. Taylor, PhD, RN, and instructors Krysia Hudson, MS, RN-C; Joyce Vazzano, MS, RN, CRNP; Phyllis Naumann, MS, RN; and Maggie Neal, PhD, RN, enter the picture. This Hopkins nursing HIT (health information technology) squad is working to integrate knowledge of these new technologies into nursing education. In “The electronic health record meets baccalaureate nursing curriculum: Stories from the battlefield,” [Nurse Leader, June 2010] they describe ways to season routine student clinical practice sessions with a dash of electronic record keeping to make accurate digital recordkeeping a natural part of a nurses workflow.  One of the barriers?  Too many older faculty who resist new practices, like electronic records. Taylor’s response is to help educate the educators, too. She says “Nurses need the savvy and confidence to navigate these emerging healthcare technologies. The result will lead to improved health, patient, and family satisfaction and, ultimately, confidence in the entire healthcare system.”

Out of the Darkness: Herpes Testing in HIV+ Patients
Nine in ten people with genital herpes (HSV) probably don’t know it. Among them are at least two-thirds of people with HIV.  Because the risk for one disease is amplified by the other, JHUSON assistant professors Hayley Mark, PhD, MPH, RN, and Jason Farley, PhD, MPH, RNP, and colleagues wanted to know why HSV testing for people with HIV isn’t regular practice.  In “Providers knowledge, practices and barriers related to genital herpes testing for patients with HIV,” [Journal of the Association of Nurses in AIDS Care, July/August 2010], one of the first articles on the topic, they discuss their analysis of American Social Health Association (ASHA) data on healthcare providers working with HIV patients to explain the reluctance to test HIV patients for herpes. The key impediment: insufficient awareness. Even in this HIV-savvy group, fewer than half knew that most people with HIV also are infected by HSV or that most often, symptoms of HSV are silent. Mark observes, “We need to better educate healthcare providers who, in turn, can educate their patients. Patients with HIV need to know that if they have HSV too, it can be transmitted to their partners. And if they don’t now have HSV, they are heightened at risk for acquiring it, unless they practice safe sex.”

Gossip Can Make or Break the Treatment Team
Trust, important in every workplace, is critical in the hospital where working relations can help or harm very sick people. How can this kind of trust be assessed? What issues are most likely to break or promote trust in the highly charged pediatric critical care environment?  Seeking answers, JHUSON associate professor Cynda Hylton Rushton, PhD, RN, FAAN, Instructor Phyllis Naumann, MSN, RN, and colleagues explored the issue of trust among doctors and nurses working in just that setting. [“Application of the Reina trust and betrayal model to the experience of pediatric critical care clinicians” American Journal of Critical Care, July 2010]. The administered trust-betrayal model explores three kinds of trust: contractual trust (following through and keeping promises); competence trust (recognizing others’ abilities and knowing one’s own limits); and communications trust (honesty, respectfulness, speaking with good purpose).  Each kind of trust is important, but the role of one may be amplified in some situations. In the sample of health professionals, both contractual and competence, most trusts were high. Communications trust was the greater challenge, primarily due to one factor: gossip. Rushton observes, “We need to cultivate relationships and improve our capacity for trust — both within and across teams and systems. After all, trust is the foundation of quality health care.”

In Other Nursing Research News
Assistant professors Sarah L. Szanton PhD, CRNP, and Kathleen L. Becker, MS, RN, CRNP, doctoral candidate Jeanne Alhusen, and others used their 54 total years as nurse practitioners to identify ways to ease the often daunting transition from student to independent nurse practitioner. [“Taking charge of the challenge: Factors to consider in taking your first nurse practitioner job,” Journal of the American Academy of Nurse Practitioners, July 2010.] The heart health of people with HIV can be damaged by anti-AIDS medications and by more common problems like obesity, smoking, and diabetes. Jason E. Farley, PhD, MPH, NP, Cheryl R. Dennison, PhD, RN, ANP, FAHA, and doctoral candidate Carrie Tudor, MPH, RN, study the central role of nurses in assessing heart risks and promoting preventive practices for these patients. [“Improving cardiovascular risk management among human immunodeficiency virus-positive individuals,” Journal of Cardiovascular Nursing, July/August 2010.]