Nursing research news from Johns Hopkins

20 Years after Cruzan: End of Life Planning Refocused, Reaffirmed

Two decades ago, the landmark Cruzan decision catalyzed individual thinking, policy discussions and lawmaking about advance care directives and choices. In "Twenty years since Cruzan and the Patient Self-Determination Act: Opportunities for improving care at the end of life in critical care settings," [Advanced Critical Care, January-March 2012], Johns Hopkins University School of Nursing professor Cynda Hylton Rushton, PhD, RN, FAAN, and colleagues explore progress and continuing challenges in this difficult, but critically important area of healthcare practice. Advance directives, like the "do not resuscitate" order have been supplanted by advance care planning, a process clarifying to family and other intimates a person's overarching end-of-life choices and preferences, including specific surrogate decision makers. Critical care nurses have a key role in upholding patients' advance care desires while alleviating their suffering and accompanying them through the disease trajectory and death. They also are instrumental in engaging and educating families and treatment teams about key decision points and care transitions. According to Rushton, "We have a moral imperative to honor the people we serve by authentically engaging them in exploring their preferences for decision makers, treatments, and care."

"Two Wives Can't Live in the Same Home:" Sexual Violence Against Men

Research and services for victims of sexual violence most often focus on girls and women. Yet, boys and men are victims of rape and sexual violence, particularly during war or other armed conflict where it can be a conscious strategy. According to a study in the Democratic Republic of Congo (DRC) by associate professor Nancy Glass, PhD, MPH, RN, FAAN, senior research associate Mervyn Christian, MPH, and others, sexual and gender-based violence against men, as for women, often is unreported and untreated and can have lasting, damaging repercussions. In a society, such as the DRC, in which men are the authority, some men deny the rape for fear of ostracism. Others share knowledge of the rape only with their family. And still others, believing the rape has transformed them into women, are convinced they no longer can head a family or earn an income. Rather than confront the stigma, they simply disappear from the community. Glass says, "Clearly, the suffering must be remedied. It doesn't matter whether the victims are male or female. Services can and must be tailored to rebuild lives and families, and to help heal the individual and community wounds left by decades of wartime sexual victimization. The human and economic implications of failing to do so are staggering." [Sexual and gender based violence against men in the Democratic Republic of Congo: Effects on survivors, their families and the community, Medicine, Conflict and Survival, October-December 2011.]

New Approaches To Late Life Wellness through Mindfulness and Monitoring

Wellness promotion activities coupled with ongoing medical monitoring can help older adults live at home despite chronic illness and frailty. But, in these cost-conscious times, wellness programs and health monitoring need to be both effective and inexpensive. Assistant professor Sarah L. Szanton, PhD, CRNP, and professors Gayle Page, DNSc, RN, FAAN, and Laura Gitlin, PhD, are confident this can happen. Writing in the Journal of Urban Health, Szanton, Page and others report on a study of how an eight-week stress reduction program helped low-income, African American older adults lower their blood pressure more than those who participated in a social support group. The program, ELDERSHINE, used the concept of mindfulness to help participants improve coping skills, patience and self-awareness. The results: Lower levels of stress-related high blood pressure, and high levels of participant enjoyment. According to Szanton, "This low-tech, low-cost program and others like it can help narrow ongoing disparities in health outcomes among medically underserved older adults." [Evaluation of a mindfulness-based intervention program to decrease blood pressure in low-income African-American older adults, February, 2012.] In other work, Szanton joined Gitlin and other colleagues to explore a more high-tech approach to low-income older adult wellness. By combining use of in-home game systems (e.g., Nintendo Wii©) to monitor weight and balance with a smart phone-based reminder and check-up system, this preliminary study found that when used together, the tools may be helpful as a low-cost strategy to help reduce heart and fall-related risks in older adults. ["A closed-loop approach for improving the wellness of low-income elders at home using game consoles," IEEE Communications Magazine, January 2012.]

In Other Nursing Research News

Assistant professor Jason E. Farley, PhD, MPH, CRNP, doctoral candidate Carrie Tudor, MPH, BS, and graduate student Kara Franz, NP, underscore the urgent need for South African tuberculosis facilities to improve infection control practices to curb widespread transmission of drug resistant tuberculosis in "A national infection control evaluation of drug-resistant tuberculosis hospitals in South Africa." [International Journal of Tuberculosis and Lung, January 2012.] Growing reliance on electronic health records (EHRs) led associate professor Patricia Abbott, PhD, RN, FACMI, FAAN, to coauthor a manual delineating ways to assure EHR effectiveness and efficiency. [Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records, National Institute of Standards and Technology, February 2012.] A recent poster session by instructors Kathryn Kushto-Reese, MSN, RN, and Shari Lynn, MSN, RN, examined the use of new technologies, including the Internet, in nurse education ["Videos, vimeos and mediasites: A creative, high impact teaching strategy," Institute for Educators in Nursing and Allied Health Professionals, February 2012.] Professor Pamela Jeffries, PhD, RN, ANEF, FAAN, co-authored Developing Successful Health Care Education Simulation Centers—The Consortium Model on the use of cost-effective simulation technologies in health professional education (Springer Publishing, 2012) as well as a chapter, "Clinical simulations: An experiential student-centered pedagogical approach," in Teaching in Nursing: A Guide for Faculty (Elsevier Saunders 2011). Writing in the Journal of Clinical Care, doctoral candidate Vinciya Pandian, PhD(c), CRNP, and others explore factors affecting survival rates in patients needing short- and longer-term mechanical breathing assistance, an increasingly common practice. ["Predictors of short-term mortality in patients undergoing percutaneous dilatational tracheostomy," December 2011.] The significant number of neuroscience ICU patients who experience subclinical seizures led professor Christine Savage, PhD, RN, CARN and others to author "The Effectiveness of a Staff Education Program on the Use of Continuous EEG with Patients in Neuroscience Intensive Care Units," testing the effectiveness of a staff educational program aimed at improving the knowledge of nurses in the use of cEEG monitoring in adults. [Journal of Neuroscience Nursing, April 2012]