Illustration by Leo Acadia
A computer-based health survey can lead to significantly higher screening and detection rates of intimate partner violence (IPV), report collaborating nurse researchers from the Johns Hopkins Hospital and Johns Hopkins University School of Nursing. Deborah Trautman, the hospital’s director of nursing for emergency medicine, and Jacquelyn C. Campbell, PhD, RN, FAAN, nursing professor, published their results with colleagues in the April 2007 issue of Annals of Emergency Medicine.
The researchers, who conducted their study among women seeking emergency department (ED) care at a major hospital, found that the self-administered health survey containing questions about intimate partner violence produced dramatic results in reports of IPV risk. Among those women taking the self-administered screening, 19 percent were found to have experienced IPV, while only 1 percent of those in the “usual care” group were detected. Social work referrals were also much higher in the computer-screened group than for those who received usual care.
But the study also underscored the need for more effective follow-up. The authors found that even when patients reported risk for IPV, 48 percent of the time emergency department caregivers did not discuss the issue with the patient.
In their conclusions, Campbell, Trautman, and colleagues emphasize the need for enhanced screening and detection methods and for better follow-up. In an earlier intimate partner homicide study, Campbell and colleagues found that 43 percent of the women who were killed had been seen in the health care system—most often in the emergency department—in the year before they were murdered. She notes, “These women might have been saved if we had identified them as abused.”
Illustration by Leo Acadia
A new diagnostic test employing fetal DNA could reduce invasive procedures such as amniocentesis and chorionic villus sampling to determine if birth defects exist, according to a recent study published online in The Lancet. Master’s student Kara Franz and research colleagues at the private biotech firm where she previously worked reported a new methodology for isolating fetal DNA that is present in maternal blood. The study focused particularly on trisomy 21, the chromosomal abnormality associated with Down syndrome. In a test of 60 pregnant women, the test results were correctly established through amniocentesis or newborn reports in 58 of 60 samples. Of the two incorrectly identified samples, one was a false positive and one a false negative. With further refinement, say the study’s authors, the test could become a useful complement to available prenatal tests.
More than 1,000 underserved East Baltimore children enrolled in Head Start are now being annually screened for height, weight, hearing, vision, and blood pressure, thanks to an effective collaboration between the Johns Hopkins University School of Nursing, Head Start, and St. Bernardine Elementary School. The Service Learning community partnership collaboration includes all Hopkins nursing students in pediatric rotations, with 240 to 300 nursing students currently participating. In addition to the screenings, the program has helped the elementary school initiate a variety of health projects, including a walking program, increased physical activity, anti-substance abuse classes, and an anti-bullying program.
Faculty members Kathryn Kushto-Reese, MS, RN, Maureen C. Maguire, MSN, RN, JoAnne Silbert-Flagg, MS, RN, Susan Immelt, PhD, RN, and Sarah J. M. Shaefer, PhD, RN, reported on the partnership in the March/April 2007 issue of Nursing Outlook.
For Korean Americans, the barriers to health care promotion research programs can be many, report Hae-Ra Han, PhD, RN, and Miyong T. Kim, PhD, RN, FAAN, in the December 2006 Journal of Immigrant and Minority Health. But, after analyzing 14 prior studies involving more than 2,400 Korean Americans, the authors arrived at a series of successful strategies for researchers to counter these obstacles, including a better understanding of traditions, values, and lifestyles; cultural competencies and culturally sensitive information materials; using ethnic media and ethnic churches as communications tools; building community partnerships; community asset mapping; and utilizing bilingual nurses.
The authors advise that all who work with this group—even those who are bilingual and bicultural themselves—should employ a “cultural humility” that does not assume inherent cultural knowledge as the norm. Han and Kim conclude, “This socially/linguistically isolated population may not have been ‘hard to reach’ after all. Rather, they may simply have been ‘hardly reached’ by researchers.”
Illustration by Leo Acadia
In today’s rapidly changing health care system, a variety of factors—from sicker patients, to increased patient loads, to the need to master new technology—contribute to creating a “burden” on hospital-based nurses that can induce stress and lead to burnout, reports post-doctoral fellow Maya Shaha, PhD, RN, and others, in a study under-taken in small county hospitals in Switzerland.
Shaha and colleagues worked with nursing teams at the hospitals to explore the situations causing “burden,” design interventions for improvement, and evaluate the effectiveness of such plans. At one hospital, for example, nursing teams created a catalog of nursing interventions—from providing sponge baths to administering medication—and prioritized each item, discussing how and when compromises could be made. For example, says Shaha, during “overwhelming” periods, all nurses could be in accordance with the policy that “brushing patients’ teeth is more important than going on rounds with physicians.” Team-level interventions like this one that apply problem-based nursing methods, and interventions that provide new knowledge, hold promise of addressing and alleviating burden on nurses, she says. Shaha completed the study, published in the April/June 2007 issue of Nursing Administration Quarterly, under the guidance of senior associate dean Anne E. Belcher, PhD, RN, AOCN, FAAN.
By Teddi Fine
Photos by Will Kirk
Rachel Walker '07 studied how violence affects HIV prevention behaviors.
Connecticut native Rachel Walker and Colorado-born Chase Gray have much in common. Both served in the Peace Corps before matriculating at the School of Nursing; both graduated with nursing baccalaureates this spring. And, as 2006 recipients of the University Provost’s Undergraduate Research Awards, both have collaborated with faculty mentors on projects valuable to nursing science.
Walker, working with guidance from associate professor Phyllis Sharps, PhD, RN, FAAN, conducted interviews with African-American women in Baltimore City to explore how health-promoting behaviors related to HIV prevention (encouraging partner’s condom use, use of health services, and HIV testing) may be influenced by the experience of intimate partner violence or violence in the community.
Walker’s research among women in Baltimore drew on some of her Peace Corps experience in Mali, where she had worked with local midwives to combat HIV/AIDS and the practice of female genital mutilation to improve women’s health outcomes. “In Mali, the concept of ‘intimate partner violence’ wasn’t a public health focus the way it is in the States. In fact, until I started working with Dr. Sharps, I didn’t even know that a body of research is being built on the topic or that nurse researchers are in the forefront of the field,” she says.
She adds, “Working with Dr. Sharps was incredible. I didn’t just learn about the process of community-based research; I also gained an even greater sense of responsibility to help find answers in the community.”
Walker is working now as an oncology nurse at the Weinberg Center while pursuing graduate studies that include both an MPH and, eventually, a nursing PhD. Her goal: “to work at the policy end to sustain change, to teach, and to improve clinical work at the community level.”
Chase Gray '07 examined the relationship between pain and anxiety using laboratory animals.
Chase Gray, who engaged in animal-based research examining the complex interconnections between pain and anxiety, was paired with mentor Gayle Page, RN, DNSc, FAAN. “Doing heavy science—in this case, testing the effects of induced low-level chronic pain on male and female rats, then measuring for baseline anxiety levels—was very different from anything I had ever done,” says Gray, whose Peace Corps experience took her to Uzbekistan. “I gained an appreciation of what it takes to move knowledge from basic research all the way to community care. It’s a long process with a lot of trial and error and a lot of replication at every step along the way.”
Still in its early pilot stages, the research is asking, for example, whether pain may be amplified as the result of pre-existing or evolving anxiety, or if anxiety is a result of the pain experience. Preliminary pilot data suggest that the pain-anxiety relationship is worth continued investigation, Gray says.
“This research ultimately can help identify better ways to help manage patient pain by showing how pain is affected by other biological and behavioral factors, such as gender and anxiety. And I got to work at the very beginnings of that discovery process,” says Gray, who is considering a PhD in nursing that would eventually allow her to combine teaching, clinical care, and policy-informing research.
In late spring, Gillian Condell ’08 was selected as the school’s Provost’s Undergraduate Research Award recipient for 2007-08. Through animal studies conducted with faculty member Gayle Page, she will be examining whether the medications used to treat post-surgical pain will aid or hinder the normalization of sleep patterns after surgery.
By Kelly Bower, MSN/MPH, RN
Photo by Will Kirk
Exulting in the “Aha!” Moments
When I entered the school’s accelerated BSN program in July 1999, I never imagined that I would eventually find myself at the front of those same classrooms. I still remember my first patient, my first care plan, the intensity of the seven-week classes, and my quest for an answer to the ultimate question: What would I do when I finally earned this degree?
The 13 months passed at lightning speed and in July 2000 I was pinned by my teary-eyed mom. But even before the pinning ceremony, I had begun the MSN/MPH program. While working on these degrees full time, I started a part-time job as a public health nurse at Dayspring Programs, Inc, a community agency that works with women who are in recovery from substance abuse and with children. This was a specialty area I never imagined pursuing and it turned into a six-year experience rich in learning about the challenges faced by the East Baltimore community. It was also where I found my passion for work in urban health and addressing health disparities.
Toward the end of my master’s program, I found myself raving to a School of Nursing faculty member about what a great experience Dayspring would provide undergraduates as a public health clinical site. To my surprise, her response was, “You’re hired.” I was not looking for a job; in fact, the idea of teaching had never entered my mind. But I was in need of post-graduation financial security, so I decided to give it a try and was hired as an instructor at the School of Nursing. The position allowed me to continue my practice at Dayspring three days a week and work as a clinical instructor two days a week.
It was challenging to develop the skill set needed for teaching; after all, I’d been trained as a nurse, not as a teacher. I sought out mentorship from colleagues whose teaching abilities I admired—and I’ve benefited greatly from the wisdom and experience they have shared. During my six years at the school I have moved from clinical teaching to classroom teaching. I have had two clinical practices, and I have realized that I love to teach. I enjoy helping students arrive at “Aha!” moments and find that their enthusiasm and optimism are contagious. I find satisfaction in mentoring students who have the same questions and anxieties I once had as they embark on their journey into nursing. I feel excited and confident about the future of nursing knowing that the students I teach are the professional leaders of tomorrow. They are full of passion and tremendous potential.
During my years at the school, little has changed (though class size has grown in an effort to ameliorate the nursing shortage and the fashion of the nursing student uniform has significantly improved). Spring and summer continue to be times of transition at the Johns Hopkins University School of Nursing. Tired, proud, confident students graduate in May and July and fresh, eager, novice students enter in June and September. It is a time when I find myself reflecting on my own professional transitions, the evolution of my career, and the lessons I’ve learned along the way. Seek out role models and mentorship; it is vitally important. However, understand that nursing is a flexible and creative profession in which there are many paths that will take you to your final destination. Know yourself. This self-awareness will give you the confidence you need to find a path that is best suited to you. Have a plan but keep an open mind. Life has a way of presenting opportunities and taking you places you don’t expect, but if you aren’t open to seeing them, you’ll never know the great satisfaction they may hold. And a lesson learned from my mom, Enjoy the journey. If you don’t, the final destination is not as sweet!
Conducting research, providing bedside care, advocating for community health-Hopkins nursing students do it all, from local to global.
Claudine Hennessey and Jeane Garcia, Cape Town South Africa
This summer, juniors Jeane Garcia and Claudine Hennessey are conducting research in Cape Town, South Africa, as part of the Minority Health and Health Disparities International Research Training (MHIRT) program. Working with researchers from the University of Cape Town, the students are analyzing the patterns of injury of women who experience rape homicides. The goal: to propose nursing and public health interventions based on the data they collect. Garcia describes the experience as “very CSI but much more gritty and incredible!”
Public Health Nursing in Haiti
Megham Bodkin, Jeremie, Haiti
Danielle Setiawan, Jeremie, Haiti
Students from the Traditional Class of 2007 traveled to Haiti in late winter to conduct community assessments and practice public health nursing skills. A group of Accelerated 2007 students followed in May and provided a glimpse into their international learning experience through their online blog:
Day 6: Holistic care
“Working at the Missionaries of Charity
was the perfect way to end our week in Haiti. Providing holistic, basic care was exactly what the patients—and we—needed. There’s a lot to be said for medical advances, for expensive drugs and technology. But in an area like Jeremie, where much medical care as we know it just isn’t available, a return to basic, low-technology nursing proved quite effective. The activity was intensely moving for both patient and student nurse.”
Lisa Becker and Julia Irwin, Singapore
In the spring and summer of 2007, 24 Hopkins nursing students traveled to locations in South Africa, Singapore, China, and the United Arab Emirates to complete the final 200-hour clinical rotation required to receive their degree.
This spring, seniors Lisa Becker and Julia Irwin worked in Singapore’s Tan Tock Seng Hospital. “Nursing practice is very similar between Singapore and the U.S., with a few striking differences,” says Becker. “Perhaps most notable was the class system used in determining hospital care.”
MSN/MPH student Kara Franz worked in the children’s ward at St. Patrick’s Hospital in the Eastern Cape of South Africa. “It was interesting to have to learn to adapt in a resource-poor facility without the use of technologies that we take for granted here in the U.S.,” says Franz.
Seniors Ron Noecker and Nicole Weddig conducted their final clinical at the Beijing United Family Hospital.
Ron Noecker and Nicole Weddig, Beijing, China
Ron Noecker, Beijing, China
By Karen Haller, PhD, RN
VP of Nursing and Patient Care Services,
Johns Hopkins Hospital
Building a new tradition at an institution steeped in history takes months of careful planning. So it is with the photographic exhibits that grace the Nutting Hallway, and change biennially to reflect another face of Hopkins Nursing.
This year, a new exhibit demonstrates how nurses, through collaboration and teamwork, have discovered new ways to improve patient care.
You are invited to meet Sharon Thompson, RN, and Amy Horne, RN who worked with physician colleagues Deborah Armstrong and Rob Bristow to promote the results of a Johns Hopkins clinical trial published in the New England Journal of Medicine in January 2006. The trial led the National Cancer Institute to recommend a new chemotherapy method that can prolong survival for ovarian cancer patients. Our nurses spearheaded the production of a DVD to teach other nurses this new technique and have distributed more than 1,000 copies worldwide.
In another photo-collage, you will meet Martha Kennedy, PhD, RN, an acute-care nurse practitioner who collaborated with Ed Horn, Pharm D, and Amy Campbell, respiratory therapist, to promote a team-based approach to improving patient outcomes in the surgical intensive care units. Patient care and safety were enhanced by developing protocols that are discussed and coordinated among team members and specialists from multiple areas. Many of this team’s innovative treatment plans have been adopted nationwide and worldwide.
The photo collection is located in the corridor that extends to the right just beyond the hospital’s Wolfe Street entrance. Thanks are given to photographer William Gray who coaxed the personality from our professionals, and created an aesthetically pleasing tribute to Hopkins nurses.
By Kelly Brooks-Staub
2007 award winners.Back row (l-r): Cynda Rushton, Jennifer Calhoun, John Shearin, Janice Hofman. Front row (l-r): Jackie Oliver, Marie Davidson. Not pictured: Amanda Pflaumer
At a schoolwide award ceremony on May 2, staff members Marie Davidson, Jackie Oliver, Amanda Pflaumer, John Shearin, and Jennifer Calhoun
were recognized for achieve-ment with School of Nursing Dean’s Awards. Through a program initiated by Dean Martha N. Hill, PhD, RN, FAAN, the awards are given to outstanding employees who “exemplify the school’s values” and “set a standard of excellence in the workplace.”
At the same ceremony, faculty members Janice Hoffman, PhD, RN, and Cynda Rushton, PhD, RN, FAAN, were named the 2007 recipients of the Johns Hopkins University Alumni Association Excellence in Teaching Awards.
Hoffman, who received the Baccalaureate Excellence in Teaching Award, “is the ultimate teacher,” according to students who nominated her. Her achievement stems from her devotion to nursing education, which is the focus of her research and her area of nursing expertise. One nominator noted, “She is more than a teacher—she is a mentor, a counselor, and a friend.”
Associate professor Cynda Rushton received the Graduate Excellence in Teaching Award. A nationally recognized expert in bioethics and palliative care, Rushton guides graduate students in learning how to deal with the unique ethical issues that arise in nursing practice. Her classes on nursing ethics “often made me see the case in another light,” said one graduate student nominator, adding, “She is enthusiastic about the field of ethics and that shows to the students.”