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Nurses Ease the Wounded Heart

Moral distress, spirituality, domestic violence, and health care disparities are among the issues nurse researchers at The Johns Hopkins University School of Nursing (JHUSON) are exploring in efforts to care for and heal //the wounded lives of a wide variety of audiences.

Sick at Heart —JHUSON Associate Professor Cynda Hylton Rushton, PhD, RN recently explored the issue of 'moral distress' experienced by many nurses, including those treating critically ill patients. Rushton defines this reaction as 'when clinicians are unable to translate their moral choices into ethically appropriate action' and adds that 'moral distress is a critical, frequently ignored problem in health care work environments. Unaddressed, it restricts nurses' ability to provide optimum patient care and to find job satisfaction...' Rushton cites a study that found half the nurses surveyed reported experiencing moral distress as a result of acting against their consciences in over- or under-treating terminally ill persons. She notes that the costs of this unrelieved moral distress can be high with some nurses leaving their hospital positions and even the profession. She urges health care environments to confront moral distress when it arises and take steps to address it, including implementing the American Association of Critical Care Nurses Association's (AACN) '4 A's Model to Rise Above Moral Distress' - Ask, Affirm, Assess, and Act. This process, coupled with implementing AACN's 'Standards for a Healthy Work Enviroment,' can begin to create a workplace where nurses can practice with integrity while providing quality, safe care.

'Deep in My Heart I Do Believe' (Anonymous African-American Spiritual)—JHUSON faculty members Fannie Gaston-Johansson, PhD, RN and Victoria Mock, DNSc and colleagues have found the spirituality and religiosity that play prominently in African-American culture can influence health practices, beliefs, and outcomes. In a study among African-American women undergoing treatment for breast cancer, the research team saw significant positive correlations between spiritual well-being and a cancer patient's physical, emotional, and functional well-being. Conversely, the study indicated that as negative or lack of religious coping increased, physical well-being decreased. The women in the study described their spirituality as having a significant role in coping with their illness. The study also suggests that culturally competent nurses can recognize the coping strategies used by women from diverse ethnic and racial backgrounds undergoing cancer treatment and work with them to incorporate spiritual well-being and religious coping strategies as part of comprehensive cancer care treatment.

Hearts of Valor—JHUSON researchers Jacquelyn Campbell, PhD, RN and Joan Kub, PhD, RN have found in interviews with active duty military women—25% of whom had experienced domestic violence (DV) during their military service—that less than half of respondents thought abuse should be reported to the commanding officer. Those who had been abused were significantly less likely to agree with informing commanding officers. The interviews revealed that more than 75% of the women agreed that routine screening would make it easier for abused women to get help, but about the same number felt by doing so, many would be at more risk for being hurt. The researchers also found respondents had concerns about the negative effect on their military careers and those of their partners if abuse was disclosed and fears that routine screening/mandatory reporting would make it less likely for military women to disclose abuse. Recent revisions in U.S. military policies—which previously directed all reports be shared with commanding officers—now allow health care providers to keep the DV information confidential if victims so desire.

Home is Where the Heart Is—JHUSON faculty member Nancy Glass, PhD, MPH, RN and colleagues believe that safe and affordable permanent housing can contribute to reducing violence in the lives of women and children. In a four year study based in and partnered with Multnomah County, OR, Glass is evaluating the effectiveness of a community program that provides rent assistance towards permanent housing for survivors of intimate partner violence and their children. Over an 18-month period, researchers will assess violence exposure, housing stability, and physical and mental health outcomes for the battered women and their children who receive the rent assistance and then compare the results to the same outcomes among battered women and their children who do not receive the assistance. The study also will evaluate the cost effectiveness of the rent assistance program. Glass and colleagues are hopeful the findings from this study can be used to influence national housing policies for vulnerable families.

Work is Good for the Heart—Dr. Glass also is leading a unique initiative to reduce health disparities for immigrant and U.S.-born employed Latina survivors of intimate partner violence. In another Oregon-based four-year study, she and colleagues are using community-based participatory research methods to create partnerships among service organizations such as restaurants, hotels/motels, and childcare agencies that typically employ low-income underserved Latinas. To help reduce the disparities battered Latina women face in accessing and receiving health and social services, the team is developing and providing—in the workplace where the Latinas spend most of their day—culturally and linguistically competent safety information, support, and other key resources.

The Heart of a DOVE—Children witnessing the intimate partner violence of their mothers are known to have serious long term physical health, mental health, and behavioral consequences—but little is known about appropriate interventions for these children and their abused mothers. A study led by JHUSON researcher Phyllis Sharps, PhD, RN is investigating the effectiveness of the Domestic Violence Enhanced Home Visitation (DOVE) intervention, a technique where nurses provide information to new and expecting mothers at risk for intimate partner violence. The intervention aims to increase the mothers' awareness of their options and allows them to decide which options seem most useful. Nurses offer written information about the cycle of intimate partner violence, risk factors that may increase a woman's danger of homicide, options for leaving an abusive partner, safety planning, and specific local and national phone numbers for more resources. In clinical trials set in three distinct settings—urban Baltimore, MD, and Kansas City, MO, and rural Missouri—new mothers will be monitored for a history of intimate partner violence, their current level of danger of such violence, adopted safety behaviors, resources used, mental health, and parenting knowledge and skills. Children will be examined for physical and mental development and health problems, including injury. According to Sharps, the study 'could go a long way towards helping the millions of children who witness this violence each year.'

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