February is American Heart Month — what better time to reassess how well you are taking care of your heart health?
Know Your Risk Factors
As a minority nurse, you probably know certain minority groups have higher risks for heart disease. According to the American Heart Association, African Americans, American Indians/Native Alaskans, and Hispanics have an increased risk of heart disease and its associated problems like high blood pressure, heart attack, and stroke.
Other risk factors include hereditary factors (others in your family have heart disease), smoking, obesity, sedentary lifestyle, and poor diet.
Know the Signs
According to the Centers for Disease Control and Prevention, there are a few heart attack signs and symptoms that you shouldn’t ignore.
If you experience any of these symptoms, call 911 immediately.
- Pain or discomfort in the jaw, neck, or back
- Feeling weak, light-headed, or faint
- Chest pain or discomfort
- Pain or discomfort in arms or shoulder
- Shortness of breath
Women also tend to have symptoms that are different from men and, therefore, aren’t always immediately considered as heart trouble.
Watch for these unusual signs:
- Nausea or vomiting
- Extreme fatigue
- Feelings of unease or anxiety
Heart disease isn’t called the silent killer for no reason. If you feel something is off, whether that’s occasional chest pain with exercise or under stress, heart palpitations, or off-and-on chest discomfort, always be cautious and get it checked.
Reduce Your Risk
If you have risk factors for heart disease, you should monitor your blood pressure, your cholesterol, and your blood sugar. Try to reduce your risk by maintaining a healthy weight, getting enough physical activity, being sure to rest, staying connected with loved ones, and trying to keep your stress levels in check.
With the hectic pace of a nurse’s day, getting any time to bring your stress down a notch is a struggle. But one simple way to help with stress reduction is to step outside. Plenty of research backs up the idea that more time outside is better for your health. A few minutes walking at lunch, parking far enough away in a parking lot, or even just getting a few breaths of fresh air on a break can have huge benefits on your physical health and your mental health. Getting into nature can clear your mind, lower your blood pressure, and help you clear out the mental clutter enough to focus better when you come back to work.
Heart disease is the number-one killer of men and women in the United States, so paying attention to your own heart health is one of the best preventative measures you can take.
The connections between the eye and the brain have been well known and established for centuries. Indeed in a sense the eye is a part of the brain. Often described as the window of the soul, the eye can actually be a window onto our cognitive and neurological functions, being a visible and accessible organ that frequently reflects changes in the larger network.
Conditions such as Alzheimer’s disease, Parkinson’s disease and even Multiple Sclerosis can have eye-based indicators. On a more basic level, the excessive avoidance of eye contact can be suggestive of autism. With roughly 83% of our perception, learning, cognition and activity mediated via sight, the eye is by far our most important sensory organ.
Across the globe eye disease is reaching epidemic proportions. According to a study published in The Lancet last year, in 2015 36 million people worldwide were blind, while a further 217 million were suffering from moderate or severe distance vision impairment. Glaucoma in Asia and Africa is a huge problem that is still on the increase, but the shocking (if hopeful) fact is that 75% of visual impairment is avoidable. 1.1bn people are vision impaired because they don’t have access to spectacles. That is a failure of social, economic and political causes rather than a scientific one. In the meantime, the development of new treatment methods and technology could see the possibilities for full and partial restoration of sight increase dramatically over the next few years.
Rohit Varma, MD, MPH, is a world leader in the study of eye disease. He has recently been researching new imaging techniques in early diagnosis of glaucomatous optic nerve damage and is involved in developing implantable intraocular pressure sensors and drainage devices. He is particularly concerned with studying eye disease in minority populations.
Elsewhere, implantable visual prosthetics have been developed by companies in California (Second Sight), Germany (Retina Implant AG), and France (Pixium Vision), while ground-breaking trials have been carried out in the UK. In 2015, Manchester surgeons restored partial sight to a blind, 80-year-old sufferer from age-related macular degeneration (AMD) using a visual prosthetic, while in 2016 a blind woman was successfully given a “bionic eye” at Oxford Eye Hospital.
So-called bionic eyes stimulate the brain with light from a tiny video camera, but scientists have also begun researching ways to restore vision by working directly on the brain, bypassing the eye altogether. We perceive patterns of light as a result of electrical impulses delivered to the visual cortex. On this basis, Second Sight has begun developing a device that generates similar electrical signals and hopes to recreate some degree of visual perception without working on the eye at all.
In recent years we have seen a huge and helpful boom in smartphone apps to diagnose medical disorders. The applications have also been employed in treating eye conditions. Peek Retina is a portable ophthalmoscope in the form of an app on your phone that can be used to capture and record retinal images and to measure visual acuity. It has been successfully used in diagnosis in remote areas such as sub-Saharan Africa.
EyeNetra meanwhile have developed a diagnostic device for easily spotting refractive errors. A headset is combined with an app to flag up errors in perception and to recommend the correct eyeglass prescription.
Advances in treatment of the eye could also be made possible using the CRISPR-Cas9 gene editing technique. CRISPR has been used to repair a genetic mutation producing retinitis pigmentosa in induced pluripotent stem cells from a patient suffering from the disease. Research at the Center for Genome Engineering at the Institute for Basic Science suggests that CRISPR can be used to correct the effects of non-hereditary conditions as well as inherited ones, following gene surgery on mice suffering from AMD.
It is to be hoped that research will provide us with a better understanding of the connections between the eye and the brain, and the way in which vision works, as well as providing practical solutions to the widespread problems of blindness and vision impairment. Speculation that virtual reality technology might one day be able to recreate our full field of vision within the visual cortex may seem far-fetched but is not beyond the bounds of possibility. Whether brain diseases and even mental illness can ever be treated using similar methods remains to be seen. When we recall that what we see is an interpretation of the world rather than the world as it is, it may be thought that problems of adjustment and understanding could be literally related to how we see things after all.
This month, New York University (NYU) Rory Meyers College of Nursing welcomed Jacquelyn Taylor, PhD, PNP-BC, RN, FAHA, FAAN, as the inaugural Vernice D. Ferguson Professor in Health Equity.
Taylor has already had a notable career. In January 2017, she was awarded the Presidential Early Career Award for Scientists and Engineers by President Barack Obama, the highest honor awarded by the federal government to scientists and engineers, where she will examine next-generation sequencing-environment interactions on cardiovascular outcomes among African Americans.
Vernice D. Ferguson (1928-2012) was a distinguished nurse leader, educator, and executive who championed the health of all people throughout her career. Ferguson, who received a baccalaureate in nursing from NYU, pioneered leadership positions for nurses and elevated the nursing profession through advocating for increased opportunities, respect, and wages, as well as fostering nursing research.
Taylor says it’s a tremendous honor to be selected to serve as the inaugural Vernice D. Ferguson Professor in Health Equity. “It is my sincere hope that the research I lead is as beneficial to the public as the work of the iconic Vernice D. Ferguson.”
Over the course of Taylor’s career her work has focused on health equity in Black populations for common and chronic diseases such as hypertension, both in the United States and in Africa.
“African Americans have the highest incidence and prevalence of hypertension than any other ethnic group in the U.S.,” says Taylor. “In particular, African American women have the highest incidence and prevalence of hypertension than any ethnicity or gender. Understanding the genomic underpinnings and social factors that contribute to this disparity can help providers to intervene early in life to eliminate such disparities. On a personal level, my father had hypertension and had a stroke, and my mother had cardiovascular complications as well. I would like for the work that I do to help others to avoid these complications.”
Another primary goal for Taylor is to study the genomics of lead poising in Flint, Michigan. She says the purpose of this project is to better understand the harmful effects of chronic lead exposure, the psychosocial insults of the Flint water crisis, and the underlying omic mechanisms involved that may contribute to increases in blood pressure in this already at-risk African American population in Flint.
“An intergenerational, multi-omic (genetic and epigenetic), and psychosocial approach will be utilized to understand one of the major symptoms of chronic lead exposure—high blood pressure—among African American families in Flint,” Taylor explains. “This research will provide critical insights that will add a layer of functional outcomes for health providers to best understand, assess, and intervene with tailored treatments based on an individual’s unique environmental, omic, and psychosocial profile and will help in mitigating long-term cardiovascular and other health risks.”
Taylor says her primary goal during her professorship is to continue to build on the work she has done in omic-environment interaction studies among minority populations by utilizing multiple advanced genomic techniques and expanding to more minority populations across the USA and abroad.
“I would also like to expand my reach as a leader in nursing science by taking on a more key administrative role that will aid in building up the next cadre of minority nurse scientists.”
With suicide rates rising and an alarming number of teens and young adults at serious risk for suicide, many health professionals are not fully prepared to recognize a patient’s psychiatric difficulties. A team of researchers at the National Institute of Mental Health (NIMH) recently came up with the ASQ Toolkit, a simple four-question survey for health professionals to help identify and get help for at-risk youth.
NIMH’s Division of Intramural Research Programs created the free Ask Suicide-Screening Questions (ASQ) Toolkit that can be used in various medical settings. According to the NIMH, the toolkit (available in many languages) is easy to use, making it effective in many settings including emergency departments, outpatient clinics, primary care offices, and inpatient medical/surgical units.
Before using the toolkit, organizations must have a plan in place to have a standard set of effective next steps for patients who do test with an outcome that indicates they are at risk. Whether that is a further evaluation with an on-site mental health counselor or another trained professional, the toolkit isn’t meant to be used without a follow-up plan.
No matter what their area of practice or setting, nurses and physicians can quickly assess patients by asking the four questions in the toolkit. If a patient answers yes to any of the questions, it’s a red flag for the medical professionals to consider the patient at risk for suicidal thoughts and behaviors. From there, the toolkit offers guidance on the next steps that will be most helpful for the patient and will also help them access the help they need.
Gaining this extra knowledge is essential skill to have no matter who your general patient population is. According to the World Health Organization, “Suicide accounted for 1.4% of all deaths worldwide, making it the 17th leading cause of death in 2015.” With such astounding facts, it’s imperative that nurses are able to have the tools to support them in identifying youth who might be at-risk. To help that, the toolkit even offers scripts like this nursing script for emergency room settings or this nursing script for inpatient medical/surgical settings.
The toolkit’s importance is highlighted in the rising numbers of youth who die by suicide. But underneath those shocking numbers are the hidden numbers of even greater numbers of people who are suffering with thoughts of suicide or even attempts at suicide. In fact, the American Foundation for Suicide Prevention estimates that for each person who dies from suicide (all ages), 25 more make a suicide attempt. Early intervention by healthcare professionals who can identify the risk and then have the resources to help the patient can be a turning point for the youth.
The ASQ Toolkit is only one resource for nurses to use in helping patients in a mental-health crisis or who are suffering from long-term suicidal ideation. With proper steps in place to help patients who do screen positive, it is also a potentially life-saving tool that healthcare setting and organizations might find worth investigating.
Can a simple B vitamin like folic acid really prevent serious birth defects? The answer is a resounding yes, but taking the vitamin in the easiest days and weeks of pregnancy is key.
When women find out they are pregnant, staying healthy often becomes a top priority. Making sure they are eating nutritious foods, getting enough rest, remaining active, and generally taking care of themselves comes to the forefront. But one of the most critical times for preventing certain birth defects is before a woman even knows she is pregnant.
Sufficient intake of folic acid (folate) can prevent serious birth defects, so January 7 to 13 marks Folic Acid Awareness Week. The observation offers a timely opportunity for nurses to become aware of their own folic acid intake and to open up discussions with their female patients of child-bearing age.
According to the National Birth Defects Prevention Network (NBDPN), sufficient folic acid intake before pregnancy occurs can “prevent up to 70% of some serious birth defects of the brain and spine, called neural tube defects.” Specifically, the vitamin has protective benefits against spina bifida and anencephaly, which begin to develop in the early weeks of pregnancy, often long before a woman even realizes she is pregnant.
Because approximately half of all pregnancies in the United States are unplanned, raising awareness about the protective benefits of sufficient folic acid intake before a pregnancy happens is essential. Luckily, getting the recommended 400 mcg of folic acid is as easy as taking a daily multivitamin or eating fortified pasta, rice, breads, or cereals (at mealtime or as a snack). Often, one small bowl of a fortified cereal can supply the minimum amount for the whole day.
Women who prefer to get enough folic acid from unfortified sources can turn to dark leafy greens, some juices, and many beans. But they need to be aware of the amounts they need to consume to meet the minimum requirement. According to the National Institutes of Health, these non-fortified foods are top sources of folate: beef liver, boiled spinach, black-eyed peas, asparagus, Brussels sprouts, and romaine lettuce.
According to the NBDPN, babies born to Hispanic women have the highest rates of these birth defects and that, in general, Hispanic women consume less folic acid overall and are less aware of the protective benefits of the vitamin during pregnancy.
For nurses, using Folic Acid Awareness Week to open up a conversation and give patients some easy-to-follow information for preventing these birth defects is worthwhile.
As an experienced nurse, a new nurse, or a nursing student in 2018, it’s tough to admit you might be biased toward some of your patients. But it happens, and the best approach to fixing implicit bias is to recognize its presence, and then constantly reassess how you feel and your approach.
Why do nurses have inherent bias? It’s a subconscious human trait and frequently interferes with best nursing practices. An inherent bias doesn’t mean you are racist and it doesn’t mean you shouldn’t be a nurse. Recognizing an inherent bias means that you understand you might have certain feelings about populations, appearances, or mannerisms that need to be addressed and dealt with to provide the best possible care.
In 2017, BMC Medical Ethics published a systematic review assessing a decade’s worth of publications for implicit bias in health care professionals. The conclusions stated a need for additional reviews and more homogeneous methodologies, but determined that implicit bias exists in health care settings and impacts quality and equity of care. Authors Mahzarin Banaji and Anthony Greenwald address the issue in books like Blindspot: Hidden Biases of Good People, as does Augstus White, III, MD, in Seeing Patients: Unconscious Bias in Health Care.
Here’s how to pay attention and fix it.
Notice Your Assumptions
Everything from language barriers to job status to regional inflections can cause people to assume a patient has certain traits, behaviors, or beliefs that you might not agree with. Notice that feeling when you are trying to explain treatments to a patient, when responding to their needs, or when dealing with an extended and involved family.
Understand What Assumptions Trigger in You
You might find there are certain accents, specific items of clothing, or ways of speaking that cause you to tag someone with undeserved qualities. A patient’s race, accent, clothing style, or appearance can spark an instant judgment in you. Do you hold back certain levels of compassion for patients who are more short-tempered? Do you assume low standards in a disheveled, unkempt patient? Does someone’s race affect how you see them?
Know Why It Matters
An implicit bias is not only harmful because it is undeserved, but it can also lead to disparities in care. Even if you are unaware of how you are feeling, your body language, your focused attention, and your level of care can be impacted directly by the way you are feeling. Each patient deserves your full care, so understanding what might trigger you to act differently will make you a better nurse.
Know Your Patient
Talking with your patients is a good way to learn more about them. Understanding cultural differences can also help you become aware of any unconscious bias and begin to overcome it.
Talk About It
You have a bias, but you are not alone. Talking about implicit bias in your work setting opens the conversation, removes the taboo, and paves the way for better patient care and outcomes. When nurses are able to address this topic in an open and nonjudgmental manner, everyone benefits. If you are a nurse manager, holding talks, open sessions, one-on-ones, and seminars gives your staff nurses the tools to confront the issue head on and make significant changes.
Everyone knows about overt bias and the harm it causes, but implicit bias is just as dangerous, and many nurses aren’t even aware they may have a bias. Becoming aware of the problem and realizing if you have any bias is a first step toward fixing the problem.