There are substantial racial disparities in the burden of lupus, according to initial data from the largest and most far-reaching epidemiology study ever conducted on the disease lupus and published recently in the journal Arthritis and Rheumatism. New data from two registries, part of the National Lupus Patient Registry (NLPR), also reveal that black females disproportionately are burdened by lupus, a devastating and complicated autoimmune disease.
An extensive review of records from hospitals, specialists’ offices, and clinical laboratories in Georgia and Michigan showed blacks had an increased proportion of lupus-related renal (kidney) disease and progression to end-stage renal disease than whites, and that black females developed lupus at a younger age than white females. To learn more, visit www.lupus.org/news.
The NLPR is the first comprehensive population-based epidemiology study in lupus, with five registry sites located in Georgia, Michigan, California, New York, and the Indian Health Service. The sites are collaborating to use similar case definitions and data collection procedures to capture diagnosed lupus in these areas and allow more accurate data comparison, critical in assessing this complicated disease. The Georgia and Michigan sites are the first to report their findings.
With a grant and under direction of the Centers for Disease Control and Prevention (CDC) and in partnership with the Georgia and Michigan state health departments, investigators from Emory University and the University of Michigan led this landmark epidemiology study to include blacks and whites of all ages.
“Black women had very high rates of lupus, with an incidence rate in Georgia nearly three times higher than that for white women, with significantly high rates in the 30-39 age group,” said Georgia principal investigator, S. Sam Lim, MD, MPH, Emory University, Department of Medicine, Division of Rheumatology. “These are young women in the prime of their careers, family, and fertility. This means a severely compromised future, with a disease that waxes and wanes, affecting every aspect of daily living for the rest of their lives.”
“We found a striking difference in patterns of lupus between the black and white populations, which may help us better assess risk for developing this disease,” explained Michigan principal investigator, Emily C. Somers, PhD, ScM, University of Michigan, Departments of Internal Medicine, Environmental Health Sciences, and Obstetrics & Gynecology. “Not only was the peak risk of lupus earlier among black females, but a higher proportion also developed severe or life-threatening complications of lupus, such as neurologic or kidney disease, including end-stage renal disease. Health care providers caring for this population should be aware of the importance of screening for early signs of lupus, in particular kidney disease.”
“The results just from these two registries illuminate the enormous burden of lupus among young women in the prime of their life,” said Sandra C. Raymond, President & CEO, the Lupus Foundation of America. “But data from these sites represent only the tip of the iceberg. Lupus is a complex and diverse disease that can take many forms. We need a more complete understanding of the impact of all forms of lupus among all populations at risk for developing the disease. The data from the next three sites will help to fill in gaps and document the urgent need to elevate lupus to a national health priority.”
The Georgia and Michigan investigators noted the challenges with diagnosing lupus, stating that likely there remain undiagnosed cases in the community and that applying more up-to-date diagnostic criteria might result in even higher incidence and prevalence rates. The investigators also said they plan to use the lupus patient registries to recruit cohorts for ongoing studies to document the progression of the disease and determine the economic burden of lupus over time, which, according to data already available, is substantial.
“The purpose of the National Lupus Patient Registry is to develop more complete population-based incidence and prevalence estimates and to assess the impact of lupus,” said Charles Helmick, MD, medical epidemiologist, CDC.
“The results of previous lupus epidemiology studies have varied widely for a number of reasons, including lack of representation of populations at high risk, different case definitions, and limited or small source populations. The Georgia and Michigan studies include four counties with a combined population of nearly four million people. The large surveillance population, along with the extensive review of records from many sources, has resulted in the most reliable and up-to-date statistics for lupus,” said Helmick.
As a registered nurse and lawyer with training in medical bioethics, Gloria Ramsey, JD, BSN, RN, knew a lot about end-of-life planning. Yet as her mother lay dying in a hospital after suffering a stroke, Ramsey’s knowledge didn’t save her from distress when it came to making final medical decisions for her.
“I will always remember [how my stomach dropped] when the attending physician asked me the question,” she recalls.
Fortunately, Ramsey knew her mother’s wishes and had the support of family members. But what about others, she wondered, who didn’t have a medical background or family to back them up? Today the question fuels her mission to educate minorities about the importance of planning for end-of-life care in advance—before they suffer a serious illness or become incapacitated.
Although most Americans believe patients should have the right to direct their medical treatment at the end of life, less than a quarter of the general population has completed advance directives. And Americans of color are even less likely to have expressed their wishes in writing.
There are two kinds of advance directive documents: a health care power of attorney (also known as a health care proxy), which identifies the person whom patients select to make medical decisions for them if they cannot speak for themselves, and living wills, which spell out patients’ preferences for end-of-life medical treatment, such as the right to refuse life-prolonging care.
“[Advance directives] help avoid the worst thing that can happen—family members left to make agonizing choices because they don’t know what the person wanted,” says Kathy Brandt, MS, vice president of professional leadership, consumer and caregiver services for the National Hospice and Palliative Care Organization (NHPCO). “If you don’t choose for yourself, the choice will be made for you.”
Removing Cultural Barriers
Nurses can make a profound difference by educating patients about the importance of end-of-life care planning. And when it comes to closing the gap of advance directive disparities, minority nurses can play a key role because they bring to the table cultural knowledge and understanding that helps establish trust in communities of color.
Gloria Ramsey, JD, BSN, RN
“Nurses are on the front lines,” says Paul Malley, president of Aging with Dignity, a nonprofit organization in Tallahassee, Fla., that promotes better care for people facing the end of life. “These are questions people feel comfortable asking a nurse.”
Minorities are less likely to complete advance directives for a variety of reasons, including a lack of access to culturally and linguistically appropriate information. Mistrust of the health care system, misperceptions about advance directives and difficulties in understanding medical terminology can also create barriers. Given the long history of racism in this country, some older African Americans suspect they will get inferior medical treatment if they complete advance directives. Many of them have not forgotten the infamous 1932-1972 Tuskegee syphilis experiment, in which 399 African American men with syphilis were misled by researchers and were not given the treatment they needed; 128 died of the disease or related complications as a result.
Ramsey, who has conducted research on African Americans’ perspectives on end-of-life planning, says that some black Americans don’t complete advance directives because they believe their families will know what to do when the time comes. Others view end-of-life treatment planning as giving up hope, or giving up on God. African Americans who do complete advance directives tend to request more aggressive life-sustaining treatment than whites.
In the Chinese culture, talking about death is taboo, and Western concepts of end-of-life care, such as hospice, may be unfamiliar to patients who are immigrants from mainland China. Some Chinese elders may have the fatalistic belief that advance end-of-life planning cannot change the future, according to NHPCO, whose Caring Connections outreach program offers informational resources on end-of-life issues developed specifically for Chinese American and Latino populations.
In focus groups with Latinos, NHPCO found that most participants were unfamiliar with the idea of advance health care planning. There were also linguistic misunderstandings about certain terms, such as “caregiver,” which in the Latino community implies a professional role rather than one undertaken at home by family members. Some Latinos have not heard of hospice and may equate it with nursing homes, which have a negative connotation because they go against the traditional cultural belief that it is the family’s responsibility to care for their sick and elderly relatives.
Still other barriers stem from legal red tape. Each state has its own advance directive laws, and some states require advance directive documents to be notarized in the presence of a lawyer. This can be a problem for minorities who live in low-income or rural communities where there is little or no access to notaries and legal services.
“Although the advance directive laws were written with good intentions, they have created hurdles that are insurmountable for many patients,” says Rebecca Sudore, MD, assistant professor of medicine at the University of California, San Francisco.
Simplifying Advance Directives
In a study published in the June 2008 issue of the Journal of the American Geriatrics Society, a team of researchers headed by Sudore recommended that oral advance directives, based on patients’ discussions with doctors, be made legally binding in all states. The study also emphasized the need for health care professionals and policymakers to facilitate opportunities for discussion about advance care planning in minority communities.
Anna Terrell, MSN, RN, BC
Of the 173 subjects who participated in the study, the majority (73%) were persons of color, and 31% had less than a high school education. The researchers found that subjects who had talked with family, friends or health care professionals about their end-of-life care preferences were more likely to take the next step and complete a written advance directive. Especially in communities where there is distrust of the health care system, says Sudore, the emphasis should be on getting people to think and talk about end-of-life planning rather than looking only at whether they have signed the legal documents.
She also stresses the need for advance directive documents that are easy-to read, easy-to-understand and culturally and linguistically appropriate. In a previous study, Sudore’s research team found that patients in California overwhelmingly preferred a simplified advance directive form to the standard form used in the state. The simplified version, which Sudore created with input from health literacy experts, patients, social workers, nurses and attorneys, uses short sentences, large type and helpful graphics that illustrate the text. Of the 205 people recruited for the study, 40% had limited literacy and 30% spoke only Spanish. Participants were able to complete greater portions of the simplified form, and almost three-quarters said they preferred it. Six months later, 19% of the group assigned to the simplified form had completed an advance directive for their personal use, compared to only 8% of those who were given the standard form. The simplified form, which is written at a fifth-grade reading level, is now legally valid in California and is available in English, Spanish, Chinese and Vietnamese.
Online Resources Nurses and nursing associations can participate in National Health Care Decisions Day (NHDD), an annual initiative held each April to encourage Americans around the country to talk about their future health care decisions and complete an advance directive. The NHDD Web site, www.nationalhealthcaredecisionsday.org, contains educational resources, ideas for community outreach activities, promotional materials and links to national and state-specific information, including copies of advance directives. The Center for Practical Bioethics’ Caring Conversations® consumer education initiative (www.practicalbioethics.org) offers a free advance care planning guidebook to help families share meaningful conversations while preparing to make decisions for end-of-life care. The guide, which includes advance directive documents, is available in English, Spanish and Braille. Aging with Dignity, www.agingwithdignity.org, provides information and resources for end-of-life care planning, including free copies of Five Wishes, an easy-to-understand advance directive available in 20 languages. Caring Connections, www.caringinfo.org, a program of the National Hospice and Palliative Care Organization, offers a variety of free downloadable resources, include state-specific advance directives and consumer education brochures in English, Chinese and Spanish. Key Topics on End-of-Life Care for African Americans, www.iceol.duke.edu/resources/lastmiles/index.html, an “electronic book” published by the Duke Institute on Care at the End of Life’s Initiative to Improve Palliative Care for African Americans, is a collection of papers presented at the Last Miles of the Way Home conference in 2004, the first national conference focusing on end-of-life care issues in the African American community. The Chinese American Coalition for Compassionate Care, www.caccc-usa.org, provides educational resources and advance directive forms in Chinese and English. Free copies of the simplified California Advance Health Care Directive developed by Rebecca Sudore, MD, of the University of California, San Francisco are available in English, Spanish, Chinese and Vietnamese from the Institute for Healthcare Advancement (IHA), www.iha4health.org. Bulk copies can be ordered by contacting IHA at (800) 434-4633 or [email protected]. What Y’all Gon’ Do With Me? The African American Spiritual and Ethical Guide to End of Life Care by Gloria Thomas Anderson, LMSW, can be ordered from her Web site, www.hearttones.com, or by emailing her directly at [email protected]. The Web site www.DoYourProxy.org offers a free online tool that helps people quickly and easily create a health care proxy and/or a living will.
Other organizations have also been working to make advance directives simpler. In 1998, Aging with Dignity introduced Five Wishes, an easy-to-use advance directive written in plain language. The document includes a health care proxy and lets people state their preferences regarding the kind of medical treatment they want or don’t want, how comfortable they want to be and what information they want their loved ones to know.
“It asks all the right questions and doesn’t make any assumptions about where someone is coming from,” Malley says. Five Wishes is valid in 40 states, and it can be used as a helpful guideline in states where the document does not meet legal requirements.
Two years ago, Aging with Dignity launched the 500,000 Wishes campaign, an outreach program designed to raise awareness of the need for advance care planning in minority communities. Funded by a $200,000 grant from the United Health Foundation, the campaign translated Five Wishes into 20 languages—including Arabic, Hindi, Hmong, Somali and Korean—and offered them for free. So far 250,000 have been distributed to individuals, community organizations, hospitals and hospices nationwide—halfway to the campaign’s goal of reaching a half million minority Americans. “Having this type of document available in so many languages is a first,” Malley says.
“It’s written in a positive and loving light,” says Leslie Piet, RN, MA, CCM, a nurse case manager in Bel Air, Md., who distributes Five Wishes to her patients. In some cases, she reads it aloud to patients. A passionate advocate for end-of-life planning, Piet was prompted by the 2005 Terri Schiavo right-to-die case to host a “living will party” for her family and friends. People gathered to discuss end-of-life choices and complete the Five Wishes document.
“[In our society,] we plan for bringing our children into this world. Now we need to get into the mindset of preparing for transition from this world,” she says. “When good end-of-life care is done well, patients and their families tend to be at greater peace.”
Positive Messages
To reach people from a variety of cultures, education about advance directives must be framed in a positive way, Piet emphasizes. “It’s not about the things you don’t want. It’s about what you do want.” Most health care facilities are required by the federal Patient Self-Determination Act of 1990 to inform patients about their health care decision-making rights and ask if they have completed an advance directive. But too often this communication with patients becomes a checkbox item.
“It needs to be about more than policy and procedure,” says Anna Terrell, MSN, RN, BC, a retired nurse in Kansas City, Missouri. “It takes some time to sit down with patients and discuss end-of-life care.”
Before her retirement, Terrell educated nurses on advance care planning, served on her hospital’s ethics committee and worked with the Center for Practical Bioethics in Kansas City to learn more about African Americans’ experiences with end-of-life care. She developed a script to use with hospital patients during the admission summary process and tailored it to each patient’s needs, always mindful of their cultural and religious backgrounds.
“You have to be culturally knowledgeable about how to introduce the subject,” she says. “Many African Americans believe that if you bring up the subject of end-of-life care, you’re trying to rush the death.”
Misunderstandings can occur when doctors and nurses don’t consider the issue from their patients’ perspectives. Gloria Thomas Anderson, LMSW, a social worker in Kansas City, recalls how one of her elderly family members became upset and had to be restrained after a nurse asked if she had completed an advance directive.
“She interpreted that to mean that the hospital staff was trying to put her in a nursing home,” Anderson says. “She had avoided medical treatment for over 20 years, because she feared doctors and hospitals.”
After her relative calmed down, Anderson explained that the purpose of the document was not to put her away or to take things from her, but to make sure her family knew her wishes if she were not able to speak for herself. The woman agreed to complete an advance directive, giving one of her adult children power of attorney over her health care needs.
Anderson, who researched end-of-life care for her master’s thesis in 2006, received a grant from the Women’s Council at the University of Missouri-Kansas City to create and produce the booklet What Y’all Gon’ Do With Me? The African American Spiritual and Ethical Guide to End of Life Care. She is now partnering with Kansas City Hospice in a joint effort to distribute the booklet as a free educational resource for African Americans in the Kansas City area. This fall, Anderson will introduce an accompanying outreach training kit that health educators and organizations can use with the booklet to increase awareness of end-of-life issues in the black community.
Forming Coalitions, Building Trust
Sandy Chen Stokes, MSN, RN
Collaborating with other health care professionals and organizations can help nurses make an even bigger difference in closing advance directive knowledge gaps in minority communities. Three years ago, Sandy Chen Stokes, MSN, RN, a public health nurse in El Dorado County, Calif., founded the Chinese American Coalition for Compassionate Care to address the lack of linguistically and culturally appropriate end-of-life care information available to California’s Chinese community. Today the coalition includes more than 50 organizations (including NHPCO), provides training for Chinese-speaking volunteers and family caregivers, and offers advance directives, booklets and other educational resources in Chinese and English.
Less than 1% of Chinese Americans have completed advance directives, Stokes says. In focus groups with Chinese American health consumers, the coalition found that many families did not have adequate information for making informed medical decisions at the end of life, and most believed their choices were limited to either aggressive life-sustaining measures or simply “giving up.”
The coalition’s future plans include developing training for health care professionals, expanding its speakers’ bureau and partnering with additional U.S. and international organizations.
“My hope is that [what we are doing in the Chinese American community] can become a model program for other minority groups,” says Stokes.
As part of her research into African Americans’ attitudes about advance care planning, Gloria Ramsey partnered with a large African American church in Harlem, where she provided education on end-of-life issues and advance directives. Ramsey, now an associate professor at the Uniformed Services University of the Health Sciences Graduate School of Nursing in Bethesda, Md., was on the faculty at New York University at the time. She soon realized that even when nurses share the same ethnicity and culture as the community they’re working with, they must still establish trust and credibility before their outreach efforts can succeed.
“Although I am an African American, and the community saw me as African American, I still had to work hard at gaining their trust,” she says. “I had to show that I had no ulterior motives.”
The church was already receiving numerous requests a month to participate in research projects, and it had recently had a bad experience with another researcher. In situations like this, Ramsey advises, “it is imperative to have a local champion, a key person who can [serve as a gatekeeper].”
She partnered with the parish nurse, who acted as a liaison with the pastor and church members. Ramsey also immersed herself in the community by attending services every Sunday and volunteering with the church’s health ministry. She was careful about how she introduced her project. The parish nurse warned her not to use any language about death and dying, for instance.
Ramsey earned the trust of the congregation, although she hit a roadblock early on when she distributed a bulletin insert mentioning organ donation, a question that’s part of the New York advance directive document. The board of trustees, concerned that she was trying to get something from church members through the back door, requested a meeting. Ramsey addressed their concerns and explained her intentions, and the project moved forward.
But she says in hindsight she would not have brought up organ donation so soon without first providing education to put the issue in perspective.
Ramsey conducted focus groups and used that input to design a comprehensive, multifaceted health education program for the church. It included information on health risks, healthy living, spirituality and health, grief and bereavement, and advance care planning, using Five Wishes. She also shared her own story of making end-of-life decisions for her mother, which brought the issue home to church members on an emotional level. Suddenly she was perceived as not just an academic but also a loving daughter confronting the challenge of carrying out her mother’s wishes.
Today Ramsey continues to think of her mother as the inspiration for her work. “This was her last gift to me,” she says. “By sharing my story with communities of color, I am able to empower them.”
Spring is the season for awards shows—the Academy awards, the Tonys—every time you turn on the television there seems to be another glamorous star stumbling through his or her lengthy acceptance speech. While actors and musicians entertain us, the real heroes in our society—those truly deserving of recognition—are often overlooked. Nurses, who do everything from performing necessary medical procedures to educating patients about health risks to even saving lives, are the real-life heroes, truly deserving of an awards show all their own.
In a special ceremony each year, the National Black Nurses Association (NBNA) does just that by recognizing one exceptional nurse as Nurse of the Year. The award is given to a NBNA member who has made a significant contribution to the nursing profession by promoting educational opportunities for African Americans, performing community service and promoting health policies. This year, Evelyn C. Gardner, RN, BSN, MSN, ARNP, was recognized for her outstanding achievements as a nurse, an educator, a mentor and a health care advocate.
Wanting to Know it All
Gardner, who is the founder and immediate past president of the St. Petersburg, Fla., Black Nurses Association, has been helping minority nurses in one way or another since the beginning of her career. The importance of encouraging other nurses was a lesson she learned before she even became a nurse; while working at a hospital as a clerical supervisor, Gardner was encouraged by the nurses there to go into nursing. They mentored and supported Gardner because they saw in her the potential to become an outstanding nurse. “Those nurses saw something in me that I did not see in myself,” she remembers.
Gardner started out her nursing career in the ’70s as an LPN. She quickly found herself performing many of the same tasks as the RNs but without receiving the same recognition. But it wasn’t the desire for a more prestigious title that motivated Gardner to continue her education; rather it was her drive to learn everything she could about nursing. Not long after receiving her LPN, Gardner went back to school and received an AS from St. Petersburg Junior College and then her AA. She later transferred to the University of South Florida where she received her bachelor’s degree. But Gardner was not content to remain at that level either. After receiving her bachelors, she went on to receive a master’s degree in nursing and an Advanced Registered Nurse Practitioner degree in gerontology.
“When I reached each level, I would stop and think, okay, what’s next? I am an eager learner; I’m self-motivated and I truly love the profession of nursing. I don’t know what it is about nursing—once you get started you just want to know it all!”
Creating a Community Through Education
Not only does Gardner have an insatiable thirst for knowledge, she also has an endless drive to help other minority nurses. Early in her career, Gardner realized that the African-American nurses in her area needed an organization of their own–so she decided to do something about it.
“After I received my masters in nursing, I was working in my community, and I realized how many nurses were in need of professional advice—a lot of them did not know how to access resources. I love to share knowledge, and I wanted to contribute what I had learned in order to benefit my peers,” she explains.
In 1989, Gardner and three of her nursing-friends decided to organize a nursing association—not knowing that they would later connect with the National Black Nurses Association. Gardner was the leader and the motivator of the group. Each time they met, members would bring a friend, and the next time, those friends would bring their friends. Soon they had enough people to organize a charter [to the NBNA??].
“Our association was motivated by the desire to share knowledge and to serve as support for other minority nurses. As a result of being organized, we have accomplished many things.”
Under Gardner’s presidency, an international student exchange program was founded that promotes nursing education to 60 Haitian students, and the St. Petersburg NBNA was awarded the Key to the City for its tutoring and mentoring programs and for the community health fairs it sponsored.
While Gardner’s efforts to help other nurses may seem exceptional, she explains her motivation very simply. “I am a very busy person, but I like helping and learning. Whenever an opportunity presents itself where I can pass my knowledge on to someone else, I am the first one to get involved,” she says.
On top of her many accomplishments, Gardner has also been instrumental in improving nursing education. As the program director for the Practical Nursing and Patient Care Technician program at Pinellas Technical Education Center, she initiated the Senior Citizens Nursing Assistants Home Health Program—a program that teaches nurses how to care for seniors in nursing homes and private residences. Gardner created this program because she saw a need in the community for increased senior citizen care, and she knew she was in a position to help provide it.
“[When creating the program], I looked for those nurses who could be helpful to the community—those who could provide direct quality health care. The nurses I work with [at Pinellas] are some of the most disciplined nurse assistants that you can find—they have all the work ethic, it’s a beautiful group of people to work with.”
“Tell me, Show me, Let me and Praise Me”
As a nurse involved in education, Gardner is keenly aware of the need to improve recruiting efforts of students into the nursing profession. So, what is the best way to encourage young students to become our future nurse leaders? According to Gardner, we need to start recruiting at the grade school level. She encourages minority nurses to go into their communities and be role models for the children. “Spend time in the classrooms and show the children what nursing entails,” Gardner says. She stresses that we cannot wait until the students are ready to go in to college to begin recruiting efforts.
“The majority of the baby-boomers who became nurses in the ’70s will be retiring within the next six years, but the need for quality health care will still be here. If we don’t mentor the new and prospective nurses and teach them leadership skills, I am afraid of where things will lead. Sure, technology is advancing but that will not replace the need for people to provide health care.”
Gardner practices what she preaches. She is involved in mentoring programs at Boca Ceiga High School, St. Petersburg Junior College, St. Petersburg Urban League and the University of South Florida.
All minority nurses should make it a priority to mentor younger nurses, according to Gardner—and not just nurses of their own racial or ethnic minority group. “All nurses need to be mentored. It doesn’t have to be African-American nurses mentoring African Americans, we have to help any one in need,” she says.
“Tell me, show me, let me and praise me—those are the needs of young nurses as they are being mentored. They have to be shown how beneficial they can be as health care providers.”
Clearly Gardner is doing her part to help mentor the new generation of minority nurses, but she is simply doing what was done for her, as a young African-American nurse, years ago. “Back in the ’70s, nurses had many mentors. We had people who really cared about us,” she says. “Even though they didn’t have a lot of formal education to provide, the older nurses offered the wisdom they had acquired through working in the field. I learned from them because I was part of their team, and they were willing to share the knowledge that they had gained.”
Keeping the Ones We’ve Got
While recruiting nurses at an early age is important, according to Gardner, we also need to focus on retaining those nurses once they enter the demanding field of nursing. “Nursing is a tremendously difficult profession. Often the younger nurses don’t realize how grueling it is and how committed one must be in order to be successful as a nurse,” she explains.
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But Gardner believes retention in the nursing field can be improved if older nurses reach back and help younger ones. “We, as nurses, can provide activities that will help them overcome some of the obstacles they encounter at their jobs. We must do anything we can to help them.”
Gardner also believes that nurses at every level need support and encouragement. “I believe whatever level students what to work at is fine. If I have a student who wants to work as a nursing assistant, that’s great; we need people on that level. If I have a student who wants to maintain an LPN license, that’s fine, too, because we need people on that level as well. I let them know how important every stage is—and how important the job of nursing is on any level. However, I do try to motivate students to increase their education if the desire is there.”
What’s Next?
Although Gardner speaks wistfully of her future retirement, when she plans to work as a nursing consultant, she shows no signs of slowing down just yet. In conjunction with the health department, Gardner recently received a grant called “Closing the Gap.” The grant is part of an effort to reduce the health disparities that affect racial and ethnic minorities in Pinellas County. The first effort of the project was to administer pneumonia vaccines to typically underserved populations, which gave her the opportunity to work with people of all different nations.
“There were Asian, Haitians, Cambodians, Philippines and many more. It’s extremely important for those of us in the health care field to come together and work as a nation to deal with health disparities,” Gardner states. “Understanding other cultures specific risk habits and behavior patterns will help nurses prevent diseases, not just treat them. The health arena will be more productive if we look at these issues early—instead of waiting until people are sick.”
Through Gardner’s example, she compels us to work together, using our unique abilities and resources to improve health care for all. As she explains, “Those of us who are educated in health care must come together with different cultures and races and share our knowledge about health. We need to respect the differences within various cultures and communities; we need to work together for the common goal of accessible, quality health care.”
According to U.S. Surgeon General David Satcher, African Americans are twice as likely to suffer a stroke than whites, making them more susceptible to stroke than any other ethnic group. Satcher spoke out on this health disparity during a stroke-screening event in Rockville, Md., called “Stroke Sunday.”
“Strokes have a disproportionate impact among African Americans, but there is something we can do as a community to combat this disease,” states Satcher, who is African American. “We can reduce our risk of stroke by lowering blood pressure, quitting smoking and keeping heart disease and diabetes in check.”
Satcher stressed the importance of African Americans learning the five warning signs of stroke. These signs, as outlined by the American Stroke Association (ASA), are:
1. Numbness or weakness of the arm, face or one side of the body. 2. A severe headache that seems to have no cause. 3. Trouble seeing out of one or both eyes. 4. Loss of balance, dizziness or trouble walking. 5. Confusion and difficulty speaking.
The ASA adds that these symptoms can occur suddenly and reacting to them quickly can make a huge difference in reducing the damaging effects of a stroke.
“A stroke is a medical emergency where every minute counts,” explains Dr. Audrey Penn, deputy director of the National Institute of Neurological Disorders and Stroke. “Immediate treatment can protect the brain from damage caused by reduced blood flow and enhance chances for a successful recovery.”
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