The Effects of Gene-Environment Interaction on Blood Pressure among African Americans

The Effects of Gene-Environment Interaction on Blood Pressure among African Americans

Jacquelyn Taylor, PhD, PNP-BC, RN, FAHA, FAAN, was recently elected to the National Academy of Medicine, and part of what those who selected her considered was her research on gene-environment interaction and its effects on blood pressure among African Americans.

“African American women have the highest incidence and prevalence of hypertension among any ethnic, racial, and gender group in the United States,” explains Taylor, who works at NYU Rory Meyers College of Nursing as the first Vernice D. Ferguson Endowed Chair. “It is important for me to understand not only the genetic or hereditary underpinnings of this health disparity, but also the psychological and/or environment interaction with genomic risks that may influence development of hypertension.”

In her research, Taylor says that she’s focused for the most part on African American women and children. Most of her studies have drawn on two or three generations of African Americans. While the ages of the children studied have often been wide, in her most recent study, she targeted children from head start programs, who ranged in age from 3-5 years old, along with their biological mothers.

“We have had a lot of discoveries in our research and have disseminated our findings in journals ranging from nursing, medical, public health, genomic, and interdisciplinary. Overall, we have found that gene-environment interactions for certain factors such as parenting stress, perceived racism and discrimination, and others significantly influence increases in blood pressure,” says Taylor.

She admits that she wasn’t shocked by the findings: “The findings were not all that surprising as I expected that social determinants of health were significant factors in health outcomes and looking at the combinatorial effects with genetics and epigenetics only further illuminates that magnitude of interaction on health outcomes such as hypertension,” Taylor says.

Although Taylor says that her research is important because of what she did discover, “One important aspect of the research is that we are able to identify genetic risk for chronic diseases such as hypertension in children as young as three prior to them developing the disorder. Early identification of risk provides an opportunity for nurses and other health professionals to intervene to reduce risk of developing hypertension as in previous generations. Interventions based on the research with this population may require focusing on social determinants of health and lifestyle modification in addition to or rather than conventional pharmacological methods.”

Critical Care Nurses Spread Holiday Cheer with Elf on a Shelf

Critical Care Nurses Spread Holiday Cheer with Elf on a Shelf

Don’t say that the American Association of Critical-Care Nurses (AACN) doesn’t know how to have fun—during the holidays, they definitely do. AACN is currently in the midst of their second annual Elf on the Shelf social media photo sweepstakes. And it’s hilarious.

(If you don’t know what The Elf on the Shelf is, he’s a doll that is said to watch over children during the holidays for Santa. Some parents have gotten creative and set up entire scenarios for him each night—and many put him in a different place in the home each evening, so that in the morning, children think he is watching them. Adults in general have done many other things with The Elf on the Shelf, many of which are also hilarious.)

Nurses at units all over the country are taking your average Elf on the Shelf and dressing him up, sending him on adventures, and making him a part of the health care community.

We asked some nurses who have participated the following questions:

  1. Tell us about your Elf on the Shelf.
  2. What was the response to your Elf on the Shelf (from patients, colleagues, etc.)
  3. What other activities does your team do to bring holiday spirit into the unit?
  4. How does that help your unit?

The answers from three nurses, and photo of their Elves on Shelves follow.

If you’d like to enter the AACN sweepstakes, visit their Facebook page here. Note that it ends on December 23, 6 a.m. Pacific time.

Now, on to the Elves…

Heather Woods, BSN, RN, NRP, Critical Care Manager at Schneck Medical Center, Seymour, Indiana:

1. We are starting our third year with our Elf on the Shelf. I was just beginning as a manager in 2016. I bought the elf to help boost morale on my units to encourage team bonding, creativity, and build good old Christmas spirit. The nursing staff had a contest on naming our elf. It has now become our tradition, and staff asked where our elf was this year.

2. The patients, families, nurses, physicians, and other employees love to see what adventures our elf has on the unit.  It amazes me how creative everyone gets with “Levophred” and “Amio.”

3. To bring Christmas spirit into the units, we adopt families and collect gifts for them. We go caroling together at the local nursing home. We pass socks, mittens, and blankets out to residents. (These items are provided by the staff.) This year, we added a wreath-making class into our activities. We do a traditional-themed Christmas party with secret Santa gifts as well. All of our events are decided upon with our unit-based council.

4. All of these activities really help boost morale in our ICU and Moderate Acute Adult Care Unit (MAACU) and bring our team together. I am very lucky to lead such a caring group.

Natalie Kresak, BSN, RN, Assistant Nurse Manager ICU, University Hospitals, UH Parma Medical Center, Parma Ohio:

1. The elves were inspired by all the employees in the Medical ICU at UH Parma Hospital. We work tirelessly and compassionately to provide the best care and experience for all our patients and their families just like Santa’s elves do! I made the elves using my cricut machine and decided the weekend after Thanksgiving (of course this was my weekend to work) to surprise the staff returning Monday to turn the unit into “Santa’s workshop” and spread the Holiday cheer.

2. The staff, families visiting, and all employees enjoyed the sight of the holiday elves. It brought a smile or laugh to them at times when sometimes that was impossible, given the setting.

3. We decorate every year with holiday-themed décor. We are a medical ICU department so we make heart rhythms out of garland and hang them up and add snowflakes to the windows of patients’ rooms with kind words on them. The staff also participates in a secret gift exchange to help spread the cheer amongst us all and partakes in a holiday party at a local restaurant or employee’s home.

4. This helps our unit feel more like home for the holidays to those who have to work and be away from their families, but also to the patients and families who are missing out as well. It brings us closer, sharing in gifts or treats that we exchange too!

Elf on the ShelfAlexandra Del Barco, BSN, RN, PCCN, TCRN, Senior Clinical Nurse I, and Tiffany Coleman RN, CCRN, TCRN, Clinical Nurse II, Neurotrauma Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center in Baltimore, Maryland:

1. Two years ago, Tiffany Coleman introduced “Trauma Trixie” to our Neurotrauma Critical Care Unit. Tiffany hoped Trauma Trixie would bring holiday cheer to the unit as a center-piece for our decorations. She also anticipated Trauma Trixie would give us an advantage in winning the holiday decorating contest sponsored by the Shock Trauma Center Healthy Work Environment Committee. (This contest judges holiday decorations on units throughout the Shock Trauma Center to determine winners in various categories such as Craziest or Most Elegant.)

Our unit staff worked together to create different scenes with Trauma Trixie as well as to find creative ways to make miniatures of the equipment we frequently use on our patient population such as a Stryker frame to prone patients made out of Yankauers and a Halo vest made from pipe cleaners. Tiffany even created an Instagram page for her @ntcc_trauma_trixie.

2. Trauma Trixie helped the unit staff to bond as we all brainstormed different creative ideas on what poses and accessories she would take on next. Families thought it was creative and the administration did as well! The first year was such a success that we won the 2017 Holiday Decorating Contest!

3. Our unit loves decorating for the holidays to get in the holiday spirit. We have a Secret Santa gift exchange for those that want to participate and hold a unit holiday party. At this year’s party we will be exchanging Secret Santa gifts as well as announcing our 2020 unit goals.

4. Doing activities such as working together to decorate Trauma Trixie, exchanging Secret Santa gifts, and having a holiday party definitely helps with teamwork, unit morale, and nurse satisfaction. Neurotrauma Critical Care is a very difficult unit to work on primarily because of the nature of our patients’ injuries–traumatic spinal cord and brain injuries. Having activities that boost unit morale are important in fostering a healthy work environment.

10 Healthy Gifts to Give this Holiday Season

10 Healthy Gifts to Give this Holiday Season

If you’re looking for special gifts to give to people you love or care about this holiday season, give them something they might not expect—even if you are a nurse—a healthy gift.

Teri Dreher, RN, iRNPA, CCM, a Board Certified Patient Advocate and founder of Seniors Alone Guardianship & Advocacy Services and NShore Patient Advocates, came up with a ton of great ideas for health-related gifts that she shared with us.

As for figuring out how to give healthy gifts, Dreher says, “Think in terms of gifts that support a healthy lifestyle and emotional well-being or that emphasize relationships over material things. Such gifts come in all shapes and price points. With a little thought, you can find such gifts for everyone on your list—from your nearest and dearest to your children’s teachers and your neighbors.”

 

 

1. A fitness track or smart watch.

For the person who wants to start up or increase their fitness program. “These irresistible gadgets can be highly motivational,” says Dreher.


 

2. A health club membership or session with a personal trainer.

These are great for someone who has been told to start a fitness program, but needs motivation. (We add that you should make sure this will be received well. Some folks might get upset if they wouldn’t want it.)


 

3. A getaway for two.

“People who take vacations live longer. Surprise your honey or your bestie with a long weekend somewhere warm and fun.”


 

4. A massage gift card.

“Who is the most stressed-out friend you have? Gift them with a soothing massage—a gentle reminder to slow down and take care of themselves.”


 

5. A pet.

“People would get out to walk a dog, thereby getting exercise as well as living longer and healthier. This is a personal gift, though, and should be wanted/needed and come with an offer to sit when the loved older person needs a break. Also think about the lifespan of each party. An older rescue dog who is housebroken may be ideal for a lonely senior. It gives them a reason to get up and care for someone else and is a source of unconditional love and affection. A mild-mannered rescue cat would be a wonderful gift. An older cat would be calmer and sleep on the lap of an older person, providing comfort for both of them.”


 

6. A gift card for a bookstore or books that will encourage learning or mental, physical, and spiritual growth.

“[Put them] in a basket with coffee/tea, a special mug, a warming neck wrap for sore muscles, etc. Wrap everything in love, not hints to control of change the person. Play on their interests.”


 

7. A season of snowplowing.

“The link between heart attacks and snow shoveling is real. A winter of snow-clearing services make a great gift for an older family member.”


 

8. An air fryer, hot pot, or sparkling water maker.

“These kitchen appliances encourage easy, healthful food prep. Pair with a cookbook and starter supplies.”


 

9. Nuts, dried fruit, or a fruit basket.

“A healthier alternative to cookies or candy. You’ll be surprised how many people will love this.”


 

10. A little of your time.

Don’t forget senior orphans—elderly people who are alone. “Not only do they have no one to exchange gifts with this holiday season, they may be silently struggling to get by. Bringing over an occasional meal and offering a little company allows you to keep an eye on them. And if at some point you see that they need help, contact your local senior organization or social service agency. Don’t let them fall through the cracks,” says Dreher.


 

NYU Professor Jacquelyn Taylor Strengthens Nursing’s Voice in National Academy of Medicine

NYU Professor Jacquelyn Taylor Strengthens Nursing’s Voice in National Academy of Medicine

Jacquelyn Taylor, PhD, PNP-BC, RN, FAHA, FAAN, has spent her career working hard, and as a result, she’s been a standout.

But she recently received an outstanding honor when she was elected to the National Academy of Medicine (NAM)—and she’s only one of two nurses selected this year.

“It is a tremendous honor to be selected as a member of NAM,” says Taylor. “Membership in NAM is one of the highest honors you can achieve in science and medicine.”

In order to be elected to NAM, Taylor explains that you must be nominated by a current member, as nominees are not involved in the nomination process. When you are elected to NAM, it means that you have been elected by a group of experts who see you as a premiere expert in your particular field.

According to a statement from NYU Rory Meyers College of Nursing, Taylor has been recognized for her “bench-to-community research in gene-environment interaction studies on blood pressure among African-Americans that has provided novel contributions on SDoH and omic underpinnings of hypertension.”

“These newly elected members represent the most exceptional scholars and leaders whose remarkable work had advanced science, medicine, and health in the U.S. and around the globe,” NAM President Victor J. Dzau said in a statement. “Their expertise will be vital to addressing today’s most pressing health and scientific challenges and informing the future of health and medicine for the benefit of us all. I am honored to welcome these esteemed individuals to the National Academy of Medicine.”

While Taylor now works as a Professor and Vernice D. Ferguson Professor in Health Equity at the NYU Rory Meyers College of Nursing, she began her academic career working as an Assistant Professor and Director of the Pediatric Nurse Practitioner Program at the School of Nursing at the University of Michigan. Taylor then worked for nine years at Yale, and became the first African American woman to go through the tenure track ranks. In 2014, she earned tenure. Later, Taylor was named the first Associate Dean of Diversity at the Yale School of Nursing where she remained until going to NYU Rory Meyers College of Nursing. She then came to NYU to serve as the first Vernice D. Ferguson Endowed Chair. She also is the Director of the Meyers Biological Laboratory and Co-PI and Co-Director of the P20 Exploratory Center on Precision Health in Diverse Populations.

“Nurses have been members of NAM for a very long time. It is very important to have a membership that is diverse across health disciplines such as Nursing, Dentistry, and Medicine because all work together for the greater good of patients,” says Taylor. “I believe that my membership in NAM will add a greater voice and representation of nursing as an integral part of scientific research and practice.”

Taylor also hopes that this membership will open up opportunities so that she can “move the science forward in a more robust way and at an even larger scale.”

Communicating with Patients Who Have Developmental Disabilities

Communicating with Patients Who Have Developmental Disabilities

As a nurse, being able to communicate effectively with patients is crucial. But communicating with patients who have developmental disabilities may be more difficult at times.

Georgia Reiner, Risk Specialist, Nurses Service Organization (NSO), knows how to interact with these types of patients and answered our questions on what you can do to communicate with them better.

Why should nurses communicate differently with patients with developmental disabilities? When do they need to make sure that a parent or guardian is there?

People with developmental disabilities such as Down syndrome or who are on the autism spectrum face significant barriers to accessing quality care. Inadequate communication between the patient and health care providers is one of those barriers that can result in harm to the patient. Effective communication is the keystone for ensuring quality, patient-centered care for patients who have developmental disabilities. With skill and patience, nurses can help keep patients safe.

It is important to ask patients if they want their support worker or caregiver to stay with them.

What should nurses do to communicate better with these specific patients?

In order to communicate better with specific patients, nurses must establish the patient’s communication strengths and challenges and tailor their approach accordingly. Nurses need to document preferences in the patient’s health record so that they are accessible to all members of the team.

It is also very important for nurses to allow enough time to listen and understand that interactions may take longer. Nurses need to know that differences in muscle tone for some individuals may complicate reading their facial expressions or body language. Additionally, it is important to choose appropriate, concrete language. Explaining concepts clearly and directly while using specific words and visual aids can be very helpful.

How can they make sure that they are being clear while not “talking down” to these patients?

Nurses can make sure that they are being clear while not “talking down” to these patients by establishing rapport. They need to make sure that they are speaking directly to the patient—as opposed to a family member or caregiver—when possible. It is also important to avoid talking to an adult as if he or she is a child. Nurses should take time to assess the patient’s understanding and to validate their own perceptions to make sure they are understanding the patient. Nurses are encouraged to use the “teach-back” method to ask the patient to repeat the information back to them.

What are the most important concepts that nurses should keep in mind when communicating with these patients?

It is important for nurses to give patients with developmental disabilities exact instructions and explain what they are doing in sequence. Try to eliminate distractions where possible, by meeting in a private, quiet room.

Nurses should also avoid asking abstract questions, and instead be direct. For example, ask “Are you tired?” instead of “How do you feel?”

If the patient uses a communication device that you are not familiar with and the patient cannot show you how to use it, ask the caregiver to do so.

Let patients know they can bring a favorite item they like to have with them in order to help regulate sensory stimuli.

What should nurses never do while communicating with these patients?

Nurses should never shout; speak slowly, in a normal tone of voice.

Nurses should never assume that their body language and facial expressions will be understood. Respect differences in communication style. For example, many patients with autism spectrum disorder prefer avoiding eye contact.

Nurses should never touch a patient without telling them when and where before doing so. Act out or demonstrate actions for patients who prefer non-verbal communication.

What else is important for our readers to know about communicating with patients with developmental disabilities?

People with developmental disabilities deserve the best possible care from health care providers, including preventive health measures and appropriate management of health conditions. By being knowledgeable on how to effectively communicate with patients who have developmental disabilities, and practicing different communication strategies, nurses can become more confident, and provide patient-centered care. Through thoughtful communication and collaboration with caregivers, family, and the interprofessional team, nurses can help achieve the goal of optimal care—and optimal outcomes.

Nurses are only one segment of the interprofessional team, but they are frequently the strongest patient advocate. At the end of the day, working as a team, advocating for patients, providing information and education in the patient’s preferred communication style, and collaborating with caregivers and family members, can help nurses end the stigma of caring for patients with developmental disabilities and achieve the goal of optimal care and outcomes.