How do Patient Navigators Contribute to Equitable, Quality and Culturally Appropriate Health Care?

How do Patient Navigators Contribute to Equitable, Quality and Culturally Appropriate Health Care?

In January 2009, the Maricopa Integrated Health System (MIHS) staged the grand opening of the Refugee Women’s Health Clinic in Phoenix, Arizona with Dr. Crista Johnson, MD, FACOG as the founding medical director. It is believed to be the only such clinic in the U.S. specializing in obstetrics and gynecology for refugee women from Africa, Asia and the Middle East.

Dr. Crista Johnson-Agbakwu.“What was striking,” said Dr. Johnson, “was the language, the cultural barriers and the stress the women experienced when they would come to the hospital.  The clinic will be an oasis to the community because there will be trained staff, knowledgeable regarding care services, resources, and specialized information who understand the patients better, and are able to facilitate a positive patient experience during their hospital contact and even in their homes.”

“These people,” Dr. Johnson continued, “are called navigators and they include nurses, public health workers, lay workers and others who would serve as a resource guiding, interpreting, communicating, facilitating and helping the refugees through the often times complicated and unfamiliar processes in obtaining satisfactory health care services.”

In the case of the refugee, who most know very little about seeing a doctor, or receiving clinical treatment, or home care of any sort and are also totally lacking in exposure to allied health services. But the engagement of navigators to improve certain service outcomes, and ultimately access to services, added a dimension that has made the service provider a key contributor to the improvement of patient satisfaction.

Duke Health in 2011 launched a robust and credible initiative using a class of employees as navigators who would serve as a resource to patients who because of cultural, economic, historical life experiences, or other reasons needed assistance in facilitating their engagement with the healthcare provider.

“The mission of the intervention,” said Dr. Angelo Moore, PhD, Assistant Director and Program Manager for Community Outreach, Engagement, and Equity (COEE) with Duke Cancer Institute, “was to be part of a highly visible community overall strategy to achieve care delivery that was equitable, culturally appropriate, and timely. The desired result would contribute to improved community health, higher performance outcomes and patient satisfaction.” The mechanism that would be employed is referred to as patient navigation. This is a concept and a process first introduced in 1990 by Dr. Harold Freeman a surgeon who saw the need for a resource for his cancer patients in Harlem Hospital, New York and who were predominantly African American women.

Patient and nurse navigator pioneer Harold Freeman. Dr. Freeman, who now oversees the operations of the Harold P. Freeman Patient Navigation Institute in New York, describes navigation as an individual intervention to help overcome barriers due to systemic reasons.  “Patient navigation is what a person does,” says Dr. Freeman. However, the type of patient navigation that is employed is based on the education, skill set, scope and who is being served. In the market-place, and since the launching of the concept, several different titles have emerged such as Nurse Navigator, Resource Navigator, Community-Facing Navigator, Clinical Navigator, Non-Clinical Navigator, Lay Navigator.  There is now an ongoing effort to harmonize these titles around a common set of descriptors common to the role and purpose of navigation.

Foundational to the role and purpose of navigation is the elimination of barriers or impediments.
What types of impediments are these? Examples of some of the frequently encountered barriers that may be eliminated through patient navigation: Financial barriers (including uninsured and under insured); communication barriers (such as lack of understanding, language and/or cultural competency), medical system barriers (fragmented medical system, missed appointments, lost results); psychological barriers (such as fear and distrust); other barriers (such as transportation and need for childcare).

Dr Freeman’s interest and desire to tackle the high percentage of African American women who were referred to him for diagnosis and treatment, was peaked when he saw that they were in the third and fourth stages of the disease of cancer. He took note that these women were also poor economically and lived very marginal lives, the circumstances that  would impact their access to care. Dr. Freeman knew from available data that white women had a lower cancer morbidity rate. He decided to conduct an investigative approach to identify, if possible, the root causes of this phenomenon.

One of the core derivatives of his work was the description assigned to the title “patient navigator.” A patient navigator is a healthcare professional who proactively guides patients through the healthcare process. They are responsible for ensuring that the healthcare provider’s system met the needs of the patient as best as possible. To that end, patient navigators spend their time communicating with patients and their families and as an interface between the patient and the provider. They engage patients by describing the relevant options, the true nature of their illness, what to expect during the treatment process, and what their recovery process will be like. They may also need to identify what are the patient’s legal rights.

It’s important that patient navigators once able to convey the specific impediments that stand in the way of effective treatment, go in pursuit of remedies to overcome the obstacles that they may encounter while pursuing treatment. This means that employees in this role need to be highly knowledgeable of healthcare systems and what can be done to ensure the patient is provided the best possible care. Attributes of compassion, positiveness, trust-building and coaching skills are key to success as a navigator.

To do well in this role, it’s critical that the employee be able to answer patients’ questions as they arise. This means that navigators must have a strong understanding of healthcare systems and how they function. They should also be a compassionate, positive individual who is capable of inspiring confidence in the patients served.

Ultimately the impact of the work of patient navigation is embedded in the social determinants of care. This addresses the social, cultural, environmental, and economic conditions in society that impact upon health. In this regard, colleagues compile and disseminate evidence on what works to address these determinants, build capacities and advocate for accelerated action.

Pivot, Power, and Purpose

Pivot, Power, and Purpose

Pivot, Power, and Purpose word cloudWe are almost at the end of 2020 and one thing that this pandemic has reinforced is that life is “unpredictable.” It is great to plan, but unexpected events can quickly turn things around. These past 10 months have caused many people to slow down and analyze their situations. Many people have lost their jobs, homes, and lives. We could focus on the negative aspects (not to disregard them); but there have been some positive aspects to this unfortunate world event. As we enter into 2021, there are three concepts to embrace and apply to our lives, moving forward: “Pivot, Power, and Purpose.”

This year has caused everyone to refocus and realign how things are done. Every aspect of our lives has been affected and we did not just stop living or doing. Thanks to technology we were able to create new ways of doing ordinary things, such as using Zoom for work meetings, keeping in touch with family and friends; other platforms for kids to attend school; online grocery shopping and food delivery; attending movies, concerts, award shows, exercising, weddings, graduations, and even funerals. We had to learn to “Pivot,” which means to turn or revolve; creating new avenues to maintain the same activities of daily living. We realized there are many things that we took for granted, but we learned to make it work.

Secondly, hopefully this year has made us stronger and more resilient. Releasing our “Power,” which means the ability to act or produce an effect; possession of control, authority, or influence over others. Instead of sitting down and feeling sorry for ourselves, many people have used this time to go back to school, start a home-based business, complete unfinished projects, and create ways to help empower others. We need to take this strength, energy, and power and move full-force ahead into the coming year.

Finally, we all need to explore the reason that we are here, what is our “Purpose?” The textbook definition is an end to be attained, intention, and determination. So, in order to attain we must plan, propose, and design our aim. Discover things that are bigger than you. It is not about what you achieve, but how have you helped or impacted others. Give of your time and talents and surround yourself with positive people.

We tend to get wrapped up in the details of our busy life; but remember we cannot live on purpose, without action. So, learn to Pivot, use your Power, and live your Purpose.

2020: A New Vision of the World

2020: A New Vision of the World

We are in the first quarter of the year and none of us expected or envisioned that we would be dealing with the course of events happening now. It is almost surreal, like a scene from a movie. Many people entered the new year with the desire of having new goals, resolutions, and dreams. This was to be the year signifying “2020 Vision” seeing things more clearly. Everyone stated “this is going to be my year.” What we are going through now has been a real eye-opening experience.

Over the course of history there have been many epidemics, disasters, and social issues, which were usually contained in one region. People may have felt safe thinking, “it is not happening in my city, state or my area of the country.” These past three months, the “Coronavirus pandemic” has affected all U.S. states and multiple countries, and crossed every race, age, and socioeconomic group. This blog is not going to be filled with statistics, because we are bombarded daily from all media sources with the data. Updated information should be obtained from reliable sources such as the CDC (www.cdc.gov) or WHO (www.who.int).

This “global shutdown” has affected every aspect of human life. Freedom and things that we took for granted, such as shopping, going to the movies, dining out, visiting amusement parks, playgrounds, attending concerts, festivals, hanging out with friends and family, and most of all traveling has been brought to a screeching halt. Now families are going to have to learn how to spend more time with their families, reflecting on things to be thankful for and creating entertainment and meals at home.

For safety, government officials have issued “Stay at home” and “Lockdown” mandates, limiting travel for only essential needs. The goal is to try to decrease the spread of the virus, especially to vulnerable populations; hence a new term has been coined “social distancing.” Everyone is to keep a 6-ft distance from each other and limit gatherings of people to 10 or less. Social distancing is a physical separation and does not mean that you cannot communicate with others. The one positive note is that in this age of technology we all can stay connected to others whether they are in the same city or across the country.

Social distancing is important, but there are two populations that this may have an adverse effect on, those with mental illness and those that are in abusive relationships or families. Social distancing could cause “social isolation” and those with depression could have an increased risk of suicide. The worst thing is having individuals quarantined in the home with their abusers. If you know anyone that is in an abusive situation or has mental health issues, reach out to them, if possible.

We are not sure when this pandemic will come to an end, so during this time find ways to decrease your anxiety and stress and try not to panic. Some things that you can do is continue to exercise, keep your humor (in light of what’s going on), watch movies, create crafts and cook together, and make sure to reach out to those that may be alone.

May this pandemic not dim our vision. Stay calm, stay focused and productive.

Resources:

Be Thankful For What You Have

Be Thankful For What You Have

I just returned from a leadership seminar in Jamaica, which was held at a luxurious resort. The thoughts of gaining leadership knowledge and skills, while on a beautiful island was exciting. Day three of my trip was devoted to community service. It was a satisfying feeling to be able to give back to others. We had the opportunity to visit a primary (basic school), a middle school, and a hospital.

Upon arriving at the schools they were surrounded by large gates. As we drove through the entrance we saw children in uniform and they were carrying their chairs from one building to the next. Despite the condition of the school, which had no air conditioning, no chalkboard, and no visible books, the children were excited to see us. The look on their faces was priceless when we gave them gifts of pens, pencils, markers, crayons, and books. They were very eager to learn about CPR and we had mini-manikins for them to practice on. Talking with many of the kids, their dreams and aspirations were amazing. Many want to be soldiers, police officers, lawyers, beauty technicians, chefs, and a scientist, just to name a few. Even though these children did not have the luxuries that most schools in the USA have, they were still enthusiastic to learn and very respectful to the teachers.

The hospital was another experience, which was very eye-opening, tear-jerking, and gut-wrenching. Although health care is free, the condition of the hospital and lack of supplies was deplorable. Again, just as at the schools, despite the poor conditions the medical staff were very pleasant, had smiles on their faces, and were very engaged in their work. We visited the pediatric unit where there were 45 patients, which normally holds 32 with only three nurses. They did not have IV poles or monitors, things that we take for granted in our health care facilities. The staff does the best that they can with what they have and they welcomed the medical supplies that we were able to donate. Seeing the other areas of the hospital, such as the laundry and central supply was very shocking; without staff there you would not know that you were at a hospital.

I think that every U.S. citizen should be required to visit a third-world country to see the conditions that people have to live and work under. They would see how blessed we are in the United States, even though we have some poor areas here. Driving down the streets of Jamaica there were multiple unfinished buildings, trash, and junk along the road. We saw a car that had caught on fire and was completely burned and charred, the firefighters were there with a hose, but the water trickled out like it was a home garden hose.

This experience was very educational, informative, and enlightening. It made me think of how thankful I am for what I have. My goal is to stop striving for material things and gain more rewarding experiences. Every U.S. citizen needs to reflect before complaining and be thankful for what they have. Be happy with the little that you have. There are people with nothing that still manage to smile. This also reminds me of a quote from Victory Today:

While you complain about your electric bill,
there’s someone with no home.
While you complain about your job,
there’s someone praying for a dollar.
While you complain about the food in your pantry,
there’s someone praying for crumbs.
While you complain about life,
there’s someone who didn’t wake up today.
Your complaints are simply blessings to others.

Be grateful and thankful every day!

Take Care of Yourself—Find Balance

Take Care of Yourself—Find Balance

Well it has been a while since my last post, due to the “busyness” of life. Often times we let the things in our life take so much of our time, that we forget about taking care of ourselves. As nurses we are focused on taking care of others: our patients, our family, our friends, and sometimes even strangers. We have heard of the saying “Take care of yourself, so you can be there for others,” but how many of us actually practice this? This really hit home after hearing about the unexpected death of two colleagues over the past month. They both devoted so much time to their job and neglected to relax and take care of themselves.

St. Thomas, VI

Credit: Leslie McRae-Matthews

We have our plates so full with other people’s issues, cares, and needs, yet there is no room on the plate for us. There has to be a balance between work and relaxation. This is not new information for us—we just need to apply it to our lives. Many of us advise our patients about taking time to relax, meditating, and thinking about things they enjoy to decrease stress. These are some of the same principles that we can use.

When you start noticing that you are feeling anxious, moody, or depressed, these are signs that it is time to step back to refocus, recover, and renew. Many people relax by traveling, but you do not have to spend a lot of money to relax. Engage in simple activities, such as drawing, photography, taking a walk to enjoy nature, riding on a swing, or going for a swim. These activities are not an escape from reality or stepping into a “fantasy world,” but they will help you take your mind off of work or other issues, so that you can refocus. Take care of yourself and find that balance.

It’s Time to Get SMART

It’s Time to Get SMART

Wow!! Can you believe that the first month of the new year is almost over? Many of us made resolutions that are probably already broken. So, what is a resolution? It is when people make a decision to do or not do something.  It has become a ritual to make them on Dec. 31st and usually by Jan 31st they are no longer being followed. Often, those decisions are generalized and vague. Here are some examples: I plan to exercise more, I am going to eat more healthy, or I am going to save money. No wonder by the end of the month people revert back to their old ways.

Instead of making “resolutions” we need to set goals that are more attainable and realistic. An acronym that works is to set SMART goals, which can be measured and determine if they have been reached. Using this principle can be applied to anything that you do and all aspects of your life (personal or business). Following is a breakdown of the elements of effective goals:

SMARTS-specific: who, what, when, where, why; simple yet significant.

M-measurable: How will you know that it has been reached? meaningful & motivating.

A-achievable: Can this happen and how? Can this goal be attained?

R-relevant: How does this help you overall to meet the goal? Is it realistic and reasonable?

T-time-bound: set a deadline or time-frame, when will this happen?

So those same resolutions set as SMART goals would look like the following:

  1. I will walk for 30 mins. each day for one month.
  2. I will avoid sugar and eat more vegetables for one week.
  3. I will start saving $50 each pay period for two months.

Make goals and establish how you will get there. You must keep track of your progress and evaluate and review them. Goals should be things that you actually have control over. With this format you can establish goals that will hopefully last until the end of the year or longer.

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