Obesity rates are alarmingly high in the United States. Altogether, overweight and obesity rates exceed 70% of the U.S. adult population according to the Centers for Disease Control and Prevention. This figure comes with staggering health care costs, as obesity is known to heighten the risk of several chronic diseases including hypertension, type 2 diabetes, and certain forms of cancer. Obese individuals also experience a decreased quality of life and a higher mortality rate. These negative health consequences are pronounced among minority populations who often have less access to health care along with a higher rate of obesity-related comorbidities.
African Americans are disproportionately affected by obesity. According to the American Heart Association, 77% of African American women and 63% of African American men are overweight or obese. Within African American faith-based communities, health education programs remain limited despite substantial evidence from the literature indicating its advantages. Significant barriers contribute to a low utilization of health promotion programs in African American faith-based communities. According to a systematic review in Obesity Reviews, some of these barriers include scheduling conflicts with church activities and keeping the interest of participants. Nonetheless, the same study concludes that health programs focused on weight management and weight-related behavior in African American churches can effectively help address the obesity issue.
The NWEP Project
The Nutrition and Wellness Education Program (NWEP) was a pilot study led by a team of two student nurses and one faculty to provide health education in the All Nations Church of God in Christ, which is a predominately African American congregation located in North Richmond, California. The program was conducted during the fall of 2016 and consisted of a series of six workshops of about two hours each facilitated by the team of student nurses. The workshops consisted of teaching using PowerPoints and handouts; group activities, such as modifying recipes and building shopping planners; and recipes/cooking demonstrations. The NWEP aimed to provide the participants with the knowledge, resources, and tools to access and select healthier food options in order to sustain positive nutritional outcomes. This program provided nutrition education regarding the basic food groups, the properties of food items, the benefits of eating certain foods, and hands-on demonstrations of healthier meal preparations. Furthermore, participants learned how to select healthier foods in groceries and restaurants within a limited budget.
The Significance of Nutrition Education
Education plays a crucial role in providing disadvantaged communities with the essential resources needed to make better lifestyle choices. Although obesity originates from a complex interplay of genetic, environmental, and behavioral factors, poor dietary habits remain an important contributor to this health issue.
Nutrition education is an integral part of reducing excessive body weight since it can increase knowledge about food and cost-effective approaches to eating healthy. In this regard, NWEP aimed to bridge the knowledge gap and stimulate the adoption of healthier dietary habits among the program’s participants. The NEWP was an eye-opening experience for the women who participated in the program. They lacked basic nutrition literacy, such as the five food groups, or the information contained on nutrition facts labels. They expressed reactions that ranged from surprise and disbelief to apprehension as they grasped the notion of added salt and sugar in food items.
For example, when the workshop facilitators showed the amount of sugar in an eight-ounce soft drink, one participant exclaimed: “Oh, that is a lot of sugar! I would have never imagined this is the amount of sugar I get from one can of Coke.” Similarly, when the facilitators demonstrated that in certain brands of chips, a single bag could contain more than the recommended daily intake of sodium, their reactions were indicative of the fact that they lacked the basic knowledge to make informed dietary choices. Other fundamental nutrition concepts covered in the program were calories and nutrients in foods. This allowed the participants to differentiate between high-calorie, nutrient-poor foods versus low-calorie, nutrient-rich foods and the benefits of incorporating more of the latter into one’s diet.
Moreover, participants had to practice the lessons learned during the workshops. Each participant was invited to explore strategies that fit their individual needs and circumstances. Most of them agreed that cooking at home allowed for a better control over their food’s quality because fast food contains a higher amount of salt, sugar, and fat. Throughout the workshops, the facilitators presented ideas for improving the nutritional qualities of their foods. These included swapping ingredients, lightening the seasoning, and improving the flavors with alternatives such as herbs and spices instead of butter or cheese. Other suggestions included using weekly meal planning, consuming in-season, fresh fruits and vegetables instead of canned foods, and baking in place of deep frying.
Nonetheless, one cannot ignore that increased knowledge alone is insufficient in achieving behavior and dietary change. In the Annals of Global Health, Himmelfarb and colleagues argued that knowledge is not everything as far as behavior modification is concerned. It is necessary to reinforce the skills of these participants and to provide them with support resources (e.g.,regular dietary counseling) to reach the goal of adopting and sustaining healthier dietary habits.
Observations and Feedback
The participants of the NWEP demonstrated a strong interest in the topics covered during the workshops. They could relate to the content of the lessons since it provided relevant information to improve their diets. These women acknowledged the importance of eating a healthy diet and the potential of this pilot program to help them make a positive impact on their health and that of their families since they were generally the primary grocery shoppers and cooks in the household. During the workshop sessions, they actively engaged in the activities, participated in the discussions, asked questions, and shared their challenges in adopting a healthier diet. This enthusiasm was indicative of the need and importance of health promotion program in this faith-based community. The women gave positive feedback overall and reported that they would be interested in staying in the program if it was extended. It was also a good opportunity to address some of their misconceptions about food properties, such as the characteristics of whole-grain foods. Beyond the learning experience of the NWEP, the participants developed a fellowship and camaraderie. They often stayed on the premises of the church and engaged in long, lively conversations at the end of the sessions. This act of bonding could be used as a support system to sustain the desired lifestyles change.
Lessons Learned and Recommendations for Future Projects
The NWEP underscores the challenges and opportunities for implementing health education programs in a faith-based environment. This study highlights the importance of nutrition education because a limited understanding of nutrition and diet also accounts for poor food choices and dietary habits. Improving nutritional literacy is a critical component of health education because it can initiate a behavior modification. The interest the participants displayed during the workshops is a clear indication of the need for health literacy and health promotion programs. Such programs should be implemented over a longer period and should be expanded to provide substantial support and sustain healthy lifestyles such as physical activity, dietary counseling, or health monitoring. Training lay-health educators among church members offers an efficient and inexpensive means to reach a wider audience within the community for a longer duration of time.
Despite its success, there were several challenges encountered while running this pilot program. Ongoing communication between facilitators and faith-based organizations will help ensure efficient workshop sessions. Also, providing the participants with monetary incentives, such as paying for their transportation or offering grocery gift certificates, may increase participants’ attendance. Using innovative technology such as text message reminders could also boost the attendance rate. Substantial financial support is equally critical for the success of such programs because the host community may lack basic equipment including a kitchen, a projector, and internet access, to facilitate the program.
The NWEP helped identify strategies to improve health outcomes in underserved communities. Health education in African American faith-based communities holds the potential to improve access to preventive care services. Despite its promise to reach a large number of individuals in underserved populations, health education programs in faith-based communities are limited. The NWEP attempts to address this gap by focusing on nutrition, which is a crucial component of health. Nutrition is a major part of health care and dietary modification is an essential, primary intervention in improving the overall health of disadvantaged populations.
A clinician sees a Somali patient with a primary complaint of back pain and, following an exam, prescribes a traditional course of western medical action. The patient, however, is reluctant to act on the medical advice because he thinks his back pain is caused by a bad relationship with his parents or guilt over something he did. “It is always good (for clinicians) to have some knowledge about their patient’s culture, to know who they are dealing with,” says Fozia Abrar, MD, of Minneapolis. “It might cost time and money, but you save more money by not getting a misdiagnosis, by improving quality of care.”
Suffering from bacterial gastritis, a Somali woman in Minnesota visits several providers but does not take the medication they prescribe. When met with a smile and a greeting in her native language by Dr. Abrar, the patient complies with the same treatment recommended by the previous providers—Dr. Abrar successfully persuaded the patient to fill a prescription and take the medication because of her knowledge of the patient’s culture. This situation is not new or unique—medical anthropologist and psychiatrist Arthur Kleinman, MD, has spent 30 years championing cultural issues in medicine. He says a great body of evidence shows culture does matter in clinical care.
Every cultural group has traditional health beliefs that shape members’ perspectives about wellness. The increasingly diverse, twenty-first-century patient population requires clear communication and practitioner awareness of patient health perspectives in order to significantly impact patient satisfaction, safety, compliance, and outcomes.
Organizational Culture, Patient Satisfaction, and Safety
Organizational culture informs every worker whether patient satisfaction is a key value. By influencing employee behavior and how employees are treated, culture drives employee effectiveness, safety, and whether employees take advantage of opportunities as they arise. Organizations that dedicate additional employee resources to patient safety signal to employees that both employee effectiveness and patient safety are high priority. In other words, organizational values and beliefs guide employee commitment to patient and worker satisfaction. According to the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture: 2016 User Comparative Database Report, patient safety improved more at hospitals where they increased employment of staff who reported incidents, compared to hospitals that did not expand the number of employees who reported incidents.
At Atrius Health, a Massachusetts ambulatory care provider with 36 locations, staff can report safety events while updating existing electronic health records (EHRs). This reporting mechanism has increased the number of reported events, and as many as 30% of events reported monthly come in through the EHR tool, according to Ailish Wilkie, patient safety and risk management director for Atrius Health.
In other words, employee accountability shapes workplace and organizational culture.
Patient Culture, Provider Culture
In addition to the effect workplace culture has on patient satisfaction and employee competency, two additional areas of culture impact health care effectiveness. Both a patient’s cultural background and the provider’s scientific/medical culture inform patient and provider wellness perspectives. If patient compliance with the treatment plan is the goal, providers need to understand the patient’s cultural identity.
By the same token, patients need to know that their perspectives are respected. Few health care observational studies have reported sufficient information to support the claim of provider bias, but a 2006 study published in the Journal of General Internal Medicine reported that most internal medicine residents gain cross-cultural skills through informal training, and most stated that delivery of high-quality, cross-cultural care was important but were skeptical about the expectation of learning every little detail about all cultures. Barriers to cross-cultural care included lack of time, not knowing enough about the religion or ethnic group of the patient they were caring for, and/or dealing with belief systems which are different than their own.
A 2000 study in Social Science and Medicine found that physicians rated minority patients more negatively than White patients; the study also reported that physicians viewed minorities as non-compliant and more likely to engage in risky health behaviors. Clearly, providers need reliable resources to add to their understanding of the patient’s perspective.
A 2017 survey of 111 health care providers revealed where providers currently turn to access cultural training and information, and what types of information providers need when they are unsure/unaware of the patient’s cultural profile and its implications for treatment decisions, patient compliance, and safety outcomes. The survey found that providers want more data on their patients’ use of nontraditional medicine; their faith beliefs; and who the health care decision-makers are.
Diversity and Disparities
An increase in racial and ethnic minority health professionals provides greater opportunity for minority patients to see a practitioner who speaks their primary language or is from their own racial or ethnic background. This can improve the quality of communication, patient safety, satisfaction, compliance, and outcomes. In addition to increasing the diversity of practitioners, hospitals are working to improve hiring diversity, employee cultural awareness, and organizational culture.
In 2015, The Health Research & Educational Trust (HRET) commissioned a national survey of hospitals and health systems to quantify the actions they are taking to promote diversity in leadership and governance, and reduce health care disparities. Data for this project were collected through a national survey mailed to the CEOs of 6,338 U.S. registered hospitals. The response rate was 17.1%, with the sample generally representative of all hospitals.
Minorities represent a reported 32% of patients in hospitals that responded to the survey, and 37% of the U.S. population, according to other national surveys. In contrast, the HRET survey data show that minorities represent only 14% of hospital board membership, 14% of executive leadership positions, and 15% of first- and mid-level positions.
As a sign of progress, though, nearly half of hospitals surveyed had a plan to recruit and retain a diverse workforce matching their patient population. Further, 42% said they implemented a program to find diverse employees in the organization worthy of promotion.
Cultural Data Collection
The HRET data show that 98% of hospitals are collecting patient data on race. Additionally, other areas of data collection included ethnicity (95%) and first language (94%). But, the percentage of hospitals that correlated the impact these factors have to the delivery of care was a mere 18%. Remarkably, in 2011 only 20% of hospitals analyzed clinical quality indicators by race and ethnicity to identify patterns, whereas 14% looked at hospital readmissions, and 8% analyzed medical errors.
A serious flaw in the HRET survey was zero data collected on hospital patient national origin. The report listed myriad reasons why hospitals might be failing to meaningfully use the data, such as fearing potential liability issues after publicly acknowledging disparities in care, concerns about the public relations backlash, and a lack of knowledge in developing clinical programs that would reduce or eliminate inequalities. Plus, some hospitals noted the lack of a “diversity champion” on their staff to help lead the effort.
Hospitals seem to be making progress in educating staff on diversity, with 80% providing cultural competence training during orientation and 79% offering continuing education opportunities on cultural competency, according to the survey.
Hospitals have begun to include leadership goals designed to reduce care disparities by implementing diversity initiatives such as: allocating adequate resources to ensure cultural competency/diversity initiatives are sustainable; incorporating diversity management into budget planning and implementation process; increasing hospital board diversity to reflect that of its patient population; board members demonstrating completion of diversity training; developing plans specifically to increase ethnic, racial, and cultural diversity of executive and mid-level management teams; and executive compensation tied to diversity goals.
Beyond the C-suite, hospitals are developing diversity plans with initiatives that include diversity goals in hiring manager performance expectations; implementation of programs to identify diverse, talented employees within the organization for promotion; documented plans to recruit and retain a diverse workforce that reflects the organization’s patient population; required employee attendance at diversity training; hospital collaboration with other health care organizations to improve health care workforce training and educational programs in the communities served; and education of all clinical staff during orientation about how to address unique cultural and linguistic factors affecting the care of diverse patients and communities.
This increased implementation of appropriate health care and adherence to effective diversity and cultural education programs at every level of health care will ultimately result in improved patient satisfaction, compliance, hospital safety, and patient health outcomes.
Did you ever look back upon your career and reflect on those humble beginnings? As educators, we sometimes forget that it was not easy to aspire to the higher academic goals we have been so fortunate to have attained. When we counsel our students, we must not disregard that they too have many barriers to overcome in their journey to be successful. In retrospect, we can embrace the challenges we must face in the effort to ensure our students’ academic success.
One morning during break, I overheard one of my student’s discussion with her colleague regarding how lucky she was that her children would be cared for over the weekend. This would allow her time needed to study for the final exam. Knowing this student, I was aware that she was a single parent and working mom, and more importantly, my student was pursuing a future career in nursing no less. It was a revelation that this fortunate incident for her was not expected, but was a gift. I began to ponder how this student would have prepared for the final if the childcare issues had not been resolved. Upon review, I realized that this student’s grades were not always consistent. During counsel, her excuses for poor grades or incomplete homework assignments were due to illness (whether be it her own or one of her children’s) or because of a busy work schedule, which entailed all shifts conceivable. So, when did she have time to study?
Lack of study time was also noticeable in the part-time evening students. I recall the blank stares on their faces during a Q&A session in preparation for the day’s lesson. Upon inquiry, the group confessed that they had not prepared for the evening’s lecture in their attempt to balance work, family, homework, and study hours. The weekends had been relegated to study time in preparation for the upcoming week’s assignments, albeit incomplete. Add this to childcare, spousal duties, and familial responsibilities and you have one overworked, fatigued, and ill-prepared nursing student.
Many times, as educators we focus on the negative aspects of our students: the fatigue, lack of engagement during lecture or clinical, and the behavioral issues (tardiness, absenteeism, and disputes with colleagues). This can hinder our ability to focus on putting interventions into place to enhance our students’ learning abilities. We might complain about time consumed due to providing an inordinate amount of time with a student that was not responding to intense tutelage. Perhaps we should invest in discussions about the ever-changing policies affecting our curriculum or work hours. Somehow, the drudgery of this negative outlook overshadows a focus on the academic pursuits of those struggling to attain a portion of our accomplishments. We must be sensitive to the vulnerability of this population during their journey. Whether it be in the case of the traditional, the returning, or the recycled adult learner, financial constraints are taxing. Adhering to professional and attendance policies takes effort. Striving to maintain a precarious balancing act to function commendably in multiple roles are all central themes of the adult learner. In acknowledging this, it is incumbent upon us to assist our students in getting past these barriers.
I have contemplated methods to assist nursing students, which have resulted in better outcomes. Some interventions I have put into place have made the difference in my students’ success as evidenced in their test scores. The following interventions are worth noting:
- Games: the Millennials love them. Who said learning should be boring? The younger generation thrives off the technological support, which surreptitiously enhances learning. The games can be competitive, informal, and applied individually or after breaking the class into groups. Games are used best when they can be accessed as a resource after classroom sessions as a study tool before testing.
- Provide a quick recap at the end of class. Some students may be so attentive during lecture that they do not take notes that were imperative to have as a review for the next test. This is easy to rectify by providing a short review of pertinent facts at the end of the day, paying special attention to the material that will be included on the test. This quick review gives the learner another chance to process and make note of what the instructor was attempting to stress in the previous lecture(s). This may seem redundant, but we cannot forget that this is all new information for the learner.
- Remind the student of your availability. I state my office hours on a weekly basis most emphatically after testing. This publicly reinforces my commitment to their learning needs and hopefully abates their reluctance to seek my instruction.
- Review one-on-one over the previous tests taken with students who have scored poorly. Allow the student to reflect, write, and question the material covered in the test(s). Educators have gained insight about their students during these sessions (e.g., what type of learner they are, if there are linguistic barriers, and/or if there is a lack of effective study habits). This session also establishes a rapport between you and the learner, which can be motivational.
- Allocate extra time to be available for hours before testing. You would be surprised to see how many students will attend for review after a long, clinical day in anticipation of a test pending the next day. Is it more time consuming? Not nearly as much as counseling them one-on-one would be.
These are a few tips I have used to incorporate in teaching my students before I notice a decline in test scores. As I look back on my humble beginnings, I realize that the barriers I encountered are not so different. I am fortunate enough to have had support and encouragement throughout my career as a student and as a practitioner. It is as challenging for both the educator and the learner; diligence is required from all parties. But we are in the trenches together. We all had to start somewhere.
A nursing career in public policy was considered unique decades ago. However, increasingly nurses have developed the skill and expertise needed to inform the policy-making process through their professional and voluntary endeavors. Nurses now serve in numerous leadership roles where they use their health policy expertise to shape the policy discourse, monitor the impact of legislation, and oversee regulatory processes.
In addition to the increased numbers of nurses working in governmental and nongovernmental agencies, nurses serve as elected officials and work as health policy consultants or health care lobbyists. Regardless of role or setting, nurses working in the policy arena are required to use their public policy acumen to inform legislation, oversee regulations, or advocate for policies that are of benefit to consumers, patients, and the profession.
Nurses serving as elected/appointed officials or health care lobbyists are immersed in the policy-making process and have a front row seat in influencing the public policy agenda. Both opportunities require a comprehensive knowledge of the complexities associated with lawmaking and a willingness to listen and assess varying perspectives. The ability to communicate well and build partnerships while working with diverse stakeholders cannot be overemphasized.
Noteworthy, three nurses are serving as elected officials during the 115th Congress. Representative Karen Bass, APRN, represents California’s 37th congressional district and is in her fourth term. Congresswoman Bass serves as a ranking member of the Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations.
Representative Diane Black, BSN, has represented Tennessee’s sixth congressional district since 2010. She serves on the House Ways and Means Committee.
Representative Eddie Bernice Johnson, BSN, is the first nurse elected to the U.S. Congress and is now in her thirteenth term representing the 30th congressional district of Texas. Representative Johnson serves on the House Committee on Science, Space and Technology; House Transportation and Infrastructure Committee; the Aviation Subcommittee; the Highways and Transit Subcommittee; and Water Resources and Environment Subcommittee.
Many nurses are familiar with former representative, Lois Capps. Capps represented California’s 24th congressional district after winning the seat in 1998 after her husband died in office. She championed numerous nursing and health care issues and started the Congressional Nursing Caucus.
No doubt, other nurses are well poised to follow suit bringing their expertise to an elected office. For example, Lauren Underwood launched her campaign last fall to represent the fourteenth congressional district in Illinois. Underwood brings a wealth of nursing and government expertise and is passionate about ensuring access to high-quality health care for all.
Nurses are also well suited to serve as health care lobbyists because of their vast knowledge of nursing, health, and health care. An extensive knowledge of these and other areas is critical to advocating for legislation aimed at improving access to health care, enhancing health outcomes, and transforming our health care delivery system. Additional competencies needed for such a role include strong interpersonal communication skills, research/analytical skills, detail orientation, knowledge of political, legislative, and regulatory processes, and the ability to create and deliver messages to a wide array of diverse stakeholders including legislative officials. Health lobbyists are responsible for conducting policy analyses and summarizing information that is suitable for a variety of audiences. Nurse lobbyists may work as a consultant employed by a professional/specialty nursing or non-nursing organization, health care facility, insurance company, or pharmaceutical company, to name a few.
The current push to increase the number of nurses serving on boards provides yet another opportunity for nurses to become more engaged in aspects of the policy-making process. Depending on the mission of the organization, board members may be responsible for shaping a legislative or advocacy agenda on behalf of the constituents they serve. To illustrate, I acquired some of my health policy skills while serving as the Chair of Public Policy for my local Susan G. Komen Affiliate. In this capacity, I along with board members advocated for breast cancer funding for underserved women and helped to shape and monitor the organization’s legislative agenda. This experience provided a unique opportunity for me to serve as a lead spokesperson providing testimony before my state legislature regarding the “Reducing Breast Cancer Disparities bill.” This bill includes significant provisions designed to reduce breast cancer disparities among underserved and underinsured women across the entire state.
In addition to some of the previously mentioned career opportunities in the health policy arena, nurses in the following roles utilize their policy knowledge and expertise to advance the nursing profession and transform today’s health care delivery system:
- Dean/Associate Dean of a School or College of Nursing
- Director of Government and/or Regulatory Affairs
- Office of Government Relations
- Director/CEO of a Government Agency
- CEO or Executive Director of a Nonprofit Health Care Organization
- CEO of a Professional Nursing Organization
- Chief Nursing Officer
- Surgeon General/Assistant Surgeon General
- Chair of Health Policy Committee for a Professional or Specialty Organization
- Health Commissioner
- Board Member for a Health Department, Hospital, or Community-Based Health Care Organization
- Chair of a Health Policy Committee for a Voluntary Organization
- Nurse Attorney
- Hospital Administrator
- Executive Director of a State Board of Nursing
- Health Policy Analyst
- Nurse Regulator
Nurses wishing to pursue a career in health policy can begin by first identifying what is most important to them. Nurses who do not have a background in political science or law may need to invest in professional development through formal/informal education. Taking health policy courses is a good step as such course work provides an overview of the policy-making process and may provide some exposure to in-person or virtual lobbying.
Getting involved with the advocacy/legislative arm of one’s professional or specialty organization is yet another great way to gain exposure and experience related to the policy-making process. Many nursing organizations have a policy agenda and work to ensure that their voices are heard on things of importance to the profession and those they serve. Serving as an intern in a legislative office for an elected official may also provide some beginning exposure to the policy and legislative process. These types of experiences can enhance one’s credibility when launching a career in public policy.
Participating in health policy fellowships, internships, or other structured immersion activities can go a long way in laying the foundation for future engagement in the policy arena. I cannot overestimate the value of talking with those already in the field. Elected officials, nurse/health care lobbyists, and individuals currently running for office as well as other nurse leaders can provide valuable insights regarding the expectations for this type of role. Attending a state board of nursing meeting is another excellent way to become acquainted with the regulatory aspects of the policy-making process. Finally, staying abreast of current and emerging issues in health care and nursing provides a critical foundation for future advocacy and political activism in the health policy arena.
Ernesto Holguin, RN, BSN, CNN, dialysis clinical coordinator at Las Palmas Medical Center in El Paso, Texas, was saddened to see his elderly patient arrive for her dialysis appointment in 2003 with a foot infection caused by a diabetic ulcer.
“Diabetes had affected her eyesight and caused her to lose feeling in her feet,” says Holguin. “It was only when she smelled a foul odor emanating from her foot that she realized something was wrong.”
Wishing there was a tool that could assist diabetic patients in preventing foot ulcers from developing, Holguin decided to invent a device.
Holguin is one of many nurses across the country who have envisioned inventions they believe will help improve patient care. One of the earliest nurse inventors, Bessie Blount Griffin, an African American nurse, invented a feeding tube during World War II to help feed paralyzed veterans. Since then, many more nurses have tapped into their natural problem-solving skills to invent devices to improve the patient experience.
Ernesto Holguin, RN, BSN, CNN
For Holguin, that meant finding a way for patients to avoid diabetic foot ulcers or in the event they did develop a foot ulcer, to prevent it from becoming infected. The American Podiatric Medical Association (APMA) says that foot ulcers are one of the most common complications in patients with diabetes and if not treated properly, can lead to infections and in some cases, diabetes-related amputation. According to the APMA, foot ulcers occur in approximately 15% of diabetic patients and are commonly located on the bottom of the foot. Among patients who develop a foot ulcer, 6% will be hospitalized due to infection or ulcer-related complications, and 14–24% of patients with diabetes who develop a foot ulcer will require an amputation.
“The current protocol for prevention of diabetic foot ulcers involves patients checking their feet on a daily basis for cuts, cracks, blisters, and signs of an open wound,” Holguin says. “Patients who have trouble viewing the bottom of their feet are often told to stand over a mirror at home, but this can be difficult for patients who are overweight, arthritic, or elderly and don’t have good balance.”
Holguin envisioned a device that patients would use at home to prevent and effectively monitor their diabetic foot ulcers. The apparatus would inspect, dry, and take pictures of a patient’s feet and then send that information to their clinician.
His idea began to gain traction in 2007 when the first iPhone was released, and the idea of doing remote patient consults became a distinct possibility. In 2015, Holguin was invited to a workshop that the MakerNurse program was holding in Texas. Founded in 2013, MakerNurse works with nurses to bring their ideas for inventions to fruition, believing the best ideas for patient care are often developed by those on the front lines who work directly with patients.
“I told Anna Young and Jose Gomez-Marquez, the cofounders of MakerNurse, about my invention and they were very enthusiastic and encouraged me to build a prototype,” Holguin recalls. “Even though I’ve always liked to tinker, I never imagined I would one day design and build a device that could help my patients.”
Gomez-Marquez says MakerNurse launched in 2013 with support from the Robert Wood Johnson Foundation. MakerNurse provides the tools, platform, and training to help nurses like Holguin make the next generation of health technology. Two years ago, MakerNurse partnered with the University of Texas Medical Branch at Galveston to open their first MakerHealth Space in John Healy Hospital.
“Too often nurses have a great idea on how to but aren’t sure how to make it a reality,” says Gomez-Marquez. “We encourage nurses who have an idea for an invention to build a prototype and run with their idea.”
Working out of his garage in El Paso, Holguin recently finished the fourth prototype for his device. The first three he says were too large and cumbersome for patients to use. The U.S. Patent and Trademark Office recently certified Holguin’s patent, and is now working with a local medical incubator to turn his idea into a medical grade device.
“The next step is to have the device tested in clinical trials, and if successful, to submit it to the Food and Drug Administration (FDA) for approval,” Holguin explains. “I’ve talked with several doctors who believe my invention could be part of an important part of a diabetic patient’s treatment plan.”
In addition to making it easier for diabetic patients to monitor their feet for foot ulcers, Holguin believes his invention would reduce hospital readmissions. And more importantly, it could also help patients maintain a better quality of life.
“Some diabetics are only in their forties or fifties when an infected foot ulcer leads to amputation and disability,” says Holguin. “I’m confident this device can help diabetic patients to remain employed and live fulfilling lives.”
Making Your Idea Reality
Do you have an invention you think would improve patient care? Here are some tips on how to get started.
Conduct Due Diligence
It’s important to research whether there are any similar products in development, and also to decide whether you want to sell your idea to a company or to start your own business. Organizations such as the Small Business Administration can help you with these decisions.
Design a Prototype
Ideas are great, but you need to have something tangible to demonstrate how your invention works. MakerNurse can help nurses learn how to sketch and design a prototype and test out their ideas.
Seek out Support
MakerNurse has MakerHealth Spaces across the country that provides nurses with direct access to tools, materials, and expertise to build prototypes and test their ideas. Interested hospitals can host a MakerNurse workshop or invest in a MakerHealth program for their hospital. Visit MakerNurse.com to learn more.
Additionally, companies like Edison National Medical lend their expertise to help inventors to make their ideas a reality. The company says inventors will never pay more than $25 so it’s low-risk.
Consider a Patent
After you’ve developed a prototype for your idea, consider getting a patent to protect your invention. Visit the U.S. Patent and Trademark Office.
Nurses as Makers
Roxanna Reyna, BSN, RNC-NIC, WCC
Roxanna Reyna, BSN, RNC-NIC, WCC, a wound care coordinator at Driscoll Children’s Hospital in Corpus Christi, Texas, calls herself “MacGyver Nurse.” True to her moniker, she invented a unique skin and wound dressing for infants with abdominal wall defects.
Reyna’s workplace, Driscoll Children’s Hospital, was one of five “expedition sites” initially launched at hospitals in California, New York, and Texas, by MakerNurse.
Reyna got the idea to make a dressing for children born with omphalocele, a type of birth defect that leaves intestines protruding from the body and covered only by a thin layer of tissue. Surgery repairs the defect, but in the interim, the infant is at risk of infection.
“There weren’t any dressings or bandages made for kids that provided the same level of healing,” says Reyna. “So, I started experimenting with bandages, sponges, and tape.”
Reyna’s invention not only helped her colleague and young patients, but she was also invited to the White House in 2014 to meet President Obama and to take part in an event honoring “makers.”
Since Reyna’s product is tailored to a specific group of patients and there’s not enough demand for it to be manufactured on a large-scale basis, she did make directions on how to construct her dressing through MakerNurse.
A Path of Beauty
Monique Rodriguez was working as a labor and delivery nurse in Indiana when she decided to launch her own beauty company, Mielle Organics.
“While looking for natural solutions for my own hair challenges, I began creating products in my kitchen and blog about my hair journey on social media,” says Rodriguez. “I gained an audience and people began to
ask if they could purchase my concoctions. A light bulb went off and Mielle Organics was born.”
Rodriquez initially stayed in her nursing job to save money to fund the company.
“I strongly believe in speaking things into existence. I wrote my resignation letter in May and dated for November and was actually able to quit my job sooner,” she says.
Although she had little entrepreneurial experience when she started her company, Rodriguez did have drive and determination. In an effort to learn as much as she could, Rodriguez read books, listened to podcasts, and scoured the Internet to obtain as much information as possible.
“When I launched my business in 2014, natural hair products for black hair was an emerging market and I was attempting to stay on the cutting edge,” she says. “Today, the market is much more competitive, and although there’s room for all brands to succeed, we strive to be number one.”
Rodriguez, who worked as a nurse for nine years, says one of the biggest barriers she faced in launching her own business was not letting fear overcome her.
“It was very scary leaving my career as a RN, because of the fear of the unknown,” says Rodriguez. “I also wish that I had a business mentor or someone to talk with in the beginning.”
Rodriguez says her background in nursing also proved helpful in developing the Mielle Organics line.
“I understood the importance of using high quality ingredients that are effective for hair growth,” she says. “When we formulate our products, we don’t just focus on hair care, but also how healthy are the ingredients.”
Today, Rodriquez leads a corporate staff of 13 and her business is thriving. Mielle Organics are now sold at Sally Beauty, Target, and CVS locations.
An Invention Leads to a New Business
Lisa Vallino, RN, BSN
Lisa Vallino, RN, BSN, still remembers when she and her nurse colleagues would turn plastic cups into makeshift intravenous (IV) covers for their pediatric patients. Although it worked to prevent patients from accidentally dislodging their IVs, Vallino thought there had to be a better way.
“Nurses are inventors by nature,” says Vallino. “I looked at these IV cups we were using to keep our young patients from snagging and pulling out their IV tubing, and it occurred to me that someone should invent a pre-cut IV insertion site cover.”
Vallino mentioned the idea to her mother Betty Rozier, and the two worked to design their own version of an IV site protector. They started with a specimen cup and tweaked the dimensions into a prototype they called “IV House.”
“The first feedback we received from nurses was that the device was too big,” says Vallino. “We went back to the drawing board and made a smaller size, as well as providing ventilation so we weren’t providing a warm, dark, and moist environment under the IV House.”
She and her mom then worked with a plastics manufacturer to produce the product in bulk.
“The first attempt was a disaster,” explains Vallino. “The manufacturer delivered the IV House shipment to the hospital without labels and we also discovered the finished product was full of flaws.”
The experience taught Vallino to fully vet and test a prototype with a manufacturer before committing to the process. While continuing to work as a nurse, Vallino spent her off hours developing her invention.
“We started with the UltraDome for pediatric patients, a clear, plastic IV site protector designed to shield, secure, and stabilize the catheter hub and loop of tubing at an IV insertion site,” says Vallino. “Since then, we’ve invented a new and improved UltraDome that is used in hospitals around the world.”
Since her first invention, Vallino has gone on to develop 19 other products under the IV House name and to also work with other nurses to develop their inventions.
“Several years ago, a nurse friend had an idea for an invention that I bought,” says Vallino. “That idea resulted in the new TLC UltraSplint, featuring an ergonomic design and see-through openings. We found that with traditional arm boards there were injuries occurring that could be avoided.”
Vallino says she still hears from a lot of nurses who have ideas for inventions. Many just want to know if their idea is viable. After signing a nondisclosure agreement, Vallino offers feedback on the ideas, and for those that show promise, she encourages those nurses to find the right buyer.
“Our business is concentrating on working to create the most effective and highest quality products available to IV therapy patients,” says Vallino. “In addition to maintaining our current products, I have ideas for an additional five to six inventions I’d like to roll out in the near future.”
Our health care system today has made tremendous progress in providing care to individuals and families. Change is good, but as the health care industry rapidly responds to emerging trends, markets, and opportunities, how staff nurses respond to different kinds of work culture is important, particularly when work culture highly impacts a nurse’s job function.
Work culture is made up of the norms, values, and beliefs that characterize an organization. Several factors, including management, workplace practices, policies and philosophies, employees and their interactions, leadership, expectations, rewards or recognitions, communications, transparency, and support within an organization, can influence work culture. Work culture,which can make or break a workplace, is powerful. It can inspire health care employees to be more productive and positive at work, or it can make them feel undervalued and frustrated. Thus, it plays a crucial role in shaping behaviors in organizations.
Your Work Culture
Ask yourself the following:
- What is the culture like in your workplace?
- Do staff naturally unite and collaborate?
- Are the leadership and executive teams available and transparent?
- What values and principles does your organization express?
Sometimes, you might say “it’s challenging.” Defining work culture can be difficult; nevertheless, it is fundamental to good (or poor) practice. Work culture is not often discussed, but clearly, nurses can be negatively or positively influenced by their work culture.
Work culture in nursing is critical to job satisfaction, nurse retention, and patient outcomes. A toxic work culture can lead to increased sick days, stress-related symptoms, and nurse turnover. It also plays a large role in the ability to provide quality nursing care. Work culture can impact everything from the safety of patients to job satisfaction. If yours is negative and discouraging, you cannot just wait for it to change. The first thing you must realize is that it might not change at all without you taking some kind of action.
Understanding your work culture is key to developing practice that aims to improve care. Although a positive work culture is mostly created from the top down, it often happens from the bottom up. Nurses should not undervalue the power of their work culture. Understanding work culture as a learning environment is related to how nurses choose to engage in their workplace and how the workplace normalizes their involvement in activities and interpersonal relations. Nurses can take inspired action, engage in networks, and initiate work culture change. This is not a simple task, but nurses can utilize their own personal power and create cultural transformation in their workplace. Keep in mind that work culture can—and will—change and evolve over time. The first approach is to define and evaluate your work culture—both what it is now and what it should be in the future.
Every workplace has its own work culture. Most of this is unspoken, but a lot can be learned from an employee handbook or company policy. Observation, assessment, and communication are key approaches to help you uncover your work culture. These key approaches can also be utilized by someone who has unique developmental and socialization needs, such as new graduate nurses, international nurses, student nurses, and nurses who are undergoing role status changes or transitioning to a new area. No matter what your status is, here are five ways to help you thrive in your work culture.
- Watch and learn. Give yourself some time to understand the reasons behind workplace behavior and you will be much more successful in understanding the causes. Observe how things are done. Take notes. Keep track. Building relationships with people in your workplace and connecting with someone on your team who has a good understanding of how the workplace culture works can help you better understand and avoid making a mistake.
- Don’t be afraid to ask questions. You don’t need to know everything. Questions are a great way to clear up differences and get to know people. Also, be sure to ask for help whenever you need it. Asking for assistance or an explanation should not be considered a sign of weakness.
- Remain motivated at work. Nurse burnout is real, so it is important to recognize the impacts you make on your patients and workplace every day. Focus on yourself and how you can be a positive influence.
- Be transparent. Let your coworkers know about your background and your career goals. Don’t hesitate to share your ideas and let your team and supervisor know what other skills you have to offer.
- Acknowledge your mistakes. Apologize and laugh it off. Keep your sense of humor and learn from every mistake you make.
Developing the skills and ability to understand and communicate effectively with all your coworkers (including your supervisor) is critical to your success in your own career, as well as the success of your organization. These skills are not innate; they require practice, but anyone can develop these skills. Adapting to a new work culture is an ongoing process. Once you have the skills, you can work more effectively with different groups of people and adjust easily to working in different cultures throughout your career.