Nurses are integral in the care of patients and their health. Exploring a plant-based diet may be beneficial to patients so they can take back their health. It is time for health care disciplines to be aware of a plant-based diet and to dispel any myths that exist. In fact, a plant-based diet is not a diet—it can be viewed as a way of life. A plant-based diet are foods consumed that is devoid of animal ingredients, such as dairy and meats. A plant-based diet relies on foods that are grown from the ground such as fruits, vegetables, whole grains and nuts, and seeds.
People are living longer, but we are also living with more chronic diseases, with heart disease being at the top of the list. Heart disease, diabetes, and hypercholesterolemia are contributors to sickness where medicine is the answer. Health care providers tell patients to lose weight by restricting food intake. While patients may see results initially, they usually do not adhere to this long term as it is not sustainable for them for a variety of reasons. In addition to that, the medications with their side effects usually do not highlight many benefits. One-third of animal products in the American diet are very concentrated in calories and are deficient in antioxidants and vitamins. Needless to say, the vast majority of chronic illness is highly correlated to what we eat. There is a different biological effect of meat versus plant-based protein such as beans. The body can store these amino acids and complete them without overshooting the hormone, Insulin Growth Factor 1 (IGF 1). On the contrary, processed foods and meats produce a lot of IGF1 where insulin ends up storing a lot of fat. It is also attributable to cancer and inflammation.
People have long touted the benefits of a plant-based diet. Brooklyn Borough President Eric Adams reversed his diabetes Type 2 due to a plant-based diet. He was already suffering from nerve damage as a result of his disease with a hemoglobin A1C of 17 (anything over 6.5% is considered diabetic), so his was very high and the doctor was surprised that he was not in a coma. Adams was placed on medications, but he also sought the help of Caldwell B. Esselstyn, Jr., the same doctor who treated Bill Clinton and author of the book, Prevent and Reverse Heart Disease. He was informed by doctors that he would be on insulin for the rest of his life. He was placed on medicine for his acid reflux, medicine for his high cholesterol, and medicine for his burning and tingling of his hands and feet. His family is diabetic and was told that it runs in his family.
This past August, there was a launch of a plant-based lifestyle program at Bellevue Hospital in New York City. Doctors, nurses, dieticians, and life coaches will help at least 100 patients across all five boroughs adopt healthy eating patterns focused on legumes, whole grains, fruits, vegetables, nuts, and seeds while reducing animal products, fried foods, refined grains, and added sugars. Michelle McMacken, director of NYC Health + Hospitals/Bellevue Adult Weight Management Program, is director of the program.
At Montefiore Hospital, Dr. Robert Ostfeld spearheaded the Cardiac Wellness Program where plant-based nutrition is the prescription for management of cardiac disease. The population most affected by these diseases are non-white populations. Dr. Kim Williams, past President of the American College of Cardiology, advocates for a plant-based diet for heart disease prevention. Affronted with a high cholesterol, he decided to take measures into his own hands, and adopt a plant-based diet.
While medical doctors are beginning to advocate this lifestyle, nurses should also set an example of this lifestyle approach. Nurses are part of the health care discipline and minority nurses, especially, need to set an example. We want patients to take control of their lives. We can teach patients eating a plant-based diet instead of a standard American diet, as a form of primary prevention. Like any diet, it may take time to adjust, but this is not just a diet, it is a lifestyle. Patients would need to make an informed decision as to whether they would want to incorporate it into their lifestyle or not. There is enough supportive evidence out there that a patient can access such as documentaries, “Fork Over Knives” and “Fat, Sick, and Nearly Dead.” There are a variety of resources, including the 21-Day Vegan Kickstart program, to include in dietary prescriptions to help patients treat and prevent obesity, type 2 diabetes, and heart disease. This will require support from the patient’s primary provider, and, whether the provider is an advocate of this lifestyle or not, it should be considered. Benefits such as less medication, weight loss, and improvements in mood as well as cholesterol have been shown. Dispel the myths about a plant-based diet and protein.
This is a plea as something to consider to take better care of ourselves and take control of our lives. There have been many initiatives and programs to lose weight. Drastic measures have also occurred due to the outcomes of being overweight, such as drastic surgery and restrictions from carbohydrates. Patients are sometimes misinformed and have to get rid of the idea that medications will solve the problem—it only delays the problem. There is a possibility of reversing diabetes and cardiac disease. This is a decision that the person has to make: continue with their lifestyle with animal protein and processed carbohydrates or see a reduction in their overall weight and health by incorporating a plant-based diet.
A plant-based diet may be considered “extreme” by some people in altering their lifestyle. But given the choice between a plant-based diet or open=heart surgery, it can be posed to the patient which one they consider as extreme. Again, it is a personal choice, an evaluation of familial and cultural values would be assessed to fit the needs of the patient. Surgery can be viewed as a band-aid in that it will manage the symptoms temporarily unless the patient alters their lifestyle. Of course, it helps if the patient has a supportive network to embrace the lifestyle. It can start off as small, simple steps, as little as incorporating a plant-based meal in their day and slowly add these meals to their lifestyle. There are vegan starter kits to kick a healthier you.
Our health is something that we all have, and unfortunately, the condition of our health is not something that we have complete control over. We do, however, have the ability to enhance the quality of our health. We all have choices to make regarding our lifestyle and how we manage our health to make sure we ensure that our health never deteriorates and we can live a long, healthy, and fulfilling life. We can control our choices to improve the quality of our overall health, and a significant part of enhancing the quality of our overall health is making doctor’s visits a priority. Being inconvenienced with taking time off work or readjusting our schedules should become secondary to the need to seek medical attention when needed. The unfortunate aspect of health care utilization is that people often wait until it is too late before they decide to become committed to ensuring that their health is maintained and monitored.
The fragility of health became very real to me about 10 years ago when my persistence to my doctor, because I was not feeling well, finally resulted in an order for a CT of the lungs to reveal I had pneumonia. The previous x-rays of my lungs were always inconclusive. My health was in jeopardy, and I knew that I had to become intentional in my pursuit to get better. My persistence of seeking medical treatment reappeared with a vengeance in 2013 when my favorite uncle was diagnosed with stage 4 throat cancer. He was a mechanic who loved his family, and he was a very talented cook. He was one of those men who never had a lot to say, but he observed everything. It was easy to tell that he was not doing well, but I had to beg and plead with him to allow me to make him an appointment at a local clinic after we noticed that his health was declining. He was a proud man who did not like to admit when he needed some help. He was self-employed with no health insurance. His case was so difficult that most of his medical team did not want to take him as a patient. One of the wonderful physicians believed in him, and she advocated for him. He went through major surgery, and he lived another two and half years that gave me and my family more time to spend with him.
Two days before my uncle passed away, I softly spoke to him and told him that I would finish my doctoral program and make him proud of me. He nodded his head, and I was blessed to keep my promise. I believe that if my uncle would have been treated sooner, the outcome would have been different. I did not know when my uncle passed away that I would devote my research efforts to racial health disparities, or that I would have such a passion for educating the African American community on the importance of seeking health care services. Through my sorrow, I have made it a part of my mission to educate African Americans regarding the importance of seeking timely and routine medical treatment.
It is so important for African Americans to seek medical treatment because of the high incidences of health diseases and conditions that plague that population, such as high blood pressure, high cholesterol, diabetes, and heart disease. In my experience from working years as a certified pharmacy technician, too many people do not treat their health like the important commodity that it is. We sometimes feel that our health is something that we will always have, and that it will always be good. Unfortunately, I know firsthand that it simply is not true. Our bodies give us signs when things are not right, but it is up to us to pay attention. We sometimes shrug things off when we notice that variance in our health occurs in hopes that it will get better without us taking on more of an active role to ensure that it happens.
The goal of my research was to evaluate how the patient-provider relationship impacts the patient’s decision to access health services. Through my quantitative research, I wanted to delve into the rationale that African American patients have about how they make the decision about when they will visit the doctor. African American cultural norms, in addition to the historical aspects of discrimination coupled with provider biases, create a divide that can become evident during the patient’s visit. African Americans often feel as if they are not heard or a priority when they make medical visits. Chronic diseases and conditions often necessitate the need for medical visits as it pertains to African Americans, so African Americans between the ages of 40 and 65 were the target population that was studied. After reviewing the demographics within Shelby County, Tennessee, it was determined that the sample could be identified after evaluating the community right within my reach. It is apparent through observation as a former practicing certified pharmacy technician that African Americans are subjected to health disparities at an alarming rate. Those racial health disparities are prevalent because of the effects of the patient-provider relationship, limited access to health care resources, and health outcomes that are less than ideal.
A group of 56 participants were gathered through the help of alumni chapters of African American sororities and fraternities located throughout the greater Memphis area. All of the participants that were used to complete the analysis lived within Shelby County, had health insurance, had an English speaking primary care physician, and were African American. The findings evaluated the interactions that occur during the medical visits. The goal was to possibly uncover why African Americans do not go to the doctor in hopes of explaining why there is a prevalence of chronic diseases within that population. The findings did indicate that there is a significant relationship between the patient-provider relationship and the behaviors of the provider. Additionally, the behavior of the provider does contribute to the African American patient’s decision to seek health care services.
The participants that were evaluated stated that gender and assumptions that the provider makes about their education level and income did play a factor in how the provider interacted with them during the medical visit. The behavior that the staff exhibits during the medical visits of African American patients does impact the decision that is made to seek services, and the way that African American patients are made to feel during the medical visit does impact their decision to seek follow-up care and even their willingness to comply with medication compliance. It is important for the African American patient to be understood and treated with compassion, care, and concern. The historical component of the racial tension that African Americans have dealt with makes it pertinent for health care providers to treat the patient’s concerns as a priority.
In summary, there is a direct correlation between the relationship that the patient has with their provider and how the behavior of the provider is perceived during the interaction. It is important that African American patients receive ongoing education regarding the importance of seeking timely and routine health care. Providers need to be cognizant of how their mannerisms and responses affects their African American patients. African Americans do not consistently go to the doctor, which is evident by the staggering statistics of preventable and treatable conditions and diseases that plague that community. The goal for both parties within the relationship is to realize that it is impacted by both the actions and reactions of both sides.
Acknowledgment. The author would like to thank Cheryl Beers-Cullen, DHA, MPA, BSN, RN, CALA and Manoj Sharma, MBBS, PhD, MCHES for their contribution and mentorship.
Many nurses are pursuing advanced education. Expanding knowledge is always a good thing—for them, for their employers, for their patients, and for their careers. But what happens if you’re going back to school while you’re also working full-time and raising a family? Perhaps it’s challenging, but it’s definitely doable. These nurses have done it and have tips to help you do it too.
When Catherine Burger, BSN, MSOL, RN, NEA-BC, was asked by her employer to return to school to earn her bachelor’s degree in order to remain in an executive leadership position, you might say that it wasn’t the perfect time. “I was working over 60 hours per week as a nursing leader for a complicated department; we had five kids at home—all with multiple sports and commitments—ranging in age from 1 to 17 years old,” recalls Burger, a media specialist and contributor for www.registerednursing.org. “There is no perfect time to start back to college.”
But Burger and many others made it work, and you can too.
Do Your Homework Before You’re Doing Your Homework
Before you jump right into a program to earn another degree, Simendea Clark, DNP, RN, president of Chamberlain University’s Chicago campus, says that you need to do some homework. “If you’re thinking about going back to school, do your homework first. Everyone has a different set of circumstances, so it’s crucial to research programs and schools that best fit your needs. Many schools offer online modalities that allow you to take some or all of your coursework from the comfort of your home, saving you travel time to and from school,” says Clark.
Be sure that the educational program you select is something that you love—not just something that will bring in the bucks. “The key for those who want to advance their education is to make sure it is something that drives your passion for nursing,” says Adam Kless, MSN, MBA, RN, NEA-BC, vice president of clinical operations for Avant Healthcare Professionals. “Selecting an educational path for mere money will leave one hollow and disappointed in the long run.”
If it will help you, see if you can spread out your coursework. “I chose to take two classes per semester, including the summers. That helped me stay full-time in the graduate program,” says Valerie C. Sauda, PhD, MSN, RN-BC, MGSF, an assistant professor at Husson University’s School of Nursing. “Although it lengthened my study a little, it definitely helped me maintain the work/life balance. I also feel that I learned the material more thoroughly and was more engaged in the classroom and online group activities. A shorter program may not always be best for learning and life. Enjoy the journey!”
Tell Your Family and Your Boss
Now you’ve found the perfect program for you. What’s next? Your best bet is to tell the people closest to you: your family and your boss.
Your family probably already knew that you were looking into an advanced degree, but if they didn’t, be sure to tell them. You may need their support and the best way of getting this is to be honest and transparent. “Have conversations with the key stakeholders in your life—your current boss, your spouse, and your children. Creating ways for them to give you critical feedback in the moment can save a lot of heartache later. When you are under a lot of stress, it can be difficult to maintain a good communication feedback loop,” says Melissa McClung, MS, LPC, a professional career advisor and owner of LBD Careers, LLC. “Setting this up in advance can preserve your important relationships when there are inevitable conflicts.”
There are many reasons why it’s crucial to tell your boss. “Getting your boss involved will allow you to successfully incorporate your education into your work life by scheduling around class, providing you extra learning opportunities while at work, or benefit from finding a mentor at work who is already doing what you desire to do,” says Kless.
“At the outset, you may need to negotiate with your employer for some flexibility with your work schedule,” explains Divina Grossman, PhD, RN, APRN, FAAN, president and chief academic officer at the University of St. Augustine for Health Sciences. “Solicit the support of your supervisor or mentor at work so that you can have more flexibility in your schedule so you can prioritize your classes, clinicals, or to write papers and projects.”
Grossman says that when you tell your boss, you may also be able to streamline your schoolwork by having “your course requirements, such as term papers or special projects, be about topics or issues that you are dealing with at work. This way, you are not only meeting the requirements for your advanced degree, but also are resolving issues in the work setting through your research and projects. Your supervisor will be thrilled to know that you are doing research-based practical work that advances them and you.”
Plan Your Schedule, But Be Flexible
When Sauda was earning her PhD in nursing/education, she planned daily, weekly, and monthly schedules. “I prioritized time for family, time for work, and time for myself, while ensuring that I blocked out time for study and research during the school year. I had to ‘give up’ a few things, including binge-watching TV, checking my social media multiple times a day, and participating in nursing groups as a volunteer,” she says. “Creating and sticking to a daily schedule is crucial for success in an advanced degree program.”
Terri Bogue, MSN, RN, PCNS-BC, a consultant to hospitals and health care through her company, Thor Projects, LLC, planned her time as well when she returned to school. “I scheduled time to study after family dinner and on weekends. I knew that my degree would open doors and opportunities that would benefit my family as well as myself. This knowledge helped me to keep focused on my goal,” she says.
“It’s also helpful to set reminders for assignments and tests on your phone’s calendar as soon as you learn about them. Review your calendar at the beginning of each week and mark down pockets of time when you will study and do the same for spending time with your family,” says Clark.
Besides having a schedule, it’s also important to be flexible. Because, let’s face it, life happens. “The most important thing to remember about balance is that it is constantly about reevaluating and making changes,” says McClung. “I suggest developing a systematic way to check in with your priorities to ensure that you are prepared to flex when you need to. For example, this can be as simple as using a planner and scheduling out time for the important things: work and school obviously, but also family time, meal planning and preparation, exercise, and household chores.”
Have Some Space
Setting up a particular area in your home can help when it comes to doing your schoolwork. “Create a study space that helps you focus. For me, it was one corner of our dining room where I had a small bookcase for my textbooks, all the study materials I needed, and good computer access,” says Sauda. “I also set up a corner in my office at work to house my short assignment work that I could complete during breaks. Whatever you decide, do what works for you and make it a pleasant experience. You’ll accomplish more in the available time that you have.”
Bogue says that she would also set aside both time and a consistent place in her room to study. That helped her to balance it all.
“It is important to have a quiet place to study and complete coursework. A private, dedicated space will allow you to get work done, free from distractions. It is also important to get an early start on assignments, give yourself extra time to complete tasks, and seek help if needed,” says Clark.
Ask for Support
All our sources say that having a support network is crucial when you work and are going back to school. Your network can be family, friends, or even colleagues.
“Surrounding myself with people who were not in the program, but who cared and encouraged me either in person or via email, made all the difference—especially when I went through those difficult courses or when I felt like I couldn’t do it all. It’s the network that made a huge difference,” says Sauda.
Grossman takes it one step further. “You cannot be all things to all people. If you are usually the designated parent for carpool, can your spouse or a friend or neighbor help you out? I learned as a parent that if I can involve other parents in a way that we can help each other, both of us can be successful,” she says. “For example, I can do the morning pick-ups, and they can do the afternoons so that I could attend my classes and do my writing. If I am in charge of cooking meals at home, can I cook in bulk on weekends and freeze the meals or can my spouse help with the cooking?”
If you still need more help, Grossman says, think about hiring someone occasionally to clean or get your kids to help so that your work is reduced.
“Keep your lines of communication open to ask for help when needed and to keep instructors, your boss, and your family informed of any last-minute changes in schedule or areas where you need help,” recommends Clark.
Don’t limit your network to just family, friends, and coworkers. “I was scared when I took my first doctoral class. I had been out of school for over 15 years, and I was afraid that I couldn’t do the work. What I learned quickly was to ask for help, use the learning resources available online and at the campus, and develop a relationship with the faculty. As a faculty member myself, I can tell you that faculty want to help you reach your advanced education goals. They want you to be successful. Asking for help can really make a difference,” says Sauda. “One of my best experiences was in doing a literature search for a paper. I was not getting the articles that I needed to complete the paper, so I finally reached out to the university librarian. Within an hour, I had more than 20 articles that I was able to look at with her support. Not only did it save me time, but I learned the value of a librarian and library services when doing my research.”
Be Good to Yourself
To balance work, school, and life, self-care is essential. “Be patient and compassionate with yourself—this is hard work,” says Bogue.
McClung says that you have to make sure that the other areas of your life are good. To succeed, you have to make sure that you also take care of your health, relationships, and anything else that is important to you.
“Eat well, exercise by taking a walk before or after completing an assignment or after dinner with your family, and make sure to get proper rest,” advises Clark.
Grossman adds that, if you’re a parent, you keep tabs on any guilt feelings—and be easy on yourself. “Do not feel guilty about not being there when you can’t be and having your spouse or relative take over for you. This period is time-limited—not forever,” she says. “When my daughter ran track and field, they knew I could not be there for all the meets, but I could be present for some of them. I could do more on weekends than during the week because of my work and graduate school schedule.”
Totally Worth It
While this time may be difficult, it will also be memorable and fun. “The most important strategy for success is our attitude. Give yourself time to adjust to your new role as a graduate student. Like anything new, you will get the hang of it in time. Above all, make the most out of it, and enjoy the experience,” says Grossman.
Clark says to stay focused on both short- and long-term goals. “Be patient with yourself as you ease into becoming a student again.”
“The challenge and personal growth that came with pursuing an advanced degree helped me find my focus for future research and teaching,” says Sauda. “Always remember that the journey to advanced degrees is worth it!”
Community and faith-based education programs have long been proven successful in reaching black communities. As an African American woman and advanced practice nurse, I have participated in many projects and studies to identify effective approaches to increase awareness, prevention, and treatment of health issues that impact my racial/ethnic group. After serving as a nurse expert for several successful community faith-based programs focused on various health issues, I worked with a local organization, in which I am a member, to address prostate cancer awareness and screening among black men in two counties in Virginia.
Prostate cancer is the second most common cancer in men, and, despite being treatable when detected early, is one of the leading causes of cancer death among men of all races, according to the Centers for Disease Control and Prevention. Prostate cancer rates among black men are significantly higher than any other race, with more than 150 new diagnoses annually per 100,000 men in the United States. Clinical progression of prostate cancer is known to be more aggressive in black men as compared to white men. However, black men are less likely than their white counterparts to engage in shared decision making (SDM) with their health care provider about the benefits and risks of the gold-standard prostate specific antigen (PSA) test. Due to the increased risk for prostate cancer among black men, screening is recommended at earlier ages than the general population.
The Education Program
Over a one-year period, I was a nurse researcher for a prostate health education program that examined whether participants had an increased awareness about key issues of prostate cancer, following a culturally targeted education program, and whether participants were more likely to engage in SDM with their health care provider about prostate cancer screening. Their knowledge was assessed through pre- and post-test surveys that addressed three topics:
- Increase in knowledge about prostate cancer screening
- Increase in intentions to have an SDM conversation with a physician about prostate cancer screening within 12 months
- Participation in an SDM conversation with a physician about prostate cancer screening within three months after the educational program
The program worked with 438 black men over the age of 40 who were recruited primarily through churches, as well as social media and community, civic, and social activities. Participants needed to be able to speak and understand English and reside in either Prince William or Stafford County in Virginia. Religious beliefs serve as a fear reducer and motivator for increased prostate cancer screening behaviors among black men, demonstrating the importance of faith and spirituality in the black community. Programs were implemented at 12 black churches, and prayer and scripture were included before and after each program session.
It’s important to ensure that programs are meeting the needs of the community. As a result, a community advisory board was developed for this program, which included key stakeholders such as nurses, physicians, ministers, local hospital representatives, prostate cancer survivors. and community advocates for black men’s health issues.
After the pretest to assess black men’s existing knowledge about prostate cancer, an educational session began with a five to 10-minute personal testimony by a black prostate cancer survivor, followed by an engaging question-and-answer session. The men then watched a short National Cancer Institute video clip, “Prostate Cancer Survivor: An African-American Man’s Perspective.” Next, two physicians who specialize in urology taught a two-hour information session that focused on prostate cancer statistics, prevention, screening, early detection, and quality of life. Last, there was another question-and-answer session, which was followed by the post-test. Contrary to previous community and faith-based programs, this one included a second post-assessment three months after the initial program to evaluate whether patients had an SDM conversation with their physician about prostate cancer screening.
The Program Results
The results showed that educating black men about prostate cancer through a community and faith-based program increased their general knowledge of prostate cancer and its treatment by 40.2%, improved their intention to have an SDM conversation with their health care provider by 17.8%, and impacted whether an SDM conversation took place within three months of the program by more than 80%. Although the results are encouraging, it’s important to note that the black men in this program were predominantly middle class and the majority were employed full-time and possessed private health insurance. Additional programs of this nature should be conducted with those without health insurance and with lower levels of household income.
The Importance of Research
Nurses can play a vital role in helping community and faith-based organizations develop and execute programs to address health disparities. The program I was a part of is an example of how community partnerships can implement a successful health education program. Doctoral programs, like Walden University’s PhD in Nursing, train nurses to become effective researchers and scholars to tackle complex health care questions and issues. It’s critically important for research to be conducted, especially in developing culturally appropriate models for diverse communities, so more contributions toward reducing health disparities can be made available to effect positive social change.
For more information about this prostate community and faith-based program, please view the summer 2018 issue of the Association of Black Nursing Faculty (ABNF) Journal.