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.
As a nurse, being able to communicate effectively with patients is crucial. But communicating with patients who have developmental disabilities may be more difficult at times.
Georgia Reiner, Risk Specialist, Nurses Service Organization (NSO), knows how to interact with these types of patients and answered our questions on what you can do to communicate with them better.
Why should nurses communicate differently with patients with developmental disabilities? When do they need to make sure that a parent or guardian is there?
People with developmental disabilities such as Down syndrome or who are on the autism spectrum face significant barriers to accessing quality care. Inadequate communication between the patient and health care providers is one of those barriers that can result in harm to the patient. Effective communication is the keystone for ensuring quality, patient-centered care for patients who have developmental disabilities. With skill and patience, nurses can help keep patients safe.
It is important to ask patients if they want their support worker or caregiver to stay with them.
What should nurses do to communicate better with these specific patients?
In order to communicate better with specific patients, nurses must establish the patient’s communication strengths and challenges and tailor their approach accordingly. Nurses need to document preferences in the patient’s health record so that they are accessible to all members of the team.
It is also very important for nurses to allow enough time to listen and understand that interactions may take longer. Nurses need to know that differences in muscle tone for some individuals may complicate reading their facial expressions or body language. Additionally, it is important to choose appropriate, concrete language. Explaining concepts clearly and directly while using specific words and visual aids can be very helpful.
How can they make sure that they are being clear while not “talking down” to these patients?
Nurses can make sure that they are being clear while not “talking down” to these patients by establishing rapport. They need to make sure that they are speaking directly to the patient—as opposed to a family member or caregiver—when possible. It is also important to avoid talking to an adult as if he or she is a child. Nurses should take time to assess the patient’s understanding and to validate their own perceptions to make sure they are understanding the patient. Nurses are encouraged to use the “teach-back” method to ask the patient to repeat the information back to them.
What are the most important concepts that nurses should keep in mind when communicating with these patients?
It is important for nurses to give patients with developmental disabilities exact instructions and explain what they are doing in sequence. Try to eliminate distractions where possible, by meeting in a private, quiet room.
Nurses should also avoid asking abstract questions, and instead be direct. For example, ask “Are you tired?” instead of “How do you feel?”
If the patient uses a communication device that you are not familiar with and the patient cannot show you how to use it, ask the caregiver to do so.
Let patients know they can bring a favorite item they like to have with them in order to help regulate sensory stimuli.
What should nurses never do while communicating with these patients?
Nurses should never shout; speak slowly, in a normal tone of voice.
Nurses should never assume that their body language and facial expressions will be understood. Respect differences in communication style. For example, many patients with autism spectrum disorder prefer avoiding eye contact.
Nurses should never touch a patient without telling them when and where before doing so. Act out or demonstrate actions for patients who prefer non-verbal communication.
What else is important for our readers to know about communicating with patients with developmental disabilities?
People with developmental disabilities deserve the best possible care from health care providers, including preventive health measures and appropriate management of health conditions. By being knowledgeable on how to effectively communicate with patients who have developmental disabilities, and practicing different communication strategies, nurses can become more confident, and provide patient-centered care. Through thoughtful communication and collaboration with caregivers, family, and the interprofessional team, nurses can help achieve the goal of optimal care—and optimal outcomes.
Nurses are only one segment of the interprofessional team, but they are frequently the strongest patient advocate. At the end of the day, working as a team, advocating for patients, providing information and education in the patient’s preferred communication style, and collaborating with caregivers and family members, can help nurses end the stigma of caring for patients with developmental disabilities and achieve the goal of optimal care and outcomes.
When vaping first began, many smokers saw it as a godsend: if they couldn’t quit, they could take up vaping, which wasn’t as toxic as smoking.
Or so they thought.
Karen Goldschmidt, PhD, MSN, RN, CNE, Associate Clinical Professor and Department Chair RN-BSN Degree Completion Program, College of Nursing and Health Professions at Drexel University, says, “E-cigarettes were introduced to the market in 2006-2007 as a lower-risk alternative for adults who smoke tobacco and as an aid in smoking cessation. At the time, because e-cigarettes were not considered tobacco products they were not regulated by the Food and Drug Administration.”
In fact, it seems that vaping is causing more problems—and ones that health care providers don’t yet fully understand. “In the last several weeks, hundreds of possible vaping-related illnesses and 18 deaths have been reported. The number of cases has been increasing at an alarming rate. Symptoms of the mysterious illness include shortness of breath, fever, fatigue, and vomiting. Some patients have experienced respiratory failure, ending up in the intensive care unit or on a ventilator,” explains Goldschmidt.
Unfortunately, Goldschmidt states that U.S. youth are the ones who use e-cigarettes the most. And it’s serious. “Today the U.S. faces a public health crisis of epidemic proportions. The use of e-cigarettes among teens has the potential to create another generation addicted to nicotine. Both youth and young adults identify flavors as a primary reason for e-cigarette use. Today there are over 7,000 flavors available. Advertising is another factor,” she says. “Exposure to e-cigarette vapor condensate is toxic to lung cells and shows similar cellular changes to chronic smokers and people with chronic obstructive pulmonary disease (COPD). The exposure increases the risk of infection and chronic lung disease.”
As nurses, you can try to help these patients by encouraging them to quit vaping, as just this kind of intervention could make a difference. According to Goldschmidt, “Studies have shown that receiving counseling regarding tobacco use has been linked with 47 percent better odds of an attempt at quitting smoking within the year. Unfortunately, only a third of adolescents’ report being asked about tobacco use by their provider.”
There are also other steps you can take to help your patients. “I recommend that nurses, nurse practitioners, and physicians screen patients for vaping/e-cigarette-use and educate patients about the risks of using these products. It’s not enough to just ask if people they smoke, drink, or use drugs. E-cigarettes and vaping are seen by people as being completely different, and many are misinformed—thinking that they are safer than smoking,” explains Goldschmidt. “Health professionals need to change their language to keep up with substance use/device use. For instance, Vaping is different than e-cigarettes and ‘Juuling.’”
Goldschmidt suggests that you give support, education, and resources to help your patients who are vaping. “Of course any nurse working with a patient with a substance use disorder needs to be aware that it is just that—that patients are most likely addicted to the Nicotine or THC and a plan of care must include caring for a patient who may decide to continue to use or helping the patient through withdrawal. Education is the key. In the end the patient needs to be ready to give up the substance,” she says. “Providing support and resources for the patient to eliminate vaping/e-cigarettes any substance is very important. I would suggest the Truth Initiative and SmokefreeTXT for Teens as resources to help teens or adults quit e-cigarettes.
“See the CDC website for the most up to date statistics. Also, the FDA, as these products may soon be regulated. Some states have already banned flavored e-cigarettes.”
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.
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.
Presidential candidates are gearing up for the 2020 presidential election and are sharing their platforms and agendas for creating a stronger and more prosperous nation. Presidential hopefuls have identified a number of proposals focused on ensuring access to health care. Some candidates vow to ensure access to health care by recommending universal health care coverage through a single payer national government health care program referred to as the Medicare- for-all proposal. Other candidates are in favor of some version of this proposal by lowering the Medicare eligibility age to 50 but also retaining the private insurance option. Still, some presidential hopefuls aim to ensure health care coverage by providing a public option for people under age 65 or by strengthening health care coverage by building on the Affordable Care Act. Regardless of a candidate’s position, the debate on how to achieve universal coverage will continue to evolve overtime leading up to the election and way beyond.
Findings from a Kaiser Family Foundation’s survey found that the majority of people who voted on a regular basis are not familiar with or clear on the Medicare-for-all proposal. Survey respondents are seeking solutions to everyday problems such as paying for care, eliminating red tape, and navigating the health care system.
While there are many proposals that are under consideration, the Medicare-for-all proposal is one of the most frequently cited proposals designed to ensure universal health care coverage. There are several versions of this approach to health care coverage, such as the proposed version introduced by Senator Bernie Sanders in 2017. Here we discuss the Medicare for All Act of 2019 (M4A), one of the most recently introduced iterations of the Medicare-for-all approach to health care coverage.
National news media such as CNN, The New York Times, and The Washington Post traditionally have provided an in-depth discussion and analysis on presidential campaign issues, including health care.
The following are a few resources that can assist nurses in staying abreast of some of the campaign health care related discussions and other issues relevant to health reform:
This proposed legislation is similar to the legislation introduced by Senator Sanders in 2017 and other single payer legislation proposed by members of Congress. While there are some similarities, there are also some differences. For the most part, Medicare-for-all proposals will constitute a major shift in health care financing and will move from the traditional focus on providing health care coverage exclusively for those age 65 and older to more widespread care coverage for those under age 65.
Here is a brief snapshot of some of the basic components of the M4A introduced by Rep. Pramila Jayapal (D-WA) on February 27, 2019:
- Single federal government administered program to cover all U.S. residents (including immigrants and possibly undocumented individuals)
- Open enrollment to those age 19 and under as well as those 55 and older one year after enactment
- Abolishes traditional benefits covered through traditional Medicaid/Medicare program, Children’s Health Insurance (CHIP), the Federal Employees Health Benefits Program, or TRICARE (health care for active and retired military)
- Recommends a ban on cost sharing (e.g., copays, deductibles)
- In addition to the 10 categories of the essential benefits in the Affordable Care Act, proposed additional covered benefits and services include hospitals services; ambulatory patient services; primary and preventive services; prescription drugs and medical devices; mental and substance abuse treatment services; laboratory and diagnostic services, comprehensive services across childbearing cycle; newborn and pediatric services; emergency services and transportation, early and periodic screening as outlined in Medicaid; transportation to health care services particularly for low income and persons with disabilities; and long-term care services and support.
Source: Health Affairs
As the nation’s largest group of health care workers, nurses must possess a fundamental awareness of the various proposals devoted to ensuring access to health care. This will be particularly important for the many individuals, families, and communities who continue to lack access to care and suffer disproportionately from a number of health conditions and illnesses. As the most trusted profession, we are well suited to lend our voices to advocate for better access to care for all and are encouraged to do so. Our role in educating our policy makers has never been greater as we have firsthand knowledge of how the lack of access to quality health care coverage impacts the health and well-being and even life expectancy of those residing in the United States.
Be sure to stay informed of the various debates and proposals on universal health care coverage. Efforts to revise our current approach to health care financing and access to health care is complex and will require that we stay abreast of the discussions surrounding this issue. The American Nurses Association, the Kaiser Family Foundation, The Washington Post, and Health Affairs, to name a few, traditionally provide a synopsis on where candidates stand on health care issues and universal coverage. In addition to watching the presidential debates, nurses are encouraged to visit the web sites of the various presidential candidates to become more familiar with their position on health care ( e.g., access, universal coverage, health care reform) along with a myriad of other health care issues (e.g., prescription drug coverage, supplemental coverage). As we continue to support access to health care as a human right, our awareness of the issues and advocacy for access to quality health care for all will remain an important factor in the upcoming presidential campaign.