ANA Takes a Stand on COVID-19 Vaccinations

ANA Takes a Stand on COVID-19 Vaccinations

As the Delta variant of COVID-19 spreads and numbers of those infected and being in treated in ICUs across the country keeps getting worse, it’s important for those not vaccinated to do so.

The American Nurses Association (ANA) recently spoke out and took a stand—stating that nurses should get vaccinated.

ANA President Ernest J. Grant, PhD, RN, FAAN, took the time to answer out questions about this and why it’s so important.

Why did the ANA feel the need to come out in favor of nurses getting the vaccine for COVID-19?

ANA has a longstanding history and commitment of supporting immunizations to protect nurses, health care professionals, and the public from highly communicable and deadly diseases—and COVID-19 is no different. For our nation to recover, heal, and return to a semblance of normalcy, enough individuals, nurses, and health care professionals must get vaccinated against COVID-19.

The swift development of COVID-19 vaccines and the execution of mass vaccination efforts is a significant public health victory and a scientifically proven strategy to slow the spread of COVID-19 and prevent the loss of more American lives. ANA continues to implore all health care professionals and the public to follow the science, adhere to the latest guidance of public health officials, and get vaccinated against COVID-19.

As we’ve seen, there are nurses and other health care workers willing to lose their jobs when they are required to get the vaccine. Why is this problematic? 

It is very disheartening to hear reports of nurses who are willing to quit their jobs rather than get the COVID-19 vaccine. There is significant clinical evidence on the safety and effectiveness of the authorized COVID-19 vaccines being administered under the Food and Drug Administration’s (FDA) Emergency Use Authorization (EUA). To those who are apprehensive about taking a COVID-19 vaccine, I say trust the science and evidence. What is more, the pillars of patient-centered care and the nursing’s own professional standards ethically obligate nurses to model the same prevention measures that nurses recommend to their patients.

Nurses play a critical role in the monumental recovery efforts currently underway to end the COVID-19 pandemic. Our nation will only be successful in recovery efforts with a robust nursing workforce at peak health and wellness, providing safe patient care, administering COVID-19 vaccines, educating communities, and setting an example for millions of Americans.

There are nurses who don’t believe the vaccine works. What can other nurses say to them to help them understand?

It is paramount for nurses to remain knowledgeable and up-to-date on the science behind the vaccines, and the ongoing clinical studies that prove its efficacy. ANA has developed key principles to guide nurses and other health care professionals’ consideration for COVID-19 vaccines. These principles provide recommendations for access, transparency, equity, efficacy, and safety of COVID-19 vaccines. Additionally, ANA’s comprehensive COVID-19 vaccine resource page stays up-to-date on the latest clinical information and news. ANA has also created a focused video education series on COVID-19 topics, covering different aspects of this crisis and providing information that nurses can apply immediately when caring for COVID-19 patients. ANA’s COVID-19 videos are FREE for all nurses.

Has the ANA received any backlash from nurses about this stance?

We are seeing more and more nurses getting vaccinated. And based on what we’re hearing from our state associations, organizational affiliates across the country, and our most recent survey, nurses are in favor of the vaccine mandates and trust the COVID-19 safety and effectiveness of COVID-19 vaccines.

Tell us about the support that the ANA has received from this stance.

Nurses working across all areas of the health care system are disseminating culturally relevant information on the COVID-19 vaccines to the communities and patients that they serve. Nurses are connecting with their patients every day to have meaningful conversations and answer questions about COVID-19 vaccines. ANA applauds those nurses who are getting vaccinated against COVID-19 and proactively setting an example for their patients and the public.

Is the ANA’s hope that other health care associations will follow their example? Why would this be important?

We strongly encourage other health care organizations and health systems to support of mandatory vaccinations against COVID-19 for all health care professionals including nurses.

Most importantly, we urge everyone to follow the evidence and science, so our nation can continue making progress in recovering from this pandemic to restore our health care systems and communities.

Discussing Minority Mental Health

Discussing Minority Mental Health

July is known as Minority Mental Health Awareness Month and it offers many opportunities to talk about important mental health issues.

The month is sponsored by the U.S. Department of Health & Human Services Office of Minority Health (OMH) which emphasizes health policies and programs that will help eliminate health disparities.

The recent news of elite Olympic athletes prioritizing their mental health and their own physical wellness over their sport has focused a national spotlight on the complexities and the prevalence of mental health struggles. And while seeing people who are suffering from mental health issues is difficult, the athletes’ public struggles have opened a door that allows healthcare providers to raise the issue with patients and loved ones.

In some minority communities, mental health struggles remain taboo to discuss openly. People who are experiencing symptoms of illness such as depression, anxiety, or obsessive-compulsive disorder, or even life-threatening suicidal thoughts face a stigma that prevents them from even seeking care. When the issues are discussed, access to affordable and high-quality mental health providers can be a barrier to getting help, as can lack of insurance and any language barriers.

According to the OMH, mental health is a serious and common health issue with approximately 18 percent of the entire U.S. population having a diagnosable mental illness within any given year. Of that percentage, only 43 percent of people who need mental health care receive treatment or counseling. For minority mental health needs, the numbers are even more concerning. While 48 percent of whites receive care, only 31 percent of Blacks and Hispanics do. And statistics for Asians were even lower at just 22 percent receiving needed mental health services. Disparities in mental health care can lead to lack of treatment or ineffective treatment.

For most people, mental health treatment is effective and improves their quality of life. Whether people choose medication (psychiatric nurse practitioners are especially), talk therapy, or a combination of both, getting help can make symptoms abate significantly. In more transient cases of mental illness, for example depressive symptoms caused by a major life change, treatment can get someone back to feeling like their old selves and can improve their resiliency moving forward.

These care disparities have lasting impact. According to the American Psychiatric Association minority and white populations have similar rates of mental illness, with white populations being slightly higher in some instances. But when Black and Hispanic people have depression, for example, the effects are more persistent. And systemic racism plays a role in proper care. The report states that “Racial/ethnic minority youth with behavioral health issues are more readily referred to the juvenile justice system than to specialty primary care, compared with white youth.” If mental health needs aren’t addressed and youth don’t receive proper care, that can lead to a disciplinary cycle that impedes educational and employment opportunities.

As a healthcare provider, keeping conversations about minority mental health open and ongoing with patients and having easily accessible resources available can make all the difference to helping patients get the care they need. From understanding the different types of mental health professionals and what they do to addressing medications or alternative therapies in a comprehensive treatment approach can help patients understand the range of help available. And with a recent uptick in the availability and acceptance of virtual therapy appointments, accessing care is somewhat easier for people.

Raising awareness and broaching the topic about minority mental health is important to removing the stigma and helping people move toward care that works for them.

Self-Care Tips for Nurses

Self-Care Tips for Nurses

Oftentimes, nurses don’t take care of themselves like they should. While they focus on taking care of others, their self-care falls by the wayside. Especially during COVID-19 and the pandemic, they’ve put everyone else first.

Imani Wilform, MHC-LP, with Empower Your Mind Therapy, took time to answer our questions and give self-care tips on what nurses can do to make sure that they are making time for self-care. Our interview, which follows, has been edited for length and clarity.

Dealing with COVID-19 and the pandemic has been tough on everyone, but especially difficult on frontline workers such as nurses. Why should nurses be sure to practice self-care now?

As much as nurses care for everyone else, it’s crucial to pay attention to your own needs too. By its own true definition, self-care is about taking intentional care yourself: your mind, your body, your environment, and your spirit.

If we don’t practice self-care, we can become burned out, resentful, angry, and may even start feeling depressed. This also lowers your immune system and can make you feel tired and low. If you’re not feeling your best, how can you manage caring for others?

What are some things that nurses can do to be sure to remember self-care and to fit it into their busy days?

While the occasional self-indulgence like a spa day or getaway can be a great way to express some gratitude to yourself and all you accomplish, self-care is about more than an occasional treat. An intentionally cultivated daily self-care routine can make a huge difference in our lives and allow us to be balanced & more restored.

Today, ask yourself:

  • How do I typically take care of myself day to day?
  • Do I take time to regularly assess and address my needs?
  • How is that impacting both my mental and physical health?

I really want you to think about how (or if) you set aside time each day to take care of yourself. Do you have time to sit back and assess your needs? Do you listen to your body when it tells you that you need a break? When you’re mentally strained, do you have a routine that helps you rest and rejuvenate?

Is there anything they can do at work on a break or at home?

There are a lot of little things that are self-care, but aren’t exciting or Instagram-able. You can do these quickly:

  • Write down your to do list for the week to stop the constant nagging in your head.
  • Set a time to be done with screens before bed.
  • Make a meal plan that gets you excited to eat 3 meals a day.
  • Take a look at your calendar: are you overbooked, need a fun outing to look forward to, need to make a doctor’s appointment?
  • Call a friend to catch up.
  • Spend time outside.

What are absolute must-dos regarding self-care?

Assess your true needs: when we’re talking about daily self-care we’re talking mainly about wellness (mental & physical). For a week, keep a log of your physical and mental expressions of stress or strain. Are you tired? Do you have frequent headaches? Look at what comes up for you and come up with small, incremental steps to take action. Maybe you have constant headaches because you’re dehydrated. Start carrying a water bottle, set some reminders on your phone to actually drink from it.

Take a critical look at your routine: What is taking up your time on a daily basis? Often times we fall so behind on creating an actual daily routine that serves us that we end up playing perpetual catch up. Finding the right way to balance what you need day to day will help ease stress and keep you feeling more balanced and in control.

Prioritize rest: if you have to put it in your schedule or “to do” list to make sure you get time to rest and recharge then do it. Maybe it’s yoga, reading, taking a bath. Rest and rejuvenation should be a priority in your daily routine. Set aside small chunks of time each day where you stop the machine, ignore “productivity” and let yourself rest.

What would you say to a nurse who says s/he doesn’t have time for self-care because too much is going on?

Self-care can be something quick and small to help yourself with your own mental and physical well-being. As a nurse, it’s important to remember that you are just as important as your patients and family. Others rely on you, so rely on yourself too. Even if it’s a quick walk around the block during lunchtime or outsourcing personal to-dos to another family member—such as creating a shopping list or picking up a birthday gift for someone—try to take some time for yourself. Also remember that self-care shouldn’t create more pressure. If it’s too much to take time every day, start with setting aside some time once a month to check in with yourself.

Addressing the Minds and Bodies of Minorities: How the Covid-19 Pandemic Has Compounded Behavioral Health Issues

Addressing the Minds and Bodies of Minorities: How the Covid-19 Pandemic Has Compounded Behavioral Health Issues

The coronavirus has hit minority communities harder in terms of health by amplifying social and economic factors while also revealing deep-rooted inequities. Racial disparities that were present before the pandemic have only been compounded and are evident in the rates of minorities contracting the virus compared with their percentage of the population. This has especially been seen in Latino and multiracial communities in the United States. According to the CDC, Latinos make up 18% of the population and account for nearly 29% of Covid-19 cases. Similarly, those who identify as multiracial (non-Hispanic) make up 2% of the population but 5% of Covid-19 cases.

Source: CDC Covid Data Tracker (as of 5/20/21)

As a result of the pandemic, racial and ethnic disparities in access to behavior health care have also been illuminated. Interestingly, the rates of behavioral health disorders in Blacks and Latinos do not differ from the general population. Yet, they do have markedly less access to mental health and substance-use treatment services. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), of the 4.8 million African Americans that live with mental health disorders 69.4% of them receive no treatment. Of the 6.9 million Hispanics who live with mental health disorders 67.1% receive no treatment. Both these statistics are alarmingly high when compared with the 56.7% of the overall U.S. population that do not receive treatment for mental illness. Likewise, alarming numbers can be seen in those with substance use disorder. Of the 2.3 million African Americans who have Substance Use Disorder, 88.7% do not receive treatment. Of the 3.3 million Hispanics who have Substance Use Disorder, 89.7% do not receive treatment.

There are already many barriers in place for Blacks and Latinos due to social determinants that only increase the vulnerability of those with mental illness. Black and Latinos have lower access to health care, are found to terminate care prematurely, and receive less culturally responsive care. The opioid pandemic is perhaps hitting the Black and Latinos the hardest due to their limited access to preventive treatment and recovery resources for substance use disorders. Despite Blacks having comparable rates of opioid misuse as the general U.S. population, they were found to have the greatest rate of overdose methadone synthetic opioid deaths.

Nurses must work with the health care team to prevent the interruption of substance use treatment and recovery services. Telehealth services must be expanded. Those with substance use disorders and mental illness who have Covid-19 particularly need support during this time. Recovery support groups that have been stopped, clinics that have closed, and the discontinuing of harm reduction services like syringe service programs have the potential to trigger relapses in our patients as well as increase the rates of HIV and hepatitis. According to SAMHSA, Blacks and Latinos who have substance use disorders and mental health disorders are found to be more likely to be homeless and incarcerated which further increases their risk of Covid-19.

There is much potential for managing this identified risk and problem in Black and Latino populations. Policy efforts can be made in the form of disaggregating data so that resources can be targeted based on more specific data. Policies and treatments should be more flexible. For example, SAMHSA released a guide which enabled dispensable take-home methadone treatment programs during the pandemic. There should also be a push for expanded and flexible coverage of telehealth so patients can continue to receive treatment via the telephone or video-conferencing.

Communication, health literacy, and public awareness must also be accounted for. Covid-19 education should be translated into the language of those in the communities we serve. Also, messages should be culturally tailored so that concepts presented like social distancing are culturally appropriate. Communication channels are also important so perhaps using Black and Latino radio stations, websites, and trusted media figures to deliver important messages about prevention strategies

Workforce efforts can also be had by augmenting the workforce with culturally competent healthcare professionals. The workforce is in dire need of the individuals. Perhaps fast-tracking immigrants, refugees, and bilingual health care professionals could create a much needed pool of such health care workers in the United States. Peer navigators and coaches are also valuable for creating outreach and engagement of Black and Latino communities so that they can be properly linked with mental and substance use disorder treatment. Peer navigators know the communities we serve well and know how to effectively communicate with clients. These could be made virtual to ensure Black and Latino communities receive proper behavioral health care.

Blacks’ and Latinos’ physical health have greatly been impacted by the pandemic with a disproportionate rate of Covid-19 infection. However, the pandemic is not only affecting the nation physically—but also behaviorally. As nurses we address the physical and emotional health of our clients because we see them as a whole being. Therefore, we must work hard to address these issues and advocate for our patients so that they can live healthy lives, not just in their bodies—but in their minds as well.

Taking a Look at Covid-19 Vaccine Research Minority Representation—Key to Increasing Minority Vaccination

Taking a Look at Covid-19 Vaccine Research Minority Representation—Key to Increasing Minority Vaccination

Last December, the FDA reported on both the Pfizer-BioNTech and Moderna Covid-19 vaccine and the respective race and ethnicity of their research participants in the Phases 2 and 3 research trials. The Pfizer trial included ages 16 or older and the Moderna trial included those 18 and older. Of 285 million in the United States population, over 40 thousand participated in the Pfizer trials and over 27 thousand in the Moderna trial. When looking at the combined totals of subjects compared to the general population, whites were found to be over represented. Whereas 73.6% of the U.S. population are white, 79.4% to 81.9% of the subjects reported their race as white. American Indian/Alaska Native and Native Hawaiian or Other Pacific Islanders had the exact percentage of research participants to those of the U.S. population; 0.8% and 0.2%, respectively. The second largest contrast in proportion of participants to the U.S. population was seen in comparing those of Asian race. Only 9.7-9.8% of research subjects reported themselves as Asian, whereas the total U.S. population percentage is 5.9%. The biggest discrepancy can be seen in research participants who reported their race as Black. Only 9.7-9.8% of research subjects were Black, whereas Blacks make up 12.3% the current total U.S. population. Regarding ethnicity, 17.6% of the U.S. population reports themselves as being Hispanic and 20-26% of participants identified themselves of Hispanic ethnicity. However, 82.4% of Americans report themselves as non-Hispanic and 73.2% to 79.1% of research subjects identified themselves as that ethnicity.

Despite these Covid-19 vaccine trials demonstrating greater diversity than previous trials of other pharmaceuticals, these statistics still represent a disparity in the representation of people of color as research participants in a vaccine designed to boost the immunity of a virus that is disproportionately affecting people of color in the United States.

The good news is that despite this disparity in the diversity of representation in the clinical trials, the findings did show that the safety and efficiency of the Pfizer-BioNTech and Moderna vaccines were similar across groups despite race. The question many pose in reaction to such statistics is why minorities are underrepresented in clinical trials. The main four reasons include: barriers to access, lack of information, and historical and continuous racism and discrimination. Barriers to access come in the form of few clinical trials being offered through under-resourced hospital systems that minorities use for health care. Also, minorities are less likely to have eligibility to participate in such trials due to having co-morbid conditions or not having health insurance. These attributes can exclude them from participation in such research studies.

Other challenges to access may be their limited or lack of transportation resources, being unable to request off of work, caregiving schedules, or not having access to technologies for monitoring during a research study. Some research studies have reported that physicians are less likely to offer clinical trial participation to minority patients. Enrollment efforts of research studies often may not reach the minority population if they are not culturally sensitive to address language or health literacy barriers. The history of medicine in the United States also has seen the abuse and mistreatment of minorities such as the Tuskegee syphilis experiment. As a result of such abuse and ongoing racism and discrimination, minorities are less willing to participate in clinical trials.

The racial and ethnic diversity of clinical trials in the further development of Covid-19 vaccines is imperative. This pandemic has impacted those of Black adults and minorities the most, so more trials should effectively recruit and maintain the participation of minorities. Minorities already historically have had lower vaccination rates and express more concerns about receiving the Covid-19 vaccine and perhaps their concerns are valid based on the data presented in this essay. Therefore, it is important that Covid-19 vaccine researchers ensure the safety and efficiency of the vaccine across all of the United States to increase the trust and confidence of minorities that they should get the vaccine.

Colorectal Cancer in the Black Community

Colorectal Cancer in the Black Community

Unfortunately, some issues or diseases are more prone to affect people in certain communities—case in point, colorectal cancer has been known to disproportionately affect the Black community as compared with white communities. In fact, according to the American Cancer Society, Black people are up to 20% more likely to get colorectal cancer and are also about 40% more likely to die from it.

We interviewed Phyllis Morgan, PhD, FNP-BC, CNE, FAANP, academic coordinator for Walden University’s MSN-FNP program, as she has conducted research on colorectal cancer in men as well as Black men and women’s health issues, including disparity in health and health care.

Phyllis Morgan, PhD, FNP-BC, CNE, FAANP

Why does colorectal cancer disproportionately affect the Black community?  

There are several reasons why colorectal cancer disproportionately affects the Black community. First, there is a general lack of knowledge about screening for colorectal cancer, which contributes to inadequate prevention and screening behaviors. There are also various fears that come into play, such as fear of cancer and of a cancer diagnosis, and fatalistic views about cancer.

A recent study showed that in Black Americans, the right side of the colon ages much faster than the left side, which could contribute to this population’s increased risk for colorectal cancer, particularly on the right side of the colon, and at a younger age.

Other factors may include delayed treatment and the fact that Black individuals have a higher incidence of obesity and more often consume a high fat, low fiber diet, which increases risk.

Why are Black people who get colorectal cancer about 40% more likely to die of it than other groups?

In addition to factors such as inadequate prevention and screening behaviors as well as delayed treatment, racial inequities in care also contribute to the fact that Black people who get colorectal cancer are more likely to die of it than other groups. There is a widespread lack of access to care for many people in this population, and some have no health insurance or inadequate health insurance for treatment.

Additionally, lifestyle factors such as diet and exercise can contribute to this.

What are the challenges facing the Black community regarding colorectal cancer?

Some challenges facing the Black community regarding colorectal cancer include inequities in health care, lack of access to quality care, and a lack of adequate resources to educate about the importance of colorectal cancer screening. It is crucial that we increase screening by providing better education for the Black community regarding screening and the importance of polyps being removed from the colon.

Additionally, we need more diverse health care providers, so patients can have providers who look like them and with whom they can connect and relate. Black health care providers can play an important role in helping patients to understand the seriousness of colorectal cancer in their community.

What can nurses do in order to get people in minority communities to go for tests, pay attention to symptoms, etc.?

First, nurses can help by providing more colorectal cancer resources for their communities. In addition, culturally appropriate educational programs and community or faith-based educational programs can be helpful in encouraging people in minority communities to undergo screening.

As an African American woman and advanced practice nurse, I have participated in many projects and studies to identify ways to increase awareness, prevention, and treatment of health issues that impact the Black community. Specifically, I worked on a community and faith-based education program to increase awareness of prostate cancer among Black men, which resulted in an increase in participants’ general knowledge of prostate cancer and treatment by over 40%. I have also implemented successful community and faith-based education programs in North Carolina and Virginia to help educate Black people about colorectal cancer and increase screening behaviors. These types of programs are proven to make a difference.

Nurses can play a vital role in helping community and faith-based organizations develop and execute programs to address health disparities. 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.

Last but not least, Walden University and the National League for Nursing are excited to launch the Institute for Social Determinants of Health and Social Change, where nurse educators and inter-professional colleagues will play an instrumental role in achieving health equity across various demographics. The institute is designed to cultivate these health care professionals into leaders who address the impact of structural racism, socioeconomic status, environment, education, adequate housing, and food insecurity on health and well-being.

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