Access to Health Care: Platforms and Agendas for the 2020 Presidential Election

Access to Health Care: Platforms and Agendas for the 2020 Presidential Election

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.

Resources

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.  

Mindfulness and Wellness Programs for Patients

Mindfulness and Wellness Programs for Patients

Nurses, like other health care professionals, have been hearing the buzz about mindfulness. Technology corporations, like Google, are instituting mindfulness programs, as are health care and wellness-related workplaces. Lifestyle magazines like Oprah and Yoga Journal are covering the topic, but surprisingly, so are Harvard Business Review and other business publications.

Perhaps you’re wondering what the term actually means, and whether it’s been proven effective in treating patients and those who want to be proactive in warding off illness and disease.

In this article, nurses and mindfulness experts will explain their unique approaches and how they help patients with health challenges. You’ll learn about the evidence behind the practice, so you can comfortably introduce it to your patients. You might even want to incorporate it into your own work and personal life.

What is Mindfulness?

Simply, mindfulness means that you direct your mind to the present versus having it wander aimlessly. You practice an awareness of your thoughts, and a focus on the here and now, not the past or future.

The opposite state, “mindlessness,” is what happens when you drive home at the end of a 10-hour shift, suddenly arrive at your front door, and can’t remember how you get there.

 

Are You Interested in Trying Mindfulness for Yourself?

The mindfulness and health site, DrJud.com, offers a free online course for health care professionals. The seven-module video course answers common questions about the practice and the evidence supporting it.

Continuing medical education (CME) credits are available through Brown University.

To learn more about the course and sign up, visit www.drjud.com/health-care-provider-course.

Though mindfulness meditation is thousands of years old, with its roots in Buddhism, today’s mindfulness practices are often not spiritually centered. Scientifically-based mindfulness programs are meant to be used by patients of all faiths (or none).

That awareness may help boost patient emotional well-being and help strengthen their immune system. One example of the benefits of mindfulness, the Cleveland Clinic reports that 20 randomized trials reviewed in 2011 show improvement in overall mental health.

Mindfulness is a drug-free tool that can help optimize neural processing, boost immune system function, address the epidemic-level of chronic pain, reduce insomnia, and even caregiver burnout.

In new research, mindfulness shows promise in reducing the incidence of physical diseases or managing existing conditions. Examples are diabetes and hypertension. Mindfulness can also be an aid in breaking unhealthy habits, such as smoking, and averting the associated risk of disease.

One Nurse’s Research on Mindfulness and Hypertension

Eunjoo An

Eunjoo An, MSN, RN, a PhD candidate in nursing at UCLA, studied ways to reduce hypertension, which is the number one risk for stroke, she says. As a nurse, An knew that simply telling people what to do—eat right, exercise, etc.—wasn’t enough. She suspected that mindfulness training along with a health promotion program could have beneficial results.

Earlier research showed that mindfulness has a calming effect on the fight or flight response, leading to blood pressure and heart rate reduction, An says. “The difference in my research is that it’s looking at not only blood pressure but habits; most patients have difficulty changing diet and exercise,” she explains. “Mindfulness brings focused attention to body. During those times you’re more likely to say to yourself: ‘I should eat better,’ and then that translates to that behavior. No study has taken that to the next step.”

An used the UCLA mindful awareness program beginner’s course, which is not as extensive as some approaches, but more approachable than others, she says. The mindfulness group was told to practice at home. She hoped that the training would help calm patients and that reduced stress would translate to behavior change.

Her research was applied to hypertension in an independent living facility that is primarily African American. She was the instructor for the health promotion group, using the six-week program modules on a government website. Both groups received information about healthy diet and the importance of exercise.

The results? “The mindfulness group, with stage 1 hypertension, reduced their systemic blood pressure to normal range at the end of the 12-week study,” she says. While blood pressure did go down in both groups, “in the mindfulness group it dropped into the normal range whereas in the health promotion group it stayed in the high range.” Mindfulness practice was beneficial in helping patients to eat and exercise in such a way that their blood pressure dropped 40%.

To learn more, watch An’s three-minute presentation about her research on the benefits of mindfulness available on YouTube.

Beyond Mindfulness for In-Patient Care

Menna Olvera Feder

The Urban Zen Integrative Therapy (UZIT) program brings mindfulness plus yoga, Reiki, essential oil therapy, and contemplative end-of-life care to patients and providers. Started in 2009 by fashion designer Donna Karan in New York, it soon expanded nationwide with the launch of the UZIT teacher training program.

“UZIT-trained therapists provide a variety of care, in a wide range of settings, to patients, staff, and caregivers, plus the community,” explains Menna Olvera Feder, UZIT acting program director.

Services can be accessed through a number of hospitals, rehab centers, senior-care and hospice facilities, as well as yoga studios offering drop-in stress-management class.

Research has been conducted at multiple facilities, including Beth Israel Medical Center in New York City and Wexner Heritage Village in Columbus, Ohio, showing significant health benefits. Patients experienced fewer symptoms of pain, anxiety, nausea, insomnia, constipation, and didn’t require as much medication for relief from those conditions.

When a UZIT-trained nurse “sees a patient isn’t breathing well, or is in pain, or is exhausted, they have what they need in their toolbox to address it,” says Olvera Feder. The UZIT protocol “adds a level of care to nursing that drew the nurse to be a nurse to begin with.”

The holistic program is used in health care environments with a diversity of patient populations. “We want to attract people of different cultures and those who are bilingual. We’re always looking for nurses who are Spanish-speaking or who speak Chinese,” says Olvera Feder.

Simple, clear terms are used to introduce the care modalities to patients and their families. For instance, “yoga,” is explained as “mindful movement to address respiration, digestion, and circulation,” Olvera Feder says. “Because when you’re in bed, you’re not doing downward dog.” Mindful movement in that case may mean that pillows aren’t stacked too high, and the patient is positioned in simple supported postures to bring them into a more comfortable state.

Anna Dermenchyan

The UCLA Health has a number of UZIT trained health care professionals, among them is Anna Dermenchyan, RN, MSN, CCRN-K. An Armenian American, Dermenchyan was an ICU nurse before transitioning to a quality role in 2013, with the aim of improving patient care. She is also pursuing her PhD in nursing at UCLA School of Nursing.

“Urban Zen is meant for patients who feel pain and anxiety—that’s pretty much any patient in a hospital—they feel so much better after,” she says. One of the moving examples of UZIT’s effectiveness was when Dermenchyan sought to help a family say their final farewells to a brain-dead patient. “We provided Reiki and essential oils to them and a sad experience was made less painful,” she recalls.

Though always aware of stress in the health care workplace and how it affects nurses and patients, “I realize now how stressed everyone is, including physicians and administrators, and how vulnerable they are to fatigue and burnout,” she adds.

Mindfulness Class in Your Pocket

Mark Mitchnick

Not every organization has a mindfulness program available for patients, and not every patient has the money or time to attend formal training sessions. That’s where digital mindfulness apps come into play.

“We consider ourselves the leader in evidence-based, digital therapeutics for mental health,” says Mark Mitchnick, MD, CEO of MindSciences, Inc. “It’s pretty easy to put an app out in the health care space, especially in mental health, but do they have evidence behind them? We get grouped with some very scientific, rigorously researched” companies, and some that are not.

Currently the company offers three apps: Eat Right Now to address emotional eating, Unwinding Anxiety to relieve anxiety and stress, and Craving to Quit for smoking cessation. They are based on the work of Judson Brewer, MD, PhD, a leading mindfulness researcher, $11 million in funding from the National Institutes of Health (NIH), and input from thousands of users in clinical trials, and later as subscribers.

Many users first learn about this brand of apps because their health care provider recommends them. “It’s offered to individuals through organizations and insurance providers, such as Humana,” he explains. “We wanted to offer [mindfulness] as something scalable and very affordable—and today that’s an app.”

For example, MindSciences is “working with coal miners in Appalachia, using our smoking app in a pulmonary clinic,” says Mitchnick. “Folks are enrolled in a clinic but still smoke.” Using a hybrid model of delivery—digital app plus the participation of health care professionals—they aim to help patients kick the smoking habit.

Similarly, they’ve started working with bariatric surgery clinics to help patients avoid regaining weight lost after surgery. “We’re not a willpower-based system,” he says. “In the case of eating, you have to separate out ‘I’m feeling hungry’ from ‘I’m feeling anxiety,’ and find a more appropriate behavior for that.”

Interested individuals can independently download the app, try it out free for three days, and later subscribe. In the case of Craving to Quit, the program is $24.99 a month, which includes the mobile app training modules, an online support community, and weekly live expert video group coaching sessions. The program has been shown to be twice as effective as a leading smoking cessation treatment, and it’s backed by a limited money-back guarantee.

Mindful Yoga-Inspired Tools for Patients

Kimberly Carson

Oregon Health & Science University (OHSU) in Portland, Oregon, offers a number of mindfulness programs to its patients and staff members. Kimberly Carson, MPH, C-IAYT, E-RYT, is a mindfulness educator and yoga therapist. She is considered a leader in the therapeutic use of mindful yoga for people with medical challenges.

Carson offers an ongoing drop-in class, Breath by Breath, as an introduction to mindfulness-based stress reduction methods. The class is free of charge to OHSU patients and any interested members of the community.

“Breath by Breath is a combination of mindfulness practices and yogic tools,” she explains, for cardiac, oncology, chronic pain, and other patients, plus their caregivers. “Sometimes people come once, sometimes a few times, or sometimes for years.” The class is held twice a week, for hour-long sessions, in conference rooms offered by participating departments.

Along with instruction in a variety of relaxation and mindfulness practices, Breath by Breath incorporates yoga-inspired adaptive movement, “We don’t take people to the floor,” explains Carson, “these movements are appropriate for most people—the postures are skillful to a medical or aging physiology.”

Group discussions and sharing make up an important component of the session. “At the beginning of the class, “I use what I call the ‘quickening question,’ which is totally spontaneous, such as ‘What inspired you today?’” she says. “The question helps give voice to people’s experience.”

She also facilitates Mindful Yoga for Chronic Pain, a five-week, drop-in series, “which is more asana heavy,” she explains. Gentle postures help patients develop mindful awareness of bodily sensations, thoughts, and emotions in this evidence-based intervention.

Beyond classes, Carson offers “bedside mindfulness” in the Bone Marrow Transplant Unit to address pain, agitation, insomnia, and existential distress. “I go in and lead patients through a mindfulness process,” she explains. “It quiets the nervous system, so they get relief right then. We do a body scan and breath awareness exercise. That’s the face-to-face introduction to the skill, to give them a taste of what’s available.” Later, patients can access more training modules on “the mindfulness channel” via OHSU’s digital education platform.

Mindfulness for Minority Communities

Jeffrey Proulx

Jeffrey Proulx, PhD, is a Native American who has been studying mindfulness as a way to reduce psychological stress and improve physical health in underserved communities. A K99/R00 award from the NIH National Center for Complementary and Integrative Health is currently funding his contemplative-based program to reduce diabetes in Native communities. He has also done culturally based mindfulness research with other ethnic minority communities.

Proulx believes that psychological stress needs to be viewed in a wider context that includes historical oppression. “They wanted to wipe Native Americans off the face of the earth, and African Americans were enslaved,” he explains. “So, for these populations, daily stress is compounded by historical stressors.” But instead of focusing on cultural trauma and the associated poor health behaviors, he works with communities to explore their resiliency and strength.

Mindfulness-Based Stress Reduction [MBSR] is the landmark evidence-based program developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center in 1979. Many health care mindfulness programs and health apps are based on this intensive, eight-week training series. Proulx has facilitated these classes for patients and health care providers at OHSU, as has Carson.

“But MBSR isn’t really geared to address cultural trauma, intergenerational trauma, people getting sicker from generation to generation,” he explains. “I’m approaching it from another way. The bigger, overall issue is how people carry on.”

One way Proulx makes sure his offering is culturally competent is by using the term “stress reduction” rather than “mindfulness.” That only goes so far, he warns: “You can call it different things to sand down the edges,” but it doesn’t change the basic shape, and what he’s trying to create “is a program to get at stress in your community, not just the upper class white community.”

The development process is long for his years-long studies in these communities who may be suspicious of him or medical professionals generally. To head off prejudice, he enlists the endorsement of community leaders (e.g., the tribal council or church pastor) and forms a small advisory group for guidance and assistance.

Proulx aims to create a safe, open, and accepting environment among community members. “You do that by learning about the history of the community, the culture, and becoming part of the neighborhood,” he says. “It’s an effort to develop trust, show trustworthiness, and embody trustworthiness.”

Their own culture then informs how these involved community members experience his mindfulness and stress reduction training. “‘Oh, it’s like Proverbs,’ I often hear,” says Proulx. “Or ‘It’s like Christian charity and compassion.’”

Underserved populations can also be a source of future trainers and greater diversity in the mindfulness field. “I encourage people in those communities to become teachers,” he explains. “Brown University is paying for that training.”

Hope Force International—Helping Others in the Face of Disaster

Hope Force International—Helping Others in the Face of Disaster

Natural disasters are scary, devastating, and sometimes fatal. There are many organizations that jump in to help when disasters occur, and Hope Force International is one of them. Tina Busby, FNP, RN, works for a group of Federally Qualified Community Health Centers, called NOAH-Neighborhood Outreach Access to Healthcare, part of Honor Health, a larger medical system in the greater Phoenix area, made up of multiple medical group practices and multiple hospitals.

She and her husband also volunteer with Hope Force International, a Christian-based disaster relief organization that, as Busby says, “works nationally and internationally to provide disaster services as well as services to help communities rebuild after disaster. It uses volunteers, both professionals and nonprofessionals, from multiple nations.”

Busby answered questions about her work with the organization.

Tina Busby in NepalHow did you become involved with Hope Force International (HFI)?

My husband and I have known the founders of HFI, Jack and Cheri Minton, since 2000 while serving with them in another faith-based ministry, Mercy Ships International. Since their conception of HFI, we have both had a desire to be involved, and we were finally able to complete our training and become HFI reservists about 6 years ago.

How does volunteering work? Are you put on alert or called in at certain times? How are you able to get time off from work?

When there is a disaster, HFI sends out a text message followed by an email to all reservists putting them on standby for possible deployment and asking them to pray and assess whether it is the right time for them to go and serve.

Because I have always been a part of a medical team, I have more notice and have not served with HFI immediately after a disaster. For the last few years, I have been a part of medical teams returning to both Haiti and Nepal. These HFI teams work with local community partnerships to show the love of Christ and advance His name. Since completing my education as an NP, I have felt a strong call from the Lord, that my skills and talents are to be used for His glory. Thus, I have tried to work in situations that allow for enough flexibility in my schedule to be able to serve others in this way.

Because we have a large family that is spread out all over the nation, finding a NP position with enough time off for both is almost impossible, and so, for the last seven years I have worked in a Per Diem or On Call position. Basically, I have an irregular schedule, and I fill in the open provider slots in multiple clinics, so that I am able to have control over my schedule and time off.

What do you do as a volunteer with HFI? How many times have you worked as a volunteer?

As a volunteer with HFI, my role has been to be a medical provider on multiple medical teams in both Haiti and Nepal, where I’ve traveled three times each with HFI. I have wanted to also help in other capacities, such as immediately after a disaster such as the recent hurricanes in Texas, Puerto Rico, and now the Bahamas. But at this point in my life, my resources (time and funds) are limited, and I also have a part-time job to keep up.

What did you enjoy most about volunteering for HRI?

I enjoy the people, all created in the image of God, both my teammates and those we are serving. I love seeing God work in so many different ways. I love meeting and making new friends and having the opportunity to serve alongside old friends. Having the luxury of going back to the same communities over the last few years, I love seeing how people’s hearts are becoming more responsive to Him and the great love He has for them.

What have been your greatest challenges?

My greatest challenge currently is that my husband, also a nurse, hasn’t been able to travel with me the last few years, due to his work schedule. Keeping my work and personal schedule flexible enough to serve, along with having the financial resources to serve, are always challenges. Some of the travel, long flights, and exciting bus rides, can be challenging for me as well.

Tina Busby in Nepal 2017What have been your greatest rewards?

Some of my greatest rewards have been the bonding of teammates and feeling the pleasure of God. I often personalize Eric Liddell’s quote to read, God gave me a compassionate heart and made me a healer. When I serve the least of the least, whether that’s at home or abroad, I feel His pleasure.

What would you say to someone who was considering volunteering for Hope Force International?

I would say, attend a Reservist Training and then go as God leads you! If you’re a nurse, we could really use you! We’ve just had to recently cancel an upcoming medical team to Haiti because we did not have enough nurses able to go.

Once you go, your life will never be the same and you will be “spoiled for the ordinary!”

Suicide Prevention Month: Know the Warning Signs

Suicide Prevention Month: Know the Warning Signs

If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 800-273-TALK (8255) or call 911 immediately.

Suicide is one of the most pressing health issues in the country today, but it’s also one many people are reluctant to discuss openly. With September designated as National Suicide Prevention Month, this is a great opportunity to help shed the stigma around suicide.

According to the National Alliance on Mental Health (NAMI) one in five adults will experience a form of mental illness this year. According to the National Institute of Mental Health (NIMH), the 47,173 suicides in 2017 makes suicide the 10th leading cause of death in the nation. But the problem is even more pervasive than even those alarming numbers. NIMH reported that in 2017, 10.6 million adults aged 18 or older reported having serious thoughts about trying to kill themselves.

Those numbers are staggering and reveal a deep level of anguish among the people in this country. Many of those people do not get any kind of professional help and many don’t even tell another person they have had thoughts of harming themselves. That’s why it’s so important for others to recognize, and act on, signs of trouble.

How You Can Help

As a nurse, you have a level of interaction with so many different people every day, so noticing subtle signs is important. It’s essential to know the warning signs of someone in crisis.

Depending on your specialty and your typical workday, your nursing career might not bring people in obvious mental health crisis into your day. That doesn’t mean your patients aren’t struggling. Friends and family might also be hiding their serious despair, so knowing what to look for and how to listen and interpret is helpful.

Warning Signs

Suicide Awareness Voices for Education offers the following behaviors as warning signs that someone is in danger and needs help:

  • Talking about wanting to die or to kill oneself
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious, agitated, or reckless
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

If you notice something is worrisome, for instance a friend’s social media posts have started to mention that “the world would be better off without me” or a struggling colleague’s behavior with drugs or alcohol is increasingly reckless, it’s okay to ask about it.

It’s Okay to Say Something

Saying something in a nonjudgmental way is best and helping that person find a professional to talk to is going to be helpful. Call a crisis line for immediate help or bring them to the ER, especially if you think they are in imminent danger of hurting themselves. It’s also probably going to be awkward and may not be met with affection, but generally those behaviors are the way someone might ask for help without really asking for help.

In your workplace, see if you’re able to post crisis hotline numbers, so others can have immediate access to the information—either for themselves, their patients, or someone they are concerned about.

How to Educate Patients About Keeping Healthy Cholesterol Levels

How to Educate Patients About Keeping Healthy Cholesterol Levels

September is National Cholesterol Month, making it a great time for nurses to revisit tools for educating patients about maintaining healthy cholesterol levels.

Nurses learn in nursing school about the two types of cholesterol: low-density lipoprotein cholesterols, or “LDLs”, and high-density lipoprotein cholesterol, or “HDLs”. Some cheeky nursing professors might teach their students that LDL’s are lousy, while HDL’s are happy, or the good and the bad cholesterol, respectively.

The goal for many patients is to elevate their HDL and lower their LDL levels, and nurses can play a big part in helping them achieve this. Maintaining healthy cholesterol levels is essential to well-being, and the consequences of not doing so can cause a great detriment to one’s quality of life and even death. The most notable sequelae of high cholesterol are a heart attack and stroke.

The Value of Patient Education

Many nurses take pride in their more technical skills such as phlebotomy, insertion, management of venous catheters, medication administration, and the development of nursing diagnoses and care plans. In many ways, however, patient education is a nurse’s most important task because it can prevent the need to carry out those more technical tasks that treat disease. Patient education instead is wellness-promoting. When it comes to cholesterol, it is a nurse’s greatest asset in assisting patients to avoid the potentially devastating consequences of unhealthy cholesterol levels.

Individualized Lifestyle Patient Education

Perhaps the most obvious factor to focus on regarding cholesterol is diet. For every fad diet, new superfood, and fasting regimen, there is a simple solution suitable for each individual patient. In order to effectively educate a patient about diet, the nurse must be armed with a straightforward understanding of where the patient is both physically and emotionally.

This means the nurse must know the patient’s existing dietary restrictions and needs based on physical conditions, such as carbohydrate restriction related to diabetes mellitus and salt restriction for heart disease. Emotionally, the nurse must also have an understanding of the patient’s dietary preferences and level of willingness.

A patient who claims to hate vegetables is unlikely to comply to eating a healthy cholesterol diet that is predicated on heavy vegetable consumption. This patient might do better if directed toward other dietary sources that support healthy cholesterol levels like oatmeal, berries, and other foods high in soluble fiber. Similarly, if a nurse works with a patient who makes clear that they are unwilling to stop eating fast food, the nurse might suggest a bowl of soup, a large glass of water, or a generous slice of watermelon helps hydrate before a meal. Hydration offers a wealth of health benefits besides relieving thirst, which many dehydrated patients confuse for hunger.

Stress management is not only a tool for a more pleasant daily life, but it is also an essential component of healthy cholesterol levels and overall wellbeing. Chronic stress can throw off our bodies’ cortisol release cycle, and there is a clearly defined relationship between abnormally elevated cortisol and high cholesterol.

Again, individualized patient education is key. Relaxation, sleep, and exercise are three fundamental components of managing cortisol and its effect on cholesterol. This doesn’t mean that every patient will be willing to start meditating, following a strict bedtime, and running marathons. By meeting with the patient and learning about their hobbies, the nurse may discover the patient loves to knit, dance, and read. For this patient, the nurse may recommend knitting to relax, dancing to music for fifteen minutes a day, and going to bed with a good book rather than watching the news.

The Role of the Nurse

Patient education is the nurse’s greatest asset in helping patients to establish lifestyle measures that support healthy cholesterol levels. In order to do this effectively, nurses must establish a rapport with a patient that engenders trust and understanding. This allows both the nurse and the patient to create a plan for the patient that is both effective and feasible to promote a patient’s cholesterol levels. Use September as a time to remind patients they are worth it!

Mercy Ships: Volunteering to Treat the Forgotten Poor

Mercy Ships: Volunteering to Treat the Forgotten Poor

When nurses think about volunteering, they may imagine doing so somewhere in their own backyard. While all type of volunteering to help others is important and valuable, there are many different types—some may even take you across the world. Meggin Tallman RN, BSN, now a Pediatric Critical Care Nurse at Children’s Hospital of Alabama, has volunteered a number of times with Mercy Ships. She wants to spread the word about this amazing organization, so she answered our questions.

What is Mercy Ships?

Mercy Ships volunteer Nurse Meggin Tallman plays the Ukelele with a patient onboard the Africa Mercy.

Mercy Ships is an international faith-based organization bringing hope and healing to the world’s forgotten poor. As many as 5 billion people lack access to safe, affordable surgical and anesthesia services worldwide, and less than 6% of all operations are delivered to the world’s poorest countries. Marginalized populations continue to suffer due to a lack of trained health care providers, inadequate infrastructure, and disproportionate out-of-pocket healthcare costs.

Mercy Ships programs offer holistic support to developing nations striving to make health care accessible for all. Since 1978, Mercy Ships has delivered services to more than 2.56 million direct beneficiaries. Mercy Ships owns and operates the Africa Mercy which is the world’s largest non-governmental hospital ship and is dedicated to the continent of Africa. Mercy Ships has an average of 1,000 volunteer crew, from up to 40 nations, serving onboard the Africa Mercy each year.

How did you get involved with Mercy Ships? Why did you decide to volunteer?

I had always had a dream to serve in developing countries upon completion of my nursing degree. I just really have a service heart, and I feel that I now have a set of skills that are desperately needed all over the world. If I am called to help and have the ability to, then how could I not volunteer?

As a new graduate, I got the opportunity to serve with the hospital I worked for, for a month in Zambia. Following that trip, I knew this was something I was uniquely called to do. When I got home, I really jumped into researching organizations doing medical missions on the continent of Africa, and when I discovered Mercy Ships, my mind was blown that they could do all the things that they do and help the amount of people they do. I instantly applied.

How long were you a volunteer? How did you get time off work?

My first service on the Africa Mercy was in Madagascar for just under four months and the second was just under three months in Cameroon. Those trips were somewhat easier to manage as I was a travel nurse at the time and could plan trips in between contracts. This last service with Mercy Ships was for six weeks in Guinea, and I, thankfully, have a boss who has a heart for missions as well. We were able to work together to help me take a leave of absence so I could fill a critical need the ship had for a pediatric ICU nurse.

What did you do with Mercy Ships? How many people did you help (estimate)?

On board the Africa Mercy I worked in D ward, which is the maxilla-facial ward, and my role was a pediatric ICU nurse. That being said, I treated kids and adults alike with ailments ranging from large tumors of the face and neck to cleft lips and palates to things as serious as neural tube defects.

In terms of how many people I specifically have helped, I don’t think that is calculable. Sure, I had my patients that I helped with medicines and wound dressings and those types things, but we also played games with patients and colored and sang songs. It’s just impossible to truly know the number of hearts and lives you affect both in the profession of nursing and just in life in general. That fact is even more so true on board the Africa Mercy, as it truly is a floating metal box of hope and healing…the patients aren’t the only people who leave the ship changed for the better.

What did you enjoy most about your experience?

Meggin Tallman, Ward Nurse (Paediatric ICU), with a patient on Deck 7.

I think if I had to choose one thing I liked most, it would be that we got to see the healing effects of love and compassion. All the interventions on the ship are surgical, so we have an instant gratification factor where the patient goes into the OR looking one way and comes out looking better. But many of these patients have endured terrible hurt and pain that surgery and medicine can’t fix. That’s where the games and songs and love come in. When you see that healing, you never forget it.

What were your greatest challenges?

I would say probably everyone who has ever served on board the Africa Mercy would say that the number one challenge is living in a tin box with 400 other people from 40 different nations. It is a challenging experience, but it grows on you.

What were your greatest rewards?

It is just such an honor to be able to be a part of the work of Mercy Ships and to play a small role in the life changes that take place on board the Africa Mercy.

What would you say to someone who was considering volunteering for Mercy Ships?

Do it! Not only will you be a part of changing people’s lives in a way that you could never have imagined, but you will come away changed too. I know it sounds crazy and scary and way too big for you–I’ve been there. But take the leap of faith; you won’t regret it.

Anything else?

My work overseas has made it evident that pursuing an advanced practice degree would make me that much more helpful in developing countries, which is why I am now earning my FNP at the University of North Alabama. Education is truly the greatest resource that you never have to worry about fitting in a duffle bag. I think that is an important thing to note when considering working in a low-resource setting.