Weight Management for Nurses: The Why’s and How’s of Losing or Maintaining Weight

Weight Management for Nurses: The Why’s and How’s of Losing or Maintaining Weight

weight management

As you well know, America is in the grips of an obesity epidemic. According to the National Institute of Diabetes and Digestive and Kidney Diseases, over 70% of adults are considered overweight or obese, which is associated with multiple medical conditions. Nurses, as role models, advocates, and educators, are poised to make a difference in reversing this trend.

Unfortunately, nurses are not immune to weight problems themselves. In fact, research suggests the rate of overweight and obesity within the profession is on par with the general working-age population.

Here nurses and wellness professionals offer savvy advice for managing weight and fitness.  Even for those working long, stressful, rotating or night shifts that offer few healthy food and exercise options.

Becoming a Healthy Role Model    

Many nurses feel hypocritical telling patients to exercise and eat right if it’s obvious that they don’t walk the talk. Maybe that’s one of the reasons nurses enjoy a stellar reputation for honesty and trustworthiness, according to annual Gallup polls.

Yes, nurses are role models for patients, but there’s another professional reason to take care of one’s weight and fitness—the health and longevity of your career. The American Nurses Association Code of Ethics for Nurses includes several mentions of the importance of self-care (e.g., “The nurse owes the same duties to self as others”).

Nurses Helping Nurses

Many nurses know about the power of a group for establishing healthier habits like eating better and moving more. Most of those groups are comprised of people from all walks of life. But you may find there’s even more power in teaming up with fellow nurses who understand the struggle, especially if they’ll be around regularly to hold each other accountable.

Victoria Randle, MSN, NP-C, is a family nurse practitioner in the Atlanta area and cofounder of Nurses 4Ever Fit. Since January of 2018, the organization has held monthly in-person events at venues such as a nurse-owned yoga studio. “We all have a special bond that only another nurse can understand. It’s a platform for like-minded individuals to talk together, it’s a form of therapy, a form of camaraderie, and you can get your fitness in,” she explains.

Randle says the emphasis is on fitness, rather than diet, because “I see a lot of nurses who are vegan, for instance, and they don’t seem healthy. The element that’s missing is movement. When you’re 90 and you don’t have good muscle tone or you have brittle bones, that’s not healthy.”

Also, many women say they are “fearful of going to a gym because ‘I’m afraid people will look at me and judge me’ but here we’re all learning, and it’s a judgement-free zone,” she adds.

Saturday morning fitness sessions are only part of the Nurses 4Ever Fit experience. “We’re going to do an annual retreat. We take a weekend away and it’s a form of therapy. It includes a massage or a hot tub together,” she explains.  “Exercise is good, but it’s not everyone’s idea of self-care. The nature of a nurse is to care for others and put the patient first. So, when it comes time to care for yourself, you don’t have much left. That is embedded in you—the workplace culture needs to change. Nursing school actually taught that if you get a 30-minute break in a 12-hour day, you’re lucky!”

Healthy Workplaces Equal Healthy Nurses

Some hospital systems have started programs to ensure that healthy food and fitness opportunities are available to their nursing staff.

MD Anderson Cancer Center in Houston, Texas, is lauded as an outstanding example of a wellness workplace. Evan Lee Thoman, MS, PMP, CWP, wellness specialist in the HR Wellness and Recognition unit has been in health promotion field for 13 years.

He works to find out what other employers at other top hospitals and universities are doing to engage employees toward a healthier lifestyle. And he investigates what his own hospital’s employees want before offering up a range of at-work health initiatives.

“The program is different for every unit. I go in and have a conversation with the leadership and we may do a needs and interest survey. We’re asking: ‘What do nurses need?’,” Thoman says. For instance, “we had many questions in one unit regarding how to make use of dental insurance. Who would not have guessed that medical consumer information was a top concern?”

But it was, so the wellness department set up a program to fill the knowledge gap. They aim to provide education and services to every shift ranging from an on-site fitness center and gym membership to ergonomic assessments and resources to address compassion fatigue, resiliency, and spiritual care.

Workplace leadership that buys into a wellness culture will reinforce the healthy behaviors that nurses must adopt. Thoman helps nurses to create those wellness habits, without overwhelming them. He asks them: “Who’s going to be your support system? Who’s going to hold you accountable?” The wellness team is there, of course, but so are fellow nurses and nurse leaders. “We get the best results and greatest engagement when we have a leader who walks the talk,” he says.

For example, nurses are notorious for neglecting to take meal or water breaks. “If you eat lunch it’s almost like you’re the weak one on the unit,” he says. “We’d been talking to nurses about planning their meals but then we thought, maybe we can bring something to the nurses. So now we try to take snacks to each department—‘Here’s a little something, a granola bar or piece of fruit, to fuel you during the day.’ We also stress micro breaks and encourage them to find five minute for a snack, go for water.”

When overworked and overstressed nurses complain that they don’t have time to take care of themselves, Thoman suggests gardening, journaling, or even coloring as a way to decompress.

Because nursing is a predominantly female occupation, Thoman notes that rest and relaxation may be difficult for women who do double-duty as caretakers at work and at home. Then there are the biological factors that may hamper a woman’s weight management efforts.

“From a weight-loss perspective, men tend to have more lean muscle than women, which burns more calories than body fat at rest, so, at the onset, men may lose weight a little faster,” explains Thoman, who was previously a university strength and conditioning coach.

Exercise Early, Exercise Often

Cara Sevier, RN, codeveloper of Nurses 4Ever Fit and the CEO of Cara Sevier Industries in the Atlanta area, knows that exercise isn’t always convenient for busy nurses working crazy shifts or living in extreme weather zones.

When nurses tell her that they have difficulty finding time to exercise, she asks them to challenge that belief. Even nurses with legitimate time constraints, such as parents of young children. “They call it a time barrier or challenge, but we say it’s a self-care issue; they feel guilt over finally taking care of themselves first,” she says.

Sevier has personally experienced that challenge and now meets it by waking up at 3:00 a.m. to drive to a gym 30 minutes away. Though the gym is open only Monday through Friday, she maintains her schedule seven days a week. “I found out I had to be consistent or I was thrown off. It gives you a peace in your body that you’re doing something for yourself—getting up at 3:00 a.m. for a 4:00 a.m. class,” she explains. “It takes discipline, forcing yourself, forcing my body to get to my highest physical self. On the weekend, I will find a cycle class or something else to do. Is it easy? No. It’s a lot of sacrifice, but it’s worth it.”

On the other hand, we do need adequate sleep to stay slim—and to stay sane. One study at Columbia University suggests that getting less than four hours of sleep a night could raise your obesity risk by an astonishing 73%. (Seven hours a night is the sweet spot.) Nurses who work overnight or pull 12-hour shifts are also at greater risk for weight gain, according to a University of Maryland study. Scientists suspect that when circadian rhythms get thrown out of whack, so do hunger and fat hormones, which results in excess pounds. Or perhaps lifestyle factors lead tired nurses working off-hours to make poor food choices and avoid exertion.

Become a Healthy Living Warrior

Uniqua Smith, PhD, MBA, RN, NE-BC, associate director of nursing programs at MD Anderson Cancer Center, slowly gained weight after transitioning to an administrative role. But with the help of a fitness boot camp and workplace wellness challenges, she started making healthier food choices and exercising consistently.

“On Sunday, you had to send in a picture of all the groceries you just bought—to show that there are no snacks, no high-sugar foods,” she explains about a challenge with friends, using a social media app for accountability. “For the weekly weigh-in, you had to take a picture of your feet on the scale.”

“Workplace weight loss challenges, like the March Madness challenge, keep you going when you have a month-long goal,” Smith explains. “You’re also motivated because you don’t want to let your team down.”

A little over a year later, she’d lost 40 pounds through calorie-cutting, portion control, and cardio exercise. Only 10 more pounds to reach her goal weight, but then came a diagnosis of breast cancer.

“I truly believe everything happens for a reason: 2017 was about getting myself together health wise,” she says. “It got me ready for 2018, when I had to fight for my life. It gave me the strength to fight cancer.”

After six months of chemotherapy, she underwent three separate surgeries over the next several months.

“I went through 16 cycles of two different types of chemotherapy. It takes a big toll on someone—I lost my taste buds and energy,” she says. “It took me literally an hour to take a shower, which before that took 10 minutes.”

She started exercising again slowly, at the beginning of 2019, after the last of her surgeries. From walking to running and then completing a 5K, she challenged herself to get to her previous state of fitness.

Smith is now a healthy living spokesperson and encourages everyone to eat clean and condition their bodies so they’re strong enough to fight any disease that comes their way.

Don’t Fool Yourself

For many nurses, weight gain happens slowly, and they may not even notice it at first. Or they have a pattern of yo-yo weight loss and gain, with pregnancy, holidays, or shift work.

Sevier knows what that’s like. “Even at my highest weight—I reached 188 lbs—I told myself every story in the book. ‘Maybe these scrubs had shrunk in the hot water. Oh, wait, is this the U.S. size or the European size?” But those excuses didn’t hold up under examination and soon she started working out with a trainer at a gym. “Now scrubs that were once tight on me are loose,” she adds.

Though it may be painful to face facts, research shows that being aware of and tracking certain behaviors can help drive healthy habits. A daily food log, whether paper or digital, can help some people to lose weight or keep it off. You can’t argue with the truth, when it’s detailed right in front of you, in black and white.

Feed Yourself Healthy Meals, Healthy Snacks

If you’re like most nurses, you struggle to plan, shop, and cook yourself nutritious meals and snacks. Regular meals may go out the window, replaced by chaotic eating habits. But simple meal planning strategies can help nurses to eat well.

Tiambe Kuykendall, BSN, RN, a clinical nurse at MD Anderson Cancer Center, does everything she can to fight off chaotic eating. “I work in pediatrics and our [patients’] parents want to feed us all the time. Nobody ever buys us a fruit basket, though we would enjoy it,” she notes. “I’ve realized that I have to pack a healthy snack to make sure there is one at work.”

But desserts, junk food, and other caloric gifts and treats aren’t the only landmines threatening your waistline at most nurses’ stations. “In my unit, someone will bake chocolate chip cookies two or three times a shift. We’re surrounded with unhealthy snacks—chocolate, cookies, chips, pizza, and other junk,” she explains. “But the wellness department brings snacks on a weekly basis—granola bars, bananas, apples, and popcorn. When everyone is trying to be healthy it makes it so much easier.”

Kuykendall notes that when she works out in the morning, her level of energy is much higher later. She’s made other changes in the a.m., too: “I don’t drink energy drinks anymore, just green tea in the morning before I go to work, and sometimes in the afternoon.”

She avoids the cafeteria even though there are healthy food options there. “We have a 30-minute lunch break and MD Anderson is huge, so the cafeteria lines are long,” she says. “Yesterday I planned meals for the next three days and will bring my own lunch and snacks. You can make small changes, like eating grapes instead of candy. I don’t advise that you deny yourself all the time, but indulging should not be the norm.”

Ditch Dieting in Favor of Mindful Eating

Most nurses are familiar with programs such as Weight Watchers, and in fact, some hospitals hold on-site meetings. But there’s been a nationwide shift in attitudes away from dieting and toward a focus on healthy living. Mindful eating is one such approach.

“We don’t promote any particular diet, or if you don’t follow a diet, we want to teach people to simply be aware of why they eat,” explains Mark Mitchnick, MD, CEO of MindSciences, Inc, a New York City developer of digital therapeutics apps. “Right now, it’s keto, but we don’t want to chase fads.” The company’s Eat Right Now app teaches users about the habit loop and how to navigate triggers to eating.

Most of us eat for a variety of reasons, most often the trigger doesn’t have anything to do with physical cues. “Sometimes it’s that you’re hungry, and sometimes it’s that you’re stressed, or you’re tired, or it’s a fight with your significant other,” Mitchnick says. “You can learn to separate the trigger from inappropriate behaviors and do something more productive. If you’re stressed about an upcoming test, study, don’t eat.”

The app helps people to break the habit loop through educational content in a highly sequenced series of 28 modules. It’s constructed to deliver a module a day, which takes only eight minutes, and which can be repeated as desired. A user can also access lessons when on a just in time basis. When feeling a craving, they can bring up a short series of questions to help shape their response to it.

A scientific study showed a 40% reduction in craving-related eating—eating for reasons other than hunger—after use of the app.

In addition to the mindful eating app, there is one to relieve anxiety and one for smoking cessation. “A lot of behavior people would like to change in a high-stress field like health care—smoking and eating—is actually stress-related. Ask yourself: ‘Do I have an eating issue or an anxiety issue?’,” Mitchnick  advises.

It’s not easy for nurses to stay slim, but it’s worth doing. Shift work, long hours, sedentary lifestyle, heavy lifting, high stress, and fatigue can be overcome with a mindful approach.

The “Do Tell” Your Doctor Tool Helps Parkinson’s Patients

The “Do Tell” Your Doctor Tool Helps Parkinson’s Patients

While Parkinson’s can be a difficult disease for many patients to deal with, there’s now a new online tool that can help them initiate helpful—and in fact, crucial—dialogue with their health care workers.

We spoke with Karen Jaffe, MD, co-founder and vice president of InMotion, a community center for people with Parkinson’s and other movement disorders. A retired OB/GYN physician, Jaffe was diagnosed with Parkinson’s in 2007. She gave us important information that nurses need to know about the “Do Tell” Your Doctor Tool.

What is the “Do Tell” Your Doctor Tool, why was it created, and how does it work?

Sample word cloud, as delivered via email upon completion of the “Do Tell” Your Doctor Tool

The “Do Tell” Your Doctor Tool aims to improve communication around “off periods” between people with Parkinson’s and their doctors. “Off periods” are the re-emergence of Parkinson’s symptoms, which can be hard to identify because they differ for each person and sometimes from day-to-day. These factors can make it difficult for people with Parkinson’s to communicate about their symptoms with their family, friends, and health care professionals.

The tool is based on a clinically validated questionnaire developed by Duke University, called the Wearing-off Questionnaire 9 (WOQ-9). Users review nine Parkinson’s symptoms and rank how bothersome each symptom is (for example, “Very Bothersome,” “Bothersome” and “Somewhat Bothersome”). After completing the questionnaire, users will receive a customized word cloud via email that visually displays the symptoms they chose, with the largest words depicting the most bothersome symptoms. They can then bring these results to their next doctor’s appointment to help guide and prioritize the discussion about their Parkinson’s symptoms.

As part of the “Live Well. Do Tell.” steering committee, my organization, InMotion, had the opportunity to participate in beta testing for the tool to ensure that it’s user-friendly.

What do nurses need to know about it?

People with Parkinson’s who experience “off periods” may not discuss their symptoms or communicate the impact to their health care professionals, as they may believe that the re-emergence of symptoms is just part of their condition, or they may rationalize the impact because they fear it signals their condition is progressing. The intent of the tool is to initiate better dialogue between people with Parkinson’s and their health care professionals about their symptoms and about “off periods.”

How can they utilize this tool or recommend that their patients use it?

If patients are having a hard time talking about their symptoms, pointing them to this tool may provide them and their care partners with a guide to recognizing and recording symptoms that may be overlooked.

The tool is an easy online resource that people with Parkinson’s can use in advance of their doctor’s appointments. With the resulting word cloud shared via email, they’ll be armed with an actionable item they can share with their health care providers, who can in turn help them better manage their Parkinson’s symptoms to live well.

Why is it important for this tool to exist? What does it provide that is new?

Many factors make it difficult for people with Parkinson’s and their care partners to distinguish their most bothersome symptoms, and many often have a hard time articulating the impact of their symptoms during a doctor’s appointment.

The “Do Tell” Your Doctor Tool can impact the care people with Parkinson’s may receive—offering a visual guide that helps to recognize and record a person’s bothersome symptoms and providing a resource they can bring to their next doctor’s appointment to spark discussion and lead to more effective communication.

The need for this kind of tool was first identified in the “Live Well. Do Tell.” Statement of Need, which serves as the foundation of the initiative and outlined actions for the Parkinson’s community to help identify and communicate about “off periods.” The Statement of Need was developed based on learnings and insights from a multidisciplinary steering committee of leaders in the Parkinson’s community who collaborated to discuss unmet needs in understanding and communicating about Parkinson’s symptoms.

The “Do Tell” Your Doctor Tool is available online at LiveWellDoTell.org/takeaction.

Gaining Policy Expertise and Influence Through Voluntary and Service Opportunities

Gaining Policy Expertise and Influence Through Voluntary and Service Opportunities

As nurses we are actively engaged in advocacy activities through our professional and specialty nursing organizations. However, an increasing number of nurses are informing the political discourse by serving as volunteers for a growing list of consumer oriented organizations such as the American Association of Retired Persons (AARP), Susan G. Komen, and the Lupus Foundation of America, all of which have local affiliates across the country. These and other organizations often provide advocacy training for their volunteers along with opportunities to engage in advocacy days.

Serving as a volunteer for these and other organizations enables nurses to use their expertise and strong familiarity with consumer concerns to inform advocacy efforts on behalf of diverse constituents.

Nursing’s engagement in this capacity compliments the current push to ensure that 10,000 nurses are placed on boards or coalitions by 2020. As of October 2019, 6,751 nurses have been placed on a diversity of boards which provide invaluable opportunities to utilize nursing expertise at the local, state, and national level, according to the Nurses on Boards Coalition.

Perhaps less popularized are calls for applications to serve on advisory boards and councils for elected officials. For example, in Illinois at the beginning of Governor Pritzker’s tenure as the state’s 43rd Governor, the governor’s office released a call for applications for volunteers to serve on a number of advisory boards. Some of the opportunities were directly related to health such as the State Board of Health. Other non-health specific opportunities were suitable for nurses to lend their expertise on topics such as aging, the environment, or child welfare. Such engagement

Resources

Nurses on Boards Coalition

Nurses can sign up for alerts and potential opportunities.

The Federal Register

Nurses can check this listing of federal agency meetings and calls for applications to serve on advisory councils in addition to a listing of meeting times and agendas for numerous federal agencies. Free subscription.

is critical to infusing a health-in-all-policies perspective into the decision making process. Illinois is not alone in this regard. Other states and municipalities have opportunities in which nurses can use their expertise to help inform elected officials about health-related matters.

For example, Catherine Waters, RN, PhD, FAAN, professor at the University of California Sans Francisco, is an accomplished nursing faculty member with expertise in community health, health disparities, and health equity. She served five years as a health commissioner for the San Francisco Health Commission. Waters not only used her expertise to shape the policy discourse around health issues impacting her city, but also developed additional skills in diplomacy, consensus building, and budgetary decision making.

In Minnesota, Shirlynn LaChapelle, an expert nurse clinician, serves as a nurse consultant to the state’s Attorney General Keith Ellison. In this capacity she serves as a member of the Attorney General’s Advisory Task Force to Lowering Pharmaceutical Drug Prices. As a nurse, she brings real life examples of how people struggle to secure access to affordable health care and life saving medications.

In Washington, D.C., Catherine Alicia Georges, EdD, RN, FAAN, professor and chairperson of nursing at Lehman College and the Graduate Center of the City University of New York is a long-term volunteer for AARP and an AARP board member. In 2017 she was elected to serve as the organization’s National Volunteer President from June 2018 through June 2020. Georges serves as the lead national spokesperson for the organization and helps to shape the policy agenda for AARP.

From a federal government perspective, some federal agencies or departments have been mandated by law to establish an advisory council. Advisory councils are mandated to include a variety of expertise including consumer representation. Many nurses serve on federal advisory councils providing recommendations to agency directors on issues germane to the agency’s mission or strategic initiatives. For example, a number of nurses continue to serve as members of the National Advisory Council for Nursing Research and the National Advisory Council on Nurse Education and Practice. Nurses also serve on federal advisory councils that are not specific to nursing but can benefit from nursing’s expertise in patient care and health care in general. For example, the National Institute on Minority Health and Health Disparities and the National Cancer Institute have selected nurses to serve as members of their advisory councils. These members join other members in weighing in on federal funding issues and shaping priorities for advancing the Institutes’ mission.

Nurses who aspire to serve in these capacities must always be prepared to respond in case there is a call for applications. Keeping one’s resume/CV up to date is key as some calls for applications may have a short turnaround for submissions. Keeping a nominator bank with a list of individuals who can provide an accurate and firsthand account of one’s excellence and contributions is also important. Nominators can be called upon to help verify an application or be asked to provide additional information that informs the selection process. In some instances, nurses can pursue opportunities to serve on advisory councils or committees through self-nomination. Either way, strong letters of nomination are often required.

Gaining additional expertise through volunteerism and service can be a strong catalyst for future opportunities in the policymaking arena. My earlier volunteer work with Susan G. Komen positioned me to pursue a board position creating a pathway to become chair of the local affiliate’s Public Policy Committee.  This volunteer experience continues to be one of my most influential gateways to more opportunities in the policymaking arena. Each time I apply for opportunities, I include this as one of my most valuable springboards for developing expertise in providing testimony and gathering evidence to provide a persuasive argument before elected officials. Nurses can gain substantive and meaningful expertise through voluntary and service activity that will enable them to rise to higher levels of engagement and influence in the policymaking arena. So, go for it!

What You Need to Know About Kate Middleton’s Nursing Now 2020 Campaign

What You Need to Know About Kate Middleton’s Nursing Now 2020 Campaign

Though well into her final trimester, Kate Middleton hasn’t let the impending birth of her third child stop her from attending royal engagements. At the very end of February 2018, the Duchess of Cambridge visited the Royal College of Obstetricians and Gynaecologists (RCOG) and St. Thomas’s Hospital in London. While there, Kate Middleton ran into the midwife who helped deliver her daughter Princess Charlotte, Professor Jacqueline Dunkley-Bent, and the two shared a warm embrace.

But Middleton didn’t make the visit just to be reunited with her former midwife: She was there to become the second patron of the Royal College and to officially announce the Nursing Now 2020 campaign, which aims to raise the profile and status of nursing worldwide. As the name suggests, the three-year campaign is scheduled to last until 2020, the 200th anniversary of the birth of Florence Nightingale, the founder of modern nursing.

“This campaign means a lot to me personally. My great-grandmother and grandmother were both volunteer nurses,” Middleton said in a speech she gave the campaign launch. “They would have learned first-hand from working with the Voluntary Aid Detachment and the Red Cross about the care and compassion that sometimes only nurses can provide.”

Find out everything you need to know about the Nursing Now 2020 campaign below.

Critical Roles Played by Nurses

Nurses are the heart of most health care teams, caring for patients from their first breaths to their last, helping with everything from checking blood pressure to offering diagnoses to administering shots and painkillers. “Nurses are always there. You care for us from the earliest years. You look after us in our happiest and saddest times. And for many, you look after us and our families at the end of our lives,” Middleton said. “Your dedication and professionalism are awe-inspiring.”

As the Duchess of Cambridge went on to point out in her speech, sometimes nurses may be the only health care provider readily accessible in certain areas of the world, which is why it’s extremely important that enough nurses be trained and placed in the coming years. “In some parts of the world, nurses are perhaps the only qualified health care professionals in their communities, so your work is all the more vital,” she said.

Coming Shortage of Nurses

According to Middleton’s speech, 9 million more nurses will need to be trained by 2030 to meet the rising demands worldwide, which works out to about 2,000 more nurses each day for the next 12 years. Nursing Now 2020 hopes to start filling that gap by increasing the profile of nursing roles and raising awareness about becoming a nurse. Indeed, the nursing shortage has been deemed a global crisis since 2002, but the recruiting and retention of nurses hasn’t been able to keep up with the health care demands of a growing population.

Five Campaign Goals

To help increase the number of nurses, and to support nurses already working in the field, the Nursing Now website lists five main goals that the initiative hopes to achieve by 2020. They are:

  1. Greater investment in improving education, professional development, standards, regulation and employment conditions for nurses.
  2. Increased and improved dissemination of effective and innovative practice in nursing.
  3. Greater influence for nurses and midwives on global and national health policy, as part of broader efforts to ensure health workforces are more involved in decision-making.
  4. More nurses in leadership positions and more opportunities for development at all levels.
  5. More evidence for policy and decision makers about: where nursing can have the greatest impact, what is stopping nurses from reaching their full potential and how to address these obstacles.

Basis for the Initiative

The goals and methods of the Nursing Now movement are based on a Triple Impact report, which was released by the All-Party Parliamentary Group on Global Health in October 2016. The report found that empowering nurses would not just improve health globally, but also build strong economies and promote gender equality (as the vast majority of nurses are still women). These three results combine to form the triple impact that nurses could potentially have. “The nursing contribution is unique because of its scale and the range of roles nurses play,” the report said.

Organizations Behind the Movement

Kate Middleton may be the most recognizable public face of the Nursing Now campaign, but two major health organizations are behind the campaigns: the International Council of Nurses and the World Health Organization. The International Council of Nurses represents millions of nurses worldwide, and seeks to represent them, advance the profession, and influence health policy. The World Health Organization is a specialized agency of the United Nations that seeks to address international health policy. The campaign is also supported by the Burdett Trust for Nursing, an independent charitable trust that helps fund nurse-led projects.

A Global Campaign

The Nursing Now Campaign Board includes both nurses and non-nurses from 16 different countries to represent a truly international group. Official launch events were held in London (where Middleton spoke) as well as Geneva. Various international nursing associations also hosted their own launch events, with locations including Canada, China, Jordan, South Africa, Taiwan, and Macao.

Ways to Get Involved

Beyond advocating for nurses and nursing, individuals who wish to support the campaign can sign the Nursing Now pledge and share the social media kit on various platforms. If there is no existing Nursing Now group in their area, nurses and non-nurses may band together to form their own group, though the process is lengthy to ensure participants are committed.

Whether you live in a developing country or an advanced health care economy, the coming nursing shortage will affect the entire globe, and is being felt in some places already. Through its five goals, Nursing Now hopes to help meet that need by recruiting new nurses and empowering existing ones through greater leadership opportunities and better policy decisions. To learn more about Nursing Now 2020, visit the campaign website.

Greater Houston Nurses Taking it to the Streets

Greater Houston Nurses Taking it to the Streets

Homelessness is a global issue. It is on the rise and it impacts health physically and mentally. According to a recently published article in BMC Public Health, emergency departments are more often used by the homeless population for acute health care versus accessing preventative health care services. A 2018 study published in SAGE Open reported that the homeless population experiences health disparities with multiple chronic health conditions, mental illness, substance abuse, and depression.

The U.S. Department of Housing and Urban Development, Office of Community Planning and Development provides an Annual Homeless Assessment Report (AHAR) to Congress. On a single night in January 2018, there were 552,830 people who experienced homelessness in the United States. Most were sheltered (65%, 358,363) compared to 35% (194,467) who were in unsheltered locations. In the United States, 17 people per 10,000 experienced homelessness in 2018. Some of those who were in shelters (3,864 people) stayed in beds that were funded because the president declared natural disaster after four Hurricanes (Maria, Irma, Harvey, and Nate) and wildfires in the west. Twenty percent (111,592) of the homeless were children, 71% were over 24 years of age, and 9% ranged from ages 18-24. There were more men in unsheltered locations compared to women. Almost half (49%, 270,568) of the homeless people identified themselves as white compared to black/African Americans (40%, 219,807).

In the state of Texas on a given night in 2018 there were 25,310 homeless people. There were 9 homeless people per 10,000 in the general population of the state. Individual estimates of homelessness in Texas was 19,199; 6,111 for people in families with children; 1,379 for unaccompanied homeless youth; 1,935 for veterans; and 3,269 for the chronically homeless individuals, according to the 2018 AHAR report.

Houston is the fourth largest city in the U.S. with over 2.3 million people, according to the U. S. Census Bureau. In January of 2019, there were 3,938 homeless individuals (unsheltered and sheltered) in the cities of Houston and Pasadena and Harris, Fort Bend and Montgomery Counties.

Risk Factors

There are various reasons that may cause an individual to experience homelessness. A 2009 study published in Psychiatric Services reported a significant association with childhood adversities and homelessness. The childhood adversities with significant findings include: having a history of running away, being ordered by a parent to leave the home, being neglected by a parent or caregiver, having a biological father incarcerated, being adopted, being in foster care, and the duration of welfare assistance before 18 years of age. Significant findings regarding socioeconomic situations included grade when respondent left school, economic difficulty in the past year, and currently employed. Mental health problems such as being diagnosed with depression and having a psychiatric hospitalization in the past five years were significant predictors of homelessness.

More recently, a 2019 study in the Community Mental Health Journal indicated the individuals with mental illness had high rates of homelessness. Addiction problems such as drugs in the past year was also a significant predictor of homelessness, according to the 2009 Psychiatric Services study. Oftentimes veterans return home after deployments to war zones suffering with invisible wounds such as post-traumatic stress disorder and traumatic brain injury. These individuals are at risk for experiencing homelessness, according to the National Alliance to End Homelessness (NAEH).

Homelessness can also be due to loss of property, family violence, or domestic violence. A 2018 study in the Journal of Community Psychology reported loss of support systems and social networks can also lead to a path of homelessness. Lower incomes often lead to an inability to pay for basics such as food, clothing, shelter, and transportation—and this places individuals at risk.

The Problem

It is a common sight in Houston to see homeless people living and sleeping on the streets. Whether you walk or drive around the city, you cannot help but see individual men and women panhandling in the streets, standing at corners and intersections. They will routinely walk up to your vehicle with signs, cups, and stretched out hands for money. The homeless can be seen sleeping on the sidewalks and huddled up against buildings and fences. Although shelters for the homeless exist and initiatives have been implemented in attempt to get the homeless off the streets of Houston, the homeless population is huge. Many people who are homeless still live in tent cities under freeways.

One might say, they want to be on the streets. One might say they do not want to follow the rules of the shelters. Therefore, they chose to be out on the streets. All of those sayings might be true. All the same, someone remains homeless.

One night during November 2018, I was driving home and it was very cold outside. The temperature was in the 30s or low 40s. I was overcome with sadness and sorrow to see so many people literally sleeping on the sidewalks without any shelter. I noticed that some did not have blankets. I found myself feeling so blessed and fortunate to not be living on the streets. But then, I wanted to do something. I said they need blankets and warm clothes if they will be sleeping on the streets in this cold weather.

The “BLESSED” sign

Community Outreach Project

As a Christmas project for the Black Nurses Association of Greater Houston (BNAGH), we decided to give out blankets and socks to the homeless people in Houston. One Saturday afternoon (December 8, 2018), nurses from the BNAGH gathered the donated items to be distributed and walked the streets where a group of homeless men and women gathered. We drove to a local fast food place near Midtown, between downtown and The Texas Medical Center, and parked with permission from the manager. While still in the parking lot, a man asked me if we were getting ready to do something with the homeless. He was told we were going to pass out blankets, hats, socks, bottled water, and brown bags with snacks (peanut butter cracker, cuties, and peppermint candy canes). He stated his name and the name of his company and said he was there with his crew to do a film about the homeless in Houston. He asked if he could film us passing out the items and we told him yes. He said he would put us in the credits.

As we gathered all the items in large black plastic bags and started walking with the water, people started coming toward us to get the blankets and socks and other items. We gave away every item that we had. We even had a set of towels and a bar of soap to give out. One man said he wanted the soap. One man and lady were yelling for us to throw a blanket over the fence to them. One lady asked if we had anything girly. She asked for a pink hat. Everyone was so appreciative. Only one person did not want the items. He said he wanted dollars. He walked back into the street, running from car to car begging for money. Overall, it was an awesome experience. We provided items to approximately 60 homeless individuals.

Taking it to the streets takes courage and a compassionate heart. The needs of the homeless are many. One might feel overwhelmed if trying to take on every issue alone. It will take many people and resources. However, everyone can do something to help improve the health and lives of others. That is what the nurses of BNAGH wanted to do and that is why you might see homeless people in Houston with a sign displaying the words “BLESSED.”

Houston nurses handing out supplies

Relevance to Nursing

Homeless Individuals are a vulnerable population and are sometimes considered invisible. However, they are not invisible. They can be seen and counted. They are at risk for health disparities including mental health issues. There were so many obvious needs. One was just basic hygiene. Nurses can advocate for housing because personal hygiene is important. Hand hygiene is the most effective way to prevent and control the spread of infection. Individuals experiencing homelessness face barriers to personal hygiene. For example, personal hygiene and self-care barriers are limited access to facilities for bathing, taking a shower, doing laundry, and washing hands. Such barriers to self-care and personal hygiene can cause one to be at risk for an infectious disease.

Some things that nurses can do to bring about change:

  • Contact local coalitions for the homeless for information about their goals and objectives;
  • Advocate for jobs and housing for the homeless;
  • Contact and lobby local and state congressional and legislative officials regarding policies to help alleviate homelessness in America.

Such efforts will help reduce health disparities among this vulnerable population.

Stepping out of one’s comfort zone is not always easy to do. The first step seems to be the hardest. However, if nurses are to make a difference, then we must rise to the calling, step up to the plate, and do something positive to make a change. There are so many things that can be done. What I attempted to do was to provide warmth and comfort to a few people on the streets of my hometown. However, I have been inspired to do more. Hopefully you will be inspired to do something to help the homeless in your community feel encouraged and strive to be healthier.


Acknowledgements: The author wishes to thank Betty Davis Lewis, EdD, RN, FAAN and the Black Nurses Association of Greater Houston (BNAGH) and Prairie View A&M University College of Nursing faculty members for donations, and the three other nurses from BNAGH (Patricia Boone, RN, BSN; Vivian Dirden, RN, BSN, MS; and Dametria Robinson, BSN, RN-BC) who also walked in the streets of Houston to distribute the items to the homeless and provided photos. In addition, the author wishes to thank Carmen Lewis, MSN, RNC-MNN, IBCLC for providing the “BLESSED” photo.

The Effects of Gene-Environment Interaction on Blood Pressure among African Americans

The Effects of Gene-Environment Interaction on Blood Pressure among African Americans

Jacquelyn Taylor, PhD, PNP-BC, RN, FAHA, FAAN, was recently elected to the National Academy of Medicine, and part of what those who selected her considered was her research on gene-environment interaction and its effects on blood pressure among African Americans.

“African American women have the highest incidence and prevalence of hypertension among any ethnic, racial, and gender group in the United States,” explains Taylor, who works at NYU Rory Meyers College of Nursing as the first Vernice D. Ferguson Endowed Chair. “It is important for me to understand not only the genetic or hereditary underpinnings of this health disparity, but also the psychological and/or environment interaction with genomic risks that may influence development of hypertension.”

In her research, Taylor says that she’s focused for the most part on African American women and children. Most of her studies have drawn on two or three generations of African Americans. While the ages of the children studied have often been wide, in her most recent study, she targeted children from head start programs, who ranged in age from 3-5 years old, along with their biological mothers.

“We have had a lot of discoveries in our research and have disseminated our findings in journals ranging from nursing, medical, public health, genomic, and interdisciplinary. Overall, we have found that gene-environment interactions for certain factors such as parenting stress, perceived racism and discrimination, and others significantly influence increases in blood pressure,” says Taylor.

She admits that she wasn’t shocked by the findings: “The findings were not all that surprising as I expected that social determinants of health were significant factors in health outcomes and looking at the combinatorial effects with genetics and epigenetics only further illuminates that magnitude of interaction on health outcomes such as hypertension,” Taylor says.

Although Taylor says that her research is important because of what she did discover, “One important aspect of the research is that we are able to identify genetic risk for chronic diseases such as hypertension in children as young as three prior to them developing the disorder. Early identification of risk provides an opportunity for nurses and other health professionals to intervene to reduce risk of developing hypertension as in previous generations. Interventions based on the research with this population may require focusing on social determinants of health and lifestyle modification in addition to or rather than conventional pharmacological methods.”