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!
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.
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.
No matter how hard you try to avoid it, it happens. The nurse becomes the patient. Whether you’ve given birth, had surgery, or a horrible case of the flu, there are times in life when conditions will send you to the hospital. And being on the proverbial other side of the hospital bed, as Jenny Ang, MSN, ARNP, FNP-BC, an NP in Washington State, says. So how can nurses be good patients?
“When the caregiver suddenly becomes the one who needs care, it’s an extremely unsettling, vulnerable, and helpless feeling,” says Ang. “Nurse can be good patients by showing patience, kindness, and compassion to their caregivers, while trying not to micromanage their health care professionals.”
Over the years, Ang has cared for many doctors and nurses in the ICU for a number of diagnoses in critical situations. She says that, for the most part, these patients have been good ones. But it’s because they had their questions answered, were updated regularly on their care, and understood both the risks as well as the rationale behind what was being done for them. So what is a “not good patient” in Ang’s opinion? “Someone who requires an excessive, grossly unfair amount of time and resources from a nurse, compared to a patient in a similar circumstance,” she says. “I have had only one patient who was a nurse act this way, but countless other non-health care people behave like this.”
Ang says that as nurses, you tend to advocate for the best care for your patients. “When we become the patient, we tend to advocate for ourselves like a mama grizzly bear protecting her cubs.”
What can you do to be a good patient? Ang has some tips:
- Remember that your professional judgement is clouded when the case is personal.
- Remember that you’re in a vulnerable state.
- Don’t lash out at your health care providers out of defensiveness.
- Don’t micromanage your health care professionals. Remember they are pros, and have sworn the same oath to do no harm, just like you have.
- You are a professional. Remember to act like one.
“It makes many nurses defensive when they are suddenly in the position of being the patient. Like in any other field of work, it is not wrong to question a health care professional, but how you ask your question is key. Don’t be accusatory,” recommends Ang. “It is most appropriate to maintain positive, clear communication with the health care professionals caring for you when they come to check on you in your hospital room. Nurse know how the system works.”
Well it has been a while since my last post, due to the “busyness” of life. Often times we let the things in our life take so much of our time, that we forget about taking care of ourselves. As nurses we are focused on taking care of others: our patients, our family, our friends, and sometimes even strangers. We have heard of the saying “Take care of yourself, so you can be there for others,” but how many of us actually practice this? This really hit home after hearing about the unexpected death of two colleagues over the past month. They both devoted so much time to their job and neglected to relax and take care of themselves.
Credit: Leslie McRae-Matthews
We have our plates so full with other people’s issues, cares, and needs, yet there is no room on the plate for us. There has to be a balance between work and relaxation. This is not new information for us—we just need to apply it to our lives. Many of us advise our patients about taking time to relax, meditating, and thinking about things they enjoy to decrease stress. These are some of the same principles that we can use.
When you start noticing that you are feeling anxious, moody, or depressed, these are signs that it is time to step back to refocus, recover, and renew. Many people relax by traveling, but you do not have to spend a lot of money to relax. Engage in simple activities, such as drawing, photography, taking a walk to enjoy nature, riding on a swing, or going for a swim. These activities are not an escape from reality or stepping into a “fantasy world,” but they will help you take your mind off of work or other issues, so that you can refocus. Take care of yourself and find that balance.
When patients seek care because they are struggling with health challenges, they encounter a complex system that’s often difficult to navigate. How will they access, pay for, and continue care in the face of insurance approvals, financial challenges, and the everyday pressures of life? And for those patients who are also facing socioeconomic challenges, these difficulties are compounded by additional serious health issues including disproportionate levels of diabetes, heart disease, obesity, untreated mental health problems, and maternal health complications. As a health care system, it’s time to redouble our efforts to fight health care disparities, and social workers need to play a more critical role. We need more social workers on the front lines to address these disparities and help make the health care system work better for all people.
Despite the profession’s long-standing commitment to clients’ health and wellness, social workers remain an often discounted component of health care teams. However, social workers play an indispensable role in helping patients navigate insurance, in-home care, community resources, economic assistance, and mental health services at the conclusion of a hospitalization. One misconception is that the role of counselor, coordinator, and advocate is needed only as an acute medical intervention draws to an end, when the reality is that a social worker can be beneficial throughout a patient’s entire medical journey.
First and foremost, social workers are trusted guides in a complex health care system that can’t always meet patients where they are. Social workers can advise on important decisions, improve communication between provider and patient, and dig more deeply to identify root causes and concerns a physician may not have time to unearth. Patients can turn to social workers with questions and concerns they may be too intimidated to discuss with their health care provider. With the time to more closely work with patients, social workers can increase compliance with care instructions, ensure proper follow-ups, and ultimately improve patient health outcomes.
Social workers can also be patients’ best advocates in a care setting, making sure their voices are heard and their needs are fully met. This is especially true when it comes to counteracting bias in the provision of care. For example, studies have shown that African American patients’ pain is often undertreated relative to that of Caucasian patients. Faced with these challenges, social workers in a care setting can help resolve communication issues, encourage patients to persist in making their needs known, and provide insights into how best to pursue proper care when a pathway doesn’t always seem open. By working to confront bias, social workers can even help correct damaging assumptions that can lower the quality of care received.
Social work is a calling, and we need more practitioners to meet the increasing demands placed on the health care system, including those caused by the opioid crisis and aging Baby Boomers. The Bureau of Labor Statistics has predicted 16% growth in the need for health care social workers through 2026, and meeting that demand with skilled, compassionate men and women is critical. If we have any hope of meaningfully reducing health disparities and better caring for disadvantaged populations, it’s time to get more serious about health care social work.
That begins with raising social workers’ profiles within the health care system. Patients and their families should know that a social work team is available to support them throughout their treatment and follow-up. Next, health care educators must do more to connect students interested in health professions to this field. When we talk to students about careers in the health care industry, health care social work should be included with other clinical disciplines. Finally, social work support should be expanded in high-need communities. With smaller caseloads, social workers can best do their jobs, which, by improving patient outcomes, provides long-term savings to our health care system.
In the media and in discussions with students, we often stress the need for the next generation of doctors and nurses, and that is undoubtedly important. However, even without a stethoscope or a prescription pad, health care social work is an essential career option in making a difference in patients’ lives and improving health care for our communities.
In April of this year, Congresswomen Alma Adams (NC-12) and Lauren Underwood (IL-14) launched the Black Maternal Health Caucus in North Carolina. Over the last 30 years, the staggering statistics associated with maternal mortality in the United States and the rate of black women who ultimately die during or after child birth due to complications raises many unanswered questions and the need for an immediate response from Congress and the medical community. The impact of maternal and infant mortality in the black community is devastating and this vulnerable population cannot continue to be invisible.
The gift of life is wondrous, to grow a human inside your womb simply defines the miraculous abilities and physical strengths of mothers. To say that this experience is joyous and simultaneously overwhelming is an understatement. While the baby is in the belly, the mother is in control and provides safeguards and protection to her unborn child through her handling of everyday stressors, her body’s ability to supply the baby with nutrition to grow and develop, and of course her intrinsic love. Most would agree this protective state of pregnancy is innate, mothers are genetically wired to provide security and safety to her unborn child. Pregnancy should be uninterrupted, uninhibited, and a celebration of procreation—life’s most precious moment.
Procreating for black mothers has unfortunately become a traumatic experience, the joys and happiness surrounding pregnancy and delivery of a newborn are drowned out by alarming statistics as more black mothers lose their lives trying to bring their children into this world. Environmental stressors, delays in treatment, poor access to health care, and miseducation plague the black maternal community. There is a great divide and misalignment of health care resources creating tragic events for mothers and families as they try to welcome a new life in the world but are often faced with raising a child without a mother.
While there has been significant research done on the causes of maternal mortality, solutions for why the underlying factors of maternal mortality in black mothers is steadily increasing in a nation rich with health care facilities and experienced clinicians remain frustratingly elusive. Is the life of a black mother and black child not as important in this country? The devastation of loss in the black community is felt for generations as we are faced with raising children without their mothers. Although the child may be supported and surrounded by love from the father and extended family members, there are lingering feelings of abandonment and an emotional disconnect by not experiencing the love and care by the mother. The impact of maternal mortality in the black community has a clinical and psychological impact that will extend into the generations yet to come. The need is great to not only decrease this statistic but to preserve the sanctity of the black family for the future.
To close this critical gap in maternal health care, three major points of action should be taken into consideration, (1) develop a standardized model of obstetric patient-centered care that targets mandatory documentation of patient education, (2) provide transparency in the costs and fees associated with the continuum of care for obstetric patients, and (3) implement a national campaign for healthy moms and healthy babies to improve community awareness and collaboration with existing maternal health organizations. Such an investment not only has a direct effect on the health and wellness of mothers and their newborns, but also drives positive outcomes for the health care system.