Nurses know all the reasons why heart health is so important. They don’t have to be a cardiac nurse to know that a healthy heart impacts everything from energy levels to brain health.
If you’re trying to take care of your heart by watching what you eat, getting enough exercise, and keeping your stress at a somewhat manageable level, you might be surprised to find your heart health is influenced by things you often just can’t control.
As a nurse, keeping some of these things in mind when talking with patients might be a flag for potential heart health trouble. Knowing a little more about those you treat can give you a broad picture of how events happening in their lives could impact their heart health.
People predisposed to heart disease because of their genetics can’t do anything about the genes they were born with. They can take steps to counter conditions such as high blood pressure or high cholesterol levels that are often handed down through generations. They should also be especially careful of their health, controlling the factors they can (diet and exercise are the big ones) and working with a health team to mitigate the ones they can’t.
Believe it or not, a recent American Heart Association report found that some jobs seem to increase a woman’s chances of poor heart health. According to this report, registered nurses are 14 percent more likely to have poor heart health, as do women in other health care roles such as a psychiatry, home health, or social work (36 percent more likely). Using data from approximately 65,000 postmenopausal women from the Women’s Health Initiative study, researchers found that women in some occupations show signs of poorer heart health than others.
Changing Economic Factors
Economic disparities have historically been linked with poorer health outcomes across regions, races, ages, and genders. But a recent report in the Journal of the American Medical Association showed a link between a significant drop in income and declines in heart health. Using data from the Atherosclerosis Risk In Communities (ARIC) study, the cohort showed that an income loss of 50 percent or more led to higher incident cardiovascular disease (CVD). Conversely, rising income levels resulted in decreased CVD.
Women lose the potentially heart-protective benefits of estrogen after menopause. Along with aging and the cumulative effects of other habits, this time in a woman’s life might increase her chances of heart disease. The American Heart Association recommends that women take stock of their health around this time and work to make changes that will be good for their hearts.
As you meet with patients and as you consider your own health, taking your heart into consideration is going to have on overall positive impact on your well-being. Understanding how other factors can have a significant impact on heart health is a great starting point for discussions about prevention, testing, monitoring, and lifestyle changes that will make the heart stronger and healthier.
Our health is something that we all have, and unfortunately, the condition of our health is not something that we have complete control over. We do, however, have the ability to enhance the quality of our health. We all have choices to make regarding our lifestyle and how we manage our health to make sure we ensure that our health never deteriorates and we can live a long, healthy, and fulfilling life. We can control our choices to improve the quality of our overall health, and a significant part of enhancing the quality of our overall health is making doctor’s visits a priority. Being inconvenienced with taking time off work or readjusting our schedules should become secondary to the need to seek medical attention when needed. The unfortunate aspect of health care utilization is that people often wait until it is too late before they decide to become committed to ensuring that their health is maintained and monitored.
The fragility of health became very real to me about 10 years ago when my persistence to my doctor, because I was not feeling well, finally resulted in an order for a CT of the lungs to reveal I had pneumonia. The previous x-rays of my lungs were always inconclusive. My health was in jeopardy, and I knew that I had to become intentional in my pursuit to get better. My persistence of seeking medical treatment reappeared with a vengeance in 2013 when my favorite uncle was diagnosed with stage 4 throat cancer. He was a mechanic who loved his family, and he was a very talented cook. He was one of those men who never had a lot to say, but he observed everything. It was easy to tell that he was not doing well, but I had to beg and plead with him to allow me to make him an appointment at a local clinic after we noticed that his health was declining. He was a proud man who did not like to admit when he needed some help. He was self-employed with no health insurance. His case was so difficult that most of his medical team did not want to take him as a patient. One of the wonderful physicians believed in him, and she advocated for him. He went through major surgery, and he lived another two and half years that gave me and my family more time to spend with him.
Two days before my uncle passed away, I softly spoke to him and told him that I would finish my doctoral program and make him proud of me. He nodded his head, and I was blessed to keep my promise. I believe that if my uncle would have been treated sooner, the outcome would have been different. I did not know when my uncle passed away that I would devote my research efforts to racial health disparities, or that I would have such a passion for educating the African American community on the importance of seeking health care services. Through my sorrow, I have made it a part of my mission to educate African Americans regarding the importance of seeking timely and routine medical treatment.
It is so important for African Americans to seek medical treatment because of the high incidences of health diseases and conditions that plague that population, such as high blood pressure, high cholesterol, diabetes, and heart disease. In my experience from working years as a certified pharmacy technician, too many people do not treat their health like the important commodity that it is. We sometimes feel that our health is something that we will always have, and that it will always be good. Unfortunately, I know firsthand that it simply is not true. Our bodies give us signs when things are not right, but it is up to us to pay attention. We sometimes shrug things off when we notice that variance in our health occurs in hopes that it will get better without us taking on more of an active role to ensure that it happens.
The goal of my research was to evaluate how the patient-provider relationship impacts the patient’s decision to access health services. Through my quantitative research, I wanted to delve into the rationale that African American patients have about how they make the decision about when they will visit the doctor. African American cultural norms, in addition to the historical aspects of discrimination coupled with provider biases, create a divide that can become evident during the patient’s visit. African Americans often feel as if they are not heard or a priority when they make medical visits. Chronic diseases and conditions often necessitate the need for medical visits as it pertains to African Americans, so African Americans between the ages of 40 and 65 were the target population that was studied. After reviewing the demographics within Shelby County, Tennessee, it was determined that the sample could be identified after evaluating the community right within my reach. It is apparent through observation as a former practicing certified pharmacy technician that African Americans are subjected to health disparities at an alarming rate. Those racial health disparities are prevalent because of the effects of the patient-provider relationship, limited access to health care resources, and health outcomes that are less than ideal.
A group of 56 participants were gathered through the help of alumni chapters of African American sororities and fraternities located throughout the greater Memphis area. All of the participants that were used to complete the analysis lived within Shelby County, had health insurance, had an English speaking primary care physician, and were African American. The findings evaluated the interactions that occur during the medical visits. The goal was to possibly uncover why African Americans do not go to the doctor in hopes of explaining why there is a prevalence of chronic diseases within that population. The findings did indicate that there is a significant relationship between the patient-provider relationship and the behaviors of the provider. Additionally, the behavior of the provider does contribute to the African American patient’s decision to seek health care services.
The participants that were evaluated stated that gender and assumptions that the provider makes about their education level and income did play a factor in how the provider interacted with them during the medical visit. The behavior that the staff exhibits during the medical visits of African American patients does impact the decision that is made to seek services, and the way that African American patients are made to feel during the medical visit does impact their decision to seek follow-up care and even their willingness to comply with medication compliance. It is important for the African American patient to be understood and treated with compassion, care, and concern. The historical component of the racial tension that African Americans have dealt with makes it pertinent for health care providers to treat the patient’s concerns as a priority.
In summary, there is a direct correlation between the relationship that the patient has with their provider and how the behavior of the provider is perceived during the interaction. It is important that African American patients receive ongoing education regarding the importance of seeking timely and routine health care. Providers need to be cognizant of how their mannerisms and responses affects their African American patients. African Americans do not consistently go to the doctor, which is evident by the staggering statistics of preventable and treatable conditions and diseases that plague that community. The goal for both parties within the relationship is to realize that it is impacted by both the actions and reactions of both sides.
Acknowledgment. The author would like to thank Cheryl Beers-Cullen, DHA, MPA, BSN, RN, CALA and Manoj Sharma, MBBS, PhD, MCHES for their contribution and mentorship.
Anyone working in a healthcare setting pays extra attention to infection prevention. With so many different people carrying infectious diseases in closed areas, infection control is a priority.
This week marks International Infection Prevention Week (October 13-19) and highlights the constant vigilance needed to keep infection control in the forefront. Sponsored by the Association for Professionals in Infection and Epidemiology (APIC), the week is a reminder to the crucial way infection control safeguards individuals and larger communities.
There’s more to stopping the spread of germs than simply washing your hands. Although hand washing is extremely important, nurses can also adopt other practices to help stop infections from spreading from person to person (and to avoid becoming a patient themselves). They are also a good resource for patients who can learn good infection control methods and also learn about other prevention methods including vaccinations.
Wash Your Hands
Nurses’ hands require near constant cleaning with soap and water or antibacterial gel. Because nurses touch everything from patients’ bodily fluids to medical devices to food, having clean hands is the top way of keeping infections in check. Nurses know this, but it’s also important for them to share this information with their patients and families. Whether it’s visitors to the nursery or family members who are taking care of wounds or stomach infections at home, this is one activity that cannot be stressed enough.
Protect Clean Surfaces
Everything a nurse touches has the potential to spread germs or infectious illness. Being mindful of the surfaces you touch, whether you are wearing gloves or not, helps you stay healthy and protects your patients.
Staying up-to-date on your own vaccinations helps protect you from preventable diseases and is a key to infection prevention. A flu shot every year, required by some healthcare organizations, is protective as are routine vaccinations to prevent tetanus or pneumonia (if you’re eligible). With the recent explosion of measles cases across the country, you can also help educate your patients on the safety and effectiveness of vaccines to keep serious and potentially deadly diseases out of their own homes and communities.
Know Proper Procedures and Protocol
Some nurses are exposed to extremely contagious and dangerous infectious diseases. Outbreaks of Ebola have caused infectious in the healthcare workers helping patients, for example. Knowing your organizations protocol for handling such cases or for handling outbreaks is essential. If you aren’t sure about the current protocol and process, keep asking until you find out or until a protocol is established. Flu outbreaks are common in the wintertime, but in our increasingly global world, outbreaks of other diseases that have primarily been in other countries can easily jump to any area. Nurses have to be ready to handle whatever might evolve.
As a nurse, infection control is a big part of your responsibility to your patients, but it’s also a responsibility to yourself. Remaining as healthy as possible lets you care for and protect your patients.
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.”
The third round of the Nurses’ Health Study (NHS3) promises to reveal information as transformative as the first version of the study. But this time around the revolutionary study is looking to make a change that will resonate with minority nurses nationwide. To better reflect the nation’s increasingly diverse population, the study is especially interested in the participation of minority nurses—both ethnic and racial minorities and also male nurses.
“We need nurses,” says Dr. Jorge Chavarro, the principal investigator of NHS3. Chavarro became involved in the third round of the study 15 years ago, with a special interest in infertility and reproductive health.
When the first Nurses’ Health Study launched in 1976 (and the second in 1989), the scientific focus was to follow women for clues to breast cancer. Specifically, the study wanted to find out if there was any correlation between birth control pills and breast cancer risk, but it also gave more general information about cardiovascular heath and diabetes as well. From there, the information gathered has revolutionized areas of healthcare.
“Interestingly, the nurses’ study has always been defined by an occupation, but it has never been an occupation cohort,” Chavarro says, noting that NHS3 will now include occupational health issues such as heavy lifting, radiation exposure, or exposure to cleaning agents. Study investigators recruited nurses to participate because they were excellent responders who had a thorough understanding of specific medical terms and could participate with less margin of error.
What’s new in NHS3?
- a targeted effort to recruit more minority nurses
- a targeted effort to recruit more male nurses
- a new participation option for Canadian nurses
- a focus to capture occupational exposure concerns and understand how that impacts a nurse’s health
- an entirely web-based participation
“We want to involve as many minority nurses as possible,” says Chavarro, “and it’s the same for male nurses.” Canadian nurses are also welcome to participate, and many of them have already been long-term participants. Chavarro says the team realized it’s not difficult to continue collecting information from nurses who have moved to Canada, and so opening the study to all Canadian nurses is only going to be helpful for study results..
The Nurses’ Health Study collects vast amounts of data on lifestyle, nutrition, exposures, and health events. The study’s history is revealing in itself and shows the vast changes over the past decades. Nurses were the designated cohort after some trial and error in the first study. Initially, doctor’s wives were going to be the chosen cohort in the pilot study as birth control pills could only be prescribed to married women then and most physicians were men.
“The second choice was nurses,” says Chavarro, “and it was the best decision ever. It changes the questions you can ask.” Nurses are going to be very clear about any medical events that happened to them and that makes all the difference in evaluating the data, he says. They can also do other tasks that are extremely valuable and that are primarily unavailable to the general population. For instance, collecting varied biological specimens is something nurses can, and do, perform with ease and accuracy.
Chavarro says nurses who participate are making a change in the health of future generations and that’s often why they get involved. The time commitment is fairly low and the benefits to humanity are significant.
“To continue being impactful, we need all nurses, but especially those who give us a picture of how the US looks as a whole,” says Chavarro. “Nurses are amazing and are the best participants ever. This is a definite opportunity to join this study and make enormous contributions as they have done in the past and will continue to do for many decades to come.”
Find out more information about signing up for NHS3.
On most days nursing is extremely rewarding. At the end of our shift, we feel we’ve done a good job caring for the needs of grateful patients. But occasionally, we encounter patients who test our patience and make it challenging to effectively care for them. So how can we improve the situation when caring for difficult patients?
1. Lend an Ear
No one is at their best when they’re in the hospital, a rehab center, or receiving medical care at home. They may have pain or nausea, or maybe they are still struggling with a change to their ordinary lives as a result of an accident or illness.
Provide them with an opportunity to talk about their situation if they feel comfortable, and make the effort to actively listen. Nurses can get caught up in the endless to-do list on any given day and aren’t always able to take the time to connect adequately with their patients. While listening closely to them, a nurse can learn what a patient’s expectations for recovery are as well as any concerns they may have about their care or prognosis.
2. Body Language Barrier
During a day’s work, our patients are often in a hospital, home bed, or sitting in a chair. When we are talking to them, we’re standing above them, which can make them feel uncomfortable. As often as possible, make the effort to put your body on the same plane as theirs. Avoid crossing your arms over your chest, putting your hands on your hips, or in your pockets, none of which communicates receptiveness and may further agitate someone who is already upset. Face them when speaking to them and modulate your voice appropriate to their hearing ability.
3. Culture Clash
Does your patient have a culture different from your own? Be respectful of any differences and try to learn what you can about their culture. You can learn either through resources available to you or by asking questions, but only if they’re receptive to educating you about their ways.
4. Build a Bridge to the Unknown
Alleviate any concerns they may have about what is unknown to them. Encourage discussion about their health condition, medications, or upcoming procedures. Welcome questions that will allow them to open up. Building a relationship with them can motivate the patient’s own investment in their care and help smooth a rough nurse-patient relationship.
5. Autonomy Can Be Helpful
Many patients express feelings of helplessness in the face of their illness, which can lead to difficult behaviors. Restoring some of their autonomy can go a long way to returning a sense of control within their lives when caring for difficult patients. Allow them control over that which can be allowed: bathing, medication times, meal times, and any other choice that can be accommodated without contradicting their physician’s orders.
Making the extra effort to reach out when caring for difficult patients can often smooth the path to a better nurse-patient relationship.