Enough is Enough: Ending Nurses’ Toleration of Workplace Violence and Bullying

Enough is Enough: Ending Nurses’ Toleration of Workplace Violence and Bullying

Nursing is a profession of service to others. Daily, nurses meet the physiological, psychosocial, and spiritual needs of the patients and patients’ significant others to whom health care is provided. The provision of quality, safe, evidenced-based practice nursing care is delivered by nurses in both inpatient and outpatient health care settings. However, the provision of nursing care can be significantly impacted when nurses are not provided safe environments to work within.

In 2018, I had the opportunity to work with my fellow nursing colleagues on the American Nurses Association (ANA) Professional Issues Panel #endnurseabuse. The panel was an advisory committee consisting of nurses throughout the United States. Our mandate, to critically and honestly discuss workplace violence perpetrated against nurses. I commend the ANA on their stance on violence against nurses in the workplace perpetrated by such entities as visitors, patients, intimate partners, nurses-to-nurses, and others, as well as their 2015 position statement on bullying, incivility and violence within the workplace. In 2019, Ambrose H. Wong, M.D., MSEd, Jessica M. Ray, PhD, and Joanne D. Iennaco, PhD, PMHNP-BC, APRN, noted in an article written within The Joint Commission Journal on Quality and Patient Safety, that “Health care workplace violence is a growing, pervasive, and underreported problem.”  Of concern is that despite the identification of the problem of workplace bullying and violence, it remains an ongoing issue.

Enough is Enough

Workplace violence can consist of both physical and psychological threats against others. While bullying can become physical, perpetrators tend to use negative words (i.e., humiliation, backstabbing, verbal abuse) to gain psychological intimidation over their victims. In February 2019, as I sat within a Sigma Theta Tau International conference on healthy workplaces breakout session, a normally quiet person, I found myself verbalizing the words, “Enough is Enough,” as stories were shared of working with disrespectful nurse colleagues in clinical and academic settings. I have been a nurse for over 29 years and became a nurse to administer care to the physically and mentally ill. It is a privilege to help in the healing process of others. If I would have known that violence and bullying was tolerated within the nursing profession as a normal ritualistic patterned behavior, I may have rethought my entry into health care.

 

Alas, I am a nurse for life. And although I have contemplated leaving the profession I never will. The truth is, I love being a nurse and I love caring for patients. And, I enjoy the collaboration that occurs with my colleagues that leads to positive health outcomes with patients we jointly care for in clinical settings.

And so, I am challenging my nursing colleagues in clinical and academic settings, nursing leadership, and nursing health care organizations, to take back our profession by deeming violence and bullying in nursing as not being acceptable. By ignoring violence and bullying in the workplace, nurses perpetuate the cycle of anger and violence. The co-existence of anger and violence in health care environments will continue if nurses do not deem these behaviors as harmful to our profession. As a profession of caritas that places the safety and health of others as a priority, we must take this professional ideal and transfer it not only to the care of our patients, but our care for one another.

​Ways Nurses Can End Violence and Bullying

Nurses are wonderful advocates for patients. Let’s become advocates for one another. If you observe bullying or violence within the health care environment, report it (i.e., notify your immediate supervisor, nursing leadership, and human resources). Calmly acknowledge that you have observed the behavior of the perpetrator and affected nurse and ask, “Can I assist the two of you in anyway? There appears to be a disagreement of some kind.” This places the bully or potentially violent person on notice that others have witnessed their behavior.

Nurses can educate themselves on how bullying and violence presents itself in the workplace by becoming familiar with the ANA Code of Ethics with Interpretative Statements, the United States Department of Labor Occupational Safety and Health Administration (OSHA) workplace guidelines, and The Joint Commission’s stance on workplace bullying and violence. Additionally, there are now several nursing articles that can provide further insight on behaviors that can negatively impact health care environments, health care workers, and patients. A list of current websites is provided in the sidebar for your reference and support.

Together, nurses united can create healthy and supportive workplace environments for all!

The 2020 Census: Since It Impacts Us, Complete It!

The 2020 Census: Since It Impacts Us, Complete It!

Since it impacts us, every household is encouraged to complete the 2020 Census. The U.S. Congress started taking the U.S. Census in 1790, as noted in the U.S. Constitution. The Constitution also required that the federal government do the census every 10 years. Political power and funding are greatly impacted by the census, which also impacts all the elements that contribute to the social determinants of health. The census is used to allocate congressional seats, electoral votes, funding for government programs, as well as the database of a lot of research.

More than $675 billion federal funding is distributed yearly based on the U.S. Census. Accuracy in the “count,” counting the correct category, clear descriptive verbiage, and engagement are imperative. Relating the importance of completing the census to all stakeholders, and creating an environment where people feel safe in completing the census, especially marginalized populations, is essential. Minorities, children, immigrants, and low-income areas are noted to be difficult to count.

The Count

Accuracy of the count has always been a concern from day one. President Washington and his Secretary of State, Thomas Jefferson, shared concern that the Census of 1790 undercounted the population greatly—and we still have this issue today. According to the U.S. Census Bureau, the first Census consisted of six questions:

the name of the head of the family, free white males at least 16 years old, free white males under 16 years old, free white females, “other free persons,” and slaves. Slaves were counted as three-fifths of a person and Indians were not counted until almost 100 year later.

The 2020 Census has had a hot debate over including a citizenship question and the negative impact it would have. Although the suppressive citizenship question will not be included, citizenship numbers could be extracted from the yearly American Community Survey (ACS), which falls under the U.S. Census Bureau. We still deal with inaccuracies of the census, concerns of undercounting the population, as well as debates over the questions included on the census. The census has a huge impact on the allocation of funding, research, and political representation.

African Americans and Latinos have been historically undercounted. These groups are even ranked by states in census tracks called HTC (Hard to Count) with New York, Texas, Florida, California, and Georgia in the top five states respectively for African Americans and for Latinos, it is California, Texas, New York, Arizona, and Florida, respectively, according to CensusCounts.org. Children also have a ranking in HTC states. Many elements play a role in why the census does not reflect an accurate count or low survey participation with minorities, low-income, children, and immigrant population. Fear, distrust, inequity, lack of information, privacy, and intent contribute to poor participation.

The 2020 Census adds a new element that for some may be a barrier and/or learning curve, which is technology. For the first time in history, the census will be available online. The addition of media brings about many issues, such as computer literacy and internet access issues. The HTC marginalized population should be targeted for support and resources to get optimal participation in completing the 2020 Census.

Political Representation

The U.S. Census data determines our political representation. Congressional seats for each state are determined by census data. As a result, a state could lose a member in Congress or your city could lose state representation. For example, the House of Representatives divides its 435 memberships or seats among the 50 states based on the total resident population (citizen as non-citizens) using a 1941 calculation methodology; a complex process. Let’s not forget two important political terms: redistricting and gerrymandering. Redistricting is the period where legislative boundaries are redrawn. The data is used to define legislative districts, school district areas, as well as other areas in government. Gerrymandering is a method that officials may use to draw district lines to influence election results, manipulating boundaries and changing voting districts to favor a political group.

Funding

Census data is used to make decisions on road repair, schools, services, jobs, education, neighborhood improvements, and more. As noted above, more than $675 billion federal funding is distributed yearly based on the U.S. Census. According to the College Board’s annual Trends in Student Aid report, in 2017-2018, there were 7 million Pell grant recipients equaling $28.2 billion. In 2016-2017, 49% of Pell grant recipients were dependent students; 37% of these students came from families with incomes of $20,000 or less, and another 36% came from families with incomes between $20,000 and $40,000. Funding is allocated in one of three ways: selection and/or restriction of recipients, award allocation, and monitoring and assessment of program performance.

Medicaid, for example, is the largest source of health insurance for low-income and disabled persons. It’s a federal and state program where funding and reimbursement level calculations include the state’s population and income levels, which are derived from the U.S. Census.

The Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) serves low-income women, infants, and children at nutritional risk by providing nutritious foods and health care referrals. WIC provides vouchers for crucial foods like baby formula, eggs, milk, and fresh fruits. According to the Food and Nutrition Service, in 2018, WIC served approximately 6.87 million (5.5 million being children and infants served). For the first five months of FY 2019, 6.4 million had been served. WIC uses the Health and Human Services (HHS) guidelines for WIC eligibility. WIC uses the Consumer Price Index, which is derived from the U.S. Census, to see monthly food voucher prices and the ACS (which is also part of the Census Bureau) to allocate funds to each state. By the way, the U.S. Department of Agriculture reported that in 2016, 58.6% of WIC participants were white, 20.8% Black or African American, 10.3% American Indian or Alaskan Native, and 4.4% Asian or Pacific Islander.

Research

We often look to the Centers for Disease Control and Prevention (CDC) for data collection and research; from tracking diseases and prevention to program evaluations for effectiveness. It is accepted as vetted, accurate information; as well as the guardians of public health while utilizing this data. The National Health Interview Survey (NHIS) is the methodology used for this data and it is based on the decennial census information and updated with every census.

Many sources that track the social determinants of health, such as income and poverty level, use census-derived data. The Current Population Survey (CPS) is one of these sources, collecting data since 1940. CPS, sponsored by the U.S. Census Bureau and U.S. Bureau of Labor Statistics, provides information about our jobs, earning, education, and other studies that note the population’s social well-being, such as volunteerism, child support, and health insurance coverage. A huge impact of CPS is obtaining the number of unemployed population and the demographics. Unemployment data and economic data are used by policymakers to address unemployment and the repercussion of it.

One of the largest, well-known research projects commissioned by the Institute of Medicine was published in Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The Institute of Medicine used data from the U.S. Census throughout this research. This study concluded, “Evidence of racial and ethnic disparities in healthcare is, with few exceptions, remarkably consistent across a range of illnesses and healthcare services.” This study confirmed what people of color have always known through personal experience, but validation by a scholarly entity through research was priceless. This research has impacted health care delivery and highlighted the realization that care is not equal, and inequities exist which we must address.

Summary

A complete and accurate count of our population by the U.S. Census is imperative. The U.S. Census data impacts many elements of life, especially funding, representation, and research. Federal funding allocation dictated by the U.S. Census affects our classrooms, jobs, senior services, health care in our communities, and numerous other programs and services. This includes health insurance programs like Medicaid; as well as WIC and Head Start. Hence, the U.S. Census impacts health care disparities and the social determinants of health as well.

Minorities and low-income people are undercounted and noted to be difficult to count for many reasons, yet census data impacts this population greatly. Our political representation and redistricting is based on the census data and being counted dictates the number of representatives. Our elected officials, our representation, advocate for funding and represent us in all issues that impact life, liberty, health, and even our pursuit of happiness. Research drives the allocation of funds, health care delivery and changes, social issues and justice, just to name a few areas in which the US Census Data is used as a resource. Funding dictated by the census impacts our classrooms, jobs, grants, and health care in our communities—especially vulnerable, underserved populations. Since the U.S. Census impacts us all, we must encourage everyone to complete it.

Strategies of Incorporating Palliative Care as a Direct Care Nurse

Strategies of Incorporating Palliative Care as a Direct Care Nurse

Palliative care is defined as a practice with emphasis on maintaining and improving a patient’s quality of life that can be incorporated at any stage during the disease process. With a focus on symptom management and identifying clear goals of care, palliative care plays a vital part in optimizing quality of life. Currently, palliative care services are offered at a multitude of health care organizations that may consist of a team of physicians, advance practice nurses, social workers, chaplain services, etc. And although palliative care can be beneficial for the patient and their loved ones, there are still many barriers preventing its integration in care delivery. This can result from a misunderstanding of what palliative care can offer, its presumed synonym to hospice, late referrals to the palliative team, or a complete lack of consultation where a patient could have benefited. However, how can direct care nurses integrate the principles of palliative care in their everyday clinical practice?

Palliative care is multifaceted; however, some essential components include pain control, symptom management, and addressing goals of care.

Pain Management

Regarding pain control,

the direct care nurse can begin by completing a comprehensive pain assessment. By understanding how to properly assess a patient’s pain, nurses can have a better understanding on how to effectively treat it. While the Numeric Rating Scale can provide some insight to the severity of pain, nurses can also utilize the OPQRST mnemonic to supplement their pain assessment.

  • Onset: Was the pain sudden or developed gradually? What were you doing when the pain began?
  • Provocation: What makes the pain worse? What makes the pain better?
  • Quality: Could you describe the pain? Words like sharp, stabbing, burning can help the nurse better understand what the patient feels.
  • Region: Is the pain localized in one area of the body or does it move?
  • Severity: From a scale of 1 – 10 with 1 being minimal pain to 10 being extreme pain, how would you rate your pain?
  • Time: When did the pain start? Have you experienced this type of pain before?

A functional assessment plays a very important role in controlling pain as well. For example, if a patient states no pain staying in only one position however discomfort when standing or sitting, that patient would be described as having limited functional ability due to inadequate pain relief. Providing efficient pain relief does have its barriers. Patients may be hesitant to accept narcotics in fear of being seen as drug-seeking or they may feel apprehensive to admitting they have pain. Because of this, education is especially important to allow patients better control of their symptoms.

Additional tools that a nurse can incorporate in their pain assessment are noticing body behaviors, like those presented in the Face, Legs, Activity, Cry, Consolability (FLACC) scale for children as well as non-verbal adults. A patient may state minimal pain; however, grimacing, clenched teeth, sweating, and tachycardia might indicate otherwise. Finally, when an intervention is implemented, such as medication, a pain reassessment should be conducted within an appropriate timeframe to evaluate its effectiveness. However, if repeated ineffectiveness of the current pain regimen, nurses should feel empowered to inquire about a proper pain management consult if services are provided at that health care institution.

Symptom Management

From a physiological standpoint, multiple symptoms can prove to be quite challenging in supporting a patient’s comfort level. Symptoms such as shortness of breath, consistent coughing, fatigue, nausea, vomiting, constipation, and diarrhea can be a difficult burden. Hospitalized patients introduced to new medications and treatments are at risk for developing side effects, which is why medication education is especially important for patients in understanding what they may expect. For example, opioid treatment may be met with resistance for fear of its constipating side effect; however, effective management is possible by addressing fears, providing education, and potentially supplementing with a stool softener.

While pharmacological interventions are utilized more often in the hospital environment, manipulating the environment can provide some benefit as well. For example, in conjunction to oxygen support and medication, having a fan blow cool air in the direction of the patient or lowering the temperature in the room can provide some additional relief. Dyspnea is not always caused by a patient’s low oxygen saturation as contributing factors such as anxiety could produce the feeling of difficulty of breathing.

Coughing can interfere with adequate sleep and oral intake and can lead to physical exhaustion. Positioning and removing environmental irritants can be supplementary interventions that can be utilized alongside medications. A full respiratory assessment should be conducted, especially in regard to assessing the characteristics of a patient’s cough. Adjectives such as dry, moist, and productive can help the provider prescribe the appropriate medication.

Constipation and diarrhea attributed by underlying disease or medication side effects are distressing and exhausting symptoms that impacts patient mood and dignity. What can be done to help alleviate these symptoms? In regard to medication-induced constipation, commonly seen through opioid usage, prophylactic laxatives/stool softeners can be started to help potential side effects. Having a consistent regimen and re-evaluating its effectiveness allows the nurse to assess if the patients’ constipation is being managed appropriately.

Communication

Communication is the foundation of palliative care; through proper communication and transparency amongst the health care team can patients and families make informed decisions around their treatment options. The nurse is pivotal in accompanying the patient through the illness journey, whether it be simply through active listening and presence to ultimately providing guidance regarding treatment effectiveness. This nurse-patient relationship is built on trust and through supporting patients and families to be active participants in their care.

How can direct care nurses improve their communication skills, especially when it comes to a goal of care conversation? One strategy that can be implemented is to utilize open-ended questions. Questions such as “What do you understand about your medical condition?” elicits the patient’s perspective of their disease course. The conversation can delve deeper potentially into the patient’s perspective of their prognosis and the treatment options they believe to be available. This Ask-Tell-Ask strategy explores the patient’s understanding first before the nurse provides information. This back and forth cycle between the patient and nurses addresses four main principles: the patient’s perspective, information that needs to be delivered, response to the patient’s emotions, and recommendations from the nurse. When delivering information, the nurse should avoid using medical jargon and speak in simple terms. Finally, trust and compassion provide a foundation of effective palliative communication. Many times, when palliative care is discussed, the conversation can be somber as it may be dealing with advanced illness and burdensome symptoms. Therapeutic presence results in empathy, thus creating a safe space to discuss difficult issues.

Conclusion

Unfortunately, barriers still exist that prevent palliative care from being effectively delivered to those patients who would benefit from it the most. Palliative care is time and time again mistaken with death or hospice, thus resulting in reluctance to appropriate consults being in place. Additionally, some nurses may feel inadequate in engaging the patient and family in palliative topics or believe that these conversations should be solely conducted by the physician. Nurses need to be involved in overcoming these barriers to reduce misconceptions and ensure that other health care providers, patients, and families understand the benefit of palliative care implementation. These benefits include early focus on comfort treatments, reduction in cost of care, and overall decreased length of stay. Nurses play a crucial role in palliative care, and with continued self-education and engagement can the direct care nurse utilize their skills and knowledge to benefit their patients by acting as that essential extra layer of support.

It’s Your Health – It Matters

It’s Your Health – It Matters

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.

Community and Faith-based Education Program on Prostate Cancer for Black Men

Community and Faith-based Education Program on Prostate Cancer for Black Men

Community and faith-based education programs have long been proven successful in reaching black communities. As an African American woman and advanced practice nurse, I have participated in many projects and studies to identify effective approaches to increase awareness, prevention, and treatment of health issues that impact my racial/ethnic group. After serving as a nurse expert for several successful community faith-based programs focused on various health issues, I worked with a local organization, in which I am a member, to address prostate cancer awareness and screening among black men in two counties in Virginia.

Prostate cancer is the second most common cancer in men, and, despite being treatable when detected early, is one of the leading causes of cancer death among men of all races, according to the Centers for Disease Control and Prevention. Prostate cancer rates among black men are significantly higher than any other race, with more than 150 new diagnoses annually per 100,000 men in the United States. Clinical progression of prostate cancer is known to

be more aggressive in black men as compared to white men. However, black men are less likely than their white counterparts to engage in shared decision making (SDM) with their health care provider about the benefits and risks of the gold-standard prostate specific antigen (PSA) test. Due to the increased risk for prostate cancer among black men, screening is recommended at earlier ages than the general population.

The Education Program

Over a one-year period, I was a nurse researcher for a prostate health education program that examined whether participants had an increased awareness about key issues of prostate cancer, following a culturally targeted education program, and whether participants were more likely to engage in SDM with their health care provider about prostate cancer screening. Their knowledge was assessed through pre- and post-test surveys that addressed three topics:

  • Increase in knowledge about prostate cancer screening
  • Increase in intentions to have an SDM conversation with a physician about prostate cancer screening within 12 months
  • Participation in an SDM conversation with a physician about prostate cancer screening within three months after the educational program

The program worked with 438 black men over the age of 40 who were recruited primarily through churches, as well as social media and community, civic, and social activities. Participants needed to be able to speak and understand English and reside in either Prince William or Stafford County in Virginia. Religious beliefs serve as a fear reducer and motivator for increased prostate cancer screening behaviors among black men, demonstrating the importance of faith and spirituality in the black community. Programs were implemented at 12 black churches, and prayer and scripture were included before and after each program session.

It’s important to ensure that programs are meeting the needs of the community. As a result, a community advisory board was developed for this program, which included key stakeholders such as nurses, physicians, ministers, local hospital representatives, prostate cancer survivors. and community advocates for black men’s health issues.

After the pretest to assess black men’s existing knowledge about prostate cancer, an educational session began with a five to 10-minute personal testimony by a black prostate cancer survivor, followed by an engaging question-and-answer session. The men then watched a short National Cancer Institute video clip, “Prostate Cancer Survivor: An African-American Man’s Perspective.” Next, two physicians who specialize in urology taught a two-hour information session that focused on prostate cancer statistics, prevention, screening, early detection, and quality of life. Last, there was another question-and-answer session, which was followed by the post-test. Contrary to previous community and faith-based programs, this one included a second post-assessment three months after the initial program to evaluate whether patients had an SDM conversation with their physician about prostate cancer screening.

The Program Results

The results showed that educating black men about prostate cancer through a community and faith-based program increased their general knowledge of prostate cancer and its treatment by 40.2%, improved their intention to have an SDM conversation with their health care provider by 17.8%, and impacted whether an SDM conversation took place within three months of the program by more than 80%. Although the results are encouraging, it’s important to note that the black men in this program were predominantly middle class and the majority were employed full-time and possessed private health insurance. Additional programs of this nature should be conducted with those without health insurance and with lower levels of household income.

The Importance of Research

Nurses can play a vital role in helping community and faith-based organizations develop and execute programs to address health disparities. The program I was a part of is an example of how community partnerships can implement a successful health education program. Doctoral programs, like Walden University’s PhD in Nursing, train nurses to become effective researchers and scholars to tackle complex health care questions and issues. It’s critically important for research to be conducted, especially in developing culturally appropriate models for diverse communities, so more contributions toward reducing health disparities can be made available to effect positive social change.

For more information about this prostate community and faith-based program, please view the summer 2018 issue of the Association of Black Nursing Faculty (ABNF) Journal.

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