In the age of smart phones, there’s an application for most everything and everyone. Nursing is no exception. Nurses, accustomed to their pocket references, have a slew of new electronic resources to choose from, including a nursing education application for the iPhone and iPod Touch created by critical care nurses at Shands at the University of Florida.
Designed especially for critical care nurses providing post-operative pediatric congenital cardiac care, two Shands nurses developed the app as a digital reference tool when treating children and infants after their heart surgeries. Users can also bookmark pages and make notes. One of the developers had field tested his own paperback pocket reference, and also on post-operative pediatric congenital cardiac care. He applied his experience to the digital content, and the application draws its evidence-based data from varied websites, journals, and textbooks. Though it’s not a free app ($9.99 at the Apple Store), proceeds benefit nursing education, research, and professional development at the hospital and its Center of Nursing Innovation.
In the fight against cancer, so often the disease seems to be one-step ahead of researchers and health care providers. And anything that gives health professionals an advantage—advanced patient screenings, genetic indicators, etc.—is an important part of the battle. One new method might be the most effective and least invasive of any existing tool, if a little cold and wet…
The same dogs that help police find criminals, airport security locate contraband, and hunters seek prey may be able to actually detect lung cancer in patients’ breath. A new study out of Schillerhoehe Hospital in Germany, published by the European Respiratory Journal, described how four dogs sniffed out lung cancer compounds in the breath of 71 out of 100 patients. The specially trained dogs (two German shepherds, a Lab, and an Australian shepherd) smelled 220 breath samples, with a mix of lung cancer and chronic pulmonary disease patients and healthy volunteers. It’s the first study of its kind of show dogs could be used as a reliably cancer detection method.
Dogs have actually been found to be able to smell skin, breast, and colorectal cancers already. But with lung cancer, the most deadly and notoriously difficult to detect form of cancer, it’s a notable breakthrough.
When patients leave a health care facility, everyone hopes it will be for the last time, as they go on to lead a healthy life. But for some African Americans with chronic obstructive pulmonary disease (COPD), their return visits might necessitate a revolving door.
The Agency for Healthcare Research and Quality (AHRQ) reports readmissions among African American COPD patients age 40 and older are 30% higher than other minority groups, and 9% higher than Caucasians, where patients were readmitted to the hospital within 30 days of treatment.
Analyzing data from 2008*, the AHRQ also found 7% of those readmissions were directly related to COPD, while 21% were all-cause readmissions. Other notable discrepancies include 22% higher readmissions among patients from poor communities when compared with their affluent counterparts, and 13% higher readmissions among males when compared to females. Economically, the surveyed COPD initial admissions cost an average $7,100; readmissions were 18% higher, at $8,400. And averaging $11,100, all-cause readmissions cost twice as much as initial admissions.
* These statistics were published in a recent AHRQ News and Numbers summary, based on a statistic brief drawing data from the State Inpatient Databases for the following 15 states: Arkansas, California, Florida, Hawaii, Louisiana, Massachusetts, Missouri, Nebraska, New Hampshire, New York, South Carolina, Tennessee, Utah, Virginia, and Washington. Visitwww.ahrq.govfor more information.
Phylicia Rashad at Wayne State University’s Hilberry Theater on 26 April 2005 Creative Commons image used courtesy of Dmetric
Former President Bill Clinton’s initiative to eliminate racial and ethnic disparities in health categorizes cardiovascular disease and diabetes as two separate health issues. Yet the connection between these two conditions is so strong that it is virtually impossible to tackle one without also addressing the other.
Heart disease is not only the number one killer in the U.S. but also the leading cause of diabetes-related deaths. In fact, people with type 2 diabetes are two to four times more likely to suffer from heart disease or stroke than non-diabetics. This is because the two diseases share a common root: insulin resistance, which affects African Americans and Hispanics at higher rates than Caucasians.
Furthermore, new research presented this summer at the 2002 annual meeting of the International Society on Hypertension in Blacks (ISHIB) revealed that African- American patients with diabetes were three times more likely to have uncontrolled hypertension than black Americans without diabetes. According to the study’s principal investigator, James H. Jackson, PharmD, “The statistics are astounding. Even though [black patients with diabetes] are seeking treatment and visiting their doctors, they are still failing to control their blood pressure.”
Because a recent survey conducted by the Association of Black Cardiologists (ABC) found that many African Americans and Hispanics do not consider heart disease and diabetes to be related conditions, the organization has teamed up with the American Association of Diabetes Educators (AADE) and GlaxoSmithKline to launch a national public awareness campaign, Take Diabetes to Heart! The campaign’s spokesperson is the popular African-American actress Phylicia Rashad, best known for her role as Clair Huxtable on “The Cosby Show.”
For Rashad, this is an issue that strikes close to home. “My father, who had diabetes, died of a heart attack,” she says. “When I read his death certificate, I learned that the root cause was diabetes. I had never made the association between heart disease and diabetes. So few people with diabetes realize how strongly these diseases are linked, and the importance of working with their health care team to actively and effectively manage their type 2 diabetes.”
This fall, Rashad will travel around the country to share her personal connection with the disease and challenge African Americans and Hispanics with type 2 diabetes to take action to control their disease early and aggressively. The Take Diabetes to Heart! campaign also offers free tips and tools for diabetes management, including an informational Web site and a cookbook. Nurses can find out more about this program by visiting www.takediabetestoheart.com or calling (800) 307-7113.
If asked what disease is the number one killer of Americans, most people would say cancer. But the truth is, cardiovascular disease (CVD) kills more Americans than any other disease. In fact, it is the leading cause of death in both genders and all ethnic groups.
According to the Centers for Disease Control and Prevention (CDC), more than 870,000 Americans will die of heart disease and stroke every year. Compare this to the American Cancer Society’s estimate that 565,650 Americans will die from cancer this year. In its December 2007 report Heart Disease and Stroke Statistics – 2008 Update, the American Heart Association (AHA) documented that in 2004 there were 869,724 deaths due to heart disease versus 553,888 deaths from cancer. The numbers speak for themselves: More Americans are dying from heart disease.
These grim statistics are even more alarming in the African American population, where research studies have shown that the prevalence of heart disease is highest. The AHA reports that cardiovascular disease claims over 100,000 African American lives each year. What’s less well known is that more than half of these fatalities are women. According to AHA, 53,850 African American females died from heart disease in 2004, compared to 48,083 African American males.
In our society there is a long-held misconception that heart disease mainly affects men. This lack of awareness that CVD is not just “for men only” is not only present in the general public but also to some degree among health care professionals. AHA reports that less than one in five physicians recognize that more women die of heart disease than men. The common belief has been that the hormone estrogen protects women from heart disease risk until menopause.
While it is true that heart disease is the leading cause of death in women 65 and older, data from the CDC show that heart disease is ranked as the third leading cause of death in women ages 25 to 44 and the second leading cause of death in women ages 45 to 64. In other words, young and pre-menopausal women are affected by and even die from heart disease.
There are two types of risk factors for heart disease: non-modifiable and modifiable. The non-modifiable category includes gender, race, age and family history. These things are beyond a person’s control and can’t be changed. Risk factors that can be modified are hypertension, diabetes, smoking, obesity, elevated cholesterol and physical inactivity. Making changes in these areas can play a significant role in helping people reduce their risk of heart disease morbidity and mortality.
Higher Awareness = Lower Risk
African American women have a high rate of occurrence for many of these modifiable risk factors. Yet studies have shown that, compared to women of other races and ethnicities, they are the least aware of their risk or of the prevalence of heart disease in women. Another disparity is that black women develop these risk factors at a younger age. AHA reports the following statistics for African American women age 20 and older:
• 46.6% have high blood pressure • 13.2% have diabetes • 17.2% smoke • 79.6% are overweight or obese • 34% are physically inactive.
Studies have also shown that CVD risk factors and prevalence are higher in populations with low income levels. This puts low-income African American women at even higher risk for developing heart disease.
As patient advocates working on the front lines of health care, nurses must reach out to these vulnerable women to create awareness and teach them how they can lower their heart disease risk. This requires nurses to become active in communities with a high African American population, including low-income communities. We must go where the need is, because many times those in need do not seek help, especially if they are unaware of their need.
To gain ground in the fight against heart disease disparities in African American women, nurses must increase awareness not only in the community but also among themselves. We must educate ourselves and our co-workers. On an individual level, we can begin by reading current journal articles and research studies relating to heart disease, race and gender, and by attending seminars and conferences. The information we gain can then be passed along to our co-workers. This can be done by personally sharing articles we have found informative and by requesting time at staff meetings to present what we have learned. In addition, the CDC, AHA and other organizations offer a wealth of free information and tools—including programs designed specifically for women and African Americans—that nurses can use to increase public awareness of heart disease risks in communities of color (see next page). These organizations’ Web sites also include links to other informative and helpful resources on the Internet.
Where to Begin in the Community
In the African American community the church plays an important role, especially in the lives of women. Churches serve as a source of support and influence, as well as a meeting place for many women. People in the community are comfortable in the church and are willing to attend health-related workshops held there. This is a good place for nurses to begin reaching out to black women to educate them about heart disease.
Resources for Reaching Out From the Centers for Disease Control and Prevention (CDC):
• Division for Heart Disease and Stroke Prevention www.cdc.gov/DHDSP/index.htm
• WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation)
• Office of Minority Health & Health Disparities (OMHD)—Black or African American Populations www.cdc.gov/omhd/Populations/BAA/BAA.htm From the American Heart Association (AHA):
• Resources for Healthcare Professionals www.americanheart.org/presenter.jhtml?identifier=3052043
• Search Your Heart www.americanheart.org/presenter.jhtml?identifier=3041580
• Resource Center for Advocates www.americanheart.org/presenter.jhtml?identifier=3028706 From the National Heart, Lung and Blood Institute (NHLBI):
• The Heart Truth: A National Awareness Campaign For Women About Heart Disease www.nhlbi.nih.gov/health/hearttruth/index.htm
Partnering with other organizations can help maximize the effectiveness of your outreach efforts. For example, you can contact your local or state health department and form a joint effort to provide heart health workshops at community churches. The health department can provide free cholesterol, blood pressure and blood glucose screening to those who attend. These workshops can be offered quarterly or biannually at different churches in the community.
Local colleges that have nursing programs are another good resource. Contact them to see if some of their nursing students would be available to assist with blood pressure and blood glucose testing. Invite black sororities and women’s clubs to help organize and sponsor community workshops and health fairs. The health care facility where you work may also be interested in being involved in this project.
During the workshop, nurses can present information on the prevalence of heart disease in African American women, risk factors, signs and symptoms, management and prevention of heart disease. Many free educational materials that can be used to communicate this information are available from programs like AHA’s Search Your Heart and the National Institutes of Health’s The Heart Truth. Through these workshops, vulnerable women can become empowered by gaining knowledge about heart disease, their risk and what they can do to decrease it.
Providing free screenings will help identify women who do not have regular health care providers, those with abnormal findings and those at high risk. These women can then be connected with health care services available from their community health department. The health department can obtain contact information during the screenings to follow up with those women who need treatment or referrals.
Once women are aware of the problem and their risk, nurses can help them organize walking groups and brainstorm other ways to increase their activity level. Resources available from the AHA, such as heart-healthy recipe books, can be used to teach women how to modify their diets to decrease cholesterol. You can also provide information on the management of diabetes, high blood pressure and any existing heart disease. Women who smoke can be referred to smoking cessation programs. These activities focusing on reducing modifiable risk factors will help women make positive changes in their lifestyle and their health.
Going out into the community enables nurses to reach a larger number of women—including those who might not attend workshops if they were offered outside of their communities or in health care settings—and those with the highest risk. This article offers suggestions on how to begin and where to find additional ideas. Armed with personal knowledge, available resources and community partners, nurses can make a difference in the fight against heart disease disparities in African American women.