Jackson, who is the Vice President of Health Equity and Social Impact for Vidant Health in Greenville, North Carolina, says that she didn’t expect to win. “I knew the chance of winning was slim, but at least we would receive feedback to make this innovation better in the future. The feedback would help us improve the Community Pop-ups, [and] that was worth the submission.”
We interviewed Jackson about her program—what it is, who it has helped, and more.
KaSheta Jackson, DNP, RN
When, why, and how did you develop “Community Pop-Ups: A Rural Approach.” When was the program actually implemented? Do you know how many people it has helped?
Our innovation started as a means to provide basic education and vaccinations in communities with low trust and hesitancy during the COVID-19 pandemic. The first Community Pop-up started April 24 in Dream Park. Team members and leaders from different organization/agencies provided services in non-traditional locations. We emphasized “unity” in the naming for events due to the goal of strengthening partnerships and reducing historical anxieties.
It’s hard to give exact numbers of how many people we have helped, but we know they provided care to more than 400 community participants, gave away 500 produce boxes, and delivered 500 health passports in rural locations across Eastern North Carolina. We collaborated with a local wireless company to offer free cellphones for eligible participants, with public assistance programs, like Medicaid or Supplemental Nutrition Assistance Program (SNAP).
What is a health passport?
In July, Vidant launched a campaign called “Get your health back on track.” This campaign focuses on providing participants health care passports that showed age-specific/gender-specific screening schedules such as cervical cancer, mammograms, and colorectal cancer screening. The campaign provided a booklet with a checklist of all screenings by age and gender, as well as how to access MyChart and virtual health care visits. The health care visit app called VidantNOW offered primary care through the telemedicine capabilities free of charge. These booklets were provided at the Community Pop-ups along with matching tee shirts.
How does this program work? What groups of people are helped? Why kind of care do they get? Do they make appointments or just drop in? Please explain.
The Community Pop-up clinic occurs by community request and/or data assessment to create healthier communities through increasing access to health care, providing jobs, removing barriers, and addressing social, economic, and environmental factors. Participants can see a health care professional and get tests such as blood pressure and glucose monitoring, as well as information on advanced care planning, organ donation, and Mental Health resources, Covid vaccines, Covid testing, sign-up for health benefits, and employment opportunities are available also. No appointments needed. We use social media and both formal and informal leaders to spread the information. Our Pop-ups are helping individuals in rural Eastern North Carolina.
Why do you think that this model is important? How does it benefit the communities it serves in ways that other programs can’t?
This model is important due to limited resources (transportation, food, medical services, and other health resources) throughout the United States. The impact our innovation had on outcomes, safety, quality, experience of patients and staff were redefining relationships with formal and informal community leaders, reestablishing our stance as community partners, listening to concerns, and instilling pride in care team.
We met with community and faith leaders to understand what was needed in their communities. Rural residents often encounter barriers to health care that limit their ability to obtain sufficient access, so they historically have trust issues with health care. Having support from the community leaders encouraged more innovation efforts to focus on more than just health care. We understood education was essential hence seeking community colleges to partner at Community to showcase their programs. By collaborating with community leaders, providing resources they deem as valuable, and collaborating with other agencies who also have needed resources, we are addressing access through local channels and building trust as well as community ownership, which creates a generational standard for better quality of life.
In addition to coming up with the program, did you participate in it?
This program was a hands-on program. I participated in every event except one over the 6-month period. From planning, designing, and coordinating, I was involved in every detail—but never alone in the planning. I was fortunate to have amazing peers who became dear friends to partner with like Shantell Cheek MAEd, RN, Director of Uninsured Programs, and Koai Martin, MHA, Administrative Resident, just to name a couple.
What was your favorite part about this whole experience? How was it to see that a program you developed ended up helping so many people?
My favorite part of the whole experience is seeing the Community Pop-ups come together. It’s humbling and magical.
Our innovation has empowered many nurses to think and behave differently with regards to changing health care delivery and where care is delivered. By aligning community and the health care system, we are addressing social, economic, equity, and population health—which will be a win-win for all involved.
The Centers for Disease Control and Prevention (CDC) continues to issue the rise in the number of youths who have been diagnosed with measles. This national outbreak of the highly contagious measles virus has been recorded as 1,282 individual cases in 31 states as of December 2019 and growing. This is the greatest number of cases reported in the U.S. since 1992. More than 73% of the cases this year are linked to outbreaks in New York. Now the necessity of the school nurse has come into focus.
According to the National Association of School Nurses (NASN), about 40% of our nation’s schools only have a part-time nurse, and 25% don’t have a nurse at all. Not surprisingly, the school systems that are largely affected or at greater risk are rural and urban schools. But with the potential of measles affecting a large number of children and adolescents, school nurse practitioners in several states hurried to refresh themselves on the measles symptoms and to reach the parents of students at risk of infection while working to keep all students safe. They have become the first line of defense in protecting school communities.
The origin of the school nurse has been traced to a Canadian trained woman named Lina Rogers Struthers who is credited as the first one in America. She was assigned to work in four different lower Manhattan schools just as a month-long experiment in October 1902. Officials wanted to see whether having a nurse would improve students’ health and attendance. Despite the fact that there were 10,000 students, her presence made a huge impact on improving the health of students. In fact, in just one month the absentee rate of students in all four schools dropped dramatically. And after the six-month mark, absenteeism fell by 90%. The surprise at the numbers spoke for themselves. The officials next secured funding to employ another 27 school nurses. By the end of 1914, there were as many as 400 in New York City alone. Noticing what the impact nurses were having, other cities quickly followed suit. Los Angeles was one of the first cities to jump on the bandwagon; it hired its first school nurse in 1904.
Today, everything that has to do with school nurses and vaccines—from unequivocal conversations with parents about the science of immunization to the firsthand monitoring of student populations for diseases, have been made difficult by the underfunding of nursing services. In school systems without full-time nurses, it is not unusual for nurses to travel between three or four schools a day or week. Burdened with caseloads of up to 1,500, they try to distribute medications and treatments on time, attempting to triage the most critical cases, while also keeping on top of a mountain of paperwork, according to the National Education Association, which shares with the NASN concern for the need to ramp up the number of full-time nurses.
At a time when the nation’s health care debate is receiving fixed attention, it is indisputable that the delivery of effective and responsive health care is dependent on adequate staffing resources and much success is dependent on adequate nurse staffing levels. But there is a current and forecasted national shortage of nurses because of talent pipeline conditions. While 25% of the country’s public schools do not employ a nurse, and in many school systems there are only part-time nurses, the issue is not merely the unavailability of talent. The overarching issue here is funding.
There are no federal laws regulating school nurses. Today, there are no federal laws regarding staffing, hours of work, compensation, or caseload. But the American Academy of Pediatrics (AAP) recommends at least one full-time registered nurse in every school—a standard many districts have failed to meet or are unable to meet.
The NASN defines school nursing as a specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of students. To that end, nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning.
A recently published research article in the NASN School Nurse journal focused on one of the most difficult problems for school nurses and families: the issue of suicide. The article concluded that a knowledge gap exists in school communities regarding suicide prevention education. It highlights two interrelated topics: nurse engagement in dialogue with students’ families, and the implementation of a community-based suicide prevention educational program at a suburban public school district. Diane Cody Roberts, MPH, BSN, RN, and her coauthors provide an overview of the public health problem of suicide for students, current student challenges, the role of the school nurse in suicide prevention, and a key gap in current school nursing practice. The two overarching goals for this community-based project were to have nurses engage in productive conversations with students’ parents and families about suicidality concerns and to increase the school community’s knowledge about suicide prevention.
But as Laurie Combe, MN, RN, NCSN, president of NASN pointed out recently, when the nurse is not in the school—because they are covering multiple schools—then the nurse misses lots of opportunities to build trust with parents and with families. If they don’t see the nurse and if the nurse is simply the person telling them to comply with immunization directives, then there is the likelihood of resistance.
In May 2017, the Joint Legislative Program Evaluation Oversight Committee of the North Carolina General Assembly directed the Program Evaluation Division (PED) to analyze the need for school nurses and determine how these nurses are funded. Need is growing due to increased attendance by exceptional children and students with chronic conditions as well as laws and policies expanding the health care responsibilities of schools. The PED found that only 46 of 115 Local Education Agencies (LEAs) currently meet the school nurse-to-student ratio of 1:750 recommended by the State Board of Education in 2004. Achieving either the 1:750 ratio or providing one nurse in every school (the current recommended standard of the NASN) would cost between $45 million and $79 million annually.
The report continued that approximately 60% of all medical procedures conducted in schools are performed by school employees who are not nurses. As a result, students are vulnerable to errors and gaps in emergency medical care, and funding intended for education is being used to subsidize health care. Furthermore, unlike other school-based services such as speech therapy, few LEAs file for Medicaid reimbursement for nursing services because, under the current Medicaid State Plan, a Registered Nurse must provide the care as ordered by a physician as part of an Individual Education Plan for the student.
Lee Antoinette Moore, MSN, on the faculty of the Durham, North Carolina Technical Community College School of Nursing, is a former school nurse with experience in New York City from 2004-2006, in North Carolina 2008-2010, and in Hawaii 2012 as a cover nurse who is called when there is an unplanned nurse’s absence. Her prior experience includes that of a military nurse in Germany. Both North Carolina and New York are comparable in many ways. As a whole, with the exception of a few districts, the nursing staff are each assigned to cover more than one school. All of North Carolina’s metropolitan areas have nurses covering more than one school. At the start of the school year, nurses are assigned to engage the schools’ support staff—the administrative support on such things as insulin injection, distribution of medication, some symptom identification, temperature taking and reading, as well as when to invite emergency assistance.
In 2016, the AAP issued a policy statement recognizing the important role nurses play in promoting the health and well-being of children in the school setting. By understanding the benefits and responsibilities of school nurses working in collaboration with the school physician, pediatricians can support and promote school nurses in their own communities, thus improving the health, wellness, and safety of children and adolescents.
Because the nurse plays such an integral role in the school, they must be able to work with a variety of people. School nursing training focuses on improving communication skills, developing organizational skills, performing clinical work, making presentations, and learning the correct methods for teaching health-related lessons to students. Nurses must be self-motivated and dedicated. In addition, they must be able to commit to continuing their education throughout the course of their careers.
Moore’s experience because of her assignment as a dedicated nurse to one school on Staten Island, New York is able to compare that experience to her North Carolina experience where she rotated up to three schools each school year over the course of her tenure.
A 1995 graduate of Winston Salem University School of Nursing, Moore chose school nursing to accommodate the school schedule of her young children after many years working in a variety of hospital and clinical nursing assignments. This is often the reason nurses choose school nursing as a career.
School nurses have a grounded understanding of the significance of the role they play in school systems where the primary emphasis is providing medical skills across a variety of health conditions and in a setting where they are not regarded as just adjunct staff. Penny Rosser, RN, BSN, NCSN, the lead school nurse in Orange County, North Carolina with its upper income city of Chapel Hill, has a nurse in almost every school.
There are 13 schools served by 12 nurses. “In this job,” Rosser says, “you are truly on your own, except for your team. Continuing education and how to keep skill sets up to date are always a concern. Working in the field, alone, is quite different from working in a hospital or clinic, as you are unable to attend many educational sessions or learn the latest techniques. We are truly generalists.”
Far too often it is the students that are on their own. The death of a student in a school because of the absence of a nurse is rare, but it does occur. California and Pennsylvania have had such occurrences in the not too distant past. Are students getting sicker—i.e., are there more cases of asthma, diabetes, and chronic and communicable diseases? Rosser responds, “I think it is inevitable that school sizes will increase and along with the increased population will come increased illness. I don’t think students are sicker than ever; I believe there is more diagnosed illness and more responsibility placed on school staff. I do believe that there has been an increase in mental health needs, however.”
As public awareness and public support for services to tackle mental health concerns grow, the school nurse will be thrust into the point position in our nationwide school systems. With increased responsibility will come greater appreciation of their contribution to the health status of our communities. Possibly, one nurse for each school will take root. From Los Angeles to New York and places in between such as Chicago and Raleigh, there is a ground-swell of support. The overarching principle is simply: Healthy students improve the potential to learn.
Tavonia Ekwegh, DNP, APRN, PHN and CEO of the I-Help Foundation, uses her nursing skills to help struggling communities gain health and wellness equity through access, education, and even the ability to grow their own fruits and vegetables in some urban food deserts.
“I-Help Foundation started with a vision my husband [Timothy Ekwegh] and I had for helping people, hence the name I-Help Foundation,” says Ekwegh. “We started with a focus on the transient population and providing them with homemade meals and hygiene packets every single weekend for three years.” After taking a break to concentrate on her educational pursuits, Ekwegh and her husband found the drive to help people offered a fulfillment they needed.
Ekwegh recently shared some insights about health inequities, starting initiatives, and I-Help’s role in making a difference.
What makes I-Help distinct?
I-Help is distinct in the sense that we are comprised of a team of upstreamists who truly believe that health can be improved by addressing the root causes of social determinants of health. I-Help Foundation works closely with stakeholders on a variety of social injustices and health inequities. Our approach is more at the community level while maintaining our relationship with the local and national health sectors. By working closely with community stakeholders, I-Help Foundation has been provided with insight into health disparities and possible root causes. This insight has led I-Help Foundation to where it is today, with a new mission and vision that focuses on remedying health inequities by taking action on the social determinants of health.
I-Help seems to adapt to the changing health needs of communities. Why is adapting to those changes is so essential to the health of community members?
I-Help Foundation works within communities to both identify and advance solutions that assist in removing stigmas and barriers, and to promote the overall health of the economically and socially disenfranchised. We pride ourselves in building a foundation of knowledge by way of research so that we can better prioritize to the changing needs of the community. On-going community health assessments have proved that the needs and the environment of communities are ever-changing and social determinants can either assist or prove to be a barrier to an entire community trying to make healthier decisions.
Are some communities at a health disadvantage? How does I-Help work with community partners to change the outcome or implement programs or activities that will begin the process of improvement?
I-Help Foundation believes that some communities are at a health disadvantage for copious reasons such as social, economic, political, and logistical reasons. I-Help Foundation is committed to addressing the root causes of health disparities by working in collaboration with communities. We empower the community stakeholders such as young people and adults to advocate for their health and identify needed changes in their neighborhoods. Then we help develop and support the community’s vision of health by cultivating partnerships to deliver unique and customized programs and services that are empathetic and inclusive.
Can you please give an example of an I-Help success story of which you are most proud?
I-Help Foundation is most proud of our Farm up 4 Health, which is an urban farming program geared toward teaching young people in economically disenfranchised communities how to farm and cultivate sustainable organic non-GMO fruits and vegetables. We do this by providing them an opportunity to gain a practical farming experience by working on an urban farm every weekend. We accomplish this by providing them with the necessary equipment, seeds to grow, and harvest crops year after year.
I-Help Foundation Farm up 4 Health provides communities access to organic and healthy fruits and vegetables in otherwise inaccessible neighborhoods. In certain communities where food deserts are prevalent, these community gardens provide a nutritional avenue for families. Communities learn how to grow fresh fruits and vegetables, some of which are new to their palate, while mentors provide information about healthy eating.
What made you decide on nursing as a career choice?
I was introduced to nursing at a very tender age by way of my mother who is a registered nurse. I watched my mother’s career trajectory from nursing assistant to becoming a registered nurse later on in life. Some of my most profound memories of nursing came from going to work with my mom when she worked at a nursing home and a physician’s office. I can recall interacting and forming relationships and bonds with many of her patients. I remember one elderly patient that I fell in love with at the nursing home; she was probably in her late 80s or 90s, she had no family and my presence brought her so much joy. Although I was not allowed in the patient’s room, I would sneak and visit her, read her books and provide her companionship for the time I was there. From that moment on, I knew I wanted to meet the physiological and psychosocial needs of individuals. I believe nursing is my calling, and even in the capacity of president and CEO of a non-profit organization, I can still exemplify the tenets of nursing.
What is your personal goal as a nurse?
My personal goal as a nurse is to become a game changer for my profession and generations to follow. I would like to see I-Help continue to improve and advocate for the overall pursuit of health and wellness for our communities.
What makes health equality so important to communities on a micro level but then also as a sign of national wellness?
Health equality is a fundamental human right that is paramount to communities being able to thrive on both a micro and macro level. Without health equality, we will continue to see disproportionate levels of disease, poverty, and limited access to healthcare and public services. The health and wealth of a nation is also contingent upon the ability and willfulness to provide equitable access to healthcare for all.
Vision boards are an excellent way to visualize your best life, goals, and dreams. Vision boards are a creative way to generate a visual of the things that you want to see manifested in your life, and a way to provide yourself a daily reminder of why you work so hard, and what your outcome will be. Creating a vision board does not have to be a tedious process. This can be a fun opportunity for a girls night, wine, and some creativity
Here is what you need to host your vision board party:
-Poster boards/Paper or Cork Board
-Most Importantly Some Good Wine/Vino
Have a Method to Your Board
There is no right or wrong way to do this. I tend to divide my poster board into sections by category. Divide you vision board into 9 different sections. The top three sections of the board (from left to right) should be prosperity, reputation, partnerships/love. The second row should be family, health, and unity. The third row should be self-improvement, career, and travel. You can see a visual example of several options on Pinterest.
It is important to remember that you can change or update your vision board as much as you deem it necessary. I typically opt for the cork board version of the vision board because it is easier to modify. If you are hosting the vision board party and would like to utilize the cork board, it may be more cost-effective to collect those funds from your guests in advance, or request that they bring their own if they would like to use that.
Don’t have the time or resources to buy supplies for everyone? Get digital with your vision boards. There are several different ways that you can complete a vision board digitally by downloading simple apps from App Store from Apple or the Android Market. I particularly like the Success Vision Board Application by Jack Canfield, the creator for chicken soup for the soul. You can also create one online at www.dreamitaliave.com.
Remember the law of attraction! Hang your vision board somewhere you will see it daily. Use it to inspire you and generate positive energy at the beginning of your day. Live and work towards your dreams every day.
Health is defined as the state of being free from illness or injury. Health is what keeps all individuals in a state of harmony and balance because when our health is good, we are good. However, the state of being free from illness or injury is not equal across all spectrums of the human species. Some of you may deal with health related issues on a daily basis, occasionally, or rarely. Despite your frequency, it’s doubtful time allows you to look up interesting facts and figures on this topic. For instance, did you know that black women have a shorter life expectancy than White women by 5 years, 50% higher all-cause mortality rates, and death rates from major causes such as heart disease, cerebrovascular diseases, and diabetes that are often 2 to 3 times higher than those for Caucasian women? Knowledge is power, so here are a few interesting facts and figures about the health of minority women that make you go hmmm.
Caucasian women are more likely to develop breast cancer than African American women. But African Ameri- can women are more likely to die of this cancer because their cancers are often diagnosed later and at an advanced stage when they are harder to treat and cure. There is also some question about whether African American women have more aggressive tumors.
African American women between the ages of 35-44, have an increased breast cancer death rate of more than twice the rate of White women in the same age group—20.02 deaths per 100,000 com- pared to 10.2 deaths per 100,000.
Black women develop high blood pressure earlier in life and have higher average blood pressures compared with white women. About 37 percent of black women have high blood pressure.
About 5.8% of all white women, 7.6% of black women, and 5.6% of Mexican American women have coronary heart disease.
A 2011 Journal of Women’s study indicated that 57 percent of Latina women, 40 percent of African American women, and 32 percent of white women had three or more risk factors for having a heart attack.
According to the article published by the Diabetes Sisters, the prevalence of diabetes is at least 2-4 times higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than among white women.
One in four African American women over 55 years of age has diabetes.