Despite the high health impact on the global community, viral hepatitis doesn’t have to be so deadly. Nurses are in an excellent position to encourage patients to get tested and learn more. According to the World Hepatitis Alliance, hepatitis causes an inflammation in the liver that is generally from a viral infection. There are five main types of hepatitis, and more than 350 million people worldwide live with viral hepatitis. And while hepatitis causes significant disease and death, 90 percent of people living with the disease are unaware they have it.
“It is important to know that hepatitis C can be cured,” says Deborah Parris, RN, of UNM Truman Health Services about one of the most common forms of hepatitis. “The sooner hepatitis C (HCV) is treated and cured, the better. HCV can affect every organ of the body and if left untreated can cause irreversible damage to the liver. It is a major risk factor for liver cancer.” At UNM Truman Health Services, Parris works with patients in a comprehensive approach to HIV, AIDS and hepatitis C care. Organizations around the world work tirelessly to raise awareness and provide access to build awareness of prevention and also of the life-saving testing and treatment.
As awareness grows about hepatitis, more patients will be diagnosed, treated, and cured. But patients need access and advocates for that to happen. “It is important for all healthcare providers to know that hepatitis C is very easy to treat and in most cases, patients do not need to be referred to a specialist,” Parris says. “Nurses can advocate for their clinics to start treating hepatitis C if they are not. Treatment belongs in the primary care setting which ensures more patients are treated and cured.”
Parris says the CDC is calling for simplified HCV testing of all adults at least once in their lifetime regardless of health history. “There are over 2 million people in the US with hepatitis C, and it is estimated that only one-third of them have been treated,” she says. The screening recommendation and process, particularly when it is applied broadly, gives nurses an opportunity to speak with their patients about HCV.
Nurses, says Parris, are in an excellent position for both prevention and treatment that will save lives. They can help patients understand how much easier it is to treat than in the past, she says. They can work in their clinics to identify patients that need to be treated and assist with treatment to educate and follow patients until they have completed treatment and have been cured.
Many people aren’t fully aware of the risks of hepatitis, and Parris says many people don’t realize that hepatitis C treatment has vastly improved. “Now you can be completely cured in 8 to 12 weeks,” she says. “It is really amazing how far treatment has advanced. Most people do not experience any side effects of the medications and these DAA or Direct Acting Anti-viral Agents are very effective at completely curing hepatitis C.”
And for many people globally, health equity is a big factor in the scope of hepatitis. Although anyone is at risk of viral hepatitis, populations that lack direct access to healthcare are particularly vulnerable. “At my clinic and many others around the country, we are working hard to remove or decrease barriers to treatment for people with poor social determinant of health,” says Parris. “Many state insurance plans and Medicaid have removed the restrictive requirements that prevented some people from getting treatment. The idea is to meet patients where they are and many are homeless with substance use disorders and mental health disorders. Treatment should never be withheld for these reasons.”
Healthcare teams that have a comprehensive approach–weaving in primary care, behavioral health, and substance use services, for example–can make a big impact. “Treatment is good for individual patients and the community,” says Parris. “Everyone deserves competent, respectful care and treatment for hepatitis C. It is a basic human right.”
Only half of Americans identified as ever having had hepatitis C received follow-up testing showing that they were still infected, according to a recent report issued by the Centers for Disease Control and Prevention (CDC).
“Many people who test positive on an initial hepatitis C test are not receiving the necessary follow-up test to know if their body has cleared the virus or if they are still infected,” said CDC Director Tom Frieden, MD, MPH. “Complete testing is critical to ensure that those who are infected receive the care and treatment for hepatitis C that they need in order to prevent liver cancer and other serious and potentially deadly health consequences.”
Testing for hepatitis C includes a blood test, called an antibody test, to determine if an individual has ever been infected with the virus. For people with a positive antibody test result, a follow-up test—called an RNA test—should be given to determine whether they are still infected so they can get needed care and treatment.
A small number of people with antibody-positive tests will have cleared the infection on their own, but most people with hepatitis C (about 80%) remain infected and can go on to develop significant health problems.
Researchers looked at data from eight areas across the nation funded by the CDC to conduct enhanced surveillance for hepatitis C virus infection. Of the hepatitis C cases reported in these areas (i.e., those cases with antibody-positive results), only 51%of the cases also included a follow-up (RNA) test result that identified current infection. Without follow-up testing, the other half are likely unaware if they are currently infected and therefore cannot get appropriate medical care.
Data included in this analysis also underscore the severe impact of hepatitis C among baby boomers. In the eight areas studied, 67% of all reported cases of current infection were among those born from 1945 through 1965. Deaths among people with hepatitis C also were more common among those born during these years (accounting for 72% of all reported deaths).
“Hepatitis C has few noticeable symptoms, and left undiagnosed it threatens the health of far too many Americans—especially baby boomers,” said John Ward, MD, director of CDC’s Division of Viral Hepatitis. “Identifying those who are currently infected is important because new effective treatments can cure the infection better than ever before, as well as eliminate the risk of transmission to others.”
Overall, approximately 3 million Americans are infected with hepatitis C and up to 3 out of 4 do not know they are infected. The vast majority of those affected are baby boomers, or those born from 1945 through 1965. Left untreated, hepatitis C can cause serious liver damage, including liver cancer. Hepatitis C is a leading cause of liver cancer and the most common indication for liver transplants. In fact, liver cancer is the fastest-rising cause of cancer-related death in the United States. Deaths from hepatitis C have nearly doubled over the past decade, now accounting for more than 15,000 deaths each year.
In light of increasing evidence that many patients are not receiving the follow-up test, as well as recent changes in testing technologies and the availability of new effective treatments for hepatitis C, the CDC is issuing updated guidance for health care providers on hepatitis C testing. These guidelines reinforce the recommended process for hepatitis C testing and underscore the importance of providers conducting follow-up RNA testing for all patients with a positive antibody test result in order to help ensure people infected with hepatitis C are properly tested and identified.
The CDC recommends that everyone in the United States born from 1945 through 1965 be tested for hepatitis C. The CDC also recommends that other populations at increased risk for hepatitis C get tested, including those who received blood transfusions or organ transplants before widespread screening of the blood supply began in 1992, or those who have ever injected drugs.
Sandra Sanchez-Zutic, RNC, a child/adolescent psychiatric nurse, gained the confidence to get more involved in her local nursing association and run for office. She’s now vice president of the New Jersey chapter of the National Association of Hispanic Nurses.
Teresa Sewall Philogene, RN, a clinical research associate for a major pharmaceutical company, renewed her commitment to continue her professional education and pursue a master’s degree.
School nurse Cynthia Samuel, RN, MS, sharpened her focus on what she wants to study on the doctoral level and made contacts that will enable her to advocate for school health issues statewide.
These three minority nurses come from diverse backgrounds and specialties, but they all share one thing in common: They have leadership potential. And now, thanks to a unique program at Rutgers, The State University of New Jersey, they are better equipped to develop their natural leadership abilities and pursue their goals. They are among 17 nurses to participate this year in the Minority Nurse Leadership Institute (MNLI), an annual nine-month program (October to June) developed through the Educational Opportunity Fund Program at the Rutgers College of Nursing in Newark.
Established in 1999, the institute’s mission is to help minority RNs continue their education, advance into leadership roles and use their influence to improve minority and community health. MNLI Project Director Deborah Walker McCall, RN, MBA, says the program is the only one of its kind in the country, as far as Rutgers officials know. As the institute becomes more established, she would like to see it become a national model and replicated at other universities.
The institute recruits nurses of color from New Jersey, New York and neighboring Northeastern states who have completed or are working toward a BSN or MSN degree and have demonstrated leadership ability in nursing, such as involvement in civic activities or professional organizations, holding offices, etc. MNLI Fellows must also demonstrate a commitment to working with minority populations in urban communities and serving as mentors to other nurses.
The size of the group is kept relatively small–no more than 25 nurses per year–so that participants can get to know one another and receive individual attention. The nurses attend monthly, daylong Saturday workshops at Rutgers on leadership topics like public speaking and networking. They ¬then get a chance to apply what they’ve learned by creating a community health project. The project must coincide with the goals of Healthy People 2010, the national campaign to eliminate minority health disparities and increase life expectancy and quality of life for all Americans. Each MNLI Fellow is also partnered with a mentor who is a leader in the nursing or health care profession.
A U.S. Department of Health and Human Services grant provided seed money to start the institute, and grants from the Kellogg Foundation and Johnson & Johnson have funded the program in subsequent years. While the MNLI is currently dependent on annual grants to continue, McCall hopes an endowment will be established to provide ongoing funding. The program, she says, has benefited from the strong support of College of Nursing Dean Hurdis Griffith, RN, PhD.
The institute’s long-term goal is for its graduates to serve as role models and agents of change who can make a far-reaching impact in providing culturally appropriate care to minority communities, championing health care reform, encouraging young people to enter the nursing profession and persuading other nurses of color to become leaders as well.
Noting that minority nurses are severely underrepresented in health care management, academia, policy making and other leadership roles, McCall, who is African American, envisions MNLI graduates advancing to positions where they can advocate for minority patients and help end race-based health care disparities. “The biggest things I’d like to see happen as a result of this institute are the improved health of minority populations and an actual elimination of the health gap,” she says.
Take Me to Your Leaders
Through the monthly workshop seminars, MNLI Fellows gain exposure to the wide spectrum of nursing disciplines and leadership positions to which they can aspire.
“It really begins to let them see that the nursing profession offers many more options than just working at the bedside,” comments Yvonne Wesley, RN, PhD, an African-American nurse and MNLI mentor who is vice president of research and development for the Northern New Jersey Maternal Child Health Consortium. “To become minority nurse leaders, they need to have that big-picture perspective.”
The institute does more than emphasize that nurses of color can rise to the top and become hospital CEOs, heads of government agencies, nursing school deans and more—it proves it by bringing participants face to face with role models who have done just that.
“The MNLI brings together a hard-core cadre of accomplished minority faculty and professionals,” says Rutgers University College of Nursing Assistant Professor Gloria McNeal, RN, PhD, CS, another mentor for the institute. “You can see in [the students’] faces that they didn’t even know people like us existed.”
Institute Fellows not only get to learn from top-ranked minority scholars and health officials in a lecture format, they also get to chat informally with them.
“Unless you’re lucky enough to be able to go to national conferences, you really wouldn’t have access to that level of professionals,” Sanchez-Zutic explains. The opportunity to get acquainted with such high-caliber nurse leaders, she adds, is akin to “physicists getting to talk to Einstein.”
Besides offering instruction, workshop leaders also share their personal stories of frustration and triumph. “It was really such an incredible opportunity to see nurses of color in these positions of power and listen to how they did it and get the feeling that yes, you can do it, too,” says Sanchez-Zutic.
Cynthia Samuel agrees that participants can’t help but be inspired by what these minority nurse leaders have accomplished. “You get consumed by their passion. You just want to be like them,” she relates. “I love to surround myself with people who are goal-oriented, who are driven and enthusiastic and willing to share information. I look forward to each session because of the caliber of people who will be there and the information that’s being presented.”
Building Leadership Skills
Behind every great leader there are great leadership skills. The MNLI program introduces minority nurses to leadership concepts that they otherwise might have to spend years learning on the job. The workshops focus on how to network, negotiate, work through the political process, give effective public presentations and form partnerships with other health care professionals.
Participants also take the Myers-Briggs personality assessment test to learn the characteristics of their leadership styles and an accompanying test that reveals the types of people with whom they work best. They also receive guidance in how to capitalize on their strong points and strengthen their weaknesses so they can shape an effective management style.
Bernice Dillard, RN, MSN, APNC, a student health services nurse at Rutgers University who attended the institute in its first year, says this skill-building approach helped her gain a greater awareness of the leadership contributions she can make, particularly in the area of influencing young people to enter the field of nursing.
That type of leadership role comes naturally to Dillard, who is currently president of the South New Jersey chapter of the National Black Nurses Association. “But I just don’t think I ever realized how significant that role was,” she recalls. “I wish I would have been able to attend this institute about 20 years ago!”
Testing Their Wings
Through the minority health projects they complete while they attend the institute, MNLI Fellows get a unique opportunity to not only translate theory into practice but also make an immediate impact on their communities. The purpose of the projects is to increase participants’ understanding and involvement in minority health care issues while enabling them to become involved in real-world leadership activities.
For example, two nurses in the program worked together to develop a prostate cancer screening initiative in partnership with the community service group 100 Black Men of New Jersey. According to the federal Office of Minority Health, the prostate cancer death rate for African-American men is more than twice that of white men.
Another MNLI participant designed a project to improve access to prenatal care for homeless women. Other nurses’ projects have run the gamut from teaching senior citizens how to manage chronic illnesses, such as diabetes, to raising Asian-American college students’ awareness about dating violence and sexual assault.
For her project, Samuel decided she wanted to increase public awareness about hepatitis C, a disease on the rise in her community. She held a workshop for students and parents at Grove Street Elementary School in Irvington, N.J. About 30 people attended and learned about hepatitis risk factors, prevention and testing. The event was so successful that the local newspaper wrote about it, giving the topic even wider community exposure.
Teresa Sewall Philogene focused on diabetes and hypertension, diseases that are disturbingly prevalent in her Caribbean culture and have touched her personally. “High blood pressure and diabetes unfortunately run in my family, so these problems are in the forefront of my mind,” she explains.
In collaboration with three African-American congregations in her community, Philogene created a program to educate people about the risk factors and how to prevent these illnesses through diet and exercise. “This gives me a chance to get back to my roots,” she emphasizes.
The Fellows’ mentors help guide them as they plan and carry out their community
projects. Samuel feels that the support she received from her mentor, Yvonne Wesley, was priceless. “She was immediately excited [about my topic]. She gave me tips on preparing information packets, who to talk to, how to advertise. She even came to the hepatitis workshop and brought colleagues with her.”
Samuel adds that she found more than a mentor in Wesley–she found a friend. “We’ve bonded significantly,” she says. “We just clicked.”
Wesley, in turn, enjoys the role of supporting future leader like Samuel, who already have the drive and vision for where they want to go. “I wouldn’t have gotten to where I am in my own career without the support of mentors who showed me the way,” she remembers. “Now, as a mentor myself, I get a sense of giving back.”
For More Information
Although many of the participants in the Rutgers University College of Nursing’s Minority Nurse Leadership Institute (MNLI) are recruited by the program, nurses of color who have demonstrated strong potential for leadership ability can also apply for MNLI Fellowships. Applicants must be racial or ethnic minority RNs and should live within easy traveling distance of the Rutgers campus in New Jersey so they can attend monthly workshops and meet with their assigned mentors.
Tuition for the nine-month program is currently $500, with discounts available to members of minority nursing associations and other nursing professional organizations. Scholarships and other forms of financial aid are available. Keep in mind, though, that admission to the program is highly competitive—the MNLI is limited to a maximum of 25 nurses per year.
For more information, visit the Web site http://nursing.rutgers.edu or contact:
Deborah Walker McCall, RN, MBA
Director, Educational Opportunity Fund
Project Director, MNLI
Rutgers College of Nursing, EOF
Conklin Hall, Suite 226
175 University Avenue
Newark, NJ 07102
(973) 353-5326, ext. 523
Fax (973) 353-1495 [email protected]
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