A framework for addressing disparities in cardiovascular health

Health disparities are pervasive in the United States. Life expectancy remains higher in women than in men and higher in whites than in blacks by approximately 5 years. In general, the health of racial and ethnic minorities, poor and uneducated people, and those without health insurance is worse than the health of the overall population. The care of these vulnerable groups tends to be of worse overall quality because they have trouble accessing the system, because standards of care are applied to them unevenly, and because health professionals are not consistently trained in culturally sensitive approaches. These disparities have been demonstrated in all aspects of health and healthcare for cardiovascular diseases, including the use of diagnostic and therapeutic interventions, prevalence of cardiovascular risk factors, and access to health information. Examination of national surveys revealed disparities in all cardiovascular disease risk factors, hospitalizations for major cardiovascular disease, overall mortality, and quality of life. Eliminating these disparities is a major public health challenge in the United States. Their causes and underlying mechanisms, however, remain incompletely understood. The healthcare delivery system itself, access to care, quality of care received, communication barriers, individual behaviors, culture and lifestyles, and discrimination and bias all play a part. The pursuit of systems and policy changes to address these determinants remains crucial. We present a strategic framework for eliminating health disparities that takes these determinants into account and provides an opportunity for cardiovascular nurses to make an impact on this important issue.     

Using the Internet for patient education

The Internet, especially the World Wide Web, has a wealth of health-related information easily accessible to patients and families. Commercial health-related Internet sites offer the "3 C's: content, commerce, and connectivity. Many are quickly adding the 4th "C": communication. A growing concern among health care professionals is the quality and the seemingly overabundance of patient education information available on the Internet. Certainly it is possible for nurses to use the Internet for patient education, but new skills and knowledge are needed by nurses who incorporate this technology into their practice. This article will briefly review the evolution of patient education on the Internet, provide a brief review of the Joint Commission on Accreditation for Healthcare Organizations (JCAHO) Patient and Family Education Standards, and offer guidelines for nurses who choose to enhance their patient education efforts by using resources readily available on the Internet.     

Evidence-based practice guidelines--one way to enhance clinical practice

Abdominoplasty and liposuction guidelines are just two of the guidelines that can be accessed and used to enhance patient care. Guidelines also can be used to increase your knowledge about many other health care topics. The NGC has approved guidelines for managing chronic pain, as well as guidelines on chronic diseases (e.g., diabetes mellitus, hypertension, chronic obstructive pulmonary disease). Many patients have chronic diseases, and you or your family members also may be affected by chronic disorders. These guidelines provide you with a quick overview of evidence-based treatment protocols. These guidelines are not a panacea for evidence-based practice, but using them is one way that perioperative nurses can enhance their clinical skills. Though not everyone has personal Internet access, most health care facilities do or can make access a reality. Other options include medical or public libraries. Then one simply has to access the NGC web site and join other professionals in improving the quality and timeliness of patient care.     

E‐Health: How to Make the Right Choice

TOPIC. The online health promotion phenomenon is a pivotal movement toward consumer empowerment. The challenges for the 21st century are to create meaningful, accurate online health communication interventions that successfully change behavior and improve health. PURPOSE. The Internet is a valuable tool for health promotion, self‐care tools, and decision aids components for a high‐quality care. The nurse educator ensures e‐health sites used meet the criteria for achieving optimal wellness for the consumer. SOURCES. Published literature. CONCLUSIONS. It is crucial for nurses to use reputable e‐health sites for consumer engagement and education. Researchers and practitioners are exploring the phenomenon of e‐health to gain a better understanding of how to engage these consumers in health behavioral change programs.     

Mental disorders and syndromes found among Asians residing in the United States

The Asian population in the United States is the fastest growing minority; consequently it behooves psychiatric nurses and other mental health professionals to be aware of symptom presentation of emotional problems that may differ from those of other population groups. Specific syndromes, psychiatric disorders, and symptoms that commonly present as physical disorders are discussed. Recommended adaptations of psychiatric interventions, including medications and other therapies, are offered to enable mental health professionals to provide culturally sensitive care. Mental health care that is culturally competent may improve access to care for Asians residing in the United States.     

Information technology training in primary care: the nurses' voice

Information technology (IT) is now essential to the development and delivery of health services. Healthcare professionals, including nurses, need appropriate educational training to enable them to use IT adequately because care is shared within multiprofessional teams in both hospitals and the community. In particular, primary care nurses have had less access than other health professionals to IT training and fewer opportunities to benefit from IT. Furthermore, there is little evidence in the literature on the current situation of IT training needs and requirements for primary care nurses. The PRACTIS (PRimary care nurses Access to Communications Technology and Informatics Skills) UK-based project has addressed these issues through an empirical investigation to establish a picture of the current primary care situation. This was done using a questionnaire, followed by practicing nurse focus groups. Directions for further work in the IT training of primary care nurses are discussed, together with recommendations to investigate the effect that the organization of the work within primary care groups may have on nurses' use and access to communications technology and informatics skills.     

Use of content management systems to address nursing workflow

Nurses are at the forefront of providing healthcare services to individuals of all age groups and with varying medical conditions. Aside from the critical knowledge and technical skills from nursing science, advancement in technology has assisted nurses in delivering quality nursing care by streamlining workflow processes and ensuring that data can easily be retrieved or modified. Electronic health records dramatically changed the landscape of the healthcare practice by providing an electronic means to store data and for healthcare professionals to retrieve and manipulate health information in a secured and collaborative environment. But with the nature of data being stored in the electronic health records, nurses still need to organize and process these data into relevant information, knowledge or wisdom so they can provide better holistic care to patients. This discussion paper details the role of content management systems in addressing nursing workflow by providing a mechanism for nurses to be developers themselves, and not just users or consumers of health innovative technologies. By using content management systems as platform for application development, nurses or other healthcare professionals, may be able to address problems with internal workflow without having to incur huge amounts in software development, or having to extensively learn programming languages.     

Use of the Internet by patients: not a threat to nursing, but an opportunity?

The Internet poses numerous challenges for health care professionals. A significant one is the way in which patients, clients and carers now have access to large amounts of unfiltered, specialized health information, much of which was, hitherto, solely the province of the professionals. The specific problems that this poses, in terms of the effect that it might have on the therapeutic relationship, are discussed, along with some of the proposed solutions, such as the National Electronic Library for Health initiative and NHS Direct Online. Since this change is inevitable, it is recommended that nurses should seek to build on their role as educators of patients and carers. One of the ways in which they can do this is by guiding patients' and carers' use of the Internet, and helping them to evaluate the information that they find.     

The nurse's role in improving health disparities experienced by the indigenous Māori of New Zealand

Many countries across the globe experience disparities in health between their indigenous and non-indigenous people. The indigenous Māori of New Zealand are the most marginalized and deprived ethnic group with the poorest health status overall. Factors including the historical British colonization, institutional discrimination, healthcare workforce bias and the personal attitudes and beliefs of Māori significantly contribute to disparities, differential access and receipt of quality health services. Māori experience more barriers towards accessing health services and as a result achieve poorer health outcomes. Contradicting translations of Te Tiriti o Waitangi have created much debate regarding social rights as interpreted by Oritetanga (equal British citizenship rights) and whether or not Māori are entitled to equal opportunities or equal outcomes. Inconsistent consideration of Māori culture in the New Zealand health system and social policy greatly contributes to the current health disparities. Nurses and healthcare professionals alike have the gifted opportunity to truly change attitudes toward Māori health and move forward in adopting culturally appropriate care practices. More specifically the nursing workforce provides 80% of direct patient care, thus are in a unique position to be the forefront of change in reducing health disparities experienced by Māori. Incorporating cultural safety, patient advocacy, and Māori-centred models of care will support nurses in adopting a new approach toward improving Māori health outcomes overall.     

The use of the Internet and information technology to facilitate teaching evidence based practice – a case study

The use of Internet and information technology for teaching nurses and other health professionals has been shown to improve learning outcomes, learners' satisfaction and the learner-learner and learner-teacher interactions. Two recent government white pa pers emphasised the central role of evidence based practice as the key component for nurses to deliver quality care to their patients, and basic IT and Internet competencies are also essential for evidence based practice.This paper reports the experience of the introduction of a dedicated web site, the Internet and information technology to augment a face-to-face Master's unit in evidence based practice. The main objective of the unit is to enable students to apply the principles of evidence based practice to their daily professional practice. The organisation of this module and the ways these new technologies were exploited are described. A brief evaluation of this module is presented: the unit was reasonably well received by the students. The practical difficulties of introducing such technologies by individual tutors and ensuring that students have adequate access to computers are discussed.     

Genetic resources: an annotated bibliography of internet and other resources

The Internet has caused a major boom in the field of genetics. Internet use among the public and health care professionals continues to rise, but caution must be exercised when searching for information. This article presents some guidelines for determining good web sites, then follows with a compilation of Internet and other relevant genetics resources.     

Barriers to Culturally Competent Human Immunodeficiency Virus Care Among the Black,Indigenous, and People of Color Community

Black, Indigenous, and people of color (BIPOC) are at a higher risk for human immunodeficiency virus (HIV) infection and face unique challenges in the United States health care system. Health care providers can understand the barriers to care for at-risk groups and identify interventions to improve health outcomes. Demographic, social, and economic factors all play a role in the health disparities regarding the HIV infection rate in these at-risk populations. There are many challenges in establishing early diagnosis of HIV infection and linking newly diagnosed people living with HIV (PLWH) to evidence-based care. Systemic barriers include a lack of access to testing resources, a lack of primary care provider training in HIV testing and counseling, and a delay of linkage to care of newly diagnosed PLWH to treatment. Delayed initiation of HIV treatment can increase morbidity and mortality and perpetuate HIV transmission. Consistent use of pre-exposure prophylaxis (PrEP) has proven to decrease the incidence of HIV transmission while maintaining a low side effect profile; however, PrEP usage among the BIPOC population is low, increasing the risk of HIV seroconversion. Increased testing, PrEP utilization, and linkage to care for PLWH promote viral suppression, reducing HIV transmission. Specific population-based interventions for prevention, testing, and treatment can encourage providers to empower patients to seek and remain in care. By decreasing racial disparities in the delivery of care, providers can help achieve viral suppression, improving the overall health outcomes among BIPOC communities.     

Mental Health Nurse Incentive Program: Facilitating physical health care for people with mental illness?

People with serious mental illness have increased rates of physical ill‐health and reduced contact with primary care services. In Australia, the Mental Health Nurse Incentive Program (MHNIP) was developed to facilitate access to mental health services. However, as a primary care service, the contribution to physical health care is worthy of consideration. Thirty‐eight nurses who were part of the MHNIP participated in a national survey of nurses working in mental health about physical health care. The survey invited nurses to report their views on the physical health of consumers and the regularity of physical health care they provide. Physical health‐care provision in collaboration with general practitioners (GPs) and other health‐care professionals was reported as common. The findings suggest that the MHNIP provides integrated care, where nurses and GPs work in collaboration, allowing enough time to discuss physical health or share physical health activities. Consumers of this service appeared to have good access to physical and mental health services, and nurses had access to primary care professionals to discuss consumers’ physical health and develop their clinical skills in the physical domain. The MHNIP has an important role in addressing physical health concerns, in addition to the mental health issues of people accessing this service.     

State of evaluation: community health workers

Disparity groups, especially racial and ethnic minority groups, are at greater risk for poor health yet experience numerous obstacles in accessing health care. Community health workers (CHWs) are indigenous, trusted, and respected members of the underserved community. They can serve as a bridge between peers and health professionals. Use of CHWs has fluctuated since the federal government first endorsed their use for expanded health access to the underserved in the 1960s. National demands to eliminate health disparities and recent socioeconomic pressures have focused attention on use of CHWs to improve community health. Still, underutilization exists due to, in part, a lack of understanding of the CHW concept and a dearth of evaluation literature on CHWs. This article describes the CHW concept, provides a summary of CHW evaluation literature, and suggests quality care indicators to strengthen evaluation. The review of evaluation research relating to CHWs provides a preliminary state of the science for nurses to begin building an evidence-based practice. Quality of care indicators pertinent to CHW are summarized from the existing evaluation literature. The three best practice domains (therapeutic alliance, risk reduction and health care utilization) are proposed along with suggestions for using quality indicators to improve evaluation. A reduction in health disparities can occur with enhanced CHW utilization.     

Evaluating web sites: reliable child health resources for parents

This article describes a framework for evaluating the quality of health care information on the Internet and identifies strategies for accessing reliable child health resources. A number of methods are reviewed, including how to evaluate Web sites for quality using the Health Information Technology Institute evaluation criteria, how to identify trustworthy Web sites accredited by Health On the Net Foundation Code of Conduct, and the use of portals to access prescreened Web sites by organizations, such as the Medical Library Association. Pediatric nurses can use one or all of these strategies to develop a list of reliable Web sites as a supplement to patient and family teaching.     

Why isn't evidence based practice improving health care for minorities in the United States?

Achieving health equity by improving the health care of all racial/ethnic groups is one of the key goals of Healthy People 2020. The implementation of evidence based practice (EBP) has been a major recommendation to achieve health equity in hopes of eliminating the subjectivity of clinical decision making. However, health disparities among racial/ethnic minorities are persistent in spite of the adoption of standardized care based on evidence.The EBP with racial and ethnic minorities is often seen as a possible cause of health and health care disparities. Three potential issues of using EBP to reduce health disparities have been identified: (1) a lack of data for EBP with ethnic/racial minority populations; (2) limited research on the generalizability of the evidence based on a European-American middle-class; and (3) sociocultural considerations in the context of EBP. Using EBP to reduce disparities in health care and health outcomes requires that nurse professionals should know how to use relevant evidence in a particular situation as well as to generate knowledge and theory which is relevant to racial/ethnic minorities. In addition, EBP implementation should be contextualized within the sociocultural environments in which patients are treated rather than solely focusing on the health problems.     

Neonatal nursing and the genetics revolution!

Discoveries from the Human Genome Project are having a significant impact on the way we look at genetic makeup, health, and disease. As a result of this new knowledge, changes will be made in how diseases are treated and how nurses work with patients and their families. The National Coalition for Health Professionals Education in Genetics was formed to strengthen baseline knowledge in genetics of nurses and other health professionals. For neonatal nurses, this is an extremely important area that will become more and more critical to care as genetics knowledge continues to rapidly expand. Neonatal nurses must be knowledgeable about genetics, genetic testing, and the use and possible misuse of genetic information. This article describes the impact of genetics on neonatal care.