Health Disparities and Public Health: Addressing Inequities in Community Health Care, Exams of Nursing

Download Health Disparities and Public Health: Addressing Inequities in Community Health Care and more Exams Nursing in PDF only on Docsity! 1 Week 1: Discussion - Exercise and Discussion Questions from Curley Text Book 50 50 unread replies. 75 75 replies. Go to the end of Chapter 2: Identifying Outcomes, in your Curley course text. Under "Exercises and Discussion Questions" select Exercise 2.5 OR 2.6 and respond in a minimum of two (2) paragraphs of 4-5 sentences each. You should address each bullet point in the exercise you select. Your work should have in-text citations integrating at a minimum one scholarly article from this week's readings and course textbook. APA format should be utilized to include a reference list. Correct grammar, spelling, and APA should be adhered to when writing, work should be scholarly without personalization or first person use. Exercise 2.5 Diabetes affects a growing number of Americans. You have been invited to join a collaborative of community agencies interested in tackling diabetes from a community perspective. What resources will you use to identify different outcomes related to diabetes? What outcomes related to diabetes are of most interest to community members? How will you compare the outcomes you select to monitor at the local level with state and national outcomes? Exercise 2.6 APRNs should not only recognize but also make it part of their practice to develop strategies to reduce or eliminate health disparities. Review information from Healthy People 2020 and the CDC Office of Minority Health and Health Disparities websites. What health disparities can you find that are relevant to your community? How can you better advocate for minority groups who have poorer health outcomes? What specific objectives in Healthy People 2020 can help this effort? Review the following for integration into your writing/responses: https://campaignforaction.org/issue/fostering-interprofessional-collaboration/ (Links to an external site.)Links to an external site. 2 Threaded Discussion Rubric can be found in Course Resources 5 can implement population care which extends to the community at large thereby advocating for the community at large. Reference Progress in disease prevention, health promotion. (2014). American Nurse, 46(4), 16. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx? direct=true&db=ccm&AN=103909733&site=eds-live&scope=site (Links to an external site.)Links to an external site. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions- resources/access-to-health (Links to an external site.)Links to an external site. 6 Reply Reply to Comment Collapse SubdiscussionANAHI MUNOZ ANAHI MUNOZ Jan 8, 2019 Jan 8 at 7:08am 7 George, Great post! As you well mentioned it was ingrained in us that advocacy, particularly patient advocacy, is one of our most important nursing duties. In that role, the nurse protects the client’s human and legal rights and provides assistance in asserting those rights if the need arises. Advocacy may include, for example, providing additional information for a patient who is trying to decide whether or not to accept a treatment. Keep up the good work! Dr. Munoz Reply Reply to Comment Collapse SubdiscussionLaura Bernal Laura Bernal Jan 11, 2019 Jan 11 at 2:44pm Hello George and Dr. Munoz, I really enjoyed reading your post, it was very informative and interesting. Advocacy represents us as nurses and future ARNP. You also came up with great ideas to reach a population that don’t have easy access to healthcare. Dental hygiene is a health disparity that definitely needs to be address, unfortunately most of the people tent to ignored dental hygiene do to the high costs and difficult access. Just to afford a dental cleaning can cost over two hundred dollars, making it very hard for people that get paid the minimum wage. What many people are not aware of is that having inadequate dental hygiene can lead to worsening the chronic illness like cardiovascular diseases. Not being able to see a dentist can be related to a range of health problems. Periodontal disease (gum infection) is associated with an increased risk of cancer and cardiovascular diseases. There is also a causal explanation for how oral health issues can lead to or worsen other illnesses. Bacteria originating in oral infections can circulate elsewhere, contributing to heart disease and strokes. Reference Fried. (2017). Preparing the Future Dental Hygiene Workforce: Knowledge, Skills, and Reform. doi:10.21815/JDE.017.032 10 Collapse SubdiscussionGeorge Davis George Davis Jan 12, 2019 Jan 12 at 6:19pm Dr. Munoz and class, the tools to implement advocacy and develop a plan can be drawn from established concepts. One such example is to use the Donabedian Model. This concept is a way to understand and implement quality care measures. According to Ayanian & Markel (2016), Donabedian “defined “structure” as the settings, qualifications of providers, and administrative systems through which care 11 takes place; “process” as the components of care delivered; and “outcome” as recovery, restoration of function, and survival. These concepts remain the foundation of quality assessment today” (para, 5). As an important advocacy tool this model is an example of how processes can be improved with defined parameters for success. Another important concept that Donabedian looked to enhance was the use of metrics to measure these quality outcomes. “He highlighted the importance of representative samples and clear measurement standards… valid measures of structure and process that could be linked to outcomes and for reliable measures of quality that were readily reproducible” (Ayanian & Markel, (2016, para,6). The field of epidemiology in healthcare, has embraced the Donabedian model to implement quality improvement to patient care through measured outcomes and increase standards of care. Thanks, George Reference Ayanian, J. Z., & Markel, H. (2016). Donabedian’s Lasting Framework for Health Care Quality. The New England Journal of Medicine, 375(3), 205–207. https://doi- org.chamberlainuniversity.idm.oclc.org/10.1056/NEJMp1605101 Reply Reply to Comment Collapse SubdiscussionDeniece Dowleyne Deniece Dowleyne Jan 9, 2019 Jan 9 at 5:37pm Hi George, 12 I am glad to have read that you included immunizations as a health disparity. I work in the emergency department (ED) and part of our triage assessment includes asking if minors under the age of 18 are up to date on childhood immunizations. There has been an increase in reports by parents with children seen in the ED that report their children not receiving immunizations. Healthy people 2020 objectives target high vaccinations coverage among children (Varan et. al., 2017). There are many barriers to why parents 15 Reference Sevin, A. M., Romeo, C., Gagne, B., Brown, N. V., & Rodis, J. L. (2016). Factors influencing adults’ immunization practices: a pilot survey study of a diverse, urban community in central Ohio. BMC Public Health, 16(1), 1–8. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1186/s12889-016-3107-9 Reply Reply to Comment Collapse SubdiscussionGeorge Davis George Davis Jan 10, 2019 Jan 10 at 6:25pm Hello Deniece, thanks for your comments on my post! Immunizations are an important prevention tool to fight illness. The health disparities within disadvantaged communities contribute to uncommon illnesses of days gone by rearing their ugly head back such as measles and even influenza. The responsibility to head off epidemic lies with policy makers and healthcare providers who can influence policy to provide the needed services to those lacking. According to Sevin, et. al (2016), “to some studies have demonstrated racial disparities in vaccine uptake even when adjusting for traditional confounders such as insurance coverage, income, access to care, education, and chronic disease burden” (p. 1). It is an important issue which needs to be addressed to find the inequities which may create these disparities. To find answers we get into the communities and get involved in the lives of people to bridge those gaps which can be filled and create outreach at the local level which can make a difference. One 16 way may beto go into community centers and give immunizations and education to address concerns and to allay fears. Thanks, George 17 Reference Sevin, A. M., Romeo, C., Gagne, B., Brown, N. V., & Rodis, J. L. (2016). Factors influencing adults’ immunization practices: a pilot survey study of a diverse, urban community in central Ohio. BMC Public Health, 16(1), 1–8. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1186/s12889-016-3107-9 Reply Reply to Comment Collapse SubdiscussionAmanda Eason Amanda Eason Jan 11, 2019 Jan 11 at 4:23pm George, As I read your post I couldn’t agree more that access to care is a growing crisis facing millions of Americans. Developing outreach programs to bring health care to patients who would otherwise be unable to obtain health care services has been well documented as an opportunity to improve the health of our communities. As promising as this strategy is for attaining a number of the Healthy People 2020 goals, the rapidly declining pool of qualified health care providers may be an obstacle that needs to addressed before proceeding. 20 greatest benefit and impact on public health (CDC, 2015). Education through application of validated research and evidence-based practice credits the information to the appropriate targeted audience and insures reception of discussed topic leading to retention and ultimately application. Prevention not only 21 affects the individuals being directly involved but extends into the community by reducing resources and allocating them to areas requiring immediate attention. Reference CDC. (2015). Retrieved from https://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_preventi (Links to an external site.)Links to an external site. Reply Reply to Comment Collapse SubdiscussionEmily Duani Emily Duani Jan 7, 2019 Jan 7 at 5:52pm Hello Prof Munoz and class: Healthy People 2020 covers about 42 health related topics that affects public health. Center for Disease Control and Prevention (CDC) is a website based informational resources for the public on achieving and promoting health. Both are great website and resources for the general population to obtain information, data analysis and statistics to recognize current health problems. The websites also assist to improve quality of care and promote evidenced-based practice in healthier behaviors across the lifespan. 22 Health care disparities are deplorable, and emerging of public health is needed to eliminate healthcare disparities (Curley & Vitale, 2016 p. 13). The health disparities I found in my community is cancer. Cancer is the second leading cause of death in United States of America. According to CDC (2018), fear of cancer, 25 Reply Reply to Comment Collapse SubdiscussionANAHI MUNOZ ANAHI MUNOZ Jan 8, 2019 Jan 8 at 7:33am Emily, Inequities are created when barriers prevent individuals and communities from accessing the opportunity to attain their highest level of health and reaching their full potential. Inequities differ from health disparities, which are differences in health status between people related to social or demographic factors such as race, gender, income or geographic region. Health disparities are one way we can measure our progress toward achieving health equity. Great work! Keep it up! Dr. Munoz Reply Reply to Comment Collapse SubdiscussionLaura Bernal Laura Bernal Jan 9, 2019 Jan 9 at 1:57pm Hello Emily, Very interesting post. I completely agree with you about the importance of early screening, yearly pap smears, and modifiable risk factors to decrease cancer in our society. Education to our patients is essential to help them understand the importance of yearly examinations and follow up appointments. I think it’s a great idea to work on health promotion in community events such as the local 5k run. I live in 26 South Florida and work in a Hospital called Baptist, in every marathon and community event, Baptist has a tent were they have nurses and volunteers working on health promotion. These are great events 27 where participants and family members have the opportunity to ask questions and be educated on certain health topics. According to healthy people 2020 (n.d) Increase the quality, availability, and effectiveness of educational and community-based programs designed to prevent disease and injury, improve health, and enhance quality of life. Using nontraditional settings can help encourage informal information sharing within communities through peer social interaction. Reaching out to people in different settings also allows for greater tailoring of health information and education. Reference Healthy People 2020. (n.d.). Disparities. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities (Links to an external site.)Links to an external site. (Links to an external site.)Links to an external site. Reply Reply to Comment Collapse SubdiscussionBrandi Wethington Brandi Wethington Jan 11, 2019 Jan 11 at 10:15am Emily, Great post! When I was doing my research to answer the original post, I was flabbergasted to find out that with diabetes cancer rates increase for liver, pancreas, uterus, colon, breast, and bladder (American Diabetes Association, 2017). According to HealthyPeople.gov website (n.d.), diabetes is the seventh leading cause of death in the United States. What we do know is that in many cases diabetes can be controlled with proper nutrition and exercise which will maximize one’s health and improve outcomes and other acute and chronic illnesses, such as cancer. I worked in hospice care for five years and cancer was one of our most common admissions. Congestive heart failure, chronic obstructive pulmonary disease, liver failure, kidney failure and dementia being the other common admission diagnoses. Many times, the person had just found out they had cancer and it was stage four. It made me think, why? Why were people being diagnosed so late? I can tell you that most people were receiving regular preventative and primary care. Many had minimal symptoms that went unrecognized as normal signs of aging. As future advanced practice nurses, we need to ensure that we do not negate a patient’s 30 American Diabetes Association. (2017). http://diabetes.org/are-you-at-risk/lower-your-risk/diabetes- and-cancer.html (Links to an external site.)Links to an external site. HealthyPeople.gov website. (n.d.). https://www.healthypeople.gov/2020/topics- objectives/topic/diabetes 31 Reply Reply to Comment (1 like) Collapse SubdiscussionAmanda Eason Amanda Eason Jan 12, 2019 Jan 12 at 10:23am Emily, I’m not sure if you are targeting one particular type of cancer but I will specifically address your comments regarding smoking cessation. As we all know, smoking has been linked to numerous health diseases, including cancer. Numerous public awareness efforts over the past several decades have shown to have positive results in reducing the incidence of cigarette smoking. According to the Centers for Disease Control and Prevention (CDC), the number of adult cigarette smokers has decreased by 67% since 1965 (CDC, 2018). In the state of Florida, adults seeking assistance with smoking cessation can utilize a free public service program, “Tobacco Free Free” that offers free nicotine replacement patches, and several options for receiving emotional support during withdrawal periods. Unfortunately, as a cardiac ICU nurse many of my patients have modifiable risk factors contributing to their heart disease, including smoking. When offered information about this program during their hospitalization, I am sad to see many of my patients refuse the assistance. It becomes very discouraging to care for these patients when they won’t even take steps to care for themselves; however, as you stated in your post, we have a professional and ethical responsibility to continue educating our patients about personal health promotion. Obviously the decision to quit smoking is a personal decision one must make for themselves, but I believe we can make a difference by identifying new and unique opportunties to promote smoking cessation and educate our communities about the detrimental effects cigarette smoking has to their general health. References: Centers for Disease Control and Prevention (CDC), (2018). Tobacco use among adults - United States, 2017. Morbidity and Mortality Weekly, 67(44), 1225-1232. Reply Reply to Comment 32 Collapse SubdiscussionMaria Sequeira Maria Sequeira 35 any help and they're not able to pay the cost of living plus insurance so he finds himself very sick because the insulin he needs is very expensive, He told me that he used our case managers advice to try and seek help and it has not been able to work, but they were working on trying to help him. It's unfortunate that we see this happen. Reply Reply to Comment Collapse SubdiscussionJonathan Padron Jonathan Padron Jan 13, 2019 Jan 13 at 3:57pm Emily, I agree with your post discussing the importance of prevention concerning cancer in the community. Through earlier recognition of the disease, appropriate treatment can be initiated with an improved success rate of morbidity and cure. Lack of education and resources limit the accessibility of early detection and screening. The advance nurse practitioner has the responsibility to advocate for the community and promote health prevention through education. Demonstration of risk factors associated to cancer as mention in your post is an example of such health promotion and prevention. Development of specific care plans and strategies are advantageous tactics for the advance nurse practice to utilize in order to target issues affecting certain populations. In order to act as a reference and foundation for the nurse's approach, community health nursing theory addresses collective concepts of nursing domains in an attempt to rectify environmental, resiliency, and community abilities for healthcare issues among diverse population and avoids simple groupings of aggregates (Fooladi, 2015). Reference Fooladi, M. (2015). The Role of Nurses in Community Awareness and Preventive Health. Int J Community Based Nurs Midwifery, 3(4). Retrieved from 36 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591566/ 37 Reply Reply to Comment Collapse SubdiscussionShari Smith Shari Smith Jan 8, 2019 Jan 8 at 4:47pm Prof Munoz and classmates, According to this week’s lesson, Healthy People 2020 is one of the most helpful documents for discerning individual and population risk factors and health indicators that can be impacted through the three levels of prevention. After reviewing Healthy People 2020, two issues that I have identified that are relative to my community is Diabetes and Heart disease and stroke. Most hospitals are promoting Patient and Family centered care and because of this, patients and their families are becoming more hands on with their care this will help when the ARNP has to educate patients on ways to minimize and or prevent these diseases. This week’s lesson states that, there is a clear and compelling need for APNs to foster, promote, and educate individuals and populations through application of epidemiological data that informs the APN's actions and plans of care with high-risk and vulnerable populations across the life span. As it relates to minority groups who have poorer health outcomes, as an ARNP, I would advocate for them by providing the education they need to maintain their disease. Healthy People 2020 states that people from minority populations are more likely to be affected by type 2 diabetes. By educating my patients, they are equipped with the tools they need to manage this disease. Lifestyle changes can also be used to advocate for patients, for example developing a realistic meal and exercise program. The objective that can help this effort is D-16 Increase prevention behaviors in persons at high risk for diabetes with prediabetes. When it comes to heart disease and stroke, I would advocate for my patients by helping them with diet modifications, an exercise program and methods on how to control their blood pressure, all these would help in reducing their chances of developing and dying from heart disease and stroke. The objective that can help this effort is HDS-1 (Developmental) Increase overall cardiovascular health in the US population. 40 Thank you, Emily Duani Reference: Akohoue, S. A., Patel, K., Adkerson, L. L., Rothman, R. L., (2015). Patients’, caregivers’, and providers’ perceived strategies for diabetes care. AM J Health Behav. 39 (9), 433-440. Reply Reply to Comment Collapse SubdiscussionANAHI MUNOZ ANAHI MUNOZ Jan 9, 2019 Jan 9 at 1:20pm Shari, Great post! As you well mentioned, a population-based approach is essential if we are to fully understand the frequency of symptoms and illnesses occurring in society, and how people respond to them. Epidemiological studies that examine the occurrence of, or risk factors associated with, disease in selected groups, such as hospital-based cohorts, provide useful information about the prevention or management of disease in the same populations but may provide misleading information about its management in the general primary care population where the incidence and prevalence is often lower. Keep up the great work! Dr.Munoz 41 Reply Reply to Comment Collapse SubdiscussionShari Smith 42 Shari Smith Jan 9, 2019 Jan 9 at 7:37pm Dr Munoz, You are correct, the information can be misleading to the general population. The more we educate our patients the better they will manage their symptoms and hopefully will be able to educate their family and friends who also make up the general population. Shari Reply Reply to Comment Collapse SubdiscussionLaura Bernal Laura Bernal Jan 10, 2019 Jan 10 at 6:25pm Hello Shari, Very interesting and informative post. I completely agree with you on the importance of patient education because is not only to prevent but to manage these chronic diseases. Patients need to understand that for this three health disparities that you mention (Diabetes, heart disease and stroke) prevention and treatment is very similar. Patients need to work on a healthier diet, routine exercise, smoking cessation and medication compliance. Unfortunately minorities have minimal or no access to health care which makes it very difficult to understand the importance of taking care of their wellbeing and learn how to live a healthier life. As future APRN we all need to advocate for our patients and focus in patient education. Improving education in the population is the major component to help reduce these preventable health disparities. Education is critical to social and economic development and has a profound impact on population health. The health benefits of education accrue at the individual level (e.g., skill development and access 45 Laursen, D. H., Christensen, K. B., Christensen, U., & Frølich, A. (2017). Assessment of short and long- term outcomes of diabetes patient education using the health education impact questionnaire (HeiQ). BMC Research Notes, 10(1), 213. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1186/s13104- 017-2536-6 Reply Reply to Comment Collapse SubdiscussionDeniece Dowleyne Deniece Dowleyne Jan 8, 2019 Jan 8 at 5:24pm Good evening Professor and class, As advanced practice nurses we will have the duty to protect our communities and its populations. In order to do so we must explore our personal feelings and reason on entering such a profession that focuses on the health and well being of others. The health care industry serves a diverse population of individuals. Advanced practice nurses should possess cultural knowledge on different populations to provide care. Entering in to this career field, one should have the desire to help others in their community have access to quality health care. Some populations are categorized under health disparities. According to Healthy People 2020 (n.d.), they define health disparities as a certain health difference that is associated with social, economic, and/or environmental disadvantage. Religion, socioeconomic status; gender; age; mental health; physical disability and sexual orientation to name a few, are linked with health disparities. Health disparities I have identified that are relevant in my community is care for individuals in the lesbian, gay, bisexual and transgender (LGBT) community and mental health community. Health care providers have the obligation to ensure obtaining a thorough health history including mental health and sexual orientation to better serve the patient. This is pertinent information that some individuals unless asked may be reluctant to share. Having an open, nonjudgmental approach towards all populations of people can build rapport and decrease barriers to trust. To better advocate for minority groups who have poorer health outcomes it will take as some would say a village. Or in our time, a community. A community-driven approach is vital to address health disparities and accomplish equality in quality of care among vulnerable populations (Wei-Chen Lee, Hani Serag & Lancaster, 2018). 46 Healthy People 2020 have identified new topics and objectives for the adolescent health, older adults and LGBT health. I have identified individuals with mental health disorders as a health disparity due to 47 the lack of resources for there individuals in my community. We have one mental health facility that serves all of Brevard county for inpatient treatment and only one hospital that only accepts individuals with insurance. For the LGBT community, I have identified to be subjected to health disparities due to the lack of screening and knowledge on the personal health concerns for this population. For the LGBT community, Healthy People 2020 (n.d.) have objective to identify individuals that identify as LGBT on health screenings and surveys. For individuals with mental health disorders Healthy People 2020 (n.d.) have focus objectives to increase the proportion of adults with mental health disorders who receive treatment and increase depression screening by primary care providers. According to the campaign for action (n.d.) website, a collaborative effort between healthcare professionals is essential in promoting improved patient outcomes in the community. Utilizing this site as a resource can aid advanced practice nursing on finding and joining coalitions that seek to better care and address health disparities. References: Campaign for Action. (n.d.). Fostering interprofessional collaboration. Retrieved from https://campaignforaction.org/issue/fostering-interprofessional-collaboration/ (Links to an external site.)Links to an external site. Healthy People 2020. (n.d.). Disparities. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities (Links to an external site.)Links to an external site. Wei-Chen Lee, Hani Serag, & Lancaster, D. (2018). Challenges to Address Health Disparities by Using Community Health Workers and Promotores (CHW/Ps) in Galveston County. Texas Public Health Journal, 70(4), 13–16. Retrieved from https://chamberlainuniversity.idm.oclc.org/login? url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=132771841&site=eds- live&scope=site (Links to an external site.)Links to an external site. 50 example, are the largest population in the United States. Hispanics or Latinos refers to a person from Puerto Rico, Cuba, Mexico, South, or Central America. Obesity and diabetes are higher in Hispanics than any other culture and with limited access to healthcare they possess a greater risk of complications. Cultural competence requires knowledge, awareness, belief, and being aware of patient’s and one’s own social cultural background (CMPA, 2014). Ethnocentrism and lack of cultural competence can hamper effective cross-cultural care (Juckett, 2005). The Health Policy Institute (2004) state that “racial and ethnic minorities have higher morbidity and mortality from chronic diseases.” The costliest medical conditions in America are cancer, diabetes, asthma, heart disease, anxiety/depression, obesity, and high blood pressure and a higher portion of African Americans and Latinos, compared to Whites, report that they have at least one of the seven chronic conditions (Healthy Policy Institute, 2004). The largest minority group is thought to be Latinos. Over the next few years, the population will become more diverse. “By 2050, racial and ethnic minorities will comprise 35 percent of the over 65 population” (Healthy Policy Institute, 2004). References: CMPA. (2014). When medicine and culture intersect. Retrieved from https://www.cmpa- (Links to an external site.)Links to an external site. acpm.ca/en/advice-publications/browse-articles/2014/when-medicine-and-culture- intersect#References Health Policy Institute. (2004). Cultural competence in healthcare: is it important for people with chronic conditions? Health Policy Institute. Georgetown University. Juckett, G. (2005). Cross-cultural medicine. American Family Physician, 72(11), 2267- 2274 51 Reply Reply to Comment Collapse SubdiscussionShamma Chery Shamma Chery 52 Jan 13, 2019 Jan 13 at 9:04pm Great point Dr Munoz , First of all, it’s important to remember that nurses have a long history of caring for underserved and vulnerable populations, and this should continue but with a focus on practices that may help to end disparities. Cultural competency can go a long way in helping minority patients overcome barriers that stand in their way of receiving excellent care, particularly for nurse case managers and oncological nurse navigators. Reply Reply to Comment Collapse SubdiscussionLaura Bernal Laura Bernal Jan 8, 2019 Jan 8 at 8:31pm Hello Dr. Munoz and Class, As future APRN we need to be involved in our community and help the population with strategies to reduce health disparities as this is an essential factor to improve population’s health. APRN can work in partnerships with community members to identify what community members see as relevant and important, build social capital, use outcome data to advocate for changes in policy, and then continue to work in partnership to identify strategies to intervene, monitor, and improve those outcomes (Curley & Vitale, 2016 p. 15). I have been working in a hospital called Baptist Hospital that is located in South Florida. The majority of the patients we see on a daily basis are Hispanics with history of obesity, diabetes and hypertension. Unfortunately, these three health issues are high disparities in my community. Most of this patient don’t understand how these disparities can lead to cardiovascular diseases that can lead to acute ischemic strokes and myocardial infarctions. Lack of education is one of the many reasons patients don’t even try to improve dietary habits, exercise daily and knowledge of medication compliance. Many times, I have asked my patients if they have any medical history, most of the times the answer is “no”. Then I ask about daily medication and they mentioned metformin and Lisinopril. These scenarios make me very sad and disappointed about the health care that is being provided to people. 55 Reply Reply to Comment Collapse SubdiscussionEmily Duani Emily Duani Jan 9, 2019 Jan 9 at 12:47pm Hello Laura, Dr. Munoz and class: Great post! I agree with you that APRN must be involved in the communities to reduce health disparately and inequality that exist in population health. We need to promote prevention and educate on modifiable behaviors to decrease health problems. I can relate to your frustration with lack of education in Hispanic population. I work in North Florida, and some patients I have encounter are Asian that does not speak English with lack of knowledge on mammogram screening. There is an inconsistency of educating patient that does not speak English at the primary care physician office because of language barrier. Many times, patients leave their office visit without fully understand or comprehend on what is going on. I think we should signs in different languages at the primary physician offices and communities center that offers interpreter service. We need to Communicate effectively without discrimination and be consistence with all patients to decrease health disparity among minority groups. 56 Thank you, Emily Duani 57 Reply Reply to Comment Collapse SubdiscussionMichelle Griffin Michelle Griffin Jan 11, 2019 Jan 11 at 8:18am Response to Laura Laura, Reading through your post and discovered that you work for Baptist in South Florida. Having been to the Baptist hospital many times in Kendall because my parents live in the Keys, and yes the Hispanic population is prevalent with a significant number of them dealing with poorly managed hypertension, obesity and diabetes. Currently, I work in Palm beach and Broward County where the health disparities are similar but in Broward it tends to be more Hispanics and African Americans. As you mentioned, many patients are unaware of exactly why they are on a certain medication to manage their diabetes or hypertension. Health literacy needs to improve and with that comes more education, reinforcement and re-educating. This is also done with a family centered approach as many conditions are seen in most members of the family. This could be related to cultural beliefs, eating habits, and activity levels seen in the family. Preventative medicine is the primary goal for most healthcare providers, but usually by the time they are with us, they are already diagnosed and dealing with a chronic condition. The next step is to continue reinforcing the importance of medication and lifestyle modifications to prevent future complications associated with their condition and lead to cardiovascular disease complications. Hypertension drives the global burden of cardiovascular disease and its prevalence is estimated to increase by 30% by the year 2025 (Diaz, et al., 2017). Hypertension is easily managed if diet and lifestyle modifications are implemented in a timely manner to further prevent the complications associated with uncontrolled and poorly managed hypertension. Reference Diaz, K. M., Booth, J. N., 3rd, Seals, S. R., Abdalla, M., Dubbert, P. M., Sims, M., Simbo, D. (2017). Physical Activity and Incident Hypertension in African Americans: The Jackson Heart Study. Hypertension (Dallas, 60 Collapse SubdiscussionLourdes Rivera Lourdes Rivera 61 Jan 8, 2019 Jan 8 at 9:54pm Hello Professor and class, As APRNs, it is our ethical duty and responsibility to advocate for our patients and our community. We absolutely must make it a part of our practice to develop strategies to identify, reduce or eliminate health disparities in our communities. As APRNs we are in a strategic position to do so. A health disparity that I can identify, relevant to my community, is that of minority women and low- income women having higher breast cancer mortality rates than Caucasian women. Early screening and detection are key for survival. Screening mammography (SM) is the single most effective method of early identification of BC and can often identify BC several years before physical signs and symptoms develop (Mennella & Holle, 2018). One way to advocate for this group is by first, arming myself with a good understanding of the cultures and their cultural barriers to screening so that I can create a strategy that is culturally sensitive, enabling greater efficacy of my evidence-based nursing intervention. One such intervention can be educating the patients about screening mammograms individually or by developing a community education program. SM program developers should create interventions that target the unique screening barriers of immigrant and minority women and individualize education to focus on the values and beliefs of a specific ethnic group (Mennella & Holle, 2018). Healthy people 2020, developed by the Department of Health and Human Services, outlines objectives for improving the health of all Americans through disease prevention and health promotion. The specific objective identified in Healthy People 2020, related to my concern, addresses the need to reduce health disparities concerning minorities and low- income population. The APRN can utilize several resources to help them in their quest to reduce health disparities. One such resource is the National Partnership for action to end Health Disparities. There is also The National Priorities Partnership, and yet another is the Office of Minority Health and Health Disparities. There are many more supportive resources that the APRN can utilize in their quest to reduce health disparities in their community. 62 Reference 65 Access to screening mammography is a fundamental determinant of the stage of breast cancer at diagnosis and can vary between persons within neighborhoods or across neighborhoods based on individual-level or area-level socioeconomic factors.Lower-income, uninsured women experience greater barriers to screening mammography due to the cost of services and a limited number of health care providers that offer free care or accept Medicaid. Access to mammography can also vary across areas because primary care providers and mammography facilities are less likely to locate in lower-income neighborhoods. The relationship between socioeconomic status and stage of breast cancer is complex.the most effective interventions to improve use of screening mammography for lower-income women may need to address barriers at both the individual-level and area-level. Reply Reply to Comment Collapse SubdiscussionShamma Chery Shamma Chery Jan 9, 2019 Jan 9 at 9:54am Health disparities are differences in health outcomes and their causes among groups of people. Reducing health disparities is a major goal of public health. As a future Family Nurse Practitioner I will be working on improving the health of all population groups, achieving health equity, eliminating disparities; which are a few goals of Healthy People 2020. Disparities occur across many dimensions, including race/ethnicity, socioeconomic status, age, location, gender, disability status, and sexual orientation. Addressing health disparities is increasingly important as the population becomes more diverse. For example, people of color and low-income individuals are more likely to be uninsured, face barriers to accessing care, and have higher rates of certain conditions compared to other with higher incomes. Obesity a major risk factor for chronic disease and can decrease longevity, quality of life, and economic productivity. Compelling ethical, human rights, and practical reasons exist for addressing social disparities in obesity. In a country where more than 100 million adults are overweight and obesity in younger children has been called an epidemic, it is time for the health consequences of obesity to be emphasized and addressed. Public education about nutrition and the importance of exercise is key to preventing and controlling problems of excess weight. To be involved in this public health initiative that has direct impact on their patients' wellbeing, I will need to have adequate knowledge in nutrition. Along 66 with teachers and other community leaders, health care providers can play a significant role in helping people develop a balanced diet and integrate exercise into their daily routine. The Nutrition and Weight Status objectives for Healthy People 2020 reflect strong science supporting the health benefits of eating a healthful diet and maintaining a healthy body weight. The objectives also emphasize that efforts to change diet and weight should address individual behaviors, as well as the policies and environments that support these behaviors in settings such as schools, worksites, health care organizations, and communities.Diet and body weight are related to health status. Good nutrition is important to the growth and development of children. A healthful diet also helps Americans reduce their risks for many health conditions, including: Overweight and obesity, malnutrition, Heart disease, high blood pressure, dyslipidemia, diabetes, some cancers and many more. The Healthy People 2020 objectives for physical activity are based on the 2008 Physical Activity Guidelines for Americans, and reflect the strong scientific evidence supporting the benefits of physical activity. More than 80 percent of the current US population, from youth to adults, is not meeting these guidelines. Healthy People 2020 highlights the way that one’s level of physical activity is affected by environmental factors such as the availability of safe sidewalks, bike lanes, trails, and parks. It also highlights the legislative policies that improve access to facilities that promote physical activity. Understanding that personal, social, economic, and environmental barriers to physical activity all have a part in determining a population’s physical activity level, is an important part of being able to provide interventions that foster physical activity. Consistent physical activity is necessary for preventing chronic disease, improving bone health, decreasing body fat, and preventing an early death. In conclusion, health and health care disparities persist in the United States, leading to certain groups being at higher risk of being uninsured, having more limited access to care, experiencing poorer quality of care, and ultimately experiencing worse health outcomes References: 67 Curley, L. A. & Vitale, A. P. (2016). Population-Based Nursing, Concepts and Competencies for Advanced Practice (2nd ed.). New York; NY, Springer Publishing Company. 70 Some of the health disparities that are relevant to my community is the prevalence of healthcare concerns among the homeless population. Working in an emergency department, I see a pattern that is among the patients that are experiencing homelessness. The prevalence of IV drug abuse and mental health disorders is hard to ignore. Many patients that frequent the emergency department suffer from mental health disorders and the majority of these patients experience homelessness and substance abuse (Lam, Arora & Menchine, 2016). A way to advocate for these patients would be to give them the proper resources that are available to them. Many patients experiencing homelessness do not know the extent of the resources available to them. The patients that I discharge are usually shocked at how many free clinics there are available to them and how many of them specialize in mental health disorders. 71 I work in an extremely small hospital and our emergency department recently hired a case manager and a social worker. These two ladies have been the best assets to our team and to our patients. The homeless population is given an ample amount of resources provided by these women in order to improve their health. Not only is drug abuse and mental health disorders a major concern for the homeless population, living with chronic conditions and not receiving preventable care can lead to major complications. Approximately half of the adults in the United States suffer from a chronic condition and these conditions are exacerbated through poor diet, poor hygiene, smoking and sedentary lifestyle (Curley & Vitale, 2016). Unfortunately, for patients experiencing homelessness, they are exposed to harsh conditions where they cannot eat right, keep up with their hygiene, or improve a sedentary lifestyle. Resources are available to them and should be brought to their attention in order to improve their lifestyle. Reviewing the objectives on the Healthy People 2020 website regarding mental health and mental disorders, there are many that can help this effort to providing the care the homeless population deserves. One objective that stands out is MHMD-12, increasing the proportion of homeless adults with mental health disorders who receive mental health services (Healthy People 2020, n.d.). By including mental health resources in a patient’s discharge paperwork whether be from the floor or from the emergency department can help them tremendously. Another objective that would increase the lifestyle of a person experiencing homelessness is MHMD-8, increase the proportion of persons with serious illness who are employed (Healthy People 2020, n.d.). Curley, L. A. & Vitale, A. P. (2016). Population-based nursing, concepts and competencies for advanced practice (2nd ed.). New York; NY, Springer Publishing Company. Healthy People 2020. (n.d.). Mental health and mental disorders. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved from 72 https://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental- disorders/national-snapshot 75 Reply Reply to Comment Collapse SubdiscussionMikala Barnes Mikala Barnes Jan 12, 2019 Jan 12 at 4:38pm Shamma, I think it is a great idea for communities to look at data on how well homeless shelters are working for people. I think it would also be a great idea to look into the statistics for the sober living houses. In Daytona, many of the sober living houses are in the middle of the major drug areas. These leads to relapsing and then these people are left on the streets to carry on with they drug habits. Resources need to be available to patients especially the mentally ill or drug abusers that would like to get clean. Homeless shelters and sober living facilities should give the best resources to these patients in order to encourage increasing their life that they need to live to the fullest. -Mikala Reply Reply to Comment Collapse SubdiscussionBrandi Wethington Brandi Wethington Jan 10, 2019 Jan 10 at 2:52pm Mikala, 76 This topic hits very close to home for me!! 77 During the last six months of nursing school, I lived in a homeless shelter with my 3-year-old son. We had nowhere to go. There was a five-year wait on housing and if I worked as a registered nurse for even three days, I made too much money and would be kicked out of housing. I had a case manager, I had support there and I understood the need to have people advocate for me during this time. In Martin and Saint Lucie County, there are five local hospitals servicing the community. They have varying degrees of care. One is a trauma center, one specializes in orthopedics, another is neonatal intensive care and cardiac care. They services patients from all socioeconomic backgrounds and like any other hospital, turn no one away. Last year a common thread between the hospitals was how they discharge patients who were homeless. They were put in a cab and sent to the corner they came from or in Martin County to the Lahia house. This is not a shelter, does not have beds or means to support these patients. What they do offer is two nutritious meals a day, hot showers, laundry facilities, clothing pantry, transportation, haircuts, and even case management. In 2017 the case managers assisted with applying for birth certificates, obtaining state identification cards, drivers licenses, job applications and even helped some move into housing or reconnect with family (www.lahia.org). The problem is that patients are discharged to this facility or to a bench; unable to walk, bedbound, needing home health services with nowhere to be serviced. Behind the Lahia house is woods, where many homeless live in tents. The cab or ambulance drops the patient off at the house, they assist the patient to the tent and then are unable to get the services they need. The home health companies will sometimes do visits to these tents but when the patients are too weak to move, they call 911 and send the patient back to the hospital. We live in an amazing country full of opportunity; no one should ever be discharged to a street corner or tent. There needs to be a global system in place to assist homeless persons with safe discharge needs. These patients are 33% more likely to have hospital readmissions with prolonged length of stay and four times more likely to seek medical care in the Emergency Department (Medcalf & Russell, 2014). Medcalf & Russell (2014), further report that their medical cost is eight times higher than people who have homes. 80 due to mental health, drug abuse and other chronic health problems associated with homelessness. As you well mentioned a way to advocate for these patients would be to provide proper resources that are available to them. The facility I work have case managers and social worker and they are doing a great job in helping these patients finding resources and placing them in rehabs, ALF etc. but still the ED revisits and hospitalization rate is still high once they run out of the time or temporary help. Most of the resources available are temporary resources, I think there should be a better way we can advocate to 81 solve these problems in a long run. I am glad your work organization had hired a case manager and a social worker to help out the homeless individuals and serving as a real assets to the facility. Shamma, I agree with you shelters are not a long-term housing strategy. Stuck with lots of people with different existing ailments and problems can also contributes to community-acquired diseases and increase medical attention and indirectly increase health care cost and affect the country’s economic status. Mikala, I am so sorry to learn about your past situation. You have the real experience what a person feels when you are at risk or in the real situation. It is really sad and scary that we discharge a homeless individual to a bush or nowhere one can imagine of. I am glad we have resources like the Lahia house, the first housing company etc. In 2016, according to the US Department of Housing and Urban Development,293000 children were living in shelters for some of the year, and ∼118000 children were living in shelters on any one day. In the United States,90% of homeless families are sheltered, ∼10 % are living unsheltered in cars, on the streets, and in other places not meant for human habitation (Dreyer,2018). As health care providers and as Nurses we should advocate for our community, state, and nation for better health care policy, cost, housing, and resources. Thank you all for the insightful contribution Sneha 82 Reference Dreyer,B,P.(2018).A Shelter Is Not a Home: The Crisis of Family Homelessness in the United States. American Academy of Pediatrics 142(5) doi: 10.1542/peds.2018-2695 (Links to an external site.)Links to an external site. 85 Jan 13, 2019 Jan 13 at 3:59pm Mikala, You couldn't be more accurate; we do have the ability to advocate and intervene when able. Homelessness is difficult for everyone, I know how it felt for my mother. I was not willing to quit school to live with a friend or family. I had to stay and complete my education or I would have nothing to offer my son. I did learn through my policy class and my project that there is a large population of homeless that have mental illness and addiction issues. These are issues we can help manage that will directly impact this population of people. I love that your hospital has come up with a plan to help this population with discharge planning and setting up follow up care. That is essential as this population is at risk for many health problems. Brandi Reply Reply to Comment Collapse SubdiscussionLourdes Rivera Lourdes Rivera Jan 12, 2019 Jan 12 at 8:38pm Hi Brandi, My heart broke to read your post. I am so impressed with your strength and courage. Look at you now. Adversity did not stop you from reaching for your dream of pursuing your masters now. You're story is inspirational. Your experience makes you a better nurse and advocate for the homeless because you’ve walked in their shoes. I’m sure God has great plans in store for you. 86 It’s so overwhelmingly sad to think of all of the homeless men, women and children out there. I especially think about it on cold winter nights. Just last night I saw an entire family; father, mother and three little children, begging outside a Walmart store. It was a cold night. What kind of resources are available for them? I felt so helpless. 87 I don’t know exactly what direction my degree will take me, but the more I learn, the more I am determined to make a difference for those that are marginalized. We must do our part to reduce health disparities. Thank you for your transparency. I wish you all the best. Reply Reply to Comment Collapse SubdiscussionBrandi Wethington Brandi Wethington Jan 13, 2019 Jan 13 at 4:08pm Lourdes, Thank you, please do not be heartbroken. I look at every situation as an opportunity for growth and understanding. I do not regret my time in the shelter. I met some amazing people, was able to offer pro bono doula care for women in need and completed my ASN degree. I afforded me the opportunity to complete my degree and support my son. I like many of our classmates have had many challenges throughout my career and life. We either overcome them or let them destroy us. It is always a choice. I appreciate your empathy. Thank you. As far as your family outside of Walmart, I am not sure what is available in your area. You could start with the Florida Coalition for homelessness and google shelters in your area. We have no family shelters or shelter for men in Martin County. Which is terrible. Homelessness is truly devastating. Brandi Reply Reply to Comment Collapse SubdiscussionMonique Exume Monique Exume 90 Exercise 2.5 Diabetes affects a growing number of Americans. You have been invited to join a collaborative of community agencies interested in tackling diabetes from a community perspective. 91 Healthy People 2020, International Diabetes Federation and the Center for Disease Control and Prevention (CDC) are great resources when delving into the topic of diabetes. Healthy People 2020 has a vast amount of information on what causes diabetes, the three most common types of diabetes, important facts, risk factors, objectives on initiatives, an overview of resources for health professionals and the community as well as statistics (HealthyPeople.gov website, n.d.). The CDC offers basic information, resources, toolkits for patients at risk or who have diabetes, programs to cope with diabetes, prevent diabetes, statistics and links for community outreach programs (Centers for Disease Control and Prevention website, n.d.). The International Diabetes Federation offers “health professionals, researchers, policymakers, advocates and people living with or affected by diabetes” a wide selection of resources promoting health for those living with or preventing diabetes (International Diabetes Federation website, n.d., para. 1). Healthy People 2020 and the CDC both identify desired outcomes related to diabetes as well as initiatives to improve the success of said outcomes. Mayega et al. (2018), did a study to find out what people who had diabetes to discover what they felt was a state of well-being and what was most important to them. One group felt there is no way to feel a state of well-being because you can become ill at any moment. The other group felt that if you were compliant with your medications, diet and activity regimen you can live a happy healthy life with diabetes (Mayega et al., 2018). The greatest interest within this community was receiving medical follow up care and medications. Without continuity of care, they will likely get ill with other illnesses while complicating their diabetes. While these people lived in Uganda, their concerns are the same for those in local communities. Access to care, affordable medications, proper diet, and activity are all relative to the prevention and success of people living with diabetes. To monitor the success of any local program for diabetes prevention and treatment, one would have to monitor the results closely within their practices. Engaging the community in prevention and treatment will enhance the overall goals of success. Education is key to the success of any program and it begins with nurses. Fawcett and Ellenbecker (2015), describe a Conceptual Model of Nursing and Population Health (CMNPH) as a way to guide nursing research and practice to enhance the understanding of population health. This would result in the best quality care for all persons while nurses prevent disease and promote health. It is this concept that can guide nursing education and care to enhance patient outcomes. These outcomes can be measured internally in the physician’s offices and then compared to local, state and national levels via the CDC and Healthy People 2020 websites. Examples of things measured on the CDC website include Hospitalizations for Myocardial Infarctions with primary diagnosis of Diabetes, Hospitalizations for lower extremity amputations in adults with diabetes, prevalence of self- 92 reported diagnosed diabetes, incidence of diagnosed diabetes, annual direct medical costs attributable to diabetes, annual total indirect cost attributable to diabetes, and number of deaths with diabetes. 95 Depression is a burdensome prevalent mental disorder that affected an estimated 16.2 million adults 18 or older in the United States in 2016 (NIH, 2017). Sixty-four percent of those adults had severe impairment from depression (NIH, 2017). Healthy People 2020 estimated 18.1% of U.S. adults ages 18 years or older suffered from any mental illness in any given year. World Health Organization (2001), states that by 2020, the 2nd leading illness, cause of disability and early death in the world is expected to be depression. Depression can have a domino effect in the body. It increases your chances of developing non-communicable diseases such as myocardial infarction, obesity, and stroke (Machado et al. 2018). Suicide and mortality are also associated with depression. Depression is costly and taxing, taking away many healthy years from individuals. Unfortunately, significant racial/ethnic health disparities still exist in the diagnosis and treatment of depression. A study by Akincigil et al., (2012) resulted that non-Hispanic whites are more likely to receive a diagnosis of depression and be treated for it than minorities. Nurses are patient advocates. One of the most important roles we play as nurses is an advocate. Our proximity and continuity with patients place us in a distinct position to advocate for them. The closeness and rapport we build with patients makes us the perfect advocate. APRN’s can advocate for their patients by becoming educated in the symptoms of depression and recognizing them in their patients. APRN’s focus is preventative screening, therefore, knowing the symptoms and educating patients can make a huge difference. Healthy People 2020 talks about prevention strategies, collaborative care, and suicide screening. Theses are all great methods to aid in the reduction and treatment of depression. There are many factors that contribute to depression. Environmental factors such as inadequate living conditions, non-communicable diseases such as diabetes, obesity, and stroke, stress, hormones, personal factors such as loss of a loved one, unemployment, certain medications such as beta-blockers, proton pump inhibitors, and histamine H2 antagonists (Qato, Ozenberger, & Olfson, 2018) have all been linked to depression. The prevalence of depression makes it a massive concern for APRNs. APRNs should be aware of the risk factors and have an understanding treatments and management available for depression. Unfortunately, not many individuals suffering from depression seek treatment, making it imperative for APRNs to understand the signs, screen and educate patients. Mental health care is just as important as physical health care and it is a APRNs role to address both. The shortage of primary care physicians intensifies the need for APRNs to screen and provide treatment for depression and other common mental health disorders (Theophilos, Green, & Cashin, 2015). 96 References: 97 Akincigil, A., Olfson, M., Siegel, M., Zurlo, K. A., Walkup, J. T., & Crystal, S. (2012). Racial and ethnic disparities in depression care in community-dwelling elderly in the United States. American Journal of Public Health, 102(2), 319-28. Machado, M.O., Veronese, N., Sanches, M., Stubbs, B., Koyanagi, A., Thompson, T., … Carvalho, A. F. (2018). The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic review and meta-analyses. BMC Medicine, 16(1), 112. https://doi- org.chamberlainuniversity.idm.oclc.org/10.1186/s12916-018- (Links to an external site.)Links to an external site. 1101-z Major Depression. (2017). NIH. Retrieved from https://www.nimh.nih.gov/health/ (Links to an external site.)Links to an external site. statistics/major-depression.shtml Mental health and health disorders. (n.d). Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental- disorders (Links to an external site.)Links to an external site. Qato, D. M., Ozenberger K., & Olfoson, M. (2018). Prevalence of prescription medications with depression as a potential adverse effect among adults in the United States. JAMA, 319(22), 2289- 2298. http://doiorg.chamberlainuniversity.idm.oclc.org/10 (Links to an external site.)Links to an external site..1001/jama. 2018.6741 Theophilos, T., Green, R., & Cashin, A. (2015). Nurse Practitioner Mental Health Care in the Primary Context: A Californian Case Study. Healthcare (Basel, Switzerland), 3(1), 162- 71. doi:10.3390/healthcare3010162 World Health Organization. (2001). The World Health Report-Mental Health: New Understanding, New Hope. Geneva: NMH Communications