Aleksandr’s Blog Tacoma Community College N211 John Miller, Instructor Spring Quarter, 2008 Infantile Colic: Effectiveness of Treatments for Infantile Colic. Teaching a new mother about infantile colic is one of the primary responsibilities of postpartum nursing. Mustafa Aksam (2006) brings to light that infantile colic (IC) is a problem that effects up to 40% of babies. IC presents itself during the first three months of life and usually has its onset during the second week of life (Aksan, 2006). Many parents and caregivers are frustrated by IC especially when they are unable to control or relieve their baby’s pain and crying. A newly discharged mother is overwhelmed by all the changes in her life. Excessive uncontrolled crying of her baby during the day and night may be an additional trigger for postpartum depression (Roberts, 2004). Nurses should insure that all new mothers receive education about the treatments for infantile colic before discharge from the hospital. The result will be that fewer new mothers will return to the hospital with maternal depression. The nurse educator will provide information about infantile colic to a new mother. According to Donna Roberts (2004), colic is often defined by “The rule of three”: an infant who is healthy and well nourished but crying “for more than three hours per day, for more than three days per week, and for longer than three weeks.” A colicky infant has attacks of high-pitched screaming in the evening with associated motor behavior such as furrowed brow, flushed face, clenched fists, distended and tense abdomen, and the legs drawn up to the abdomen. The loud cry may persist for several hours. It may be terminated when the infant becomes fatigued, or passes feces or flatus (Roberts, 2004). It is most important for the mother to have reassurance that her baby is healthy and the colic is self-limited with a short term effect unless there are other signs and symptoms of illness (Roberts, 2006). E. Rosenthal (2004) states that infant colic is considered by many as “stressful yet harmless” (Rosenthal, 2004). According to Donna Roberts (2004), the cause of infantile colic remains unclear, and there is no effective medication that may help to resolve this problem without harming a baby. However, nurses are teaching new mothers several effective treatments that show a significant decrease in the time of infant’s crying episodes (Roberts, 2004). Mustafa Aksam (2006) discusses the study conducted in Isparta Maternity Hospital in Turkey about the effect of oral hypertonic glucose solution in a treatment of infantile colic. In this study, thirty healthy infants with colic were selected and the double blind study with crossover trial was conducted. Two bottles were prepared for each patient: one bottle with 30% of hypertonic glucose solution used for IV injection and another bottle with distilled water. The same patient used one bottle for four days and then used another bottle for four days. All parents were instructed to give 1 mL of solution before each feeding using medicine droplets. The infants were examined in the clinic repeatedly and the parents described the effect of the last treatment on their infants. The study showed that 64 % of the parents reported an improvement in their infant’s condition while using 30 % of hypertonic glucose solution. However, 36 % of the parents also reported an improvement after using distilled water (Aksan, 2006). No one reported any side effect in this study. Since oral hypertonic glucose solution has a significant effect for the treatment of infantile colic, nurses will recommend it for the new mother as a natural, safe, and cheap therapy. According to one study reported by P. Kearney (1998), lactase is effective in management of infantile colic. Incomplete lactose absorption in the small intestine provides carbohydrates for bacteria, which are present in the large intestine. Those bacteria metabolize lactose and produce hydrogen that causes infantile colic. Adding a few drops of lactase to the milk formula 24 hours prior to feeding the baby, significantly (95% or 1.14 hr/day) decreases crying time for babies with infantile colic. However, there is no effect of adding lactase to formula during the baby’s feeding. It is possible that stomach acid destroys lactase making it ineffective. The study showed that there was no difference in stool of the babies who had lactase or placebo in milk. Also, there were no side effects reported during this study (Kearney, 1998). According to Sally Wade (2001), two systematic studies found that the infants fed with soya milk formula have less colic than infants fed with standard milk formula. Soy milk formula compared with standard milk formula reduces the duration of crying by 50-75% (Wade, 2001). However another research suggests that infants fed with soya milk formula do not receive important vitamins and proteins that are found in standard milk formula. Donna Roberts (2004) suggested that herbal mixture containing chamomile, licorice, fennel, and lemon balm is effective in treatment of infantile colic. The mixture should be given to the infant three times a day, 150 mL per dose. However, there is a lack of standardization of strength and dosage, and it is too much for an infant to drink 150 mL of fluid at once. So, the new mother should be cautioned about the use of herbal treatment of infant colic (Roberts, 2004). According to E. Rosenthal (2004), behavioral and environmental modification can decrease infant crying time during the colicky time. Also, E. Rosenthal suggested another herbal mixture called “Gripe Water” which may include cardamom, chamomile, cinnamon, clove, dill, fennel, ginger, lemon ball, licorice, peppermint and yarrow. This product provides relief from flatulence and indigestion, however it has not been scientifically evaluated. Parents should avoid products that are made with sugar and alcohol and are manufactured outside of the US (Rosenthal, 2004). Donna Roberts (2004) suggested behavior modification treatments for infantile colic. Some infants may reduce or even stop crying if placed near clothes dryer or near the room with a vacuum cleaner turned on that makes “white noise”. “Colic hold” is also suggested, which is a gentle pressure on infant’s abdomen (Roberts, 2004). E. Rosenthal (2004) suggested movements such as gentle rocking motion in a baby swing, in parent’s arms with walking or sitting in a rocking chair, or riding in a car also soothes some babies. Taking a warm bath together not only soothes the baby but also his mother (Rosenthal, 2004). According to those studies, there are some effective and safe treatments and behavior modifications for infantile colic. If nurses provide the education about infantile colic to the new mothers, it will significantly increase their physical and mental ability to take care of their infants. Nurses prepare mothers to cope with the challenges that their babies will give them. Health care cost will decrease and the baby’s health will increase because mothers will use safe treatments and behavior modifications to treat infantile colic. Fewer mothers will return to the hospital for treatment of post-partum depression as the result of education that nurses will provide to new mothers prior to discharge from the hospital. Intervention 1. Administering oral glucose hypertonic solutions for infant in treatment of infantile colic. Disadvantage 1. Oral glucose hypertonic solution does not affect all infants similarly. According to the study conducted in Disadvantage 2. Another disadvantage is a knowledge deficit. A very small amount of health care workers and parents in US are familiar with this treatment and even a smaller percentage of them use oral glucose hypertonic solution for treatment of infantile colic. The study about how oral glucose hypertonic solution treats infantile colic was conducted in Intervention 2. Soy milk formula compared with standard milk formula reduces the duration of crying by 50-75%. Disadvantage 1. One disadvantage of soy milk formula is affected by socioeconomic status. Soy milk formula is more expensive than cow’s milk formula. One Internet store shows that soy milk formula cost two dollars more than cow’s milk formula for the same can size (Diper.com, 2008). Disadvantage 2. According to Natalie Reiss, soy milk formula compared to breast milk has another disadvantage. Breast milk reduces the risk of getting infectious and non-infectious diseases in infants. Breast milk also reduces the risk of chronic diseases such as diabetes, cancer, allergies, and asthma in infants. Breast feeding infants also have less risk of becoming overweight compared to infants fed by formula (Reiss, N. 2007). References Akcam, M. & Yilmaz, A. (2006, April). Oral hypertonic glucose solution in the treatment of infantile colic. Pediatrics International, 48(2), 125-127. Retrieved February 12, 2008 from CINAHL database. Badiee, Z. (2006). Pak J Physiol. Oral hypertonic glucose, for analgesia in the premature newborns. 2(2). Retrieved May 5, 2008, from http://pps.org.pk/PJP/2-2/zohrah.pdf Diapers.com. (2008). Baby Formula/Similac. Retrieved May 5, 2008, from http://www.diapers.com/Shop/SubBrand.aspx?CategoryID=2&CategoryName=Baby+Formula&BrandCode=SM&BrandName=Similac Roberts, D. Ostapchuk, M. & O’Brien, J. (2004, August). Infantile colic. American Family Physician, 70(4), 735-741. Retrieved February 12, 2008 from Proquest database. Reiss N. (2007, May). New research suggests that breastfeeding babies for at least six months is best. Pediatrics for Parents, 23(5), 2-3. Retrieved May 5, 2008, from Proquest database. Rosinthal E. (2004, December). Recognizing and treating infant colic. Primary Health Care, 14(10), 45-49. Retrieved February 12, 2008 from CINAHL database. Wade S. & Kilgour T. (2001, August). Infantile Colic. Clinical Evidence, 323(7310), 437-440. Retrieved January 30, 2008 from Pubmed central database.
Monday, May 26, 2008
Effectiveness of Treatments for Infantile Colic
Tuesday, May 20, 2008
Role of the Nurse Educator in Preventing Teenage Osteoporosis
Role of the Nurse Educator in Preventing Teenage Osteoporosis
Kelly Johnson
Tacoma Community College Associate Degree in Nursing
Nursing 211: Caring for the client with Acute Problems
John Miller, Spring 2008
The risk of osteoporosis among the teenage population has become a major health concern because of the high intake of carbonated beverages and the low consumption of dairy products such as milk. Soft drink consumption by teenagers is twice the consumption of milk. In addition to the already unhealthy high sugar content, these beverages increase the excretion of calcium in a calcium depleted diet. Therefore, the nurse plays a pivotal role in educating the teenage population about the risks and consequences associated with the unhealthy intake of carbonated beverages. Strategies the nurse should implement in osteoporosis prevention include teenage education regarding prevention and early detection, positive role modeling, and self-care implementation, specifically, diet and exercise.
The high levels of sugar contained in some carbonated beverages increase excretion of calcium through homeostatic processing. Teenage boys and girls alike consume twice as many soft drinks as compared to milk and research indicates that this trend is contributing to an earlier onset of teenage osteoporosis (Hightower, 2000). When reduction in bone mass is sufficient to compromise normal function, osteoporosis develops (Martini, 2006). As the human body ages, it naturally loses bone thickness and strength. Usually, osteoporosis is detected between the ages of 30 and 40 and affects women sooner than men; however, due to lack of proper diet and education, the disease is progressing at an alarming rate among teenagers. When education is absent or delayed, the nurse misses the opportunity to prevent the next generation from developing osteoporosis.
Teenage education regarding prevention, early detection, and self-care should focus on well-balanced diets and well-planned exercise regimes. Prevention includes reducing sugar and caloric intake, encouraging water to quench thirst instead of soft drinks, and going to the gym instead of playing video games. In order to effectively present this educational strategy at the local public school, the nurse educator could include visual aids provided by the National Dairy Council. Prior to the nurse’s presentation to the class of teenage students, the nurse educator should first analyze the dietary profile of one of the students in the class (Borchardt, 2000; Hunt, 1998). This preparation by the nurse is a good strategy to get the students more involved. An important goal of the presentation is to educate the teenagers on the importance of the proper intake of calcium and vitamin D through healthy food choices because unhealthy diets leave the adolescent at a much higher risk for osteoporosis later in life. Exercise that promotes bone strength, such as weightlifting, must also be emphasized and encouraged.
Positive role modeling is an important aspect of the educational strategy. This can be achieved by the individual nurse being fit and healthy himself. According to Bandura’s Social Learning Model described by (Borchardt 2000), individuals learn by observation. In the same way children learn from observing their parents, the teenager can learn from positive role models to become an agent of his own care. Role modeling is not a responsibility of the nurse alone, but rather involves all those who have an impact on the adolescent. This includes the parent who carefully plans meals, the physical education teacher who encourages the students to be fit, or the nurse educator who is passionate about the prevention of this disease. When a student displays interest, enthusiasm, and ownership as a result of positive role modeling, his motivation is increased and he is much more likely to participate and remain compliant with healthy expectations (Fitzgerald, 2003).
The American teenagers’ eating and exercise behaviors are not the only obstacles in this silent disease (Berarducci, 2004). One of the most difficult hurdles to overcome for the teenagers is the commercialization of carbonated beverages, fast foods, and candy bars. This pressure has enormous impact. For example, grocery stores are set-up for the compulsive shopper with candy bars and soda pops strategically close to the checkout line. It is through education that teenagers can begin to recognize these influences and question their eating and exercise habits. Information can be provided for teens and their families on self-care in brochures and pamphlets given during the presentation. This should include information on free or sliding scale clinics where providers evaluate clients, and the nurse offers educational sessions regarding healthy diets and exercise classes (Hightower, 2000; Curry, Hogstel, Davis & Frable, 2002). The consequences of having a poor diet and exercise routine must be honestly and thoroughly presented so that teenagers do not remain unconcerned or defenseless in the face of this disease and its long term effects on their health.
Osteoporosis due to poor diet and insufficient exercise is a preventable disease. The staggering increase in consumption of carbonated beverages and the decreased consumption of calcium have caused a rise in the incidence of osteoporosis in the teenage population. Education is crucial for teenagers if they are to develop healthy habits to reverse this trend. When the nurse encourages osteoporosis-preventative behaviors and promotes healthy lifestyle strategies, prevention of osteoporosis is the focus. This is much preferable to coping with the long term consequences of this disease. Prevention through education is best accomplished by a well-educated, healthy and fit nurse who really wants to see the teenage population improve their diet and exercise habits so they can live longer and healthier lives.
Role of the Nurse Educator in Preventing Teenage Osteoporosis
Intervention #1
Teenage education regarding prevention and early detection of osteoporosis.
Disadvantage #1
Because osteoporosis is a pediatric disease with geriatric consequences, failure to educate the teenage population is a disadvantage. This disease is silent and remains dormant for several years with no signs or symptoms until a disabling fracture occurs. “The key to prevention of osteoporosis is early detection and prevention within the vulnerable, at-risk population” (Hunt, 1998 p. 56). Health promotion has always been an integral part of nursing, and has become increasingly important. In fact, most state Nursing Practice Acts mandate patient education. Since osteoporosis develops during adolescence, the nurse needs to target this age group at the public schools with aggressive presentations in the classrooms. Without education about the risk factors and prevention of osteoporosis to this vulnerable population now, the next generation has acquired the disease, increased the risk, and the window of opportunity to prevent this debilitating disease has closed.
Disadvantage #2
The nurse educator who is compassionate about his/her desire to help prevent teenage osteoporosis should take the prime opportunity and major responsibility to initiate osteoporosis prevention education. The education must emphasize health promotion and disease preventions, not on treating the disease. “It is imperative that nurses possess the required knowledge base and resources to adequately provide instruction to healthcare consumers in an effort to promote wellness, manage illness, and prevent disease” (Beraducci,2004, p. 121). In addition, the nurse educator needs greater access to knowledge and information about the identifiable behaviors of those at risk for developing osteoporosis, and the pathogenesis of osteoporosis to be effective in their presentations at the public schools. If the nurse is not well educated the outcomes will be as debilitating as the disease.
Intervention #2
Self-care implementation, specifically, diet and exercise.
Disadvantage #1
Positive role modeling is an important and effective aspect of the educational strategy. The reflection of the nurse’s personal values will impact the teenagers, and help pave the way for. When the nurse educator’s lifestyle cannot be viewed as healthy, the teaching opportunity has lost its effectiveness. “Awareness of one’s self-care patterns, and implementing strategies to maintain or change these patterns, can be an important step in helping others achieve a high level of wellness” (Borchardt, 2000, p. 30). By taking the leading role in delivering healthcare messages, the nurse educator needs to view him/her self as healthy, or more importantly, the classroom full of teenagers needs to have that perspective of the nurse. When the nurse instructs about the importance of the combination of diet and exercise, the nurse needs to be that healthy living example. “We as nurses and health educators are expected to provide good examples of healthy lifestyles” (Borchardt, 2000, p. 30). When the nurse is viewed as unhealthy through the eyes of the students, the opportunity to promote wellness has been lost.
Disadvantage #2
Lifestyles and diet are closely related. The selection of food is heavily influenced by one’s socioeconomic status. The foods of choice are usually cheap, energy-dense, and nutrient poor. These choices have adverse effects on the growth of the child. There is a great deal of evidence compiled that shows that childhood socioeconomic status contributes to disease later in life, such as osteoporosis (Caballero, 2005). “A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes” (Lukar, 2007, p. 137). Nutrients, like calcium, in the teenager’s diet will help prevent osteoporosis. Because of cost, carbonated beverages are being purchased instead of dairy products, contributing to the calcium-deficient teenager. The insufficient consumption of calcium in the adolescent diet is leaving them predisposed to osteoporosis. It has been determined that socioeconomic status affects lifestyles, and lifestyles affect diets (Hightower, 2000).
References
Berarducci, A. (2004,Mar-Apr). Osteoporosis education: Orthopedic Nursing. 23(2), 118-127. Retrieved May 15, 2007 from Proquest database.
Borchardt, G. L. (2000,Jul-Sep). Role models for health promotion: The challenges for nurses. Nursing Forum. 35(3), 29. Retrieved April 10, 2007 from Proquest database.
Curry, L. C., Hogstel, M. O., Davis, G. C., & Frable, P. J. (2002). Population-based osteoporosis education for older women. Public Health Nursing. 19(6), 460-469. Retrieved January 10, 2007 from Proquest database.
Fitzgerald, K. (2003). Nurse as Educator: Principles of Teaching and Learning for Nursing Practice (2nd ed., pp. 371-372). Boston: Jones & Bartlett.
Hightower, L. (2000,Sept-Oct). Osteoporosis: Pediatric disease with geriatric consequences. Orthopaedic Nursing. 19(5), 59-62. Retrieved April 17, 2007 from Proquest database.
Hunt, A. H. (1998,Nov-Dec). Assessment of learning needs of registered nurses for osteoporosis education. [Electronic version]. Orthopedic Nursing, 17(6), 55-60.
Martini, F. H. (2006). Fundamentals of anatomy and physiology. San Francisco: Pearson
Caballero, B. (2005, April). A Nutrition paradox – underweight and obesity in developing countries. The New England Journal of Medicine 352(15), 1514-1517. Retrieved July 16, 2007, from Proquest Database.
Hamil-Lukar, J. & O’Rand, A. (2007, February). Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood. Demography 44(1), 137-148. Retrieved July 16, 2007, from Proquest Database.
Tuesday, May 13, 2008
Diabetes Complication: the Nurse’s Role in Reducing Diabetic
Sun Young Kim
About 17 million people in America are currently suffering from diabetes. “A significant public health problem, diabetes is the seventh leading cause of death in the United States.” (Black, 2005, p.1244)
Because diabetes can cause serious complications such as retinopathy, neuropathy, renal failure, and even death, nurses play a critical role in reducing diabetic complications through holistic care and education. Nurses can prevent diabetes complications in patients by providing diabetes education to newly diagnosed patients, creating a multidisciplinary diabetic control regimen with the patient, nutritionist, and diabetes educator, and calling patients bimonthly to check upon patients’ compliance with diabetes control regimen. Through these interventions, nurses can greatly reduce diabetes complications in patients.
Diabetes mellitus is a “chronic systemic disease characterized by either a deficiency of insulin or a decreased ability of the body to use insulin.” (Kronmal, 2006, p.401) Diabetes mellitus can be divided into either type I or type II. Type I diabetes is characterized by absolute insulin deficiency caused by destruction of pancreatic beta cells. Patients with type II diabetes produce insulin, but their liver and peripheral tissues are resistant to the effects of insulin. As a result of defective insulin utilization, diabetes patients experience decreased glucose utilization, increased fat mobilization, and increased protein utilization. If untreated, diabetes mellitus can cause more serious complications such as coronary artery disease, hypertension, retinopathy, nephropathy, and neuropathy.
Diabetes is a disease that requires a tremendous change in a patient’s life style. Since patients have to live with diabetes for the rest of their lives, it is essential that they are educated early after the diagnosis on what they need to know to improve the quality of their life. The diabetes education nurse can set up a convenient time for the patient, choose a private room, and explain the pathology, clinical manifestations, and complications of diabetes. During this education session, it is important to emphasize to patients that they did not do anything wrong to cause the disease. Glycemic control is directly linked to the patient’s exercise level and dietary regimen, and thus it is easy for patients to think that they have earned the disease. According to the Diabetes Attitudes, Wishes, and Needs (DAWN) study “diabetes distress was common among patients, with 85.2% of them experiencing a feeling of shock, guilt, anger, anxiety, and depression at the time of the diagnosis” (Funnell, 2006, p.155). The study also stated that these psychological distresses lead to poor glycemic control in patients, so it is critical to educate patients and answer any questions they have, soon after the initial diagnosis.
Once the patient has accepted the diagnosis of diabetes, the nurse can coordinate a multi disciplinary approach to create a diabetes control regimen. The multidisciplinary team can consist of a nutritionist, physician, diabetes education nurse, and the patient. This team can decide on measures to keep patients’ glucose level as normal as possible, such as eating a balanced diet, exercising regularly, and administering daily medication. During the meetings, the nurse should act as a patient advocate and actively involve the patient in the decision making process. Since diabetes is a chronic condition, the control regimen “should be individualized to each patient’s goals, age, lifestyle, nutritional needs, activity level, and type of diabetes” (Davidson, 2003, p.2291) to produce optimal outcome. The nurse plays a critical role in creating this individualized regimen by assessing the patient’s needs and what they are willing to do.
Once the diabetes control regimen has been implemented, the nurse can increase patient’s compliance by calling them bimonthly to check their status. Asking a few simple questions such as the patient’s recent glucose levels, recent meals, or last time that the patient exercised, can give a nurse valuable clues about how the patient is doing. Patients also benefit from these phone calls by building a better care relationship with the providers. Patients can utilize this time to ask any additional questions that they came up with or simply express concerns. According to the research study performed by Taylor, et al, (2003) patients who have received the bimonthly calls from nurses “showed significant reduction in blood glucose level, total cholesterol level, and total LDL level.” (p.1063)
Diabetes is a complex disease that requires extensive change in the patient’s life style. Nurses can help the patients adjust to change in their lives by providing diabetes education to newly diagnosed patients, creating a multidisciplinary diabetic control regimen with the patient, nutritionist, and diabetes educator, and calling patient bimonthly to check upon patient’s compliance with the diabetes control regimen. Nurses can help diabetes patients better than any other healthcare team members, since they spend most time with patients. Through careful observation and active listening, nurses can be more attuned to each patient’s beliefs and attitudes toward diabetes and can come up with individualized diabetes control regimens that can effectively reduce complications from diabetes.
References
Black, J.M., Hawks, J.H. (2005). Management of clients with Diabetes Mellitus. In Medical-Surgical Nursing (pp.1243-1287). Missouri: Elsevier
Davidson, M.B. (August 2003). Effect of a nurse-directed diabetes care in a minority population. Diabetes Care, 26(8), 2281-2291. Retrieved from ProQuest Smart Search database on May 29, 2007. (384283331)
Funnell, M. M. (2006). The diabetes attitudes, wishes, and needs (DAWN) study. Clinical Diabetes, 24 (4), 154-156. Retrieved from ProQuest Smart Search database on May 23, 2007. (1166450571).
Kronmal, R.A., Barzilay, J.I., Smith, L.N, Psaty, B.M., Kuller, L.H., et al. (2006) Mortality in Pharmacologically Treated Older Adults with Diabetes: The Cardiovascular Health Study, 1989–2001. Public Library of Science Medicine 3(10), 400-404. Retrieved from PLoS Medicine database on April 30, 2007. (p.0030400)
Taylor, C. B., Miller, N.H., Reilly, K.R., Greenwald, G, et al. (2003). Evaluation of a nurse-care management system to improve outcomes in patients with complicated diabetes. Journal of Diabetes Care, 26 (4), 1058-1064. Retrieved from ProQuest Smart Search database on April 19, 2007. (324968961).
Intervention #1
Nurses need to provide diabetes education to newly diagnosed patients.
Disadvantage #1
One problem with nurses providing education to diabetes patient is that nurses have to spend extra effort and time to learn about diabetes. Diabetes is a complex disease that impacts patient’s overall health status. As a result, nurses first have to become knowledgeable about different aspects of diabetes management before they can educate their patients. According to a study in Magson-Robert’s paper, only 38% of nurses responsible for diabetes education had “attended a diabetes study day within the past two years.” Nurses are not mandated to regularly update themselves in diabetes management, and this lack of continuing education can lead to nurses giving invalid or inappropriate advice to their patients.
Disadvantage #2
Some patients might not follow instructions given by the diabetes education nurses, due to the faulty perception that nurses don’t have the authority or knowledge to educate them. In his paper, Martin stated that “authorities seen as credible sources of information are particularly effective as agents of behavior change.” Conversely, patients’ compliance will decrease if the patient view nurses as having no authority. Thus, nurses need to be creative in devising a way to convey their expertise to the patients to increase patient’s compliance.
Intervention #2
Nurses need to call their patients bimonthly to check upon patient’s compliance with diabetes regimen.
Disadvantage #1
One problem that occurs with this intervention is that nurses are so short staffed that they don’t have time to call all their patients’ bimonthly. Nurses’ workload are heavy as it already is and added responsibility of telephone checks can lead to dissatisfaction of the nursing staffs. According to study done on 43,000 nurses, more than 40% of the nurses working in the hospitals in the US reported dissatisfaction with their jobs(Mees, 2008). Also only 34% of surveyed nurses reported that they had enough RNs to provide high-quality care in the facility where they work.
Disadvantage #2
Another barrier to this intervention is that the patient’s might not have adequate socioeconomic means to participate in the program, even if it is offered. For instance, according to Borsky’s research article, Asian Americans were less likely than whites to receive eye examinations, physiological testing, and self – care instructions. This can be attributed to the fact that Asian Americans have the highest rate of uninsurance (6%), compared with white (0.2%), reflecting different work pattern. This socioeconomic status of having no insurance had significant influence on health outcomes for Asian Americans since diabetes is the fifth leading cause of death among Asians, and the prevalence of diabetes is higher among Asians compared with whites.
Works Cited
Borsky, A..E., Greenberg, L., Moy, E. (2008). Community Variation: Disparities In Health Care Quality Between Asian And White Medicare Beneficiaries. Health Affairs, 27(2), 538-550. Retrieved May 10th, 2008from ProQuest Smart Search database (1447860551)
Magson-Roberts, S. (2007). The Role of the District Nurses in Diabetes Management. Journal of community Nursing, 21 (3), 10-12. Retrieved May 10th, 2008 from ProQuest Smart Search database (1240618771)
Martin, Steve (2008). The Science of Compliance: Believing in an Expert. Practice Nurse, 35(7), 39-40. Retrieved May 10th, 2008 from ProQuest Smart Search database (1470885181)
Mee, C.L., Robinson, E. (2003). What’s Different About this Nursing Shortage? Nursing, 33(1), 51-53. Retrieved May 11th, 2008 from ProQuest Smart Search database (276207061)
Monday, May 12, 2008
Childhood Obesity: How Nurses Can Work
There are more than one billion people affected by obesity in the world. In fact, the second-leading cause of death is from the effects of obesity (Miller, Rosenbloom, & Silverstein, 2004).
Worldwide, there are over 22 million children under the age of 5 who are considered obese or overweight based on their body mass index (BMI) (Miller, Rosenbloom & Silverstein, 2004). Emphasis needs to be placed on prevention of obesity, rather than correction of the problem. Three nursing strategies that can be implemented to help reduce this trend are educating children on health lunch and drink choices while they are at school, promoting increased physical activity and working with the media to reduce junk food advertising.
Statistics show the number of overweight children in North America could reach 50% in the next 4 years (The Associated Press, 2006). Obesity results in high blood pressure, higher insulin levels, increased heart rate and cardiac output, and a high level of low-density lipoprotein cholesterol (LDL) (Davis, Kolar, Morthington, Davis, & Moll, 2002). These factors contribute to the development of diabetes, heart disease and strokes at an earlier age than children of normal weight (The Associated Press, 2006). Overweight children also have higher rates of infertility (Dehghan, Danesh, & Merchant, 2005). Due to these health trends, this generation may have a shorter life expectancy than their parents (The Associated Press, 2006). There are several contributing factors to the problem of obese children. One factor is a movement toward a more sedentary lifestyle. This results from increased television viewing and playing computer games. There is also a decreased sense of safety, resulting in fewer children walking to school each year and to other activities due to safety concerns. More parents are working and have their children stay inside while they are gone. Working parents also lack time to cook nutritional meals and have higher rates of fast food consumption. By addressing these contributing factors, nurses can help to reduce the rates of childhood obesity.
One nursing strategy is to educate children and parents on healthy food and drink choices. School and public health nurses have an opportunity to do this with school age children, especially since children eat one to two meals while at school. Nurses can go into classrooms and teach children how to make nutritional food choices through demonstration, visual aids and class discussion. Nurses can place educational emphasis on improving nutrition, the importance of exercise, preventing obesity and discouraging unhealthy lifestyle practices like smoking, alcohol and drug use to school age children (Davis et al, 2002). This will encourage children to make healthier lifestyle choices, decreasing obesity levels which will result in lower levels of cardiovascular disease and diabetes. Schools can provide healthy lunch option, such as fruits, vegetables, and whole-grain foods, which will help to encourage positive practice for making nutritional meal choices (Davis et al, 2002). Soda machines can be replaced with water and milk machines (Laing, 2002). In order to get parents involved, a child’s weight problem can be addressed on a report card. Studies have shown that parents who received health and fitness report cards for their children were more likely to address the weight problem and encourage health activities (Dehghan, Danesh, & Merchant, 2005).
While eating a healthy diet is essential to reducing childhood obesity, other lifestyle choices must also be made to correct the overweight trend. Another nursing strategy that can be implemented to help reduce increasing childhood obesity is to promote increased levels of physical activity. This can be accomplished through several different avenues. Since a sense of safety is vital for children and parents to participate in outdoor activities, nurses need to work with the local government to create safe play areas for children. Parks and ply zones that will be monitored for safety can be created in neighborhoods. These areas need to be easily accessible to children and need to promote play, exercise and physical recreation (Laing, 2002). Nurses can also work with parents and children to increase participation in sports activities. Children would be involved in regular physical exercise during which they receive positive support from their peers (Davis, et al, 2002). Schools can develop physical education programs that are longer in time and emphasize cardiovascular health (Dehghan, Danesh, & Merchant, 2005). With decreased caloric intake, the metabolism will slow down so physical activity is vital to promoting weight loss among obese children. Physical activity will also help increase insulin sensitivity and increase cardiovascular fitness (Miller, Rosenbloom, & Silverstein, 2004).
A third and final nursing strategy for reducing childhood obesity is to work with the media and marketing groups to promote healthy lifestyle choices and reduce junk food advertising. By using toys, music and easily identifiable characters, fast food chains promote their products to children (Miller, Rosenbloom, & Silverstein, 2004). Snacks, fast foot and other junk food products are most heavily advertised during children’s television programs (Laing, 2002). Nurses need to work with the media to change the advertising emphasis to healthy food and lifestyle choices. Making healthy food choices easy to identify for both parents and children while grocery shopping is another way nurses can work with marketing companies to reduce childhood obesity. Packaging can be changed to include easy to read nutritional information. Characters can be created and associated with nutritional food products (Dehghan, Danesh, & Merchant, 2005)
The number of overweight children is growing worldwide. This trend poses several health risks such as cardiovascular disease, diabetes, hypertension, and infertility. If this trend is not corrected soon, the lifespan of this generation and those to follow will shorten. Nurses can focus on strategies such as educating parents and children on healthy food choices, promoting physical activities through the creation of safe play areas and organized physical activity, and reducing the marketing of poor nutritional foots to children in order to help reduce this growing problem. These strategies will promote healthy lifestyles in children and reduce the percentage of overweight children which will help them to live longer and healthier lives.
References
Davis, S., Kolar, K., Northington, L., Davis, M., & Moll, G. (December 2002). Childhood Obesity Reduction by School Based Programs. Association of Black Nursing Faculty Journal. Retrieved January 16, 2008 from http://findarticles.com/p/articles/mi_m0MJT/is_6_13/ai_95915535/pg_1
Dehghan, M., Akhtar-Danesh, N., & Merchant, A. (September 2005). Childhood Obesity: Prevalence and Prevention. Nutrition Journal, 4. Retrieved October 14, 2007, from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1208949
Laing, P., RN. (2002) Childhood Obesity: A Public Health Threat. Pediatric Nursing Journal, 14(10), 14-16.
Miller, J. Rosenbloom, A., & Silverstein, J. (September 2004). Childhood Obesity. JCEM, 89(9):4211-4218. Retrieved January 16, 2008, from http://jcem.endojournals.org/cgi/reprint/89/9/4211
The Associated Press. (March 7, 2006). Study: Childhood Obesity Expected to Soar. Retrieved September 28, 2007, from http://www.msnbc.msn.com/id/11694799/
Intervention #1
Nurses need to educated children and parents on healthy food and drink choices.
Disadvantage #1
A problem that arises with nurses educating children and their parents is the lack of motivation on the client’s end toward learning and change. They are either comfortable in their lifestyle, don’t seen the future health concerns, or are too busy with work and other time limitations to take the time to correct their knowledge deficit (St.Onge, Keller, and Heymsfield, 2003). Studies have shown that homes with two parents working are more likely to consume fast food due to the convenience rather than prepare meals for nutritional value (St.Onge, Keller, and Heymsfield, 2003). Once families can be educated on and realize the importance of nutritional meals and are taught the skills needed to implement proper nutrition choices they will overcome this barrier.
Disadvantage #2
Another disadvantage for nurses trying to educate children and their parents is the lack of reimbursement by either insurance companies or other healthcare corporations for their time and resources used. Studies have shown that clinics specializing in pediatric obesity were rarely reimbursed for their expenses by insurance companies. Healthcare workers are not given any incentives to go out into the community and provide education and resources for preventing childhood obesity through proper nutrition (Story, Neumark, Sherwood, Holt, Sofka, Trowbridge, & Barlow, 2002). If insurance companies can see the importance of obesity prevention in children and the long term health benefits for the children, they may start to reimburse and invest in nutritional education for children and their families.
Intervention #2
Nurses need to focus on promoting physical activity for children by working with the community to develop safe play areas and parks.
Disadvantage #1
Socioeconomic status could prevent nurses from working to develop safe play areas for children. Low-income neighborhoods may not have the community involvement or resources needed to develop safe and monitored play areas. Since unsafe communities lead to children not being able to play outdoors, it will be more challenging to ensure children’s safety while playing in these neighborhoods (Laing, 2002).
Disadvantage # 2
If a community is already thoroughly developed, it may be difficult to gain support for the building of parks and walking trails (Dehghan, Danesh, & Merchant, 2005). Losing business and profit-generating areas for physical activity promotion may not be welcome by a community. These parks and trails also need to be placed near neighborhoods for easy access if they are to be used regularly. This may prove to be a difficult task in existing communities.
Nursing Management in Multiple Sclerosis
Multiple Sclerosis (MS) is a disease that affects a person’s entire life. Since MS has major neurological effects that are progressive, it can force a person to alter many routine activities within their daily life.
MS, a chronic illness, causes those affected to balance their disease and feelings about their illness within their already busy and bustling life. Keeping this in mind, nurses and MS nurse specialists can have a profound impact on helping a patient manage their Multiple Sclerosis. Because it is the MS nurse that helps manage patient expectations, it is imperative for the MS nurse to develop a therapeutic relationship with the patient, help patients and their families incorporate the disease into their lives and to encourage the patient to seek medical interventions early.
According to the Multiple Sclerosis Society website (2007), “MS is the result of damage to myelin- a protective sheath surrounding nerve fibres of the central nervous system. When myelin is damaged, this interferes with messages between the brain and other parts of the body” (Paragraph 1). Multiple Sclerosis is a disease that has caused a host of problems from a patient care and disease management perspective. For instance, “for the majority of people diagnosed many years ago and told to ‘get on with life,’” today new treatments and support are offered to those who are diagnosed with this life changing disease (D’Arcy, 2005, p. 2). Though there is no cure for MS, great strides “have focused on pharmacological management and therapeutic strategies, education, provision of emotional support and advocating change in governmental policies” (D’Arcy, 2005, p. 2). Hence, the disease management process for MS has come a long way since it was first discovered as being a life threatening and altering disease. The health care community is working hard to educate people living with this disease while at the same time alleviating the unnecessary complications that come with Multiple Sclerosis.
Multiple sclerosis brings with it a multitude of issues. One of the most important topics to address is patient expectations. A significant way this can be done is for the nurse to develop a healthy, therapeutic relationship with the patient and the patient’s family during the patient’s first visit to the clinic. The nurse should concentrate on establishing a connection with the patient and their family, having an open dialogue with them about how things are going and how they are feeling. People who are affected by MS are looking for that one person who will truly listen to their needs and feelings. Furthermore, “the desired outcomes for this relationship are for patients to have an increased awareness and knowledge about MS, DMDs, and the rationale for treatment” (Ross, Costello, & Kennedy, 2005, p. 1). This piece is so important to the nurse/patient relationship. Honesty and trust are key in developing the therapeutic relationship needed and these characteristics of successful communication pave the way to success for the relationship and health goal at hand.
Incorporating any disease into ones life is so important, which stands true for Multiple Sclerosis. According to D’Arcy (2005), one way a nurse specialist may help a patient and their family incorporate a disease into their lives is by “[helping] deliver personlised, patient focused care and [giving] appropriate information so that patients can make informed choices” (p. 3). Often, a newly diagnosed MS patient does not know what his/her needs are going to be. The nurse specialist may help this patient with focused goals, such as continuing with daily activities and exploring new treatments, to better manage the disease and prevent relapse. These goals may be set over a few visits with the nurse specialist and will change as the person’s disease progresses. “Part of the MS nurse’s role involves the correct identification of relapse, assessment and the application of appropriate intervention” (Embrey, 2003, p. 2). A relapse, also called an exacerbation, could be the patient developing optic neuritis, which would than be treated.
Inquiring about interventions and following through with them is essential with a disease like Multiple Sclerosis. According to a study done by Fleming-Courts (2004), MS focus groups “support nursing interventions that empower and teach self-management techniques” (p.1). It is very important for the patient to understand the options he/she has to fight this disease. The patient should be prepared to "Fight your own fight…be your own advocate and [take] charge (Fleming-Courts, 2004, p. 12).” During routine visits with the MS nurse specialist, the patient is encouraged to use various interventions and follow through with therapies. The nurse may follow-up with the patient after their appointments to ensure that the patient left with all of the information needed and questions answered. The MS nurse specialist is a great resource and in a unique position to help the person on a medical regimen and be forthcoming with therapies.
Within any disease process, it is important for the nursing staff to assess the patient’s expectations, which help guide the MS nurse specialist to the appropriate treatments for patients and their individual needs. Further assessment of these expectations provides focus to the nurse and their responsibility to develop a therapeutic relationship with the patient; help patients and their families incorporate the disease into their lives; and to encourage the patient to seek medical interventions early. Essentially, these steps provide a very good start to the management and treatment of a disease that is progressive and unrelenting, yet treatable to whatever extent the patient is willing to go.
Intervention #1
Nurses need to guide patients through the process of setting realistic expectations and getting the right treatments early for the patient.
Disadvantage #1
There are several things that happen when a person is diagnosed with Multiple Sclerosis (MS). Patients are often new to the disease and have to deal with the knowledge deficit that they face because of this newly diagnosed disease. Because of this knowledge deficit, the nurse is expected to help guide the patient through the entire process. The nurse is responsible for filling in where there is a deficit in knowledge as well as being abreast of the latest resources and treatments that are offered. With being knowledgeable about these treatments, at times practitioners and patients can get over excited with the “hype” of new products that show promise in treating MS. With this “hype,” unrealistic expectations may be set by the patient and nurse. Therefore, the nurse must stress that the Disease Modifying Drugs (DMD’s) “reduce exacerbation and slow disease progression but are not cures” (Ross p. 2). The patient must understand that relapse is expected with a disease like MS. If the nurse prepares the patient for this kind of reality, the patient will be less likely to be emotionally distraught during a relapse. Nurse must ensure that patients are setting realistic expectations for their disease process.
Disadvantage #2
With setting realistic expectations also comes choosing the right treatment and getting the patient treated early. The nurse must help the patient decide on the correct treatment by taking into consideration several factors. Lifestyle, stage or severity of disease and the patient’s ability to adhere to treatment are all things that should be considered when choosing a treatment. Another very important aspect of treating MS is to start early. Early interventions should include “pharmacological management and therapeutic strategies, education, provisions of emotional support, and advocating change in government policy” (D’Arcy p. 2). Though early intervention is key, “some [patients] refused the medications because the physician would not assure them of its effectiveness, they were doing well at the moment, and the cost was a deterrent” (Ross et al p.7). MS is a disease that needs time and attention right away; however, high costs, ineffective explanations and poor communication practices with practitioners perturb patients from seeking the health care needed.
Intervention #2
The MS Nurse Specialist should begin to develop a therapeutic relationship with the patient, and help patients and their families incorporate the disease into their lives.
Disadvantage #1
Developing relationships with patients can prove to be challenging. Some times nurses will see patients for the first time after the disease has already progressed. Furthermore, “there is often limited time to discuss individual concerns and provide counseling” (Ross p. 3). This means that the nurse must establish a healthy, therapeutic relationship within a limited amount of time and possibly take over care of a patient that has or has not been established with MS treatments. These issues listed above make it difficult for the nurse to help the patient and family come to terms with MS and its effects.
Disadvantage #2
Though it would seem that following the interventions listed above is easy to do, it can prove to be difficult. Establishing the relationships are important to ensure patient adherence and family support. However, in some case adherence is an issue. In Counseling Points, Ross states, “There are signs that indicate patients may not be adhering to therapy. In some cases, patients try to act as if everything is going well or they avoid giving direct answers. It is up to the nurse to be aware of these signs and to be able to assess what is really going on” (p. 6). Therefore, nurses must try to counteract these types of situations with consistent and frequents follow-ups with the patient and their family. This may help with patient adherence and family participation.
References
D’Arcy, C. (2005, Oct). Managing multiple sclerosis: working in partnership: Caroline D'Arcy describes how healthcare professionals can respond to the needs of people with long term conditions such as multiple sclerosis. Nursing Management. 12(6) 32-35. Retrieved on April 3, 2007 from Expanded Academic ASAP database.
Embrey, N. (Feb. 12, 2003). Benchmarking best practice in relapse management of multiple sclerosis. Nursing Standard, 17(22), 38-42. Retrieved May 28, 2007, from the Expanded Academic ASAP database
Fleming Courts, N., Buchanan, E., & Werstlein, P. (2004). Focus groups: The lived experience of participants with multiple sclerosis. Journal of Neuroscience Nursing, 36(1), 42-47. Retrieved April 3, 2007, from the Expanded Academic ASAP database.
Multiple Sclerosis Society. May 23rd, 2007. Retrieved on May 29, 2007 from http://www.mssociety.org.uk/index.html
Ross, A., Costello, K., Kennedy, P., & Pfohl, D., (2005). Managing patient expectations. Multiple Sclerosis: Counseling Points. 1(1). Retrieved April 28th, 2007, from http://www.iomsn.org/pdf/counseling_pts_Vol1_Num1.pdf
Assisted Reproductive Technologies: the Nurse’s Role in Preconception Counseling
Infertility prevents around 6.1 million people in the United States from having children. As a result, infertile couples and individuals often seek to become parents through assisted reproductive therapies (ART).
Each client has a different situation, so there are a number of assisted reproductive techniques available to suit their needs. Because assisted reproductive technology is a successful option for managing infertility, nurses must assess and evaluate factors affecting fertility, screen for genetic problems, and educate clients about the reproductive options available depending on each individual situation.
Involuntary infertility affects 10% of reproductive-age individuals. Basic infertility services may be used to treat the majority (85-90%) of infertile males and females, but the remaining 10-15% require assisted reproductive technologies. ART also provides options for individuals with or at risk for transmitting a genetic disorder and those experiencing infertility due to advanced maternal age. Since 1992, there have been over 850,000 ART cycles in the U.S. resulting in over 210,000 children conceived (Jones, 2004, p.116). The most common adverse outcome from ART treatment is multiple births which may lead to complications during pregnancy; though studies have found that many patients seeking ART treatment prefer to have twins or triplets instead of just a single infant (Grainger, Frazier, & Rowland, 2006, p.162). “Experience with and refinement of these technologies continue to increase the likelihood that an infertile woman, man, or couple is able to conceive and give birth to a child through the various technologies now available” (Jones, 2004, p.115).
Nurses are often the first healthcare providers that women encounter for preconception and prenatal issues. Preconception care involves the “assessment of risk factors for having a child with a genetic disorder, providing information about preconception, prenatal testing, and reproductive options to minimize the chance of having children with genetic problems.” Nurses obtain the family, medical, obstetric, and genetic history, physical examination, and laboratory results which provide vital information for determining risk factors. Once the risk factors have been assessed, appropriate lifestyle modifications (ex. diet, medications, environments) can be made to optimize preconception and prenatal care (Shapira & Dolan, 2006, p.143).
Nurses provide appropriate preconception and prenatal care, education, and medical counseling for those with known genetic problems to decrease the risk of complications or genetic disorders. Genetic screening of both parents is helpful in diagnosing risks for transmitting a genetic disorder. Around 85-90% of repeated pregnancy loss is due to genetic problems. If one or both parents are carriers of a genetic disorder, or have a genetic disorder themselves, preimplantation genetic diagnosis (PGD) is a very effective option. PGD involves determining the sex and chromosomal make up of an embryo produced through in-vitro fertilization. One benefit of this option is knowing the genetic health of the embryo before it is implanted, therefore eliminating the decision of whether to terminate or not if a genetic condition was found later in the pregnancy. It is possible to find out if embryos are affected with disorders such as cystic fibrosis, sickle cell anemia, and Huntington’s disease (Jones, 2004, p.126). Gender selection is helpful when the parents have been screened with either an X-linked recessive, or a Y-linked disorder. Gender selection is also available for non medical reasons and is virtually always accurate (Barad & Gleicher, 2007, p.2).
Comprehensive preconception care requires building a strong nurse/patient relationship and knowledge of the advances in genetics and reproductive health options. It is critical for nurses to use this knowledge to provide anticipatory guidance and encourage clients to think through their options. The most common assisted reproductive options available include the following: in-vitro fertilization (IVF), preimplantation genetic diagnosis (PGD), and intracytoplasmic sperm injection (ICSI) (Barad, 2007, p.3). In-vitro fertilization is a useful option for clients with diagnoses such as: fallopian tube defect, ovulatory disturbance, or idiopathic infertility (Jones, 2004, p.124). Male infertility is a factor in about 40% of couples seeking ART. Intracytoplasmic sperm injection (ICSI) may be used to achieve pregnancy in this situation. Since only one sperm is needed to fertilize the egg, only very small quantities of semen are needed. This method is used for male clients with semen anomalies, congenital or surgical absence of vas deferens, spinal cord injury, impotence, azoospermia, or idiopathic infertility. An established nurse/patient relationship provides psychosocial support and allows the opportunity for nondirective, nonjudgmental reproductive decision making. Care is delivered in a nondiscriminatory manner, protecting and respecting client autonomy, dignity, and rights. Privacy and confidentiality issues are regulated by state, and federal laws and standards of practice by the ANA (Wille, Weitz, Kerper, & Frazier, 2004, p.37). Nurses also provide referrals to other healthcare providers or professional resources such as genetic counselors, support groups, religious groups, or social workers when needed.
There are a number of factors affecting fertility (ex. diet, exercise, medications, work conditions). Nurses identify risk factors, suggest any modifications needed to maximize fertility, and provide appropriate preconception and prenatal care. Since there are a number of options available for clients experiencing infertility, nurses provide information, resources, and support to help clients make the best possible reproductive decisions. Nurses are effective in the assessment of factors affecting fertility, identifying risks for genetic problems, and providing education and support for clients making the reproductive decisions unique to their situation.
References
Barad, D., & Gleicher, N. (n.d.). Treatment options assisted reproductive technology. Retrieved May 6, 2007, from http://www.centerforhumanreprod.com/treatment_assisted.html
Grainger, D. A., Frazier, L. M., & Rowland, C. A. (2006). Preconception care and treatment with assisted reproductive technologies. Maternal and Child Health Journal, 10(7), 161-164. Retrieved May 28, 2007, from PubMed Central database.
Jones, S.L. (2004). The confluence of two clinical specialties: Genetics and assisted reproductive technologies. MedSurg Nursing, 13(2), 114-122. Retrieved April 16, 2007, from Expanded Academic ASAP database.
Shapira, S. K., & Dolan, S. (2006). Genetic risks to the mother and the infant: Assessment, counseling, and management. Maternal and Child Health Journal 10(7), 143-146. Retrieved May 28, 2007, from PubMed Central database.
Wille, M. C., Weitz, B., Kerper, P., & Fraizer, S. (2004). Advances in preconception genetic counseling. Journal of Perinatal and Neonatal Nursing, 18(1), 28-41. Retrieved April 16, 2007, from ProQuest database.
Intervention 1: Nurses must assess and evaluate factors affecting fertility.
Disadvantage 1: Clients may not be able to provide complete family history for both partners or may not be completely honest.
Disadvantage 2: Clients may be unwilling to make the necessary lifestyle changes to improve fertility (such as smoking cessation, avoiding drugs and alcohol, and hazardous environments).
Intervention 2: Nurses must screen for genetic problems.
Disadvantage 1: One disadvantage could be the cost of genetic testing. Heteroduplex analysis costs $260, DGGE tests cost $250-$800, ASO and PTT tests can cost between $190-$450, while sequencing tests can cost $500-$3,000 each. A few reasons for the high cost are that genetic tests are rare, labor intensive, and undergo multiple levels of review. There may be additional costs to you besides the actual cost of the genetic test. These may include any cost for blood draw or specimen collection, Federal Express or other shipping costs, and genetic counseling or physician fees (Toland, 2000, pg 2).
Disadvantage 2: Clients may not want to know what the risk factors are and leave things up to chance. Others may not want to make the ethical decision of what to do if they conceive a child with a genetic disorder.
References
Toland, A. E., (2000). Genetic testing: Costs of genetic testing. Retrieved May 12, 2008, from http://www.genetichealth.com/GT_Genetic_Testing_Costs_of_Genetic_Testing.shtml
Breastfeeding: the nurse's role
Breastfeeding has been proven to have many positive outcomes on the child. It has been shown to have effects on the child’s intelligence, immunologic development, weight, social development, and overall health.
There are many positive results on the mother as well. Because research shows many positive effects of breastfeeding, nurses should include breastfeeding education in both prenatal care and when teaching new mothers. Nurses can implement the following strategies to address this issue: involving lactation consultants in prenatal care, making it policy that lactation consultants are involved in educating new mothers during the immediate puerperium period, and making follow-up home health appointments with nursing standard during the puerperium period.
Historically, the popularity of breastfeeding has had its ups and downs. Like many other things, it has faded in and out of favor by people throughout the years. This partially could have been due to the fact that people didn’t know or fully understand all of the effects of breastfeeding. However, enough is now known about breastfeeding that the benefits are no longer debatable. In every situation (but very few cases) it is the best option for the baby. Not everyone is educated enough about the subject to understand the strong case for doing it. Most people understand it’s good for the baby, but they may not understand just how good it is and the numerous effects it will have on that child throughout its lifetime.
Involving nursing lactation consultants during prenatal care or even prior to pregnancy is extremely beneficial. It helps the woman (or couple) make a more informed choice about breastfeeding. “A woman’s decision about the method of infant feeding is made before pregnancy; thus it is essential to educate women of childbearing age about the benefits of breastfeeding” (Hockenberry, Lowdermilk, Perry, Wilson, Wong, 2006, p. 277). Doing so earlier could make a huge difference. Making comprehensive breastfeeding education a standard part of prenatal care would impact the number of people that decide to breastfeed. Most people at this point know that breastfeeding is good for the baby, but they may need more thorough education by nursing to understand the vast number of ways that it is beneficial for the baby throughout its lifetime.
Having nursing lactation consultants present very soon after birth is very helpful for the woman. It provides her with the education, support and encouragement that are necessary when beginning to breastfeed. “Mothers often identify support received from healthcare providers as the single most important intervention the healthcare system could have offered to help them breastfeed” (CDC, 2006, p. 1). This immediate education and attention by the nurse lactation consultant would start the woman “off on the right foot” when it comes to breastfeeding. It would give them an opportunity to spend time with someone who is focused solely on the success of their breastfeeding experience. Implementing a policy by the hospital’s nursing committee, which makes it standard practice to have nursing lactation consultants present for education and coaching during the first breastfeeding experience, could make a significant difference in a woman’s breastfeeding experience. Research has shown a “positive relationship between delivering at a hospital that employed IBCLCs (International Board Certified Lactation Consultants) and breastfeeding at hospital discharge” (Castrucci, Hoover, Lim, Maus, 2006, p. 6).
It is recommended by the American Academy of Pediatrics that breastfeeding be done for at least 12 months. Follow-up home health visits by nurses are a great way to help mothers accomplish this goal and a very positive addition to breastfeeding education. Surveys conducted by the CDC in 2004 have shown that 73.8% of babies were ever breastfed, 41.5% were still being breastfed at 6 months of age and 20.9% were still being breastfed at 1 year. “The key reason women stop breastfeeding before the recommended 6-month period is because of perceived difficulties with lactation rather than maternal choice” (Krueger, Sheehan, Sword, Watt, 2006, p. 1). Continuing to provide constant professional nursing support has been shown to increase the number of women who continue to breastfeed, despite experiencing a perceived breastfeeding barrier or lactation crisis. This support, for many women, needs to include education on continuing breastfeeding even after returning to work. The lactation consultants coach women on how to use breast pumps, how to store the milk or anything else that could be a potential breastfeeding barrier. Home health visits by lactation consultants could have a significant impact on breastfeeding duration.
Breastfeeding is extremely beneficial for both mother and baby. Mothers who breastfeed have been shown to have lower rates of some types of ovarian and breast cancers, hip fractures and osteoporosis after menopause as well as other health conditions (U.S. Department of Health and Human Services, 2005). Breastfeeding also helps mothers lose their “baby weight.” Babies who are breastfed have lower rates of asthma, ear infections, SIDS, diabetes, leukemia, lymphoma; the list of benefits for babies goes on and on (U.S. Department of Health and Human Services, 2005). There are societal benefits as well, the greatest being that breastfeeding saves on healthcare costs because breastfed babies need less medical care than those who aren’t breastfed. The three outlined nursing strategies: involving nursing lactation consultants in prenatal care, in the immediate puerperium period and in home health visits during the postpartum period would make a significant impact on the number of women who not only initiate breastfeeding, but also those who choose to continue.
References –
Castrucci, B., Hoover, K., Lim, S., & Maus, K. (2006). A comparison of breastfeeding rates in an urban birth cohort among women delivering infants at hospitals that employ and do not employ lactation consultants. Journal of Public Health Management and Practice, 12 (6), 578-585. Retrieved April 29, 2007 from Expanded Academic ASAP database (A154690153).
Centers for Disease Control. (2006, August). The CDC guide to breastfeeding interventions: Professional support. Retrieved on May 29, 2007 from http://www.cdc.gov/breastfeeding/pdf/BF_guide_5.pdf
Davies, B. & Edwards, N. (2003, September). Breastfeeding best practice guidelines for nurses. Retrieved on May 7, 2007 from http://www.rnao.org/bestpractices/PDF/BPG_Breastfeeding.pdf
Hockenberry, M., Lowdermilk, D., Perry, S., Wilson, D. & Wong, D. (2006). Nursing care during pregnancy. In Maternal Child Nursing Care (pp. 277-278). Third Edition. St. Louis: Mosby Elsevier.
Krueger, P., Sheehan, D., Sword, W., Watt, S. (2006). The impact of a new universal postpartum program on breastfeeding outcomes. Journal of Human Lactation, 22 (4), 398-408. Retrieved May 28, 2007 from Expanded Academic ASAP database (A152872149).
U.S. Department of Health and Human Services, (2005, October). womenshealth.gov: Benefits of Breastfeeding. Retrieved on February 18, 2008 from http://www.4woman.gov/breastfeeding/index.cfm/index.cfm?page=227
Intervention #1 - Involving lactation consultants in prenatal care.
Disadvantage #1 – One disadvantage of this intervention would be cost. It would be a struggle to get insurance companies to cover this in addition to the other things that are covered in prenatal care. And many people would not be able to afford to pay for this out of their pocket or more accurately would not choose to spend their money on this. The only way this intervention could truly be successful is if it was something that was standard for everyone. This intervention is aimed at educating those who aren’t planning to breastfeed and those who belong to groups of people that typically don’t breastfeed. Even though the long-term benefits far outweigh the cost and even though the insurance companies have the potential to save themselves a significant amount of money down the road, convincing the insurance companies of this would not be such an easy sell.
Disadvantage #2 – Another disadvantage of this intervention would be that it would not be able to address many of the problems that arise that cause women to stop breastfeeding. “The key reason women stop breastfeeding before the recommended 6-month period is because of perceived difficulties with lactation rather than maternal choice.” (Krueger, Sheehan, Sword, Watt, p. 1). It would be extremely valuable to start educating parents on the many benefits of breastfeeding as soon as possible, however, because this education happens so early it could not focus on helping mothers solve some of the problems that arise during breastfeeding, mothers that want to breastfeed but end up stopping early because of problems doing it.
Intervention #2 - Making it policy that lactation consultants are involved in educating new mothers during the immediate puerperium period.
Disadvantage #1 - One disadvantage of this intervention would again be cost. It would be difficult to convince insurance companies to cover this in addition to other costs associated with having a baby or convincing hospitals that it’s in their best interest to have a lactation consultant on staff. “The odds of breastfeeding at hospital discharge for a women delivering at a facility that employed an IBCLC were more than 2 1/4 times higher than women delivering at a facility that did not employ an IBCLC.” (Castrucci, Hoover, Lim, Maus, p. 6). Despite the fact that the initial cost would be minimal, I suspect insurance companies would still just view this as another cost, as opposed to viewing it as paying a little now to save big later. The same goes for the hospital, they may not see it as their responsibility to address the breastfeeding issue and therefore a cost that’s not in their best interest to spend.
Disadvantage #2 - Another disadvantage of this intervention would be that most people have made up their minds by then whether or not to breastfeed. If they have decided to breastfeed they would be very receptive to this additional education, however, if they have decided not to breastfeed they would most likely not be very receptive to receiving this education. They may actually perceive it as disrespectful if they have already made their plans known. This intervention would probably not be able to make much of an impact on breastfeeding initiation, but it could potentially effect breastfeeding duration.
Disadvantages of Cardiovascular Disease Prevention Methods
Diet and exercise have been proven to help prevent cardiovascular disease, yet according to the American Heart Association (AHA) it continues to be the leading cause of death in the United States (American Heart Association, 2008). There are 79.4 million adults currently living in the U.S. with one or more forms of cardiovascular disease including angina pectoris, myocardial infarction, and heart failure (Parkosewich, 2008). It is important that action be taken to help reverse the prevalence of cardiovascular disease. Patients need to be taught how to eat right, how to create an exercise plan that is manageable for them, and what healthcare actions can be taken to detect and prevent the disease. Because preventive care activities reduce the incidence of cardiovascular disease nurses must educate patients on the importance of diet and exercise.
Nation-wide, obesity is becoming an increasing problem. AHA recommends that disease prevention begin by age 20, however younger and younger patients are presenting with signs and symptoms of cardiovascular disease (American Heart Association, 2008). There are many factors that come together to contribute to one’s risk of developing the disease such as lifestyle, age, sex, race, and genetics (Berra, Miller, Fair, 2006). Unfortunately many of these factors are out of the patient’s hands.
Because many of the reasons that lead to an increased risk of cardiac disease are unable to be controlled it is important for nurses to emphasize what can be controlled. Nurses can collaborate with patients to develop an exercise regimen that will fit into their lifestyle and is tailored to meet their level of ability. Exercise plans need to be individualized for each patient and it is important that nurses pay close attention to what is available to the patient and their perception of the need for intervention. Ideally, the
U.S. Surgeon General recommends 30 minutes of moderate-intensity exercise most days of the week to prevent diseases associated with a sedentary lifestyle such as cardiovascular disease, cancer, and diabetes (Swain, 2006). Although moderate-intensity exercise is beneficial, it is not as beneficial as vigorous-intensity exercise (exercise that can be maintained for no longer than 5 minutes) and if possible, vigorous-intensity exercise should be recommended to patients (Swain, 2006). However, not all patients are capable of such intense exercise and therefore, it is important that exercise plans are suitable for each patient.
Along with exercise, diet is another contributor to cardiovascular disease that can be controlled. There are many effective dietary modifications that can be made. The modifications include eating foods that are low in cholesterol, saturated fat, and trans-fat, foods that decrease the body’s absorption of cholesterol, and foods that are high in fiber (Scott, 2005). It is important for nurses to teach patients to avoid foods that are greasy like fried foods and instead eat more lean meat and fish, fruits, vegetables, nuts, and healthy carbohydrates like oatmeal (Scott, 2005). It is also important to tell patients that they can still enjoy the foods they like, but caution needs to be taken in regards to portion size, as moderation is key.
Although eating healthy and getting adequate exercise are extremely important in maintaining a healthy lifestyle, they do not guarantee the prevention of developing heart disease. Preventive care and the early detection of cardiovascular disease are equally crucial. Stress tests, cholesterol tests, and regular physical exams are all ways that one’s risk for the development of cardiovascular disease or the presence of existing disease can be assessed. These methods help in the avoidance ever having a cardiac event or the
recurrence of additional events by determining whether education and treatment need to focus on preventing disease in the future or managing the disease that has already taken place and avoiding worsening. Monitoring and reporting progress toward a healthy lifestyle is a key to success in cardiovascular health (Flynn, Cafarelli, Petrakos, and Christophersen, 2007). Nurses need to stress the importance of preventive care to patients and encourage them to take the initiative to keep on top of their health maintenance. Everyone has the potential to develop cardiovascular disease; therefore preventive methods and nursing education need to be aimed at every patient regardless of current level of wellness.
The incidence of cardiovascular disease is an increasing problem and is occurring in younger and younger people all the time. Poor nutrition and sedentary lifestyles are leading to shorter life spans and a decreased quality of life in millions of people. Prevention of cardiovascular disease is extremely important and it is crucial for nurses to educate patients on the value of eating a proper diet and getting adequate amounts of exercise. The three primary components to cardiovascular disease prevention are participating in an individualized exercise regimen, eating a healthy diet that consists of foods low in fat and cholesterol, and having regular health screenings that include a close examination of cardiovascular health. Through nurse-patient collaboration and encouragement of a healthy lifestyle, patients can live longer, more enjoyable lives.
Intervention 1 - Diet in Relation to Cardiovascular Disease
Disadvantage 1 – Difficulty in Making Lifelong Dietary Changes
While cutting down on the intake of saturated fats, trans fats, and cholesterol can reduce the risk of developing cardiovascular disease (CVD) many people have difficulty making the necessary dietary modifications. When viewing the recommended dietary changes, patients may feel overwhelmed as changes in eating habits need to become a lifelong way of living. Patients may also have misconceptions regarding what foods can be included in a heart-healthy diet. The perceived inability to make this lifestyle change can make patients feel discouraged and unwilling to comply, therefore doing nothing to lower the risk of CVD development. To make dietary changes feel more manageable and realistic to patients, emphasis should focus on the accomplishment of small goals such as eating a piece of fruit rather than potato chips for lunch, and healthy fat consumption like those in olive oil and fish. Better education needs to be provided to patients on what foods should be eaten and how to make “healthy foods” better tasting so that patients will want to eat them. By setting and meeting small goals, patients may gain a sense of accomplishment and have better success at making healthy eating a way of life.
Jefferson, A. (2008). Nutritional management of coronary heart disease. Journal of Community Nursing, 22(5), 28-30.
Disadvantage 2 – Cultural Factors Leading to Obesity
High consumption of high calorie food and sedentary lifestyle is the overall cause of the obesity epidemic that is occurring. There are many reasons fast foods have become a way of life for so many people including convenience and inexpensiveness. Such a high level of fat consumption with so little physical activity is causing the prevalence of CVD to increase quickly. In addition to peoples’ ever-expanding waistline is portion size. Opportunities to “super-size” are available at most fast food restaurants and the readiness of people to order “super-sized” meals can be attributed to wanting the best value for the money spent. To overcome this issue of overeating high calorie foods without adequate energy expenditure, cultural modifications need to be made. Consumer education on the reduction of portion size needs to be made a focus as well as providing healthier, less expensive options for on-the-go eating.
Hill, J., & Peters, J. (1998). Environmental contributions to the obesity epidemic. Science, 280(5368), 1371-1374.
Intervention 2 – Health Prevention in Relation to Cardiovascular Disease
Disadvantage 1 – The Uninsured Population
Preventive health care is extremely important in detecting and reducing the development of CVD, however preventive care is unobtainable to many due to the lack of health care insurance. Although the knowledge of the need for medical management may be present, many people simply cannot afford to receive care. Because many people do not seek prevention and treatment for CVD, the occurrence of complications and premature death that results from CVD is much higher. The cost of health insurance continues to rise which causes employers to take larger and larger amounts of money out of employee paychecks or discontinue the benefit of health care altogether, and according to the Association of Operating Room Nurses (AORN), nearly 45 million Americans were uninsured for all of 2005. With better health care coverage, less people would forego or delay treatment, and therefore better patient outcomes would be achieved.
Thompson, J. (2007), The effect of health insurance disparities on the health care system. AORN Journal, 86(5), 745-764.
Disadvantage 2 – Complications with Prevention
Patient education by health care workers is of huge importance to CVD prevention. It is necessary for healthcare workers to provide information to at risk patients on the importance of issues such as diet, exercise, smoking cessation, and medical management of CVD. However, increased demands being placed on health care employees and the health care provider shortage are causing the amount and quality of patient education to be compromised. Because the workload placed on health care staff has increased, they are forced act more as problem focused care providers rather than holistic, preventive providers. Without adequate time to spend with each patient, education falls away from what is considered priority. In order to correct this problem, the importance of providing patient education needs to be emphasized to employees and re-implemented as a responsibility to providing overall quality patient care.
Anonymous. (2008). Practice nurse barriers to prevention. Australian Nursing Journal, 15(8), 6.
References
Berra, K., Miller, N., & Fair, J. (2006). Cardiovascular disease prevention and disease management: a critical role for nursing. Journal of Cardiopulmonary Rehabilitation, 26(4), 197-206.
Flynn, F., Cafarelli, M., Petrakos, K. & Christophersen, P. (2007). Improving outcomes for acute coronary syndrome patients in the hospital setting: successful implementation of the American heart association “get with the guideline” program phase I cardiac rehabilitation nurses. Journal of Cardiovascular Health, 22(3), 166-176.
Hill, J., & Peters, J. (1998). Environmental contributions to the obesity epidemic. Science, 280(5368), 1371-1374.
Jefferson, A. (2008). Nutritional management of coronary heart disease. Journal of Community Nursing, 22(5), 28-30.
Parkosewich, J. (2008). Cardiac rehabilitation barriers and opportunities among women with cardiovascular disease. Cardiology in Review, 16(1), 36-52.
Scott, S. (2005). Medical report: preventing coronary artery disease. American College of Sports Medicine, 9(6), 27-29.
Swain, D. (2006). Moderate- or vigorous-intensity exercise: what should we prescribe?. American College of Sports Medicine 10(5), 7-11.
Thompson, J. (2007), The effect of health insurance disparities on the health care system. AORN Journal, 86(5), 745-764.
Preventing, Recognizing and Treating Hepatitis C Virus
The spread of the Hepatitis C Virus (HCV) is a significant health issue across the United States. An estimated 4.1 million Americans are infected with HCV, and about 80% of those are presenting with no symptoms (National Center, 2006).
It is the nurse’s role to provide education about prevention, exposure, and treatment of HCV in all aspects of the disease. If the nurse successfully fills the role of a patient advocate, collaborator and teacher before, after and during treatment, chances are much higher the patient will become an active participant in the process as well.
There are six major strains of HCV, identified genotypes 1 through 6. The genotypes can be broken down more specifically into subtypes (1a, 1b, etc.). Genotypes are important in the diagnosis and treatment of HCV because they indicate how well patients will respond to treatment. HCV is a blood-borne virus, spread primarily through the sharing of needles and paraphernalia used to inject illicit drugs. Other possible, yet less prevalent, modes of transmission include that from infected mother to newborn, sexual transmission, needle sticks in health care workers, tattoos and body piercing. A small amount of those infected with HCV have been by exposure through hemodialysis and transfusion of blood products. Most people with chronic hepatitis C are asymptomatic for the first two decades of infection (Fahey, 2007). Patients who experience symptoms may present with jaundice, abdominal pain, decreased appetite, nausea, dark urine, fatigue and depression. Because HCV is “silent” it is extremely important for high risk individuals to be tested regularly. Blood tests for HCV begin with EIA (enzyme immunoassay) or CIA (enhanced chemiluminescence immunoassay) if positive, the diagnosis should be confirmed with RIBA (recombinant immunoblot assay), a test used to confirm a positive EIA test. If a patient has a positive HCV blood test the next step is to measure the level of ALT (alanine aminotransferase), a liver enzyme in the blood, which indicates inflammation of the liver. Liver biopsy can provide additional information, including extent of fibrosis and cirrhosis, but is no longer a requirement for diagnosis and treatment decisions. Liver biopsies are often recommended for other reasons, usually as a way of determining the extent of the disease (Fahey, 2007). Those at increased risk for contracting HCV include people who have injected drugs at any time, children of mothers infected with HCV, health care workers, and people with tattoos and piercings performed in environments with poor infection control procedures.
There is no vaccine to prevent HCV, making education an extremely important part of preventing the spread of HCV. It is vital that nurses ensure patients’ understanding of the following practices in keeping themselves and others safe from HCV. If patients use intravenous drugs, encourage attending a treatment program and the use of clean needles and other paraphernalia. Do not share items with potential for the presence of blood (e.g. razor, toothbrush). Health care workers use precaution to avoid contact with bodily fluids (e.g. gloves, safety syringes). Follow good health practices when tattooing and body piercing. If infected with HCV never donate blood, organs or tissue.
Hepatitis C is a treatable disease, with many advancements is treatment over the years. Combination therapy is the recommended, and most common, treatment for infected patients. Standard combination therapy with pegylated interferon alpha (peginterferon alpha) and ribavirin has been found to be most effective. Over 50% of patients receiving combination therapy have undetectable HCV in blood tests six months after treatment is completed (Zic, 2005). It is important for patients to know about the medication therapy they receive, as it can be difficult, with many side effects. Interferon alpha is a naturally occurring protein produced by cells after viral infection. The goal of treatment is to eradicate the virus and prevent progression of liver disease before cirrhosis, liver failure, cancer or death occur (Fahey, 2007). Peginterferons are a version of the natural interferon alpha which has been chemically modified to reduce the rate of elimination, therefore increasing the amount of time it is effective (Zic, 2007). Ribavirin is a nucleoside analogue with the ability to act as an inhibitor of the virus, HCV. The mechanism of action of treatment is not yet fully understood and holds no guarantee of success (Fahey, 2007).
Adverse reaction to treatment can vary in intensity, severity, nature and management. It is important to monitor side effects on an individual basis and create a plan for management individually as well. Many patients experience flu-like symptoms early in treatment, these typically lessen as treatment continues. Additional side effects resulting from interferon may include fatigue, hair loss, difficulty focusing, moodiness, and depression. Severe side effects are rare (seen in less than 2% of patients) and include thyroid disease, depression with suicidal ideations, seizures, acute heart or kidney failure, eye and lung problems, hearing loss, and sepsis. In addition ribavirin can cause serious anemia. In treating patients with history of anemia or conditions increasing risk for anemia, such as kidney failure, combination therapy should be avoided until anemia has resolved. Ribavirin causes birth defects and pregnancy should be avoided during treatment. It is imperative to review the product manufacturer information with the patient prior to treatment (National Center, 2006).
Success of treatment of HCV is dependent on patient adherence to the treatment program. Because of the many side effects, frequency of medication administration and patient responsibility to administer the medications, it is not uncommon for patients to discontinue the therapeutic regimen prematurely. The nurse has an important role in encouraging the completion of treatment. After formation of a relationship based on mutual trust and development of a nurse-patient bond the nurse can provide education, empowering the patient to make informed decisions regarding treatment options and other interventions (Zic, 2005) It is important for the nurse to be open and trusting of the information provided by the patient and not be judgmental, as this attitude will be conveyed to the patient. A survey involving nursing care of the HCV infected patient revealed patients discussed issues with the nurse, regarding infection and treatment, that in some cases, they did not address with the physician (Zic, 2005). If a patient offers information they are still using illicit drugs it is imperative the nurse address the issue immediately. Drug users can be offered much support to attain a drug-free status and it is felt to be unethical to offer treatment to patients still using drugs, because of the complications involved with both treatment and drug use (Fahey, 2007).
A number of supports groups exist for the HCV infected patient, along with friends, family members and caregivers. Support groups are an important piece of treatment as they provide a comfortable environment for patients to discuss concerns and hear others, similar to them, share experiences. HCV support groups provide a place for patients to compare challenges of infection and treatment and give suggestions and encouragement to complete treatment (Cormier, 2005).
As more people are diagnosed with viral hepatitis C there is a growing need for nurses in this specialized field. Acknowledging the relationship social support, health promotion and education is the first step in successful treatment of the HCV infected patient. Nurses involved in the care of HCV patients must evaluate and facilitate the need for services to ensure success for the patient.
References
Cormier, M. (2005). The role or hepatitis C support groups. Gastroenterology Nursing,
28(3), S4-S9.
Fahey, S. (2007). Developing a nursing service for patients with hepatitis C. Nursing
Standard. 21(43), 35-40. Retrieved February 12, 2008 from Academic Search Premier.
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. (2006,
December 8) Viral hepatitis C. Retrieved February 16, 2008 from http://www.cdc.gov/nchhstp/.
Zic, I. (2005). Peginterferon alpha/ribavirin comination therapy for the treatment of hepatitis C infection. Gastroenterology Nursing, 28(4), 317-328.
Interventions and Disadvantages
A. Provide education about prevention, exposure and treatment of HCV
I. Difficult to reach and receive follow through from patients/high risk individuals
Many high risk individuals hear stories about how difficult treatment can be and decide not to even attempt seeking diagnosis or treatment as a result. Some were informed that hepatitis treatment was inaccessible if they were currently injecting drugs. Others perceived treatment as inaccessible to those without health insurance. Many state they were likely to accept testing if it were more readily available. Since there seems to be a lack of awareness of locations offering free testing and lack of transportation to the testing and treatments sites, high risk individuals have been deterred from getting tested and treated (Page-Shafer 2002).
II. Low income, under educated, drug addicted patients make education challenging.
There are many factors which hinder education regarding Hepatitis C virus (HCV). It seems that disease specific information is lacking, creating a barrier for preventative health services. This lack of information is evidenced by the injection drug user’s (IDU) perception of low risk for contracting HCV, despite self-reported needle sharing. Because they do not consider themselves to be at risk many IDUs do not get tested. Despite “constant” HIV education many IDUs express little or no exposure to information regarding HCV. HIV and HCV education should be delivered concurrently, as many IDUs report receiving HIV information during drug treatment programs. Drug treatment facilities are prime sites to offer testing and treatments opportunities as well. Limited knowledge of HCV is evidenced during interviews with IDUs.
“Hepatitis has got something to so with HIV, doesn’t it? Your body turns yellow, or some shit like that? No. No. I don’t be around yellow people.” 42-year-old African American woman, lives with
her grandmother. (Lally et al, 2008)
Patients who actually got tested were often confused and frustrated related to lack of information and
education delivered at the time of diagnosis.
“When I was pregnant they said, “You know you have hepatitis C?” And I said, “Yeah, why?”…They said, “It’s no big deal”…so I thought, why should I even bother following up?...Maybe I misinterpreted that…But I did learn…you can get very sick and die from it…The only thing I know of is changing your diet and interferon.” 36-year-old white homeless woman. (Lally et al, 2008)
The most serious barrier is prioritization of obtaining drugs over attention to one’s health. IDUs report that during times when they are actively using they are less likely to get tested, treated or follow up because time is consumed by obtaining and using drugs, interfering with ability to attend to health needs. These barriers are confirmed in statements by drug addicted women.
“When you’re using you just don’t have time for really anything …not your children, not bathing…not eating, not sleeping…not being responsible. It basically consists of money and using. And worrying how to contact your connections. And trying not to get arrested in the process…Users have a 25 hour a day joc.” 33-year-old, white, homeless woman (Lally et al, 2008)
“The last thing on my mind is going to get tested…I got to be tested and I know that. But I care about being an addict more than I care about my health.” 23-year-old, African American woman.( Lally et al, 2008)
B. Administer pharmaceutical treatment with regular visits to monitor effectiveness of treatment
I. Lack of health insurance/financial resources to fund Hepatitis C treatment programs
Injection drug users (IDU) are a medically underserved population, nationally, and confront many barriers to accessing medical services. Lack of regular medical care and low to non-existent levels of insurance coverage represent significant obstacles. Because IDUs access to and utilization of medical care is inconsistent, current medical complaints often override infectious disease detection, diagnosis and education during instances when care is sought. (Lally et al, 2008) Once diagnosed payment for treatment remains a huge concern to patients.
"I though of [treatment] a lot. I've got to go to the doctor…Oh my God, I don't know how much it's going to cost. Let me see if I can get medical first, and then I'll go." 31-year-old white woman, stays with brother (Lally et al, 2008).
Patients on Medicaid are significantly more likely to be treated for HCV than patients with only Medicare coverage or private/commercial insurance. Patients with Medicaid are more likely to seek and follow through with treatment because Medicaid pays the total cost of prescription medications including interferon-based combination treatments. Medicare alone does not cover the total cost of medications resulting in large out of pocket expenses for patients (Narasimhan et al, 2006). Free, federally funded HIV testing and counseling is much more accessible through local agencies and health departments than for Hepatitis C, services which would seem to fit hand in hand.
II. Difficult to follow up for continued treatment and monitoring for many reasons, including, lack of transportation, accurate and stable contact information, mental illness and patient priorities other than health care follow up
Common reasons for non-treatment include minimal/mild disease on biopsy (38%), noncompliance (31%) , patient refusal (22%) and significant psychiatric problems (8%) (Narasimhan et al, 2006). A study reveals very low income is the strongest correlating group of HCV infected patients. Four California counties participated in the study which revealed 60% of those infected earn a monthly household income of less than $999 and only 7% earning over $3000 per month. 90% had not earned a college degree and 41% did not complete high school. 62% of those infected with HCV were single, 54% having more than 5 sex partners and 45% diagnosed with an STD other than HCV (Page-Shafer et al 2002). Lack of education and financial resources make continuation of treatment and monitoring very challenging for healthcare professionals.
Many patients indicate that a lack of transportation hinder their ability to receive testing, results, treatment and monitoring.
"Transportation…would help a heck of a lot because people are out here catching buses and they're [drug] sick. Who wants to go out there in the snow, rain, sleet, whatever, even when they're not sick?...I haven't been making appointments because I don't have a ride out there. And I'm not going to get on no bus and all that shit when I don't feel good." 43-year-old CapeVerdian woman, homeless (Lally et al, 2008)
References
Lally et al (2008). A qualitative study among injection drug using women in Rhode Island: attitudes toward tesing, treatment, and vaccination for hepatitis and HCV. AIDS Patient Care and STDs. 22(1). 53- 63. Retrieved May 9, 2008 from Academic Search Premier.
Narasimhan, G. et al (2006). Treatment rates in patients with chronic hepatitis C after liver biopsy. Journal of Viral Hepatitis. 13. 783-786. Retrieved May 4, 2008 from Academic Search Premier.
Page-Shafer, K. et al (2002). Hepatitis C virus infection in young, low-income women: The role of sexually transmitted infection as a potential cofactor for HCV infection. American Journal of Public Health. 93(4). 670-676. Retrieved May 4, 2008 from Academic Search Premier.Preventing, Recognizing and Treating Hepatitis C Virus