DiversityNursing Blog

Approximately 56 million American adults are struggling with a mental illness or substance use disorder, according to the American Psychiatric Nurses Association (APNA).

An article from mentalhealth.gov, shows the current mental health workforce shortage is projected to grow and would leave the country 250,000 professionals short by 2025.

Only 44% of adults and 20% of children in the U.S. receive the mental health and substance use care they need because there is a growing shortage of qualified professionals trained to provide timely and effective treatment.

This lack of treatment significantly contributes to one of the leading causes of death in the U.S, suicide.

According to the same mentalhealth.gov article, suicide is the 10th leading cause of death in the United States. It accounts for the loss of more than 41,000 lives each year, more than double the number of lives lost to homicide.

An article in the Journal of the American Medical Association (JAMA) discusses the increase in children under 18 going to emergency departments due to attempts of suicide or suicidal ideation.

One reason demand for mental health professionals has increased is because more Americans are gaining health coverage. It's the law per the Affordable Care Act that insurers can no longer deny coverage to people who have diagnosed mental illnesses.

Also fewer medical students are specializing in psychiatry because psychiatry jobs don't pay as well as other fields. Students facing high medical school debt are more likely to pick the jobs offering better pay.

There has also been a surge in substance use disorders and greater public awareness of mental illness. Increased public awareness means more people living with mental illness will seek treatment.

Healthcare providers and the medical community at large need to implement a more supportive environment for the psychiatry profession. There should also be increased compensation for psychiatry jobs and student loan forgiveness or free/low-cost psychiatry schooling.

Policy makers should support and enact quality mental health services that will improve public health, particularly populations who most often have no access to mental health services.

LGBTQ+ people of all ages, races and ethnicities, religions, and social classes have experienced health inequalities.

According to the Office of Disease Prevention and Health Promotion (ODPHP) and healthypeople.gov, research suggests that LGBTQ+ individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBTQ+ persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBTQ+ individuals, and have long-lasting effects on the individual and the community. Personal, family, and social acceptance of sexual orientation and gender identity affects the mental health and personal safety of LGBTQ+ individuals.

It is difficult to estimate the number of LGBTQ+ individuals and their health needs because most national or State surveys do not include sexual orientation and gender identity questions.

In order to document, understand, and address the environmental factors that contribute to health disparities in LGBTQ+ communities, we need to increase the number of nationally-representative health-related surveys that collect information on sexual orientation and gender identity (SOGI). This will allow researchers and policy makers to accurately characterize LGBTQ+ health and disparities.

The ODPHP and healthypeople.org research has found,

• LGBTQ+ youth are 2 to 3 times more likely to attempt suicide.
• LGBTQ+ youth are more likely to be homeless.
• Lesbians are less likely to get preventive services for cancer.
• Gay men are at higher risk of HIV and other STDs, especially among communities of color.
• Lesbians and bisexual females are more likely to be overweight or obese.
• Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals.
• LGBTQ+ populations have the highest rates of tobacco, alcohol, and other drug use.

According to the Aging with Pride: National Health, Aging, and Sexuality/Gender Study, about 2.7 million U.S. adults 50 and older identify as LGBTQ+, including 1.1 million age 65 and older. Those numbers are expected to nearly double by 2060.

And among subgroups within the LGBTQ+ community, some are struggling with their health more than others:

• Both Hispanic and African-American LGBTQ+ older adults in the project are more likely to report having HIV than their white counterparts.
• Hispanic LGBTQ+ adults are more likely to report asthma, diabetes and visual impairment.
• African-American LGBTQ+ older adults are more likely to be obese and have high blood pressure.
• Native American LGBTQ+ older adults are less likely to report cancer than whites but more likely to report poor physical health, disability, obesity, asthma and cardiovascular disease.
• Asian/Pacific Islander LGBTQ+ older adults are more likely to have visual impairment.

Along with collecting SOGI information in national surveys and health records, other efforts needed to improve LGBTQ+ health disparities include,

• Better access to health insurance, employment, and housing
• More laws protecting against bullying in schools
• More social programs targeted to and/or appropriate for LGBTQ+ youth, adults, and elders
• Better access to health care providers who are knowledgeable and culturally competent in LGBTQ+ health
• Prevention of violence and homicide toward the LGBTQ+ community, and especially the transgender population

It is necessary that efforts are enhanced to improve LGBTQ+ health and eliminate disparities so LGBTQ+ individuals can lead long, healthy lives.

Americans rate the honesty and ethics of Nurses highest among a list of professions for the 18th year in a row according to the National Gallup poll.

Nurses are consistently rated higher in honesty and ethics than all other professions by a wide margin.

Currently, 85% of Americans say Nurses' honesty and ethical standards are "very high" or "high," essentially unchanged from the 84% who said the same in 2018.

"The public trusts Nurses because we put the safety of our patients above all else," Massachusetts Nurses Association President and RN Donna Kelly-Williams said. "Every day across the United States, Nurses strive to provide the highest quality care despite the massive challenges posed by corporate healthcare. We are inspired by our patients to advocate for safe, accessible care and we appreciate their trust and respect."

National Nurses United Executive Director, Bonnie Castillo, RN said, “We are honored by this poll and what it reflects - that our patients, their families and the public know that they can trust and count on Nurses to stand up for them. This year’s results have special meaning for us as we move into 2020, which the World Health Organization has declared the ‘Year of the Nurse and Midwife."

Gallup notes that since Nurses were added to the survey in 1999, they have topped the list of most trusted professions every year except in 2001, when firefighters were recognized shortly after the Sept. 11, 2001 terrorist attacks for their heroism and bravery.

We at DiversityNursing.com know how special, compassionate and giving you are. We are delighted that you consistently receive this recognition from the National Gallup poll. You earn it – every day!

Vision impaired patients face many challenges when visiting hospitals for treatment. There are different ways staff and hospital design can help assist patients who are struggling.

According to research from JAMA Ophthalmology, vision-impaired Medicare beneficiaries and commercial health insurance patients had significantly higher healthcare utilization and costs during and immediately after hospitalization. This is happening because vision-impaired patients have difficulty following hospital routines and struggle to read discharge orders and medication instructions. The excess costs were estimated at more than $500 million annually.

Hospital staff can play a major role in helping these patients by being actively engaged with them and their families.

Lisa Allen, PhD, MA, Chief Patient Experience Officer at Johns Hopkins Medicine in Baltimore, which includes the Wilmer Eye Institute, says, "The biggest issue is to ask the patient or the patient's family what they need to keep them safe. We need to ask that question to everybody, but that patient engagement question is the most important piece for visually impaired patients. When we assume there is a one-size-fits-all for the visually impaired, we are making a mistake. In other words, if you are not a braille reader, and many blind people are not braille readers, then having braille is not going to help when you are in the hospital."

According to Health leaders media, Johns Hopkins Medicine and Bascom Palmer Eye Institute shared their best practices for caring for vision-impaired patients which included measures designed for discharge and medication management, patient safety, and special accommodations.

Johns Hopkins provides discharge instructions in large font type and has the capability to audio-record instructions for patients. They also provide discharge instructions in a format that can be used with a screen reader.

Johns Hopkins staff are trained to promote safety. After surgery, all Johns Hopkins patients have a staff member with them when they are getting up for the first time and when they are walking the hallways.

The Americans With Disabilities Act (ADA) says, staff should initiate an introduction to a patient who is blind by addressing the patient by name. They should always identify themselves by name and function and the reason they are there.

At the University of Miami Health System's Bascom Palmer Eye Institute, stairwells are designed to lower fall risk for vision-impaired patients. They lengthened the staircase guard rails so they extend beyond the bottom of the stairs.

Johns Hopkins is implementing a Bluetooth way-finding app that can be used from home and while using public transportation. "We made sure when we bought the program that it had voice capability, so it can tell you to go to an elevator, it can tell you that you are at an elevator, it can tell you what floor button to push, and it can guide you throughout the inside of the hospital", said Allen.

If your health system does not have a bluetooth way-finding app, the ADA recommends being verbally specific. When a visually impaired patient wants to independently find their way with a cane or a guide dog, be sure to use right and left as they apply to the person who is blind. What is on your right is on the left of a person facing you. For example indicate the number of blocks, hallways, or doors to the elevator. Let the patients know exactly how far the bathroom is located outside of their room or where their food is closely located to them inside their room and what the food is. Verbal interaction is key.

It is important to offer assistance in a way that is not demeaning to the patient. With more research and input from patients, the future of health system's best practices should improve to provide even better patient care.

Social isolation is a growing epidemic. It's becoming increasingly recognized as having critical consequences. According to recent surveys, the percentage of American adults who say they’re lonely has doubled from 20% to 40%, since the 1980s.

Loneliness is a serious health concern. Studies show that elderly people who are socially isolated were twice as likely to die prematurely. According to The New York Times, about one-third of Americans older than 65 now live alone, and half of those over 85 do.

The increased mortality risk is comparable to that from smoking. And loneliness is about twice as dangerous as obesity.

One recent study found that isolation increases the risk of heart disease by 29% and stroke by 32%.

John T. Cacioppo, a psychology professor for the University of Chicago, studies how loneliness and social isolation affect people’s health. He says, "In terms of human interactions, the number of people we know is not the best measure. In order to be socially satisfied, we don’t need all that many people. The key is in the quality, not the quantity of those people. We just need several on whom we can depend and who depend on us in return."

Many programs aimed at reducing social isolation and/or loneliness in older adults may help improve physical, mental (e.g. depression and mental well being), and social (e.g. social support and loneliness) health in older adults who are or are thought to be lonely or socially isolated. These programs include: a psychosocial activity group involving art, discussions, therapeutic writing, group therapy, and exercise that led to new friendships.

Some health systems and payers are making strides linking screenings for social isolation with referral to social and clinical support services.

Both Denmark and Great Britain are devoting more time and energy to finding solutions and staging interventions for lonely people, particularly the elderly.

Even though the internet has possibly contributed to our isolation, it might hold a key to fixing it. According to TIME, online dating statistics show that couples who found each other online and stayed together shared more of a connection and were less likely to divorce than couples who met offline. If these statistics hold up, it would stand to reason friendships could also be found in this way.

To help reduce social isolation, communities should ensure elders have easy access to transportation, through discounted bus passes or special transport services, so they can maintain social connections.

Although there is no one-size-fits-all approach to fixing social isolation and loneliness, addressing these issues and offering support services and group activities for these patients is a step in the right direction.

The holidays are meant to bring feelings of joy and cheer, but this time of year can also bring a lot of stress. No matter what holiday you celebrate, this season can affect us all. Especially Nurses, who work in an already stressful environment, as you juggle more difficult demands of your time, emotions and patience. 

Most people celebrate the holidays with family and friends at home, but you miss many holidays to take care of your patients. Having celebrations with your coworkers is nice, but nothing feels like home. Some families will try to move dates around so they can all celebrate together.

If you're missing holidays to treat patients, then those patients are missing out on their holiday celebrations too. Spreading extra holiday cheer can make you both feel some joy. Fortunately, you get to go home at the end of the shift.

Another stressor can be financial as people go crazy buying gifts and worry how to pay for them. Try not to overspend. Perhaps you’re crafty and can make some of those gifts.

The loss of loved ones is more difficult this time of year. In your profession, you witness the passing of patients and often you’re coping with your own feelings of loss as you try to console the family. Lean on fellow coworkers and managers to help relieve some of the stress. Don't hold it all in and try to get through it alone.

In colder climates, as the season changes to winter, many people are affected by SAD seasonal affective disorder. With less daylight, spending more time indoors and the sense of isolation it can bring, dealing with the cold, and extreme weather conditions, can be quite depressing unless… you love outdoor winter sports! To combat SAD, try light therapy, exercise, planning social get-togethers, talking to a mental health professional, or using medication to help lighten your mood.

The Mayo Clinic offers more tips to help with holiday stress.

• Acknowledge your feelings. It's OK to take time to cry or express your feelings. You can't force yourself to be happy just because it's the holiday season.
• Reach out. If you feel lonely or isolated, seek out community, religious or other social events.
• Stick to a budget. Before you go gift and food shopping, decide how much money you can afford to spend. Then stick to your budget. Don't try to buy happiness with an avalanche of gifts.
• Learn to say no. Saying yes when you should say no can leave you feeling resentful and overwhelmed. Friends and colleagues will understand if you can't participate in every project or activity.
• Don't abandon healthy habits. Don't let the holidays become a free-for-all. Overindulgence only adds to your stress and guilt.
• Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.
• Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.

At the end of the day, no one is going to be happy around you if you’re not happy. It’s so important to take care of YOU. We’ve offered some suggestions to help you deal with stress during the holidays. Now it’s up to you to choose what will work for you. Good Luck!

Happy Holidays, Peace and Joy from your friends at DiversityNursing.com!

For the first time in history, the world will unite in celebrating the benefits that Nurses and Midwives bring to the health of the global population. The World Health Organization (WHO), has declared 2020 as The Year of the Nurse and the Midwife (YONM).

It is celebrated in honor of the 200^th anniversary of Florence Nightingale's birth. President of the International Council of Nurses (ICN), Annette Kennedy, said "The 20 million Nurses around the world will be thrilled to see their profession recognized in this way. Florence Nightingale used her lamp to illuminate the places where Nurses worked, and I hope the designation of 2020 as the International Year of the Nurse and Midwife will provide us with a new, 20-20 vision of what Nursing is in the modern era, and how Nurses can light the way to universal health coverage and healthcare for all.”

WHO is working with partners such as, the International Confederation of Midwives (ICM), International Council of Nurses (ICN), Nursing Now and the United Nations Population Fund (UNFPA). Their goal for this year-long global focus on Nurses and Midwives is to: 

• Celebrate the contributions of health workers, with particular focus on Nurses and Midwives, in improving health globally,  
• acknowledge, appreciate and address the challenging conditions Nurses and Midwives  face while providing care where it's needed most and
• advocate for increased investments in the Nursing and Midwifery workforce

Lord Nigel Crisp, co-Chair of the Nursing Now campaign said, “The WHO has provided a unique opportunity both for countries to demonstrate how much they appreciate their Nurses and Midwives and to showcase what more Nurses and Midwives can achieve if given the support to do so."

Check out the World Health Organization's video, Nurses and Midwives: Key To Universal Health Coverage

We at DiversityNursing.com are thrilled Nurses and Midwives are receiving recognition for their commitment to the profession and selfless dedication to their patients, families and students.

November is Diabetes Awareness Month. This is the perfect time to discuss diabetes health disparities. Racial and ethnic minorities have higher prevalence rates, worse diabetes control, and a higher rate of complications, according to an article from the U.S. National Institutes of Health's National Library of Medicine.

According to the American Diabetes Association (ADA), compared to white adults, the risk of having a diabetes diagnosis is

·         77% higher among African Americans

·         66% higher among Latinos/Hispanics

·         18% higher among Asian Americans

The article from the ADA also notes, even though there is a high rate of this condition, minorities receive lower care quality and experience more barriers to self-management than white patients. They are less likely to receive advised services such as annual hemoglobin A_1c (HbA_1c) testing, annual LDL cholesterol (LDL-C) testing, and an annual retinal examination. 

Minorities are more likely than white people to live in areas of low socioeconomic status. These neighborhoods lack shared ideas about health promotion, access to healthcare services, healthy foods, and safe places to exercise. These are all needed to improve an individual’s management of their diabetes.

The Office of Minority Health (OMH) at the Food and Drug Administration (FDA) said they are teaming up with the American Diabetes Association and other groups to help people prevent and treat diabetes, and to specifically address the disparities in minority groups.

An article from the Food and Drug Administration said, "OMH's outreach work includes raising awareness of the need for more research in diabetes therapies that address racial and ethnic differences. OMH is also working to make sure minorities are included as subjects in clinical trials of medical products for the treatment of diabetes and other diseases."

The Centers for Disease Control and Prevention (CDC) started the National Diabetes Prevention Program (National DPP) which is a partnership of public and private organizations who work together to provide an affordable, evidence-based lifestyle change program to help people with prediabetes prevent or delay type 2 diabetes.

However, according to the CDC some racial and ethnic minority groups were enrolling in the program at lower rates than other groups. To help increase access, the CDC recently funded 10 national organizations to start new in-person programs in underserved areas (regions with fewer resources to address health disparities). In addition to in-person delivery, the program can also be accessed online, by distance learning, or through a combination of these formats.

An estimated 250,000 service members transition out of the military each year. According to a survey by Navy Federal Credit Union, in partnership with the nonprofit Hire Heroes USA, health care topped the list of the 10 best career employment opportunities for those transitioning.

Service members have skills, principles, and standards that fit perfectly into a hospital or health system’s own core values and needs.

Veterans are trained to keep an eye on the big picture, while also keeping a strong sense of details.

Military personnel are the ultimate team players and are team-trained leaders. One of the first things they learn in the military is to become a good leader, you must first be a good follower. For them, rising through the ranks is a rite of passage and allows all military leaders to create their own management styles based on what they've learned from their superiors.

Veterans are able to adapt and work well in extreme conditions. They are accustomed to assessing situations and quickly forming a plan of action.

These trained service members are experts in delivering emergency services in under-resourced environments. This is an invaluable resource for rural and critical access hospitals.

Veterans can also relate to a Nurses' 12-hour shift, foregoing bathroom and lunch breaks during long durations.

According to an article from the National Institutes of Health, The Nursing shortage in the United States is expected to reach 260,000 Registered Nurses by 2025. Capitalizing on prior education, experience, and skills of military clinical personnel to fill these jobs could significantly reduce the projected Nursing shortage.

Many Nursing schools offer Veterans' Bachelor of Science Degree in Nursing (VBSN) programs. Programs like these, strengthen and grow the Nursing workforce through increased enrollment, progression, and graduation of veterans from baccalaureate Nursing programs.  These programs help veterans transition from their former military role to a civilian Registered Nurse.

Veterans possess clinical skills and have received excellent training in care delivery. All of the qualities mentioned will add value to your health system.

According to Diversity Best Practices, from 2015 to 2030, the US population is projected to grow by 12 percent, from about 321 million to 359 million. Most of that growth will come from minority and immigrant populations.

In order to better serve this growing population there needs to be more diverse healthcare professionals in leadership roles that mirror a culturally competent workforce. 

Modern Healthcare covered the industry’s lack of diversity in the C-suite mentioning, "Only 14% of hospital board members and 9% of CEOs are minorities, according to the most recent study by the American Hospital Association's Institute for Diversity and Health Equity—the same percentages as in 2013."

Yvonne Wesley, PhD, RN, FAAN and M. Jane Fitzsimmons, MSN, RN worked together to better understand the barriers diverse Nursing leaders faced in progressing their careers into higher leadership roles.

They created a survey that asked, "What do you perceive as the top three barriers for diversity Nurse leaders in advancing their careers to the executive level?" 

The answers were:

• Lack of equal access to inclusion.
• Lack of mentorship and sponsorship.
• Lack of opportunities for leader experiences.

Here are some ways to promote diversity in healthcare leadership.

In order to destroy these barriers, leaders of all backgrounds and ethnicities must first understand and accept that these barriers do exist. Those leaders can take that knowledge and their own personal cultural insights and use them to effectively address disparities within their own communities.

Mentoring programs are extremely important and should be implemented ASAP. As in any business, Nurses need leaders to help guide and inspire them. Representation of diverse Nurses in leadership positions creates positive influence and confidence in other Nurses looking to achieve leadership goals in the future.

Recruiting diverse candidates at every level increases representation in management, but also develops a diverse workforce and future pool of qualified candidates.

Utilize pro-diversity initiatives to reduce social isolation. Hire a Diversity & Inclusion Officer and appoint a diversity committee. There should be a diversity action plan, diversity training, social gatherings, and resource groups.

In healthcare, trust and representation matters. More diversity in healthcare leadership roles will create better patient outcomes.