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DiversityNursing Blog

Erica Bettencourt

Content Manager and Social Media Specialist

Recent Posts

A Nurse Scientist and An Engineer Create Heart App

Posted by Erica Bettencourt

Thu, Apr 06, 2017 @ 03:40 PM

heartapp.pngTwo professors at USF collaborated to work on improving self-care at home for patients with congestive heart failure. Another goal was to reduce their hospital readmissions. They knew most patients are living on their own after they get out of the hospital and it can be a challenge for patients to keep up with their regimen. They teamed up to create an app that could help them.
 
Learn all about it in the article below. Perhaps you have an idea that can help your patients and their families?

A nurse scientist and an engineer created a smartphone application for patients with heart failure — and the patients participating in a pilot study said they’re finding it useful in helping them make the right choices about their health, according to an article published online by the University of South Florida in Tampa.

Called HeartMapp and now copyrighted by USF, the device can be used on Android smartphones by patients with congestive heart failure.

Ponrathi Athilingam, PhD, assistant professor at the USF College of Nursing, and Miguel Labrador, PhD, professor in the Department of Computer Science and Engineering at the USF College of Engineering, created HeartMapp. Their goal was to improve patient self-care and reduce costly hospital readmissions.

“As a cardiology nurse of 25 years, I know that patients with heart failure, who must follow an intricate medication regimen and self-management practices at home to stay healthy and prevent getting admitted to the hospital, struggle with self-care,” Athilingam said in the article. “After patients leave the hospital, they are alone. However, they do have a phone as a companion. So, we developed this easy-to-use, patient-centered technology to help them keep their heart health on track.”

Monitoring vital signs

The app has six modules which help patients monitor their vital signs, perform breathing and walking exercises, take their medication, read educational information on heart health and see how they’re doing. The app also reminds them to check their weight and blood pressure in the morning and assess any symptoms.

Patients check the app to see if they’re in the green, yellow or red zone. The green zone means they’re doing fine, according to the article. “The red zone means they’re gravely ill and need to immediately go to the hospital,” Athilingam said in the article. “But the goal is to have patients note when they’re in the yellow zone so they can contact their physicians and work to get back to the green zone, she said.

Athilingam and Labrador are testing HeartMapp with nine patients from the USF health cardiology clinic, and USF hopes that will lead to making the app commercially available, according to the article.

The app creators also wrote several articles about small studies they’ve done regarding the app’s usage.  In one study, they surveyed 25 patients with congestive heart failure and 12 healthcare workers via questionnaires.  In that study published by the journal Applied Nursing Research, the authors, which included Athlingam and Labrador wrote that “patients reported moderate self-confidence in using HeartMapp.”

They also wrote in the abstract: “The healthcare members demonstrated high confidence in recommending HeartMapp to patients and in utilizing data from HeartMapp for clinical decision making.”

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Topics: smartphone applications, heart app, congestive heart failure

2017 Best Nursing Apps

Posted by Erica Bettencourt

Mon, Apr 03, 2017 @ 04:08 PM

appsfornurses.jpgNurses are on the move and they aren't carrying around medical books and a computer to help them when they need it. Wait, on second thought, that little smart phone in your pocket is just that, a computer, filled with apps catered to your needs. 
 
If you need definitions to medical terms, there's an app for that. There's also one that will keep you up to date on medical news and others that will provide you with information on specific diseases and medical cases. If you haven't looked into apps that can help you out in the Nursing field, here's a list of the best of the best. 

 

Nursing Central App1. Nursing Central

Unbound Medicine’s award-winning Nursing Central app is available on Android and iOS devices. Users are satisfied with its extensive drug and disease information. Nurses and students are able to work more efficiently thanks to Nursing Central providing detailed information on diseases, tests, drugs and procedures on the go.

What users are saying:

“This app is awesome! I love that it has all the necessary references. The search is great and pulls up the item in all the references…”

 

Rating: 4-star rating

Cost: Free

Available: Android and iTunes

Diseases Dictionary App2. Diseases Dictionary

A free Android and iOS app, Diseases Dictionary offers a long list of illnesses and conditions nurses are apt to encounter, along with symptoms and preferred treatments. Nurses and students can type in the symptom and a list of possible diseases will appear; this app provides comprehensive information about how to deal with symptoms/how to prevent the disease; and how to improve knowledge about diseases.

What users are saying:

“High informative. I recommend this app.” “A Must-Have app! What an educative app!”

Rating: 4-star rating

Cost: Free

Available: Google Play and iTunes

Black's Medical Dictionary App3. Black’s Medical Dictionary

For over a century, medical professionals have relied on Black’s Medical Dictionary. With over 5,000 definitions of medical terms, this app features a navigational display with rich media experience; user-friendly, intuitive interaction; and the ability to share with friends using social media features. Reviews are mixed, with some users complaining of the app’s $14.99 price tag.

Rating: 3-star rating

Cost: $14.99

Available: Google Play and iTunes

The Color Atlas of Family Medicine App4. The Color Atlas of Family Medicine

2,000 full-color photographs will help you visually diagnose common and uncommon conditions and diseases encountered in clinical practice. At $124.99, it’s not ideal for nurses on a budget — but satisfied users report that the app’s thorough explanations and color pictures are well worth the money.

What users are saying:

“Full of pictures and useful facts about diseases and treatments…I refer to it often in my practice.” “Great primarily outpatient reference.” “Very impressed with the app, good photo resolution when searching for specifics.” 

Rating: 5-star rating

Cost: $124.99

Available: Google Play and iTunes

Merck Manual App5. Merck Manual

The oldest continuously published textbook for English-speaking medical professionals, the Merck Manual is free on iTunes. This app includes “How to Do” videos on numerous outpatient procedures and physical examinations; quizzes that check knowledge of medical disorders, symptoms and treatments; interactive case simulations that test the ability to treat a specific patient over the disease course; and editorials written by top medical experts. Some users believe it is a must-have for nurses, but others feel it’s difficult to navigate.

What users are saying:

“I downloaded this new Merck Manuals reference when I saw it first available, and have the home user version too.” “Offline use and excellent interface!”

Rating: 4-star rating

Cost: Free

Available: Google Play and iTunes

MedPage Today App6. MedPage Today

Get up to date with the latest developments in the medical world with MedPage Today, MedPage is the leading source for breaking medical news, daily coverage of over 30 specialties, annual coverage of over 60 meetings and symposia and free CME and continuing education credits.

What users are saying:

“Very good app for doctors. Awesome and authentic information with reference.” “Best app for medical students, but needs more details.”

Rating: 4-star rating

Cost: Free

Available: Google Play and iTunes

Pedi STAT App7. Pedi STAT

Satisfied users on iTunes claim that Pedi STAT is the easiest medical app to use. Described as a rapid reference for RNs, paramedics, physicians and other healthcare professionals caring for pediatric patients in the emergency or critical care environment. The Google Play version costs $7.87.

What users are saying:

“Great resource for paramedic, CCP, or ER RN, use it frequently. “Awesome…use this app in clinical situations a lot.”

Rating: 4-star rating

Cost: $2.99

Available: Google Play and iTunes

NurseTabs: Fundamentals App8. NurseTabs: Fundamentals

The NurseTabs series offers a thorough overview of several important topics, with many concepts discussed in video form. App users will have access to over 120 skills and procedures separated by topic areas learned through fundamental nursing courses. After selecting a skill, you’re presented with the equipment needed to perform the procedure and a step-by-step of how to perform it safely. The app is $9.99, but in-app videos cost another $4.00 — a fact that does not please some users.

Rating: 4-star rating

Cost: $9.99

Available: Google Play and iTunes

NurseTabs: MedSurg App9. NurseTabs: MedSurg

Another valuable app in the NurseTabs series, MedSurg focuses on diseases and conditions. This app is suited for novice nurses and nursing students with over 340 common diseases and disorders that are separated by the body system. Once a disease/disorder is selected, nursing processes, managing client care and tons of other useful information is at your fingertips. Like Fundamentals, it costs $9.99. The two apps are available in bundle form for $19.99 on Google Play.

What users are saying:

“Good for students, but basic and vague for nursing…” “I am an LPN a charge nurse and I love this app. So easy to use. Every diagnosis u can think of is on the app…”

Rating: 4-star rating

Cost: $9.99

Available: Google Play and iTunes

Nurse's Pocket Guide App10. Nurse’s Pocket Guide

The Nurse’s Pocket Guide is constantly updated with new information on diagnosis and interventions. Each diagnosis listing includes a definition, related factors, defining characteristics, prioritized actions/interventions, NIC/NOC classifications and documentation of guidelines. The free app is available on iTunes and Google Play.

What users are saying:

“It’s a good app if you are willing to pay for (in-app purchases).”

Rating: 3-star rating

Cost: Free

Available: Google Play and iTunes

Voalte One App11: Voalte One

An HIPAA-compliant app, Voalte One provides exceptional communication for caregivers. It provides alarm and nurse alert notifications, text messaging on easy-to-use app. It also offers VoIP calling. This tool helps streamline communications in tough situations. It’s easy to use and provides a way to gather information immediately. 

Rating: 4-star rating

Cost: Free

Available: Android and iTunes

NursingCenter CEConnection App12. NursingCenter CEConnection

Earning continuing education credits can be a challenge, but NursingCenter CEConnection makes it easy. Thanks to this easily accessible app, you can view CE courses and complete them offline whether you’re at home, on your commute or on your shift. Once you return to a wifi connection, your assignments will automatically sync with your CE Planner account and access your certificate.

Rating: 3-star rating

Cost: Free

Available: Google Play and iTunes

Heather's Nursing Cheat Sheets App13. Heather’s Nursing Cheat Sheets

Download Heather’s Nursing Cheat Sheets on your Android device and get ready to access the detailed information you need, when you need it. The app has a temperature conversion chart, a neurological coma scale, and several other helpful cheat sheets. It is important to know that the information in this app is compiled from a variety of sources and you should always know your own facility’s protocols.

What users are saying:

“Amazing app! As a RN working bedside in the critical care setting, this is my quick go to tool…” “Great reference tool!” “Awesome! A student nurse’s dream!”

Rating: 5-star rating

Cost: $2.99

Available: Google Play

Davis's Drug Guide For Nurses App14. Davis’s Drug Guide For Nurses

With information on over 5,000 generic and brand name drugs, Davis’ Drug Guide is a great and comprehensive tool. With practical information on trade name and generic drugs, each focuses on safety and patient care, including information on dosing and administration, interactions, side effects and patient teaching. The app has numerous rave reviews on Google Play.

What users are saying:

“I love the website, but the app is frustrating because I cannot search medications…” “Fast, easy access to information without having to lug a book around…”

Rating: 4-star rating

Cost: Free

Available: Google Play and iTunes

Epocrates Rx App15. Epocrates Rx

Available on iTunes and Google Play, Epocrates Rx boasts high ratings on both platforms, and 1 out of every 2 physicians rely on Epocrates to enable better patient care. The app offers detailed information for a wide range of brand, generic, and over-the-counter medications. A one year Epocrates Plus subscription is available for $174.99.

What users are saying:

“Superb guidance.” 

Rating: 4-star rating

Cost: Free

Available: Google Play and iTunes

I.V. Drug Handbook App16. I.V. Drug Handbook

Published by McGraw-Hill, this useful Android app helps nurses successfully carry out one of the profession’s trickiest tasks. It features several helpful learning tools, including a ‘Favorites,’ ‘Recent’ and ‘Word of the day’ features to help you further enhance your vocabulary from an extensive library. The Google Play version is free, but offers in-app purchases.

What users are saying:

“Very ok.” “Stellar”

Rating: 3-star rating

Cost: $44.99

Available: Google Play and iTunes

NCLEX Flashcards App17. NCLEX Flashcards

Whether you’re currently in nursing school or could use a refresher, the NCLEX Flashcards app has over 1,600 practice questions, quizzes, mnemonics, and strategies. Bonus: If you purchase the mobile version, you’ll be granted access to the full-featured online version. The Google Play version is free, but offers in-app purchases.

What users are saying:

“Love it buy after 2 questions it stops, please fix!” “Excellent! Very helpful and it makes it easy to remember everything.” “Good app for NCLEX review…it does freeze at times.”

Rating: 4-star rating

Cost: $3.99

Available: Google Play and iTunes

Nursing Guide App 18. Nursing Guide App

Quantum X. Inc’s Nursing Guide App offers a range of information for nursing students and experienced nurses alike. Equipped with mnemonics, articles and tips and quotes, this app was created to share basic to complex information about the nursing field.

What users are saying:

“Very helpful.” “Excellent. More than expected.” “Does not give full info…”

Rating: 4-star rating

Cost: Free

Available: Google Play and iTunes

Critical Care ACLS Guide App19. Critical Care ACLS Guide

The Critical Care ACLS Guide is the smartphone age’s response to a classic, twenty-year-old booklet that made it easier for nurses to check doses and interpret EKGs. You can have immediate access to critical information loaded with rich content, detailed illustrations and features including quick navigation, expanded search capability, calculators and custom bookmarks.

What users are saying:

“Effective.” “Well designed to provide fast information.” “Better than expected for immediate needs.”

Rating: 4-star rating

Cost: $7.99

Available: Google Play and iTunes

NurseGrid App20. NurseGrid

Scheduling can be a hassle for nurses, but with iTunes’ NurseGrid, it doesn’t have to be. Used by over 200,000 nurses, the app allows for schedule management across several work sites. Because of this app’s user-friendly features, it only takes a few seconds to create your shift calendar for the next few months. You also have the opportunity to connect with other NurseGrid users who work in your department.

What users are saying:

“Nice app. I love how easy it is to add my work schedule and that my coworker can see my schedule.” “Sluggish, but a great app on iOS.” “It’s okay. It shows my shifts and is easy to add shifts…”

Rating: 3-star rating

Cost: Free

Available: Google Play and iTunes

Nursing Procedures App21. Nursing Procedures

Nursing Procedures focuses largely on providing nurses the best resources before they begin a procedure. Ranging from assessments to medication administration to code blue situations. As a bonus, you’ll get a Weekly Funny once a week that gives you a funny video, quote, picture or meme to cheer you up. The iTunes version is free.

What users are saying;

“Great app but please add more procedures to the midwifery aspect…” “Please add the requirements for the various procedures. That I think will help us a lot.” “Great app.” “It’s a great app. Easy to use and understand. Big ups.” 

Rating: N/A

Cost: $0.99

Available: Google Play and iTunes

Nurses First App22. Nurses First

The Nurses First app features daily nursing tips, fun facts, nurse quote section, Vines section and a giveaway section. Information is pulled from the top nurse blogs and fan sites; everything you need to know in one mobile app.

What users are saying:

“Perfect app for nurses. This one has it all.” “I keep opening this app, even while I’m at work…it just makes the day go well.” “I am so glad I downloaded the nurses first app. LUV it.”

Rating: 4-star rating

Cost: Free

Available: Google Play

IV Drip Rate Calculator App23. IV Drip Rate Calculator

Most features of the IV Drip Rate Calculator app are available on modern pumps, but modern pumps aren’t always available. With this app you can add a drug amount in mg, mcg, grams or units to a volume of fluid, select the dose ordered and the ml/house necessary to deliver that dose will display. Several satisfied users claim that the app has made their jobs easier.

What users are saying:

“Good math, would be better if you could scroll the screen to the next couple fields..” “Good for when I need to think faster while multi-tasking.”

Rating: 4-star rating

Cost: Free

Available: Google Play

IV Infusion Calculator App24. IV Infusion Calculator

This simple and straightforward iOS and Android app work whether you are using gravity or pumps. It will give you your answer in mL/hr, gtts/min and gtts/15 seconds. This app also includes an IV Push calculator and a Fluid Rate calculator. The Pro upgrade to the app costs $0.99.

What users are saying:

“Very useful and covers all types of calculations I use.” “I use this app every week.”

Rating: 3-star rating

Cost: Free

Available: Google Play and iTunes

Nursing Reference Center App25. Nursing Reference Center

Amp up your nursing skills with Nursing Reference Center. The app provides relevant clinical resources to nurses, directly at point-of-care and offers the best available and most recent clinical evidence from thousands of full-text documents. Note: to use the NRC app, you must obtain an access key.

What users are saying:

“Wonderful resource for nursing staff.”

Rating: 4-star rating

Cost: Free

Available: Google Play and iTunes

Lippincott Nursing Advisor App26. Lippincott Nursing Advisor

Quick answers for pressing medical questions are available on the iOS Lippincott Nursing Advisor app. Although many facilities offer free use of the app, some users must make in-app purchases. You’ll have access to regularly updated clinical content by a team of nurses and clinical subject matter experts as well as the ability to add your own protocols and notes.

What users are saying:

“Time saver. I bought this app mainly to benefit my Lippincott account was such a huge pain…this however has saved me time and headache and I can get it on my phone as well.”

Rating: 3-star rating

Cost: Free

Available: Google Play and iTunes

Wellbeing For Nurses App27. Wellbeing For Nurses

Stress and fatigue make it a challenge for nurses to stay healthy. Wellbeing For Nurses Magazine aims to combat this with a useful app. You’ll have access to monthly doses of in-depth articles that focus on the fields of health, happiness, and well-being.

What users are saying;

“Perfect…” and “A good one.”

Rating: 4-star rating

Cost: Free

Available: Google Play

Intensive Care Medicine App28. Intensive Care Medicine

Stay up to date on the latest research with the Intensive Care Medicine app. Google Play users appreciate the free app’s advanced search and article saving capabilities. This app comes from the Intensive Care Medicine journal that continually publishes review articles, original papers, and education articles written by leading members of the medical community.

What users are saying:

“Very nice, but should allow members to use their individual subscriptions to access.”

Rating: 4-star rating

Cost: Free

Available: Google Play and iTunes

Organs 3D App29. Organs 3D

Brush up on your anatomy with Organs 3D, which has tens of thousands of positive reviews on Google Play. The nursing app features 3D models, video, audio lectures, quizzes and text to create a rich learning experience for users.

What users are saying:

“I liked it. It gives brief explanation of most internal organs.” “Graphics quality is very low…” “Five stars. This is exactly what I’ve been looking for great 3D image!”

Rating: 4-star rating

Cost: Free

Available: Google Play and iTunes

Nursing Jokes App30. Nursing Jokes

Nursing is a notoriously stressful profession, and sometimes, what you need most is a lighthearted break from the anxiety. Look to Nursing Jokes on Android for some necessary humor to get you through long shifts.

What users are saying:

“Repetitive. Not enough content and not all that funny.” “Good, funny jokes.”

Rating: 3-star rating

Cost: Free

Available: Google Play

Medibabble Translator App31. MediBabble Translator

MediBabble is a professional-grade app that provides medical interpretation for healthcare workers and nurses. This app aims to improve safety and efficiency nurses can provide to non-English speaking patients. It aims to allow users to communicate faster, on the go, with those who do not speak English.

What users are saying:

“Very useful…” and “Amazing for gathering information!” Users say the app is “very good for asking patients questions and describing their conditions…”

Rating: 3-star rating

Cost: Free

Available: iTunes

IDdx Infectious Diseases App32. IDdx: Infectious Diseases

This app allows users to search by description and lists a number of infectious diseases that could relate to it. It lists symptoms and conditions of diseases to allow for fast recognition and diagnostic support. The searchable component of this app helps users to quickly find vivid images and information so that fast response time is possible. It displays pictures for diagnostics and support for emergency situations.

What users are saying:

“Very fine reference especially with multiple sources integration…” and “Using patient systems was effective for a precise conclusion.”

Rating: 4-star rating

Cost: Free

Available: Android and iTunes

Skyscape Medical Library App33. Skyscape Medical Library

The SML app is a tool to support diagnostics for physicians and nurses. It pulls from 400 resources from various associations to make finding information easy. Searches by keyword are easy and highly effective. A total everything-you-need tool, this app makes it easy to find key information whenever it becomes immediately necessary and you’re on the go.

What users are saying:

“It’s a go-to app for medical information…”

Rating: 4-star rating

Cost: Free

Available: Android and iTunes

Eponyms App34. Eponyms

Eponyms features hundreds of common and obscure medical eponyms for easy searching and verification. It allows users to quickly look up the meaning of a term, no matter how obscure or unique it is, to find out what it refers to. This makes finding information faster than trying to navigate complex medical conditions by limited names.

What users are saying:

“Excellent. Very thorough.” And “”Really nice app, very helpful, but needs more eponyms added…”

Rating: 4-star rating

Cost: Free

Available: Android and iTunes

 

  • Nursing Central app is available through the Amazon store and is compatible on some Android devices.
  • Ratings are based on the current app version for either Google Play or iTunes stores. Ratings are current at the time of publishing.
  • For clarity, ratings have rounded to the whole number. Please visit the app store to review the current ratings.
  • Some apps may require you to purchase. Some additional costs may also incur after initial payment. Please refer to the app’s terms of service agreement before purchasing.
  • Some apps may require you to sign up before using.
  • Some free apps may have in-app advertising or purchases.
  • Please refer to the app’s compatibility requirements as they may not work on all devices.

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Topics: nursing apps

Two Parents Thankful For A Nurse Who Happened To Be Driving By

Posted by Erica Bettencourt

Wed, Mar 29, 2017 @ 02:12 PM

Walker_032817_29baby_2940x.jpgThankfully Nurse Markey decided to take a different route to pick up her step-kids at school because she ended up at the right place at the right time.

A couple who wanted to have a natural birth were getting more than they bargained for on a very special day. As much as they wanted to, they couldn’t deliver in the hospital. The baby had other ideas and they ran out of time. Markey sprung into action and helped the couple. 

She’s thankful for the experience. Normally she’s around at the end of a patient’s life, but this time, she was there from the very start. Continue reading below for more details about what happened that day.

Michelle Markey sensed that something unusual was going on Friday morning as she drove down Route 101 in Wilton, N.H. “When you’re a nurse, you look at the whole situation,” she said.

And the situation she saw signaled distress. A young man was standing next to his truck, pacing, cellphone pressed to his ear. Markey pulled over.

Crammed in the front seat was a woman in full labor, the baby’s head showing. Markey is a cardiac nurse at Tufts Medical Center. She had never delivered a baby.

Orion and Janella White had wanted a natural birth for their second child, and nature was certainly taking charge.

Janella had been feeling some cramping overnight, but she told Orion not to worry when he got up for work early Friday. When their daughter was born two years ago, Janella had contractions for two days and spent six hours in labor at the hospital.

Even if this one took half as long as his sister, they still had plenty of time to get to the Birth Cottage, a birthing center in Milford where they hoped to deliver the baby in a homelike setting.

So Orion headed out to his job as an aircraft mechanic in Westfield, Mass., an hour and 25 minutes from their Rindge, N.H., home.

About 8:30 or 9 a.m., Janella could tell that the baby was coming that day. She texted Orion that he might want to head home, but that there was no rush. By the time Orion arrived, though, she knew it was urgent. Orion grabbed some pillows, and they took off.

“We started out, and I was, like, ‘Look out for the bumps!’ ” Janella said. “About eight minutes into the ride, I said, ‘Who cares about the bumps, let’s go!’ ”

But as it became clear they wouldn’t make it in time, Orion pulled over and called their midwife, Adrian Feldhusen. 

“I said: ‘Her water broke, and she can feel the head.’ She said, ‘OK, pull over, and I’ll walk you through this.’ ”

He pulled into the driveway of a condo development. A stranger pulled up behind them and called 911. 

Markey arrived seconds later. It was strange she was even driving on this road. She was off from work and heading to pick up her stepchildren at school, but she had some extra time and decided to try out a different route.

The Whites were relieved to have a nurse on hand. Markey was relieved to have a midwife on the phone. Feldhusen told Markey how to turn the baby’s head to release the shoulders. The baby came out quickly, but he wasn’t crying.

At the other end, Feldhusen heard the phone go dead. Not given to panic, she figured someone put it down. So she grabbed her bag to head out.

Meanwhile, Markey smacked the baby, gingerly. 

“He started breathing, then he stopped,” Markey said. “I hit him a little bit harder, then he started crying a little bit.” 

Keihin White had successfully entered the world, sharing a birthday with his 26-year-old father, who stripped off his shirt and wrapped the baby in it.

The ambulance came moments later, and Feldhusen arrived as Janella was being put on a stretcher. She joined mother and baby in the ambulance, where she delivered the placenta, cut the cord, and helped Janella start breast-feeding.

The Whites spent the night at St. Joseph Hospital in Nashua and went home Saturday. On Tuesday, Keihin had his first checkup with the pediatrician — all was well. And later that day, the Whites reunited with Feldhusen and Markey in Milford, and told their tale to the press.

Markey isn’t thinking of taking up obstretrics. But she was glad to have helped. As a cardiac nurse, she deals a lot with people who are dying. It felt good to be at the other end. 

“To see someone be born is amazing,” she said.

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Topics: emergency delivery, nurse hero

Gender Identity Terms You Need To Know

Posted by Erica Bettencourt

Fri, Mar 24, 2017 @ 04:33 PM

untitled-collage.jpgAfter reading this article, I am happy a documentary like this, “Gender: The Space Between,” airing on March 27, 2017 on CBSN is coming out. Even though I try to stay educated on people's rights and beliefs, I didn't know what many of the gender identity termsmentioned below meant.
 
Familiarizing yourself with these gender identity terms and their meaning can help you better connect with your patients. Our patient's needs are changing. Understanding these changes will help you provide the best possible care for them

The latest CBSN Originals documentary, “Gender: The Space Between,” takes a deep dive into the complexities of gender identity and gender expression. While transgender stories have become more visible in the media, there are many identities and terms outside of the two most culturally accepted genders — man and woman — that fall under the trans umbrella. And in many social circles, the vocabulary related to gender identity is unfamiliar or inaccessible.

Gender identity is an extremely personal part of who we are, and how we perceive and express ourselves in the world. It is a separate issue entirely from sex, our biological makeup; or sexual orientation, who we are attracted to. There are dozens of dynamic and evolving terms related to how people identify. While this glossary cannot cover every possible identity a person might have, it provides definitions for some of the most common vocabulary necessary to understand the layered world of gender.

Below is a guide to some of the topics and terms discussed in “Gender: The Space Between,” as defined by the Human Rights Campaign, GLAADThe Trevor Project, and the National Center for Transgender Equality.

Gender Identity Definitions

Agender: A term for people whose gender identity and expression does not align with man, woman, or any other gender. A similar term used by some is gender-neutral.

Bigender: Someone whose gender identity encompasses both man and woman. Some may feel that one side or the other is stronger, but both sides are present.

Binary: The gender binary is a system of viewing gender as consisting solely of two identities and sexes, man and woman or male and female.

Cisgender: A term used to describe someone whose gender identity aligns with the sex assigned to them at birth.

Dead name: How some transgender people refer to their given name at birth.

Gender dysphoria: Clinically defined as significant and durational distress caused when a person’s assigned birth gender is not the same as the one with which they identify.

Gender expression: The external appearance of a person’s gender identity, usually expressed through behavior, clothing, haircut or voice, and which may or may not conform to socially defined masculine or feminine behaviors and characteristics.

Gender fluid: A person who does not identify with a single fixed gender, and expresses a fluid or unfixed gender identity. One’s expression of identity is likely to shift and change depending on context.

Gender identity: A person’s innermost concept of self as man, woman, a blend of both, or neither – how individuals perceive themselves and what they call themselves. Gender identity can be the same or different from one’s sex assigned at birth.

Gender non-conforming: A broad term referring to people who do not behave in a way that conforms to the traditional expectations of their gender, or whose gender expression does not fit neatly into a category.

Gender questioning: A person who may be processing, questioning, or exploring how they want to express their gender identity.

Genderqueer: A term for people who reject notions of static categories of gender and embrace a fluidity of gender identity and often, though not always, sexual orientation. People who identify as genderqueer may see themselves as being both male and female, neither male nor female or as falling completely outside these categories.

Misgender: Referring to or addressing someone using words and pronouns that do not correctly reflect the gender with which they identify.

Non-binary: Any gender that falls outside of the binary system of male/female or man/woman.

Passing: A term used by transgender people which means that they are perceived by others as the gender with which they self-identify. 

Queer: An umbrella term people often use to express fluid identities and orientations. 

Sex: The classification of a person as male or female at birth. Infants are assigned a sex, usually based on the appearance of their external anatomy.

Transgender: An umbrella term for people whose gender identity and/or expression is different from cultural and social expectations based on the sex they were assigned at birth.

Transitioning: The social, legal, and/or medical process a person may go through to live outwardly as the gender with which they identify, rather than the gender they were assigned at birth. Transitioning can include some or all of the following: telling loved ones and co-workers, using a different name and pronouns, dressing differently, changing one’s name and/or sex on legal documents, hormone therapy, and possibly one or more types of surgery. 

Transsexual person: A generational term for people whose gender identity is different from their assigned sex at birth, and seek to transition from male to female or female to male. This term is no longer preferred by many people, as it is often seen as overly clinical, and was associated with psychological disorders in the past.

Two-spirit: A term that refers to historical and current First Nations people whose individual spirits were a blend of male and female. This term has been reclaimed by some in Native American LGBT communities to honor their heritage and provide an alternative to the Western labels of gay, lesbian, bisexual, or transgender.

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Topics: gender identities

Nurse Uses Her Experience With Brain Tumor To Better Serve Patients

Posted by Erica Bettencourt

Tue, Mar 21, 2017 @ 12:06 PM

Screen Shot 2017-03-21 at 11.56.19 AM-274568-edited.pngYou take care of people in your job every day. However, if the tables are turned because you became ill and now it’s you being taken care of, the situation is bound to introduce you to a different perspective on how things feel. 
 
In the past, Nurse Kelly Northrip could only sympathize with her patients. Now she can relate to them and identify with things they are going through because she was once in their shoes. See how she pushed through her medical journey to come out the other side stronger and with an even better perspective for her patients. 

The squeak of tennis shoes moving quickly across the linoleum floors adds to the cacophony of alarms and beeps pulling nurses and doctors in every direction on the acute care floor of Florida Hospital Memorial Medical Center.

In the midst of the commotion, nurse Kelly Northrip sits quietly at the bedside of a patient, listening with the kind of intensity that doesn't come natural to most.

"I get told all the time I spend too much time with my patients, so to speak, and I say there is no such thing," said Northrip, a licensed practical nurse. "Each one is a learning experience."

Northrip knows firsthand the impact a few extra moments can have on a patient. If any of her patients doubt her, she might tell them about the golf ball-sized tumor that was discovered on her brain or the surgery she endured, answering doctors' questions while they probed her brain.

Usually, it's enough for Northrip simply to be there for her patients, hearing their concerns and reassuring them that everything will be all right. She's experienced that firsthand as well.

A DREAM THREATENED

After 18 years in the restaurant industry, Northrip embraced a career change to pursue her dream of becoming a registered nurse. After graduating and starting her career as a licensed practical nurse, Northrip's newly established career was almost sidelined forever when a tumor was discovered in her brain last summer.

Overnight, the career she had worked so hard for was in jeopardy, and so was her life.

Northrip's specialists presented her with three options: do nothing; do a biopsy and determine how to proceed; or, the riskiest option, an awake craniotomy.

"Doing nothing wasn't an option for me, for us," said Northrip, whose husband and two kids supported her decision to go with the most aggressive option.

In an awake craniotomy, the patient is awakened after surgeons open the skull. That way doctors can ask a series of questions while removing the tumor and ensure other areas of the brain aren't damaged.

Sounding just like an eager nursing student, Nothrip described the prospect as "scary and exciting at the same time."

"I was more nervous than she was," said her husband, Steven.

But the surgery is rare — and risky. Her doctors recommended that she seek out surgeons who were specialists in the procedure.

"He said you'd be better off going somewhere where they've done thousands. If it won't bankrupt you, go to Duke," she recounted. On a morning in August 2016, Northrip and her family loaded up into her brother's motor home to drive from Florida to North Carolina so that the drowsy Northrip could sleep during the trip, a symptom of the tumor. After three blown tires, and countless frazzled nerves, the motor home delivered them safely to Duke University Hospital where Northrip would undergo brain surgery the next morning.

Northrip remembers being wheeled into the operating room for the surgery, where a big TV on the wall showed images of her brain. After being put to sleep, Northrip awoke to a bright room full of people and the distinct sensation of pressure in her head.

"I could feel the doctor working in my head," she recalled. "I could feel him working in there and I actually spoke to him and he spoke back. I could feel discomfort, but not great pain."

As the surgical team began to remove Northrip's tumor, they asked a series of questions to ensure they didn't affect other areas of her brain.

"He had me move my feet, wiggle my toes, do a number of things. I just tried to relax, and they tried to keep me calm through the whole thing. I can remember almost everything. I can even remember their faces."

The surreal experience of being conscious during brain surgery left Northrip feeling "very much awake and alive."

The next thing Northrip recalls is waking in a recovery room, feeling like she was being hit in the head with a hammer — proof she had survived the surgery.

The pain subsided when Northrip received the news she had hoped for — the tumor was benign, and she wouldn't have to undergo chemotherapy.

"The only thing I would be required to do was an MRI every year," she said.

Other challenges still lay ahead.

THE RECOVERY

While insurance covered a large portion of the rare surgery, Northrip and her family still had numerous medical bills to pay on top of regular living expenses. Family, friends and coworkers rallied to the family's aid, hosting golf and dart tournaments and online fundraising campaigns.

"It makes you think, 'What did I do to deserve this?' I don't look in the mirror every day and say I'm a wonderful person. I don't think you ever feel deserving," Northrip said. "You're just trying to do your thing, trying to be a good, decent person and do things to the best of your ability."

The outpouring of support continued into Christmas when her family was adopted by the hospital staff, who bought presents for the kids. Northrip's co-workers also provided gift cards for the family.

The financial help allowed Northrip to focus on recovery and her goal of getting back to the job she loved. She pushed herself hard through physical therapy with the goal of coming back to work quickly but learned she couldn't force her body to recover faster than was possible.

The emotions of the recovery caught her off guard.

"I didn't think anything about the after, I just jumped in (to the surgery) with both feet and thought I would deal with it as it came," she said. "It was a very eye-opening, learning experience."

Physical therapist Donna McQuade worked with Northrip and knew the obstacles she would have to overcome to return to the job.

"When you do the job every day, you forget what it takes," McQuade said. "But having had such an extensive surgery, I don't think she was aware how much it affected her emotionally."

True to her persistent nature, Northrip tried to come back ahead of schedule, only to realize she wasn't ready and needed to continue her physical therapy.

"She's been doing it for so long she just didn't realize how much strength it took" to work a nursing shift, McQuade said.

Northrip persisted, and in January she returned to work.

"It's really miraculous, the amount of time from when she found out she was sick to when she was back to work," said McQuade.

While the experience challenged Northrip in more ways than she expected, being on the other side of the bed brought her a rare perspective that changed the way she views her job.

"Prior to this, I could only sympathize with my patients," Northrip said. "But after being hospitalized I can truly empathize and identify their anguish and stress."

To her coworkers, there was little doubt she would return and be a better nurse for her experience.

"We knew she would be back and rise to the challenge," said McQuade. "She's got a good support system here because she's a good support system to us."

Being back at work has also allowed Northrip to pursue her original goal, to become a registered nurse.

After years of applying to a full program, Northrip's application was recently accepted and she started school to become a registered nurse — while also returning to work.

"Ironically, I didn't expect it to be happening my second week back to work. I kind of bit off more than I could chew," Northrip said. "I don't take it lightly. I know it's a privilege for me to be working where I am. I want a better life for me and my family and help others to the fullest extent."

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Topics: Brain Tumor, Serving patients

The Top 15 Cities For Nurses In 2017

Posted by Erica Bettencourt

Mon, Mar 13, 2017 @ 04:38 PM

seattle.jpgRecently, Indeed.com – a massive job search platform that greets over 200 million monthly visitors – took a look at which cities in the U.S. pay nurses the most while giving them the biggest bang for their bucks. The west of the U.S. – California especially – was overwhelmingly dominant.

See the list below.

15. Atlanta, Georgia. Average Salary, Adjusted for cost of living: $63,862

14. San Diego, California. Average Salary, Adjusted for cost of living: $65,092

13. Los Angeles, California. Average Salary, Adjusted for cost of living: $65,092

12. San Jose. Average Salary, Adjusted for cost of living: $65,113

11. Oxnard, California. Average Salary, Adjusted for cost of living: $65,402

10. Seattle, Washington. Average Salary, Adjusted for cost of living: $65, 856

9. Houston, Texas. Average Salary, Adjusted for cost of living: $67,101

8. Anchorage, Alaska. Average Salary, Adjusted for cost of living: $68,158

7. Phoenix, Arizona. Average Salary, Adjusted for cost of living: $72, 548

6. Riverside, California. Average Salary, Adjusted for cost of living: $73, 742

5. Portland, Oregon. Average Salary, Adjusted for cost of living: $73, 958

4. Sacramento, California. Average Salary, Adjusted for cost of living: $76, 870

3. Modesto, California. Average Salary, Adjusted for cost of living: $80,368

2. Bakersfield, California. Average Salary, Adjusted for cost of living: $80,731

1. Fresno, California. Average Salary, Adjusted for cost of living: $81,344

In compiling its list, Indeed calculating the average hourly salary for registered nurses in the US from 2015 thru 2016 by metropolitan area and adjusted the annual salaries based on cost of living. The numbers used were those published by the U.S. Bureau of Labor Statistics (BLS).
The city that offers the best wages and standard of living costs, according to the data, was Fresno, California. In that city of roughly half a million, a nurse can expect $81,344 in annual pay, adjusted for cost of living.

In second place we find Bakersfield, California, where nurses make $80,731 in salary, on average. In third place, Modesto, also in California, they make $80,368.

All in all, California cities accounted for nine of the fifteen spots on the list. Others on the charts are Sacramento (4thplace), Riverside (6th), Oxnard (11th), San Jose (12th), Los Angeles (13th), and San Diego (14th).

The one city not in the western half of the U.S. that made the list was Atlanta, Georgia, which ranked 15th. In Atlanta, nurses make an average $63,862.

Indeed’s report notes that it has seen evidence that there is a shortage of nurses in the United States, with many more postings looking for talent than there is interest (see graphic below). Interest in new positions, the job platform says, meets only about one third of demand.

Why are nurses needed so badly now? Two reasons Indeed puts forward are, A) people are living longer, thanks to advancements in healthcare and require more medical services, and B) More people have become insured over the past several years due to the implementation of the Affordable Care Act, which many have taken to calling ‘ObamaCare.’ Better access to medical insurance has led to more people seeking medical attention for their ills and taking preventative measures like getting checkups.

The position of registered nurse is expected to add more than 439,000 new jobs by 2024, according to the BLS, which the Bureau says is a faster leap than is average.
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Topics: best places to work

Hospital Nurse Plays Video Games With Patients

Posted by Erica Bettencourt

Wed, Mar 08, 2017 @ 11:00 AM

tommy-sing-conner-quigley-grand-river-hospital-video-game-guy.jpgWhen Nurse Tommy Sing answers a patient's call he has to put his game face on, literally. Sing spends his days pushing different buttons on medical machines as well as game controllers. He may want to keep his actual day job though. His patients seem to always beat him. 
 
Read more below to see how Nurse Sing puts smiles on his patient's faces.

"No! No! Don't die! You died!"

The shrieks come hurtling down the hallway of the Children's Unit at Grand River Hospital, but don't be alarmed. They are punctuated by laughter — a lot of laughter.

Registered nurse Tommy Sing is playing a video game with 10-year-old patient Conner Quigley, and he's losing badly. 

"I've always liked to play," he says, "I was never good at them, obviously, but I've always enjoyed playing them."

Sing, who has been working on the Children's Unit for almost six years, has been dubbed the unofficial video game guy for the amount of time he spends playing with patients.

"I've played everything from Minecraft – not very well, but I've played Minecraft – all the way to games on the Nintendo Wii, all the way up to playing Call of Duty with some 16 and 17-year-old patients," he said. 

"You know, I'll walk into a patient's room and they'll already have the Xbox or the Nintendo Wii already set up and then we'll start talking video games. Obviously, sometimes, on the floor it's too busy for me to play with them, but if the opportunity presents itself or I finish my shift at 7:00 p.m. I'll stay after work and play a couple of rounds with them."

Although video games often get a bad rap in the health sector, being blamed for everything from poor eating habits to behavioural problems, Sing says they help him build quick rapport with the kids on the unit.

"It gives you one thing definitely that we have in common," he said. "It's so easy to just break the ice by playing the games and it just helps snowball into finding more and more about each other and even having more and more in common with each other."

He says the relationships he's been able to form with the patients makes it easy to crawl out of bed in the morning and come to work, even when his shift starts at 7:00 a.m.

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Topics: nurse plays video games, video games

See What This Stylist Did When A Nurse Fell Asleep In Her Chair

Posted by Erica Bettencourt

Thu, Mar 02, 2017 @ 10:12 AM

shoes.jpgNurses do so much, including laying our heads down to rest during our toughest moments. A hair stylist had the opportunity to turn the tables and let the Nurse do the resting and let her be taken care of. The stylist wanted the Nurse to have no worries and be completely relaxed and safe in her hands at that moment, the same way a Nurse treats a patient. 
 
Have people in your life, strangers or loved ones, shown appreciation for all you do? We would love to hear your stories! 

Medical professionals like doctors, nurses, and paramedics devote much of their time and energy to making sure we are safe and healthy. They don’t get a lot of time to themselves, and many would argue that they don’t get the recognition they deserve.

Ashley Bolling is a stylist and mother of three who is letting it be known that these people, particularly nurses, deserve more than just a thank you. She posted a sweet message for nurses everywhere after one came into her salon, Captivate Salon & Spa, and dozed off in her chair. The woman hadn’t slept all night and was clearly exhausted. Ashley gently rested her head against her stomach, but it was her shoes that grabbed her attention. They weren’t worn down or dirty — she was simply amazed by how much weight they carried, both literally and figuratively.

You can read Ashley Bolling’s sweet and moving tribute to nurses below.

I had one of those “stop-you-in-your-tracks,” extremely humbling moments, while working quietly on the hair of a very exhausted, sleeping nurse.

She’d been at work all night and hadn’t been to bed when she landed in my chair, but not before stopping to buy my breakfast on her way.

As she dozed off, I gently rested her head on my stomach and continued to foil her hair…. then I noticed her shoes.

I wondered how many miles those shoes have walked. I wondered what they’d walked through. Blood? Tears? In & out of the countless rooms of the patients she’s cared for? I wondered how many hours they’ve carried her, and all those like her, while they literally save the lives of those we love and hold the hands of the ones who can no longer fight that fight.

But with those shoes propped up in that chair, phone in her lap, I got the chance to take care of her (even if it was just for a few hours) and I felt extremely honored to take care of such a hard working, inspiring woman I’m so lucky to call my friend.

I’ve always respected and valued these amazing superheroes and am proud to be the sister, daughter, niece, friend and hairstylist of so many. Know you are appreciated, know you are irreplaceable, know you are loved!

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Topics: thank a nurse, tired nurse, Nurse appreciation

Nurse Welcomed Home From War

Posted by Erica Bettencourt

Mon, Feb 27, 2017 @ 11:52 AM

warnurse

Master Sgt. Christopher Herndon is one selfless Hero with a big heart. Both of his careers are about saving lives and putting others before himself. Herndon works at DCH Regional Medical Center which proudly supports and hires military veterans. They wanted to show their appreciation with a surprise for Herndon. 

A registered nurse at DCH Regional Medical Center was given a hero's welcome Friday on his first day back to work after his fifth deployment with the U.S. Air Force Reserve.

Master Sgt. Christopher Herndon spent September through January stationed in Germany, where he served as a flight medic.
 
"We'd fly two or three times a week," Herndon said. "We'd leave Germany to go to Iraq or Afghanistan, wherever people are that need us, then transport them back to Germany, or load them up in Germany and fly them to Andrews Air Force Base in Maryland."
 
Herndon has worked at DCH since 2012, and returned to his job in the trauma surgical intensive care unit Friday morning. Believing he was going to be fitted for a respirator, he was instead led to a conference room where his wife, Misti, and their 4-year-old daughter Ava joined his father, his supervisor and several DCH administrators for to welcome him home.
 
"It meant a lot, especially seeing all the upper level people show up," Herndon said "A whole roomful of people showing up unexpectedly."
 
James Shirley, the hospital's facility property manager, said DCH employs 11 active-duty service members and is glad to support them however possible.
 
Herndon's nurse manager, Donna Prophitt, echoed Shirley's sentiments and said she is always willing to work with their military employees to schedule around drills and deployments.
 
"As a leader and manager here, I serve my staff and they in turn serve our patients. It's a very easy thing to do," Prophitt said. "If we take care of (military employees), they take care of us, so it's a win-win on both sides."
 
Herndon said being back on the ground will take some getting used to after patching up service members on a plane for six months, but said he's glad to be back on the job.
 
He said he might consider a sixth deployment, but right now his focus is on the work at DCH and his young family.
 
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Topics: military nurse

A More Diverse America Needs Health Care Adjustments

Posted by Erica Bettencourt

Wed, Feb 15, 2017 @ 04:02 PM

0209-tiled-flag-of-american-diversity.jpgHow can you properly care for a patient if you don’t understand their personal needs? Communication is key. Making a patient comfortable goes far beyond providing warm blankets. It is about the patient trusting you and knowing you have things in common that show them you understand how they feel and what they need. 

Many healthcare providers are seeing how important diversity and inclusion is to delivering quality patient care. Hospitals are providing language services by hiring a diverse staff, many of whom are bilingual or multilingual. Culturally appropriate care strategies are also key. Religious views may alter the way staff would normally provide care. That means you might assist a patient who needs to move in order to pray or work out special blood testing times to allow the patient to fast. The population is rapidly changing and by 2050, the white population will no longer be the majority.

On any given day at the Salud Clinic, Lucrecia Maas might see 22 patients. They come to the community health center tucked away in an office park here needing cavities filled, prescriptions renewed and babies vaccinated. When they start to speak, it’s rarely in English. Sometimes it’s Hindi. Or Dari. Or Hmong. Or Russian.

Maas is fluent in English and Spanish, but that gets her only so far. She often has to hop on the phone with a medical interpreter, who relays her questions to the patient and then translates the patient’s answers. “It just takes a little more time,” the nurse practitioner said. 

The future of American health care looks a lot more like the Salud clinic than Norman Rockwell’s iconic small-town doctor’s office. The country is on course to lose its white majority around 2050. That future is already visible in Sacramento County and neighboring Yolo County, where West Sacramento is located: by 2013 the combined population of Hispanic, black, Asian and other nonwhite residents had edged out whites. In West Sacramento, a historically working-class county across the river from the state capital, more than 2 out of 5 public schoolchildren already speak a language other than English at home.

Sacramento-area hospitals, community health centers and doctor’s offices have had to adapt. They’ve hired more multilingual, bicultural staff. They’ve contracted with interpretation services. The medical school at the University of California, Davis, is trying to figure out how to recruit more Latino students to a profession that remains largely white and Asian. And doctors are being trained to deliver culturally appropriate care to patients of many backgrounds. 

When a diabetic pregnant Afghan woman wanted to fast during Ramadan, the Salud Clinic’s nutritionist recalculated the best time of day to measure her blood sugar. If Mexican mothers say they’re rubbing gentian violet on their baby’s umbilical cord area to keep it clean — a harmless natural remedy — doctors encourage them to keep doing so.

Similar stories are playing out across California, which became majority minority in 2000. Health systems are using new data tools to get a better handle on just who they’re serving — and where the trend lines are pointing. County health departments, nonprofits and clinics have invested in recruiting and training bilingual community health workers.

Insurance doesn’t always pay for the extra costs of services like translation. Patient visits take extra time, straining schedules for doctors and nurses. “You can’t really help somebody if you don’t understand how they value health, and how they understand health and the health care system,” says Robin Affrime, CEO of CommuniCare Health Centers, the nonprofit that operates the Salud Clinic.

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Immigrants Drive Change

Most of the nation’s population growth since the 1960s has come from the immigration of nearly 59 million people from foreign countries who settled in the U.S. in that time, mostly from Latin America and Asia, according to the Pew Research Center. (The Pew Charitable Trusts funds the Pew Research Center and Stateline.)   

Hispanic, black, Asian and multiracial babies in the United States already outnumber white babies. In three years’ time, a majority of U.S. children and teenagers will be some race other than non-Hispanic white. And in about 30 years, whites will cease to be the national majority, demographers say.

A more diverse patient population may mean a different mix of health conditions, because some are linked to country of origin. People who were born in Asia are particularly prone to hepatitis B, for instance. African-Americans are more likely to have sickle cell anemia, an inherited blood disorder more common in Africa, the Middle East, India, and parts of southern Europe and Latin America. 

Asians and Hispanics — the groups likely to drive population increase going forward — have longer life expectancies than whites. Hispanics are less likely to suffer from many chronic conditions than whites even though they’re typically poorer and less educated.

Yet second- and third-generation Hispanic-Americans are often less healthy than their immigrant parents. One theory is that with assimilation, younger generations pick up bad American habits such as eating fast food and not getting enough exercise. And health continues to vary by subgroup. For instance, Californians with roots in Mexico are much more likely to be obese than Californians with roots in Puerto Rico, survey data show.

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Health Challenges

One of the challenges facing health care providers is obvious: many new immigrants can’t speak English. About 60 million Americans speak a language other than English at home and about 25 million can’t speak English very well, according to the U.S. Census Bureau.

Salud doesn’t typically bring in in-person interpreters, because they’re more expensive. But it does contract with a phone interpretation service, a business that’s growing rapidly across the county. The service provides real-time translation between English and at least 12 other languages. Interpretation of some of the less common languages, like Hmong, needs to be scheduled in advance. And there have been instances in which the interpreter speaks the wrong dialect of a language like Dari, spoken in several countries in Central Asia.

Often a staff member can help. The health center has doctors and nurses who speak Hindi, Urdu, Punjabi, Tagalog and Spanish, and has hired administrative staff and medical assistants who speak Hmong and Mien, a language spoken by some Indochinese refugees who fled to the United States during the Vietnam War.

But Mien has no written language. And some cultures and languages have concepts that defy easy translation. “There are some words where we really cannot use the translator,” said Rubina Saini, a Salud physician who speaks several South Asian languages.

Other clinics don’t do as well as Salud. Under federal civil rights law, hospitals, nursing homes and other providers that receive federal funding must take reasonable steps to accommodate patients who can’t speak English well. But the legal requirement isn’t well-enforced and services can be spotty. “Where people need language services isn’t necessarily where they’re being offered,” says Melody Schiaffino, an assistant professor at San Diego State University’s Graduate School of Public Health.  

In a recent study, Schiaffino found that about 30 percent of all hospitals nationwide don’t offer translation services. The share is even larger for public safety-net and for-profit hospitals, even in diverse cities. That’s because the government hospitals can’t afford to do so, she said, and for-profit hospitals tend to serve well-insured patients who speak English.

State policy helps determine who gets interpretation and translation help. Only 15 states directly pay for interpreters needed by Medicaid patients. California isn’t one of them, although a 2009 task force created by the state Department of Health Services recommended the change. (California does require private health insurers to provide — although not necessarily pay for — language services. The state also requires health plans in its state Medicaid program, Medi-Cal, to translate certain written materials into common languages.)

Most Salud Clinic patients have a Medi-Cal insurance plan that will cover the cost of interpretation, Donna Paul, the clinic manager, says. If a patient doesn’t have coverage, CommuniCare Health Centers absorbs the cost.

Then there’s the need to navigate cultural differences. The front-office staff knows that Southeast Asians may be uncomfortable making direct eye contact, and that Russians may speak loud and fast, Paul said. They’ve learned not to take such things personally.

Ethnic Disparities     

Treating a more diverse population also means confronting gaps in care that go beyond socioeconomic status. African-Americans, and in some cases Hispanics, tend to receive lower-quality care than whites even after controlling for income, age and symptoms, according to an often cited 2003 report by the Institute of Medicine (now the National Academy of Medicine). Black patients are less likely to be prescribed pain medication than white patients, for instance, and less likely to receive antiretroviral drugs if they’re HIV positive.

There’s no simple reason for the gap in quality, which still persists, although researchers say unconscious bias or stereotyping by physicians, cultural and language gaps, and even geography play a role. “Race and ethnicity matter, whether you like it or not,” says David Acosta, associate vice chancellor for diversity and inclusion at the University of California, Davis, health system.

To erase the gap, medical schools are adopting strategies to better prepare the next generation of doctors. One of these is to recruit and train more minority students. The second is to train all students to examine their own biases and be more sensitive to cultural differences.

In California, where almost 40 percent of residents are Latino, 4 percent of physicians are. Nearly 20 percent of all physicians in the state speak Spanish, but Acosta says bilingualism isn’t enough. As a Latino physician, he says he’s bilingual and bicultural, familiar with his Hispanic patients’ approach to health, such as the folk remedies they might try. That kind of cultural match improves trust between doctors and patients.

Black and Hispanic physicians are also underrepresented in the physician workforcenationwide. Increasing their numbers could also help ease the shortage of primary care physicians, Acosta said, because black and Hispanic physicians are more likely than white and Asian physicians to provide primary care to low-income minority communities desperately short on doctors.

UC Davis launched an effort to recruit more Latino students to health careers last summer, funded by the Permanente Medical Group, a physician group that works with Kaiser Permanente.

The UC Davis program, called Prep Médico, is aimed at undergraduates from northern and central California and starts with a summer session at the UC Davis medical school. Participants get ongoing support from mentors, access to research opportunities, and help studying for the medical school admissions exam.

Once students reach medical school, they need to be trained to treat patients of a different race, ethnicity, culture, sexual orientation or socioeconomic status than their own. Twenty-one states, including California, have adopted health equity standardsthat help guide physician training.

But there’s a debate over how best to teach so-called cultural competency. The concept is often presented to students like another task to master or acronym to memorize, said Jann Murray-García, an assistant adjunct professor at UC Davis’ school of nursing. But it’s not something you can memorize with flashcards. “There’s just no way to master the complexities of other people’s lives and personhoods,” she says. And recognizing one’s own racial biases and stereotypes, and learning how to deliver good care despite them, can be a lifelong process, she says.

Crunching Data

Kaiser Permanente has turned to data, to make sure these new populations are getting the care they need.

For more than a decade, the organization has broken down its quality of care data by race, gender and ethnicity and used it as a guide to drive health care priorities, with a goal of narrowing health care disparities.

For example, African-Americans are more likely than whites to have very high blood pressure and — partly as a result — to suffer from strokes, heart disease and end-stage kidney disease. First, Kaiser’s analysts figured out what the gap looked like for their own patients. Then they created a new set of instructions for care teams, informed partly by patient focus groups.

Among other changes, physicians were asked to prescribe African-Americans medications proven to be more effective for them. Physicians, nurses and other health workers took additional care to listen to patients, follow up, and nudge them to stay on top of their treatment plan. The effort has paid off: Since 2013, Kaiser has cut the high blood pressure control gap between its African-American and white patients in half.

Health systems can use data to improve their language services, too, says Glenn Flores, a physician and chair of health policy research at Medica Research Institute, a nonprofit research group. All it takes is asking new patients a few questions to check their English fluency, and noting what other languages they speak. That way clinics and hospital systems can arrange for in-person interpreters ahead of time for patients who need them and figure out which languages are essential when they are hiring staff or contracting for medical translation services. “Very few hospitals around the country do this,” he says. 

Nationally, health data need to more accurately capture racial and ethnic subgroups, says Kathy Ko Chin, president and CEO of the Asian & Pacific Islander American Health Forum. The “Asian and Pacific Islander” category used by the U.S. Census Bureau, for instance, encompasses everyone from third-generation Chinese-Americans to Pakistani engineers to Cambodian refugees. People with origins in the Middle East have no U.S. Census designation of their own, and can self-identify as white, Asian, African or “other.” Without more specific data, it’s hard to know what problems local communities have and what services they need, Ko Chin says.

California policymakers have unusually detailed data at their fingertips thanks to the California Health Interview Survey, conducted by the University of California, Los Angeles. Researchers have been able to tease out findings that can inform better care, such as the fact that Korean women are much less likely to receive mammograms than Japanese women in the state.

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