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DiversityNursing Blog

Erica Bettencourt

Content Manager and Social Media Specialist

Recent Posts

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.

58a1c72c280000ca3a99881b.png

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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Topics: hiring, cultural competence, Diversity and Inclusion

First Ever Real-time Efficacy Study on Fertility App Launched

Posted by Erica Bettencourt

Thu, Feb 09, 2017 @ 03:44 PM

257489.jpgDo you worry about family planning with some of your patients? If so, this article about an “app” that helps to avoid unwanted pregnancies may be helpful. “Dot” is the only family planning app that relies solely on period start dates. Health experts believe an estimated 225 million women worldwide are not using effective family planning methods, but want to avoid pregnancy.

The Dot app will be studied over a year. If used correctly, researchers in an earlier study found the app is almost 100% effective at avoiding an unwanted pregnancy. Continue reading below for more details about the study and more information about the Dot app.

Researchers at Georgetown University Medical Center’s Institute for Reproductive Health (IRH) announced the launch of a year–long study to measure the efficacy of a new app, Dot™, for avoiding unintended pregnancy as compared to efficacy rates of other family planning methods. The Dot app, available on iPhone and Android devices, is owned by Cycle Technologies. Up to 1,200 Dot Android users will have the opportunity to participate in the study.

The study, funded by a grant from U.S. Agency for International Development (USAID), will be the first known study to examine how women use a fertility app in real–time and to evaluate its effectiveness at avoiding unintended pregnancy. In a previous study, a research team found that Dot is theoretically 96 to 98 percent effective at avoiding unintended pregnancy if used correctly. As a woman continues to use it, the app increases its individual accuracy.

While there are thousands of menstrual cycle tracking apps on the market, recent research has demonstrated that the majority are not accurate enough to avoid unintended pregnancy or plan a pregnancy. One study evaluated 100 fertility awareness apps. Only six could correctly identify the fertile window. This finding highlights the importance for app–based family planning tools to rely on scientifically–backed methods and to be evaluated thoroughly for their accuracy.

“Our new study is unique because we’re testing the efficacy of Dot as a method to avoid unplanned pregnancy in a real–time situation,” says Rebecca Simmons, PhD, a senior research officer at IRH.

The study will evaluate Dot’s efficacy in avoiding unplanned pregnancies using a protocol that allows researchers to compare the results to known efficacy rates of other family planning options. It will also explore social factors, such as how Dot affects relationships. The researchers will recruit participants through Dot for Android, issue surveys in the app, and interview participants four times during the study. Participants will receive a gift card each time they enter period start date information and each time they complete a survey.

The IRH study could have global significance because multiple studies suggest that the main reason women stop using the birth control pill is side effects. If Dot can help women avoid pregnancy without the pill’s high abandonment rate, it’s a compelling alternative, says Simmons. The app would be especially useful in the developing world, where there is significant unmet family planning need. Global health experts estimate that 225 million women worldwide are not using effective family planning methods but want to avoid pregnancy.

“Dot users have a historical opportunity to advance the science of birth control and family planning,” said Leslie Heyer, president and founder of Cycle Technologies. “No fertility app has undergone such rigorous testing. Users who join our effort can help make free, effective fertility tools accessible to women throughout the world.”

Cycle Technologies developed the science and algorithm behind Dot™ in collaboration with global health experts from Georgetown University, Duke University and The Ohio State University. Dot is the only family planning app that relies solely on period start dates to determine a user’s individual fertile days.

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Topics: fertility apps, family planning, Dot app

Mom Gives Birth After Surviving Aneurysm and Brain Surgery While Pregnant

Posted by Erica Bettencourt

Mon, Feb 06, 2017 @ 11:23 AM

anna2.jpgWe need a Wednesday feel good story and this is a terrific one! Anna Weeber suffered frequent headaches since she was 16 years old. Now she's 26 weeks pregnant, 27 years old and this headache is unlike any she's ever had in the past. 
 
The doctor who took on Anna's case had a pregnant wife the same age and was 24 weeks pregnant. Dr. Singer said that 50 percent of patients with Anna's case don't even make it to the hospital alive and of the 50 percent of those patients that do survive, 30 - 50 percent don't recover to their previous level of health and function. See below for details of Anna and her baby’s survival. 

Anna Weeber was getting dressed for a bike ride with her husband and 2-year-old son, Declan, one September afternoon last fall when she was struck by a blinding headache.

The 27-year-old mom had suffered from frequent headaches – about three times a week since she was 16, she says – but this was a completely new level of agony.

“It was the most intense headache I’ve ever had in my life,” Anna, who was 26 weeks pregnant at the time, says. “It felt like a balloon was filling with tar in my head.”

The pain was so intense that she began sweating and vomiting. Then, as her husband Nate called 911, the Zeeland, Michigan, mom realized she couldn’t move the left side of her body.

“From that moment on, I don’t remember anything,” she says.

An ambulance arrived and Anna was rushed to the nearest hospital, where a CT scan identified a ruptured brain aneurysm.

An aneurysm is a ballooning of a blood vessel in the brain. When an aneurysm ruptures it releases blood into the spaces around the brain, which can cause a life-threatening stroke.

“About 50 percent of patients who have a ruptured brain aneurysm don’t even make it to the hospital alive,” explains Dr. Justin Singer, Director of Vascular Neurosurgery at Spectrum Health. “Of the 50 percent of those patients that do survive, another 30-50 percent don’t recover to their previous level of health and function.”

After Anna’s aneurysm was identified, she was rushed to Spectrum Health where she was treated by Dr. Singer. Singer says he felt deeply affected by Anna’s case, as she is about the same age as his wife, who was 24 weeks pregnant at the time.

By the time Anna reached Dr. Singer, she was lucky to be alive – but still in a condition that threatened not just her life, but also the life of her unborn child.

A maternal fetal specialist joined the case and together Anna’s medical team and family decided that a brain surgery to insert a clip that would isolate the aneurysm from the circulatory system so it could be removed was the best treatment option.

“I know if my wife was in that position I would want the most definitive treatment option that poses the least risk to the baby,” Dr. Singer tells PEOPLE. “And that’s surgery so that’s what I advised them to do.”

While Anna was in surgery, Nate continued to ask for prayers on Facebook, as he had been doing since the first ambulance ride.

“Hundreds if not thousands of people started praying for us all around the world,” Anna says.

Twenty hours after the nightmarish episode began Anna emerged from the successful surgery. After a day and night of worrying that Anna could suffer lasting effects from the stroke, Nate was elated to find that “she was completely back to herself,” the 33-year-old says.

Anna remained in the hospital so that doctors could look out for vasospasms, a common complication of a brain aneurysm that limits blood flow within the brain and can cause stroke-like symptoms, paralysis or death.

Anna was treated for severe vasospasms and after 18 days she was released from the hospital. “It was so good to be home with our little family again we finally went apple picking and all of the normal fun fall activities,” she says.

The rest of the pregnancy went smoothly and on December 30, Anna and Nate welcomed a healthy baby boy they named Hudson.

anna1.jpg“We were just praying that Hudson wouldn’t suffer any effects from the surgery and as far as we can tell he is one perfectly health little boy,” she says.

Still, Anna says she can’t help but feel overwhelmed with emotion when she thinks about all she and Hudson have been through together.

“The first couple of days after Hudson was born, he and I would look at each other and make eye contact and I would just start crying knowing everything we’ve been through together,” she says. “We both knew God got us through this huge miracle.”

Dr. Singer and his wife welcomed a baby girl they named Jordyn the following week and the two families have already gotten together for a play date.

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Despite the grim statistics, Anna has only discovered two changes since the surgery. She was thrilled to find that her headaches stopped completely, and less thrilled to learn she has begun snoring. All things considered, she says, even that feels like a blessing.

“My husband is totally fine with the snoring considering that of all the possible outcomes I’m here and alive,” she says.

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Topics: aneurysm, brain surgery

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