Ben Franklin said an ounce of prevention is worth a pound of cure. Now the role prevention plays in the efficiency of the American healthcare system has been a hot topic on the national front as scarce federal funds are funneled toward proven interventions.
Nurses are playing a leading role in the prevention movement, heading up programs on the local level that help prevent disease before it happens.
A study by the Trust for Americas Health shows every dollar spent on prevention saves $5.60 over five years. The consumer advocacy group estimates an investment of $10 per person annually in disease-prevention strategies, such as nutrition and exercise, could save the country more than $16 billion annually in five years.
In honor of National Nurses Week, Nursing Spectrum reached out to the nurses who reach out to their communities to prevent disease and improve patient outcomes. Here is a sampling of the nurse-run programs we found:
The National Institute of Mental Health estimates 26.2% of American adults 57.7 million people will suffer from a diagnosable mental disorder in a given year. The main burden of illness is concentrated in approximately 6% who suffer from a serious mental illness. Mental disorders are the leading cause of disability in the U.S. and Canada for ages 15 to 44, according to the NIH. Data from the World Health Organization reveals mental illness accounts for more than 15% of the burden of disease in established market economies, such as the U.S..
Washington: Providence Everett (Wash.) Healthcare Clinic meets the needs of medically underserved residents of Snohomish County who used to end up in the ED with illnesses exacerbated by depression, anxiety, or other mental health disorders, says Susan Jones, ARNP, MSN, who oversees the clinical operations of a training grant at the clinic. We also have many patients whose major concern is a mental illness. They cannot receive treatment due to lack of insurance, a or shortage of mental health or primary care providers comfortable treating mental illness as part of primary care, Jones said.
The clinic hired psychiatric mental health nurse practitioners and trained the primary care NPs in recognizing and managing mental illnesses. This allows the psych/mental health NPs to focus on the more complex patients, and the primary care providers manage a patients depression along with their diabetes and hypertension.
Due in part to medical research, public health, and social services supported by the U.S. Department of Health and Human Services, infant mortality has declined over the past three decades from 20 deaths per 1,000 live births in 1970 to 6.9 deaths in 2003 (the latest available data). The leading causes are congenital anomalies, premature delivery, sudden infant death syndrome, and maternal complications. There is a racial disparity. The rate is 5.8 deaths per 1,000 for white babies and 13.9 for black. Preterm delivery resulting from insufficient prenatal care has been blamed.
Pennsylvania: In order to help change the infant mortality rates in some of Pennsylvanias most rural counties, Beth Ann Swan, CRNP, PhD, has offered educational opportunities far from Philadelphia, where she serves as a professor and dean at Thomas Jefferson Universitys School of Nursing. Swan is principal investigator of the grant program Promoting Health Access: Online Graduate Programs for Rural Underserved Communities, which is training neonatal nurse practitioners by meeting them on their home turf.
Of five graduates from Thomas Jeffersons neonatal nurse practitioner program last year, four stayed in rural communities. Swan said seven students are on track to graduate this year from the program.
The Healthy People 2010 infant mortality target is 4.5 infant deaths per 1,000 live births. Counties targeted by the grant have rates ranging from 9 to 27. The need is driven by those health disparities. Were responding to that, Swan says.Carol Grove, RN, (left) and Becki Weir, LPN
The prevalence of obesity continues to be a health concern in the United States, according to the Centers for Disease Control and Prevention. National studies show 31.1% of adult men and 33.2% of adult women are obese, meaning they have a BMI of 30 or higher. The latest statistics show 16.3% of children aged 2 to 19 are obese. Obesity is a contributing factor in many health problems, including coronary heart disease, type 2 diabetes, cancers, hypertension, dyslipidemia, stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, and gynecological problems.
Maryland: The overweight patients who enter the KidShape program at Washington County Hospital, Hagerstown, Md., often have one thing in common. When our children have come into the program, theyre mostly all wearing hoodies or big, heavy sweatshirts, maybe hats pulled down over their heads, says Carol Grove, RN, who oversees the program along with Becki Weir, LPN. What we find as we go along is that the hoodies come off and they dont really care.
Along with shedding baggy clothes, KidShape is helping kids learn healthy habits that are bringing about weight loss, increased self-esteem, and healthier families. A TeenShape program began in mid-April.
The program, which started last fall, involves children ages 6 to 13 and their families and emphasizes eating management, fun activities to get kids active, and small group classes designed to support families in making healthy lifestyle changes.
Two things that really grab us … are the long-term physical consequences on the children and their quality of life if theyre living with childhood obesity and the impact thats going to have on that child as they become an adult. A lot of these kids will end up, if we dont intervene, with some type of a chronic disease that then is going to put a drain on our healthcare system.
The words of some of the youngest participants in the program are evidence of its impact, including a 6-year-old who cautioned her mother about a lunch of SpaghettiOs.
She read the label and said, Mama, this says it has two servings in it. Please only give me half the can, Grove says.
About 20 million Americans suffer from asthma, according to the American Academy of Allergy, Asthma and Immunology. Every day in America, 40,000 people miss school or work, 30,000 people have an asthma attack, 5,000 people visit the ED, 1,000 people are admitted to the hospital, and 11 people die because of asthma flare-ups, the AAAAI says. About 5,000 people die from asthma complications annually, according to the American Lung Association. Although the pathophysiology of asthma is fairly well understood, the exact etiology is not.
Connecticut: Noraliz Santa-Grondin, RN, knows what its like to live with asthma, speaks English and Spanish, and is there for her patients where they most need it in their communities.
This is why she is the nurse coordinator for Hartford (Conn.) Hospitals Asthma Control and Education Program. ACE, a bilingual, bicultural disease management program for asthma, started in 1997. Since its inception, more than 1,000 patients and their families have been empowered with the ability to control their asthma so it does not control them, Santa-Grondin says. She has seen ACE grow with such great frequency that another nurse, Migdalia Rodriguez, RN, has joined the team.
The program centers around education through handouts, physician referrals, and support groups open to the community.
There is a misconception that [asthma] can be cured. This isnt true, but it can be controlled, Santa-Grondin says.
ACE in-services and educational seminars are conducted at local health fairs and at more than 20 shelters. Non-allergen mattresses and pillow covers, as well as other asthma tools, are given to patients who attend group-support classes.
There is a strong need for community asthma education, Santa-Grondin says, because about 80% to 85% of patients are Spanish-speaking, and many live in low-income areas. Because control over a patients environment is key, she visits some patients homes to ensure their environments are controlled and allergen-free. This is difficult, she says, but it can be very rewarding.
Spirits are uplifted during an annual Christmas party that Santa-Grondin coordinates. She saves the memories in an album, and says although the program will continue to grow, she remains strongly connected to her patients.
The American Diabetes Association says 23.6 million people in the U.S., or 8% of the population, have diabetes. Type 1 diabetes accounts for 5% to 10% of all diagnosed cases. The National Institutes of Health puts the number of children age 19 and under with type 1 diabetes at 125,000, but some 13,000 children are newly diagnosed with the disease each year. Non-Hispanic white youth had the highest rate of new cases of type 1 diabetes in the latest data collected by the federal government, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Florida: Most children who attend summer camps dance, swim, ride horses, or play baseball. But campers at Camp KoralKids, who have type 1 diabetes, also are learning how to check their blood sugars, inject insulin, and count carbs, says Kathy Byrne, RN, coordinator of community education, director Camp KoralKids, and coordinator of volunteer services for Coral Springs (Fla.) Medical Center, part of Broward Health.
Children must have type 1 diabetes to attend and must be between the ages of 5 and 11. Most come to the day camp with goals their parents have identified, such as giving their own injections or performing their own fingersticks. The majority of the kids are on insulin pumps, says Byrne. Campers get a nutritional lesson each day from a registered dietitian and a fitness lesson by an activities director. Other activities include journaling, scrapbooking, and team building, all while having fun with other kids.
Kids with diabetes even have their own lingo, like checking their blood sugar rather than pricking their fingers. If their glucose levels are high, they check their peetones or ketone levels.
Camp RNs are pediatric nurses who are specially trained to care for children with diabetes. Training includes inservices provided by the pump companies, hospital inservices throughout the year, and a one day orientation.
After the two week day camp is over, children keep in touch via e-mail and cell phone, forming their own support group.
The rewards for Camp KoralKids nurses are many. Theyve had nothing but positive feedback from children and parents, says Byrne. It keeps us going back and doing it a second year. The same nurses come back each year.
Cancer is the second-leading cause of death in the U.S., at about 560,000 in 2005 (the most recent figures available), according to the American Cancer Society. However, from 2002 to 2003 and from 2003 to 2004, the decline in the cancer death rate, about 2%, was large enough to overcome the impact of the growth and aging of the population and result in the first declines in the actual number of cancer deaths since mortality recording began in 1930, the group reports. Cancer death rates have been decreasing since 1991 in men and since 1992 in women, meaning there are more survivors.
Texas: To address the survivors life after cancer, M.D. Anderson Cancer Center in Houston, one of the leading cancer hospitals in the country, has established five clinics specially designed to help cancer survivors, according to Fran Zandstra, RN, BSN, OCN, MBA, director for cancer survivorship programs at Anderson.
The Institute of Medicine looked at adult cancer survivors, she says. What they found is that although many go on to lead happy, productive lives, a significant number have late effects from their cancer a cost for the cure.
Cancer survivors can expeience problems such as sexual dysfunction, fertility issues, fatigue, and bone loss, among others.
Anderson began its pediatric survivor clinic 20 years ago, Zandstra says. Since then, the cancer center has added similar long-term specialized clinics to address the health issues of survivors of breast cancer, gynecological cancers, thyroid cancer, and genital/urinary cancers.
Nurses play a key role in the clinics, Zandstra says.
Nurses spend more time with the patient than any other member of the healthcare team, she says. They often provide an interface between the patient and other healthcare providers.
Services at the survivor clinics include complete physical examinations, blood work, and X-rays; regular cancer screenings; identification and help in managing side effects of cancer and treatment; genetic counseling; and education on health behaviors that can reduce cancer risks.
U.S. citizens are vulnerable to a wide array of new and resurgent organisms, such as severe acute respiratory syndrome, according to the Infectious Diseases Society of America. Previously recognized pathogens can develop resistance to antibiotics and other traditional treatments. Methicillin-resistant Staphylococcus aureus falls into this category. The CDC estimated there were 94,360 cases of MRSA in 2005, 18,650 of these fatal. Crowded situations and easy travel make populations more vulnerable to the spread of infections in general.
Ohio: When the Outpatient Antibiotic Therapy service first was proposed in 2006 at Cincinnati Children’s Hospital Medical Center, the need was evident. At the time, there were an increasing number of patients discharged home on IV therapy and simultaneously increasing confusion regarding who would be responsible for these patients, says Jennifer Kelley, CNP, MS, who runs the clinic.
In the past year, referrals have increased steadily as more divisions within the medical center and community physicians are getting familiar with the service.
Typically, clinic patients are inpatients and preparing to be discharged home on antimicrobial medications through a PICC for a variety of infections, including osteomyelitis, mastoiditis, meningitis, UTI, pyelonephritis, and pneumonia.
Once the patient is discharged home, says Kelley, we are responsible for monitoring their clinical progress, following labs for response to therapy as well as potential adverse reactions to their treatment, and any issues related to their PICC.
The OPAT clinic also sees patients within three to four days after discharge and follows up as needed until the end of therapy.
The goals of the service include ensuring seamless continuity of care from the medical center to home, Kelley says. Furthermore, we strive to make sure there is always support available for the families if problems arise.
HEART ATTACK, STROKE
Coronary heart disease is the nations single leading cause of death. This year, about 1.2 million Americans will have a first or recurrent coronary attack, according to the American Heart Association. About 452,000 of these people will die. About 8.9 million Americans have angina pectoris. Also this year, about 700,000 people will suffer a new or recurrent stroke. More than 150,000 of these people die.
Illinois: The emergency care of patients experiencing chest pain has improved dramatically at St. Joseph Hospital in Chicago, says Ronna Atlas, RN, MS, BSN, nurse manager of the ED. We had a patient from door to cath lab in 15 minutes, Atlas says. The standard for door-to-balloon time is 90 minutes.
The improvement in patient care has coincided with the creation of St. Josephs chest pain center, which received accreditation by the Society of Chest Pain Centers in late February. St. Joseph also recently created a stroke center, and Atlas says having staff throughout the hospital involved in both, which has allowed St. Joseph to streamline its process, has been key to improving patient care.
Atlas says the hospital staff has gone through 12 to 14 hours of education on chest pain and the same for stroke training. The hospital hopes to have its stroke center accredited soon.
To educate the community, the hospital has done such things as put up posters and hand out informational flyers to staff, patients and others in the community who frequent St. Josephs popular cafeteria. Staff members also speak with community members, such as at the recent free discussion on the warning signs of heart attack and stroke at the hospital conducted by Atlas and Kathy Cooley-Ponds, RN, the hospitals stroke coordinator.
We are exceeding expectations with these two new initiatives, Atlas says. Everyone is so proud of what weve done. Were tackling the things that are important to our patients.
Cigarette smoking is the leading preventable cause of death in the U.S. Smoking is responsible for about one in five deaths annually, or about 443,000 deaths per year, according to the CDC. Among current adult smokers, 70% report they want to quit completely, according to the CDC. In 2006, an estimated 19.2 million (44.2%) adult smokers had stopped smoking for at least one day in the preceding 12 months because they were trying to quit. Brief clinical interventions by healthcare providers can increase the chances of successful cessation, the CDC reports. Quitting lowers the risk of several types of cancer, coronary heart disease, stroke, and premature birth.
North Carolina: Quitting smoking is the best thing smokers can do for their health, and Janet Whitesides, RN, can help. Whitesides, who is a clinical compliance nurse at UNC Healthcare, Chapel Hill, N.C., reviews all adult inpatient admissions each morning to look for smokers, especially among congestive heart failure, myocardial infarction, and pneumonia patients.
The counseling at UNC includes providing patients with written materials that inform patients about the hazards of smoking, information on UNCs outpatient smoking cessation program, and verbal counseling.
Whitesides estimates that 15% to 20% of inpatients are smokers; about half of those arent ready to quit. Sometimes you have to wait until theyre well enough to take it on, she says. Some 80% of UNCs inpatients who are smokers now receive smoking cessation materials while they are in the hospital.
The work is important since smokers often have comorbidities. Todays short hospital stays make her job challenging for example, CHF patients are often admitted for just three days. Yet she has time to plant the seed.
Whitesides says she is usually received very well and patients are appreciative. When people are receptive and say they want to try to remain smoke-free, thats reward enough, says Whitesides.
Natasha Emmons, Barry Bottino, and Laura Stakal, editors with Nursing Spectrum, and freelance writers Tom Clegg and Teresa McUsic contributed to this report.