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 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.
Drive-Thru Screening Served up at King’s Daughters Hospital in Temple, Texas
Diabetes Drive-Thru may conjure up images of fast-food indulgences and insulin overload, but the blood-sugar screening program at Kings Daughters Hospital in Temple, Texas, actually serves up something sweeter. In about five minutes, customers drive through three nurse-staffed stations and receive free tests, results, and information without leaving their cars.
Pam Pierce, RN, CDE, director of clinical support services for Kings Daughters, noticed most patients attributed their symptoms to age and discovered their diabetes through unrelated blood tests. By catching them earlier, we can give them advice to prevent type 2 diabetes, she says. So 13 years ago, Pierce created the recipe for early diagnosis, serving 100-200 people at each four-hour screening.
They come because theres no cost, its easy, and they dont have to schedule it, she says. We get a community cross-section, usually middle-age to elderly, some overweight, and many with a family history. Were clear its a screening, not a diagnostic test, to see if theyre within normal ranges. Results from 102 recent participants indicated 20 were prediabetic.
Minutes after checking in, signing consents, and getting a finger stick, participants are given written results. Many are surprised their results are outside the norm.
Weve had a few with readings of 300 and over, which is pretty significant if they arent diagnosed already, says Pierce. We suggest they seek immediate medical care.
The last stop serves up fruit, juice, and information on signs along with symptoms and modifying diet and activity. They can immediately take steps to decrease their chances or prevent prediabetes and type 2 diabetes, she says. Its a great service with a tremendous impact at a minimal cost.
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.
The Methodist Hospital Systems Weight Management Center in Houston
At The Methodist Hospital Systems Methodist Weight Management Center in Houston, the staff help patients, including bariatric surgery patients, take control of their weight issues.
We mostly deal with outpatients on the medical weight management side, says Terri Corbett, RN, CGRN, a certified gastroenterology nurse.
Corbett says patients drink four nutritionally complete beverages per day as well as the recommended amount of water usually half of their current weight in ounces. For example, a 300-pound patient would drink about 150 ounces of water daily.
We use a very low-calorie, high-protein liquid diet as a tool to help patients, she says. How long theyre on this regimen depends on their weight loss goal.
The program also involves nutritional counseling and an exercise regimen. To be honest with you, says Corbett, the first week or so is hard for patients. Later on, we have difficulty getting them to transition back to food. Sometimes patients are afraid of eating regular food again. They dont trust themselves to use the skills they have learned in our classes.
The programs staff includes dieticians, counselors, nurses, and a physician. The hospital also has bariatric surgeons who perform gastric bypass and Lap-Band surgeries. Initially when you have gastric bypass surgery, you have volume restrictions plus some degree of malabsorbtion, so you lose a lot of weight rapidly, says Corbett, who has worked at the center for four years. After about 18 months to two years weights plateau. Thats where the tools come in handy. Patients use the dietary education provided at the weight management center to maintain their new weight.
Texas, along with almost every state in the country, is plagued by an obesity problem. I think society in general is vulnerable to the problem because were on the go a lot, we eat out a lot, which makes an unhealthy diet more likely. Also, some people are genetically predisposed to obesity.
Patients qualify for the weight management program if they have a body mass index of 35 or above. Normal is 22 to 25. In addition to the weight loss, patients also benefit from lower cholesterol, triglycerides, and blood pressure and many diabetic patients are able to reduce the amount of medication they are taking to regulate their blood sugars.
They typically leave much happier than when they come in, with a lot more confidence, says Corbett.
Typical patient load at the center is about 350 patients per week.
Corbett is a former bariatric surgical patient herself. She had gastric bypass surgery almost five years ago. I saw what the surgery did for me, she says. My health is so much better because of it. My husband also had it done five months after I did. I felt so blessed to be able to have my life back again that I basically begged them for a job here. I feel like God led me to this place in my life, and I love it here.
The weight management center is developing a new program for patients who dont have a BMI of 35 but are still overweight. Were excited about it and hope it goes over well. We have a lot of patients who dont meet the criteria but still need help losing weight.
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.
M.D. Anderson Cancer Center in Houston
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.
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.
UNC Healthcare in Chapel Hill, N.C.
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.
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.
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.