February is American Heart Month, the perfect time to help others develop and practice healthy lifestyle behaviors and reduce their risk of developing CVD. As nurses we know that modifying eating habits, becoming more physically active and reducing stress can make significant differences in our patients’ well-being. But these changes are not always easy to incorporate into everyday life.
One nurse, Jo-Ann Eastwood, a recipient of an American Heart Association Clinical Research award, wanted to do something to change that and decided to help the young women in the Los Angeles area improve their cardiac health and overcome the barriers they faced. A clinical nurse specialist and acute care nurse practitioner, Eastwood, PhD, RN, CNS, ACNP-BC, FAHA, FPCNA, FAAN, is associate professor, program director, Advanced Practice, UCLA School of Nursing. “For many years I saw women 55 years and older who had heart disease, and I knew something had to change,” she said. “They had cardiac risk factors but were not aware of how to manage the disease or take preventive action.”
Eastwood wanted to work with the younger population, where she knew she could make the greatest impact.
In her program, “Staying Connected,” which combined a community-based participatory research study along with mobile health technology, 45 African-American women made lifestyle changes over time with weekly education followed by smartphone interventions and one-on-one support. After only six months, they lowered their blood pressure and total cholesterol, increased their HDL cholesterol, reduced their waist circumference and decreased their stress.
Eastwood recruited 90 participants, with half randomly placed in the intervention group and the other half randomly placed in the control group. Those in the intervention group received four weekly educational classes and were given smartphones with apps Eastwood had developed in collaboration with UCLA’s Wireless Health Institute. Those in the control group received the usual care from their providers and performed all components of the visits, that is, monitoring of height, weight, cholesterol levels and blood pressure. All of the women had to have at least two cardiac risk factors, such as sedentary lifestyle or a diet high in fat or low in fruits and vegetables.
Eastwood shares what she learned from her research and the program she developed, and along with that, some words of wisdom for nurses who want to implement a similar initiative.
Provide support and encouragement
“Teaching self-management skills that incorporate the individual’s perceived needs is key,” Eastwood said. “People usually know what works best for them. What they need is the education, support and encouragement in making necessary lifestyle changes.”
Eastwood credits much of the program’s success, which spanned almost three years, to regular remediation and consistent and close follow-up. She and her team used wireless coaching through text messaging and phone calls to reinforce what the women learned and used every week.
The smartphones tracked the individual’s physical activity throughout the day and transmitted blood pressure results once a week to the team. The app sent prompts and daily reminders, such as “How many servings of vegetables did you eat today?” and “Did you try to reduce your stress today?” Participants responded to the questions, which were streamed in real time to Eastwood’s team.
Individualize education and care
The four weekly education sessions covered topics such as family history, heart-healthy nutrition, the importance of physical activity and techniques for stress reduction. To ensure they used the teachings in their own lives, the participants in the intervention group kept individual notebooks in which they identified personal health goals and barriers to reaching them, according to Eastwood.
Each woman also learned about her own family history and how it could affect her health. “Learning that a first-degree relative who had a stroke or heart attack at a relatively young age could predispose her to the same emergent condition was a red flag for action,” Eastwood said. They also learned about the predisposing factors they had, such as prehypertension or gestational diabetes, which placed them at risk for future cardiovascular problems, Eastwood said.
Know your patients
“Learning about your patients and their families is important to your success,” Eastwood said. When nurses recommend ways for patients to get more exercise and reduce stress, they have to consider if the suggestions are viable alternatives. Climbing the stairs every two hours and putting on some music to dance with children may be more user-friendly options than walking around the neighborhood, especially if safety is a concern, according to Eastwood.
“Suggested interventions need to suit the population, and mine was a group of busy, young mothers,” said Eastwood, who explained that yoga class was not something they wanted to consider, but deep, slow abdominal breathing in a chair for a minute or two was relaxing and an easy method of stress reduction for them.
Engage others in improving health
Eastwood and her team didn’t expect to learn that family members also benefited from the program. The women began serving meals that were low in sodium, fat and cholesterol and incorporated more fresh fruits, vegetables, seeds and nuts into their cooking.
In the future Eastwood plans on including and engaging family members in her educational programs. Currently, she is analyzing the data from the study and working on disseminating the results through medical and nursing journals and community and national presentations. She works with the American Heart Association and the Preventive Cardiovascular Nurses Association, and hopes to continue her research and build on what she has learned from the study.
All of us, each in our way, can make a difference in the fight against heart disease with initiatives like the one Eastwood developed in Los Angeles. February is the perfect time to start thinking about what we can do at our workplaces, in our communities and right in our own homes. As nurses we know the national statistics on CVD are both alarming and unacceptable, and together we change them.
For information on cardiac health continuing education modules for nurses, click here.