On December 5, 2014, the Robert Wood Johnson Foundation (RWJF) held its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. It was a dynamic event that drew a standing-room-only audience in Washington, D.C. Following the conversation, the Human Capital Blog asked six participants to answer the question, What do you think is the most important step the country can take now to make progress in reducing disparities?
Gloria Sanchez, MD
Alumna, RWJF Summer Medical and Dental Education Program
“The United States has the ability to reduce disparities, but we need a movement that creates neighborhoods that provide sound and affordable nutrition, safe environments to exercise, and supportive communities that are free of pollution. Initiatives should guarantee that those individuals most afflicted by disparities are engaged in re-inventing their communities through assessments and interventions that truly create sustainable, positive change.
“Our nation can overcome the multitude of disparities that afflict so many. With directed resources, research, compassion, and community involvement, there is no doubt we will achieve equality.”
For the 25th anniversary of the Robert Wood Johnson Foundation’s (RWJF) Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Juan Jose Ferreris, MD, a member of the Class of 1989.
‘It is easier to build strong children than to repair broken men.’
The words of abolitionist Frederick Douglass resonate for Juan Jose Ferreris, a pediatrician and assistant clinical adjunct professor at University of Texas Health Science Center. He sees a straight line between the public funds allocated for children’s care and their well-being as adults.
“Kids receive less than 20 cents of every health care dollar. Meanwhile, 80 percent goes to adult end-of-life care. Why aren’t we spending those funds on people when they’re young, when it could make a genuine difference?”
Ferreris contends that money also shapes health in less obvious ways. Salaries of primary care physicians are well below those of more “glamorous” specialists. Some fledgling MDs, burdened with medical school debt, reason that they can’t afford not to specialize. Consequently, he says, only 3 percent of medical students choose primary care.
For Ferreris, who is both humbled and inspired by his young patients, building a Culture of Health necessitates recalibrating priorities.
“Nobody’s concentrating on the whole; they’re only looking at one part. And they’re not paying attention to the human—the brain, the spirit, the soul.
“We overlook that aspect...but it’s where I believe the primary care doctor has irreplaceable value.”
Partners Investing in Nursing’s Future (PIN), an initiative of the Northwest Health Foundation and the Robert Wood Johnson Foundation (RWJF), was represented in the U.S. Affiliated Pacific Islands (USAPI) by two partnerships: Building Nursing Faculty Capacity in the U.S. Affiliated Pacific Islands, which brought together the American Pacific Nurse Leaders Council, the World Health Organization and others to strengthen nursing education in the USAPI; and Step by Step, Hand in Hand: Expanding PIN Synergies in the Pacific, which introduced the Dreyfus Health Foundation’s Problem Solving for Better Health® (PSBH®) model to effect change within nursing education and within communities.
As part of a series of posts on PIN’s legacy of encouraging innovative collaborative responses to challenges facing the nursing workforce in local communities, a number of the USAPI partners have responded to the question: What do you think has been the major impact of the Pacific PIN?
“Since the first meeting of the Pacific PIN, we have come to learn more about each other’s nursing programs and the common needs that we shared. Through the years, this knowledge has expanded our friendship to those who have patiently stayed with us and directed us toward sharing resources and seeking new learning experiences, all to increase the number of qualified nurses for the Pacific region. I am most grateful to the foundations that were directly involved and the special people who made this all possible. Fa’afetai tele.”
--Lele Ah Mu, RN, BSN, Chair, Nursing Department, American Samoa Community College, American Samoa
This is part of the December 2014 issue of Sharing Nursing’s Knowledge.
“This holiday season, my one wish is that every nurse knows their worth and that every patient knows theirs.”
--Shelly Lopez Gray, RN, blogger, Adventures of Labor Nurse: The Highs and Lows of Labor and Delivery, A Nurse’s Wish in Labor and Delivery, Huffington Post Parents, Dec. 8, 2014
“Nurses have new and expanding roles. They are case managers, helping patients navigate the maze of health care choices and develop plans of care. They are patient educators who focus on preventative care in a multitude of settings outside hospitals. And they are leaders, always identifying ways for their practice to improve. Because nurses have the most direct patient care, they have much influence on serious treatment decisions. It is a very high stakes job. Everyone wants the best nurse for the job, and that equates to the best educated nurse.”
--Judy Evans, MS, RN, associate professor of nursing, Colorado Mountain College, Patients Benefit When Nurses Have Advanced Education, The Glenwood Springs Post Independent, Dec. 7, 2014
“Nurses are not just doers. Our work is supported by evidence and guided by theory. We integrate evidence and theory with our knowledge of patients and make important decisions with and for patients and families at the point of care. Research and practice are not separate but integrated. Nursing is a practice discipline with our own theories and research base that we both generate, use, and disseminate to others.”
--Antonia Villarruel, PhD, RN, FAAN, professor and Margaret Bond Simon Dean of Nursing, University of Pennsylvania, Q&A with Antonia Villarruel, Penn Current, Nov. 20, 2014
Roland J. Thorpe, Jr., PhD, MS, is an assistant professor in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and director of the Program for Research on Men’s Health at the Johns Hopkins Center for Health Disparities Solutions. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held December 5th. The conversation continues here on the RWJF Human Capital Blog.
Nearly half a century ago, Dr. Martin Luther King Jr. famously said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Yet decades later, only modest progress has been made to reduce the pervasive race- and sex-based disparities that exist in this country. African-American men who are at the intersection of race and sex have a worse health profile than other race/sex groups. This is dramatically evidenced by the trend in life expectancy.
For example, African-American life expectancy has been the lowest compared to other groups ever since these data have been collected. Today the lifespan of African-American men is about six years shorter than that of white men. Furthermore, a study from the Program for Research on Men’s Health at the Johns Hopkins Center for Health Disparities Solutions provides a financial perspective around this issue.
Lainie Ross, MD, PhD, is a 2013 recipient of the Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research and a 2014 Guggenheim Fellow. During her fellowship year, she will work on a book tentatively titled, From Peapods to Whole Genomes: Incidental Findings and Unintended Consequences in a Post-Mendelian World.
Human Capital Blog: What are some of the incidental findings and unintended consequences you will discuss in your book?
Lainie Ross: First, let me explain what I mean by “incidental findings.” Incidental findings refer to unanticipated information discovered in the course of medical care or research that may or may not have clinical significance. They are not unique to genetics. In some studies, up to one in four diagnostic imaging tests have incidental findings, although most do not have immediate clinical consequences.
One example of an incidental finding that I discuss in the book involves incidental findings uncovered while screening candidates for research participation. This can range from discovering high blood pressure (known as the “silent killer”) to extra sex chromosomes in people who volunteer as “healthy controls.” This raises the question of what is a clinically significant or “actionable” finding, and what information should be returned to the research participant. These types of questions are critical, especially because many research consent forms have historically stated that “no results will be returned.”
Brendan Saloner, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar and an assistant professor at Johns Hopkins University. On this first Universal Coverage Day, Saloner examines holes in access to care that remain after the Affordable Care Act. His post is cross-posted with the Leonard Davis Institute of Health Economics blog.
The United States is the last remaining rich country in the world where a large percentage of the population lacks health insurance coverage. This situation is being improved under the Affordable Care Act (ACA), with recent estimates showing that from early 2013 to mid-2014 the uninsured rate dropped from 19 percent of adults to 14 percent. The uninsured rate will no doubt continue to fall in 2015, but the problem of the uninsured will not go away with the ACA. It will not go away even if all 50 states expand Medicaid for poor adults, and will not go away if the U.S. Supreme Court rules against the plaintiffs in a pending challenge to the power of the administration to provide subsidies in the federally facilitated insurance exchanges.
In its 2012 baseline estimate, the Congressional Budget Office (CBO) projected that by 2022 the ACA might cut the number of uninsured by half, but would still leave behind 30 million people without insurance. This projection assumed full implementation of the ACA provisions. We don’t yet have a clear sense of how much larger that number will be with incomplete implementation of the core ACA coverage provisions, but even an optimistic assessment is that tens of millions of Americans will continue to spend periods of time without health insurance.
Who does the ACA leave behind? By design, the ACA excludes undocumented immigrants, a group that numbers around 11 million today. Some undocumented immigrants purchase private insurance, receive coverage from an employer, or participate in public programs funded with non-federal dollars, but the majority have no insurance. Undocumented immigrants are prohibited from enrolling in Medicaid, receiving subsidies, and purchasing coverage on the exchanges. Although President Obama recently signed an executive order protecting many undocumented immigrants from immediate deportation, the ACA exclusion will continue in the foreseeable future, barring an act of Congress.
This is part of the December 2014 issue of Sharing Nursing’s Knowledge.
Study: ‘Alarm Fatigue’ Poses Danger
After a while, alarms stop being so alarming. That’s the warning growing out of a study of the sheer volume of physiological alarms generated by bedside monitoring systems in hospitals. The barrage of beeps can become so overwhelming that it creates “alarm fatigue,” which in turn can lead nurses and other clinicians to discount the urgency of alarms or to ignore them altogether.
In the study, led by University of California, San Francisco (UCSF) School of Nursing Professor Barbara Drew, PhD, MS, researchers tracked the quantity and accuracy of alarms generated in five intensive care units at the UCSF Medical Center over a 31-day period. They found a high rate of false positives—alarms generated when patients were not in need of treatment beyond what they were already receiving. For example, during that time, researchers counted 12, 671 alarms for arrhythmia, 89 percent of which were false positives. Most of those were the result of problems with the alarm system’s algorithms, incorrect settings, technical malfunctions, or brief heart rate spikes that did not require further attention.
In all, during the 31-day period, the systems generated an average of 187 alarms per patient bed per day, adding up to more than 380,000 audible alarms over the course of the month, across the five ICUs.
This is part of the December 2014 issue of Sharing Nursing’s Knowledge.
On television and in other media, nurses are often portrayed as gendered stereotypes: the angel, the handmaiden, the battle-axe, or the sex-object.
Turns out, these portrayals aren’t new. That is evident in a new postcard exhibit at the National Library of Medicine in Bethesda, Md., that illustrates cultural perceptions of nursing over the last century.
The exhibit, entitled Pictures of Nursing, hails from a collection of more than 2,500 postcards that were donated by Michael Zwerdling, RN. The collection includes postcards that date to the late 1800s, and features images of nurses portrayed as everything from Greek goddesses to Amazon princesses to the Virgin Mary. It also includes rare images of male nurses.
Some of the exhibit’s more contemporary postcards depict nurses in modern uniforms and as skilled members of health care teams—images that counteract sexist and gendered notions of nursing that come through in other postcards.
Collins O. Airhihenbuwa, PhD, MPH, is professor and head of the Department of Biobehavioral Health at Penn State University. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held last week. The conversation continues here on the RWJF Human Capital Blog.
As we address disparities and inequities, the challenge is to think about solutions and not simply defining the problem. Most would agree that health is the most important part of who we are. It is the first thing we think about in the morning when we greet one another by asking, “How are you this morning?” It is the last thing we think about at night when we wish someone a restful night.
What may be different is what health means to us and our families. This is why place and context are important. How we think about health and what we choose to do about it is very much influenced by where we reside. Our place and related cultural differences about health are less about right or wrong and more about ways of relating and meeting expectations our families and communities may have of us, whether expressed or perceived. More than that is the way we relate to what our place means in terms of how it is defined and subsequently how that definition shapes how we define it for ourselves. In other words the ‘gate’ through which we talk about our place and ourselves is very important in having a conversation about who we are and what that means for our health.