Rebel Nurses: Jalil Johnson’s Journey to Nursing Empowerment

Rebel Nurses: Jalil Johnson’s Journey to Nursing Empowerment

This series takes a look at the stories appearing in The Rebel Nurse Handbook, which features inspiring nurses who push the boundaries of healthcare and the nursing profession. This installment focuses on nurse, writer, public speaker, and acting director of Show Me Your Stethoscope, Dr. Jalil Johnson.

Jalil Johnson found his career in nursing at what might have been the lowest point of a hard life. After graduating from high school, the impoverished Tennessean was struggling. Living from paycheck to paycheck, he ultimately found himself working as a $7.00-an-hour dishwasher. Then came the night—at a time when he had no more than $10 to his name—that Johnson found himself laid off.

During the relentless job hunt that followed, a newspaper ad for free Certified Nursing Assistant (CNA) classes caught his eye. Johnson was intrigued, but in his impoverished state, the cost of the course textbooks was beyond his means. As he sat in front of the school planning his next move, he happened to encounter the Dean of the program. The Dean was touched by Johnson’s situation and his astounding resolve. With his encouragement and assistance, Johnson applied for financial aid, enrolled in the CNA classes, and embarked upon a career in nursing.

The CNA training, and later the job itself, changed his life. After getting his CNA, Johnson decided to continue his nursing education. What inspired this decision? Johnson says, “there were many pivotal moments that encouraged me to pursue higher education. An important moment was the sense of absolute fulfillment I felt after working with my first patient as a CNA. Until that point in my life, I’d never actually helped a person with their care, health, or with the simple aim to make their life a little better. When my patient sincerely said ‘thank you so much’ to me that day, I knew I wanted to learn as much as I could about how to do this work. I wanted to expand my ability to have positive impact on people.”

Johnson spent the next two decades climbing the professional ladder: he became an LPN, an RN, was awarded a BSN, went on to take his master’s degree and training as a Nurse Practitioner, and later received his PhD as a nurse scientist. “Each time I completed another degree or level of licensure, my scope of practice and experience changed. The impact I had on patients wasn’t better with more education, but it was different. I enjoyed being challenged in this way. I continued this way of thinking through my studies, including my journey to become a nurse practitioner and nurse scientist (PhD).” Along the way, he worked in positions ranging from traveling nurse, to ICUs and EDs, to substance use treatment programs and behavioral health, and teaching CNA, LPN, RN, and DNP students. “I’ve never forgotten how amazing it feels to empower someone else,” he says.

Empowerment is a keyword for Johnson, who vividly recalls “the powerlessness I often felt throughout my career. Regardless of my level of practice, I always felt that the work and the care could be better, but I never felt I had any power to really change anything. My assumption was that more education would lead to having more say in my practice, and subsequently less feelings of powerlessness. Well, I was wrong about that. The powerless feeling followed me throughout many practice settings and scopes of practice.”

Johnson sought ways to overcome this sense of powerlessness, and found that his views were shared by “hundreds of thousands of nurses out there, who love their work as I do, but also feel like the healthcare system doesn’t work for them or their patients.” Seeking empowerment for himself and his fellow nurses, he began to work in self-advocacy with communities like Show Me Your Stethoscope and Nurses Take DC, and became a writer and public speaker.

When asked what he feels most passionate about in his career, Johnson replies, “I’m passionate about many things. I enjoy caring for my patients and love teaching. However, I’m most passionate about inspiring other bedside nurses to unify behind causes they believe in. As the largest profession within healthcare, I believe nurses have the opportunity to be truly revolutionary if we band together and support each other. This is one of the ideas that motivated me to start writing my forthcoming book, Nation of Nurses, where I discuss specific ways nurses can mobilize and revolutionize healthcare.”

He is also passionate regarding his advocacy groups: “these online communities are filled with bedside nurses who are passionate about improving the nursing and the healthcare system. Honestly, through this work, for the first time in nearly 20 years, I feel like nurses are taking back their power; and this gives me so much hope.”

Health Equity: What Does it Mean for Nursing?

Health Equity: What Does it Mean for Nursing?

According to the Robert Wood Johnson Foundation, “Health equity means increasing opportunities for everyone to live the healthiest life possible, no matter who we are, where we live, or how much money we make.”

Health equity is of vital concern to nurses, whose daily work as patient educators and healthcare practitioners is influenced by interrelated factors such as:

  • Health Disparities
  • Social Determinants of Health
  • Cultural Competence
  • Social Justice

With the help of Drs. Janice Phillips (PhD, RN, FAAN) and Margaret Moss (PhD, RN, JN, FAAN), editors of the upcoming book Health Equity and Nursing, DailyNurse is looking at these basic concepts and exploring the role of health equity considerations in the day-to-day work of nursing.

Health Disparities

“Health disparities” refers to the inequalities in health and health care between different population groups. There are widespread inequalities that impinge upon public and individual health and well-being. Among the patients most directly affected are members of ethnic minorities, immigrant and low-income families, and people living in areas far from accessible care. According to a 2018 study, the US spends an estimated $93 billion in excess medical costs per year due to racial disparities alone.

DailyNurse: Can nurses help to overcome health disparities that affect their patients?

Janice Phillips: “It’s been over a decade since nurse leader Dr. Gloria Smith wrote a commentary “Health Disparities: What Can Nursing Do?’ In her commentary, Dr. Smith encouraged nurses to promote nurse managed primary care and focus on changing local, state and national policies to help address health disparities.

In recent years however, we have expanded our efforts to reduce health disparities to include an emphasis on achieving health equity. Healthy People 2020 defines health disparities as a type of particular difference in health status that is closely linked with economic, social, or environmental disadvantages. Populations that experience greater social and economic hardships are more likely to experience health disparities.

In contrast, health equity is a principle that underscores a commitment to reducing and ultimately eliminating health disparities. Health equity occurs when all populations (especially vulnerable, less advantaged socioeconomic populations) experience their highest level of health. Efforts to achieve health equity are intertwined with our ability to effectively eradicate health disparities. In our daily practice, nurses can be mindful to assess for these and other conditions that may adversely impact health outcomes and make appropriate referrals to members of the health care team such as social workers and case managers who are skillful in addressing identified social needs and can make appropriate referrals for additional services.

On a higher level of intervention, nurses must become skillful in advocating for social policies that can positively impact the myriad of social and economic conditions (inadequate housing, lack of employment and education opportunities) that adversely impact the health and well-being of those we serve.”

Health Equity and Social Determinants of Health (SDOH)

Social determinants of health (SDOHs) are factors apart from medical care and genetics that account for roughly 80 percent of overall individual health outcomes, according to the National Academy of Medicine. SDOHs are factors such as socio-economic status, availability of nutritious food, air and water quality, housing, education, transportation, racial segregation, and exposure to racism and violence. SDOHs can include a patient’s neighborhood and environment, access to health care (including insurance); social, cultural, and community context; level of education; and economic stability—all of which play a role in a nurse’s assessment of a patient’s wellbeing and risks to the same.

DN: In what ways can a nurse incorporate SDOH considerations into treatment?

Janice Phillips: “As they are working on the frontlines providing direct care to patients, it is important for nurses to be mindful of the many social and economic factors that may impact the health and well-being of patients and communities at large. In recent years hospitals have started screening patients for social needs that may have some bearing on a patient’s health and health outcomes. Factors such as access to stable housing, primary care, nutritious foods and transportation have emerged as significant factors impacting health status and health outcomes. Thus nurses are pivotal to integrating these factors when conducting patient assessments and making referrals that can help address the identified social needs. Other factors such as structural racism, income, education, poverty also impact health status and outcomes.

As patient advocates, nurses are well positioned to relay important information to social workers, case managers and other members of the interprofessional health care team who have the expertise to refer patients to needed resources. Nurses are valued collaborators in this regard and are encouraged to familiarize themselves with how their respective hospitals and health care systems are assessing and addressing the identified needs of patients. According to the American Hospital Association, by 2023, 48% of health care organizations will have a standardized means for collecting data on the social determinants of health, making this an important opportunity for nursing practice. Knowing where one’s organization stands with these efforts is an important first step.

Public policies that address the root causes of poor health status and longevity are central to any effort devoted to addressing the social determinants of health. Nurses are encouraged to get involved with their professional organizations, home institutions or other stakeholders who can work together to advance a policy agenda aimed at addressing the myriad of social and economic factors that impact health.”

Cultural Competence

According to Dr Jasmin Whitfield (RN, MSN, MPH, DNP), “culturally competent care is not just acquiring information on a particular group of people but rather developing a respect for and understanding that the beliefs, attitudes, behaviors, language, and rituals of that group all play a role.” The epidemiology, manifestation of disease, and effects of medications vary among different ethnic and cultural minorities, so nurses need to make themselves aware of matters such as ethnicity and culture, sexual preferences, and other points of identity as part of their patient dialogue, as all of these matters have specific health connotations.

DN: How can a nurse deal with topics such as patients’ ethnicity, language, culture, sexual orientation, and gender identity in a sensitive, yet direct manner?

Margaret Moss: “It may be of help for the practicing nurse to know of other care modalities recognizing a cultural component. There is Cultural Safety, defined by Williams (1999), “as an environment that is spiritually, socially and emotionally safe, as well as physically safe for people”. This includes being safe to tell your nurse how you identify, relay your spiritual and other needs without fear of retribution etc. Especially when there is patient-provider racial, gender or ethnic discordance, there can be a tentativeness on either side to communicate effectively and fully.

There is Cultural Humility and Cultural Respect as well. So, a big tip is just ask…very simple. With humility, state you are unaware of any special needs or care they may have and ask. Ask, how do you identify? Instead of guessing and then go from there. Whereas Cultural Competency can be seen as useful for the dominant culture caring for the ‘other’. As an Indigenous nurse, no one offered me a Cultural Competency course or workshop as I cared for dominant culture patients. However, safety, humility and respect always serve to increase a patient’s comfort and optimize results.”

Health Equity and Social Justice in Nursing

Social justice is a key aspect of health equity and is a core concept of nursing ethics. The American Nurses Association (ANA) states that nursing has a “professional responsibility to address unjust systems and structures.” Adhering to this ethic can lead to involvement in some divisive issues, but nurses have been advocates for social justice and human rights since the days of Florence Nightingale.

DN: In your view, what role do today’s nurses have in working towards social justice?

Margaret Moss: “Social Justice (from the Oxford Dictionary at Lexico) is justice in terms of the distribution of wealth, opportunities, and privileges within a society. It is well known, published, proved, that minorities in the US suffer, daily and out of proportion to non-minority peoples, at the lower end of these distributions.  Other groups such as the poor, working poor, chronically ill and disabled, and LGBTQQ2+ suffer as well. To help even out these disparities in the health realm, nurses must advocate. At times, they are the only thing standing between a patient and health or death. 

Similarly, nurses are and must be advocates beyond the individual. Nursing programs at the bachelor’s level and above incorporate Community Health, Population Health, Leadership and often Health Policy into the curriculum. I sought a law degree after my PhD in nursing, as both have at their base-advocacy. I have worked my career in advocating for more just American Indian Health. Social Justice Issues face every nurse every day and they are deep and wide. They hit ethics; policy and procedures that may be seen as detrimental but are, “always done that way”; unpotable water such as in Flint, MI; or Uranium on American Indian reservations; lack of available medicines; unfunded programing, and the massive leading edge of aging care; autism; and a host of other issues.”

DN: Finally, what actions can nurses take to further social justice and health equity in healthcare?

Margaret Moss: “Nurses at 3 million strong have the collective and individual power to help change these imbalances, by showing up (legislatures); speaking up (comment on proposed rules); and participating (in practice and advocacy associations).”

In the Midst of an OUD Crisis, Are Health Practitioners Biased Against Addicted Patients?

In the Midst of an OUD Crisis, Are Health Practitioners Biased Against Addicted Patients?

It is well-known that people with Substance Use Disorder (SUD) and Opioid Use Disorder (OUD) face a heavy stigma in society at large. For instance, in Victoria, BC, while exceptional caregivers such as Corey Ranger, the roving Narcan-toting nurse are saving addicts’ lives, hostile bystanders often offer disdainful suggestions such as “Oh, why bother? Just let them die!”

Indeed, it is not uncommon for the general public to regard SUD and OUD as examples of societal weakness and personal failure, rather than viewing the condition as a medical condition that is frequently combined with other chronic disorders. In many cases, those suffering from addiction are also subjected to negative attitudes from nurses, doctors, and other healthcare practitioners. As a nurse in one study says of SUD patients, “[they create] a cycle of problems,” where “the staff perceives them to be annoying or obnoxious…” Another nurse in the same study notes, “staff attitudes are obvious, you can’t really hide them that well.” It is acknowledged that “Stigmatizing attitudes among health professionals have been shown to be widespread, which has detrimental consequences for connecting persons with OUD to treatment.”

Nurses, Doctors and SUD; Nurses and Doctors with SUD

There is an irony when healthcare practitioners display this attitude toward patients with SUD and OUD. According to the American Journal of Psychiatry and the National Council of State Boards of Nursing [NCSBN] publication “Substance Use Disorder in Nursing,” the prevalence of substance use disorders among doctors and nurses is similar to that of the general population—and is higher than the general public in the case of prescription drugs.

However, doctors’ tendency to protect colleagues with SUD, and the policy of the NCSBN that promotes a nonjudgmental, stigma-free approach to treatment of nurses with SUD (approximately 70% of nurses who seek treatment successfully return to practice) coexists with strong evidence that a substantial number of doctors and nurses have a negative attitude toward addicted patients. The consequences are as grave as they are incongruous; as a study in Canadian Nurse.com remarked, “perceived discrimination on the part of health-care staff was a major barrier to [patients’] seeking medical help, both for their substance abuse and for treatment of general and chronic conditions.”

Doctors and OUD: A Static System

“Fresh out of medical school, you can prescribe for pain relief any of the opioid medications that can lead to addiction, but you have to get a special waiver to treat addiction, a disease process. That just doesn’t make sense…”

–Dr. Sandeep Kapoor, director of the Screening, Brief Intervention and Referral to Treatment (SBIRT) program at Northwell Health

The situation of doctors is particularly unfortunate with regard to patients with OUD. The reaction of one doctor, when asked about the sparse availability of buprenorphine treatment, was a flat comment that “Most doctors don’t want to treat OUD or SUD patients.” A Statnews editorial on this topic concludes that a pervasive problem is that a) many doctors do not see addiction “as a brain disorder requiring treatment, but as a personal failing,” and b) “some physicians believe that medication-assisted therapy is little more than switching one addiction for another.”+

Even among those doctors who are willing to treat OUD patients, the problem is compounded by the fact that even now—in the midst of an opiate crisis—treating addicted patients with medications such as buprenorphine is highly regulated, requiring strict state and federal registration. To be permitted to prescribe, regulations require that doctors take eight hours of training (for NPs and PAs the requirement is 24 hours of training), after which they are required to register for a DEA waiver.

A further deterrent to the propagation of buprenorphine treatment is the inspection of office records by DEA agents (see within link, “What to Expect When the DEA Comes to Your Office”). An independent-minded physician—who may already be unenthusiastic about treating “addicts”—is unlikely to readily tolerate this sort of heavy-handed government interference in his or her practice. As it is, at present, despite the generally acknowledged opiate crisis, fewer than 7% of US physicians currently have DEA waivers for the prescription of one of the safest and most effective methods of treatment for opiate addiction.

Ties that Bind

This means that while the opiate crisis is raging, the hands of the practitioners who ought to be on the front lines of the fight are bound—both self-bound and bound by regulations. Doctors Kevin Fiscella and Sarah Wakeman ask in another StatNews editorial, “Would deregulation work?” They go on to note that “after France instituted this approach in 1995, deaths from opioid overdoses dropped nearly 80 percent.” Until attitudes among caregivers become more advanced, and until a proper deregulation movement for the prescription of buprenorphine gains national attention, attempts to stem the crisis are little more than a grand display of running in place.

Influenza Vaccinations: Do Jails and Prisons Vaccinate Inmates?

Influenza Vaccinations: Do Jails and Prisons Vaccinate Inmates?

By Jeffrey E. Keller, MD, FAACP

Border detention facilities that house immigrants have been in the news recently because of their policy of not providing influenza vaccinations to their detainees, sparking high-profile protests. Why would an immigration detention facility, tasked among other things with providing comprehensive medical care to its detainees, refuse to provide them with flu vaccines?

To answer this question, it might be instructive to ask how influenza vaccinations are handled at other prisons and jails in the U.S. It depends on what type of facility you are in and how long you will be there. All prison systems I know of offer influenza vaccinations to their inmates. On the other hand, most jails (short-term detention facilities) do not have a routine flu vaccination program, though there are exceptions.

Vaccinations in Prisons

Inmates are sentenced to prison for a minimum of one year and usually longer. As a result, prison populations are stable. Almost all of the inmates in a particular prison now will still be there next year. Also, prisons are tasked with providing comprehensive medical care to their inmates. This includes influenza vaccinations, but also other recommended vaccinations and boosters. Of course, just like in the community at large, not all inmates want to be vaccinated. The percentage of prison inmates who get vaccinated depends on how vigorously the prison pushes the program.

If a prison advertises the availability of the flu vaccine and actively encourages its inmates to be vaccinated, the acceptance rate can be greater than 50% (compared to about 33% of adults in the community who get vaccinated). Most prisons have a “big push” campaign to encourage flu vaccines once a year in the fall. However, if a prison does not advertise the availability of the flu vaccine, the percentage of inmates vaccinated can be very low. It makes economic sense for prisons to actively encourage their inmates to be vaccinated. Every dollar spent on influenza vaccinations will save more than a dollar down the road trying to deal with influenza outbreaks.

Vaccinations in Jail

Influenza programs in jails are different for several reasons. The first issue is that the inmate population in a jail is not stable. The average length of stay in the average jail in the U.S. is around 2-3 weeks and many are released within days. If a jail offers influenza vaccinations in October, most of the inmates vaccinated will be gone by November. The jail will now be filled with new, unvaccinated inmates. If you vaccinate the November inmates, most (again) will be gone by December. So, to be effective, influenza programs in a jail must last the length of the influenza season — making jail influenza programs more difficult and expensive to administer than a prison program.

As an example, remember that one must order influenza vaccines well in advance. In order to have influenza vaccines ready in the fall, a prison or a jail has to order them at least six months earlier. A prison will know how many influenza doses it will need based on its population and previous acceptance rate. But how many doses will a jail need with inmates coming and going over the course of an entire flu season? That can be hard to get right in a jail! It is expensive and maddening to order too many vaccines only to throw the unused doses away at the end of the flu season.

Also, jails vary greatly by size and sophistication of the medical services they provide. There are many small jails in the U.S. (think 10 beds) where no medical personnel ever come to the jail for routine medical care. If their inmates need medical attention, the deputies have to load them into a van and take them to a clinic or ER in the community. Such a jail is unlikely to offer influenza vaccinations to their inmates. On the other hand, bigger jails (say, more than 1,000 beds) with a full-time medical staff may indeed have an influenza vaccination program.

“Kicking the Can Down the Road”

The most successful jail influenza programs that I have seen are done in cooperation with the local health department. The health department is tasked with providing vaccinations to the community at large, which includes jail inmates. When asked, health departments often will come to the local jail once a month to provide influenza vaccinations to any inmate who requests one. (This is also a good way to provide screening for sexually transmitted diseases in asymptomatic inmates.) Even small jails can approach their local health department about providing immunizations to inmates, though few do.

Customs and Border Patrol reportedly defended its policy of not providing influenza vaccinations during border detention by saying that immigrants are only there for a few days and are expected to get the flu vaccine later, when they are moved to a long-term facility. Where I grew up, this was called “kicking the can down the road.” To my mind, deferring vaccinations until later makes little medical or financial sense. Since none of these detainees is going to be released, and since you are going to vaccinate them later anyway (as reported), why not do it as part of their initial medical screening?

Jeffrey E. Keller, MD, FACEP, is a board-certified emergency physician with 25 years of experience before moving full time into his “true calling” of correctional medicine. He now works exclusively in jails and prisons, and blogs about correctional medicine at JailMedicine.com.

This post was originally published in MedPage Today.

Border Flu Shot Protest: 4 Docs arrested

Border Flu Shot Protest: 4 Docs arrested

Four physicians and two others protesting their inability to vaccinate migrant detainees at the U.S. Customs and Border Protection (CBP) headquarters here were arrested last Tuesday for failing to comply with federal orders to disperse.

They were held for about an hour, according to some of those who were arrested.

The two groups of protesters — about 60 people in total — had gathered in two driveways leading to CBP headquarters for about an hour when one of the groups received a warning from federal officials that if they stayed in the driveway, they would be arrested, said Marie DeLuca, MD, an emergency room physician from New York who was one of those arrested. Some of the members had blocked the driveway by laying down across the road while others chanted, “No more death.”

“We stayed peacefully in the driveway entrances of their building and said that if they weren’t going to let us in to vaccinate against the flu, we were going to remain. They didn’t let us. Instead they chose to arrest members in one of the two groups,” DeLuca said.

She said her hands were secured behind her back with zip ties by officials from the Department of Homeland Security (DHS) as she and the other protesters were led into a conference room and told to wait. After about an hour following the protest, they were issued tickets with a court date for “failure to comply with the lawful direction of federal police officers or other authorized individuals,” and then released, she said.

A San Diego Union-Tribune reporter posted a video of some of those doctors being arrested.

At about 2 p.m. Tuesday, DHS’s press secretary tweeted a picture of the protesters and said, “Of course Border Patrol isn’t going to let a random group of radical political activists show up and start injecting people with drugs.”

Sen. Elizabeth Warren (D-Mass.) also tweeted a link to a video of the protesters, saying that “Children are dying in CBP custody due to the flu. Refusing to administer flu vaccines is neglectful and cruel.”

Other doctors arrested, who were part of the group Doctors For Camp Closure, included Mario Mendoza, MD, a former anesthesiologist who now lives in New York City and runs the organization Lifeundocumented.org; Hannah Janeway, MD, an emergency room physician in Los Angeles who helps run the Refugee Health Alliance; and Mathieu De Schutter, a pediatric hospitalist from San Luis Obispo, California. The non-physicians arrested were Rebecca Wollner of Jewish Action San Diego and Matthew Hom, a graduate student from Cerritos, California, who works with the group Never Again Action.

On Monday, the physicians began their three-day vigil and protest of federal immunization policies at the gate of the detention center in San Ysidro at about 11:30 a.m. They stayed until about 4:30 p.m. with no response despite repeated requests. Tuesday’s action took place nearby at the Chula Vista CBP headquarters.

DeLuca said the doctors and their supporters planned to return Wednesday to try one more time to administer the 120 influenza vaccines they brought with them for the detainees. They say it’s important for public health, not just to protect these detainees, but also everyone else they come in contact with.

Members of the groups chanted slogans and carried banners and signs calling on federal officials to let them administer the vaccinations to those inside. The vaccines were purchased with financial donations.

Originally published in MedPage Today.

Climate Change Awareness: The Role of Health Providers

Climate Change Awareness: The Role of Health Providers

As trusted professionals in the eyes of the public, health providers are considered stewards of public health and safety.

A view of Hong Kong smog from Victoria Peak.
A polluted morning in Hong Kong.

Health providers are ethically bound to advance health holistically, and with climate change, this means translating information into advocacy. The effects of climate change call for the many roles that medical providers take on: first responder to disaster, risk educator of patients and public, and — in an almost exact reenactment of Florence Nightingale’s work — defender of clean water, nutritious food, and sanitation.

The scope of climate-related effects on human health is simultaneously as broad as global drought and as specific as increased incidence of skin cancers. Health providers are uniquely positioned to address the health implications of climate change, providing education within the context of direct patient care and speaking with authority on policy decisions that affect public health.

Climate Change and Human Harm

Health providers warn that climate change can cause or increase the severity of a range of dangerous respiratory ailments.

Scientists are still working to understand the full impact of climate change on human health; however, there are existing studies that show severe effects on human health as a result of environmental hazards. According to the National Institutes of Health, there are several key areas of concern regarding climate and health, and many opportunities for health providers to offer prevention and education.

THREATS TO RESPIRATORY HEALTH

Implications: Lung disease, allergies, and asthma will be worsened by longer allergy seasons and deteriorating air quality.

Health Provider Recommendations: Support staying inside on poor air quality days and remind vulnerable populations to adhere to medical treatment plans and medication.

VECTOR-BORNE DISEASES

Implications: Ticks and mosquitoes will be more active for longer and range farther.

Health Provider Recommendations: Encourage people to use bug repellent when outdoors or in any areas with insects. Monitor and record reports of disease outbreaks. Inform others about signs and symptoms of diseases and when to call a health care provider.

WEATHER-RELATED ILLNESS AND INJURY

Implications: Extreme temperature fluctuations affect outdoor laborers, children, pregnant women, and older adults and can cause pulmonary and cardiovascular problems and dehydration. In addition, increased particulate matter, ozone concentrations, and extreme weather events may trigger stress and respiratory issues that lead to heart disease.

Health Provider Recommendations: Educate about the risks of heat exposure. Ensure access to air conditioning for vulnerable or older adults and homeless populations. Also, encourage people to drink enough water throughout the day and not just when they feel thirsty.

MENTAL HEALTH AND STRESS DISORDERS

Implications: Extreme weather can be destructive to property and quality of life, often resulting in the loss of homes, belongings, and loved ones. Prolonged exposure to these stressful experiences can manifest psychologically as people try to navigate grief and loss with interrupted access to care.

Health Provider Recommendations: Encourage others to speak openly about their grief to reduce stigma. Identify gaps in mental health literacy and teach patients about signs and symptoms of mental health risks. In addition to educating, refer at-risk patients to a mental health provider as soon as possible.

Spreading the Word About Disaster Preparedness and Dangers

One result of climate change is more frequent and more powerful natural disasters, like hurricanes. Pictured are specialists testing the flooded river during Hurricane Harvey
Flooding after hurricane Harvey

In a 2018 World Health Organization report on climate change and health,  experts state that “globally, the number of reported weather-related natural disasters has more than tripled since the 1960s.” For this reason, it’s essential that health providers inform their communities about disaster preparedness and dangers. The best time to get involved is before a disaster; therefore, it’s critical for providers to leverage any one-on-one time with patients to address holistic health and emergency concerns. Special attention should be paid to those who may be vulnerable in the wake of disasters. For example, this could include people with chronic conditions, physical disabilities, or respiratory diseases; infants and children; pregnant women; and older adults.

Thin Ice: The Life-Threatening Effects of Climate Change

Air Temperature Change

  • Increase in heat exhaustion
  • Spread of disease vectors among animals, insects, and people

Air Pollution

  • Increased movement of airborne allergens and diseases
  • Higher risk of respiratory illness  
Climate change affects pets, too. Rescued dogs from Hurricane Harvey are being treated by volunteer health providers.
Volunteer care providers treat pets rescued after hurricane Harvey.

Extreme Weather

  • Chronic stress
  • Geographic displacement
  • Loss of loved ones and pets

Water Temperature Change

  • Changes to coastal ecosystem health that will affect food supply and erosion
  • Increased likelihood of extreme precipitation, drought, or flooding
  • Water contamination due to harmful chemicals and pathogens

Food Security

  • Malnutrition, especially for prenatal or early childhood development
  • Exposure to pesticides and toxic contaminants
  • Increase in harmful algal blooms

Source: Health Effects of Climate Change.  U.S. Department of Health and Human Services, 2018. Accessed April 23, 2019.

All health providers are important voices in preemptively educating patients about disaster preparedness, but nurses specifically make up a crucial part of disaster response.

More than 20,000 licensed and student nurses serve the Red Cross in a variety of roles — some as first responders and CPR educators and others as supervisors and organizational managers.

While the effect of climate-related health issues increases alongside the shortage of nurses and other medical providers, there’s great reason for all providers to advocate for change.

A Rising Tide Lifts All Boats: Advocacy for Climate-Related Health Policy

Nurses and other health providers are advocating for climate action.
Alliance of Nurses for Healthy Environments at September 2019 rally in D.C.

Climate change may be politically polarizing, but illness and injuries seen by first responders and health providers are concrete outcomes and can translate into loss of life on a global scale.

In a 2018 report on climate change and health that accounted for continued economic growth and medical progress, the World Health Organization stated that “climate change is expected to cause approximately 250,000 additional deaths per year between 2030 and 2050.” These fatalities are projected to come from the following climate-related health complications:

— 38,000 due to heat exposure in older adults

— 48,000 due to diarrhea

— 60,000 due to malaria

— 95,000 due to childhood undernutrition

Health providers can draw awareness to this dire need for attention at the policy and community levels. They can also share firsthand experience and research. This is an ethical duty that can result in widespread support of strong public health programs and climate justice.

How to Get Involved in Climate and Health Policy

In addition to in-person education with patients, health providers can do a variety of things to spread awareness about climate and health policy in their communities:

Leverage social media. Share articles with verified, evidence-based information on social channels. Use hashtags related to climate and health that make your posts easier to find. For example, #ActOnClimate, #Go100Percent, #Renewables, #SaveThePlanet, and #ClimateChange.

Continue your education. Request or attend an educational presentation from a trained professional, then collaborate with community organizations to educate people in your area. Volunteer with climate- or policy-focused organizations to gain perspective.

Participate in civic engagement. Call your representatives to let them know whether you support specific legislation. And always, vote in local and national elections.

Organizations for Further Reading or Involvement

If you are a health care provider looking to learn more about climate and health policy, you may wish to visit the websites of these organizations.

Citation for this content: [email protected], the online DNP program from the Simmons School of Nursing

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