Springer Publishing launched a new monthly health care podcast series, Conversations About Health Care Delivery in the United States, featuring discussions with prominent experts, innovators, and leaders in the health sector available on Spotify, Apple Podcasts, and Amazon Music starting on March 7.
The podcast series is hosted by Jim Knickman, the former Robert Derzon Chair at the NYU Wagner Graduate School of Public Service, and Brian Elbel, MPH, Professor of Population Health and Health Policy at NYU Wagner and the NYU Grossman School of Medicine. The series dives into complex and challenging issues affecting the U.S. health care system, its workforce, and the populations interacting with it, covering topics like health management, public health, health behavior, population health, healthcare quality, and health economics.
Knickman and Elbel engage with guests who are leaders in the health sector, from aging services to health policy, to learn more about the key drivers shaping the health care system, challenges and complexities related to health inequities, and the exciting career opportunities available to future health care professionals and leaders.
The podcast series is a companion to the 13th edition of Jonas and Kovner’s Health Care Delivery in the United States, as each episode has ties to essential concepts, challenges, complexities, and themes in the textbook.
Podcast Episode
How the U.S. Health Care Systems is Preparing for the Demographic Cliff features Ramsey Alwin, President and CEO of the National Council on Aging, and Kathleen Cameron, Senior Director of the National Council on Aging’s Center for Healthy Aging.
The episode offers an in-depth discussion about the demographic shift, how the roles of families and social systems have evolved, federal and state-level programs for seniors, social isolation and inequities in the aging population, healthy aging, and exciting career opportunities in aging services.
The podcast series also features a supplemental instructor guide for anyone using the textbook that provides learning activities, discussion questions, and other guidance to engage with each episode, delivering practical and engaging content to learners and professionals in the health care space.
Betsy Peyton is a community health nurse in Virginia who founded WellAWARE, a program that connects high-tech medicine with clients’ low-tech, high-touch needs—the grassroots, person-to-person program zeroes in on those who might fall through the cracks.
Peyton and two other community health workers regularly visit about 60 clients across central Virginia, focusing on people who frequently use local emergency rooms for low-acuity health problems while avoiding preventative primary care.
During a recent visit with her patient, Dorothy Bishop, Peyton was asked if eating grapefruit would interfere with her medications. Peyton advised avoiding grapefruit because it can hinder the stomach’s natural enzymes and cause too much or too little of her medicines to be absorbed. The discussion then went to Bishop’s foot pain and whether her landlord had resolved a mildew issue in her apartment.
WellAWARE is just shy of its third anniversary and has already shown great results, with clients using the emergency room 48% less often and being hospitalized 30% less frequently for at least six months. Peyton hopes to secure funding to continue and expand the program and sees its value to humans and hospitals’ bottom lines in real-time.
Daily Nurse proudly names Betsy Peyton the Nurse of the Week for using home visits to build relationships with patients and her appreciation of the therapeutic value of listening to people’s stories to help clients overcome entrenched barriers to good health and healthcare.
Peyton and WellAWARE’s staffers are professional problem-solvers who organize medications, offer nutrition counseling, purchase air conditioning units, and intervene with difficult landlords. They also provide rides to food banks and pharmacies, pass out gas and grocery cards, figure out what to do if the electricity or water’s been cut off, and even handle a snake in the house.
As a University of Virginia (UVA) School of Nursing student, Peyton was inspired to pay special attention to the patients who sometimes got overlooked. After becoming a nurse, Peyton worked in group homes with dementia patients in a locked psychiatry unit and found a passion for being with people when they’re “not at their best.”
“I love going on visits and reminding myself of how great and rewarding it is to sit with someone. Sometimes, people who are not at their best bring about healthy outcomes through this. It’s not hanging IV, but you’re talking about important stuff and motivating change. Sometimes you’re strengthening their relationship with the health system,” she says.
Peyton says she respects the dignity of people when they’re struggling.
“Psychiatric nursing is a field where you’re often called to be with people and hear their stories. I’ve always appreciated the therapeutic value of listening to people’s stories,” she says.
For most of 2021, Peyton knocked on doors, chatted on porches, attended neighborhood association meetings, and tuned in. Guided by census-tract maps showing areas where citizens frequently turned to emergency rooms for primary care, Peyton’s approach built trust, giving community members a sense of ownership in the project.
“We want people to trust that the system wants what’s best for them, wants to know their stories, and cares deeply about their situations. And so trust is key to trust. It all comes down to trust,” says Peyton.
What began as a collaboration with the Charlottesville Free Clinic, UVA Primary Care, and Central Virginia Health Services, WellAWARE now offers help that augments the groups’ services and the clients’ needs. Peyton and her colleagues do house calls, the kind of care she was drawn to, which has been demonstrated to save money.
“When the healthcare system saves money, it’s good for everyone. But that’s not what I wake up most excited about,” says Peyton. “The benefits to the community, neighbors, local families, and individuals make this work worthwhile. It really works.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
Any nurse entering the field, no matter how prepared or well trained, will do their best to learn about the realities of caring for others on the job. When I started working as a nurse back in the 1970s, I had no idea that in a few years, I would find myself on the frontlines of an epidemic that would irrevocably change and touch all our lives while also changing the career trajectories for a great number of people in healthcare.
As a young nurse, I suddenly saw many patients developing complex and difficult-to-manage illnesses. Just as devastating was that many of my friends, colleagues, and loved ones became ill. Soon, we would give this disease a name: HIV/AIDs. As the impact of the disease reverberated, it was terrifying to see the level of stigma, bias, discrimination, and fear that so many of my patients faced, with many in the medical establishment refusing care for those most in need. There was a great deal of misunderstanding and spreading of harmful misinformation about what HIV/AIDS was. It is not an exaggeration to say I felt like I was working in a war zone.
At the nonprofit VNS Health, where I worked, our home health nurses were not ones to turn their backs on the communities we served and lived in. Soon, we found ourselves on the frontlines, caring for an average of 600 HIV/AIDS patients daily in New York City in the late 1980s. By 1997, half of all HIV/AIDS patients in the city were cared for by VNS Health. Like many other nurses, I quickly learned that we were providing far more than physical care, as we helped address mental health needs and education equally for AIDS patients and their loved ones.
Despite the challenges and devastating loss all around us, it was also inspiring to work among healthcare workers, activists, and others who saw the epidemic as an opportunity to revolutionize healthcare. Those experiences helped shape the work we do today, as we strove to keep up with a rapidly evolving healthcare landscape, provide empathetic care for all underserved communities, and develop new models of care that would provide safe, in-home care.
On National HIV/AIDS and Aging Day, it’s heartening to see how individuals with HIV/AIDS now have many more treatment options and can live long, healthy, happy, and productive lives. Currently, more than half of all individuals with HIV are over the age of 50. While treatment for physical symptoms has improved by leaps and bounds, we still can’t forget the social and emotional symptoms accompanying this illness and its impact on the community and people’s loved ones.
Among older adults with HIV/AIDS, there are typically two categories of patients. The long-term “warriors” who have lived with their diagnosis for years, including those who may have contracted HIV/AIDS at birth and those who received a diagnosis more recently as an older adult. Across the board, as the number of older adults receiving care at home grows, so will the need for nurses and caregivers specializing in home health, including nurses who understand the specific needs of individuals with HIV, which vary from person to person. Race, income, gender identity, and sexual orientation are key to how someone experiences care. Being mindful of our patients’ lived experiences and understanding the unique needs of those with HIV/AIDS makes us stronger clinicians and teachers. We can improve healthcare outcomes by supporting this community in the full context of their lives, which includes addressing preventive care, psychosocial care, nutrition, housing, and other social determinants of health.
As a nurse, when you first meet an older patient with a long-standing HIV/AIDS diagnosis, it’s important to know that they’ve likely had extensive experience with the healthcare system—and it may not all have been positive. In addition, factors that many adults experience as they age, from multiple chronic illnesses to social isolation, are amplified by having HIV or HIV/AIDS. These patients are used to being told what more they need to do or how to better adhere to treatments, so it is crucial to focus on the positive and offer them options and resources.
Working in home care, we have the privilege of meeting our patients where they are most comfortable and getting to know them beyond a list of symptoms. Home care nurses are increasingly filling a crucial care gap within the HIV/AIDS community, acting as a bridge for patients by helping to determine the full spectrum of support they might need. That might mean working to connect them with a social worker to help them apply for housing and food benefits, recommending local support groups, or something as simple (but important!) as making sure they closely follow prescribed medical treatment and go to all their appointments.
Individuals with HIV/AIDS also want to be seen as more than their diagnosis and accepted as their most authentic selves. We need to recognize the bravery and hard work many have put into maintaining their health over time, often in the face of stigma and barriers to care. Ensure they feel recognized for all they have done to maintain their health!
For clinicians who want to provide informed patient-centered care to older patients with HIV/AIDS but don’t know where to start, there are many educational resources out there. Connecting with seasoned nurses with experience working with HIV/AIDS patients or with HIV advocacy groups can help give you perspective on the challenges your patients may have faced within the healthcare system. Many national and local organizations provide specialized training for clinicians and caregivers of HIV/AIDS patients.
As any nurse will tell you, we learn much from all our patients and their families. The resiliency and bravery of those living with HIV/AIDS cannot be underestimated, and it has been a privilege caring for so many who have had to fight back against hate and stigma. Caring for this community is an honor and an opportunity to help some of those who need it most and make a difference by providing care imbued with empathy, dignity, and respect.
The role of school nurses often has the reputation of being a treater of injuries for rambunctious kids. But they have a more profound impact. Nurses in educational settings contribute to kids’ physical, personal, and social growth. One of the most important ways this is evident is in how school nurses influence the development of students’ health literacy.
Health literacy isn’t just about understanding information on wellness matters. Instead, it is discovering information, acting on it, and advocating for oneself to improve quality of life. Therefore, it is vital to encourage these abilities in children from an early age, as it impacts how they navigate wellness issues throughout their school years and into their life beyond the classroom.
Let’s take a closer look at school nurses and their vital role in developing children’s health literacy.
Providing Relevant Knowledge
Among the key components of health literacy is the ability to gain and use information about medical and wellness matters. This allows patients, no matter their age, to make informed decisions about their lives and care. School nurses have a significant impact in helping children develop in this area by providing general health knowledge and offering the most relevant guidance to help them thrive.
This is a result of the fact that the role of a school nurse sees them being front-line workers in children’s day-to-day lives. This means they tend to have a more nuanced understanding of their communities’ wellness challenges, concerns, and trends than other healthcare professionals. They can, therefore, offer a relevant range of tailored healthcare information to children and parents alike to empower them to navigate these components.
Indeed, this closeness to the community also means school nurses have the opportunity to address local wellness misinformation trends. For example, children are likely to be subjected to rumors and poorly researched opinions from their peers and parents, which can impact their understanding of specific health issues. School nurses can counter this by identifying common challenges and helping children find and use more credible sources of information.
Building Trust
Trust is vital to effective relationships between patients and medical professionals. When health literacy is in place, this can help patients to be better advocates for their needs and develop trusting, collaborative connections with a range of healthcare providers. The earlier this component can be in place, the more valuable it is to patients and communities. School nurses play a crucial role in children’s early development of such connections.
One of the benefits school nurses have over other medical professionals is the nature of their place in children’s lives. They are a familiar and friendly part of regular school interactions. Children can also independently choose to go and speak to the school nurse when they have questions or concerns. Not to mention that they attend appointments without parents or teachers present, meaning they are speaking perhaps more openly than they would otherwise. Each component contributes to developing children’s confidence in professionals and taking charge of their wellness.
That said, it’s essential to understand that this trust is often hard-won. School nurses must be prepared for the challenges of interacting with that demographic to play a role in children’s health literacy. Working with kids requires patience and empathy, as they’re still growing emotionally and socially. Not to mention that school nurses may need to kneel, bend over, or sit on the floor to communicate at the kids’ level, which can make them feel more comfortable.
Overcoming Anxiety
One of the hurdles to health literacy is the propensity for healthcare anxiety. This is where patients have fears surrounding being in medical environments or interacting with professionals. Unfortunately, children can be particularly susceptible to this. When not effectively addressed, it can lead to patients delaying getting medical attention or information they need, which may exacerbate matters.
School nurses have a chance to help identify and mitigate this trait in children. This isn’t just reassuring kids that medical professionals are there to help and guide them. There are common symptoms that can suggest medical anxiety is in place, such as skipping appointments or experiencing a racing heart. School nurses can be mindful of the presence of these in students and note the root causes, like previous negative experiences or misconceptions about specific medical procedures.
School nurses are often able to provide the attention required to address such issues that other medical professionals may not be able to. The fact that the nurse’s office is in the familiar environment of the school can help reinforce that medical spaces are safe. This provides the foundations upon which school nurses can teach children coping mechanisms for their anxiety and provide accurate information about medical care in general.
Conclusion
School nurses are invaluable influencers in children’s development of health literacy skills. Their position in the community enables them to identify key challenges and provide relevant education. They also hold a unique position of trust, which can influence kids’ future interactions with healthcare providers. School nurses have an opportunity to provide the individual support and guidance required to address potentially damaging medical anxiety hurdles. This nuanced role has an early impact on children and the community.
The COVID-19 pandemic highlighted how healthcare settings could contribute to the spread of infections, harming patients and healthcare personnel. More than 1.7 million healthcare-associated infections (HAIs) occur in the U.S. each year, resulting in more than 99,000 annual deaths. As a result, the Centers for Disease Control and Prevention (CDC) launched Project Firstline, a transformational initiative for infection prevention and control (IPC) training and education for millions of frontline healthcare workers in the U.S.
The CDC’s mission is to provide innovative and accessible IPC training for frontline healthcare workers. Emory University’s Healthcare Human Factors Lab (HHFL), Relias, and Inception X.R. are partnering to support Project Firstline. The goal is to improve clinical outcomes by embedding key elements of IPC protocols for a wide range of healthcare professionals in a compelling, multi-sensory immersive experience to significantly reduce the burden on patients, communities, and caregivers caused by healthcare-associated infections.
IPC is essential to ensure safe healthcare, and the key is to follow best practices consistently and confidently by caregivers. Inception X.R.’s technology platform will accelerate nurses’ acquisition of knowledge and increase daily application in a clinical setting while reducing training costs and enhancing the ease of deployment.
“This is a highly strategic project for us, leveraging insights into IPC practices we have gained as a Project Firstline partner, market access, and cutting-edge technology to ultimately support infection prevention in any medical setting,” says Joel Mumma, Ph.D., Research Director of the HHFL.
With this joint project, the companies can validate the value of their technology in the healthcare industry and generate an evidence base for future expansion in this field while developing additional content and products that support better care.
This is the first milestone in a comprehensive and scalable healthcare personnel immersive learning model in collaboration with respected partners such as Emory University’s HHFL.
The HHFL has conducted standardized inpatient care simulations with nurses to understand the cognitive processes that underlie successful and unsuccessful IPC practices and to develop methodologies for assessing and training IPC competencies. Acknowledging the need for an innovative, advanced immersive learning solution, HHFL will support InceptionXRtechnology implementation, addressing one of the most complicated healthcare problems in the U.S.
InceptionXR has also partnered with Relias, the trusted education, and development partner to more than 11,000 healthcare organizations worldwide.
“We are delighted to support advanced technology initiatives into healthcare and education training, as part of our mission statement, especially in infection control, where they can make a dramatic difference in both outcomes and healthcare teams’ best practices,” said Lora Sparkman, RN, BSN, MHA, Patient Safety and Quality Executive, at Relias.
Phase I of the year-long project launched in October 2022, during which the infection assessment simulation will be evaluated by the HHFL and piloted in five additional U.S. healthcare systems. Following the successful completion of Phase I, Emory aims to support the distribution of the IPC assessment simulation to hospitals across the U.S.
Tampa General Hospital’s emergency department are the first in the nation to use an FDA-cleared rapid blood test to successfully evaluate patients 18 and older with mild traumatic brain injury (TBI), including concussions. Results are available in approximately 15 minutes.
A plasma sample is inserted into the portable device to conduct a test. Then the test can quickly provide important information that can help providers determine care and treatment plans. In addition, this streamlined process could rule out the need for a CT scan.
A rapid blood test for evaluating concussions can be a real game-changer,” says Dr. Jason Wilson, associate professor, Department of Internal Medicine, in the USF Health Morsani College of Medicine and director of the Emergency Department Clinical Decision Unit, Tampa General. “It provides definitive data as we work to confirm a concussion or a traumatic brain injury.’’
Neurological and cognitive exams have been the primary method of diagnosing a concussion. Typically, CT scans are used to identify a more serious injury, such as a brain bleed. The i-STAT TBI Plasma test uses plasma from a patient’s blood sample to look for markers associated with brain injury to rule out the need for a CT scan.
The test can improve efficiencies in emergency departments, reduce wait times and improve the overall quality of patient care.
“Patients can spend less time in the emergency department and will walk away with lab results that can help their doctors make treatment decisions for a full and successful recovery,” Wilson says.
Recently published research also demonstrated that the proteins this test measures may help clinicians predict recovery for someone with a more severe injury.
Here’s how the test works:
This test measures specific proteins present in the blood after a traumatic brain injury, including concussion.
A “not elevated” result can be used to rule out the need for a head CT scan.
For those whose test shows elevated levels, the next step is often a CT scan, and clinicians could leverage both results to evaluate whether someone has a TBI.
The test can free up resources in the emergency department, reducing costs and enhancing a hospital’s value-based care. For patients, it can reduce exposure to radiation from unnecessary CT scans and lessen wait times in the emergency room.
“Tampa General is the first emergency department to use this test method and make it available for patient use,” says Michele Moran, senior nursing director in the Tampa General Emergency Department. “This test gives us another tool to evaluate potential TBI patients properly. During the patient’s risk assessment and physical examination, we will determine who can most benefit from the blood test versus the CT scan.”
