Skip to content

Posts from the ‘Uncategorized’ Category

Healthstyles on December 11: Choosing Wisely and Women’s Economic Development

WBAI

There’s an old saying that “women hold up half the sky”. But around the world, women–and thus their families–are living in poverty with little access to the education that can help them to make a decent living and promote the health of their families. A longstanding international development practice has targeted investments in women’s enterprises, particularly in small businesses and agriculture. These investments have involved partnerships among public, private and philanthropic sectors. But one nurse is advocating that its time to invest in the education and work of female nurses and midwives in low income countries–and that doing so would not only be a wise investment in women’s education and economic development, but could also strengthen local health systems and reduce maternal and infant mortality.

This week’s Healthstyles program opens with producer and co-host Diana Mason, PhD, RN, FAAN, talking this nurse about her new approach to women’s economic development in low resource countries. The nurse is Marla Salmon, ScD, RN, FAAN, Professor of Nursing and Global Public health, and Senior Visiting Fellow at the Evans School of Public Affairs at the University of Washington. She is also a member of the Institute of Medicine where she has worked on developing this idea and building multi-sector support for it. You can listen to the interview here:

The second half of Healthstyles focuses on unnecessary care. The United States spent between $158 billion and $226 billion on overtreatment in 2011. This overtreatment includes unnecessary tests and procedures that can be harmful and costly. For example, pregnant women who deliver in a hospital are often put on continuous electronic monitoring of fetal heart rate ostensibly to ensure that the soon-to-be-born baby is not in distress. But the monitoring means that the laboring woman is unable to move around, which can slow down the labor, and misinterpretation of the monitoring can lead to unnecessary inducement of labor or Caesarean sections that can jeopardize the health and outcomes for both the mother and the infant.

So why do we do these unnecessary tests and procedures and how do we know what is unnecessary? Choosing Wisely is designed to help the public identify which tests and procedures should be questioned if recommended by a provider. On the second half of Healthstyles, Diana Mason discusses the problem of unnecessary care and the Choosing Wisely initiative with Daniel Wolfson, MHSA, Executive Vice President of the ABIM Foundation that developed Choosing Wisely; Karen Cox, RN, PhD, FAAN, Chief Operating Officer of Mercy Children’s Hosptial in Kansas City, MO, and the chair of the American Academy of Nursing’s Task Force for selecting nursing’s list of Choosing Wisely recommendations; and Lisa Woodward, Vice President of Nursing Education at Doctors Hospital at Rennaisance in Edinburg, Texas, and Co-leader of the South Region for the Texas Action Coalition that is involved in promoting the use of the Choosing Wisely list throughout the state.

You can listen to the segment on unnecessary care and Choosing Wisely here:

So tune in for Healthstyles on Thursday, December 11, 2014, on WBAI in New York City at 99.5 FM or online at wbai.org.

Healthstyles is sponsored by the Center for Health, Media & Policy at Hunter College, City University of New York.

 

CHMP welcomes Liz Scherer to the National Advisory Council

_LAJ0100

We welcome Liz Scherer to the Center for Health, Media & Policy’s National Advisory Council.  We look forward to working together with you and the rest of the Council. Below you can read Ms. Scherer’s bio.

Liz Scherer has been providing strategic direction for health and wellness businesses since 1990. Working with North American and European clients, she has engaged with multiple stakeholders in the healthcare arena, including practitioners, educational scientific and medical publishers, digital agencies, pharmaceutical companies and the media.

With health as a framework, Liz has followed an evolutionary career path that not only allowed her to hone her skills in the trenches but also facilitated a thorough understanding of how stakeholders connect, interact and diverge in the healthcare sphere. A pioneer in digital health, Liz has held social media advisory board positions on the Council of Responsible Nutrition – Life Supplemented campaign and on Health Justice-CT, supporting efforts to boost wellness ratios and end racial and socioeconomic health disparities. Additionally, she has worked with farming cooperatives to develop their presence across multiple social media platforms. Her keen interest in the interaction of health and technology  made her an ideal candidate for a Corporate Advisory Board position in 2012 for Cognovant Inc, a mobile health start-up company.

Widely recognized as a woman’s health advocate, Liz was part of the inaugural blogger team for Disruptive Women in Healthcare and has authored the award-winning menopause/midlife blog Flashfree since 2006.

In addition to her extensive experience as a strategist, Liz has worked as a journalist, reporter, medical education writer, copywriter, blogger and editor, and maintains active memberships in the National Association of Science Writers and the Association of Health Care Journalists.

Formerly from New York City, Liz is currently based outside Washington, DC.

What Would #ThisNurse Say? Local Grieving Postponed, A Nursing Backstory

This post is by CHMP’s graduate fellow, Amanda Anderson, RN.  Amanda is a practicing bedside nurse in Manhattan, and a grad student at the Hunter-Bellevue School of Nursing, where she co-directs The Nurses Writing Project. Her personal site, This Nurse Wonders, hosts her writing, and she tweets @12hourRN01010394There’s really nothing in this world that prepares you for care of a brain dead patient. Certainly nothing in nursing school, anyway. My first experience was early in my career as an ICU nurse, and although I technically knew what brain death was, I had no clue how perplexing and traumatic it would be to sort out as a nurse, or for a family, or in regards to organ donation.

This week, I watched a story unravel in the Times that, after eight years of ICU nursing, is sadly familiar to me: Local patient declared brain dead after violent act, kept alive in organ donation dispute. Despite the lack of nurse voice, I have no major criticism of the coverage of this sad saga. I realize that analysis was not the purpose of these pieces, and the message behind the facts simple – with brain death, comes conflict. What I wish to explain, though, is how I believe nursing voice might bring clarity and maybe even comfort to this sad story.

No matter the background or the cause, I have never seen a brain death case that did not lead to, at minimum, traumatic confusion. Most of the time, as this story proves, brain death is often linked to sudden, complicated trauma – a crushing stroke, a violent act, a car crash, a drug reaction. More than most emergencies or incipient illnesses, emotions and conflicting desires encircle brain death care. There is mess. As one article’s clinical source aptly infers – when someone’s body is being kept alive by machines, there’s bound to be conflict in the family.

Brain death twists our familiar algorithm of hospital death in a horribly confusing way. One moment, a patient lies in the bed. This patient has a heart that beats, lungs that move oxygen, and a brain that reacts. Nurses and doctors work tirelessly for that patient, assessing their living body and the products of their functioning organs with second-to-second care. Then, tests are done, a protocol is followed, and suddenly, the person you’re desperately working to keep alive is, quite simply, no longer a person.

Typically, declaration of death follows a failed resuscitation attempt, paired with a visual display of absence of life, via the heart monitor. But in brain death, sometimes nothing physically changes. The patient’s skin stays warm, their heart keeps beating, and the ventilator continues the chest’s natural-looking rise and fall. You, the nurse, the family, the doctors, see the same patient in the bed – a person, with life to fight for. Except now, they are legally dead. It’s not surprising for me to read that Terrell Smith, the father of Thaiya Spruill-Smith, said, “my daughter’s still alive,” three days after she was declared brain dead; she likely looked alive.

Imagine me, as a young nurse, trying to explain to a young family, that, yes, their father was now dead, as the doctors had just told them, even though he lay in the bed looking exactly the same as he did an hour before. Heart monitor beeping, ventilator breathing, their increasingly persistent, “Now what? Is he gone?” expelling any sense of control or prediction we all thought we might’ve had for the situation. The brain, I think, is poorly equipped to handle these tricks of the body, amidst the emotions of death.

So, when the organ people arrive, as they always very quickly do, families – understandably – have a hard time. Sometimes, people decide right away about donation; dad had always told us yes. Other times, they fight and walk away. Often, patients’ illnesses disqualify them. Whatever the decision, the path to it is never an easy one. From religion, to family conflict, to just not wanting grandma to “die” on a certain day, I have seen many patients stay on life support and undergo aggressive treatment long after their time of death was declared. Bodies waiting in conflict.

Eventually, the end always comes, and the machines get shut off. The patient – the mother, father, sister, daughter, grandmother – that was already dead, “dies” a second time. This time, we all see it; the heart stopping very quickly, the body following brain. Loss relived again.

There is no point in correcting errors of speech in this indefinable moment – even Stephanie Clifford, one of the Times reporters on this story, wrote that little Thaiya died Wednesday, when her death certificate will more accurately list November 14th, the Friday before. Her family will probably always remember her day of death that way, anyway – the day when her little heart stopped beating, when they watched her go.

There is no right or wrong in any of these cases, there is only grief. A tiny girl shaken and hurt, while perhaps a perfect match for a million organs, is still gone. Her mother still spent her daughter’s last living day in police custody, receiving mixed messages from doctors. Her father, entangled in a court battle, thought his daughter was still alive, afraid she’d be “cut up.” Her stepfather will likely spend what would have been her youth behind bars.

So, what does this nurse wish to say? Closure is the most difficult thing for families to achieve in brain death, with a loved one’s mind cheating their body of a coordinated exit. Organ donation is much more complicated than a check on the back of your license, and while some people mourn by passing gifts forward, others grieve by keeping things whole and close. No choice is an easy one. Perhaps this sadness doesn’t need to be news.

What Would #ThisNurseSay? Hard-Hitting, Expensive-To-Produce Hyperlinking

This post is by CHMP’s graduate fellow, Amanda Anderson, RN.  Amanda is a practicing bedside nurse in Manhattan, and a grad student at the Hunter-Bellevue School of Nursing, where she co-directs The Nurses Writing Project. Her personal site, This Nurse Wonders, hosts her writing, and she tweets @12hourRN

photoPerhaps I should have started this blog with a disclaimer: I read the paper. As in, I’m one of those worldly city dwellers helping to keep the New York Times’ shrinking home delivery market afloat. In addition to killing trees each morning, I eat pricey doughnuts in my $10 million kitchen. Or so I’m told.

My preference for formal, in-person breakfasts with The Grey Lady means missing out on hyperlinks. With newsprint wrinkling between my fingers, an article by Richard A. Oppel, Jr. about the new VA chief’s push to hire more clinicians, that mentioned nurse practitioners, seemed promising. But later, online, the same, “…nurse practitioners…,” led me to a chronological listing of all NYT nursing content. It took me a minute to realize I had landed on the equivalent of a generic Google search.

The lone, nurse-centric sentence in this article, which is about the VA Health system’s push to solve its critical shortage of providers, calls attention to the widely discussed idea that nurse practitioners might be a crucial part of the solution. But Oppel’s link wastes an opportunity for readers to understand the real story – or anything pertinent – about nurse practitioners.

The hyperlink is the modern-day citation, and really quite incredible. As a writer, it’s your wild card chance to allow your reader to choose to go deeper into the story, into another dimension of comprehension. Obviously, if, as a news organization, you hope to garner as many clicks as possible, it’s good to stick to self-promotion, like the Times largely does. But a well-linked piece not only has the power to contextualize an unfamiliar subject, it moves readers to act beyond the page before them.

A strategic hyperlink also helps readers see between the lines, behind the newsprint. Oppel’s mass-linking shortchanged his readers from understanding the specific reality that this new VA administration could bring to patients via its use of nurse practitioners: By filling provider gaps with these highly-capable clinicians in all fifty states, the VA would likely play a critical role in decreasing NP barriers to full practice, while simultaneously fixing its own short staffing. Regardless of the Times’ stance, readers should get a chance to enter this dialogue.

So, when the Times broke from its usual MD-speak and referenced “nurse practitioners” in print, it felt like a celebrated event. Deflated by his lackluster online follow up, I asked Oppel for an explanation. He dismissed my query with the simple: “I assume he [the copy editor] thought it would be good for people who wanted to read more about nurses and NPs.” Although Oppel linked other topics in the article similarly, it’s interesting that “doctors” wasn’t one of them.

I don’t think many nurses recognize the true power of the almighty click.  With each hyperlink we post or share, we pass along our stamp of digital endorsement, one that says we hope the organization or author we linked, sees more page views, readers gained, money made, information spread, and maybe even policy improved. Linking and getting linked to is a way of sending business, like an intentional product placement.  Me linking to these hard-hitting Times folk will likely go unnoticed, but if they linked to this nurse? Well, shoot. So, while it’s nice that Oppel gave the public a shortcut to the Times’ comprehensive nursing content, I’m starting to think twice about pushing free advertising – via my hyperlinking – to an orgaization whose linking morals don’t really line up with my own.

You see, the content behind Oppel’s link isn’t the biggest issue, here –  I’m primarily frustrated by its lack of intention. When I’m reading a sentence that suggests the existence of an ongoing discussion about a topic, it’d be a lot more helpful if I was directed to content that furthers my understanding of its specifics. Oppels’ – and his editors’ – blanket-link to all nursing content, when writing specifically about the role nurse practitioners play in solving the shortage of primary care physicians in America, suggests they see the nursing profession as a simplistic and one-dimensional topic unworthy of an intentional link.

Oppel didn’t have to take a stand, but he didn’t have to halfheartedly link, either.  I found plenty of articles via his original link that might’ve prompted a meaningful dialogue about this topic. After I typed in, “nurse practitioners,” that is.

Healthstyles Today: Ebola and Breastfeeding

wbaiThe World Health Organization (WHO) has estimated that 20,000 people will be infected with the Ebola virus before the current crisis in West Africa is contained. Earlier in the week, it reported that 120 health care workers have died from the disease, leaving unafflicted doctors, nurses, and other health care workers with fewer human resources to care for those who become ill from Ebola. In some cases, remaining health care workers have refused to work and whole hospitals have closed because of insufficient staff. The WHO has issued a roadmap to contain the spread of the virus but some believe that the international response to the spread of Ebola has been woefully insufficient.

Today on Healthstyles, producer and host Diana J. Mason, PhD, RN, interviews Kate Mort, Director of Human Resources for Medecin Sans Frontieres (MSF) or Doctors Without Borders, about the challenges this NGO faces in West Africa, particularly Monrovia, Liberia, as well as the response of the international community and need for volunteers to help to contain the spread of this deadly disease in which only 47% of those infected with the virus are surviving.

The program opens with HealthCetera, an update on health news, and ends with an interview with Nancy Manister, PhD, RN, FNP, Assistant Professor of nursing at Fairfield University in Connecticut about breastfeeding as part of a national conversation this month to raise awareness of the importance of breastfeeding to mother, baby, family, and society. You can listen to the interview here:

So tune in at 1:00 today on WBAI, 99.5 FM (www.wbai.org) in New York City.

Healthstyles is sponsored by the Center for Health, Media & Policy at Hunter College, City University of New York.

Follow

Get every new post delivered to your Inbox.

Join 8,294 other followers

%d bloggers like this: