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May 15

More than a “technical” error: sending the wrong message

David M. Keepnews, PhD, JD, RN, FAAN, a CHMP Senior Fellow, is an Associate Professor at the Hunter-Bellevue School of Nursing and the City University of New York (CUNY) Graduate Center. He is Editor of Policy, Politics & Nursing Practice, a journal focusing on nursing and health policy.

Riding the subway home recently, I noticed a Spanish-language ad placed by the New York City Department of Education (DOE). The ad, part of an effort to promote the new Common Core Learning Standards and exams being given to 3rd to 8th graders, bore a headline reading (in translation) “Higher standards. Different tests. It’s a new day.”

It ended with: “Deseamos prepararlos para la unversidad y las carreras técnicas”—“We want to prepare them [students] for college and technical careers.”

A few days later, I noticed an English-language ad headlined “This Spring, we’re aiming higher.” As I read it, I saw that despite the different headline, this was the English-language version of the ad I had read before. The text was largely identical to the Spanish-language version. However, I couldn’t help but notice that the last sentence was a little different:

“We want them prepared for college and a career.” Note: Not specifically a technical career—simply a career, in general.

This seemingly small discrepancy jarred me: The ads end with two different messages to two different audiences—English-speaking and Spanish-speaking families—about the futures they can anticipate for their children. Read more

Mar 21

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Preparing for that Health Visit

taking charge 4

How many times did you leave the office of a health care provider realizing that you had forgotten to ask an important question, or didn’t understand part of the discussion, or had no idea what to do next for your health?Most everyone has had such an experience, including Kathryn Koehne, BSN, RN-TNP, Nursing Systems Specialist at
Gundersen Lutheran Health System in La Cross, Wisconsin. Her personal experiences with this scenario led her to take the advice that she was giving to patients about preparing for these visits in thoughtful but easy ways.

Tonight on Healthstyles on WBAI, 99.5 FM from 11:00 to 11:25, host Diana Mason, PhD, RN, interviews Kathryn Koehne about her tips for preparing for visits to health care providers, whether physicians, nurse practitioners, registered nurses, physician assistants, nutritionists, nurse midwives, specialists, or others. Additional tips can be found at the website for Taking Charge of Your Health at http://www.takingcharge.csh.umn.edu. You can listen to the interview by clicking here: KOEHNE

Mar 7

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A New Prescription for Health?

Tucked inside the pediatric clinic at Nassau University Medical Center (NUMC) in East Meadow, NY, is the help desk of Health Leads, a new program staffed by enthusiastic and committed students from Hofstra University.

These young advocates fill “prescriptions” for food, utilities, transportation, and other services for local families in need.

The program addresses non-medical needs of families that may affect their health and wellness, such as living environments, access to nutritious food, or child care. Clinicians learn about these needs through questionnaires that patients fill out at each visit. They then “prescribe” items like food, or electricity to run home health equipment just as they would prescribe an inhaler for asthma or antibiotic for an infection.

This is a first-of -its-kind program in Nassau County and could serve as a care model for other large suburban locales.

With support from a professional case manager, trained students connect families with appropriate resources and help them with applications, navigate red tape, and ensure needs are actually met. The students essentially act as case workers, helping families determine what services they are eligible for and how to traverse the often-confusing process of applying for aid or special programs. Read more

Feb 13

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Narrative Medicine Special Event in Brooklyn

Jim Stubenrauch is a senior fellow at the CHMP.

A quick notice about an upcoming event—this Friday—for anyone interested in narrative medicine and interdisciplinary studies in health sciences and the humanities:page-0

The New York City College of Technology kicks off “Comparative Perspectives on Health, Illness, and Healing,” a new NEH-funded curriculum development project that supports collaboration between CUNY faculty in the health care professions and the humanities. The year-long project explores “the practice of medicine as an expression of beliefs and value systems that differ across cultures.” Rita Charon, MD, PhD, founder of Columbia University’s Program in Narrative Medicine is giving the keynote, “Narratives of Culture in Health, Illness, and Health Care: How We Humans Unify in the Face of Sickness.” CHMP poet-in-residence Joy Jacobson and I will also be there to discuss our writing courses and workshops for nursing students and professional nurses.

The event is scheduled for Friday, February 15, from 10:00 am to 1:00 pm, and will be held in the Atrium Amphitheatre at NYCCT, 300 Jay St (or 259 Adams St), Brooklyn, NY. Phone: 718-260-4934. Subways: A, C, and F trains to Jay Street–Metro Tech Station, or R, 2, and 4 trains to Court Street.

Hope to see you there!

Jan 22

1 Comment

Roe v. Wade is 40 – How far have we really come?

It’s been 40 years since the Supreme Court’s 7-2 decision affirmed the right of women to decide the issue of abortion for themselves. By invalidating restrictive state laws, the Court held that reproductive rights — at least during the first trimester of pregnancy — were a given under the Constitution. Wholesale bans and unreasonable restrictions on the procedure by states were in violation of the Fourteenth Amendment and a woman’s right to privacy.

The decision spawned a national debate about choice, government intrusion into personal lives, religion, ethics, and politics. It’s been a hot topic in every presidential race, many state and local contests, and has sharply divided this country into “pro-life” and “pro-choice” camps. The two movements are no closer to consensus in 2013 then they were in 1973.

roe-wade signsIf anything, the vitriol has become more intense and ugly. Medical professionals have been shot. Clinics bombed. Threats, violence, and vandalism common among some extremists. A few months ago, then-Rep.Todd Aiken’s ridiculous remarks about rape and pregnancy set off a firestorm in the state of Missouri, the nation, and unintentionally  helped several Democratic candidates in their respective races.

Many in the Republican party vow to pass legislation repealing Roe v Wade. The issue of [mostly] Republican, white males, who never have and of course never will become pregnant, telling women what they can or can’t do with their bodies might be humorous, if there wasn’t so much at stake. Unfortunately, some of them are doing a two-step around the law.

Texas recently defunded Planned Parenthood, making it extremely difficult, if not impossible for mostly poor, minority, and rural women to obtain any kind of health care – including well-women checkups and preventive screenings – let alone make a choice about pregnancy. Other states are following suit. The Guttmacher Institute developed a state-by-state breakdown of abortion laws and their major provisions. None seem as invasive as the new  Virginia law requiring a vaginal ultrasound for every woman undergoing an abortion prior to the procedure. It may be the ultimate invasion of privacy. Read more

Jan 10

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Sandy’s Aftermath: Overstretching a Health Care System

Glassman&SmithGlassman&SmithGlassman&Smith

Source:Huffington Post (AP Photo/ John Minchillo)

Source:Huffington Post (AP Photo/ John Minchillo)

Many people saw the television coverage of New York University Langone Medical Center’s evaluation of patients during Hurricane Sandy, including very sick newborns. While the evacuation appeared to be very well managed, it nonetheless presented significant challenges to administrators, staff, and rescue workers. Hospitals that took in these patients and those from Bellevue Hospital and the VA Hospital of Manhattan, as well as outlying nursing homes, were also confronted with how to accommodate more patients safely. While Sandy is behind us, the health care system in New York City continues to be stretched beyond capacity.

Tonight on Healthstyles, host Diana Mason, PhD, RN, talks with Kimberly Glassman, PhD, RN, Senior Vice President for Patient Services and Chief Nurse Officer at NYU Langone Medical Center, and Thomas Smith, DNP, RN, Senior Vice President and Chief Nurse Officer at Brooklyn’s Maimonides Medical Center, about their experiences during Sandy and the continuing impact of the storm on their institutions.

So tune in tonight on WBAI, 99.5 FM (www.wbai.org) at 11:00 PM; or click here to listen to the interview:Glassman&Smith

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

Jan 7

Saving Lives: Abortion and Exemptions

Anger and shame: Irish women protest following the death of Savita Halappanavar Source: The Telegraph; Photo: AFP/Getty Images

Anger and shame: Irish women protest following the death of Savita Halappanavar Source: The Telegraph; Photo: AFP/Getty Images

I’m tempted to say that Savita Halappanavar died at University Hospital Galway in Ireland from a 17-week, wanted pregnancy that went awry. But it’s more accurate to say that she died in a Catholic country from a policy that deemed the heartbeat of a dying fetus to be more important than the life of its mother. Some may argue that Halappanavar would not have died had she been in a U.S. hospital, but after the wrangling over reproductive rights in the last year’s national elections I think she very well could have.
Halappanavar was 31 years old when she was admitted to University Hospital Galway for back pain. According to the Irish Times, she presented fully dilated and leaking amniotic fluid. When she was told that a miscarriage was in process, she requested that the pregnancy be terminated. But the fetus still had a heartbeat, her doctors said, which meant in that Catholic hospital and country that terminating the pregnancy was not permissible. It didn’t matter that she was not Catholic. Three days later, the fetus died and Savita Halappanavar was admitted to the intensive care unit, where she died of septicemia.

Abortion is illegal in Ireland, except to save the life of the mother. But, as noted in a 2010 report by Human Rights Watch, that country rarely supports this exception. Marianne Møllmann of Amnesty International maintains that health professionals in Ireland want clarity on when they can intervene in cases like Halappanavar’s without fear of criminal prosecution. Indeed, in the case of Halappanavar, the hospital and its clinicians essentially invoked a “conscience clause” that provides health care providers to opt out of intervening in ways that they find morally objectionable. Dr. Jen Gunter, an OB-GYN physician, has suggested that the clinicians didn’t intervene because they did not want to be judged as violating the country’s abortion laws and criminally prosecuted. She argues that Halappanavar’s symptoms should have assured that she receive pain medication and a termination of the pregnancy immediately to prevent sepsis.

Could this happen in the United States, where abortion is legal? Read more

Dec 21

Prez Says Yes to Gun Control; Press Hangs onto Fiscal Cliff

Jim Stubenrauch is a CHMP senior fellow and a co-founder of the program in Narrative Writing for Health Care Professionals. Follow him on Twitter: @jimstuben.


At a press conference on Wednesday afternoon, five days after the mass murder in the Sandy Hook Elementary School in Newtown, CT, President Obama announced the formation of a task force on gun control to be headed by Vice President Biden—and then for the next 22 minutes of a half-hour Q & A, he took questions from a roomful of White House correspondents—the crème de la crème of the Washington press corps—about the so-called fiscal cliff. (Here’s a video and here’s the official transcript.)

At the precise instant that the POTUS stood up before the world and spent some precious political capital in declaring that, at long last, some serious effort would be made to end decades of paralysis on gun control and that substantive changes might soon help prevent acts like Adam Lanza’s slaughter of defenseless schoolchildren and teachers, the AP’s chief White House correspondent, Ben Feller, and the Wall Street Journal’s Carol Lee, among others, took the opportunity to turn away from discussion of this critical issue and return to the topic that had so preoccupied the news media before last week’s mass murder. The questions that followed amounted to an obsessively detailed but redundant parsing of the stalled budget negotiations. Half of that conversation is already old news.

I understand that this kind of thing happens all the time at presidential pressers, but in this particular instance I found the business-as-usual approach to the business of Washington insufferable and inappropriate. What this says to me—and I’m not the only one criticizing the press for this—is that the professionals in the room didn’t necessarily see the president’s statement as anything out of the ordinary; to them it was nothing more than the expected response to yet another routine tragedy that, in the long run, won’t make any difference in how guns are manufactured and sold, used and misused, or how—all too often in our country—innocent people die. The gun violence task force and the prospect of bipartisan support for gun control legislation are apparently of less moment than the same old same old about tax hikes and entitlement cuts. (And let’s leave aside the question of whether it’s accurate to say that we’re experiencing a “fiscal crisis” or whether what we’re hearing is anything more than the cynical maneuvering of antigovernment ideologues on behalf of the richest of the rich.)

Perhaps I found this incident particularly galling because of the way television and radio had been for the previous five days not only reporting on the shootings but dramatizing the nation’s collective response to the event. Read more

Dec 20

Media and Sandy Hook

Steve Gorelick

Steve Gorelick

Media coverage of traumatic events can affect the mental health of those involved in the trauma and those who learn about it through radio, television or social media. In the aftermath of the Sandy Hook killings in Connecticut on December 14th, media coverage included “unconfirmed” speculations on the facts, moralizing by so-called spiritual experts, and even raw interviews of the surviving children after they left the school and their parents. On tonight’s Healthstyles program, producer and host Diana Mason, RN, PhD, talks about this coverage and its impact with Steve Gorelick, professor at Hunter College, City University of New York, and member of the Board of Advisers for the Columbia University Dart Center on Journalism and Trauma. Gorelick was a member of a team of experts invited to Norway to study the 2011 mass murders in Utoya. Healthstyles is sponsored by the Center for Health, Media & Policy at Hunter College (www.centerforhealthmediapolicy.com). You can listen to the program on WBAI, 99.5 FM at 11:00 PM tonight, or click here: Gorelick

Dec 16

2 Comments

A Nation of Violence

Keiran Healy, Duke University. Source: Wonkblog, http://tinyurl.com/bt29w79

Keiran Healy, Duke University. Source: Wonkblog, http://tinyurl.com/bt29w79

As are so many others, I am deeply saddened by the violent deaths at the Sandy Hook school. Repeated episodes of mass killings may lead us to think that this is simply our world today. It doesn’t have to be. A public health approach to reducing the risk of perpetuating such violence leads to at least the following possibilities:

1. Reinstate the ban on assault weapons. They have no place in hunting and cannot be justified. The Federal Assult Weapon Ban signed into law in 1994 by President Bill Clinton included a sunset provision that allowed it to lapse after ten years. Attempts to restore it have been unsuccessful. A Harvbard School of Public Health review of the evidence on gun control found that fewer guns means fewer murders. For those who dispute the evidence, why would you not want to err on the side of reducing the risk of mass murders by making these guns less available?

2. Physician Denise Dowd, director of the Injury Free Coalitioin for Kids of Kansas City, is calling for all health care providers need to include routine questions for families about whether there are any weapons in the house. A number of years ago, the Oregon Nurses Association was part of a state-wide campaign to encourage primary care providers to ask their patients, particularly those with children living at home, if there were weapons in their homes. Since this is a state that supports gun rights, the campaign focused on encouraging safe storage of guns (including keeping guns stored unloaded and putting the ammunition in a separate locked space), and actually worked with stores to provide discounts on locked gun storage cabinets. In October, the American Academy of Pediatrics reissued a policy statement supporting this position on guns in the home. But the final analysis of the Sandy Hook situation may indicate that this will not be sufficient to stop mass murderers. Health care providers should advise parents to remove guns from their homes, particularly if there is any indication of mental illness in the family.

3. We have a mental health system that is broken, particularly in relation to our nation’s youth. We can and must use the opportunity that the Affordable Care Act is providing to transform how we think of mental health assessment and treatment.

4. Finally, we need to mandate the teaching of non-violent conflict management in all of our schools. The Quakers have long recognized the importance of teaching non-violent responses to conflict and have incorporated it into the Friends Schools’ curriculum. Why aren’t all schools following this model?

The profound sadness that we feel about Friday’s events can be tempered by a commitment to reduce the risk of this ever happening again.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

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