Minority Nurse Fall 2019

The Career and Education Resource for the Minority Nursing Professional • FALL 2019

Transitioning from

Clinician to Scholar

+

Mindfulness and Wellness Programs MEDICAL CANNABIS NURSING FAITH-BASED EDUCATION

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Diversity Nurse Nurse Diversity Virtual Career Career Fair Fair Virtual October 23, 23, 2019 2019 October 12:00 -- 3:00 3:00 p.m. p.m. EDT EDT 12:00

EMPLOYERS EMPLOYERS Connect one-on-one with diverse nursing Connect one-on-one with diverse nursing professionals at this virtual event. professionals at this virtual event.

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Why Attend?

Attend?

Why

JOBSEEKERS JOBSEEKERS Connect one-on-one with the country’s top Connect one-on-one with the country’s top employers at this virtual event. employers at this virtual event.

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Attend?

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Table of Contents

In This Issue 3 Editor's Notebook 4 Vital Signs 7 Making Rounds

Academic Forum 26 Community and Faith-based Education Program on Prostate Cancer for Black Men

By Phyllis D. Morgan, PhD, FNP-BC, CNE, FAANP

Cover Story 8 School Days: Successfully Transitioning from Clinician to Scholar

By Michele Wojociechowski

Features 14 Mindfulness and Wellness Programs for ­Patients

By Jebra Turner 29

It’s Your Health – It Matters

By Andrea N. Curry, CPhT, MHA, PhD

20 Nurses Find Success in Growing Field of Medical Cannabis Nursing

Second Opinion 32 Exploring Alternatives to Healthy Eating and Lifestyle with a Plant-Based Diet

By Karla Rodriguez, DNP, RN, CNE

Health Policy 34 Access to Health Care: Platforms and Agendas for the 2020 Presidential Election

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By Janice M. Phillips, PhD, FAAN, RN

Minority Nurse | FALL 2019

By Linda Childers

Editor’s Notebook:

CORPORATE HEADQUARTERS/ EDITORIAL OFFICE

Eye on the Prize

H

11 West 42nd Street, 15th Floor New York, NY 10036 212-431-4370 ■ Fax: 212-941-7842

ave you ever wanted to make a change but were too worried about disrupting your work/life balance? Expanding your knowledge base is always a good thing, but you want to make sure you aren’t burning the candle on both

ends. If you are interested in pursuing advanced education while balancing a career

SPRINGER PUBLISHING COMPANY

CEO & Publisher Mary Gatsch Vice President & CFO Jeffrey Meltzer

and/or a family, be sure to read Michele Wojociechowski’s tips on keeping your sanity MINORITY NURSE MAGAZINE

throughout the process in this issue’s cover story.

Self-care is vital to our health, and It’s no secret that the health of your mind and body are equally important. As a nurse, you can play an important role in educating your patients on the benefits of mindfulness. In Jebra Turner’s article, nurses and wellness experts share their research and experiences on how wellness programs have impacted patients’ lives in a positive way.

Anxiety levels are at an all-time high for most Americans, which makes holistic care more important than ever. Cannabis is gaining popularity as a treatment for a variety of ailments, which means that it’s crucial for all nurses to get up to speed so they can better educate their patients on available treatment options and give them back some control over their health care. Linda Childers interviewed several cannabis nurses who share their firsthand experiences of how cannabis is becoming a game changer in modern medicine.

Most of us want to be healthy, but sometimes we need a little outside help in getting there. In this issue’s columns, Phyllis Morgan describes the success of a community and faith-based program in increasing prostate cancer awareness among black men; Andrea Curry shares a personal story about the fragility of health and the importance of encouraging others to seek preventive care; Karla Rodriguez seeks to dispel the myths of a plant-based diet; and Janice Phillips provides an overview of the health care plans being proposed by presidential hopefuls.

We all take missteps once in a while, but never lose sight of the bigger picture. Your health will thank you!

—Megan Larkin

Publisher Adam Etkin Editor-in-Chief Megan Larkin

Creative Director Mimi Flow

Production Manager Diana Osborne

Digital Media Manager Andrew Bennie Minority Nurse National Sales Manager Andrew Bennie 212-845-9933 abennie@springerpub.com Minority Nurse Editorial Advisory Board Anabell Castro Thompson, MSN, APRN, ANP-C, FAAN President National Association of Hispanic Nurses Birthale Archie, DNP, BS, RN Faculty Davenport University Iluminada C. Jurado, MSN, RN, CNN Chair, Scholarship Committee Philippine Nurses Association of America Martha A. Dawson, DNP, RN, FACHE Assistant Professor, Family, Community & Health Systems University of Alabama at Birmingham Wallena Gould, CRNA, EdD, FAAN Founder and Chair Diversity in Nurse Anesthesia Mentorship Program Romeatrius Nicole Moss, RN, MSN, APHN-BC, DNP Founder and President Black Nurses Rock Varsha Singh, RN, MSN, APN PR Chair National Association of Indian Nurses of America Debra A. Toney, PhD, RN, FAAN Director of Quality Management Nevada Health Centers

Minority Nurse (ISSN: 1076-7223) is published four times per year by Springer Publishing Company, LLC, New York.

Articles and columns published in Minority Nurse represent the viewpoints of the authors and not necessarily those of the editorial staff. The publisher is not responsible for unsolicited manuscripts or other materials. This publication is designed to provide accurate information in regard to its subject matter. It is distributed with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice or other expert assistance is required, the services of a competent professional person should be sought. The publisher does not control and is not responsible for the content of advertising material in this publication, nor for the recruitment or employment practices of the employers placing advertisements herein. Throughout this issue we use trademarked names. Instead of using a trademark symbol with each occurrence, we state that we are using the names in an editorial fashion to the benefit of the trademark owner, with no intention of infringement of the trademark.

Subscription Rates: Minority Nurse is distributed free upon request. Visit www.minoritynurse.com to subscribe.

Minority Nurse ® is a registered trademark of Springer Publishing Company, LLC. © Copyright 2019 Springer Publishing Company, LLC. All rights reserved. Reproduction, distribution, or translation without express written permission is strictly prohibited.

Eric J. Williams, DNP, RN, CNE, FAAN President National Black Nurses Association

For editorial inquiries and submissions: editor@minoritynurse.com For subscription inquiries and address changes: admin@minoritynurse.com

Vital Signs

CDC Press Release: Most Americans Have Never Had an HIV Test, New Data Show The CDC recommends that everyone between the ages of 13 – 64 years be screened at least once in their lifetime, yet less than 40% of people in the U.S. have ever been tested for HIV, according to a CDC report published in the Morbidity and Mortality Weekly Report (MMWR).

T

he new data, released on National HIV Testing Day, underscore the urgent need to scale up HIV testing to end America’s HIV epidemic. The analysis of 2016-2017 data from a national population-based survey suggest most people are not getting the recommended screening, even in areas with a high burden of HIV. Highlights of the analysis include the following: •• Overall, fewer than 40% of people in the United States have ever had an HIV test.

•• Nationally, less than 30% of people in the United States most at risk of acquiring HIV were tested in the past year.

•• In the 50 local jurisdictions where more than half of HIV diagnoses occur, less than 35% of people recommended for annual HIV testing were tested in the past year.

•• In states with rural areas that are particularly affected by HIV, just 26% of people recommended for annual HIV testing were tested in the past year.

“Diagnosis and treatment are the first steps toward affording individuals living with HIV a normal life expectancy,” says CDC Director Robert R. Redfield, MD. “As we encourage those at risk for HIV to seek care, we need to meet them in their journey. This means clearing the path of stigma, finding more comfortable ways of

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delivering health services, as well as learning from individuals already in treatment so the journey becomes easier for others who follow.”

CDC recommends people with specific risk factors be screened at least once a year.

That includes: •• Sexually active gay, bisexual, and other men who have sex with men; •• People who inject drugs; •• Anyone who has had more than one sex partner since their last HIV test; and •• People who have been diagnosed with another sexually transmitted infection, hepatitis, or tuberculosis.

“Knowledge is power when it comes to HIV—that is why everyone in America should get an HIV test at least once in our lives,” says Jonathan Mermin, MD, MPH, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “It is a simple way we can all help end the HIV epidemic in the U.S.”

Everyone Should Get Tested, Take Control of Their Health Whether the result is positive or negative, getting tested for HIV helps people take control of their own health. A negative HIV test result can lead to prevention options like pre-exposure prophylaxis (PrEP), a daily pill to prevent HIV acquisition.

A positive result should lead

that person to care and treatment, ideally on the day the diagnosis is made. This protects their health and is key to preventing new infections.

When taken as directed, HIV treatment reduces the amount of HIV in a person to a very low level – known as viral suppression or having an undetectable viral load. People who reach and maintain viral suppression have effectively no risk of transmitting HIV to others through sex.

The new study mentions promising novel approaches to increase access to HIV testing. These approaches included integrated and routinized HIV screening in a variety of health care settings, as well as scaling up partner notification and social/sexual network screening strategies, and mass distribution of HIV self-tests.

HIV Testing and the HHS Plan to End the Epidemic The proposed HHS-wide initiative, “Ending the HIV Epidemic – A Plan for America,” is a bold new multiyear initiative designed to end the HIV

epidemic over 10 years by significantly increasing public health resources, technology, and expertise on the ground in the hardest-impacted areas. The plan, if funded, will focus first on the geographic areas with the greatest HIV burden, including the 50 local jurisdictions and seven states highlighted in the MMWR report, before expanding to reach all areas of the nation affected by HIV. “Getting tested for HIV is quicker and easier than ever before – and when you take the test, you take control,” says Eugene McCray, MD, director of CDC’s Division of HIV/AIDS Prevention. “It’s my hope that through the initiative to end the HIV epidemic, we will increase testing and early diagnosis, speed linkages to care, and help ensure rapid treatment is available to help save lives and prevent new HIV infections.”

You can find more information on CDC’s role in furthering the federal plan to end the HIV epidemic here.

Vital Signs

Immune Cell Therapy Shows Early Promise for Patients with Pancreatic Cancer A nonengineered, multiantigen-specific T-cell therapy was safe, tolerable, and showed signs of clinical activity in patients who had pancreatic adenocarcinoma, according to preliminary results from a phase I clinical trial presented at the AACR special conference on Immune Cell Therapies for Cancer, held July 19–22.

“P

ancreatic aden o c a rc i n o m a is extremely hard to treat,” says Brandon G. Smaglo, MD, assistant professor of internal medicine and medical director of hematology/oncology at the Dan L. Duncan Comprehensive Cancer Center of Baylor College of Medicine in Houston. “Most patients have intense chemotherapy, which often has severe adverse effects, and we urgently need alternative approaches to treatment.

“We are encouraged by the early results suggesting that the T-cell therapy we are testing is a feasible approach to pancreatic adenocarcinoma treatment that is tolerable and shows signs of clinical activity,” continues Smaglo. “We look forward to treating more patients and continuing to follow those whose responses are ongoing.”

Smaglo explained that certain proteins are specific to cancer cells and that these proteins are referred to as tumorassociated antigens. He and his colleagues set out to investigate whether it is possible to use a patient’s blood to generate large numbers of T cells that recognize tumor-associated antigens, and that target and kill cancer cells once they are infused back into the patient.

To create each patient’s customized treatment, the researchers start by harvesting immune cells from the patient’s blood. T cells in the immune cell mixture that can recognize any of five tumorassociated antigens (PRAME, SSX2, MAGEA4, NY-ESO-1, and Survivin) are expanded in number in the laboratory under conditions that promote cancer-killing functionality and infused back into the patient.

As of July 5, 2019, 18 patients had been treated with up to six infusions of customized, nonengineered, multiantigen-specific T cells.

Nine of the patients had unresectable or metastatic pancreatic adenocarcinoma that was responding to initial treatment with chemotherapy, and six

had pancreatic adenocarcinoma that had progressed despite initial treatment with chemotherapy. The final three patients had pancreatic adenocarcinoma that could be removed by surgery. These patients received one T-cell therapy infusion before surgery and continued to receive T-cell therapy infusions after surgery; they are being followed for surveillance.

Seven of the nine patients who received the T-cell therapy alongside chemotherapy were evaluable for response.

Five of those seven have had responses for longer than six months from the time of starting the T-cell therapy.

The responses for these five patients are all ongoing. One of these responses is a radiographic complete response, two are partial responses, and four are stable disease.

One of the patients who had pancreatic adenocarcinoma that had progressed despite initial treatment with chemotherapy has stable disease that has been ongoing for more than six

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months since starting the T-cell therapy. Smaglo explained that while the others had progression of their disease, two had a clinical benefit with stabilization of their symptoms.

“We are excited that not only have we seen some clinical activity with our T-cell therapy, but we have seen no serious adverse effects, including no infusion-related systemic toxicity or neurotoxicity,” says Smaglo. “The tolerability of the treatment is very important because other treatments for pancreatic adenocarcinoma can cause severe adverse effects.”

According to Smaglo, the main limitation of the study is that only a small number of patients have been treated to date, so many more need to be treated to fully determine the effectiveness of the T-cell therapy. Smaglo also noted that generating the customized treatment is time and labor intensive for patients and health care providers, which may limit scalability of the T-cell therapy in the future.

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Vital Signs

Researchers Get a Handle on How to Control Blood Sugar After Stroke Hyperglycemia, or high levels of glucose, is common in patients with acute ischemic stroke and is associated with worse outcomes compared to normal blood sugar levels. Animal studies also pointed to an effect of high blood sugar in worsening stroke injury. Stroke experts have debated whether intensive glucose management after acute ischemic stroke leads to better outcomes, but a new study in JAMA finds that aggressive methods are not better than standard approaches. The study was supported by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.

“A

fter decades of uncertainty about how to manage blood sugar in acute stroke patients we finally have strong clinical evidence that aggressive lowering does not improve patient outcome,” says Walter Koroshetz, MD, NINDS director.

The Stroke Hyperglycemia Insulin Network Effort (SHINE) study, a large, multisite clinical study led by Karen C. Johnston, MD, professor of neurology and associate vice president of clinical and translational research at the University of Virginia, Charlottesville, compared two commonly used strategies for glucose control in ischemic stroke patients.

More than 1,100 patients underwent intensive glucose management, which required the use of intravenous delivery of insulin to bring blood sugar levels down to 80-130 mg/dL, or standard glucose control using insulin shots, which aimed to get glucose below 180 mg/dL, for up to 72 hours. After 90 days, the

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patients were evaluated for outcomes, including disability, neurological function, and quality of life.

The results suggested that the two treatments were equally effective at helping the patients recover from their strokes. After 90 days, about 20% of the patients showed favorable outcomes regardless of whether they were given intensive or standard treatment.

Intense glucose therapy increased the risk of very low blood glucose (hypoglycemia) and required a higher level of care such as increased supervision from nursing staff, compared to standard treatment.

The study was stopped early when a pre-planned interim analysis revealed that intensive glucose control did not improve outcomes compared to standard treatment.

“We found that the extra risks associated with aggressive treatment were not worth it,” says Johnston. “We are so grateful to the patients and research teams from across the country who helped us answer this important

question. As a result of their participation, patients around the world will benefit.”

This study was supported

by NINDS’ Neurological Emergencies Treatment Trials (NETT) Network, a system of research institutions dedicated to emergency medical issues, including stroke. The study was also conducted in collaboration with NINDS’ StrokeNet, which is a network of hospitals providing

resources for multi-site clinical trials evaluating new therapies to treat stroke.

More research is needed to better understand the role of glucose in stroke recovery and to identify additional treatments to improve outcomes in hyperglycemic stroke patients. Future studies will also determine whether high blood sugar is a cause or effect of unfavorable stroke outcomes.

Making Rounds

October

March

16-19

10-13

Transcultural Nursing Society 45th Annual Conference Omni Hotel Richmond, Virginia Info: 888-432-5470 E-mail: staff@tcns.org Website: www.tcns.org

24-26

American Academy of Nursing Annual Conference on Transforming Health, Driving Policy Marriott Marquis Washington, District of Columbia Info: 202-777-1170 E-mail: info@AANnet.org Website: www.aannet.org

October/ November

October 31 – November 2

The American Assembly for Men in Nursing 2019 Annual Conference Wyndham Lake Buena Vista Orlando, Florida Info: 859-977-7453 E-mail: info@aamn.org Website: www.aamn.org

November 8-10

Organization for Associate Degree Nursing 2019 National Convention Omni Louisville Hotel Louisville, Kentucky Info: 800-809-6260 E-mail: oadn@oadn.org Website: www.oadn.org

15-18

Academy of Neonatal Nursing 2020 Spring National Advanced Practice Neonatal Nurses Conference Hilton Hawaiian Village Oahu, Hawaii Info: 707-795-2168 E-mail: conferenceinfo@academyonline.org Website: www.academyonline.org

National Association of Clinical Nurse Specialists 2020 Annual Conference Indianapolis Downtown Marriott Indianapolis, Indiana Info: 215-320-3881 E-mail: info@nacns.org Website: http://nacns.org

May

18-20

7-9

Southern Nursing Research Society

American Nursing Informatics Association

34th Annual Convention Sheraton New Orleans New Orleans, Louisiana Info: 877-314-7677 E-mail: info@snrs.org Website: www.snrs.org

2020 Annual Conference Hyatt Regency Chicago Chicago, Illinois Info: 866-552-6404 E-mail: ania@ajj.com Website: www.ania.org

18-21

Dermatology Nurses’ Association 38th Annual Convention Crowne Plaza Denver Denver, Colorado Info: 800-454-4362 E-mail: dna@dnanurse.org Website: www.dnanurse.org

June 23-28

American Association of Nurse Practitioners 2020 National Conference TBD New Orleans, Lousiana Info: 512-442-4262 E-mail: conference@aanp.org Website: www.aanp.org

April 15-19

National Student Nurses’ Association 68th Annual Convention Disney’s Coronado Springs Hotel and Convention Center Orlando, Florida Info: 718-210-0705 E-mail: nsna@nsna.org Website: www.nsna.org

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July 1-5

Philippine Nurses Association of America 2020 Annual Convention Manchester Grand Hyatt San Diego San Diego, California E-mail: infomypnaa@gmail.com Website: www.mypnaa.org

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School Days Successfully Transitioning from Clinician to Scholar

BY MICHELE WOJOCIECHOWSKI 8

Minority Nurse | FALL 2019

Many nurses are pursuing advanced education.

Expanding knowledge is always a good thing— for them, for their employers, for their patients, and for their careers. But what happens if you’re going back to school while you’re also working fulltime and raising a family? Perhaps it’s challenging, but it’s definitely doable. These nurses have done it and have tips to help you do it too.

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W

hen Catherine B u r g e r, BSN, MSOL, RN, NEA-BC, was asked by her employer to return to school to earn her bachelor’s degree in order to remain in an executive leadership position, you might say that it wasn’t the perfect time. “I was working over 60 hours per week as a nursing leader for a complicated department; we had five kids at home— all with multiple sports and commitments—ranging in age from 1 to 17 years old,” recalls Burger, a media specialist and contributor for www. registerednursing.org. “There is no perfect time to start back to college.”

But Burger and many others made it work, and you can too.

Do Your Homework Before You’re Doing Your Homework Before you jump right into a program to earn another degree, Simendea Clark, DNP, RN, president of Chamberlain University’s Chicago campus, says that you need to do some homework. “If you’re thinking about going back to school, do your homework first.

Everyone has a different set of circumstances, so it’s crucial to research programs and schools that best fit your needs. Many schools offer online modalities that allow you to take some or all of your coursework from the comfort of your home, saving you travel time to and from school,” says Clark.

Be sure that the educational program you select is something that you love—not just something that will bring in the bucks. “The key for those

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who want to advance their education is to make sure it is something that drives your passion for nursing,” says Adam Kless, MSN, MBA, RN, NEA-BC, vice president of clinical operations for Avant Healthcare Professionals. “Selecting an educational path for mere money will leave one hollow

and disappointed in the long run.”

If it will help you, see if you can spread out your coursework. “I chose to take two classes per semester, including the summers. That helped me stay full-time in the graduate program,” says Valerie C. Sauda, PhD, MSN, RN-BC,

MGSF, an assistant professor at Husson University’s School of Nursing. “Although it lengthened my study a little, it definitely helped me maintain the work/life balance. I also feel that I learned the material more thoroughly and was more engaged in the classroom and online group

activities. A shorter program may not always be best for learning and life. Enjoy the journey!”

Tell Your Family and Your Boss Now you’ve found the perfect program for you. What’s next? Your best bet is to tell the people closest to you: your family and your boss.

There are many reasons why it’s crucial to tell your boss.

“Getting your boss involved will allow you to successfully incorporate your education into your work life by scheduling around class, providing you extra learning opportunities while at work, or benefit from finding a mentor at work who is already doing what you desire to do,” says Kless.

“The key for those who want to advance their education is to make sure it is something that drives your passion for nursing,” says Adam Kless, MSN, MBA, RN, NEA-BC, vice president of clinical operations for Avant Healthcare Professionals.

Your family probably already knew that you were looking into an advanced degree, but if they didn’t, be sure to tell them. You may need their support and the best way of getting this is to be honest and transparent. “Have conversations with the key stakeholders in your life—your current boss, your spouse, and your children. Creating ways for them to give you critical feedback in the moment can save a lot of heartache later.

When you are under a lot of stress, it can be difficult to maintain a good communication feedback loop,” says Melissa McClung, MS, LPC, a professional career advisor and owner of LBD Careers, LLC. “Setting this up in advance can preserve your important relationships when there are inevitable conflicts.”

“At the outset, you may need to negotiate with your employer for some flexibility with your work schedule,” explains Divina Grossman, PhD, RN, APRN, FAAN, president and chief academic officer at the University of St. Augustine for Health Sciences.

“Solicit the support of your supervisor or mentor at work so that you can have more flexibility in your schedule so you can prioritize your classes, clinicals, or to write papers and projects.”

Grossman says that when you tell your boss, you may also be able to streamline your schoolwork by having “your course requirements, such as term papers or special projects, be about topics or issues that you are dealing with at work. This way, you are not only meeting

the requirements for your advanced degree, but also are resolving issues in the work setting through your research and projects. Your supervisor will be thrilled to know that you are doing research-based practical work that advances them and you.”

Plan Your Schedule, But Be Flexible When Sauda was earning her PhD in nursing/education, she planned daily, weekly, and monthly schedules. “I prioritized time for family, time for work, and time for myself, while ensuring that I blocked out time for study and research during the school year. I had to ‘give up’ a few things, including bingewatching TV, checking my social media multiple times a day, and participating in nursing groups as a volunteer,” she says. “Creating and sticking to a daily schedule is crucial for success in an advanced degree program.”

Terri Bogue, MSN, RN, PCNS-BC, a consultant to hospitals and health care through

after family dinner and on weekends. I knew that my degree would open doors and opportunities that would benefit my family as well as myself. This knowledge helped me to keep focused on my goal,” she says.

“It’s also helpful to set reminders for assignments and tests on your phone’s calendar as soon as you learn about them. Review your calendar at the beginning of each week and mark down pockets of time when you will study and do the same for spending time with your family,” says Clark.

Besides having a schedule, it’s also important to be flexible. Because, let’s face it, life happens. “The most important thing to remember about balance is that it is constantly about reevaluating and making changes,” says McClung.

“I suggest developing a systematic way to check in with your priorities to ensure that you are prepared to flex when you need to. For example, this can be as simple as using a planner and scheduling

“At the outset, you may need to negotiate with your employer for some flexibility with your work schedule,” explains Divina Grossman, PhD, RN, APRN, FAAN, president and chief academic officer at the University of St. Augustine for Health Sciences.

her company, Thor Projects, LLC, planned her time as well when she returned to school.

“I scheduled time to study

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out time for the important things: work and school obviously, but also family time,

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meal planning and preparation, exercise, and household chores.”

Have Some Space Setting up a particular area in your home can help when it comes to doing your schoolwork. “Create a study space that helps you focus. For me, it was one corner of our dining room where I had a small

Ask for Support All our sources say that having a support network is crucial when you work and are going back to school.

Your network can be family, friends, or even colleagues.

“Surrounding myself with people who were not in the program, but who cared and encouraged me either in person or via email, made all the

“The most important thing to remember about balance is that it is constantly about reevaluating and making changes,” says McClung.

bookcase for my textbooks, all the study materials I needed, and good computer access,” says Sauda. “I also set up a corner in my office at work to house my short assignment work that I could complete during breaks. Whatever you decide, do what works for you and make it a pleasant experience. You’ll accomplish more in the available time that you have.”

Bogue says that she would also set aside both time and a consistent place in her room to study. That helped her to balance it all.

“It is important to have a quiet place to study and complete coursework. A private, dedicated space will allow you to get work done, free from distractions. It is also important to get an early start on assignments, give yourself extra time to complete tasks, and seek help if needed,” says Clark.

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difference—especially when I went through those difficult courses or when I felt like I couldn’t do it all. It’s the network that made a huge difference,” says Sauda.

Grossman takes it one step further. “You cannot be all things to all people. If you are usually the designated parent for carpool, can your spouse or a friend or neighbor help you out? I learned as a parent that if I can involve other parents in a way that we can help each other, both of us can be successful,” she says. “For example, I can do the morning pick-ups, and they can do the afternoons so that I could attend my classes and do my writing. If I am in charge of cooking meals at home, can I cook in bulk on weekends and freeze the meals or can my spouse help with the cooking?”

If you still need more help, Grossman says, think about hiring someone occasionally

to clean or get your kids to help so that your work is reduced.

“Keep your lines of communication open to ask for help when needed and to keep instructors, your boss, and your family informed of any last-minute changes in schedule or areas where you need help,” recommends Clark.

Don’t limit your network to just family, friends, and coworkers. “I was scared when I took my first doctoral class. I had been out of school for over 15 years, and I was afraid that I couldn’t do the work. What I learned quickly was to ask for help, use the learning resources available online and at the campus, and develop a relationship with the faculty. As a faculty member myself, I can tell you that faculty want to help you reach your advanced education goals. They want you to be successful. Asking for help can really make a difference,” says Sauda. “One of my best experiences was in doing a

Within an hour, I had more than 20 articles that I was able to look at with her support.

Not only did it save me time, but I learned the value of a librarian and library services when doing my research.”

Be Good to Yourself To balance work, school, and life, self-care is essential.

“Be patient and compassionate with yourself—this is hard work,” says Bogue.

McClung says that you have to make sure that the other areas of your life are good. To succeed, you have to make sure that you also take care of your health, relationships, and anything else that is important to you.

“Eat well, exercise by taking a walk before or after completing an assignment or after dinner with your family, and make sure to get proper rest,” advises Clark.

Grossman adds that, if you’re a parent, you keep tabs on any guilt feelings—and be easy on yourself. “Do not feel

“Surrounding myself with people who were not in the program, but who cared and encouraged me either in person or via email, made all the difference—especially when I went through those difficult courses or when I felt like I couldn’t do it all. It’s the network that made a huge difference,” says Sauda.

literature search for a paper.

I was not getting the articles that I needed to complete the paper, so I finally reached out to the university librarian.

guilty about not being there when you can’t be and having your spouse or relative take over for you. This period is time-limited—not forever,”

she says. “When my daughter ran track and field, they knew I could not be there for all the meets, but I could be present

for some of them. I could do more on weekends than during the week because of my work and graduate school schedule.”

To balance work, school, and life, self-care is essential. “Be patient and compassionate with yourself— this is hard work,” says Bogue.

Totally Worth It While this time may be difficult, it will also be memorable and fun. “The most important strategy for success is our attitude. Give yourself time to adjust to your new role as a graduate student.

Like anything new, you will get the hang of it in time.

Above all, make the most out

of it, and enjoy the experience,” says Grossman.

Clark says to stay focused on both short- and long-term goals. “Be patient with yourself as you ease into becoming a student again.”

“The challenge and personal growth that came with pursuing an advanced degree helped me find my focus for future research and teaching,” says Sauda. “Always remember that the journey to advanced degrees is worth it!”

Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about the nursing field but comes close to fainting when she actually sees blood. She’s also author of the humor book, Next Time I Move, They'll Carry Me Out in a Box.

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Mindfulness and Wellness Programs for Patients

BY JEBRA TURNER

N

urses, like other health care professionals, have been hearing the buzz about mindfulness. Technology corporations, like Google, are instituting mindfulness programs, as are health care and wellness-related workplaces.

Lifestyle magazines like Oprah and Yoga Journal are covering the topic, but surprisingly, so are Harvard Business Review and other business publications.

Perhaps you’re wondering what the term actually means, and whether it’s been proven effective in treating patients and those who want to be proactive in warding off illness and disease.

In this article, nurses and mindfulness experts will explain their unique approaches and how they help patients with health

challenges. You’ll learn about the evidence behind the practice, so you can comfortably introduce it to your patients.

You might even want to incorporate it into your own work and personal life.

What is Mindfulness?

Simply, mindfulness means that you direct your mind to the present versus having it wander aimlessly. You practice an awareness of your thoughts, and a focus on the here and now, not the past or future.

The opposite state, “mindlessness,” is what happens when you drive home at the end of a 10-hour shift, suddenly arrive at your front door, and can’t remember how you get there.

Though mindfulness meditation is thousands of years old, with its roots in Buddhism,

today’s mindfulness practices are often not spiritually centered. Scientifically-based mindfulness programs are meant to be used by patients of all faiths (or none).

That awareness may help boost patient emotional wellbeing and help strengthen their immune system. One example of the benefits of mindfulness, the Cleveland Clinic reports that 20 randomized trials reviewed in 2011 show improvement in overall mental health.

Mindfulness is a drug-free tool that can help optimize neural processing, boost immune system function, address the epidemic-level of chronic pain, reduce insomnia, and even caregiver burnout.

In new research, mindfulness shows promise in reducing the incidence of physical

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diseases or managing existing conditions. Examples are diabetes and hypertension.

Mindfulness can also be an aid in breaking unhealthy habits, such as smoking, and averting the associated risk of disease.

One Nurse’s Research on Mindfulness and Hypertension Eunjoo An, MSN, RN, a PhD candidate in nursing at UCLA, studied ways to reduce hypertension, which is the number one risk for stroke, she says. As a nurse, An knew that simply telling people what to do— eat right, exercise, etc.—wasn’t enough. She suspected that mindfulness training along with a health promotion program could have beneficial results.

Earlier research showed that mindfulness has a calming

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Mark Mitchnick

Menna Olvera Feder

Kimberly Carson

Jeffrey Proulx

effect on the fight or flight response, leading to blood pressure and heart rate reduction, An says. “The difference in my research is that it’s looking at not only blood pressure but habits; most patients have difficulty changing diet and exercise,” she explains.

“Mindfulness brings focused attention to body. During those times you’re more likely to say to yourself: ‘I should eat better,’ and then that translates to that behavior. No study has taken that to the next step.”

Her research was applied to hypertension in an independent living facility that is primarily African American.

She was the instructor for the health promotion group, using the six-week program modules on a government website. Both groups received information about healthy diet and the importance of exercise.

The results? “The mindfulness group, with stage 1 hypertension, reduced their systemic blood pressure to normal range at the end of

To learn more, watch An’s three-minute presentation about her research on the benefits of mindfulness available on YouTube.

health benefits. Patients experienced fewer symptoms of pain, anxiety, nausea, insomnia, constipation, and didn’t require as much medication for relief from those conditions.

When a UZIT-trained nurse “sees a patient isn’t breathing well, or is in pain, or is exhausted, they have what they need in their toolbox to address it,” says Olvera Feder. The UZIT protocol “adds a level of care to nursing that drew the nurse to be a nurse to begin with.”

The holistic program is used in health care environments with a diversity of patient populations. “We want to attract people of different cultures and those who are bilingual. We’re always looking for nurses who are Spanish-speaking or who speak Chinese,” says Olvera Feder.

Simple, clear terms are used to introduce the care modalities to patients and their families. For instance, “yoga,” is explained as “mindful movement to address respiration, digestion, and circulation,” Olvera Feder says. “Because when you’re in bed, you’re not doing downward dog.”

Mindful movement in that case may mean that pillows aren’t stacked too high, and

Mindfulness is a drug-free tool that can help optimize neural processing, boost immune system function, address the epidemic-level of chronic pain, reduce insomnia, and even caregiver burnout.

An used the UCLA mindful awareness program beginner’s course, which is not as extensive as some approaches, but more approachable than others, she says. The mindfulness group was told to practice at home. She hoped that the training would help calm patients and that reduced stress would translate to behavior change.

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the 12-week study,” she says.

While blood pressure did go down in both groups, “in the mindfulness group it dropped into the normal range whereas in the health promotion group it stayed in the high range.”

Mindfulness practice was beneficial in helping patients to eat and exercise in such a way that their blood pressure dropped 40%.

Beyond Mindfulness for In-Patient Care The Urban Zen Integrative Therapy (UZIT) program brings mindfulness plus yoga, Reiki, essential oil therapy, and contemplative end-of-life care to patients and providers. Started in 2009 by fashion designer Donna Karan in New York, it soon expanded nationwide with the launch of the UZIT teacher training program.

“UZIT-trained therapists provide a variety of care, in a wide range of settings, to patients, staff, and caregivers, plus the community,” explains Menna Olvera Feder, UZIT acting program director.

Services can be accessed through a number of hospitals, rehab centers, senior-care and hospice facilities, as well as yoga studios offering drop-in stress-management class.

Research has been conducted at multiple facilities, including Beth Israel Medical Center in New York City and Wexner Heritage Village in Columbus, Ohio, showing significant

Eunjoo An

Anna Dermenchyan

the patient is positioned in simple supported postures to bring them into a more comfortable state.

The UCLA Health has a number of UZIT trained health

care professionals, among them is Anna Dermenchyan, RN, MSN, CCRN-K. An Armenian American, Dermenchyan was an ICU nurse before transitioning to

Earlier research showed that mindfulness has a calming effect on the fight or flight response, leading to blood pressure and heart rate reduction, An says.

a quality role in 2013, with the aim of improving patient care.

She is also pursuing her PhD in nursing at UCLA School of Nursing.

“Urban Zen is meant for patients who feel pain and anxiety—that’s pretty much any patient in a hospital— they feel so much better after,” she says. One of the moving examples of UZIT’s effectiveness was when Dermenchyan sought to help a family say their final farewells to a braindead patient. “We provided Reiki and essential oils to them and a sad experience was made less painful,” she recalls.

Though always aware of stress in the health care workplace and how it affects nurses and patients, “I realize now how stressed everyone is, including physicians and administrators, and how vulnerable they are to fatigue and burnout,” she adds.

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Mindfulness Class in Your Pocket Not every organization has a mindfulness program available for patients, and not every patient has the money or time to attend formal training sessions. That’s where digital mindfulness apps come into play.

“We consider ourselves the leader in evidence-based, digital therapeutics for mental health,” says Mark Mitchnick, MD, CEO of MindSciences, Inc. “It’s pretty easy to put an app out in the health care space, especially in mental health, but do they have evidence behind them? We get grouped with some very scientific, rigorously researched” companies, and some that are not.

Currently the company offers three apps: Eat Right Now to address emotional eating, Unwinding Anxiety to relieve anxiety and stress,

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and Craving to Quit for smoking cessation. They are based on the work of Judson Brewer, MD, PhD, a leading mindfulness researcher, $11 million in funding from the National Institutes of Health (NIH), and input from thousands of users in clinical trials, and later as subscribers.

Many users first learn about this brand of apps because their health care provider recommends them. “It’s offered to individuals through organizations and insurance providers, such as Humana,” he explains.

“We wanted to offer [mindfulness] as something scalable and very affordable—and today that’s an app.”

For example, MindSciences is “working with coal miners in Appalachia, using our smoking app in a pulmonary clinic,” says Mitchnick. “Folks are enrolled in a clinic but still smoke.” Using a hybrid model of delivery—digital app plus the participation of health care professionals—they aim

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to help patients kick the smoking habit.

Similarly, they’ve started working with bariatric surgery clinics to help patients avoid regaining weight lost after surgery. “We’re not a willpower-

and weekly live expert video group coaching sessions. The program has been shown to be twice as effective as a leading smoking cessation treatment, and it’s backed by a limited money-back guarantee.

Not every organization has a mindfulness program available for patients, and not every patient has the money or time to attend formal training sessions.

That’s where digital mindfulness apps come into play.

based system,” he says. “In the case of eating, you have to separate out ‘I’m feeling hungry’ from ‘I’m feeling anxiety,’ and find a more appropriate behavior for that.”

Interested individuals can independently download the app, try it out free for three days, and later subscribe. In the case of Craving to Quit, the program is $24.99 a month, which includes the mobile app training modules, an online support community,

Mindful Yoga-Inspired Tools for Patients Oregon Health & Science University (OHSU) in Portland, Oregon, offers a number of mindfulness programs to its patients and staff members. Kimberly Carson, MPH, C-IAYT, E-RYT, is a mindfulness educator and yoga therapist. She is considered a leader in the therapeutic use of mindful yoga for people with medical challenges.

Carson offers an ongoing drop-in class, Breath by Breath, as an introduction to mindfulness-based stress reduction methods. The class is free of charge to OHSU patients and any interested members of the community.

“Breath by Breath is a combination of mindfulness practices and yogic tools,” she explains, for cardiac, oncology, chronic pain, and other patients, plus their caregivers. “Sometimes people come once, sometimes a few times, or sometimes for years.” The class is held twice a week, for hour-long sessions, in conference rooms offered by participating departments.

Along with instruction in a variety of relaxation and mindfulness practices, Breath

by Breath incorporates yogainspired adaptive movement, “We don’t take people to the floor,” explains Carson, “these movements are appropriate for most people—the postures are skillful to a medical or aging physiology.”

Group discussions and sharing make up an important component of the session. “At the beginning of the class, “I use what I call the ‘quickening question,’ which is totally spontaneous, such as ‘What inspired you today?’” she says.

“The question helps give voice to people’s experience.”

She also facilitates Mindful Yoga for Chronic Pain, a fiveweek, drop-in series, “which is more asana heavy,” she explains. Gentle postures help patients develop mindful awareness of bodily sensations, thoughts, and emotions in this evidencebased intervention.

Beyond classes, Carson offers “bedside mindfulness”

in the Bone Marrow Transplant Unit to address pain, agitation, insomnia, and existential distress. “I go in and lead patients through a mindfulness process,” she explains. “It quiets the nervous system, so they get relief right then. We do a body scan and breath awareness exercise. That’s the face-to-face introduction to the skill, to give them a taste of what’s available.” Later, patients can access more training modules on “the mindfulness channel” via OHSU’s digital education platform.

Mindfulness for Minority Communities Jeffrey Proulx, PhD, is a Native American who has been studying mindfulness as a way to reduce psychological stress and improve physical health in underserved communities. A K99/R00 award from the NIH National Center for Complementary and Integrative Health is currently

One way Proulx makes sure his offering is culturally competent is by using the term “stress reduction” rather than “mindfulness.” funding his contemplativebased program to reduce diabetes in Native communities.

He has also done culturally based mindfulness research with other ethnic minority communities.

Proulx believes that psychological stress needs to be viewed in a wider context that includes historical oppression.

“They wanted to wipe Native

Americans off the face of the earth, and African Americans were enslaved,” he explains.

“So, for these populations, daily stress is compounded by historical stressors.” But instead of focusing on cultural trauma and the associated poor health behaviors, he works with communities to explore their resiliency and strength.

Mindfulness-Based Stress Reduction [MBSR] is the landmark evidence-based program developed by Jon KabatZinn at the University of Massachusetts Medical Center in 1979. Many health care mindfulness programs and health apps are based on this intensive, eight-week training series. Proulx has facilitated these classes for patients and health care providers at OHSU, as has Carson.

“But MBSR isn’t really geared to address cultural trauma, intergenerational trauma, people getting sicker from generation to generation,” he explains. “I’m approaching it from another way. The bigger, overall issue is how people carry on.”

One way Proulx makes sure his offering is culturally competent is by using the term “stress reduction” rather than “mindfulness.” That only goes so far, he warns: “You can call it different things to sand down the edges,” but it doesn’t change the basic shape, and what he’s trying to create “is a program to get at stress in your community, not just the upper class white community.”

The development process is long for his years-long studies in these communities who may be suspicious of him or medical professionals

Are You Interested in Trying Mindfulness for Yourself?

The mindfulness and health site, DrJud.com, offers a free online course for health care professionals. The seven-module video course answers common questions about the practice and the evidence supporting it.

Continuing medical education (CME) credits are available through Brown University.

To learn more about the course and sign up, visit www.drjud.com/health-care-provider-course.

generally. To head off prejudice, he enlists the endorsement of community leaders (e.g., the tribal council or church pastor) and forms a small advisory group for guidance and assistance.

Proulx aims to create a safe, open, and accepting environment among community members. “You do that by learning about the history of the community, the culture, and becoming part of the neighborhood,” he says.

“It’s an effort to develop trust, show trustworthiness, and embody trustworthiness.”

Their own culture then informs how these involved community members experience his mindfulness and stress reduction training. “‘Oh, it’s like Proverbs,’ I often hear,” says Proulx. “Or ‘It’s like Christian charity and compassion.’”

Underserved populations can also be a source of future trainers and greater diversity

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in the mindfulness field. “I encourage people in those communities to become teachers,” he explains. “Brown University is paying for that training.”

Jebra Turner is a freelance writer located in Portland, Oregon. Visit her at www.jebra.com.

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Nurses Find Success in Growing Field of Medical Cannabis Nursing

BY LINDA CHILDERS

Fame Conway, RN, has seen firsthand how medical cannabis can be a game changer when it comes to fighting chronic illness. Decades of suffering from chronic inflammation and autoimmune disorders made it challenging for Conway to juggle her busy life as an operating room (OR) nurse and mother of two.

Then in 2016, a devastating car accident killed Conway’s son and left her with a femur fracture and an uncertain future.

“After the accident, I suffered from intense pain and

Post-Traumatic Stress Disorder (PTSD),” Conway says. “I wasn’t sure if I would ever walk again.”

During her long recovery, Conway began researching the medical uses of cannabis.

She was intrigued by research showing how cannabis could ease symptoms ranging from chronic pain to nausea and she felt the knowledge could also benefit her clients.

A member of the Cannabis Nurses Network, Conway is one of many nurses across the country who is increasing her knowledge of cannabis and its

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use in modern medicine. As of June 2019, eleven states and Washington, D.C.., have legalized cannabis for recreational

Fame Conway

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from pain, anxiety, psoriasis, and insomnia.”

Knowing she wanted to help others suffering from autoimmune diseases and chronic inflammation, Conway launched GraceandFame.com, and has created an online health program. She also advises clients on how to adopt a plant-based diet and find the right cannabis product to safely and effectively treat their individual health condition.

Helping Women Through Life’s Different Stages

“I think it’s important for nurses to be able to answer questions about medical cannabis, proper dosing, and the different methods that can be used to administer cannabis that include smoking, edibles, and tincture forms (that work sublingually by applying a drop under your tongue).”

use for adults over 21, and 33 states have legalized medical cannabis. Yet regardless of whether a state has enacted legislation, it is estimated that several million Americans currently use cannabis and that it’s a topic that interests many patients.

Conway took online courses through the American Cannabis Nurses Association

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(ACNA), where she learned about the endocannabinoid system (ECS), a network of receptors that affect appetite, mood, memory, pain, and other physiological functions.

Graduates of ACNA’s cannabis courses are deemed competent in cannabis nursing.

“The ECS isn’t covered in most nursing programs, but it’s important for nurses to

achieve a better understanding of ECS, how it works and how, and why cannabis can be a safe and effective medication,” Conway says.

After adopting a holistic lifestyle that included a plantbased diet and cannabis products when needed to combat pain and PTSD, Conway found she was able to reverse her chronic inflammation and autoimmune diseases in a natural way.

“I learned that whole plant nutrition supplemented with cannabinoids has the ability to regenerate health and restore wellness,” Conway explains. “I’m now able to enjoy an inflammation-free life without taking medication, and I no longer suffer

A midwife for over 20 years, Sakina O’Uhuru, CNM, RN, cofounded Black Ash Cannabis in Fort Lee, New Jersey last year after seeing the benefits of CBD oil, which is made by extracting CBD from the cannabis plant, then diluting it with a carrier oil such as hemp seed or coconut.

“CBD oil has been shown to relieve pain, reduce anxiety and depression, and alleviate cancer-related symptoms such as nausea and pain,” O’Uhuru says. “It also helps to reduce symptoms of menopause such

Sakina O’Uhurna

as hot flashes, mood swings, and insomnia.”

After seeing the positive effects of CBD oil, O’Uhuru decided to integrate it into her

“As an end-of-life doula, I’ve found many patients who prefer medical cannabis over morphine because it can combat their pain with fewer side effects,” Cruz says. “It also helps patients who are terminallyill and may be experiencing anxiety or nausea as a side effect of cancer treatments.”

practice. She now sells a CBD oil, derived from hemp plants, that is legal in all 50 states.

“I had clients who were inquiring about the benefits of cannabis and I wanted to be able to answer their questions and address their health needs,” says O’Uhuru, who proceeded to take online cannabis education classes and join the Cannabis Nurses Network prior to launching Black Ash Cannabis. “I think it’s important for nurses to be able to answer questions about medical cannabis, proper dosing, and the different methods that can be used to administer cannabis that include smoking, edibles, and tincture forms (that work sublingually by applying a drop under your tongue).”

O’Uhuru has worked as a midwife for over 20 years and is the author of Journey to Birth: The Story of a Midwife’s Journey and a Reflection of the Heroic Women She Served Along the Way. “I work with women of all ages, through childbearing age to menopause,” O’Uhuru says.

“I see my training as a cannabis nurse as another part of the cornucopia of services I offer my clients.”

master herbalist and endof-life doula, Cruz thought adding cannabis nurse to her extensive resume was a natural progression.

“I’ve been a nurse for over 15 years and have worked in hospice, home care, and in a hospital setting,” Cruz says.

“In home care, I encountered a lot of patients who had heard about medical cannabis and had a lot of questions about whether it might benefit their health condition.”

Cruz took over 30 hours of continuing education courses through the ACNA

Vanessa Cruz

and discovered that medical cannabis had the potential to treat a number of health conditions. She also joined the Cannabis Nurses Network to network with other nurses who had an interest in the field.

“As an end-of-life doula, I’ve found many patients who prefer medical cannabis over morphine because it can combat their pain with fewer side effects,” Cruz says.

“It also helps patients who

are terminally-ill and may be experiencing anxiety or nausea as a side effect of cancer treatments.”

While opioids can produce side effects such as constipation and nausea, and prolonged use can lead to addiction in some cases, Cruz says patients view cannabis as a more holistic alternative. She now offers paid consultations to clients through her business, Traditional Holistic Care.

“I meet with patients who are seeking direction on stateapproved medical diagnoses for medical cannabis and have questions on how to obtain a medical cannabis card, and the right product and dosage for their medical condition,” Cruz says. “I’ve seen the potential cannabis has in treating seizure disorders [and] muscle spasms, such as those associated with multiple sclerosis.”

Cannabis Education Comes Full Circle Vanessa Cruz, LPN, of Pueblo, Colorado, has always embraced traditional alternatives in health care. As a www.minoritynurse.com

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As medical cannabis continues to grow in popularity, Cruz encourages all nurses to gain an understanding of the field and expand their knowledge of what it means to be a cannabis nurse.

As medical cannabis continues to grow in popularity, Cruz encourages all nurses to gain an understanding of the field and expand their knowledge of what it means to be a cannabis nurse.

“At some point, all nurses are going to encounter a patient who is using cannabis,” Cruz says. “It’s important for them to be able to determine if there are any potential cannabisprescription drug interactions [and] how they can answer a patient’s questions and ensure the safe use of cannabis.”

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Helping Patients Become Cannabis Confident In Honolulu, Hawaii, Me Fuimaono-Poe, FNP-BC, serves as owner of the Malie Cannabis Clinic, a medical practice that provides marijuana education evaluations, education, and electronic approval for medical marijuana cards.

“We see patients with a wide variety of qualifying conditions, with the most common being pain,” Fuimaono-Poe says.

“My youngest patient is about three months old and my oldest patient is 103.”

Fuimaono-Poe first became interested in cannabis after meeting Dennis Peron in 1997 at the first Cannabis Buyers Club in San Francisco. Peron, an American activist and businessman, was an early leader in the fight to legalize cannabis.

Her interest in medical cannabis led her to take online classes through the ACNA and the Cannabis Nurses Network.

“I also attended several cannabis conferences throughout the United States so I can stay up on the latest research,” Fuimaono-Poe says. “There’s currently no certification for a cannabis nurse, but we’re working to change that.

The ACNA has been actively involved in getting cannabis nursing to be seen as a nursing sub-specialty in the same

Me Fuimaono-Poe

way as diabetes, oncology, and critical care.”

In 2016, Fuimaono-Poe, who had previously worked in both a hospital and family medical practice, opened the Malie Cannabis Clinic, dedicated to educating patients about medical marijuana.

She notes that even in states where medical cannabis

“Nurses are educators, advocates, and caregivers, which make them a natural fit in the cannabis space,” Fuimaono-Poe says. “Some nurses work in dispensaries, some as health education consultants, and others actually cultivate cannabis.”

Resources for the Canna-Curious The American Cannabis Nurses Association (ACNA)

isn’t yet legal, patients have questions about how cannabis might have the potential to help their specific health condition.

And since many dispensaries don’t have nurses on staff, nurses can counsel patients on potential drug interactions and how cannabis used in liquid form or through vaping, might be used as an effective replacement for opioids.

“We educate patients at every appointment on topics such as dosing information based on symptoms and side effects,” Fuimaono-Poe says. “If patients are prepared for the possibility of side effects, I feel like it decreases their fear around using cannabis.”

While acknowledging that on the whole medical cannabis is a safe and effective option, Fuimaono-Poe and her staff tell patients there’s a small risk of side effects.

“If medical marijuana patients stand up too quickly, they can get dizzy, so we let them know that that’s a possibility, and advise them to get up slowly,” she says. “Dry mouth can also be a side effect, so it’s important to stay hydrated and use an over-the-counter product dry mouth product such as Biotene if it becomes worse.”

Fuimaono-Poe believes all nurses should have a working knowledge of cannabis therapeutics.

“Nurses are educators, advocates, and caregivers, which

make them a natural fit in the cannabis space,” FuimaonoPoe says. “Some nurses work in dispensaries, some as health education consultants, and others actually cultivate cannabis.”

Looking to the future, Fuimaono-Poe says her hope is that cannabis nursing will soon become a sub-specialty and that one day in the near future there will be at least one cannabis nurse in every medical setting.

“I see cannabis nurses working in a position similar to a diabetes education nurse and helping to train both other staff members and patients on how to use cannabis safely and effectively,” she says. “Nurses are great at taking complex information and explaining it in terms that all patients can understand.”

Linda Childers is a freelance writer based in California.

is currently the only professional nursing organization working towards being recognized by the American Nurses Association as a certifiable nursing sub-specialty.

In conjunction with The Medical Cannabis Institute, ACNA offers an online course for nurses, as well as resources for nurses who want to learn more about medical cannabis and how it can be safely and effectively used to manage a patient’s health condition.

Patients Out of Time is a non-profit educational charity dedicated to educating health care professionals and the general public about the therapeutic use of cannabis and the ECS system. They hold an annual conference and offer educational resources and information on their site.

The Cannabis Nurses Network was formed in 2015 and offers professional development courses networking, professional recognition, and legal and medical advocacy.

Cansoom offers nurses and other medical professionals classes to become medical cannabis consultants.

Founded by Lolita Korneagay, MBA, BSN, RN, Cansoom courses equip nurses with the knowledge they need to assist patients in consuming cannabis safely and effectively.

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Academic Forum

Community and Faith-based Education Program on Prostate Cancer for Black Men

By Phyllis D. MORGAN, PHD, FNP-BC, CNE, FAANP

Community and faith-based education programs have long been proven successful in reaching black communities. As an African American woman and advanced practice nurse, I have participated in many projects and studies to identify effective approaches to increase awareness, prevention, and treatment of health issues that impact my racial/ethnic group. After serving as a nurse expert for several successful community faith-based programs focused on various health issues, I worked with a local organization, in which I am a member, to address prostate cancer awareness and screening among black men in two counties in Virginia.

P

rostate cancer is the second most common cancer in men, and, despite being treatable when detected early, is one of the leading causes of cancer death among men of all races, according to the Centers for Disease Control and Prevention.

Prostate cancer rates among black men are significantly higher than any other race, with more than 150 new diagnoses annually per 100,000 men in the United States.

Clinical progression of prostate cancer is known to be more aggressive in black men as compared to white men.

However, black men are less likely than their white counterparts to engage in shared decision making (SDM) with their health care provider about the benefits and risks of the gold-standard prostate specific antigen (PSA) test.

Due to the increased risk for prostate cancer among black men, screening is recommended at earlier ages than the general population.

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The Education Program Over a one-year period, I was a nurse researcher for a prostate health education program that examined whether participants had an increased awareness about key issues of prostate cancer, following a culturally targeted education program, and whether participants were more likely to engage in SDM with their health care provider about prostate cancer screening. Their knowledge was assessed through pre- and post-test surveys that addressed three topics: •• Increase in knowledge about prostate cancer screening •• Increase in intentions to have an SDM conversation with a physician about prostate cancer screening within 12 months •• Participation in an SDM conversation with a physician about prostate cancer screening within three months after the educational program The program worked with 438 black men over the age of 40 who were recruited

primarily through churches, as well as social media and community, civic, and social activities. Participants needed to be able to speak and understand English and reside in either Prince William or Stafford County in Virginia. Religious beliefs serve as a fear reducer and motivator for increased prostate cancer screening behaviors among black men, demonstrating the importance of faith and spirituality in the black community. Programs

Community and faithbased education programs have long been proven successful in reaching black communities. were implemented at 12 black churches, and prayer and scripture were included before and after each program session.

Academic Forum It’s important to ensure that programs are meeting the needs of the community. As a result, a community advisory board was developed for this program, which included key stakeholders such as nurses,

Nurses can play a vital role in helping community and faith-based organizations develop and execute programs to address health disparities. physicians, ministers, local hospital representatives, prostate cancer survivors. and community advocates for black men’s health issues.

After the pretest to assess black men’s existing knowledge about prostate cancer, an educational session began with a five to 10-minute personal testimony by a black prostate cancer survivor, followed by an engaging question-and-answer session. The men then watched a short National Cancer Institute video clip, “Prostate Cancer Survivor: An AfricanAmerican Man’s Perspective.”

Next, two physicians who specialize in urology taught a two-hour information session that focused on prostate cancer statistics, prevention, screening, early detection, and quality of life. Last, there was another question-and-answer session, which was followed by the post-test. Contrary to previous community and faith-based programs, this one included a second postassessment three months after the initial program to evaluate whether patients had an SDM conversation with their

physician about prostate cancer screening.

The Program Results The results showed that educating black men about prostate cancer through a community and faith-based program increased their general knowledge of prostate cancer and its treatment by 40.2%, improved their intention to have an SDM conversation with their health care provider by 17.8%, and impacted whether an SDM conversation took place within three months of the program by more than 80%. Although the results are encouraging, it’s important to note that the black men in this program were predominantly middle class and the majority were employed full-time and possessed private health insurance.

Additional programs of this nature should be conducted with those without health insurance and with lower levels of household income.

It’s critically important for research to be conducted, especially in developing culturally appropriate models for diverse communities, so more contributions toward reducing health disparities can be made available to effect positive social change.

The Importance of Research Nurses can play a vital role in helping community and faith-based organizations develop and execute programs to address health disparities.

The program I was a part of is an example of how community partnerships can implement a successful health education program. Doctoral programs, like Walden University's PhD in Nursing, train nurses to become effective researchers and scholars to tackle complex health care questions and issues. It’s critically important for research to be conducted, especially in developing culturally appropriate models for diverse communities, so more contributions toward reducing

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health disparities can be made available to effect positive social change.

For more information about this prostate community and faith-based program, please view the summer 2018 issue of the Association of Black Nursing Faculty (ABNF) Journal.

Phyllis D. Morgan, PhD, FNP-BC, CNE, FAANP, is a nurse educator, certified family nurse practitioner, and researcher focused on black health issues. She is the academic program coordinator for Walden University’s Family Nurse Practitioner specialization and a nurse practitioner for MinuteClinic in northern Virginia.

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Academic Forum

It’s Your Health – It Matters

By Andrea N. CURRY, CPHT, MHA, PHD

Our health is something that we all have, and unfortunately, the condition of our health is not something that we have complete control over. We do, however, have the ability to enhance the quality of our health.

W

e all have choices to make regarding our lifestyle and how we manage our health to make sure we ensure that our health never deteriorates and we can live a long, healthy, and fulfilling life. We can control our choices to improve the quality of our overall health, and a significant part of enhancing the quality of our overall health is making doctor’s visits a priority.

Being inconvenienced with taking time off work or readjusting our schedules should

become secondary to the need to seek medical attention when needed. The unfortunate aspect of health care utilization is that people often wait until it is too late before they decide to become committed to ensuring that their health is maintained and monitored.

The fragility of health became very real to me about 10 years ago when my persistence to my doctor, because I was not feeling well, finally resulted in an order for a CT of the lungs to reveal I had pneumonia. The previous

x-rays of my lungs were always inconclusive. My health was in jeopardy, and I knew that I had to become intentional in my pursuit to get better. My persistence of seeking medical treatment reappeared with a vengeance in 2013 when my favorite uncle was diagnosed with stage 4 throat cancer. He was a mechanic who loved his family, and he was a very talented cook. He was one of those men who never had a lot to say, but he observed everything. It

was easy to tell that he was not doing well, but I had to beg and plead with him to allow me to make him an appointment at a local clinic after we noticed that his health was declining.

He was a proud man who did not like to admit when he needed some help. He was selfemployed with no health insurance. His case was so difficult that most of his medical team did not want to take him as a patient. One of the wonderful physicians believed in him, and

The unfortunate aspect of health care utilization is that people often wait until it is too late before they decide to become committed to ensuring that their health is maintained and monitored.

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Academic Forum she advocated for him. He went through major surgery, and he lived another two and half years that gave me and my family more time to spend with him.

Two days before my uncle passed away, I softly spoke to him and told him that I would finish my doctoral program and make him proud of me. He nodded his head, and I was blessed to keep my promise. I believe that if my uncle would have been treated sooner, the outcome would have been different. I did not know when my uncle passed away that I would devote my research efforts to racial health disparities, or that I would have such a passion for educating the African American community on the importance of seeking health care services.

Through my sorrow, I have made it a part of my mission to educate African Americans regarding the importance of seeking timely and routine medical treatment.

It is so important for African Americans to seek medical treatment because of the high incidences of health diseases and conditions that plague that population, such as high blood pressure, high cholesterol, diabetes, and heart disease. In my experience from working years as a certified pharmacy technician, too many people do not treat their health like the important commodity that it is. We sometimes feel that our health is something that we will always have, and that it will always be good. Unfortunately, I know firsthand that it simply is not true. Our bodies give us signs when things are not right, but it is up to us to pay attention.

We sometimes shrug things off when we notice that variance in our health occurs in hopes that it will get better without

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us taking on more of an active role to ensure that it happens.

The goal of my research was to evaluate how the patientprovider relationship impacts the patient’s decision to access health services. Through my quantitative research, I wanted to delve into the rationale that African American patients have about how they make the decision about when they will visit the doctor. African American cultural norms, in addition to the historical aspects of discrimination coupled with provider biases, create a divide that can become evident during the patient’s visit. African Americans often feel as if they are not heard or a priority when they make medical visits. Chronic diseases and conditions often necessitate the need for medical visits as it pertains to African Americans, so African Americans between the ages of 40 and 65 were the target population that was studied. After reviewing the demographics within Shelby County, Tennessee, it was determined that the sample could be identified after evaluating the community right within my reach.

It is apparent through observation as a former practicing certified pharmacy technician that African Americans are subjected to health disparities at an alarming rate. Those racial health disparities are prevalent because of the effects of the patientprovider relationship, limited access to health care resources, and health outcomes that are less than ideal.

A group of 56 participants were gathered through the help of alumni chapters of African American sororities and fraternities located throughout the greater Memphis area. All of the participants that were used to complete the analysis

lived within Shelby County, had health insurance, had an English speaking primary care physician, and were African

Americans have dealt with makes it pertinent for health care providers to treat the patient’s concerns as a priority.

Our bodies give us signs when things are not right, but it is up to us to pay attention.

American. The findings evaluated the interactions that occur during the medical visits. The goal was to possibly uncover why African Americans do not go to the doctor in hopes of explaining why there is a prevalence of chronic diseases within that population. The findings did indicate that there is a significant relationship between the patient-provider relationship and the behaviors of the provider. Additionally, the behavior of the provider does contribute to the African American patient’s decision to seek health care services.

The participants that were evaluated stated that gender and assumptions that the provider makes about their education level and income did play a factor in how the provider interacted with them during the medical visit. The behavior that the staff exhibits during the medical visits of African American patients does impact the decision that is made to seek services, and the way that African American patients are made to feel during the medical visit does impact their decision to seek follow-up care and even their willingness to comply with medication compliance. It is important for the African American patient to be understood and treated with compassion, care, and concern.

The historical component of the racial tension that African

In summary, there is a direct correlation between the relationship that the patient has with their provider and how the behavior of the provider is perceived during the interaction.

It is important that African American patients receive ongoing education regarding the importance of seeking timely and routine health care.

Providers need to be cognizant of how their mannerisms and responses affects their African American patients. African Americans do not consistently go to the doctor, which is evident by the staggering statistics of preventable and treatable conditions and diseases that plague that community. The goal for both parties within the relationship is to realize that it is impacted by both the actions and reactions of both sides.

Andrea N. Curry, CPhT, MHA, PhD, is a newly minted doctor who simultaneously published her dissertation and her first book. She travels as a motivational speaker while working fulltime in health care and hosting her own podcast.

Acknowledgment. The author would like to thank Cheryl BeersCullen, DHA, MPA, BSN, RN, CALA and Manoj Sharma, MBBS, Ph.D., MCHES for their contribution and mentorship.

Dedicated to Diversity

Minority Nurse magazine is committed to increasing diversity and inclusiveness in academics and nursing practice.

Diversity is more than a check box on a form, more than a dry statistic hidden in a table of demographic data. It is more than the color of one’s skin, the nation of one’s heritage, or the origins of one’s social beliefs.

Diversity celebrates culture.

Diversity is inclusive.

Diversity is the catalyst for the collaboration and discovery that is essential for an understanding and appreciation of the human spirit. Diversity allows us to engage with our differences and provides the mechanism that leads to acquiring cultural sensitivity and achieving cultural competence.

We honor the individual and the community.

We encourage ourselves and others to behave equitably.

We promote acknowledging and respecting different beliefs, practices, and cultural norms.

We uphold academic excellence, celebrate best practices, honor traditions, and embrace change that advances our objectives of caring for ourselves, advancing our educational and career opportunities, and providing quality health care for our patients.

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Second Opinion

Exploring Alternatives to Healthy Eating and Lifestyle with a Plant-Based Diet

By Karla RODRIGUEZ, DNP, RN, CNE

Nurses are integral in the care of patients and their health.

Exploring a plant-based diet may be beneficial to patients so they can take back their health. It is time for health care disciplines to be aware of a plant-based diet and to dispel any myths that exist. In fact, a plant-based diet is not a diet—it can be viewed as a way of life. A plantbased diet are foods consumed that is devoid of animal ingredients, such as dairy and meats. A plant-based diet relies on foods that are grown from the ground such as fruits, vegetables, whole grains and nuts, and seeds.

P

eople are living longer, but we are also living with more chronic diseases, with heart disease being at the top of the list. Heart disease, diabetes, and hypercholesterolemia are contributors to sickness where medicine is the answer. Health care providers tell patients to lose weight by restricting food intake. While patients may see results initially, they usually do not adhere to this long term as it is not sustainable for them for a variety of reasons. In addition to that, the medications with their side effects usually

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do not highlight many benefits. One-third of animal products in the American diet are very concentrated in calories and are deficient in antioxidants and vitamins. Needless to say, the vast majority of chronic illness is highly correlated to what we eat. There is a different biological effect of meat versus plant-based protein such as beans. The body can store these amino acids and complete them without overshooting the hormone, Insulin Growth Factor 1 (IGF 1). On the contrary, processed foods and meats produce a lot

of IGF1 where insulin ends up storing a lot of fat. It is also attributable to cancer and inflammation.

People have long touted the benefits of a plant-based diet.

Brooklyn Borough President Eric Adams reversed his diabetes Type 2 due to a plant-based diet. He was already suffering from nerve damage as a result of his disease with a hemoglobin A1C of 17 (anything over 6.5% is considered diabetic), so his was very high and the doctor was surprised that he was not in a coma. Adams was placed on medications, but he also sought the help of Caldwell B. Esselstyn, Jr., the same doctor who treated Bill Clinton and author of the book, Prevent and Reverse Heart Disease. He was informed by doctors that he would be on insulin for the rest of his life.

He was placed on medicine for his acid reflux, medicine for his high cholesterol, and medicine for his burning and tingling of his hands and feet. His family

is diabetic and was told that it runs in his family.

This past August, there was a launch of a plant-based lifestyle program at Bellevue Hospital in New York City. Doctors, nurses, dieticians, and life coaches will help at least 100 patients across all five boroughs adopt healthy eating patterns focused on

Needless to say, the vast majority of chronic illness is highly correlated to what we eat.

legumes, whole grains, fruits, vegetables, nuts, and seeds while reducing animal products, fried foods, refined grains, and added sugars. Michelle McMacken, director of NYC Health + Hospitals/Bellevue Adult Weight Management Program, is director of the program.

At Montefiore Hospital, Dr. Robert Ostfeld spearheaded

Second Opinion

While medical doctors are beginning to advocate this lifestyle, nurses should also set an example of this lifestyle approach. Nurses are part of the health care discipline and minority nurses, especially, need to set an example. the Cardiac Wellness Program where plant-based nutrition is the prescription for management of cardiac disease. The population most affected by these diseases are non-white populations. Dr. Kim Williams, past President of the American College of Cardiology, advocates for a plant-based diet for heart disease prevention.

Affronted with a high cholesterol, he decided to take measures into his own hands, and adopt a plant-based diet.

While medical doctors are beginning to advocate this lifestyle, nurses should also set an example of this lifestyle approach. Nurses are part of the health care discipline and minority nurses, especially, need to set an example. We want patients to take control of their lives. We can teach patients eating a plant-based diet instead of a standard American diet, as a form of primary prevention. Like any diet, it may take time to adjust, but this is not just a diet, it is a lifestyle. Patients would need to make an informed decision as to whether they would want to incorporate it into their lifestyle or not. There is enough supportive evidence out there that a patient can access such as documentaries, “Fork Over

Knives” and “Fat, Sick, and Nearly Dead.” There are a variety of resources, including the 21-Day Vegan Kickstart program, to include in dietary prescriptions to help patients treat and prevent obesity, type 2 diabetes, and heart disease.

This will require support from the patient’s primary provider, and, whether the provider is an advocate of this lifestyle or not, it should be considered.

Benefits such as less medication, weight loss, and improvements in mood as well as cholesterol have been shown. Dispel the myths about a plant-based diet and protein.

This is a plea as something to consider to take better care of ourselves and take control of our lives. There have been many initiatives and programs to lose weight. Drastic measures have also occurred due to the outcomes of being overweight, such as drastic surgery and restrictions from carbohydrates. Patients are sometimes misinformed and have to get

rid of the idea that medications will solve the problem—it only delays the problem. There is a possibility of reversing diabetes and cardiac disease. This is a decision that the person has to make: continue with their lifestyle with animal protein and processed carbohydrates or see a reduction in their overall weight and health by incorporating a plant-based diet.

A plant-based diet may be considered “extreme” by some people in altering their lifestyle.

But given the choice between a plant-based diet or open-heart surgery, it can be posed to the patient which one they consider as extreme. Again, it is a personal choice, an evaluation of familial and cultural values

would be assessed to fit the needs of the patient. Surgery can be viewed as a band-aid in that it will manage the symptoms temporarily unless the patient alters their lifestyle. Of course, it helps if the patient has a supportive network to embrace the lifestyle. It can start off as small, simple steps, as little as incorporating a plantbased meal in their day and slowly add these meals to their lifestyle. There are vegan starter kits to kick a healthier you.

Karla Rodriguez, DNP, RN, CNE, is a clinical assistant professor at Rory Meyers New York University College of Nursing and has taught there since 2007.

A plant-based diet may be considered “extreme” by some people in altering their lifestyle. But given the choice between a plant-based diet or open=heart surgery, it can be posed to the patient which one they consider as extreme.

Leading Causes of Death: How Many Are Related to Food?

At least seven are directily related to our food choices...

Source: Centers for Disease Control and Prevention, National Vital Statistics Reports, Vol. 63, No. 9, August 31, 2015

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Health Policy

Access to Health Care: Platforms and Agendas for the 2020 Presidential Election

By Janice M. PHILLIPS, PHD, FAAN, RN

Presidential candidates are gearing up for the 2020 presidential election and are sharing their platforms and agendas for creating a stronger and more prosperous nation.

Presidential hopefuls have identified a number of proposals focused on ensuring access to health care.

S

ome candidates vow to ensure access to health care by recommending universal health care coverage through a single payer national government health care program referred to as the Medicare- for-all proposal. Other candidates are in favor of some version of this proposal by lowering the Medicare eligibility age to 50 but also retaining the private insurance option.

Still, some presidential hopefuls aim to ensure health care coverage by providing a public option for people under age 65 or by strengthening health care coverage by building on the Affordable Care Act. Regardless of a candidate’s position, the debate on how to achieve universal coverage will continue to evolve overtime leading up to the election and way beyond.

Findings from a Kaiser Family Foundation’s survey found that the majority of people who voted on a regular basis are not familiar with or clear on the Medicare-for-all

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proposal. Survey respondents are seeking solutions to everyday problems such as paying for care, eliminating red tape, and navigating the health care system.

While there are many proposals that are under consideration, the Medicare-for-all proposal is one of the most frequently cited proposals designed to ensure universal health care coverage. There are several versions of this approach to health care coverage, such as the proposed version introduced by Senator Bernie Sanders in 2017. Here we discuss the Medicare for All Act of 2019 (M4A), one of the most recently introduced

iterations of the Medicare-forall approach to health care coverage. This proposed legislation is similar to the legislation introduced by Senator

will constitute a major shift in health care financing and will move from the traditional focus on providing health care coverage exclusively for those

As the nation’s largest group of health care workers, nurses must possess a fundamental awareness of the various proposals devoted to ensuring access to health care.

Sanders in 2017 and other single payer legislation proposed by members of Congress.

While there are some similarities, there are also some differences. For the most part, Medicare-for-all proposals

age 65 and older to more widespread care coverage for those under age 65.

Here is a brief snapshot of some of the basic components of the M4A introduced by Rep.

Health Policy Pramila Jayapal (D-WA) on February 27, 2019: •• Single federal government administered program to cover all U.S. residents (including immigrants and possibly undocumented individuals) •• Open enrollment to those age 19 and under as well as those 55 and older one year after enactment •• Abolishes traditional benefits covered through traditional Medicaid/Medicare p r o g r a m , C h i l d r e n ’s Health Insurance (CHIP), the Federal Employees Health Benefits Program, or TRICARE (health care for active and retired military) •• Recommends a ban on cost sharing (e.g., copays, deductibles) •• In addition to the 10 categories of the essential benefits in the Affordable Care Act, proposed additional covered benefits and services include hospitals services; ambulatory patient services; primary and preventive services; prescription drugs and medical devices; mental and substance abuse treatment services; laboratory and diagnostic services, comprehensive services across childbearing cycle; newborn and pediatric services; emergency services and transportation, early and periodic screening as outlined in Medicaid; transportation to health care services particularly for low income and persons with disabilities; and long-term care services and support.

Source: Health Affairs As the nation’s largest group of health care workers, nurses must possess a fundamental awareness of the various

As the most trusted profession, we are well suited to lend our voices to advocate for better access to care for all and are encouraged to do so.

Resources National news media such as CNN, The New York Times, and The Washington Post traditionally have provided an in-depth discussion and analysis on presidential

proposals devoted to ensuring access to health care. This will be particularly important for the many individuals, families, and communities who continue to lack access to care and suffer disproportionately from a number of health conditions and illnesses. As the most trusted profession, we are well suited to lend our voices to advocate for better access to care for all and are encouraged to do so. Our role in educating our policy makers has never been greater as we have firsthand knowledge of how the lack of access to quality health care coverage impacts the health and wellbeing and even life expectancy of those residing in the United States.

Be sure to stay informed of the various debates and proposals on universal health care coverage. Efforts to revise our current approach to health care financing and access to health care is complex and will require that we stay abreast of the discussions surrounding this issue. The American Nurses Association, the Kaiser Family Foundation, The Washington Post, and Health Affairs, to name a few, traditionally provide a synopsis on where candidates stand on health care issues and universal coverage. In addition to watching the presidential debates, nurses are encouraged to visit the web sites of the

campaign issues, including health care.

The following are a few resources that can assist nurses in staying abreast of some of the campaign health care related discussions and other issues relevant to health reform: • Health Affairs www.healthaffairs.org/journal/hlthaff • Kaiser Family Foundation www.kff.org • Rand Health Care

www.rand.org/health-care/key-topics/ health-policy/in-depth.html

Efforts to revise our current approach to health care financing and access to health care is complex and will require that we stay abreast of the discussions surrounding this issue.

various presidential candidates to become more familiar with their position on health care (e.g., access, universal coverage, health care reform) along with a myriad of other health care issues (e.g., prescription drug coverage, supplemental coverage). As we continue to support access to health care as a human right, our awareness of the issues and advocacy for access to quality

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health care for all will remain an important factor in the upcoming presidential campaign.

Janice M. Phillips, PhD, FAAN, RN, is an associate professor at Rush University College of Nursing and the director of nursing research and health equity at Rush University Medical Center.

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