the politically active nurse · • yesterday • today • tomorrow for order form see page 14 ......
TRANSCRIPT
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Professional Nursing in Kentucky • Yesterday • Today • Tomorrow
For order form see Page 14
President’s Pen . . . . . . . . . . . . . . . . . . . . . 1
Student Spotlight . . . . . . . . . . . . . . . . . . 3-4
KNA Centennial Video . . . . . . . . . . . . . . . . 4
Medication Administration Errors . . . . . . . 5
Membership Application . . . . . . . . . . . . . . . 6
Nurses On The Move . . . . . . . . . . . . . . . 6-7
Chapter News . . . . . . . . . . . . . . . . . . . . . 8-9
Cultural Diversity . . . . . . . . . . . . . . . . . . . 10
Nursing: Light of Hope . . . . . . . . . . . . . . . 12
Limited English Proficiency . . . . . . . . . . . 13
Professional Nursing in KY . . . . . . . . . . . . 14
The Human Touch . . . . . . . . . . . . . . . . . . 15
Index
THE OFFICIAL PUBLICATION OF THE KENTUCKY NURSES ASSOCIATIONQuarterly publication direct mailed to approximately 79,000 Registered Nurses & LPNs in KentuckyVolume 64 • No. 1 January, February, March 2016
President’s PenTeresa H. Huber, DNP, MSN, RN
Happy New Year!
As the largest and most trusted profession, nurses need to be aware of how politics work. Politics impact our profession at the local, state and national level. It is imperative that nurses analyze and understand proposed policy and how it may impact our clients and our profession. Understanding how politics work and what influences are present in the process are critical to ensuring effective public policies.
States are ultimately responsible for client safety, thus pass legislation and set requirements for who is qualified to practice. The mandate for nursing is to assist legislators to understand how nursing standards are established and help develop legislation with an achievable agenda for political action by nurses at the state level through the State Boards of Nursing.
Professional organizations provide a way to influence policy change and legislation at the state and federal level. Provision 9 of the ANA Code of Ethics calls for nurses to be active in social policy and political involvement. The American Nurses Association (ANA) has a Political Action Committee (PAC) focusing on influencing federal legislation. The ANA has focused on many issues such as the RN Safe Staffing Act, Home Health Care Planning and Improvement, Veterans Access to Care Act, and the Title VIII Nursing Workforce Reauthorization Act. Through the Kentucky Nurses Association (KNA)
political and legislative programs, the Association has taken firm positions on everything from HIV/AIDS policy, a patient’s right to self-determination, creation of the Patient Safety Act, to access to health care and adequate reimbursement for health care services.
Nurses have the potential to be a powerful political force. Nationally, with 3 million nurses licensed to practice, the profession constitutes the largest body of healthcare providers in the country. Once nurses identify what needs to be done, they can use their significant political power to make change.
What can one nurse do? The ultimate political power is the vote. Nurses can make a difference for a candidate who supports legislation that empowers nurses, and who recognizes what is needed for healthcare reform. Nurses can serve on boards which may have strategic influence to improve the health of communities and the nation. Examples of boards may be corporate/industry boards, hospital boards, advisory boards, taskforce positions appointed by a president/governor, mayor or state legislator, school boards, and nonprofit boards as well.
The willingness of nurses to become involved in politics is the key to developing legislative respect for the profession, and improving healthcare. We have a responsibility to broaden our advocacy to include health policy, which in turn, will empower nurses to have control over our practice in many healthcare issues. Your membership in ANA/KNA and your specialty nursing association offers many
opportunities to engage in policy making efforts while supporting you in your efforts.
Encourage students and others to participate in advocacy days at the state capital, and meet with local legislators to support their cause, during Legislative Days.
The Kentucky Nurses Association is your professional organization that can bring about change. As a member driven organization, KNA works diligently to educate legislators and to advance legislation supportive to our profession and our patients. The depth and breadth of nursing knowledge and critical thinking that nurses bring to the table is vital in shaping our nation and our state’s policymaking, especially in the healthcare arena.
The “Surviving Your First Year” event for students and new graduates is upcoming, and will be held April 8 in Bowling Green. Please join us!
1. American Nurses Association (2015). About the code. Retrieved from: http://nursingworld.o r g /M a i n MenuC at e gor i e s/E t h i c s S t a nda r ds/CodeofEthicsforNurses/AboutTheCode.html
2. American Nurse Today (2015). Retrieved from: http://www.americannursetoday.com/archive/july-2015-vol-10-no-7/
3. Catalano, J. (2013). Nursing now! Today’s issues, tomorrow’s trends (7th ed.). Philadelphia: F. A. Davis.
4. Gallup Poll (2015). Honesty and ethics in professions. Retrieved from: http://www.gallup.com/poll/1654/Honesty-Ethics-Professions.aspx
The Politically Active Nurse
Medication Administration Errors
Page 5
Page 2 • Kentucky Nurse January, February, March 2016
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Chapters Presidents and Treasurers - 2016 PRESIDENTS TREASURERS
RIVER CITY CHAPTER (Formerly District 1) Charolette Rock H: 502-409-8128 Paulette F. Adams, EdD, RN H: 502-267-4372 3829 Spring Arbor Dr 3047 Crystal Waters Way Louisville, KY 40245 Louisville, KY 40299-4897 E-Mail: [email protected] E:Mail: [email protected]
BLUEGRASS CHAPTER (Formerly Chapter 2) Heather Norris, MSN, RN H: 502-316-1400 Nancy Garth, RN C: 859-312-0599 100 Mallory Meadow Way 3292 Shoals Lake Drive H: 859-271-9529 Nicholasville, KY 40356 Lexington, KY 40515 W: 859-323-0733 E-Mail: [email protected] E-Mail: [email protected]
NORTHERN KENTUCKY CHAPTER (FORMERLY DISTRICT 3) Carla Hamilton, MSN, RN, NE-BC H: 606-782-0131 Mary A. Crowell H: 859-727-4340 1020 Marshall Road W: 859-572-3596 3504 Susan Lewis Dr W: 859-371-9393 Brooksville, KY 41004-7712 Erlanger, KY 41018 E-Mail: [email protected] E-Mail: [email protected] [email protected]
HEARTLAND CHAPTER (FORMERLY DISTRICT 4) Kathleen M. Ferriell, MSN, BSN, RN H: 502-348-8253 Susan E. Nesmith, APRN, RN H: 270-300-4062 125 Maywood Avenue W: 270-692-5146 1623 Hutcherson Lane W: 270-706-1683 Bardstown, KY 40004 Elizabethtown, KY 42701-8977 E-Mail: [email protected] E-Mail: [email protected]
WEST KENTUCKY CHAPTER (FORMERLY DISTRICT 5) Nancy Armstrong, MSN, RN H: 270-435-4466 Katy Garth, PhD, RN H: 270-435-4544 1881 Furches Trail W: 270-809-4576 358 Butterworth Road W: 270-762-6669 Murray, KY 42071 Murray, KY 42071 E-Mail: [email protected] E-Mail: [email protected]
KENTUCKY NURSES REACH – RESEARCH, EDUCATE, ADVOCARE, CARE, HELP (FORMERLY DISTRICT 7) Ann Afton, MSN, RN, APRN O: 270-745-4574 Kim Bourne, MSN, RN, CNE H: 270-427-5554 1813 Boyce Fairway Road C: 270-791-3675 147 Bulldog Road Alvaton, KY 42122-7606 Glasgow, KY 42141 E-Mail: [email protected] E-Mail: [email protected]
GREEN RIVER CHAPTER (FORMERLY DISTRICT 8) Carole Mattingly, RN, MSN, MBA, FCN O: 270-831-9786 Carol Murch, MSN, RN, APRN H: 270-521-9980 2660 S. Green Street C: 270-860-4072 18143 Upper Delaware Road W: 270-831-9787 Henderson, KY 42420 Henderson, KY 42420 E-Mail: [email protected] E-Mail: [email protected] NIGHTINGALE CHAPTER (FORMERLY DISTRICT 9) JoAnn Wever, MSN, BSN, RN H: 859-336-5938 Charlene Maddox, BSN, RN H: 859-236-6936 300 Covington Avenue 4330 Lebanon Road Springfield, KY 40069 Danville, KY 40422 E-Mail: [email protected] E-Mail: [email protected] NORTHEASTERN CHAPTER Michelle L. Rayburn, MSN, RN W: 606-783-7789 St. Claire Regional Medical Center 222 Medical Center Morehead, KY 40351 E-Mail: [email protected]
SCHOOL NURSES IN EVERY KENTUCKY SCHOOL CHAPTER Kathy Hager, DNP, APRN, FNP-BC, CDE (2015) W: 502-272-8103 C: 502-682-0651 TREASURER TBD Bellarmine University 1508 Main Street Shelbyville, KY 40065 E-Mail: [email protected]
“The purpose of the Kentucky Nurse shall be to convey information relevant to KNA members and the profession of nursing and practice of nursing in Kentucky.”
Copyright #TX1-333-346For advertising rates and information, please contact Arthur L.
Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. KNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.
Acceptance of advertising does not imply endorsement or approval by the Kentucky Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. KNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of KNA or those of the national or local associations.
The Kentucky Nurse is published quarterly every January, April, July and October by Arthur L. Davis Publishing Agency, Inc. for Kentucky Nurses Association, P.O. Box 2616, Louisville, KY 40201, a constituent member of the American Nurses Association. Subscriptions available at $18.00 per year. The KNA organization subscription rate will be $6.00 per year except for one free issue to be received at the KNA Annual Convention. Members of KNA receive the newsletter as part of their membership services. Any material appearing herein may be reprinted with permission of KNA. (For advertising information call 1-800-626-4081, [email protected].) 16mm microfilm, 35mm microfilm, 105mm microfiche and article copies are available through University Microfilms International, 300 North Zeeb Road, Ann Arbor, Michigan 48106.
2015-2016 EDITORIAL BOARD
EDITORSIda Slusher, PhD, RN, CNE (2013-2016)
Maureen Keenan, JD, MAT
MEMBERSDonna S. Blackburn, PhD, RN (2014-2017)
Patricia Calico, PhD, RN (2015-2018)Sherill Cronin, PhD, RN, BC (2014-2017)
Vickie Ann Miracle (2013-2016)
REVIEWERSDawn Garrett-Wright, PhD, RN
Elizabeth “Beth” Johnson, PhD, RNConnie Lamb, PhD, RN, CNE
Joyce E. Vaughn, BSN, RN, CCMDeborah A. Williams, EdD, RN
KNA BOARD OF DIRECTORS
PRESIDENTTeresa H. Huber, DNP, MSN, RN (2013–2016)
PRESIDENT ELECTKathy Hager, DNP, APRN, FNP-BC, CDE (2015)
VICE-PRESIDENTDana Manley, PhD, APRN (2015-2017)
SECRETARYBeverly D. Rowland, PhD(c), RN, CNE (2015-2017)
TREASURERJoe B. Middleton, MSN, APRN, CEN, CC/NRP (2014-2016)
DIRECTORS-AT-LARGETeena L. Darnell, DNP, RN (2015–2017)
JoAnn M. Wever, MSN, RN (2014 – 2016)Michael Wayne Rager, DNP, PhD(c) FNP-BC, APRN, CNE
(2015-2017)Cathern S. Velasquez, DNP, RN, CPHM (2014-2016)
EDUCATION & RESEARCH CABINETLiz Sturgeon, PhD, RN, CNE (2014-2016)
GOVERNMENTAL AFFAIRS CABINETShawn Nordheim, Ed.D., RN (2015-2017)
PROFESSIONAL NURSING PRACTICE &ADVOCACY CABINET
Karen Blythe, MSN, RN, NE-BC (2015-2017)
KNF PRESIDENTMary A. Romelfanger, MSN, RN, CS, LNHA
KANS CONSULTANTTo be determined by Board of Directors
KNA STAFF
EXECUTIVE DIRECTORMaureen Keenan, JD, MAT
DIRECTOR OF COMMUNICATIONSMichelle Lasley
ADMINISTRATIVE COORDINATORLisa Snyder
Information for Authors• Kentucky Nurse Editorial Board welcomes submission articles to be
reviewed and considered for publication in Kentucky Nurse.• Articlesmaybesubmittedinoneofthreecategories:• Personalopinion/experience,anecdotal(EditorialReview)• Research/scholarship/clinical/professionalissue(ClassicPeerReview)• ResearchReview(EditorialReview)• Allarticles,exceptresearchabstracts,mustbeaccompaniedbyasignedKentucky Nurse transfer of copyright
form (available from KNA office or on website www.Kentucky-Nurses.org) when submitted for review.• Articleswillbereviewedonly if accompanied by the signed transfer of copyright form and will be considered for
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Editor, Kentucky Nurse, Kentucky Nurses Association, 305 Townepark Circle, Suite 100, Louisville, KY 40243(502)245-2843•Fax(502)245-2844•oremail:[email protected]
Jane Todd Crawford Hospital isrecruiting for APRNs.
Jane Todd Crawford Hospital is a 25-bed critical access facility located in Greensburg, KY, with one new rural
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For more information, contact:Rusty Tungate, Administrator/CEO
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January, February, March 2016 Kentucky Nurse • Page 3
Student SpotlightKerri Eklund, RN
RN to BSN StudentWestern Kentucky University
The Guide to the Code of Ethics for Nurses serves as a moral compass and map to direct nurses towards a path of practice that is paved with quality care. As it says in the title, this document illustrates a standard that every nurse among all educational levels and professional pathways should follow in order to accomplish the ethical responsibilities of the nursing profession. The purpose of this article is to briefly expand upon what the Guide to the Code of Ethics for Nurses truly is by discussing its development and purpose as well as its importance to nursing practice.
Development and PurposeThe idea of a code of ethics was initially discussed
in 1896 by the group that, in the future, would form the American Nurses Association (ANA). By the time the ANA House of Delegates unitedly accepted the Code for Professional Nurses in 1950, there had already been years spent discussing and selecting the fine print that would influence millions of nurses around the world. Revisions to the initial code of ethics were published in 1956, 1960, 1976, 1985, 2001, and 2015 in order to ensure the code evolves along with the constantly adapting nursing profession (Fowler, 2015). The Guide to the Code of Ethics for Nurses was developed to provide a standard for nurses. This standard not only serves as a guideline for the basis of nursing practice, but it also acts as a reflection of the credibility of the nursing profession as a whole. Like children, new nurses must be guided and taught with continuity in order to see the true importance of following the rules that have been presented to them. The Code of Ethics
outlines the rules and expectations for nurses and allows them to develop their own interpretation of the universal nursing expectations and integrate such into their professional growth.
Importance to Nursing PracticeJust as the Ten Commandments served as the
rock upon which Christians built their practices and beliefs, the Code of Ethics serves as the foundation for nursing practice. Growing up in the Catholic Church and attending a Catholic school from kindergarten to eighth grade, I was constantly taught to base my inner conscience around the Ten Commandments. To this day, I judge every action I take according to those ten guidelines. The Guide to the Code of Ethics for Nurses serves as my nursing inner conscience. Whether it be during a calm shift when I could choose to sit and chat with a patient, or during a hectic shift and I have a million responsibilities to juggle, I depend upon my inner conscience to keep me on track. This book is extremely important as the basis for my nursing practice.
SummaryThe Guide to the Code of Ethics for Nurses is
an excellent guideline for all nurses regardless of their area of practice. I greatly enjoyed reading the revisions in place within the 2015 edition and refreshing my nursing conscience. I plan to always keep my Guide to the Code of Ethics for Nurses near in order to keep my moral compass from veering off the path of quality care.
ReferencesFowler, M. (2015). Guide to the code of ethics for nurses:
Interpretive Statements: Development, Interpretation, and Application (2nd ed.). Silver Spring, MD: American Nurses Association.
Summary of Code of Ethics
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Page 4 • Kentucky Nurse January, February, March 2016
Student Spotlight KNA Centennial VideoLest We Forget Kentucky’s
POW NursesThis 45-minute video documentary is a KNA Centennial Program Planning Committee project and was premiered and applauded at the KNA 2005 Convention. “During the celebration of 100 years of nursing in Kentucky—Not To Remember The Four Army Nurses From Kentucky Who Were Japanese prisoners for 33 months in World War II, would be a tragedy. Their story is inspirational and it is hoped that it will be shown widespread in all districts and in schools throughout Kentucky.
POW NURSESEarleen Allen Frances, Bardwell
Mary Jo Oberst, OwensboroSallie Phillips Durrett, Louisville
Edith Shacklette, Cedarflat
___ Video Price: $25.00 Each
___ DVD Price: $25.00 Each
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Brittany Janes, RNRN-BSN Student
Western Kentucky University
Nursing is a subject that is not easily defined. Before I entered nursing school, or my career, I would have just thought of nursing as “taking care of sick people.” I never understood why my stepmother (who is a nurse in a local emergency room) would say she worked until 7:00 p.m. but arrived home an hour or later after said time. “When it’s your time to leave, why don’t you leave?” I would ask her. She would sometimes say, “I just couldn’t leave.” It wasn’t until I began my own nursing journey that I understood. Nurses develop relationships with their patients, and their coworkers, and feel a personal obligation to maintain those relationships. Leaving at 7:00 on the dot isn’t of the upmost importance; the patient’s well-being is.
The American Nurses Association (ANA) developed the Nursing Social Policy Statement (2010), which includes various components of nursing practice. The Elements of Nursing’s Social Contract includes many points, but one sticks out to me. “Health and illness
are human experiences. The presence of illness does not preclude health, nor does optimal health preclude illness” (ANA, 2010, p. 6). This statement is so profound, and captures the essence of what nursing involves. Nurses are witnesses to life when it’s at its most vulnerable. We observe life as it begins, and when it is complete. We hold the hand of a laboring mother as she’s giving birth to her first child, and also to the elderly man who takes his last breath. What other career can say that? Health and illness are human experiences, and nurses bear witness to both.
The definition of nursing is complex, but one of the components is “Advocacy in the care of individuals, families, communities, and populations.” (ANA, 2010, p.3) Nurses are personal activists for their patients. I try to mirror this example in my career. I listen to my patients and their families, and try to understand their concerns. I do not hesitate to call a doctor when I know that it is in my patient’s best interest, even if it is 3:00 a.m. I allow family members to remain at the bedside after visiting hours because I know there’s a good chance that moment could be the last time they see their family member alive.
Nursing is not black or white. There is a very large gray area in which we practice. The Nursing Social Policy Statement provides excellent guidelines in nursing practice. It formulates excellent definitions of practice, and outlines the scope in which we should practice. It establishes that relationships between the nurse and patient are of the highest value. Creating rapport with my patient is very important to me. It is only now after being a nurse that I understand why many times my stepmom was late arriving home. Nursing has no time constraints. The patient in front of you is more important than your schedule. Now when I come home late and someone asks me what took so long, I can say with a smile, “I just couldn’t leave.”
ReferencesAmerican Nurses Association. (2010). Nursing’s social policy
statement: The essence of the profession (3rd ed.). Silver Spring, Md.: American Nurses Association.
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Sterling Health Solutions, a Federally Qualified Health Center (FQHC) in Mount Sterling, Kentucky, is seeking a Full-time and a Part-Time Psychiatric
Nurse Practitioner,duetoclinicgrowth.CandidatesshouldholdavalidKentuckyAPRNlicense,activeDEAcertificate,andvalidBLScertification.Experience of three to five years treating Behavioral and MentalIllness among adults and children is preferred. Also, ability to speakSpanish is a plus. Benefits include competitive salary with productionbonus, loan repayment program, malpractice coverage through FTCA,Insurance (health, dental, vision, life, disability), 403 B, and CMEallowance. For immediate consideration, forward CV to Lori Coffey at [email protected]. For more information on the position or SterlingHealthSolutions,pleasecall859.404.7686,extension114.
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January, February, March 2016 Kentucky Nurse • Page 5
Medication Administration Errors
Catherine Forston and Morgan Tardiff, BSN students, and Rachel Hazelwood, BHS student,
at Bellarmine University, Louisville, KY
Patient safety and quality of care are the center of the healthcare industry. Unfortunately, medication errors, regardless of route, are a common problem. According to a study completed by the National Academy of Sciences in 2000, medical errors are the eighth leading cause of death in the United States. It has been reported that an estimated $3.5 billion is spent a year on preventable medication administration-related events in the United States.
A group of nurse researchers at a hospital in Fort Wayne, IN recently conducted a study to examine the effect of distractions and interruptions on medication administration errors. The purpose was to discover protocols that would aid in decreasing medication administration errors and associated adverse events. The researchers anticipated that decreased numbers of distractions and interruptions could decrease the frequency of medication administration errors, since research suggests that nurses are interrupted on average 6.7 times an hour and as many as 14 times an hour while preparing medications. Fifty-six nurses and twenty-four nursing students on a 45-bed acute care unit in a community hospital participated in the study.
The project began by obtaining baseline analysis of the rate of medication administration errors. The participants were then educated on the project interventions, which included clearly marked signs in areas for medication preparation,
an updated medication administration checklist, instructions not to speak to others or attempt to multitask while preparing medications, as well as instructions related to reporting, using a Medication Administration Distraction Observation Sheet. Twenty-six nurses reviewed the Medication Administration Distraction Observation Sheet for content validity. The inter-rater reliability of the observation tool was .90. The nurses were also instructed to wear orange vests that clearly stated that the nurse was administering medications and was not to be interrupted. The study was conducted over the course of 3-months.
The pre and post intervention error rates were compared. The reported medication administration error rate increased from 1.68 to 2.88 per 1000 patient days. However, the researchers concluded that the increase in reported medication errors was due to the nurses’ increased awareness of what constituted a medication error. The ten post-intervention errors reported were identified as preventable, had the nurses adhered to the checklist and avoided interruptions. Environmental factors such as distractions or interruptions during medication preparation and/or administration were found to contribute to medication errors. Initially, nurses received undesired attention from patients and families regarding the vests, but this decreased over time. An unexpected finding was that the nurses continued to use the vests beyond medication administration as a means to avoid interruption throughout their shift. Coincidentally, while not the focus of the study, there was an increase in patient
satisfaction while the study was going on. This was attributed to patient recognition of the efforts to increase quality of care on the unit. The overall response to the implementation was positive, as the nurses recognized that there were more things they could do to decrease medication errors.
The study successfully addressed the desire to decrease the overall risk of medication administration errors by the project participants and increase their awareness of distractions and/or interruptions during the medication administration process. The authors suggest that in order to continue to decrease the number of medication administration errors, healthcare facilities should provide and adhere to an environment that supports reducing distractions, interruptions, and conversation during medication administration and preparation.
Source: Yoder, M., Schadewald, D., & Dietrich, K. (2015). The effect of a safe zone on nurse interruptions, distractions, and medication administration errors. Journal of Infusion Nursing, 38(2), 140-151.
Data Bits is a regular feature of Kentucky Nurse. Sherill Nones Cronin, PhD, RN-BC is the editor of the Accent on Research column and welcomes manuscripts for publication consideration. Manuscripts for this column may be submitted directly to her at: Bellarmine University, 2001 Newburg Rd., Louisville, KY 40205.
ACCENT ON RESEARCH DATA BITSKeep Your Distance! Preventing Distractions to Reduce Medication Errors
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Nurses on the MoveLocal Healthcare Leader
Wins International Award for Excellence in Research
Dr. M. Cynthia Logsdon Honored with Elizabeth McWilliams Miller Award for Excellence in Research from Sigma Theta Tau International
M. Cynthia Logsdon, Ph.D., WHNP-BC, FAAN, Professor, University of Louisville, School of Nursing and Associate Chief of Nursing for Research, University of Louisville Hospital has won the 2015 Elizabeth McWilliams Miller Award for Excellence in Research from Sigma Theta Tau International (STTI), the honor society of nursing. Logsdon, an alumna of the Spalding University School of Nursing, which nominated her for the award, was presented the award at the STTI biennial convention in Las Vegas, NV Nov. 7-11, 2015. STTI lauds nurses and health care professionals with the International Awards for Nursing Excellence, and this award honors Logsdon for her achievements in research and contributions to the profession of nursing.
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Nurses on the MoveUK College of Nursing
Kentucky Nurse KNA Nurses on the Move
4th quarter 2015
Kristin Ashford, PhD, WHNP-BC, FAAN, associate professor with the University of Kentucky College of Nursing, has been awarded a four-year, $2,327,683 RO1 grant from the National Institute on Drug Abuse (NIDA). The Impact of Electronic Cigarettes (e-cigs) on Perinatal Immune Responsiveness and Birth Outcomes in Appalachia seeks to determine the effects of e-cigs on prenatal biomarkers and birth outcomes. Ashford and her team seek to generate the necessary data to guide regulatory authorities.
Three nurse faculty from the University of Kentucky College of Nursing and a nurse administrator with UK HealthCare were recently inducted as fellows of the American Academy of Nursing. They are Kristin Ashford, PhD, APRN, WHNP-BC, FAAN; Patricia Burkhart, PhD, RN,
FAAN; Cecilia Page, DNP, RN-BC, CHCIO, CPHIMS, FACHE, FAAN; and Deborah Reed, PhD, MSPH, RN, FAAOHN, FAAN.
Debra Moser, PhD, RN, FAHA, FAAN, professor and director of the Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease at the University of Kentucky College of Nursing, was chosen for the 2015 President’s Award from the Friends of the National Institute of Nursing Research (FNINR). The prestigious honor recognizes a nurse researcher who epitomizes a commitment to scientific inquiry and whose long-standing contributions to the field serve to advance knowledge and understanding of human health and health care.
The University of Kentucky College of Nursing has opened a primary care clinic with limited services in Wilmore, Ky. Sharon Lock, PhD, APRN, FNAP, FAANP, professor and primary care DNP track coordinator, is director of the clinic and practices with UK colleague Nancy Kloha, DNP, APRN, FNP-BC.
Jenna Hatcher, PhD, MPH, RN, University of Kentucky College of Nursing, took on a new role as director of diversity and inclusivity for the College. She hopes to recruit a more diverse body of undergraduate and graduate nursing students and instill a culture of inclusivity in all facets of the College and that this will translate into the larger nursing workforce.
Several faculty members at the University of Kentucky College of Nursing have taken on or have transitioned into different administrative roles. Kristin Ashford, associate professor, is now assistant dean of research; Patricia Burkhart, professor, is now associate dean of undergraduate faculty affairs; Susan Frazier, associate professor, is now the PhD program director; Jennifer Hatcher, associate professor, has been named the College’s director of diversity and inclusivity; Sherry Holmes is now assistant dean of academic operations and
Nurses on the Move continued on page 15
Page 8 • Kentucky Nurse January, February, March 2016
Chapter NewsBluegrass Chapter:
The Bluegrass Chapter has worked very hard this past year.
To address our community care focus identified in our bylaws, we have collected coats, canned goods and money for many organizations within our geographical area. These include Habitat for Humanity and Salvation Army
In an effort to support our membership drive and message, we meet with the classes and we have presented KNA/ANA mission and goals to the graduating class of every nursing program in our geographical region. We have found that this has led to nearly doubling our membership over the past several years.
Our members requested CE offerings and our mission is to reach out to the bedside nurse. Combining these goals, we offer clinically driven CE at all membership meetings. Our meetings occur on the third Tuesday of the odd months at the Chop House on Richmond Road at 6pm.
As we work to improve quality and safety and clarify our mission, we are currently updating our bylaws and planning a patient safety conference for 2016.
Communication with members is super important. We have established a Shutterfly account and we email members meeting information and important research provided by the KNA. Additionally, we have established a website and Facebook and we share meeting information and evidence based practice changes as driven by the ANA.
We welcome new members and students to our meetings. For any questions about meeting times, please contact Heather Norris at 502-316-1400.
Green River Chapter:The Green River Chapter continues to focus on
education within both the academic and practice arenas. The November meeting is scheduled for 6pm November 10th at the Miller House in Owensboro Kentucky. The chapter welcomed new members from the University of Louisville (Owensboro Campus) and Madisonville Community College this fall.
The chapter hosted KNA Executive Director, Maureen Keenan at the October meeting. Maureen presented an informative continuing education program on legislative issues to the membership that
sparked discussion on a variety of practice issues. Future plans for the chapter include development of a spring continuing education offering in collaboration with KNA.
Heartland Chapter:The Heartland Chapter has reviewed the updated
State Association bylaws and developed the new chapter bylaws to be congruent. The chapter bylaws were approved and were forwarded to the State Office. Necessary structural changes for the transitions from District 4 to Heartland chapter, including bank account name changes, bank account access/authorization, and chapter logo are still being finalized. Bernie Sutherland is working with the State office to determine how to access and update chapter membership numbers and data.
Chapter members who have agreed to run for State offices in 2015 include Anne Sahingoz, Jean Statz, Laurie Heckel, Jerri Passo, Rhonda Vale, Susan Nesmith, and Beverly Rowland. Currently there are several Heartland members already elected to State offices. Thank you to all our chapter members who are serving in State offices or have agreed to be on the 2015 ballot.
The KNA financial update information from the Convention was reviewed at our chapter meeting. Recommendations concerning investment and financial plans for association relevance and membership growth were forwarded to the State office, as requested.
An article on the ANA Workplace Violence and Incivility Panel and Advisory Committee was published in the Kentucky Nurse. Janice Elder, one of several KNA members, was appointed to the Advisory Committee.
Thanks to our officers, loyal members, hosts, and interested nurses for their attendance and work on our Chapter business.
Kentucky Nurses Reach Chapter:REACH Chapter Happenings: The REACH Chapter
was formerly District 7. REACH stands for Research, Educate, Advocate, Care, Help. The purpose of the chapter is to stay abreast of current research and evidence-based practice, to participate in and provide on-going education and advocacy, and to be a caring and helping organization in our community.
The REACH chapter met in September and enjoyed a presentation by Detective Matt Travis of the Kentucky State Police entitled Street drugs: Recognizing signs and symptoms. Items were collected for and donated to BRASS (Barren River Area Safe Space). On November 3rd, Dr.
JR Hansbrough, a local Pulmonologist, will be doing a presentation on “Asthma Phenotypes, Immunology, and Implications for Treatment.” Also, a representative from Toys for Tots will be talking about this program. We will be collecting items for Toys for Tots. Our spring meetings will be on February 16th and April 19th.
We welcome all members (old and new) and students to our meetings. If you are interested in attending a meeting or joining our chapter, please contact Kim Bourne at [email protected] for further information.
Nightingale Chapter:At the November meeting of the Nightingale
Chapter of KNA held at Shaker Village, a scholarship was awarded to a deserving student. Our Nightingale scholarship winner for Fall 2015 is Sandra Lane. She is a BSN student at Indiana Wesleyan University and will graduate May 2016. Sandy decided to pursue her BSN not because it was required at her facility but because she wanted to further her education and grow professionally. She is employed at Heritage Hospice in Danville. Along with her employment obligations, Sandy, also, serves as a healthcare resource for her church and community.
Northeastern Chapter:The Northeastern Chapter of the Kentucky Nurses
Association (KNA) was started by several members of St. Claire Regional Medical Center’s nursing staff in Morehead, KY. Mattie Burton, PhD, RN, Past President of KNA from 2010-2012, first suggested forming a new chapter. A Chapter formation meeting was held on April 29, 2014 and an Executive Council was elected. The Northeastern KNA Chapter became official on June 4, 2014 when KNA Board of Directors happily approved the new chapter application.
The Executive Council members include: Chair – Michelle Rayburn, MSN, RN; President Elect – Christa Thompson, MSN, RN; Secretary – Shelly Brown, MSN, RN and Treasurer – Phelan Bailey, RN. The Northeastern Chapter purpose is to improve health for the communities we serve and inspire nurses to achieve nursing excellence. We are devoted to high-quality patient care, patient safety, evidence-based practice and advancing community health.
The Chapter has participated in a number of community events. Chapter members taught community CPR during the “Arts and Eats Festival” and women’s cardiac health during the “Women’s Conference” in Morehead, KY. The Chapter donated a UK Basket to auction during the KNA Convention to help with fundraising. Additional community efforts include a “Coat for Kids” drive which helped two area elementary school resource centers during the bitter cold winter months and support for the “Adopt a Family” program during the holiday season.
This year’s holiday community events will be to “Stuff the Turkey.” This will be a Thanksgiving food drive to benefit a local food pantry in Olive Hill, Kentucky. We are also delighted to be able to “Adopt a Family” again this year to help provide a wonderful Christmas to a family in need. Also some members have participated in “Operation Christmas Child.” This program partners with churches worldwide to give boys and girls in underdeveloped countries shoeboxes full of gifts for Christmas.
All active KNA members in eastern Kentucky are encouraged to join the KNA Northeastern Chapter. If you are interested in joining or would like more information on the KNA Northeastern Chapter, please contact Michelle Rayburn at 606.783.7789 or [email protected].
Northern Kentucky Chapter:The Northern Kentucky Chapter is working on a
legislation proposal to mandate CEUs for KY Nurses related to Chemical Dependency (similar to head trauma or HIV). We are working to present this in 2016 KY Legislation. Teresa Huber will present to the board in November.
River City Chapter:The River City Chapter hosted an informal get
together for members in September at Bravo’s Restaurant to talk about future activities for the chapter. Part of the evening was spent discussing
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Chapter Newshow to communicate more effectively with members since most do not want to come to monthly meetings. Dialogue will continue on how to make River city more relevant to members in the future.
Dr. Karen Cassady from Hildegarde House was the speaker for the October meeting. She is in the throes of establishing a place where homeless who are dying and qualify for Hosparus care can live out their final days. Karen talked about this concept’s origin in Germany where she has visited several of these houses. Hildegarde House is located in the St. Joseph Church convent and will open in January. Attendees were invited to participate in the orientation for volunteers which includes material related to Hildegarde House and Hosparus.
The November meeting provided a forum for stimulating discussion on future goals for KNA and how chapters can be a part of those goals. Leading the discussion was KNA President-elect Dr. Kathy Hagar. Much of the discussion centered around using updated and varied technology to reach membership such as chat rooms, more sophisticated websites, email blasts, texts and Instagrams. There was also discussion about more connection with Board members, posting Board minutes on the website section for members and making the Kentucky Nurse more relevant to all nurses.
The River City Chapter board is going to try quarterly meetings at KNA Headquarters beginning in January, 2016 with monthly updates through email in the other months.
School Nurses in Every Kentucky School Chapter:
In 2013, Eva Stone, ARNP, Lincoln County Director of Student Support Services, presented a program on the Social Determinants of Health in Kentucky’s school age children at the KNA Leadership Summit. Following that presentation, several attending KNA members started meeting with various nurse leaders around the state. With their help, a group of over 80 stakeholders (some parents, some child advocate group members, some legislators, some KNA members, some school health coordinators, and many school nurses) started communicating and working toward a plan to place a school nurse in every Kentucky school.
In 2015, Dr. Teena Darnell surveyed all Kentucky high schools and came up with some great data
supporting the presence of school nurses in high schools. Dr. Darnell found, that when schools with full time school nurses were compared to schools without access to a nurse, the schools without access had a 76.9% graduation rate, compared to an 83.1% graduation rate for those students with access to a full time nurse (p=0.001).
Phase II of this research is to link reading at grade level and calculating math at grade level, for grades 3-8, to the presence, or absence of a school nurse. The Internal Review Board application is in process at this time. Concurrently, the group is meeting with Senator Reggie Thomas, thanks to Carol Komara, a School Nurse Group member and a past board member of the Kentucky Board of Nursing.
One sub-committee of the School Nurse group has already met and proposed a delivery model that would place a school nurse in every school, and more than one nurse, if the number of students exceeded the 1 nurse: 750 students proposed National Association of School Nurses ratio. Another sub-committee is looking at best methods for funding the initiative. Plans will be underway to file a bill for the 2017 Kentucky Legislative session.
Current efforts also involve activation of discussion boards / forums for KNA chapters.
For the School Nurse Chapter, the members want to be able to communicate with each other about strategies, and every day stories, as well as house important documents supporting the value of school nurses.
At the December 11 meeting, the group will strategize on how best to circulate information related to the value of the school nurse, and the personal stories of the many school nurses who make a difference, every day, for our Kentucky kids. Legislative approaches will also be discussed.
West Kentucky Chapter:The West Kentucky Chapter of the Kentucky
Nurses Association (KNA) supported activities to promote nursing in the western Kentucky area. We helped to sponsor the Baptist Health Paducah Research Forum, with several chapter members presenting in the forum. We also sponsored Heather Raley, a Murray State University senior nursing student, in attending a Sigma Theta Tau conference. She was receiving the Rising Star award for her undergraduate research and is also presenting her research. Our goals were to promote nursing and professional nursing activities in our community. I believe we were able to do that this year.
Page 10 • Kentucky Nurse January, February, March 2016
Cultural DiversityUnequal Access: African Immigrants and
American Health Care***Adebola O. Adegboyega, RN, BSN
PhD studentUniversity of Kentucky College of Nursing
andJennifer Hatcher, RN, MPH, PhD
Associate Professor and Director of Diversity & Inclusivity
University of Kentucky College of Nursing
Access to health care is defined as the empowerment of an individual to use health care. It is a multidimensional concept based on the interaction (or degree of fit) between health care systems and individuals, households, and communities (McIntyre, Thiede & Birch, 2009). Inequities in health care cover not only inadequacies in access to care but also differences in the quality of both informal and formal care, as well as the burden of payment. The existence and magnitude of these inequities increase the disease burden, widen social inequities in health status, and generate adverse social and financial effects (Dahlgren & Whitehead, 2007). When opportunities for efficacious health services are unavailable to certain groups in society, there are access issues that may need to be addressed (Gulliford et al., 2002).
Examining access to health care among African immigrants is an important and timely issue as a result of the growing health inequities related to health care access in this underserved population (Edward, 2014). The African immigrant group is a rapidly rising new population in the United States (Capps, Mc Cabe & Fix, 2012). From 1980 to 2013, the sub-Saharan African immigrant population in the United States increased from 130,000 to 1.5 million (Zong & Batalova, 2014). African immigrants differ by country of origin, reasons for migration, primary languages spoken, health practices and beliefs, human capital, education status, and cultural background (Reed & Tishkoff, 2006). Managing the health care needs of this group is challenging due to the diversity and vulnerability of the group.
Penchansky and Thomas (1981) conceptualized that access has five dimensions; (a) availability, (b) accessibility, (c) affordability, (d) accommodation, and (e) acceptability. These dimensions of access are interwoven and may not be easily separated. The purpose of this paper is to briefly explore
the dimensions of access as it relates to African immigrants health using the model provided by Penchansky and Thomas as a conceptual guide.
Availability: Immigrants experience limited access to care due to citizenship status (De Alba, Hubbell, McMullin, Sweningson, & Saitz, 2005; Echeverria & Carrasquillo, 2006; Goel et al., 2003; Ojikutu, Nnaji, Sithole-Berk, Bogart, & Gona, 2014; Othieno, 2007). The immigrant provisions of the 1996 welfare reform act, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), made most legal immigrants ineligible for publicly funded services such as Medicaid for the first five years of residence (undocumented immigrants are ineligible irrespective of their length of stay) but states can determine eligibility by funding services and/ or restrict the eligibility of qualified aliens (Derose, Escarce, & Lurie, 2007). Many immigrant families hesitate to enroll in critical health care, job-training, nutrition, and cash assistance programs due to fear and confusion caused by the laws’ chilling effects (Broder & Blazer, 2014). Uncertainty about government program eligibility and fear limit healthcare use. For example, when immigrants are out of legal immigration status, they may hesitate to seek care because of the profound fear of deportation (Othieno, 2007).
Although millions of uninsured American residents gained access to healthcare coverage through the implementation of the Patient Protection and Affordable Care Act of 2010, millions more will remain uninsured due to mandates that forbid undocumented immigrants and legal residents of less than five years from purchasing insurance through the newly available market exchange (Agabin & Coffin, 2015).
Accessibility: Having knowledge of services and the proximity to health facilities may improve access to care. However, some African immigrants have reported that they do not know where to go for health care and are confused about how the U.S. health care system works (Boise et al., 2013). Accessibility of health care facilities can be influenced by geographical location. New immigrant settlements are less likely than established destinations to have well-developed safety nets, culturally competent providers, and immigrant advocacy or community-based organizations (Derose et al., 2007). Cities with strong community-clinic networks and a long history
of serving immigrants still have uneven access to care (Okie, 2007). Immigrants living in rural areas may have limited access to specialty care, difficulty getting specialty care referral due to insurance status and they may have long wait times before getting appointment.
Affordability: The high cost of health care and lower socioeconomic status (SES) impacts the affordability of healthcare for the African immigrant population (Foley, 2005; Odedina et al., 2011; Wafula & Snipes, 2013). As of 2013, 26% of Sub-Saharan African immigrants were more likely to be uninsured compared to the 12% native-born population (Batalova, 2014). Even though the majority of African immigrants are educated and have high labor force participation, their earnings are surprisingly low (Capps, McCabe & Fix, 2012). The underemployment is often due to recent arrival, difficulty transferring home country credentials and labor market discrimination (Capps, McCabe & Fix, 2012). Lower socio economic status is associated with poorer health status (Dunlop, Coyte, & McIsaac, 2000). In two studies of African born patients attending HIV clinics in Minnesota, The researchers reported that African immigrants receive care at later stages of HIV infection or when they have AIDS and do not routinely get tested for HIV compared to US born population (Akinsete et al., 2007; Page, Goldbaum, Kent, & Buskin, 2009).
Accommodation: African immigrants have reported language difficulties as a barrier to healthcare access (Adekeye, Kimbrough, Obafemi, & Strack, 2014; Boise et al., 2013; Carroll et al., 2007; Pavlish, Noor, & Brandt, 2010; Simbiri, Hausman, Wadenya, & Lidicker, 2010). Limited English proficiency affect the quality of care immigrants receive; for instance, immigrants with limited proficiency report lower satisfaction with care and lower understanding of their medical situation (Derose et al., 2007). Language barriers play a major role in health system navigation difficulty (Adekeye et al., 2014).
Although the use of interpreters may alleviate communication problem, it has some limitations. Boise et al, 2013 found that communicating through interpreters added to the complication of scheduling appointments; an aspect of health care that was an unfamiliar for many immigrants and some Africans are deterred from seeking care
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January, February, March 2016 Kentucky Nurse • Page 11
Cultural Diversitybecause of fear that private health information might be spread to the community by interpreters who lived in their neighborhood. Skills like reading, writing, communicating, and listening in English are needed to accomplish health related tasks. One needs familiarity with the technical, jargon-rich, biomedical vocabulary used within the health care system (Singleton & Krause, 2010), this may prove a challenge for immigrants for whom English language is not the primary language.
Acceptability: Discrimination experienced in health care settings may inadvertently influence individuals’ use of needed health care (Quach et al., 2012). In a study among a multiethnic population in the United States, African immigrants reported that they perceived that they were treated unfairly and with disrespect in the health care system based on the way they speak English (Johnson, Saha, Arbelaez, Beach, & Cooper, 2004).
Furthermore, researchers have expressed that a “double jeopardy” phenomenon exists for immigrants of color (Pavlish et al., 2010). Since African Immigrants are grouped with African Americans based on race, they continue to face the same discrimination, limited resources allocation and scarce opportunities. These treatments coupled with other lived experiences unique to African immigrants put them at a more disadvantaged position. Immigrant persons of color reported more incidents of discriminatory practices by health care professionals than United States born persons of color (Lauderdale, Wen, Jacobs, & Kandula, 2006) and felt that they were treated differently by hospital due to their accents or cultural mode of dressing (Adekeye, 2014). Also, African immigrants have expressed that they received poor and insensitive care, and were disrespected because providers portray racist attitudes and do not treat them as “a whole person” but as poor minority newcomers at the bottom of the socio-cultural ladder (Boise et al., 2013; Carroll et al., 2007).
Implications for practice and researchThe Penchansky and Thomas framework (1981)
is a useful guide in explaining the dimensions of access. The framework highlights healthcare access as a multidimensional concept requiring a comprehensive approach that encompasses far more than our traditional definition of access.
Nurses are at the forefront of patient care and have a significant role that includes providing appropriate and empathetic healthcare. In the case of immigrant populations this includes understanding and providing healthcare
navigation and resources as highlighted by the application of the framework to access issues in African immigrants. For example, it is critical that nurses and other health care providers utilize professional interpreter services to facilitate effective communication and ensure patients’ privacy. As nurses encounter immigrants and other vulnerable populations, they can address access equity not just through their individual patient care but as patients’ advocates ensuring that all patients are treated with respect and dignity.
Policies addressing health access equity may improve health care use and better the overall health of all Americans. Improving cultural competence has been recommended as a strategy to address inequities based on the premise that improving provider-patient communication is an important component of addressing differences in quality of care that are based on the race, ethnicity, or culture of the patient (Betancourt, Corbett, & Bondaryk, 2014; Julliard et al., 2008; Morales, Cunningham, Brown, Liu, & Hays, 1999).
Furthermore, educating recent immigrants about US healthcare services through more established community members and healthcare navigators may assist in achieving improved access and utilization rates of services. Education should be focused on areas such as scheduling appointments and follow up, information about available programs and resources in the community, and strategies for effective communications with providers and how to be active participants in their healthcare decisions.
Finally, there is limited research addressing issues related to health care among African immigrants. Researchers should continue to provide data and knowledge of the health care needs of this growing population. The body of literature that results from this continued exploration will serve as a basis for improved practice and policies that better the health of African immigrants.
References Adekeye, O., Kimbrough, J., Obafemi, B., & Strack, R. W.
(2014). Health literacy from the perspective of African immigrant youth and elderly: A photovoice project. Journal of Health Care for the Poor and Underserved, 25(4), 1730-1747. doi: 10.1353/hpu.2014.0183
Agabin, N., & Coffin, J. (2015). Undocumented and uninsured: Aftereffects of the patient Protection and Affordable Care Act. Journal of Medical Practice Management, 30(5), 345-348.
Akinsete, O. O., Sides, T., Hirigoyen, D., Cartwright, C., Boraas, C., Davey, C.,...Henry, K. (2007). Demographic, clinical, and virologic characteristics of African-born persons with HIV/AIDS in a Minnesota hospital. AIDS Patient Care and STDS, 21(5), 356-365. doi: 10.1089/apc.2006.0074
Betancourt, J. R., Corbett, J., & Bondaryk, M. R. (2014). Addressing disparities and achieving equity: Cultural competence, ethics, and health-care transformation. Chest, 145(1), 143-148. doi: 10.1378/chest.13-0634
Boise, L., Tuepker, A., Gipson, T., Vigmenon, Y., Soule, I., & Onadeko, S. (2013). African refugee and immigrant health needs: Report from a community-based house meeting project. Progress in Community Health Partnership, 7(4), 369-378. doi: 10.1353/cpr.2013.0045
Broder T. and Blazer, J. (2014). National Immigration Law Center. Overview of immigrant eligibility for Federal programs. Retrieved August 11, 2015, from http://www.nilc.org/immigrantshcr.html
Capps, R., Mc Cabe, K., & Fix, M. (2012). Diverse streams: African migration to the United States. Retrieved 11/3/2014, from http://www.migrationpolicy.org/research/CBI-african-migration-united-states
Carroll, J., Epstein, R., Fiscella, K., Gipson, T., Volpe, E., & Jean-Pierre, P. (2007). Caring for Somali women: Implications for clinician-patient communication. Patient Education and Counselling, 66(3), 337-345. doi: 10.1016/j.pec.2007.01.008
Dahlgren, G., & Whitehead, M. (2007). A framework for assessing health systems from the public’s perspective: The ALPS approach. International Journal of Health Services, 37(2), 363-378.
De Alba, I., Hubbell, F. A., McMullin, J. M., Sweningson, J. M., & Saitz, R. (2005). Impact of U.S. citizenship status on cancer screening among immigrant women. Journal of General Internal Medicine, 20(3), 290-296. doi: 10.1111/j.1525-1497.2005.40158.x
Derose, K. P., Escarce, J. J., & Lurie, N. (2007). Immigrants and health care: Sources of vulnerability. Health Affairs (Millwood), 26(5), 1258-1268. doi: 10.1377/hlthaff.26.5.1258
Dunlop, S., Coyte, P. C., & McIsaac, W. (2000). Socio-economic status and the utilisation of physicians’ services: Results from the Canadian National Population Health Survey. Social Science & Medicine, 51(1), 123-133. doi: http://dx.doi.org/10.1016/S0277-9536(99)00424-4
Echeverria, S. E., & Carrasquillo, O. (2006). The roles of citizenship status, acculturation, and health insurance in breast and cervical cancer screening among immigrant women. Medical Care, 44(8), 788-792. doi: 10.1097/01.mlr.0000215863.24214.41
Edward, J. (2014). Undocumented immigrants and access to healthcare: Making a case for policy reform. Policy, Politics, & Nursing Practice, 15(1-2), 5-14. doi: 10.1177/1527154414532694
Flaskerud, J. H., & Winslow, B. J. (1998). Conceptualizing vulnerable populations health-related research. Nursing Research, 47(2), 69-78.
Foley, E. E. (2005). HIV/AIDS and African immigrant women in Philadelphia: structural and cultural barriers to care. AIDS Care, 17(8), 1030-1043. doi: 10.1080/09540120500100890
Goel, M. S., Wee, C. C., McCarthy, E. P., Davis, R. B., Ngo-Metzger, Q., & Phillips, R. S. (2003). Racial and ethnic
Cultural Diversity continued on page 12
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Cultural Diversity continued from page 11
disparities in cancer screening: The importance of foreign birth as a barrier to care. Journal of General Internal Medicine, 18(12), 1028-1035.
Gulliford, M., Figueroa-Munoz, J., Morgan, M., Hughes, D., Gibson, B., Beech, R., & Hudson, M. (2002). What does ‘access to health care’ mean? Journal of Health Services Research and Policy, 7(3), 186-188.
Johnson, R. L., Saha, S., Arbelaez, J. J., Beach, M. C., & Cooper, L. A. (2004). Racial and ethnic differences in patient perceptions of bias and cultural competence in healthcare. Journal of General Internal Medicine, 19(2), 101-110. doi: 10.1111/j.1525-1497.2004.30262.x
Julliard, K., Vivar, J., Delgado, C., Cruz, E., Kabak, J., & Sabers, H. (2008). What Latina patients don’t tell their doctors: A qualitative study. The Annals of Family Medicine, 6(6), 543-549. doi: 10.1370/afm.912
Lauderdale, D. S., Wen, M., Jacobs, E. A., & Kandula, N. R. (2006). Immigrant perceptions of discrimination in healthcare: The California health interview survey 2003. Medical Care, 44(10), 914-920. doi: 10.1097/01.mlr.0000220829.87073.f7
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Scott GilbertsonFolio Studio, Louisville, Kentucky
Photo submitted by the Kentucky Nurses Association, July 2005 to the Citizens Stamp Advisory Committee requesting that a first class stamp be issued honoring the nursing profession. (Request Pending)
Package of 5 Note Cards with Envelopes - 5 for $6.50
I would like to order “Nursing: Light of Hope” Note Cards
______ Package of Note Cards @ 5 For $6.50 ______ Shipping and Handling (See Chart) ______ Subtotal ______ Kentucky Residents Add 6% Kentucky Sales Tax ______ TOTAL
Make check payable to and send order to: Kentucky Nurses Association, 305 Townepark Circle, Suite 100, Louisville, KY 40243 or fax order with credit card payment information to (502) 245-2844 or email to [email protected]. For more information, please call (502) 245-2843.
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McIntyre, D., Thiede, M., & Birch, S. (2009). Access as a policy-relevant concept in low- and middle-income countries. Health Economics Policy and Law, 4(Pt 2), 179-193. doi: 10.1017/s1744133109004836
Morales, L., Cunningham, W., Brown, J., Liu, H., & Hays, R. (1999). Are latinos less satisfied with communication by health care providers? Journal of General Internal Medicine, 14(7), 409-417. doi: 10.1046/j.1525-1497.1999.06198.x
Nandi, A., Loue, S., & Galea, S. (2009). Expanding the universe of universal coverage: The population health argument for increasing coverage for immigrants. Journal of Immigrant and Minority Health, 11(6), 433-436. doi: 10.1007/s10903-009-9267-2
Odedina, F. T., Dagne, G., LaRose-Pierre, M., Scrivens, J., Emanuel, F., Adams, A.,...Odedina, O. (2011). Within-group differences between native-born and foreign-born black men on prostate cancer risk reduction and early detection practices. Journal of Immigrant and Minority Health, 13(6), 996-1004. doi: 10.1007/s10903-011- 9471-8
Ojikutu, B., Nnaji, C., Sithole-Berk, J., Bogart, L. M., & Gona, P. (2014). Barriers to HIV testing in black immigrants to the U.S. Journal of Health Care for the Poor and Underserved, 25(3), 1052-1066. doi: 10.1353/hpu.2014.0141
Okie, S. (2007). Immigrants and health care–at the intersection of two broken systems. The New England Journal of Medicine, 357(6), 525-529. doi: 10.1056/NEJMp078113
Othieno, J. (2007). Understanding how contextual realities affect African born immigrants and refugees living with HIV in accessing care in the twin cities. Journal of Health Care for the Poor and Underserved, 18(3 Suppl), 170-188. doi: 10.1353/hpu.2007.0085
Page, L. C., Goldbaum, G., Kent, J. B., & Buskin, S. E. (2009). Access to regular HIV care and disease progression among black African immigrants. Journal of National Medical Association, 101(12), 1230-1236.
Pavlish, C. L., Noor, S., & Brandt, J. (2010). Somali immigrant women and the American health care system: Discordant beliefs, divergent expectations, and silent worries. Social Science and Medicine, 71(2), 353-361. doi: 10.1016/j.socscimed.2010.04.010
Penchansky, R., & Thomas J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. Medical Care 19(2):127-140.
Quach, T., Nuru-Jeter, A., Morris, P., Allen, L., Shema, S. J., Winters, J. K.,...Gomez, S. L. (2012). Experiences and perceptions of medical discrimination among a multiethnic sample of breast cancer patients in the greater San Francisco Bay Area, California. American Journal of Public Health, 102(5), 1027-1034. doi: 10.2105/ajph.2011.300554
Reed, F. A., & Tishkoff, S. A. (2006). African human diversity, origins and migrations. Current Opinions in Genetics and Development, 16(6), 597-605. doi: 10.1016/j.gde.2006.10.008
Simbiri, K. O., Hausman, A., Wadenya, R. O., & Lidicker, J. (2010). Access impediments to health care and social services between Anglophone and Francophone African immigrants living in Philadelphia with respect to HIV/AIDS. Journal of Immigrants and Minority Health, 12(4), 569-579. doi: 10.1007/s10903-009-9229-8
Singleton, K., & Krause, E. M. (2010). Understanding cultural and linguistic barriers to health literacy. Kentucky Nurse, 58(4), 4, 6-9.
Wafula, E. G., & Snipes, S. A. (2013). Barriers to Healthcare access faced by black immigrants in the US: Theoretical considerations and recommendations. Journal of Immigrant and Minority Health. doi: 10.1007/s10903-013-9898-1
Zong, J., & Batalova, J. (2014). Sub-Saharan African immigrants in the United States. Retrieved 11/3/2014, f rom http://w w w.migrat ionpol icy.org/a r t ic le/sub-sa ha ra n-a f r ica n-imm ig ra nt s - united-states
***Article reprinted due to an editorial error that omitted the author’s names.
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January, February, March 2016 Kentucky Nurse • Page 13
Limited English Proficiency
Joshua Capps, RN, BSN, PhD Student, School of Nursing,
University of Louisville555 S. Floyd Street, Louisville, Kentucky 40202
[email protected] Rolfe, BSN Student, School of Nursing,
University of [email protected]
M. Cynthia Logsdon, PhD, WHNP-BC, FAANProfessor, School of Nursing,
University of Louisville555 South Floyd Street, Louisville, Kentucky 40202
The population of the United States is increasingly diverse. In health care settings, diversity continues to be associated with health disparity (Institute of Medicine, 2003); minorities are less likely than Caucasians to receive needed health services. Disparity is particularly common in those with Limited English Proficiency (LEP). LEP means individuals are unable to communicate effectively in English because their primary language is not English and they have not developed fluency in the English language. A person with LEP may have difficulty speaking or reading English. An LEP person may need documents written in English translated into his or her primary language so that the person can understand important issues related to health and human services.
LEP can drastically affect a patient’s overall health literacy. The United States Department of Health and Human Services (2010) defines health literacy as “The degree to which individuals have the
capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (p. 1). Health literacy can be affected by education level, socioeconomic status, race/ethnicity, and culture. Health literacy is an integral component of successful navigation of the health care system and positive health outcomes.
A comprehensive review by Andrus and Roth (2002) examined several studies conducted in the United States and found that low health literacy is directly correlated with poorer health status, decreased knowledge of medical care and conditions, lack of understanding and use of preventive services, poorer compliance rates, increased hospitalizations, and increased health care costs. The prevalence of low health literacy has also been reported for numerous ethnic groups. Previous studies have demonstrated Hispanic ethnicity is associated with lower levels of health literacy compared to other races and ethnicities (Garbers & Chiasson, 2004; Guerra, Dominguez, & Shea, 2005; Nokes et al., 2007). The United States Census Bureau data indicate there are 25.3 million LEP individuals in the United States, of which Hispanic individuals comprised 63% (2011). Hispanics are the fastest
Limited English Proficiency:Impact on Health Literacy and Health Disparity
Limited English Proficiency continued on page 14
growing minority population in Louisville, KY, and second largest minority group comprising 4% of the city’s population in 2010 (US Census Bureau, 2015). As more Hispanics migrate to the United States and utilize the health care system, it is imperative that interventions are both culturally and linguistically tailored to this population.
There may be stigma variations among Hispanic subgroups depending on specific regional or ethnic influences on culture and attitudes. For example, with all Hispanic subgroups, time since immigration to the US, stronger ethnic identity, and greater Spanish language/social preferences were strongly associated with a lower odds of mental health service utilization (Keyes, et al., 2012). There is also evidence indicating a gap in provider recognition and service provision for Hispanic LEP women with postpartum depression (Chaudron et al., 2005).
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Triad is looking for healthcareprofessionals to join our team!
Triad Health Systems, Inc. is a Federally Qualified Health Center located in Warsaw and Owenton, KY. We are currently seeking a Registered Nurse for a full time position.
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Camp Laurel, a private, co-ed, residential camp in Maine seeksa Nurse Manager, Charge Nurses and Staff Nurses. Oftenclaimed as one of New England’s premier summer camps, Laurel boasts excellent facilities and a well-staffed medical
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Page 14 • Kentucky Nurse January, February, March 2016
Limited English Proficiency continued from page 13
Limited English ProficiencyProfessional Nursing in Kentucky * Yesterday * Today * Tomorrow
KNA’s limited edition was published in 2006. Graphics by Folio Studio, Louisville and printing by Merrick Printing Company, Louisville.
Gratitude is expressed to Donors whose names will appear in the book’s list of Contributors. Their gifts have enabled us to offer this limited edition hard-back coffee-table-type book at Below Publication Cost for Advance Purchase Orders.
The Editors have collected pictures, documents, articles, and stories of nurses, nursing schools, hospitals, and health agencies to tell the story of Professional Nursing in Kentucky from 1906 to the present.
Special Price - $18.87 Per Book
___ $18.87 per book
___ $1.13 sales tax per book
___ Add $6.50 shipping and handling per book
___ (for 1-5 books - $10 or 6-19 books $20)
___ Total Purchase
___ Grand Total
Name ________________________________________________
Address ______________________________________________
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Signature ____________________________________________
Fax, Mail or E-mail Order to:Kentucky Nurses Association305 Townepark Circle, Suite 100, Louisville, KY 40243FAX: 502-245-2844E-mail: [email protected]
Recommendations Federal guidelines require that assistance
be provided to individuals with LEP. Since its enactment, Title VI of the Civil Rights Act of 1964 has prohibited discrimination on the basis of race, color or national origin in any program or activity that receives federal financial assistance. Title VI requires that recipients take reasonable steps to ensure meaningful access to their programs and activities by LEP persons. Steps must be taken to ensure that all individuals receiving health services understand their health situation, are aware of their options, and know how to promote and manage their own health. Although interpreters are available at health care facilities, either by phone or in person, each nurse in the commonwealth of Kentucky has a responsibility to ensure these services are offered in a timely, effective manner to those in need.
To eliminate health disparities, researchers and practitioners must also identify specific stigmas and barriers which prevent the Hispanic population from more readily accessing health services. Thorough assessments of patients’ health literacy skills, health knowledge, attitudes towards treatment, and preferred methods of receiving health care services allow nurses to more accurately understand the various facilitators and barriers in place for Hispanics with LEP. As these barriers to care are eliminated, interventions must be designed to address cultural, linguistic, and ethnic values as well as providing information in a way that is easily understood. Nurses are able to significantly impact
this phenomena in their patient advocacy role. This pivotal role in nursing affords great responsibility and power in assisting LEP patients to successfully navigate the health care system. Moving forward, it is essential that nurses embody strong cultural competence skills grounded in evidence-based practice to alleviate the significant health disparities of cultural minority populations.
ReferencesAndrus, M., & Roth, M. (2002). Health literacy: A review.
Pharmacotherapy, 22(3), 282-302.Chaudron, L., Kitzman, H., Peifer, K., Morrow, S., Perez, L.,
& Newman, M. (2005). Self-recognition of and provider response to maternal depressive symptoms in low-income Hispanic women. Journal of Women’s Health, 14(4), 331-338.
Garbers, S., & Chiasson, M. A. (2004). Inadequate functional health literacy in Spanish as a barrier to cervical cancer screening among immigrant Latinas in New York City. Preventing Chronic Disease, 1(4). Retrieved from http://www.cdc.gov/pcd/issues/2004/oct/03_0038.htm.
Guerra, C. E., Dominguez, F., & Shea, J. A. (2005). Literacy and knowledge, attitudes, and behavior about colorectal cancer screening. Journal of Health Communication, 10(7), 651–663.
Institute of Medicine. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press.
Keyes, K., Martins, S., Hatzenbuehler, M., Blanco, C., Bates, L., & Hasin, D. (2012). Mental health service utilization for psychiatric disorders among Latinos living in the United States: The role of ethnic subgroup, ethnic identity, and language/social preferences. Social Psychiatry and Psychiatric Epidemiology, (47), 383-394.
Nokes, K. M., Coleman, C. L., Cashen, M., Dole, P., Sefcik, E.,Hamilton, M. J., et al. (2007). Health literacy and health outcomes in HIV seropositive persons. Research in Nursing & Health, 30(6), 620–627.
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National action plan to improve health literacy. Washington, DC.
U.S. Department of Health and Human Services. (2000). Healthy people 2010 http://www.healthypeople.gov/2010/topicsobjectives2010/overview.aspx
U.S. Census Bureau. (2011). 2011 American community survey. Retrieved May 7, 2015, from http://factfinder.census.gov.
U.S. Census Bureau. (2015). State and county quick facts: Louisville/Jefferson county, Kentucky. Retrieved May 8, 2015, from http://quickfacts.census.gov.
WithadegreefromUSI,youwillbeabletocompeteforselectnursingjobs.Ourprogramsfocusonextensiveclinicalnursingexperiencewhileprovidingsuperiorpreparationforprofessionallicensing/certificationexams.Ouraward-winningfacultyprovidepersonalizedattentionthatfosterssupportiverelationshipswithnursingstudents.We are currently offering the following degrees:
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Knowledge for Life
CURRENT OPPORTUNITIES include an experienced MANAGER for one of our Medical/Surgical units and experienced RNs on the ICU.
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Berea College’s Nursing Program announces a tenure-track position in Medical/Surgical
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Casey County Hospital isrecruiting for APRNs.
Casey County Hospital, built in 2008, is a 24-bed criticalaccessfacilitylocatedinLiberty,KY.ItisJointCommission accredited and features two rural health
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January, February, March 2016 Kentucky Nurse • Page 15
Nurses on the Move continued from page 7
assessments; Patricia Howard is executive associate dean of academic affairs and partnerships; Sheila Melander, professor, is assistant dean of graduate faculty affairs and the MSN and DNP program director; and Darlene Welsh, associate professor, is now assistant dean of undergraduate faculty affairs and the BSN program director.
Janie Heath, PhD, APRN-BC, FAAN, dean of the University of Kentucky College of Nursing, has been selected to become a fellow of the AACN-Wharton Executive Leadership Program. Heath has more than 38 years of acute and critical care nursing experience in various positions, from staff to administration to advanced practice and academia. She has been awarded more than $12 million for academic and/or research initiatives, generated more than 150 publications and abstracts, and served on numerous regional and national task forces for tobacco control and advanced practice nursing initiatives.
Four University of Kentucky College of Nursing faculty members have been accepted to UK Chairs’ Academy Fall Cohort. The Chairs’ Academy encourages faculty to consider leadership career paths and develop the skills necessary for effective institutional leadership. Those selected are Kristin Ashford, PhD, WHNP-BC, FAAN; Susan Frazier, PhD, RN, FAHA; Sheila Melander, PhD, APRN, ACNP-BC, FCCM, FAANP; and Darlene Welsh, PhD, MSN, RN.
Mary Rado Simpson, PhD, RN (PhD, UK 2001), alumnus of the University of Kentucky College of Nursing, was recently appointed as the founding dean of the Elizabeth Akers Elliott School of Nursing at the University of Pikeville after serving as both division chair and interim dean for the nursing programs.
Nora Warshawsky, PhD, RN, CNE, University of Kentucky College of Nursing, has been appointed as the inaugural Baptist Health Lexington Healthservices Leadership Scholar. Dr. Warshawsky will be helping to provide leadership with a research project focused on the identification of competencies among the Baptist Health Lexington organization leaders (department directors and executives)
The Human Touch
Copyright 1980 | Limited Edition Prints by Marjorie Glaser Bindner RN Artist
Limited Edition Full Color Print | Overall size 14 x 18 | Signed and numbered (750)—SOLD OUTSigned Only (1,250)—$20.00 | Note Cards—5 per package for $6.50
THE PAINTING“The Human Touch” is an original oil painting 12” x 16” on canvas which was the titled painting of Marge’s first art exhibit honoring colleagues in nursing. Prompted by many requests from nurses and others, she published a limited edition of full color prints. These may be obtained from the Kentucky Nurses Association.
The Human Touch
Her step is heavyHer spirit is highHer gait is slowHer breath is quickHer stature is smallHer heart is big.She is an old womanAt the end of her lifeShe needs support and strengthFrom another.
The other woman offers her hand
She supports her armShe walks at her paceShe listens intentlyShe looks at her face.She is a young woman at theBeginning of her life,But she is already an expert in caring.
RN PoetBeckie Stewart*
*I wrote this poem to describe the painting, The Human Touch
by Marge.” Edmonds, Washington 1994
FOR MAIL OR FAX ORDERSI would like to order an art print of “The Human Touch”©
_____ Signed Prints @ $20.00 ____________ Total Purchases _____ Package of Note Cards @ 5 for $6.50 ____________ Shipping & Handling (See Chart) _____ Framed Signed Print @ $180.00 ____________ Subtotal ____ Gold Frame Kentucky Residents Add 6% Kentucky Sales Tax ____ Cherry Wood Frame Tax Exempt Organizations Must List Exempt Number _____________TOTAL _______________________________________
Makecheckpayabletoandsendorderto:KentuckyNursesAssociation,305TowneparkCircle,Suite100,Louisville,KY40243orfaxorderwithcreditcardpaymentinformationto(502)[email protected].
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City: _____________________________________________ State ______________ Zip Code: ______________
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Signature (Required): ___________________________________________________________________________
Shipping and Handling$ 0.01 to $ 30.00 . . . . . . . . . . $6.50$ 30.01 to $ 60.00 . . . . . . . $10.95$ 60.01 to $200.00 . . . . . $30.00$200.01 and up . . . . . . . . . $45.00
*Expressdeliverywillbechargedatcostandwillbechargedtoacreditcardaftertheshipmentissent.
and the development of a leadership development curriculum (the Evolving Leader Program).
Governor Steve Beshear reappointed University of Kentucky College of Nursing Assistant Professor Kathy Wheeler, PhD, RN, APRN, FAANP, to the Kynect Advisory Board in September 2015. Dr. Wheeler will represent health care providers in counsel to the Kynect initiative, which assists the state in pursuing the development of a state-based health care system. The board—a direct outcome of the Affordable Care Act—has members representing every aspect of health care and health care delivery in the Commonwealth.
Ellen Hahn, PhD, RN, FAAN, of the University of Kentucky College of Nursing, and her team recently received a one-year, $17,857 award from the Kentucky Association of Radon Professionals to coordinate and evaluate radon measurement and mitigation trainings statewide, as well as coordinate quarterly radon coalition meetings.
There is a place where pain is met with compassion, fear is met with reassurance, and anger is met with understanding. At The Ridge Behavioral Health System,
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We are currently offering a $1,000 sign on bonus for exceptional RNs.
To submit an application the applicant must go to our website at www.uhsinc.com and click on Career Options to select the position of interest.
Page 16 • Kentucky Nurse January, February, March 2016
ALL SHIFTSDay, Evening, Swing, Weekend
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