Health Care in the African American Community
Transcription
Health Care in the African American Community
Health Care in the African American Community Breast Cancer: Guest Editorial by Maimah Karmo: Breast Cancer & Young Women (page 3) PLUS: Prevention (page 4) Risks (page 6) Screening (page 8) Cervical Cancer (page 9) Children’s health issues: Hypertension (page 10) Infant Mortality (page 12) Vaccine Debate (page 13) Childhood Trauma (page 14) Babies & Breastfeeding (page 15) Also featuring: Million Hearts Initiative (page 16) The Air We Breathe (page 17) Prostate Screening (page 18) nbna nurse leadership: (See pages 20 - 27) THE NBNA NEWS IS THE OFFICIAL PUBLICATION OF THE NATIONAL BLACK NURSES ASSOCIATION SPRING 2012 in this issue President Speaks................................................................................................. 1 GUEST EDITORIAL: Young Women and Breast Cancer............................................................... 3 NBNA NEWS The NBNA News is printed quarterly; please contact the National Office for publication dates. Breast Cancer Prevention............................................................................. 4 NBNA News 8630 Fenton Street, Suite 330 Silver Spring, MD 20910 www.NBNA.org Know Your Cancer Risk................................................................................ 6 Ronnie Ursin, DNP, RN, NEA-BC Editor-in-Chief Breast Cancer Screening Deterrents........................................................... 8 Cervical Cancer Vaccines............................................................................. 9 The Silent Killer in African American Children........................................... 10 African American Infant Mortality............................................................... 12 The Anti-Vaccine Movement....................................................................... 13 Childhood Trauma....................................................................................... 14 Babies are Born to Breastfeed................................................................... 15 Health Care Perspectives: Women & Children The Million Hearts Initiative............................................................................... 16 The Air We Breathe............................................................................................ 17 Prostate Screening............................................................................................ 18 Opposing Cuts to Medicaid.............................................................................. 19 Recruiting The Next Generation........................................................................ 19 NBNA Leadership Prescription Drug Abuse Epidemic............................................................ 20 A Look at Practical Nursing........................................................................ 21 NBNA Strategic Plan................................................................................... 22 Are You a Leader?...................................................................................... 23 Embracing the Challenge of Nursing......................................................... 24 A Helping Hand........................................................................................... 25 Raise the Voice!.......................................................................................... 26 Parliamentary Tidbits.................................................................................. 27 Members On The Move............................................................................... 28-39 Chapter Websites.............................................................................................. 40 Chapter Presidents............................................................................................ 42 NBNA Newsletter NBNA Newsletter Criteria for Submitting Articles: • • • • • 500-750 Word Article Title of Article, Author’s Name and Credentials (Alison Brown, MSN, RN) Three-line biographical sketch & author’s headshot photograph (high res) Resources where appropriate Send all articles, member news, chapter highlights, pictures, and other information to [email protected]. Deadline: August 10 NBNA National Office Staff Millicent Gorham, HD, MBA, FAAN Executive Director and Associate Editor Estella Lazenby Administrative Assistant Frederick George Thomas Administrative Assistant Dianne Mance Conference Services Coordinator BOARD OF DIRECTORS: Deidre Walton, JD, MSN, RN President, Phoenix, AZ Betsy L. Harris, MSN, RN 1st Vice President, Atlanta, GA Lola Denise Jefferson, BSN, RN, CVRN 2nd Vice President Houston, TX Irene Daniels-Lewis, DNSc, RN, APN, FAAN Treasurer, Redwood City, CA Veronica Clarke-Tasker, PhD, MBA, MPH, RN Secretary, Mitchellville, MD Debra A. Toney, PhD, RN, FAAN Immediate Past President, Las Vegas, NV Ronnie Ursin, DNP, RN, NEA-BC Parliamentarian, Frederick, MD Birthale Archie, MSN, BS, RN Historian, Kentwood, MI Lauranne Sams, PhD, RN* Founder, President Emeritus, Tuskegee, AL Patty Palmer, LVN Student Representative, Enigma, GA Keneshia Bryant, PhD, RN, FNP-BC Little Rock, AR Barbara Crosby, MPA, BSN, RN-BC Baltimore, MD Martha Dawson, DNP, RN, FACHE Birmingham, AL Audwin Fletcher, PhD, APRN, FNP-BC, FAAN Jackson, MS C. Alicia Georges, EdD, RN, FAAN Ex-Officio, Bronx, NY Deborah Jones, MS, RN-C Texas City, TX Marcia A. Lowe, MSN, RN Birmingham, AL Linda Mitchell, BSN, RN Honolulu, HI Rhonda E. Ruben, BAAS, LVN Beaumont, TX Ora D. Williams, MHCA, BSN, RN Atlanta, GA *Deceased Dr. Deidre Walton, President National Black Nurses Association The Politics of Health Care: The Role and Responsibility of Nursing I n March 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA), providing the United States the opportunity to transform its health care system. Nurses can and should play a fundamental role in this transformation (Institute of Medicine, 2010). The 2010 Affordable Care Act also gives nurses new opportunities to deliver care and play an integral role in leading change (Hassmiller, 2010). As an advocate for change and improving the quality of health care in our communities, the National Black Nurses Association (NBNA) focuses on five guiding principles: accessible health care; affordable health care; endorsements of nursing best practice models; development of ethnic minority nurse leaders in areas of health policy, practice, education, and research; and, the promotion of the professional and educational advancement of ethnic minority nurses in the workforce. The nursing profession is the largest segment of the nation’s health care workforce. Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act. The Institute of Medicine’s (IOM) report on the Future of Nursing details recommendations for an action-oriented blue-print for the future of nursing (Institute of Medicine, 2010). In leading the transformation, the NBNA deems it essential to be committed to its mission of eliminating health care disparities and has established an Ad Hoc Committee on the Future of Nursing. In their commitment to transforming the nursing profession, NBNA members are taking leadership roles in preparing our communities for the marketplace in the post-health care reform era. The IOM’s report will help this nation prepare professional licensed nurses to assume leadership roles at the hospital, in the boardroom, and within the political arena. Mary K. Wakefield, PhD, RN, HRSA Administrator (Wakefield, 2011) has stated that a well educated, highly skilled, and diverse nurse workforce is critical to meeting future health care needs. Rita Wray, chair of the NBNA’s Ad Hoc Committee on the Future of Nursing, plans to determine further the NBNA’s goals by advancing its organizational impact. The NBNA plans to increase the proportion of nurses with baccalaureate degrees from 50% to 80% by 2020 and establish relationships with universities in order to encourage and offer ways for NBNA members to achieve academic progression. The committee also plans to formulate steps to make an impact in leadership such as representation on the State Action Coalitions (Walton, 2011). In addition, the NBNA is taking an active role in the diversity agenda as it relates to the future of nursing to ensure a workforce that will deliver culturally and linguistically appropriate services. As it continues to evolve, the Affordable Care Act will open new doors and become a catalyst for change in our health care delivery system. And, as advocates for change, nurses across this nation must join forces and contribute to the transformation in health care delivery by preparing future nurses to meet the needs of our communities, improve the quality of care, and prepare a high quality, diverse workforce. References Hassmiller, S. (2010). Nursing’s Role in Health Care Reform. American Nurse Today, 5(9). Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: Institute of Medicine of the National Academies. Wakefield, M. (2011, July 29). U.S. Department of Health and Human Services. Retrieved from: http://www. hhs.gov/news/press/2011pres/07/20110729a.html Walton, D. (2011, December). President. The NBNA: What We Have Accomplished and Where We Are Headed. Washington, DC, US: National Black Nurses Association, Inc. Guest Editorial NurseGuard ® Because Your Own Malpractice Policy Is Your Best Protection. n n n n n n Low $99 Rate*, Whether Employed or SelfEmployed Available In 50 States Worldwide, Portable, 24/7 Coverage That Travels With You, Regardless Of Specialty RN, LPN/LVN, First Year Graduate & Student Coverage Options A++ Rated Insurance Carrier Serving The Insurance Needs Of Nursing Professionals Since 1947 99 Hudson Street, 12th Floor New York, NY 100132815 Tel: 18002214904 Email: [email protected] VISA/MasterCard www.NurseGuard.com (* in most states) Guest Editorial Young Women and Breast Cancer NBNA.org — 3 Maimah Karmo W hen we embark on this journey called life, one never knows the twists and turns that fate or destiny will bring. I had life all planned out, until I heard the words, “you have breast cancer.” Those words threw me into a tailspin. I remember my mother teaching me to do my breast selfexams at thirteen years old. She told me to do them every month and she told me that if I did, when a change occurred, I would know. Her words echoed in my head as I stood in the shower 18 years later and felt a lump in my chest. I went to see my doctor, who referred me to a breast surgeon. She performed an unsuccessful aspiration then told me that I was too young to get breast cancer and to “Come back in six months.” Six months later when the lump had doubled in size, I again went to see the doctor. I insisted on a biopsy, against the doctor’s wishes. The next day, she called. I had breast cancer. The day was February 28, 2006. The time was 4:45pm, I immediately got a new doctor. I later found out that I had stage II, triple negative breast cancer. If I had waited six months, I may have been facing a death sentence. My biggest concern was for my 3-year-old daughter. During my second round of treatment, Tigerlily Foundation was born. I knew the mission had to be something that would impact younger women. Younger women generally do not consider themselves to be at risk for breast cancer, as research shows that women aged 40 or below comprise approximately 5% (roughly 11,000 cases per year) of all new breast cancer diagnoses (American Cancer Society, 2006). However, while breast cancer is not common in young women, young women share an inordinate amount of the burden—from being diagnosed at a time in their lives when they least expect it, to receiving more aggressive, more toxic therapy and experiencing unique psychosocial and medical effects including potential loss of menses and fertility. Complicating this is the fact that diagnosing breast cancer in younger women is more difficult because their breast tissue is generally more dense than the breast tissue in older women, early warning signs are ignored and some health care providers dismiss breast lumps in young women as cysts and adopt a “wait and see” approach. Breast cancer in younger women may be aggressive and less likely to respond to treatment. This population experiences greater effects of the disease and/or treatment on menopausal symptoms, fertility and family planning, genetic risk, role functioning at home and/or work, beauty and attractiveness and sexual functioning (Ganz, et al, 2003). Some of these factors can at times prevent young women from pursuing (timely) screening, treatment and follow up. Ganz also found that distress among young women with breast cancer may be further compounded by the lack of provider awareness (patients may miss opportunities for intervention), information, and resources to address young women’s issues and the lack of peer support. All of these dangers lead to gaps in care. Tigerlily fills this gap. We offer education, peer support, buddy bags, meals, financial assistance, and support for those with stage 4 breast cancer. In 2009, I met Representative Debbie Wasserman Schultz. After sharing my story, she asked to meet again. Within days, we were in her office, with my 6 year old running around her desk, the Breast Cancer Education and Awareness Requires Learning Young (EARLY) Act was born. Her office engaged breast organizations nationwide and within a year, the legislation was passed, as part of the Patient Protection and Affordable Care Act. The EARLY Act called for a public health campaign to teach young women that breast cancer can and does occur in young women, and to help them establish healthy breast habits to follow as they mature; an education campaign to increase awareness among providers that breast cancer occurs in young women; and support services for young women with breast cancer. As part of the legislation, the Centers for Disease Control (CDC) was required to develop initiatives to “increase knowledge of breast health and breast cancer among women, particularly among those under the age of 40 and those at heightened risk for developing the disease” (www.cdc.gov). The legislation also called for a Federal Advisory Committee, which works to assist CDC in developing evidence-based approaches to advance understanding and awareness of breast cancer among young women through prevention research, public and health professional education and awareness activities, and emerging prevention strategies. It has been my honor to have served on the committee. I often think my life since diagnosis. I never would have imagined a life better than this, where every day, I can help others. I’d love for you to join Tigerlily in our mission. Visit www.tigerlilyfoundation.org for more information or email [email protected]. References American Cancer Society (2006). Breast cancer facts and figures 2005-2006. Atlanta. American Cancer Society, Inc. Cleveland Clinic. (2012). Diseases and condition: Breast cancer in young women. Retrieved June 30, 2012, from http://my.clevelandclinic.org/ disorders/breast_cancer/hic_breast_cancer_in_young_women. aspx Ganz et al. (2003). Breast cancer in younger women: Reproductive and late health effects of treatment. Journal of Clinical Oncology, 21, 4184-93. Retrieved June 30, 2012, from http://jco.ascopubs.org/ content/21/22/4184.full.pdf Maimah Karmo is the Founder of Tigerlily Foundation and a three year survivor of breast cancer, who most recently received the Congressional Black Caucus Leadership in Advocacy Award for her work with young women and breast cancer. In October 2011, Maimah was appointed to the Federal Advisory Committee on Breast Cancer in Young Women, a committee established by the Affordable Care Act, on which she will work to develop initiatives to increase knowledge of breast health and breast cancer, particularly among women under the age of 40 and those at heightened risk for developing the disease. 4 — NBNA.org Women & Children’s Health Issues Breast Cancer Prevention for African American Women: The Role of the Advanced Practice Nurse (APN) or Doctor of Nursing Practice (DNP) Deborah Robinson, DNP, RN, Miami Dade College, School of Nursing Marie O. Etienne, DNP, ARNP, PLNC, Miami Dade College, Medical Campus Patricia R. Messmer, PhD, RN-BC, FAAN, Miami Dade College, Medical Campus Guerna Blot, ARNP-BC, MSN, MBA/HCM, OCN, Mount Sinai Medical Center G iger (2011) reports that African American women have a higher mortality for breast cancer than other racial and ethnic groups. Of African Americans, 119.9 per 100,000 women develop breast cancer per year, compared to 127.3 per 100,000 Caucasian women (http://seer. cancer.gov). However, mortality is higher, 32 per 100,000 African American women die of this disease each year, compared to 22.8 Caucasian per 100,000. Furthermore, the 5-year breast cancer survival rate is 77% for African American women, compared to 90.4% for Caucasian (http://seer.cancer.gov). Although African American women are less likely to get breast cancer than their Caucasian counterparts, they are more likely to die from the disease, partially due to access of health care and mammogram screening. The American Cancer Society (ACS) in 2012 recommended women aged 40+ receive annual mammogram and clinical breast examinations; women 20-39 years need clinical breast examinations every three years. A screening MRI is recommended along with annual mammograms at age 30 for high risk women. In 2003, the American Cancer Society ceased recommending all women perform monthly breast self-exams (BSE) since research demonstrated BSE offered little additional advantage over heightened breast awareness. ACS recommends health care providers informing women about BSE potential benefits and limitations. The focus of breast cancer screening is not articulated well in the Black community. There is a complex web of deleterious factors, including racism in the health care system, lack of insurance, distrust of the white medical establishment, and high daily stress levels. “Race and class differences affect the type of care patients receive...the darker a women’s skin and/or the lower place in the economic scale, the poorer the care and efforts at explanation she gets’’ (Thistlewaite, 2003) When African American women are diagnosed with breast cancer, there are multi-facet factors operating in the complicated mechanisms that must be viewed in a much larger perspective. For decades, lower survival rates were assumed to be due primarily to societal issues; African American women were less likely to have health insurance for mammograms, detecting early and highly treatable cancers. Historically, research focused on the biological differences between cancers attacking women of color. African American women are more likely to be diagnosed at an earlier age but less likely to be diagnosed with smaller tumors and more likely to be diagnosed with larger and Dr. Deborah B. Robinson Dr. Marie O. Etienne not pictured: Dr. Patricia, R. Messmer Guerna Blot, MSN, RN more aggressive tumors, making treatment problematic (http:// seer.cancer.gov). Cultural beliefs shape African American women’s ideas and decisions about breast cancer and screening. For example, screening practices can be seen as “heralds of disease” that bring death, whereas faith in God is one if the few benign yet powerful therapies available (Ashing-Giwa et al, 2004). The importance of alternatives therapies and cultural views on cancer can affect breast cancer screening among African American women. According to the National Health Interview survey, the percentage of women 40+ years of age having a mammogram within the past two years increased form 29% in 1987 to 70% in 2000. Because breast cancer mortality rates are higher in African American women they must be encouraged to have early screening to reduce late-stage cancer diagnosis and mortality (ACS, 2012). CONTINUED ON PAGE 5 Women & Children’s Health Issues prevention continued from page 4 The role of the Advanced Practice Nurse (APN) or the Doctor of Nursing Practice (DNP) provides opportunities to design breast cancer prevention programs targeting the African American community while addressing research questions: n Since African American women have an earlier onset of breast cancer, does mammography screening at a younger age decrease mortality rates? n What new breast screening methodologies are beneficial to African American women? n What is the percentage of BRCA 1 and BRCA 2 gene occurrence in African American women? When African American women experience breast cancer symptoms, they should initiate diagnostic testing rather than adopt a “wait and see” attitude. The Advanced Practice Nurse or the DNP must foster the advocacy of sisterhood of African American women in encouraging each other to seek help when breast cancer symptoms are discovered. Women must be assertive and provide a coordinated plan of care based on evidence-based practice. APN s or DNPs must ensure that African American women receive comprehensive, holistic and timely care, focusing on primary prevention by: n Providing health care services (breast cancer screening and educational programs on Triple Touch II methods). n Referring clients to a primary care provider and/or Nurse Practitioners for further assessment. n Consulting social services for patient financial information and eligibility in governmental programs. n Dissemination of breast cancer awareness, anti-smoking media campaigns, and lifestyle changes in the media. n Providing clinical and psychological support to clients/families diagnosed with breast cancer. n Developing alliances with ministers/church groups to sponsor breast cancer prevention, screening clinics and support groups, capturing cultural aspects. APNs and DNPs should lobby for state/national policies promoting breast cancer awareness in African American communities. APNs and DNPs must promote interdisciplinary collaboration, decreasing health care disparities, and foster health care quality standards. NBNA.org — 5 References American Cancer Society. Breast Cancer Facts & Figures 2011-2012. America Cancer Society, Inc. Atlanta,Georgia. Ashing-Giwa, K., Padilla,G., Tejero, J., Kraemer, J., Wright, K., Coscararelli, A., Clayton., Williams, I., Hills, D. (2004). Understanding the breast cancer expereince of women: a qualitative study of African American, Asian American, Latina and Carucasian cancer survirosr. Psycho-Oncology 13, 408-428. Consedine, N. M. (2004). Fear, anxiety, worry and breast cancer screening behavior. Cancer Epidemiology Biomakers & Prevention 13 , 501-510. Giger, J.N. (2011). How African Americans fare with susceptibility to disease: forty years after the founding of the NBNA. The Journal of the National Black Nurses Association. 22(1), vii-viii Giger, J.N. & Davidhizer, R (2008). Transcultural nursing: assessment and intervention (5th ed.) St Louis: Mosby Elsevier. Thistlewaite, S.B. (2003). The ‘Case” of breast cancer Adam, Eve, and the Genome (p. 165-166). Minneapolis: Fortress Press. Surveillance epidemiology and end results retrieved from http:seer. cancer.gov/statfacts/html/breat.html Dr. Marie O. Etienne is a professor at Miami Dade College (MDC), Medical Campus, School of Nursing and the 2007 recipient of the MDC Stanley G. Tate and Family Endowed Teaching Chair for Excellence in Academia. Dr. Patricia R. Messmer is a consultant for Nursing Education & Research at Miami Dade College, chair of the Nurses Charitable Trust, serves on the ANA Nominating Committee, was past ANF trustee/treasurer and ANA-PAC trustee/secretary. Dr. Messmer received the 2009 ANA Jessie Scott Award and conducted a historical study of ANF scholars (1955-2011). Dr. Messmer facilitated funding of the ANF Elizabeth Carnegie grant to support minority nurses conducting research studies. Dr. Deborah B. Robinson is currently an assistant professor in the RN-BSN Program at Miami Dade College School of Nursing. She is a graduate in 2009 as a member of the inaugural class of University of Miami Doctorate of Nursing Practice. In 1993, she received her MBA with a concentration in Health Administration for the University of Miami School of Business. She obtained her BSN in 1975 from the Indiana University School of Nursing. Guerna Blot, MSN, RN, began her nursing career at Mount Sinai Medical Center in 1989 in the oncology unit, where she is currently the Nurse Director of the unit. Her nursing experience encompasses many areas including oncology nursing, telemetry and medical surgical. She is very active and well known in the South Florida community through the Haitian American Nurses Association of Florida (HANA). 6 — NBNA.org Women & Children’s Health Issues Know Your Cancer Risk: A Daughter’s Story Veronica Clarke-Tasker, PhD, MBA, MPH, RN Lelena Gebremariam, SN Rev. Dr. Veronica A. Clarke-Tasker W hen a woman finds a lump in her breast, it can be a very frightening experience. Usually the first thought or question that comes to mind as they wish the lump away is, “is this breast cancer?” I know because I’ve been there four times since my 31st birthday in 1979. The shock and disbelief can be unbearable. As nurses, we are expected to remain calm, supportive and empathic as we encourage ourselves, our patients and our loved ones to seek medical attention. We are also expected to educate women along with their family about their cancer risks and be their advocate. As many of you know from your own personal experience with breast cancer, sometime knowledge about a disease can keep us from acting positive. What happens when the person you are to be supportive of is your Mom? I had to be there for Mommy who knew I was an oncology clinical specialist, yet didn’t want me to know about her rapidly growing breast mass. I also had to be there for one of my dearest friends who called me late one evening and said I want the truth, what are my chances of surviving breast cancer? You see, her sister had undergone a mastectomy for breast cancer just five years earlier. Yes, my colleagues, it is a big responsibility but it must be done. Breast Cancer Risk factors The Washington Post has provided testimony and much needed information about breast cancer particularly in the African American community (The Washington Post, March 21, 2012 and April 10, 2012). One of the most valuable tools we can equip our family and public with is accurate information about breast cancer and their breast cancer risks. Yes, it is true we still do not know the exact cause of breast cancer. However, we do know what factors may increase an individual’s risk for developing this disease. A more complete list of breast cancer risk factors can be found in Table 1 below. (ACS, 2011) Race and ethnicity: In 2011, the American Cancer Society estimated 26,840 African American women would be diagnosed with breast cancer making it the most commonly diagnosed cancer in African American women. In addition, their prognosis of dying from the disease, an estimated 6,040 of those diagnosed, is greater than any other racial group. Factors contributing to poor prognosis include distal stage of disease, higher tumor grade, and having a negative hormone receptor status. Age: Although African American women have a lower risk of developing breast cancer they have a higher risk for developing the disease before the age of 45. It is believed that 1 out of 8 invasive breast can found in younger women. Genetic risk factors: Inherited mutation BRACA1 and BRCA2 are the most common cause of hereditary breast cancer. It is highly recommended that women speak to a genetic counselor before seeking genetic screening. Talking with a trained professional that can interpret results along with what the test can and cannot tell you may reduce the stress and answer questions that many people have about genetic testing. Table 1 is the US Preventive Services Task Force’s recommendations for genetic testing for BRCA mutations. Family history of breast cancer: A women’s risk for developing breast cancer doubles if the relative was their mother, sister, or daughter. The risk increases 3 fold if breast cancer is diagnosed in a 2nd degree relative. Having a father or brother diagnosed with breast cancer may also increase her risk. Table 1: US Preventive Services Task Force recommendations for genetic testing for BRCA mutations: n Two first-degree relatives (mother, sisters, daughters) with breast cancer, one of whom was diagnosed when they were younger than 50 n Three or more first- or second-degree relatives (includes grandmothers, aunts) diagnosed with breast cancer n Both breast and ovarian cancer among first- and seconddegree relatives n A first-degree relative diagnosed with cancer in both breasts n Two or more first- or second-degree relatives diagnosed with ovarian cancer n A male relative with breast cancer n A first-degree relative with breast or ovarian cancer n Two second-degree relatives on the same side of the family with breast or ovarian cancer Source: Adapted from Breast Cancer Facts & Figures 2011-2012, p 13 Table 2: Factors That Increase the Risk for Breast Cancer in Women; Relative Risk Factor n Age (65+ vs. <65 years, although risk increases across all ages until age 80) n Biopsy-confirmed atypical hyperplasia n Certain inherited genetic mutations for breast cancer (BRCA1 and/or BRCA2) n Mammographically dense breasts n Personal history of breast cancer n High endogenous estrogen or testosterone levels n High bone density (postmenopausal) n High-dose radiation to chest n Two first-degree relatives with breast cancer n Alcohol consumption n Ashkenazi Jewish heritage n Early menarche (<12 years) CONTINUED ON PAGE 7 Women & Children’s Health Issues know your risk continued from page 6 n n n n n n n n n n n Height (tall) High socioeconomic status Late age at first full-term pregnancy (>30 years) Late menopause (>55 years) Never breastfed a child No full-term pregnancies Obesity (postmenopausal)/adult weight gain One first-degree relative with breast cancer Personal history of endometrium, ovary, or colon cancer Recent and long-term use of menopausal hormone therapy containing estrogen and progestin Recent oral contraceptive use Source: Breast Cancer Facts & Figures 2011-2012, p. 12 My Story It was May 1985 and I just returned from an oncology nursing workshop when I received a call from my younger sister. Quietly she told me, “Mommy found a lump in her breast but said not to tell you.” Needless to say, I couldn’t believe what I was hearing. I remember that day like it was yesterday down to the color top she wore and the room we were standing in when she arrived home. When she saw me she looked at me as she put her bags down and said, “I see your sisters can’t keep their mouths shut.” She knew they were going to tell me and maybe that’s why she told them. As she removed her blouse, I just stood still. I saw the lump before she pointed it out to me. Mommy had large hanging breast and the lump was the size of a small lemon. I just couldn’t believe what I was seeing. Can you imagine how hard it was to remain calm when the women who birth you, stands before you with a large breast lump and didn’t tell you when she first found it? I felt like a failure and trust me my three sisters made sure they reinforced those feelings. Mommy agreed to see the surgical oncologist I worked with the next day. I cried all night feeling guilty, and hating the strong possibly that Mommy had breast cancer. On top of that, how were my grandmother and the rest of the girls going to handle the possibility of Mommy having cancer? Dr. R and I had worked together for over 6 years. He was a very supportive and caring physician who had asked me to join his team. I loved what I did as an oncology nurse, but that day in June 1985 was different. I had to be the supportive daughter with too much knowledge about cancer. After her clinical breast examination and mammography Mommy agreed to a one step surgical procedure. She consented to have a right modified radical mastectomy. I tried to encourage her to have a two-step procedure where she would get the diagnosis from the biopsy and then make her decision. But Mommy being Mommy opted to have her breast removed if the tissue biopsy during surgery was positive. In addition, she wanted to have reconstructive breast surgery. My grandmother and I accompanied Mommy to the hospital on June 13, 1985. If any of you know me, I could not sit still. I prayed and tried to not appear frightened as I held my grandmothers hand. When Dr. R came into the waiting room his face said it all. Not only was the diagnoses positive but she had a very aggressive rare cancer known as cystosarcoma phyllodes. I knew that the next couple of months would be hard but I had to be strong. Within a year Mommy had successfully NBNA.org — 7 undergone radiation and chemotherapy as prescribed along with reconstructive breast surgery. When the cancer returned one year later it was even more aggressive and she was encouraged to undergo additional treatment. Mommy was in the hospital receiving chemotherapy Memorial Day weekend, 1987 when she asked me to call the family together for our usual celebration. I got permission to bring her home for the day. I knew as she tried to stand on her own that this may be the last time she would see all her family together. I tried to get the family to come the week before to the Tumor Board as Dr. R had asked Mommy’s permission to present her case. I, along with my colleagues at the hospital, knew the severity of her cancer and how important it was for others to learn from this case. As my aunt and uncle stood by my side during the tumor board, I knew her time here on earth was very short. None of my sisters would come because they didn’t believe Mommy was dying of breast cancer. On June 13, 1987, exactly two years after being diagnosed, and in her own bed at home, Mommy quietly went home to be with the Lord. My daughter walked into her bedroom at 6 a.m. and thought her grandmother was sleeping, as she had a smile on her face. However, when she touched her she knew Mommy had passed. Although the pain was great, and I did not agree with all the decisions Mommy made about discontinuing her treatments, I was at peace. My colleagues helped me to be the supportive daughter and not the caregiver. For two years my sisters did not speak with me because they felt I should have made Mommy continue therapy. No, I said, the best thing you can do is join me in the clinical trial that I had enter which may prevent us from getting breast cancer. For you see all of us have fibrocystic disease of the breast just like Mommy and are at high risk for developing breast cancer. I successfully completed five years in the Star Clinical trial in November, 2011. During this double-blind clinical trial, I later learned I was taking Tamoxifen. Although I gained weight, I was thankful. I was at high risk for developing breast cancer and I did something about it. In closing, if you or anyone in your family has not followed the recommendation for breast cancer screening, start now. If you don’t know your breast cancer risks talk with your nurse practitioner or physician. My sisters and cousins are now having yearly mammograms. Lastly, talk to your family about breast cancer and teach them the correct way to examine their breast. In Loving Memory of Doris Mae McLeod and Sadie Brown-Hicks References American Cancer Society (2012). Cancer facts and figures. Atlanta, GA: Author American Cancer Society (2011). Cancer facts and figures for African Americans, Atlanta, GA: Author American Cancer Society (2011). Breast Cancer: Early Detection, Atlanta, GA: Author Williams, Vanessa: Black Women in America: Fighting fear as well as disease. The Washington Post, Wednesday, March 21 2012, A1. Rev. Dr. Veronica A. Clarke-Tasker, is a Professor in the Division of Nursing at Howard University College of Nursing & Allied Health Sciences, Washington, DC. She is also the Secretary for the National Black Nurses Association. 8 — NBNA.org Women & Children’s Health Issues Exploring Deterrents to Breast Cancer Screening in African American Women Charlotte M. Wood, PhD(c), MSN, MBA, RN Joan Tilghman, PhD, CNE B reast Cancer is a health condition that has relevance for all races; however it is a particularly significant issue for African American women. African American women make up greater than 20 million of our country’s entire population and have been identified as a target population with pronounced breast cancer disparities (United States Census Bureau, 2010; Phillips & Cohen, 2011). There are a host of reasons why African American women are at greater risk. Behavioral risk factors are primary and include a sedentary life style, diets high in fat, and a lack of dietary fiber (Kelley, 2011). Given the circumstances, it is vitally important that community engagement be addressed to impact the deterrents to breast cancer screening, and early detection initiatives needed for the prevention of breast cancer. In 2012, approximately 577,190 Americans are expected to die of cancer, accounting for more than 1,500 people a day. Cancer is the second most common cause of death in the US, exceeded only by heart disease, accounting for nearly 1 out of every 4 deaths (ACS, 2011). An estimated 226,870 new cases of invasive breast cancer are expected to occur among women in the United States (US) during 2012; about 2,190 new cases are expected in men. Excluding cancers of the skin, breast cancer is the most universally diagnosed cancer in women and the second leading cause of cancer death in women (Ravert & Huffaker, 2010). The mortality rate for African American women is 32 out of 100,000, the highest rate among all ethnic groups reported in the United States. Although, breast cancer survival rates are at approximately 77% for African American women, the overall survival can be as high as 97% (Kelley, 2011). Deterrents to Breast Cancer screening It has been reported that one of the primary deterrents to breast cancer screening for African American women is the fear of cancer (Kelley, 2011). However, the lack of health insurance and other financial barriers prevent many African American women from receiving optimal health care. The National Institutes of Health (NIH) estimates that the over-all costs of cancer in 2007 were $226.8 billion: $103.8 billion for direct medical costs (total of all health expenditures) and $123.0 billion for indirect mortality costs. Other barriers include the cultural beliefs, lack of knowledge, socioeconomic factors, access to screening and treatment, and a lack of early detection practices (McCaskill, 2006). Charlotte M. Wood Dr. Joan S. Tilghman Uninsured patients and those from ethnic minorities are substantially more likely to be diagnosed with breast cancer. According to the US Census Bureau (2010), almost 51 million Americans were uninsured in 2009; almost one-third of Hispanics (32%) and one in 10 children (17 years of age and younger) had no health insurance coverage. Early Detection Techniques Routine screenings are fundamental to early detection and prevention of breast cancer. Included in routine screenings is diagnostic testing such as mammography, ultrasound, and breast magnetic resonance imaging (MRI), (Ravert & Huffaker, 2010). Early detection involves genetic counseling, clinical breast examinations (CBE), and self-breast examinations (SBE). When individuals actively participate in early detection techniques and routine screenings, evidence based practices (EBP) suggests that breast cancer mortality and morbidity rates decrease (McCaskill, 2006). Community Strategies to Address Breast Cancer Disparities Strategies to address breast cancer disparities in African American women involve engaging community leaders and the creation of community based breast health education programs. Breast health education programs are established through churches and community associations. The programs consist of encouraging CBE, SBE training, educational handouts, and the practice of regular exercise and eating of healthy nutritious meals. The goal of the breast health education programs is to teach the participants to become more self-aware. This strategy promotes a healthy lifestyle, engagement in early detection practices, and the encouragement to follow-up abnormal findings. These measures are essential to the prevention of breast cancer, and will assist in the decrease in mortality rates for African American women (Kelly, 2011). CONTINUED ON PAGE 41 Women & Children’s Health Issues Cervical Cancer Vaccines: What We Need to Know NBNA.org — 9 Denise Linton, DNS, FNP-BC F or many decades the only strategy that was available to fight cervical cancer, a preventable cancer, was screening with the Pap test. “Disparities in the cancer burden among racial and ethnic minorities largely reflect obstacles to receiving health care services related to cancer prevention, early detection, and high-quality treatment...”(American Cancer Society [ACS], 2012, p. 43). More than 90% of all cases of cervical cancer are caused by the HPV and 70% of these cases are caused by HPV types 16 and 18. At the moment, there are two safe and effective vaccines that can prevent infection with the human papillomavirus (HPV) among 9 to 26 year old females. Healthy females clear the HPV but HPV may persist and progress to cervical cancer in females who smoke, engage in sexual activity at a young age, and have multiple sex partners (ACS, 2012). In addition to educating teenagers about reducing and eliminating high risk behaviors, health care providers need to become informed about the cervical cancer vaccines and subsequently educate parents, guardians, and teenagers about the vaccines. In this way, they can make informed decisions regarding being vaccinated. Gardasil® is the first cervical cancer vaccine that was approved by the Food and Drug Administration (FDA) in 2006 and it is indicated for the prevention of cervical, vaginal, vulvar, and anal dysplasia and cancer caused by HPV types 16 and 18 and genital warts caused by HPV types 6 and 11 in females and males (Castle & Cox, 2010). Females and males between the ages of 9 and 26 years of age are eligible for this vaccine which is administered in three doses of 0.5 milliliters intramuscularly; the second dose is administered two months after the first dose and the third dose is administered six months after the first dose (Monthly Prescribing Reference [MPR], 2012b). This vaccine is contraindicated in females and males with yeast allergy and females who are pregnant or nursing mothers (MPR, 2012b). Adverse effects include those that are common to other immunizations but syncopal episodes and subsequent falls and injury may occur in individuals who receive Gardasil® (Merck & Co., Inc, 2011). Therefore, vaccine recipients should be observed for at least 15 minutes after receiving the vaccine. Thromboembolic events may occur among females who are on oral contraception pills or who have a family history of clotting disorders (Merck & Co., Inc). If these females decide to be vaccinated they should be informed of the risk and signs and symptoms of thromboembolic diseases. Cervarix® was approved by the FDA in 2010 and it prevents cervical dysplasia and cancer caused by HPV types 16 and 18 (Castle & Cox, 2010). Unlike Gardasil®, it is indicated for use only among females between the ages of 10 and 25 years and the second dose is administered one month after the first but the third dose is administered six months after the first dose (MPR, 2012a). Females who are allergic to latex or those who are pregnant or nursing mothers should not receive Cervarix® (MPR). The vaccines prevent the development of cervical intraepithelial neoplasia 2 or greater that is caused by HPV 16 or 18 among women who have never been infected (Castle & Cox, 2010). Additionally, they are effective against cervical cancers that are caused by HPV types that are closely related to HPV types 16 and 18 and are the etiologic agents in 20% of all cases of cervical cancer (Merck & Co., Inc, 2011). The average duration of protection against dysplasia and cancer is 42 months but research study is in progress in order to determine whether the duration of protection is longer (Merck & Co., Inc). Additionally, individuals who miss a dose of vaccine do not have to restart the series, it is not necessary to perform serology testing prior to vaccination nor is it necessary to monitor individuals with titers after vaccination, individuals who have had a positive HPV test result can be vaccinated, and Gardasil® can be administered at the same time as recombivax HB, Menatra, and Adacel but they should be administered at different sites (Merck & Co., Inc). Finally, while vaccination should be promoted as a plausible strategy to reduce racial and ethnic cervical cancer disparity, Pap testing should continue among eligible women. References American Cancer Society. (2012). Cancer facts & figures 2012. Retrieved March 9, 2012 from http://www.cancer.org/acs/groups/content/@ epidemiologysurveilance/documents/document/acspc-031941.pdf Castle, P, & Cox, J. (2010). Recommendations for the use of human papillomavirus vaccines. Retrieved November 28, 2011, from http:// www.uptodate.com/contents/recommendations-for-the-use-ofhuman-papillomavirus-vaccine?view=print Merck & Co., Inc. (2011). Gardasil. Whitehouse Station, NJ. Monthly Prescribing Reference. (2012a). Cervarix. Retrieved May 1, 2012, from http://www.empr.com/cervarix/immunization/drug/7722 Monthly Prescribing Reference. (2012b). Gardasil. Retrieved May 1, 2012, from http://www.empr.com/gardasil/immunization/drug/5305 Dr. Denise Linton is an assistant professor at the University of Louisiana at Lafayette in the College of Nursing and Allied Health Professions. She is a founding member and the 1st vice president of Acadiana Black Nurses Association. Character statement: Health care providers need to become more knowledgeable about the cervical cancer vaccines in order to be able to discuss them with eligible females and their parents or guardian. 10 — NBNA.org Women & Children’s Health Issues The Silent Killer Among African American Children Travis “Pete” Lewis, PhD, RN Charlene Brown Smith, PhD, RN Pamela Williams-Jones, MN, RN, WHNP “The sorceress silently stalks the victims, the younger the child, the greater the trophy.” H igh blood pressure (hypertension) is called the silent killer because it has no warning signs (Enersen, n.d.). It is well established that primary hypertension begins in childhood (Berenson, 1995). Presently, high blood pressure, or hypertension, may spell worse heart trouble for African American children under the age of 13 than for other children of the same ages (Persheva, 2010). African American children are more prone to left-ventricular hypertrophy, one of hypertension’s earliest, most insidious and most complicated, and is particularly most pronounced in children younger than 13 years of age (Persheva, 2010). Persheva (2010) further reports that researchers found that African American teenagers had more severe hypertension than teens from other races, and that blood pressures remained in the dangerously hypertensive range for longer periods. Although, a single episode of high blood pressure is not hypertension, all children with one episode of high blood pressure should be monitored. (Persheva, 2010). Facts Obese children are 3 times more likely to develop hypertension than children of normal weight (Rodriquez-Crug, Moore, Spitzer& Windle, 2011). Younger African American children have higher rates of obesity and being overweight, more likely to have higher levels of rennin, the blood-pressure-regulating hormone produced by the kidneys (Persheva, 2010), and are twice as likely to have thickening of the heart muscle. Risk factors What leads to hypertension in children? Hypertension may be the result of cardiac or renal pathology, or secondary to medications. Most often physician cannot determine the direct cause and must rely on contributing factors. These factors include family history, excess weight or obesity, and race, particularly African Americans (High Blood Pressure in Children, n.d.). The Bogalusa Heart Study tracked twenty four hundred 5-10 year-old children for a mean of 17 years and concluded that the children who were obese were more likely to become obese adults than their Caucasian counterparts (Berenson, 1995). Education and Cultural Consideration Understanding the characteristics that places a young person at increased risk for hypertensive disease is critical for developing approaches to intervention and preventing the natural course of essential hypertension. Therefore, health practitioners must first recognize that hypertension does exist in children. The goal should be to identify and institute early treatment and prevention to prevent organ damage and ultimately clinical disease (Berensen, 1995). Berensen (1995) states the first approach to therapy for prevention in childhood hypertension should be nonpharmacological. Berensen (1995) further recommends that prevention be achieved through health education and health promotion for all school children. One of the primary roles of the nurse is teaching. Nurses should be strong advocators in preventing this crippling disease. Nurses should stress to parents the importance of setting a good example. Teaching topics should include the dangers of second hand smoke, appropriate diet and regular physical activity. Emphasis should be on teaching children to adopt healthy lifestyles. Culture has a profound effect on the development of one’s attitudes and behaviors. According to Caprio, et al., (2008) culture is believed to contribute to the disparities in childhood obesity in numerous ways. These include development of body image, child feeding practices, the type and frequency of physical activity, the perception of risk and obesity, utilization of health services and the manner in which the risk varies on social status. Furthermore, Caprio et al (2008) finds that the risk for obesity should be routinely discussed by primary care providers during even brief encounters with children and their families. Conclusion There is a need for early diagnosis and prompt treatment of high blood pressure in all children. Once again, a single episode of high blood pressure is not necessarily hypertension, but all children with one episode, should be closely monitored. Pesheva (2010) quoted Tammy Brady, MD, MHS, “pediatricians should also keep in mind that African American patients may develop worse complications or develop them sooner.” All children with hypertension should be referred to a kidney specialist and have an ultrasound to check the heart muscle thickness and function (Pesheva, 2010). As health care advocators it is imperative that we are actively engaged in the prevention of hypertension through health screening and education. The ultimate goal should be to prevent the sorceress from conquering our children. CONTINUED ON PAGE 11 NBNA.org — 11 Women & Children’s Health Issues silent killer continued from page 10 References American Heart Association (n.d.) High Blood Pressure in Children. Retrieved from http://www.heart.org/HEARTORG/Conditions/ HighBloodPressure/UnderstandYourRiskforHighBloodPressure/ High-Blood-Pressure-in-Children_UCM_301868_Article.jsp Berensen, G. (1995). The control of hypertension in African American children: The Bogalusa study. Journal of the National Medical Association, 87 (Suppl), p. 614- 616. Caprio,S., Daniels, S., Drewnowski, A., Kaufman, F., Palinkas, L., Rosenbloom, A., & Schwimmer, J. (2008). Influence of race, ethnicity, and culture on childhood obesity: Implications for prevention and treatment. Diabetic Care, 31(11), p. 2211-2221. You Belong Here Cruz-Rodrigues, E. Moore, J., Spitzer, A., Windle, M. Pediatric Hypertension. (2011). Retrieved from http://www.Medience.medscape. com/article/889877-overview#aw2aab6b2b5 Enersen, J. (2011). African American children are hit hard by hypertension. Retrieved from http://www.king5.com/health/childrenshealthlink/African-American-boys-are-hit-hard-by-hypertension-113091189.html Pesheva, E. (2010). High blood pressure may take greater toll on youngest black children’s hearts. Retrieved from http://www.hopkinschildrens.org/High-Blood-Pressure-May-Take-Greater-Toll-onYoungest-Black-Children-s-Hearts.aspx Dr. Travis “Pete” Lewis received his BS degree from Mobile College in 1970. His Diploma in Nursing from Providence School of Nursing in 1973. His Master in Nursing Degree from the Medical College of Georgia in 1975. Earned his PhD in Philosophy from the University of Southern Mississippi in 2005 with a focus on curriculum design. Is currently employed as faculty at Nicholls State University in the Department of Nursing. Dr. Charlene Brown Smith received her BS Degree in Nursing from Dillard University in 1978. Later received her Master Degree in Nursing from LSU in 1986. Earned her PhD in Nursing from Southern University with a focus on African American women and breast cancer in 2008. Is currently employed as faculty at Nicholls State University in the Department of Nursing. Pamela Williams-Jones received her BS Degree in Nursing from Southeastern Louisiana University in 1981. Later received her Master Degree in Nursing from LSU in 1986. Received her Women’s Health Nurse Practitioner from the University of South Alabama. Currently pursuing PhD in Natural Health Sciences . Pamela is currently employed as faculty at Nicholls State University in the Department of Nursing. Experienced Nurses Become Exceptional Nurses Where Experienced Nurses: Froedtert Health is a regional take your skills to the next level. Learn and grow at Froedtert Health, where you’ll have the opportunity to work with the best and the brightest in an environment committed to providing the best quality of care. health care organization made up Do you strive to be the very best? Apply Yourself Today. of Froedtert Hospital, Milwaukee; Community Memorial Hospital, Menomonee Falls; St. Joseph's Hospital, West Bend; and Froedtert Health Clinics, Waukesha and Washington counties. Joining the capabilities of an academic medical center affiliated with The Medical College of Wisconsin, two community hospitals and 32 community-based primary and specialty clinics, Froedtert Health delivers highly coordinated, cost-effective health care to residents of southeastern Wisconsin and beyond. We are proud to be an Equal Opportunity / Affirmative Action Employer. We encourage diverse candidates to apply. We maintain a drug-free workplace and perform pre-employment substance abuse testing. froedterthealth.org Apply Yourself Today. 12 — NBNA.org Women & Children’s Health Issues African American Infant Mortality: An Urgent Cry–Bridging the Gap Jennifer Jeames Coleman, PhD, RN, CNE I n 1979 the United States federal government began a program targeted at improving the overall health of its citizens. With the goal of ensuring a healthy future for all Americans the US Department of Health and Human Services (2010) began the Healthy People Initiatives. Over the last three decades, objectives related to health promotion and disease prevention have included the elimination and/or reduction of health disparities. When assessing the well-being of America’s children, infant death rate is an important health indicator. Alarming statistics While US infant mortality rates continue to decline nationwide, there remains a significant disparity in rates of death among African American infants and the majority population. The infant death rate for African Americans is over twice that of Whites. Overall US infant mortality rate is 6.75 deaths per 1,000 live births. When listed by race and ethnicity however, considerable variation is seen. The highest infant mortality rate is 13.31 per 1,000 live births for non-Hispanic African American mothers. That is more than twice the rate of 5.63 for nonHispanic Whites (National Center for Health Statistics, 2008). Of the leading causes of infant deaths, sudden infant death syndrome (SIDS) ranks third. As with the death rate, gaps in incidence of SIDS exist with African American infants suffering disproportionately. A matter of justice Infant sleep environment is consistently linked to SIDS occurrence with documented high associations between prone sleeping and SIDS occurrence. Thus, the American Academy of Pediatrics recommends that all healthy infants be placed supine for sleep. After a nationwide “Back to Sleep” campaign was begun in 1992, a dramatic decrease in rates of SIDS occurred. The decline in SIDS deaths was, and remains disproportionately less in minority groups. Research further indicates that this racial disparity is also seen in infant sleep positioning. Significant numbers of African American infants are still being placed prone to sleep. The resultant disparity in sleep patterns and increased occurrence of SIDS are closely associated with the persistent gap in infant mortality rates for African American infants. Possible reasons for African American parents’ lack of adherence to safe sleep recommendations include the lack of health teachings that are respectful of the values and beliefs of the individual. Despite the fact that African American parents consistently report having heard about supine sleep position recommendations, lack of trust of health care providers is a barrier to their adherence. Shortly after initiation of the “Back to Sleep” campaign a large study of inner city African American parents revealed that only 54% of families reported that they followed the supine sleep advice they had been given by clinic personnel (Ray, Metcalf, Franco, & Mitchell, 1997). Reports continue to suggest that care recipients are less likely to follow the advice of health care providers if recipients are distrustful and/or if actions and behaviors of care providers are perceived as discriminating or disrespectful. Call to action African American parents are more likely to adhere to health education suggestions if received from nurses who are friendly, attentive, and respectful. The nurse’s behavior and attention are critical to the parents’ perceptions of care. Parents consistently report that nurses who respect family’s cultural values are trustworthy (Coleman, 2009). Thus, to positively impact the infant mortality rate of African Americans, nurses must provide culturally congruent care that is meaningful and inclusive of family views. African American parents are more likely to adhere to teaching related to safe infant sleep position if nurses are friendly, concerned, and attentive (Coleman, 2009). Family involvement in teaching as a source of strength is also important to African American parents. Consequently, nurses must include family members when counseling parents on the importance of supine sleep position for infants. Nursing behaviors that include a family’s cultural values are meaningful and lead to increased trust in nursing care. Parents who feel respected perceive that the nurse will protect and care for their infant appropriately and are more receptive to the nurse’s recommendations. As a result, increased African American parent adherence to supine sleep position can be expected. The resultant behavior change of parents will ensure safer care and first year survival of significant numbers of African American infants. References Coleman, J. J. (2009). Culture care meanings of African American parents related to infant mortality and health care. Journal of Cultural Diversity, 16(3), 109-119. National Center for Health Statistics (2008). Recent trends in infant mortality in the United States. NCHS Data Brief. Retrieved May 3, 2012 from http://www.cdc.gov/nchs/data/databriefs/db09.htm Ray, B. J., Metcalf, S. C., Franco, S. M., & Mitchell, C. K. (1997). Infant sleep position instruction and parental practice: Comparison of a private pediatric office and an innercity clinic. Pediatrics, 99, 12. US Department of Health and Human Services (2010). Healthy People 2020 Framework. Retrieved May 3, 2012 from http://www.healthypeople.gov/2020/Consortium/HP2020Framework.pdf Dr. Jennifer Jeames Coleman is an Associate Professor at the Ida V. Moffett School of Nursing in Samford University, Birmingham, AL. She is the Vice President of the Birmingham Black Nurses Association and chair of the education committee and mentorship program. Women & Children’s Health Issues The Anti-Vaccine Movement: NBNA.org — 13 Taking Preventative Medicine in the Wrong Direction Brent Straley, MSN, MBA, RN, CPN T he anti-vaccine movement may seem like a recently new cause, but the history of the anti-vaccine movement can go back to 1722 when the inoculation of smallpox was just beginning, with a sermon entitled, “The Dangerous and Sinful Practice of Inoculation” by Rev. Edward Massey (“March 18th,” n.d.). The belief then, and for some to this day, is that these diseases are sent by God to punish those who sin. The vaccine movement we recognize now, which focuses heavily on the measles-mumps-rubella (MMR) vaccine, started in 1998 with a research study authored by Dr. Andrew Wakefield. His research showed a connection between the MMR vaccine and autism (Wakefield et. al., 1998). However, this research was later discredited and retracted in 2010. The anti-vaccine movement increased rapidly in 2007 when a popular celebrity appeared on several television shows and published books advising parents not to get their children immunized. The increase in the anti-vaccine movement was also supported by the improvement to obtain information via the Internet. The anti-vaccine movement has caused an increase in children not being vaccinated. Pertussis, another preventable disease, in which the first immunization is given to an infant at 2 months of age, has been on the rise as well. In California alone, there were over 9000 cases of pertussis in 2010, more than the state has had since 1947 (Diekema, 2012). California’s rate of vaccine exemption has also increased to 2.5% in 2010, which makes it the largest rate of declined vaccines in California since 1978 (Kumar, 2011). Other areas of the country can be higher than this. As more parents prevent their children from getting vaccinated out of self-interest, they are putting the public at risk. In the case of measles, because it is so contagious, at least 96% of the country’s population must be vaccinated to obtain herd immunity (Poland, 2011). Herd immunity is what protects those who do not qualify for the vaccine, such as children less than 12 months old and the immunocompromised. The herd immunity of measles is already being compromised. There were over three times as many measles cases reported than are seen in a typical year alone in the first six months of 2011. According to the Centers for Disease Control and Prevention (CDC, 2012), the country had a total of 222 cases and 17 measles outbreaks in 2011. From 2001-2010, the yearly mean was 60 cases and only 4 outbreaks (CDC). The anti-vaccine movement took a toll on the public. An investigation into Dr. Wakefield’s work, showed that he participated in fraud in order to manipulate his data to show a relation between the MMR vaccine and autism. His research that was published in The Lancet was retracted immediately in 2010. Now there are more than 20 studies that show no link between the MMR vaccine and autism. Scientific societies have also claimed that there is no reason to suspect a link between the MMR vaccine and autism. Although Dr. Wakefield’s research has been found to be fraudulent, the damage has been done. Thousands of kids may not have received the vaccine causing some preventable illnesses and even deaths (Poland, 2011). While there will always be exemptions to vaccines, health care and the country as a whole needs to reeducate society in order to decrease the amount of unvaccinated children. This will be increasingly harder as the generation shift continues into the parents who were not alive when these diseases did not have vaccines available. The diseases we are protecting not only our children from, but also our society from, are diseases that are highly contagious and can cause serious harm, and even death. Now that serious harm and death are rarely seen, and that immunizations are close to but not 100% effective, it is easier to say that the vaccines are dangerous and not the disease. References Centers for Disease Control and Prevention. (2012). MMWR weekly: Measles - United States 2011. Retrieved from http://www.cdc.gov/ mmwr/preview/mmwrhtml/mm6115a1.htm Diekema, D. S. (2012, February) Improving childhood vaccination rates. The New England Journal of Medicine, 366, 391-393. Retrieved from http://www.nejm.org Kumar, S. V. (2011, September 26). Thousands in Calif. started school without vaccines. USA Today. Retrieved from http://www.usatoday. com March 18th. (n.d.). The Hyperlinked & Searchable Chambers’ 1869 ‘The Book of Days’. Retrieved from http://www.thebookofdays. com/months/march/18.htm Poland, G. A. (2011) MMR vaccine and autism: Vaccine nihilism and postmodern science. Mayo Clinic Proceedings, 86(9), 869-871. doi: 10.4065/mcp.2011.0467 Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., Walker-Smith, J. A. (1998). Ileal lymphoid nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [retracted]. The Lancet, 351(9103), 637-641. doi:10.1016/ S0140-6736(97)11096-0 Brent Straley is a Charge Nurse at Children’s Mercy Hospitals and Clinics in Kansas City, Missouri, in the hospitals primary care clinic. 14 — NBNA.org Women & Children’s Health Issues Childhood Trauma: An Opportunity for Nurses to Engage Adrienne M. Smith, PhD, MS, CHES T rauma occurs whenever an external threat overwhelms a person’s coping resources (Report of the Federal Partners Committee on Women and Trauma, A Federal Intergovernmental Partnership on Mental Health Transformation, A Working Document, 2011). It can stem from physical, emotional, or sexual abuse, disasters, war, violence, or childhood neglect, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), within the U.S. Department of Health and Human Services (HHS). These distressing events may have long-lasting, harmful effects on a person’s physical and emotional health and well-being (http:// www.integration.samhsa.gov/clinical-practice/trauma). In the United States, 61% of men and 51% of women report exposure to at least one lifetime traumatic event, and in public behavioral health settings, 90% of clients have experienced trauma (http://www.integration.samhsa.gov/clinical-practice/ trauma). These traumatic events can be singular or multiple events over time, that leave victims feeling terrified, humiliated, and threatened. In 2009, researchers found that more than 60% of youth age 17 and younger have been exposed to crime, violence, and abuse either directly or indirectly, including witnessing a violent act, assault with a weapon, sexual victimization, child maltreatment, and dating violence. Moreover, nearly 10% were injured during the exposure to violence, 10% were exposed to maltreatment by caretaker, and 6% were a victim of sexual assault (http://www.samhsa.gov/children/data.asp). Evidence now exists that unaddressed, and sometimes concealed, childhood trauma may have long-term physical and emotional consequences that compromise health status as an adult. The ongoing Adverse Childhood Experiences (ACE) Study, being conducted by Drs. Vincent Felitti and Robert Anda, examines whether and how childhood experiences affect adult health. They followed over 17,000 patients for adverse experiences in childhood, including living in a home with domestic violence, experiencing emotional, physical or sexual abuse as a child, having an alcoholic or drugaddicted parent, having a mentally ill family member, having an incarcerated parent, and experiencing neglect (http:// www.cdc.gov/ace/index.htm). They found adverse childhood experiences had a profound effect on adult health and well-being decades later, and certain childhood experiences were major risk factors for the leading causes of illness and death in the United States. Furthermore, with multiple, complex traumatic experiences, the risk of compromised adult health increased. This groundbreaking study suggests that advances in the prevention of chronic disease morbidity and mortality, as well as social problems, could be obtained from a better understanding that many of these circumstances arise, at least in part, because of adverse childhood experiences. If childhood trauma is recognized and addressed early (in childhood), the possibilities for better adult health are greater. Trauma-informed care is a service approach based on universal precautions and organizational sensitivity. This approach incorporates 1) an appreciation for the high prevalence of trauma experienced by persons receiving services; and 2) an understanding of the profound neurological, biological, psychological, and social effects of trauma and violence on the individual. Trauma-informed organizations, programs, and services provide patient-centered care, and understand possible vulnerabilities of trauma survivors that traditional service delivery approaches may overlook or exacerbate. In addition, these services are more supportive and consciously aim to avoid re-traumatization (http://www.samhsa.gov/nctic/trauma. asp). A skilled and well-trained provider could recognize that a traumatic event has occurred, identify the symptoms, and assist with navigating appropriate care and treatment. Yet, many survivors are resilient for various reasons, and require limited or no recovery care. Factors that influence how an individual adapts are numerous, but with help from families, providers, and the community, children and youth can demonstrate resilience when dealing with trauma. SAMHSA’s National Center for Trauma-Informed Care (NCTIC) is one resource for technical assistance to health care professionals. NCTIC offers consultation and training, education and outreach, and resources to support a broad range of service systems, including systems providing mental health and substance abuse services, housing and homelessness services, child welfare, criminal justice, and education. The center also provides guidance for trauma-specific interventions, national hotlines, referral resources, and support services (http://www.samhsa.gov/nctic/default.asp). All health care professionals need to provide trauma-informed care. Pediatric health professionals, especially nurses, play an important role in this effort. Nurses have a unique opportunity to engage children and provide a safe and supportive care environment that nurtures children into resilience and recovery. Making the commitment to be aware of and respond to the physical and emotional needs of children will foster positive life-long health outcomes. Dr. Adrienne M. Smith is a Public Health Advisor with the U.S. Department of Health and Human Services’ (DHHS) Office on Women’s Health (OWH). Within the Division of Outreach and Collaboration, she manages programs and outreach activities focused on minority women’s health, and girl/adolescent health promotion. Women & Children’s Health Issues The New Call to Action: Babies are Born to Breastfeed NBNA.org — 15 Phyllis W. Sharps, PhD, RN, CNE, FAAN M others of newborns are faced with many decisions, including how best to feed their infants. The decision about feeding methods, formula feeding or breastfeeding is a personal choice. The major medical groups and governmental agencies that are charged with making recommendations for parenting practices that are most associated with optimal infant and child health and wellbeing. Professional and governmental groups such as the American Academy of Pediatrics (AAP), Centers for Disease Control and Prevention, Health and Human Services, have all recommended breastfeeding as best. For example, AAP still recommends that despite economic, cultural and political influences on decisions about infant feeding, breastfeeding is the preferred method for infant feeding, and it ensures the best possible health for infants and onto childhood (American Academy of Pediatrics, 2005). The Surgeon Generals’ Call to Action to Support Breastfeeding also supports AAP’s recommendation stating, “given the importance of breastfeeding for the health and well-being of mothers and children, it is critical that we take action across the country to support breastfeeding” (Health and Human Services, 2011). Breastfeeding has important health benefit for both mothers and infants. Maternal benefits include: less bleeding immediately after deliver, quicker recovery of the reproductive organs to their pre-pregnant statues, swifter return to re-pregnant weight (American Academy of Pediatrics, 2005). Breastfeeding is also associated with decreased risk for certain cancers breast cancer (rates reduced by 28%); ovarian cancer (rates reduced by 27%) (Chung, Raman, Chew, Magula, DeVine, Trikalinos, & Lau, 2007). Other studies suggest that there are decreased risks for osteoporosis among women who breastfeed their infants (Patton, Alexander, & Nowson, 2003). Maternal l breastfeeding maybe an important strategy for reducing health disparities related to cancer and obesity (Sharps, 2009). There is much research that provides of the benefits of breastfeeding for infants that last into childhood and adulthood. These benefits include: lower incidence of certain viruses, lower incidences of respiratory illness; reduction in ear infections and meningitis, protection against developing allergies (Voices for American Children, 2010). Other research studies have shown that governmental studies such from the national Institute of Environmental and health Sciences found that there is a 20% lower risk of breastfeeding babies dying between 28 days after birth through the first 2 months of life; that there is a connection between breastfeeding and cognitive development (higher intelligence) and also there is a connection between breastfeeding and a lower incidence of obesity as a teen and adult. Both for infants and mother breastfeeding can be an important strategy for reducing health disparities related to infant mortality, and obesity for African American children (Voices for American Children). Despite all of the benefits and health related reasons for choosing to breastfeed, the rates among African American mothers still lags behind other groups. African American mothers have the lowest rates for initiate breastfeeding (54.4%); continuing to 3 months (26.6%) and continuing through to 6 months (11.7%). AAP recommends that infants be exclusively breastfed through 6 months of life. There are many structural or cultural barriers that may influence African American mothers to breastfeed. Barriers include lack of knowledge about the benefits of breastfeeding as well as techniques for breastfeeding; lactation problems and no support to help mothers resolve issues related to baby latching on, poor suck, poor milk supply; poor family and social support; social norms and values that do not support breastfeeding; embarrassment; employment and child care issues and health care services including access and poorly trained health providers to support breastfeeding. NBNA fully supports “babies are born to breastfeed.” NBNA recognizes that although rates of breastfeeding have risen slightly among African American women, breastfeeding initiation and duration rates among African Americans and Hispanics still lag behind the Healthy People 2020 goals for breastfeeding initiation and duration. Low income and low levels education make it even more difficult for women of color to initiate and maintain exclusive breastfeeding for 6 months. Barriers such as lack of education about the benefits of breastfeeding, lack of health care provider and family support, the need to return to work and barriers in the work place are a few of the obstacles women of color face as they attempt to start and maintain breastfeeding. NBNA members can support the recent Surgeon General’s Call To Action to Support Breastfeeding by: n Educational campaigns targeting the benefits of breastfeeding for women and infants emphasizing breastfeeding as a low cost, and effective strategy for addressing health disparities among African American women and infants. Breastfeeding is an important strategy to include in all efforts to reduce and prevent health disparities as African American women, infants and children suffer disproportionate burdens specifically in terms of certain cancers, obesity, diabetes and infant and childhood infections. CONTINUED ON PAGE 41 16 — NBNA.org General Health Care The Million Hearts Initiative John Michael O’Brien, PharmD, MPH Liana Orsolini-Hain, PhD, RN T he National Black Nurses Association has a long track record of promoting initiatives which promote health. By promoting population health nurses can be a leading force in improving the health of our nation. Getting involved with the Million Hearts Initiative is an evidence-based way to improve the cardiovascular health of Americans. Million Hearts is a national initiative led by the Department of Health and Human Services (HHS) to prevent 1 million heart attacks and strokes in the U.S. by 2017. It aligns existing efforts and is creating new programs to improve heart health and help Americans live longer, more productive lives. The Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS), co-leaders of Million Hearts, are working alongside other federal agencies and private- and public-sector organizations to make a lasting impact against cardiovascular disease. Million Hearts has two key components: n Community prevention activities to prevent tobacco use and reduce sodium and trans fat consumption, decreasing the number of people who need medical treatment, and, n Clinical prevention activities to improve care for those who do need treatment by encouraging a targeted focus on the “ABCS”—aspirin for people at risk, blood pressure control, cholesterol optimization and smoking cessation—which address the major risk factors for cardiovascular disease and can help to prevent heart attacks and strokes. Million Hearts aims to achieve the ABCS goals by promoting an enhanced focus on cardiovascular disease prevention in health care facilities and health care systems, including a focus on these key “pillars”: n Developing a simple, uniform set of measures for the ABCS, ensuring that the data used to calculate the measures moves seamlessly within the flow of care, minimizing the burden of collection and reporting of outcomes, and linking high performance on these measures to recognition and reward. Nearly 50 Health and Human Service (HHS) rules, regulations, and grant programs have aligned their performance measures, reporting measures, or other program elements with the aims of the Million Hearts initiative. n Fully deploying health information technology including: clinician use of registry functions to identify gaps in care, intervene, and track progress of people with high blood pressure or elevated lipids; point-of-care risk assessment tools to ensure that interventions are targeted to individuals most likely to benefit; clinical decision support that is patient-specific ensuring that the right care is delivered the first time and every time; and electronic reminders to help consumers adopt and stick to new health habits (e.g., medication adherence). n Discovering and spreading clinical innovations that focus on the ABCS and recognize and reward value and outcomes over volume and process, such as team-based care, patient-centered medical homes and interventions to promote medication adherence. In addition to nurses, physicians and physician assistants, pharmacists, cardiac rehabilitation teams, health coaches, community health workers, and peer wellness specialists are among many powerful change agents who can support healthy behaviors and improve the appropriate use of medications. What can your organization do to promote the Million Hearts Initiative? Here are some easy first step ideas: n Take a personal pledge to decrease your risk of heart attacks and strokes (http://millionhearts.hhs.gov/be_one_ mh.html). Have a pledge drive among your organization members and in your community. Convince your family and friends to pledge. n Print out and distribute our Consumer Fact Sheet to your family, friends, and patients and also place them in public places. This fact sheet is found in the partnership toolkit (http://millionhearts.hhs.gov/resources/toolkits.html) n Sponsor an Inter-professional Grand Rounds using the Grand Rounds toolkit n Take it, Say it, Explain it. Commit to always stating the blood pressure and pulse to everyone you assess and explain what it means in terms of the American Heart Association Guidelines for Blood Pressure http://www.heart.org/ HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp Dr. John Michael O’Brien is a Senior Advisor at the CMS Innovation Center and to Million Hearts, a U.S. Department of Health and Human Services initiative with the explicit goal to prevent a million heart attacks and strokes in five years. He joined Million Hearts after launching and serving as Field Director for the HHS Partnership for Patients, a public-private partnership to reduce preventable hospital-acquired conditions by 40% by 2013, and improve care transitions such that readmissions are reduced by 20% by 2013. Prior to joining the CONTINUED ON PAGE 17 NBNA.org — 17 General Health Care The Air We Breathe Unhealthy air remains a threat to the lives and health of millions of families in the United States, despite the great progress made with the Clean Air Act. Stephanie Owens I spent my childhood in Detroit, MI, and many of my adult years in Los Angeles, CA—two places listed in a 2011 American Lung Association report ranking the top 20 polluted cities in America. Some days were better than others, and on the bad days, I noticed more of my peers struggled with symptoms of asthma or other respiratory ailments. I’m not a scientist or health practitioner by trade, but it was easy to make the connection between the days with a lot of smog and haze in the air and my co-workers asthma attacks. With such an obvious correlation between asthma symptoms and air quality, I wondered why I hadn’t heard more about this disease and its causes while growing up. In my current role as deputy associate administrator for the Office of External Affairs and Environmental Education at EPA, I help disseminate information about the indoor and outdoor environmental factors that can trigger asthma attacks such as ozone and particulate pollution, dust mites, molds, cockroaches, pet dander and secondhand smoke. I engage stakeholders and think of innovative ways we can spread our message about public health and the environment. Air pollution lingers as a widespread and dangerous reality—even as some seek to weaken the Clean Air Act, the public health law that has driven cuts in pollution since it was passed in 1970. The State of the Air 2011 report by the American Lung Association shows that air quality in many places in the US has improved, but more than 154 million Americans—just over one half of the nation—still suffer pollution levels that can be dangerous to breathe. Asthma is one of the most common serious chronic diseases affecting children. An average of one out every 10 school-aged children has asthma. The rate is even higher for African American children at 16 percent—among the highest of all minority groups. Among children with asthma, African American children are twice as likely to be hospitalized or have an emergency room visit. They are also more than four times more likely to die due to asthma than white children. This disparity has encouraged me to think creatively on how to get the message out about the environment and asthma triggers. My staff works with various stakeholder organizations to educate them and their networks through social media and public events with EPA staff. During the month of May, we marked National Asthma Awareness month by working with our partner organizations to educate their membership on screening for asthma, and provide guidance and better access to resources on this chronic disease (www.epa.gov/asthma). While this is an important step, we have a lot more work ahead of us. That’s why we look to organizations such as National Black Nurses Association, who day in and day out are at the front lines dealing with families and their children who struggle with the realities of asthma. Both NBNA and EPA have missions to protect public health. By working together, we can raise awareness and make the connection between environmental hazards and its impact on the health of our communities. Engaging the American people through organizations like NBNA is one of the most powerful ways to affect change. I look forward to working with NBNA and its members to promote healthier environments where children live, work, and play. Please take the time to review the resources below. Asthma Fact Sheet: http://www.epa.gov/asthma/pdfs/asthma_fact_sheet_en.pdf Community Asthma Network: www.AsthmaCommunityNetwork.org Check the Air Quality near You: www.Airnow.gov Stephanie Owens is the Deputy Associate Administrator for the Office of External Affairs and Environmental Education in the Office of the Administrator at the United States Environmental Protection Agency Million hearts (continued from page 16) Department of Health and Human Services, Dr. O’Brien was a Professor of Clinical and Administrative Sciences at the College of Notre Dame School of Pharmacy and a Health Policy Fellow in the United States Senate. Dr. Liana Orsolini-Hain is a 2011-2012 Robert Wood Johnson Foundation Health Policy Fellow serving in the Immediate Office of the Secretary of Health, Health and Human Services. She is an Advisory Board member for the Million Hearts Initiative and is working to mobilize nurses nationally to improve the health of families, communities and populations. She is also on the Centers for Medicare and Medicaid (CMS) Nursing Steering Committee. She was a member of the IOM Committee on the Initiative on the Future of Nursing: Leading Change, Advancing Health, which produced recommendations for an action-oriented blueprint for the future of nursing. 18 — NBNA.org General Health Care Prostate Screening: A Race for Awareness Richard Cooks, RN I n the United States, the Centers for Disease Control and Prevention (CDC, 2011) identifies the following four cancers as the leading cause of cancer death among men: Lung, Prostate, Colorectal, and Liver. While statistics show that lung cancer is responsible for the majority of cancer deaths among men, prostate cancer is the most common cancer diagnosis in the adult male population (CDC). The CDC estimates that 223,307 men are diagnosed annually, and unfortunately, 13% (29,093) of them die (2011). Even though prostate cancer is a commonality among men of all races, African American men succumb to the disease more often than other races; for example, the general male population has a 1 in 33 chance of dying from prostate cancer while African American males have a 1 in 19 chance (Prostate screening guide, 2003). This health disparity prompted the CDC to develop the Prostate Screening Guide: A Decision Guide for African Americans. While the guide provides 20 pages of informative literature, it emphasizes risk factors, signs and symptoms, prevalence, and health promotions and maintenance. health promotions and maintenance Although the exact cause of prostate cancer is surrounded by dubiety, along with the CDC, Ignatavicius & Workman (2010) identifies increasing age, high fat diet, familial predisposition, vitamin D and E deficiencies, and environmental substances as a few risk factors (1719). Prevention is the key to combating prostate cancer. Prostate screening targets asymptomatic men in order to detect signs, symptoms, and risk factors early (Prostate screening guide, 2003). With screening, modifiable risk factors, such as diet, environmental influences and nutritional deficiencies can be alleviated (Prostate screening guide, 2003). As nurses, we have a responsibility to teach men and their families about prostate cancer and its associated screening guidelines. In particular, the Birmingham Black Nurses Association, is fulfilling our responsibility to the Birmingham Metropolitan area by participating in community and church sponsored health fairs. Using the CDC and American Cancer Society’s guidelines for prostate cancer screening, we inform all patrons who visit our booth that a Prostate specific antigen (PSA) test and digital rectal examination (DRE) should be performed annually on the following men: Men of the age 50 and older; African American men and any man age 45 with a first degree relative with prostate cancer; and men of the age 40 who have two or more first degree relatives with prostate cancer. We teach all men that the DRE is the physical examination of the prostate, in which a health care provider inserts a gloved finger into the rectum to palpate the prostate for abnormalities. In terms of the PSA, we inform men that blood is collected and PSA levels are screened for elevation(Prostate screening guide, 2003). Signs & symptoms conclusion risk factors Most men are asymptomatic, however, others might experience blood tinged urine, trouble urinating, urine retention, frequent trips to the bathroom, painful urination or intercourse, or pain that radiates throughout the pelvis, flank, or bones. In regards to prevalence, men older than 60 and men with a first degree relative with prostate cancer are at the greatest risk (Prostate screening guide, 2003). Fear and anxiety is a normal reaction to health care procedures and laboratory test. However, as nurses, we can relieve some of the fear and anxiety of prostate screening by providing accurate and complete knowledge. In turn, more men will visit their health care providers for screening. I end with this question and hope that it will be a topic at your next chapter meeting, “How many men have you encouraged to partake in a prostate screening and what literature do you have available to distribute to your community? References Ignatavicius, D. D., & Workman, M. L. (2010). Medical-surgical nursing, patient-centered collaborative care. (6th ed.). St.Louis, Missouri: W B Saunders Co. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). (2003). Prostate screening guide: A decision guide for African Americans. General Health Care NBNA.org — 19 Christensen Rallying National and Local Organizations to Support Her Efforts to Oppose Cuts to the Territories Medicaid Program T hough her amendment to strike the language that would deliver a crippling blow to the U.S. Virgin Islands and other territories’ Medicaid programs was voted down yesterday on a roll call vote along party lines, Congresswoman Donna Christensen has no intentions of letting up on her efforts to oppose the Republicans’ efforts to protect and preserve the Medicaid funding for the territories that was achieved under the Affordable Care Act. “The Republicans—in an effort to cut their portion of the more than $96 billion from the deficit over the next decade— are targeting the territories’ Medicaid programs in a manner that is unjust, unnecessary and socially, economically and medically irresponsible,” noted Congresswoman Christensen. “These proposed cuts have nothing to do with the unmet medical needs in the territories, nor do these proposed cuts consider the health and wellness of the men, women and children in the U.S. Territories whose health care needs surpass their financial resources.” “As a Member of the Energy and Commerce Committee, who—along with my delegate colleagues—fought extremely hard to achieve the $6.3 billion increase in Medicaid over the next decade and the FMAP increase to 55 percent, there is simply no way that I can or will sit idle and watch this unfold without exhausting every avenue I have to stop it” added Congresswoman Christensen, a physician who also Chairs the Congressional Black Caucus Health Braintrust. “This is particularly true when I consider that the successes we achieved under the Affordable Care Act that put the U.S. Virgin Islands’ Medicaid program on a glide path to parity.” In addition to introducing her amendment, Congresswoman Christensen also called on local, regional and national organizations to register their support. Today, dozens of organizations have expressed their formal support for the Delegate’s efforts to strike the Republican language attacking the territories’ Medicaid programs. “Given all that is at stake, this fight is far from over and I am pleased that so many local and national organizations have expressed their support for my efforts and those of my delegate colleagues to protect our Medicaid programs and—more importantly—the individuals they serve,” expressed Congresswoman Christensen. “I am confident that together, we can and will ensure that these unethical and unfair recommendations never truly come to fruition, and that the health, wellness and thus life opportunities of Virgin Islanders and other individuals in the territories are preserved and protected.” Nurses’ Health Study is recruiting “The Next Generation” The Nurses’ Health Study is recruiting 100,000 nurses for the “next generation” of its landmark research on women’s health-NHS3. Female RNs, LPNs, and nursing students ages 20-46 across the US and Canada are eligible to become part of this world-renowned study. Much of what we know about health today—from the risks of tobacco and trans fat to the benefits of physical activity and whole grains—is thanks to the Nurses’ Health Study. It has provided valuable insight into the unique health challenges that nurses face, like shift work and occupational exposures. More than 250,000 nurses have participated since the study began in 1976, and 90% of them are still engaged. NHS3 will continue to explore the long-term effects of lifestyle on health among a younger and more diverse population of women that the previous two cohorts. It also looks at new issues like nurses’ work life and adolescent diet. If you’re eligible, NBNA encourages you to learn more and join on the study’s website (www.nhs3. org). After you’re enrolled, you’ll be asked to complete the online study’s confidential questionnaires. Participation takes about one hour per year. If you’re not eligible, we hope you will help spread the word among your colleagues and encourage them to help change the future of women’s health. For more information, please visit the NHS3 website: www.nhs3.org. 20 — NBNA.org NBNA Nurse Leadership Prescription Drug Abuse: The Nation’s New Drug Epidemic Janice Phillips, PhD, RN, FAAN Associate Professor, Rush College of Nursing, Rush University P rescription drug abuse is now the country’s fastest growing drug problem. While prescription drug abuse, misuse and diversion are not new, this growing epidemic has stimulated a call to action on a number of fronts including the United States Congress. During the 112th Congressional session, lawmakers introduced several legislative proposals in response to this growing epidemic. While each legislative bill seeks a solution to prescription drug abuse from a different perspective some offer a comprehensive approach to this complex issue. OxyContin and Vicodin are among the most frequently abused prescription painkillers and Xanax and Valium are the most frequently abused central nervous system depressants. Concerta and Adderall are among the most frequently abused prescribed ADHD medications. Sadly, more and more people are abusing over the counter drugs such as DXM (dextromethorphan), the active cough suppressant found in many over-the-counter cough and other cold medications.1 Recent data reveal that 7.0 million persons reported past month use of non-medical psychotherapeutic drugs, this equates to 2.8% of the U.S population.2 The same survey revealed that prescription drug use was highest among young adults aged 18-25, with 6.3% reporting nonmedical use of prescription drugs in the past month prior to the survey. Older adults are another high-risk population. Persons age 65 and older are particularly at risk because they are more likely to be prescribed long term and numerous medications. Other vulnerable populations include individuals taking multiple controlled substances from multiple providers, people who take high daily doses and those who abuse numerous abuse prone prescription drugs, low income individuals residing in rural areas. The increased availability of prescription drugs, the push for aggressive pain management along with misconceptions regarding the addictive potential of prescription drugs in part, are contributing to this epidemic. This growing public health epidemic has resulted in numerous legislative proposals in Congress. Legislation introduced during the 112th legislation includes a focus on stricter penalties for “pill mill” operators, education for providers with prescriptive authorities, consumer education and state funding to better support state drug monitoring programs. The author worked on Senate Bill 507 during her Fellowship in the office of Senator John D Rockefeller. Briefly, S 507, The Prescription Drug Abuse Prevention and Treatment Act of 2011 (now updated to 2012) addresses prescription drug abuse by: 1) Recommending mandatory education for providers before they can be licensed to prescribe controlled substances; 2) Educating consumers on the safe use of painkillers and preventing of diversion and abuse; 3) Using basic clinical guidelines for safe use and dosage of pain meds including Methadone; 4) Increasing federal support for state drug monitoring programs and; 5) Improving opioid death registries. Similarly, the 2011 Prescription Drug Abuse Prevention Plan, an extension of the Obama Administration’s National Drug Control Strategy, includes an emphasis on consumer and provider education, implementing state prescription drug monitoring programs, facilitating safe and proper disposal of medications and enforcing stricter law and legal actions to eliminate improper prescribing practicing and mill mil operators. Numerous legislative initiatives are underway in state and local governments as well. As we seek to find solutions, all parties must consider the balance between drug control and appropriate pain management. As the legislative process continues to unfold, the nation stands to benefit from the Secure and Responsible Drug Disposal Act of 2010. President Obama signed this into legislation fall of 2010 as part of the Administration’s efforts to combat prescription drug abuse. Briefly, this legislation provides consumers with a means to dispose of unused and expired medications at a safe designated place at select times during the year. Referred to as National Take Back Days, the next National Take Back Day is scheduled for April 28, 2102 from 10am 2pm. Since the inception of these events the DEA, and its state, local, and tribal law-enforcement and community partners have removed 995,185 pounds (498.5 tons) of medication from circulation in the past 13 months. Combating prescription drug abuse should be everybody’s business. The current epidemic is impacting urban and rural communities nationwide. Our various chapters and members are well positioned to provide patient and community education on the safe use and disposal of prescription drugs as well as promote the national take back initiative. For detailed information and related locations, members are encouraged to visit: http://www.deadiversion.usdoj.gov/drug_disposal/takeback/ index.html References National Institute of Drug Abuse (NIDA). (2011). Prescription drug abuse and addiction. Retrieved from http://drugabuse.gov/PDF/ RRPrescription.pdf Substance Abuse and Mental Health Services Administration (SAMSHA) (2010). Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings (Office of Applied Studies, NSDUH Series H-38A. HHS Publication No. SMA 10-4856Findings) Rockville, MD. Retrieved September 6, 2011, from http://oas. samhsa.gov/nsduhLatest.htm NBNA.org — 21 NBNA Nurse Leadership A Reflective Look at Practical Nursing Ottamissiah Moore, President, National Federation of LPN; NBNA Life Time Member O ver 26 years ago, I stood with a group of my peers in a crisp white uniform, holding a nightingale lamp. It was my graduation from License Practical Nursing (LPN) school and my entrance into the nursing profession. Armed with my new license, a new nursing venture and a great mentor, I was preparing myself for best career of my life. The past When I look at the history of practical nurses, some contend it began in 1897, with the programs at Massachusetts General Hospital in Boston, and New Haven Hospital in Connecticut which opened around 1873. Others believe LPN practice started with the programs established in New York. These “trained” nursing schools were Bellevue Hospital in New York City, the Ballard School in New York (1893) (Anderson, 2001, p. 17); and a training program for practical/vocational nurses developed by the American Red Cross (1892) at the Young Women’s Christian Association in New York City. After the turn of the century, LPN education and licensure became more formalized with the opening of the Thompson Practical Nursing School in Vermont in 1907 and the Household Nursing School in Boston in 1918 (White & Duncan, 2001). World War II brought the need for additional nurses, which focused attention on the contributions of the LPN/LVN. The “Practicals” were licensed through waivers and different States had different ways. Some required a letter of recommendation from a physician, a supervisor, etc., and the nurse had to have worked as a practical nurse for at least five years immediately prior to application. State-by-State, they were waived into nursing. Their licenses had a “W” on it and for many of them it was a stigma until they actually took the licensure exam. By 1945, 19 states and one territory had licensure laws. One state was permissive licensing. The National Federation of License Practical Nurses (NFLPN) was organized in 1949 to provide a structure at the national level through which LPNs and LVNs (Licensed Vocational Nurses) could promote better patient care and to speak and act on behalf of the occupational group. It is the only organization in the United States governed entirely by LP/VNs for LP/VNs. NFLPN is recognized by the other national nursing organizations as the official voice of LP/VNs. The Present The discussion about the “phasing out” practical nurses has been going on for more than 26 years. Although the conversation is quietly spoken, practical nurses are slowly leaving areas they have practiced in for many years. Licensed Practical/ vocational Nurses across the county are voicing their concern over several issues as discussed below. The underutilization of practical nurses, in some states and workplaces, prohibits practical nurses to perform tasks that they have been taught, and show knowledge, skill and competency to perform. LP/VNs are being replaced by unlicensed assistive personnel. During periods of nursing shortage, LP/ VNs are often recruited for positions which were originally RN jobs and assistive personnel are often recruited for jobs traditionally held by LP/ VNs. While they can assist with tasks associated with the maintenance and support of the aged, they do not and cannot replace the LP/VN at the bedside. While we may not be able to conduct comprehensive assessments of the patient, we do understand patient response, we have been taught how to conduct general assessments and able to accurately convey patient status, care concerns and needs in a manner unknown to unlicensed assistive personnel. LP/VN students are not receiving the education and career opportunities previously afforded the profession. Clinical experience has always been an integral part of nursing education. It prepares student nurses to be able to perform as well as have knowledge about the clinical principles in practice. Clinical practice stimulates students to use their critical thinking skills for problem solving. There is a strong demand for high-quality, cost-effective clinical education experiences that facilitate student learning in the clinical setting. The clinical learning environment (CLE) is the interactive network of forces within the clinical setting that influence the students’ clinical learning outcomes. We believe clinical experiences would improve the knowledge, skills and abilities of LP/VNs. We have heard about problems existing with students obtaining clinical experiences, preceptorships, and job placement. No studies have been conducted on this issue. Concerns about lack of clinical experiences for LP/VN students may be one of the barriers to the NCLEX pass rate and employment opportunities. The Future of practical nursing It appears there are more questions than answers. The practice, the market and the education of LP/VNs is changing every single day. The questions are… How will LP/LVN become educated? Who will offer clinical sites to LP/LVN students? What will the skill set of an LP/VN look like over the next 10 years? How will practical nurses transition to another position if the market does not utilize them? Who will precept LP/VNs new to practice? These questions and others about the issues are endless. Leadership in nursing must take a look at what part LP/VNs have in nursing history, bedside nursing, patient outcomes and work together to carve out a role and practice specifically for LP/VNs now and for the future. Leadership must be creative in our thinking to assist LP/VNs to transition to the role of an RN. The nightingale light of LP/VNs is still shining. Given the opportunity, LP/VNs will prove the value of practical nursing in the primary, preventive and long-term care settings. We only need to have our light shine brighter. CONTINUED ON PAGE 23 22 — NBNA.org NBNA Nurse Leadership NBNA Strategic Plan at a Glance Keneshia Bryant, PhD, RN, FNP-BC Little Rock Black Nurses Association of Arkansas NBNA Board Member/Lifetime Member I n order for any organization to be successful, each member should know and understand the organization’s strategic plan and work towards obtaining its goals. A strategic plan is the process of determining an association’s longterm goals and then identifying the best approach for achieving those goals. The mission of NBNA is to “represent and provide a forum for black nurses to advocate for and implement strategies to ensure access to the highest quality of health care for persons of color.” Based on this mission the NBNA 2011-16 Strategic Plan contains seven goals. Below is an overview of each goal. Goal 1: Membership – Enhance and maintain a viable membership that can fulfill and sustain the mission and goals of NBNA. There is power in numbers and in order to fulfill the mission of NBNA, a growing active membership is vital. Membership recruitment and retention are the key elements of the membership goal. The membership recruitment objectives are to: 1) develop a comprehensive recruitment campaign; 2) identify and eliminate barriers to recruitment; and 3) increase visibility at Historically Black Colleges and Universities and key nursing organizations. For membership retention the objectives are to: 1) develop and implement effective retention plan and strategies; 2) increase and enhance member services; and 3) maximize chapter benefits. Goal 2: Leadership – Promote NBNA as a global health care leader. The growth and advancement of the NBNA membership to become global nurse leaders is the basis for this goal. The strategic plan includes the development of a leadership track for members which includes leadership programs and institutes. Additionally the plan is to establish and maintain collaborations and networks with other professional organizations for leadership development. Goal 3: Health Policy – Maintain and strengthen the organization’s capacity to influence health policy. The purpose of this goal is to: 1) promote NBNA’s position on health policy issues. This will be done by the development of an annual national health policy agenda and increasing the number of skilled health policy nurse leaders; 2) seek and support membership appointments to policy, regulatory, and governmental committees; 3) strengthen the ability of chapter members to shape national health policy that is based on local issues; and 4) to provide support to international health policy students. The expected outcomes for this goal are to strengthen the ability of NBNA chapters, board members, and chapter members to shape national health policy that is based on local issues. Goal 4: Program Development – Establish and maintain a comprehensive NBNA program agenda. Programs are often the key to establishing community partners, promoting health and wellness, and diversifying the workforce. Therefore, NBNA is dedicated to health promotion, health protection, and disease prevention programs. Examples of these programs include: The obesity initiative; the identification of annual health goals; participation in international health conferences; and providing annual educational scholarships. Goal 5: Research – Establish and maintain, in collaboration with the National Black Nurses Foundation, a NBNA research agenda that promotes the community’s ability to promote health. Through this goal, NBNA will prioritize research activities, which leads to the increased body of knowledge about health care needs of African Americans/Blacks and other minorities, effective health care delivery systems for minorities and the utilization of nursing services. Additionally, identify funding sources to promote and support nursing research. Goal 6: Sustainability – Improve and sustain the organization’s financial stability. The strategic direction for this goal is to develop a secure a financial base for operating expenses and budgeting for marketing campaigns, in addition to increasing the organization’s overall revenue. Goal 7: International Health – To establish NBNA as a partner in global health care. The desired outcome for this goal is to promote a dialogue around nursing education practice as it relates to global health. In addition, distinguish global health issues as they relate to local policies. These goals will be achieved by collaborating with NBNA members in the Caribbean, conducting forums focused on nursing education issues, and highlighting global health issues. Each member has a responsibility to be active in the fulfillment of the NBNA strategic plan. Without the support of the membership the goals cannot be obtained. Therefore, a member’s charge is to identify the areas they would like to support and strengthen to move the organization towards its desired outcomes. Dr. Keneshia Bryant is an Assistant Professor and Translational Research Institute KL2 Scholar at the University of Arkansas for Medical Sciences in Little Rock, Arkansas. NBNA.org — 23 NBNA Nurse Leadership Leadership... Are You a Leader? Beulah Nash-Teachey, PhD, LTC (Ret), RN I s leadership learned or are you born with the gift? It can be both. My first response to the question is, it a gift from God. I truly believe God has given individuals very different attributes that can only be explained as a gift. Thus, in this short article, I will discuss some general applications to leadership, my growth and development in the military and list Bass Theory (the leadership guide I use when helping young military officers). In life’s journey we choose to lead and in other circumstances we are forced into a leadership position. In either situation, you must lead with passion and determination. How you lead will determine how successful you will be and how those who follow you will remember you. Leadership literature and research has repeatedly confirmed that most of the time we lead by example. If you expound on procedures or techniques that you do not follow or demonstrate, those who follow you will probably fail. Then the question is what happened, why is this situation failing? The answer most likely will reflect badly on you as the leader. Being able to stand the test of leadership requires an individual to live by what you teach. My mentor echoes. “Leaders must accept each opportunity to lead and always do your best.” Brian Tracey (leadership guru) suggest that a leader should read at least one hour every day, be committed to learning for life, embrace every opportunity to lead, and learn to listen. Being a leader, weather a gift from God or if you are thrust into the position, serving in the military will soon put most individuals on the right path. As an Army Nurse Corps Officer for over 27 years, it has given me a wide view of leading, mentorship, and how to govern. I have pondered the question, “Am I a leader?” Leadership is defined in many different terminologies. I view leadership as the ability to influence others to complete the mission, no matter how hard the task may be. Striving to be a great leader has been my center of growth and development as a nurse and Staff Officer. Commanding troops and being responsible for their safety requires knowledge, will power, understanding your surrounding and having a no none sense attitude. However, of all the traits that have been identified in leadership, the ability to first follow is very important. Being able to motivate individuals to move forward to complete the mission, although in a threat, is always challenging. Good leaders are developed through a process of selfstudy, education, training, and experiences (Jago, 1982). Bass theory has helped me to develop and guide other military officers. Bass’ Theory of Leadership Bass’ theory of leadership states that there are three basic ways to explain how people become leaders (Bass, 1990). The first two explain the leadership development for a small number of people. These theories are: n Some personality traits may lead people naturally into leadership roles. This is the Trait Theory. n A crisis or important event may cause a person to rise to the occasion, which brings out extraordinary leadership qualities in an ordinary person. This is the Great Events Theory. n People can choose to become leaders. People can learn leadership skills. This is the Transformational or Process Leadership Theory. It is the most widely accepted theory today and the premise on which this guide is based. References Bass, Bernard (1990). From transactional to transformational leadership: learning to share the vision. Organizational Dynamics, 18(3), Winter, 1990, 19-31. Jago, A. G. (1982). Leadership: Perspectives in theory and research. Management Science, 28(3), 315-336. Newstrom, J. & Davis, K. (1993). Organization Behavior: Human Behavior at Work. New York: McGraw-Hill. Practical Nursing... continued from page 21 References Blegen, M., Vaughn, T., Vojir, C. (2007). Nurse staffing levels: Impact of organizational characteristics and registered nurse supply. Health Services Research, 43(1), 154-173. Larson, J. (2008). Are LPN jobs moving outside the hospital? Retrieved July 12, 2012, from http://www.nursezone.com/nursingnews-events/more-news/Are-LPN-Jobs-Moving-Outside-theHospital_26658.aspx Magnet Doesn’t Attract Everyone found at http://www.afscme.org/ publications/4194.cfm Lafer, G. & Moss, H. (2007). The LPN: A practical way to alleviate the nursing shortage. Labor Education and Research Center, University of Oregon, for the United Nurses of America. Retrieved July 12, 2012, from http://www.afscme.org/news/publications/health-care/ the-lpn-a-practical-way-to-alleviate-the-nursing-shortage Spector, N. (2005). Practical Nurse Scope of Practice White Paper. National Council of State Boards of Nursing. Available at: https:// www.ncsbn.org/Final_11_05_Practical_Nurse_Scope_Practice_ White_Paper.pdf 24 — NBNA.org NBNA Nurse Leadership Embracing the Challenge of Increasing Workforce Diversity within the Nursing Profession Clarise H. Ottley, PhD, RN Faculty, Shepherd University, Department of Nursing Education O ver the course of many years, there have been numerous campaigns launched in support of the need to transform the nursing profession. One such campaign is Johnson and Johnson and the American Association of Colleges of Nursing (AACN) Minority Nurse Faculty Scholars Program, which was designed to increase the number of nurse educators from underrepresented minority groups. The Institute of Medicine’s report (2010), The Future of Nursing: Leading Change, Advancing Health, examined the nursing workforce and how nurses can play a fundamental role in the support of transforming the profession. Opportunities to advance the nation’s health needs must not lose site of the challenge to prepare a workforce that “mirrors the faces and values of those who seek care” (Wilson, Sanner, & McAllister, 2010, p. 144). The nation’s demographic population is changing. The United States Census Bureau (2010) projects a decrease in the number of Whites between 2010 and 2050, and an increase in the Hispanic or Latino population. The population in the United States is expected to reach 439 million by 2050, with a projection that 82% of this increase will be largely due to immigrant families. A report released by the Sullivan Commission (2004) on Diversity in the Health care Workforce indicated that the nation’s health professions have not maintained the needed pace of the changing demographics necessary to provide the kind of care that is needed for the population it serves. The lack of diversity in the nursing profession compared with the fast changing diversity in demographics may be a cause of disparities in health access and outcomes (Sullivan Commission, 2004) The lack of diversity in the nursing profession is believed to be a result of the lack of minority nurse educators (AACN, 2001). There is a correlation between the number of minority nurse educators and the number of minority nursing students enrolled in nursing programs. Research indicates that a lack of minority faculty is a barrier to the recruitment and retention of culturally diverse nursing students (Zajac, 2011; Mills-Wisneski, 2005). AACN indicated that this need to attract diverse nursing students is paralleled by the need to recruit more nursing faculty from minority populations. It is encumbered upon nursing not only to actively recruit more minority nursing faculty, but also to collaborate on ways to retain them. Creative strategies must be developed that will provide both. Mentoring of nursing faculty is one strategy that researchers have identified as key to recruitment and retention. The National League for Nursing (2006) indicated that mentoring as a strategy, will help recruit and retain qualified nurse educators because it helps establish healthful work environments. Mentoring, defined as one-to-one reciprocal relationship between a more experienced and knowledgeable faculty member and a less experienced one, characterized by regular/consistent interaction over a period of time to facilitate the mentee’s development (Haggard, Dougherty, Turban, & Wilbanks, 2011), is necessary for job satisfaction and faculty retention According to authors Wroten and Waite (2009), in addition to guidelines for effective mentoring, the impact of race as a salient factor in development of mentoring relationships should not be overlooked. Both cross-race and same-race mentoring relationships provide career support for the faculty member. However, for minorities, whether nursing students or faculty, same-race relationship mentoring provides an added psychosocial support when considering trust and attachment that they may not find with cross-race mentoring. The connection between the mentor and the mentee with same-race mentoring is vital to attracting minority faculty and students. Hubbard (2006) indicated that the most persistent and statistically significant predictor of enrollment and graduation of an African American graduate student is the visible presence of an African American faculty member. A barrier for this type of effective mentoring is the small pool of minority faculty who are in a position of leadership that can mentor other minority faculty and minority students. In supporting the changing face of nursing, so that it is more reflective of a diverse profession and the current population, the establishment of opportunities for mentoring of minority faculty is a priority. There must be a commitment to increase diversity in nursing by actively recruiting minority faculty, and providing them with the environment that nurtures and supports them along each of their continuum. The belief is that visible nurse educators will send a signal to potential nursing students that nursing values diversity, and encourages support through same-race mentoring. Dr. Clarise Hairston Ottley, a recent protégé in the National League for Nursing/Johnson & Johnson Faculty Leadership and Mentoring Program, is a faculty member at Shepherd University in the Department of Nursing Education. She received a bachelor of science degree from North Carolina Central University in 1977, an associate of science in nursing from Shepherd in 1991, a master of science from George Mason University in 1997, and a Ph.D. in nursing from Duquesne University in 2009. In addition to being an academician, Dr. Ottley is a certified nurse specialist, specializing in maternal/newborn care, and a certified childbirth educator, licensed to teach childbirth education/Lamaze classes. CONTINUED ON PAGE 25 NBNA Nurse Leadership A Helping Hand NBNA.org — 25 Edward M. Rogers W hen a person thinks of a hotel they would never associate it with a hospital. Indiana University Health Methodist Tower Inn provides housing for patients throughout the world who come see the best doctors. Not only does the Methodist Tower house potential patients, but in addition families come from all parts of Indiana and throughout the country to visit a loved one or friend at Indiana University Health Hospital in Indianapolis, IN. Doctors, nurses, and other employees also have the ability to obtain rest while on-call without having to travel back from home and work. Being in a hospital for hours without any rest or a place to stay can be very stressful to a person who is not from the city of Indianapolis. The best solution when a person has a loved one in the hospital is always being by their side. That feeling of guidance and protection to the patient can help no matter what is going on with their health condition. Always trying to be there for someone when you’re not from that area can be hard on an individual and can come with an expensive price. Indiana University Health has created a concierge program to give families a place to rest without draining their wallets during a time when they have to take care of a family member. Having the comfort of being by a sick loved one gives the family relief that they can be by their side when the patient needs them. The Indiana University Methodist Tower Inn started around 1980 as on the twelfth floor providing rooms for transplant patients. Indiana University Methodist Tower Inn now operates between 66 to 86 rooms on a daily basis filled with those who have some association with the hospital. Accommodations are very suitable and pleasant. The Methodist Tower provides transportation to other area Indiana University Health hospitals. Housekeepers are staffed to clean and also provide any service needed to the family at that time. The Methodist Tower provides free laundry services to those who are guest and those who have been staying within the hospital. In addition to laundry services, the Methodist Tower provides public showers to individuals who are not guests at the hotel, but who have been staying in the hospital with a patient. This service is good for families to know that the hospital can assist with any problem one may encounter. Accommodating those who are visitors to a patient in the hospital is a good idea for Indiana University Health to implement. The feeling of being treated like you’re important to them, which you are, can go a long way emotionally when someone is in the time of need. Be glad to know that those employees, doctors, and nurses will do everything possible to make you feel welcomed. I’m glad to say that I’m proud to have experienced an organization that empathizes with people in adverse situations. diversity continued from page 24 References American Association of Colleges of Nursing (AACN), (2011) Statement of Diversity and Equality of Opportunity. Retrieved May 7, 2012 from the AACN Website: http://www.aacn.nch-e.edu/publications/ positionss/diverse.htm American Association of Colleges of Nursing. Fact Sheet: Enhancing diversity in the nursing workforce. Retrieved from http://www.aacn. nche.edu/media-relations/diversityFS.pdf Haggard, D., Dougherty, T.W., Turban, D.B., Wilbanks, J.E. (2011) “Who is a mentor? A review of evolving definitions and implications for research,” Journal of Management, vol. 37, 280-304 Hubbard, D., (2006). The color of our classroom, the color of our future. Academe, 92(6), 27-29. Institute of Medicine (2010).The future of nursing: Leading change, advancing health. Retrieved May 10, 2012 from the IOM website report: http://www.iom.edu/Reports/2010/The-Future-of-NursingLeading-Change-Advancing-Health.aspx Mills-Wisneski, S. (2005). Minority students’ perception concerning the presence of minority faculty: Inquiry and discussion. The Journal of Multicultural Nursing & Health, 7(2), 49-55. National League for Nursing (2006). Statement: Mentoring of nurse faculty. Nursing Education Perspectives, 110-113. Sullivan Commission on Diversity in the Health care Workforce, “Missing Persons: Minorities in the Health Professions,” 20 September 2004, http://www.jointcenter.org/healthpolicy/docs/SullivanExecutiveSummary.pdf (accessed 8 May 2012); http://www.aacn.nche. edu/Media/pdf/SullivanReport.pdf Wilson, A.H., Sanner, S., & McAllisteer, L.E. (2010). An evaluation study of a mentoring program to increase the diversity of the nursing workforce. Journal of Cultural Diversity, 17(4), 144-150. Wroten, S.J., & Waite, R., (2009) A call to action: Mentoring within the nursing profession - a wonderful gift to give and share. Association of Black Nursing Faculty Journal. 106-108 U.S. Census Bureau (2010). Census 2010 Population distribution in the United States and Puerto Rico; http://www.census.gov/geo/ www/maps/2010_census_nighttime_map/nighttime_map_2010. html Zajac, L. (2011). Double-loop approach: Recruitment and retention of minority nursing faculty. Association of Black Nursing Faculty Journal. Summer 2011. 26 — NBNA.org NBNA Nurse Leadership Raise the Voice! Joanne Disch, PhD, RN, FAAN “H ealth care in America today is inaccessible to many, expensive for most and fragmented for all.”1 In January 2012, the Institute of Medicine published Living Well with Chronic Illness: A Call for Public Health Action2, outlining the ‘epidemic’ of chronic disease which represents 75% of the $2 trillion spent annually on health care. The report emphasized the numerous determinants affecting health, such as genes, biology, behavior, coping responses, the role of peers and family, the social-cultural context, and the physical environment. None of this is new to us as nurses: We have always worked with the patient in the context of the family, environment, community and socioeconomic considerations. In fact, while health care systems have created monumental structures that perpetuate the physician-dominant, acuityoriented, hospital-based care model evident today, nursing innovators have quietly gone about developing new models of care that are cost-effective, personalized, convenient and successful in helping individuals and families deal with chronic illness. Perhaps too quietly. This is why the American Academy of Nursing, under the leadership of then-president Linda Burnes Bolton, launched the Raise the Voice! campaign to educate the public and policymakers about the creative approaches that nurses are taking to assure that people, often the under- and un-insured, receive the care that they need and minimize the complications of chronic disease. Over the past six years, 49 nurses have been identified as Edge Runners, or practical innovators who have developed new care models that achieve significant clinical and financial outcomes. Here are profiles of a few Edge Runners and their work: n 11th Street Family Health Services is a community-based center that provides access to not only clinical services but to a wide range of health promotion and disease prevention services to inner-city Philadelphia residents. Employing a broad trans-disciplinary team of health professionals, it also has a strong educational and research component, serving as a clinical site for many health professions’ students. In addition to more than 25,000 clinical visits, it has made 1650+ home visits to pregnant or new mothers, and thousands of wellness and health encounter sessions. In 2011, the center reduced pre-term births to 2.5% in African American for their women, compared to 15.6% in the city. (Patty Gerrity, PhD, RN, FAAN) n The St. Francis Health Center improves access to quality primary health care services for the poor and uninsured, integrating both physical and mental health assessment, treatment and follow-up services, regardless of employment status or income. Founded and managed by a team of nurse practitioners and clinical nurse specialists in Joliet Il, they use weekly team meetings to discuss case management and approaches to care. Their patient base includes place-bound elderly and disabled, victims of domestic violence, the working poor and uninsured. Since their opening, they have provided services to more than 6,500 patients. They offer services daily, with some evening hours and weekend coverage by NPs. (Carol Jo Wilson, PhD, RN, CNP) n INSIGHTS help parents and teachers recognize children’s temperaments so that they can deal effectively with minor behavioral problems, help them learn self-regulation strategies and enhance their interpersonal relationships with families, teachers and friends. This 10-week intervention, developed in partnership with African American and Hispanic community members, has helped children with ADHD without using medication, reduced the behavior problems of children with serious disruptive behaviors, enhanced parents’ ability to handle their children’s behavior; and reduced aggressive behavioral episodes in the classroom. (Sandee McClowry, PhD, RN, FAAN) The Academy website (http://www.aannet.org/raisethevoice) offers details on these innovators and other Edge Runners. Also on the website are the criteria for becoming an Edge Runner. Consider applying for this designation or nominating colleagues if you or they have developed an innovative care model that has made a measurable difference in health care outcomes. Nominees need not be Fellows in the American Academy of Nursing. Here are the criteria: n Nominations support the innovative work of nurses and demonstrate the holistic and integrated philosophy underlying nursing care. n The nomination demonstrates how an innovative solution (intervention or model of care) remedied a problem in the delivery of health care or an unmet health need of a population. n Although single demonstrations are acceptable, data that substantiate the success and impact of the project must be included with the nomination. n There is evidence that the original work has been replicated or has the promise of leading to replications in other settings. In conclusion, nurses have historically understood what the public wants from health care, and have generated creative solutions for delivering it. It’s time to showcase the important work that nurses are doing, and Raise the Voice! on the significant contributions that nurses are making to achieve a reformed health care system. Dr. Joanne Disch is a Clinical Professor and Director of the Katharine J. Densford International Center for Nursing Leadership, and the Katherine R and C Walton Lillehei Chair in Nursing Leadership at the University of Minnesota School of Nursing. She is currently the President of the American Academy of Nursing. References 1. American Academy of Nursing (2011). Edge Runners. Retrieved February 25, 2012 from http://www.aannet.org/edgerunners. 2. Institute of Medicine (2012). Living well with chronic illness: A call for public health action. Retrieved February 25, 2012 from http://www. iom.edu/~/media/Files/Report%20Files/2012/Living-Well-withChronic-Illness/livingwell_chronicillness_reportbrief.pdf. NBNA.org — 27 NBNA Nurse Leadership Parliamentary Tidbits: Your Role Has Been Cast Azella C. Collins, MSN, RN, PRP O rganizational presidents are dependent upon many individuals; committee members, committee chairmen, officers both elected and appointed. Most members are probably more familiar with the duties of the secretary than with other officer because the secretary is more visible in the performance of duties during meetings. According to Robert’s Rules of Order, Newly Revised, 11th Edition, (RONR), the secretary, “is the recording officer of the assembly and custodian of its records, except those specifically assigned to others...” There are eleven duties listed for the secretary on pages 458-459 of RONR. If you are a secretary, make sure you read the list as well as your organization’s bylaws. The secretary should be an individual who is organized and detailed oriented. Minutes should be prepared promptly after a meeting when the details are fresh. The secretary should make a list of tasks to be completed after a meeting and check them off as they are completed. Additional duties are listed in The Complete Idiot’s Guide to Robert’s Rules, by Nancy Sylvester. In organizations where there is more than one secretary, the bylaws should specify the duties of each position. Many people think that the treasurer is the most important officer. RONR page 461 states, “The treasurer of an organization is the officer entrusted with custody of its funds. The treasurer, and any other officers who handle the organization’s funds, should be bonded for a sum sufficient to protect the organization from lost.” The duties of the treasurer will vary depending upon the size of the organization and the complexity of its finances; but this officer cannot disburse funds except by authority of the organization or as the bylaws so prescribe. Once the board or members have adopted the budget, it is the treasurer’s responsibility to make sure the organization spends within the established budget. It is important for the treasurer to keep accurate records and to make deposits and promptly pay bills. When writing checks, the treasurer should use a gel pen, which is more difficult to ‘wash’ than ballpoint pens. The treasurer is required to make a full financial report as prescribed by the bylaws or rules. The treasurer’s report should include, but is not limited to: balance on hand at the beginning of the reporting period; all income; all disbursements; and balance on hand at the end of the reporting period. This report is for information only and is never adopted, but filed pending audit. For organizations with annual expenses of less than $50,000, an internal audit can be conducted by financial savvy members who are not officers or committee chairmen. The Complete Idiot’s Guide to Robert’s Rules page 224, provides a list of items that must be available for internal and or external auditors. If your organization has grants and/or monies from various foundations a Grant and Finance Committee Procedure Manual is needed. The vice president—the understudy for the president— stands in the wings, prepared to fill in at the last minute or assume the position permanently if the president is unable to continue in the office, and many think that this is the most important office. “A vice president should always be prepared to take over for the president. Some ways of doing that include discussing with the president the agenda before each meeting; having an agenda, the bylaws, and parliamentary authority for all meetings; and arriving at the meeting early enough to be prepared for the start of the meeting. If a vicepresident prepares in that manner, then in an emergency that delays the president, attendees won’t have to sit around wasting time waiting for the president. The vice president can start the meeting on time.” (Sylvester, page 23). In organizations where there is more than one vice-president, the bylaws should specify the duties of each position. RONR page 462 devotes four lines to describing the duties of the historian, in the opinion of this writer the historian is the most important officer. The historian prepares a narrative account of the organization’s activities during his or her term of office, which, when approved by the assembly, will become a permanent part of the organization’s official history. The principal duty of the historian is to keep a continuous, systematic written record in chronological order of significant historical events and activities, for the term of his office. Most organizations require the historian to have other duties and responsibilities in addition to compiling a written history. Some organizations require the historian to keep a scrapbook or file of newspaper and publicity notices, pictures, reports, yearbooks, workshops, seminars Christmas brunches, etc. and other historically significant material. In the age of computers, the reports should also be saved on a CD or memory card. Unfortunately, many organizations lose their history when a member dies and leaves no instructions for the family about what to do with the organization’s material. Committee chairpersons must obtain minutes of previous committee meetings, review annual reposts, newsletters, and member surveys if applicable. Their principal duties should be outlined in the organization’s bylaws. The chairpersons must be the most knowledgeable person in the group. Plan the meeting, have an agenda ensure each member knows what business is being considered by discussing one item at a time. Allow for adequate discussion (when committee members begin to repeat issues tactfully limit discussion and bring the issue to a vote). Keep a list of action items and check them off as they are completed. The most important people in any organization are the committee members who must understand their overall tasks and specific role. Majority rules: if you were not on the prevailing side, work hard to ensure group success, do not be a poor loser. You are the workhorses of all organizations. What role in the cast will you play? How do you prepare to fulfill your duties and responsibilities? How will you support your organization? Abigail Adams once stated, “Learning is not attained by chance. It must be sought for with ardor and attended to with diligence.” References: 1. Robert’s Rules of Order, Newly Revised 11th Edition. 2. Sylvester, Nancy. The Complete Idiot’s Guide to Robert’s Rules. 28 — NBNA.org MEMBERS on the MOVE NBNA President’s Photo Highlights LEFT: Dr. Deidre Walton meets with Kathleen R. Fogarty, Hospital Director and Laureen Doloresco, MN, RN, NEA-BC, Associate Director, Patient Care/ Nursing Service/CNO at the John Haley VA Medical Center in Tampa, FL. ABOVE: Dr. Deidre Walton, NBNA President, with Dr. Ruth Caggins, BNA of Greater Houston President, Yvonne Olusi, RN, FBCBNA President, and Lola Denise Jefferson, NBNA 2nd Vice President at the Fort Bend County Black Nurses Association’s 11th President’s Scholarship & Awards Ball LEFT: Dr. Walton, NBNA President, with members of the National Black Nurses Tampa Bay, Inc. Dr. Walton, NBNA President, with members of the Tampa chapter of NBNA. MEMBERS on the MOVE NBNA.org — 29 San Diego Black Nurses Association, Inc. (SDBNA) Michael Deangelo Jackson, RN, has been appointed to the California Board of Registered Nursing by Governor Jerry Brown. Jackson has been a clinical nurse II in the Department of Emergency Medicine at the University of California, San Diego Medical Center since 2000. He has been an adjunct clinical faculty member in the registered nursing program at Southwestern Community College and an operations supervisor at Scripps Mercy Medical Center since 2007. Jackson was a mental health worker at Scripps Mercy Medical Center from 1992 to 2000. He served as a lance corporal in the United States Marine Corps Reserve from 1989 to 1993. San Diego Black Nurses Association, Inc. hosted its Annual Prayer Breakfast on Saturday, December 10, 2011 at Bayview Baptist Church Martin Luther King Auditorium. The theme was, “Hear Me While I Pray.” The late Yvonne Hutchinson, RN, past SDBNA President and NBNA Board member, originated the Annual Prayer Breakfast concept in the 1980’s. Initially, the event occurred in the homes of SDBNA members, but it has since grown exponentially. The December 10, 2011 attendance of 260 guests was the largest attendance since inception of the Annual Prayer Breakfast. The primary focus of the Annual Prayer Breakfast is to demonstrate SDBNA’s appreciation of the organization’s many supporters, friends, and collaborators. During the program SDBNA members expressed appreciation to guests for their continued support to our organization. Gifts were given to guests as tokens of appreciation. Guests’ were also given the opportunity to express their appreciation to the organization for their indefatigable efforts to decrease disparities in the community. Sharon Smith, RN, SDBNA President, presented Dr. Deidre Walton, NBNA President, with a gift from Kenya which she acquired on a humanitarian trip in 2011 with two other SDBNA members, Rose Jones and Shenell Baker. Dr. Walton was the keynote for the event. She spoke passionately about health issues in African American and underserved communities and the importance of prayer in our lives. We were challenged to actively combat health issues individually and as a community. Dr. Irene Daniels-Lewis, NBNA Treasurer, was in attendance. She serves as the Chapter Liaison and is a member of the San Jose Black Nurses Association. Dr. Daniels-Lewis expressed encouraging and heart-felt remarks that SDBNA members and guests appreciated. Dr. Walton attended church services with SDBNA members at Bayview Baptist Church. Pastor Timothy J. Winters introduced Dr. Walton to the Bayview congregation where she received a warm welcome. Dr. Walton had lunch with SDBNA members after church before departing to her home in Scottsdale, AZ. The weekend of memorable events with Drs. Walton and Daniels-Lewis were highlights of a successful and productive year for the San Diego Black Nurses Association, Inc. under the capable leadership of Sharon Smith, SDBNA President. Birmingham Black Nurses Association (BBNA) Deborah Andrews. MSHSA, RN, President of BBNA has been invited to serve on the Alabama Advocacy Subcommittee for the American Heart Association/ American Stroke Association. At BBNA’s monthly meeting on Monday night, March 19, 2012, Tamara Marshall MD, Clinical Science Manager for Abbott Renal Care presented, “Health care disparities: An associated link between chronic kidney disease & cardiovascular disease.” Dr. Jennifer Coleman, President-elect presented a podium presentation entitled, “The Power of Simulation in Pediatrics: Effect on Confidence & Clinical Reasoning Skills” at Drexel University annual simulation conference. The conference title was Simulation in Health care: Where No One Has Gone Before and was held in Fort Lauderdale, Florida on March 20-23, 2012. Conference sponsor was Drexel University College of Nursing & Health Professions, Division of Continuing Nursing Education. Deborah Andrews, BBNA President, Candace Grimes, Deborah Thedford-Zimmerman and Carthenia Jefferson, JD, RN, attended the American Heart Association, Heart Walk Executive Leadership Breakfast on March 7, 2012 at Vulcan Park and Museum in Birmingham. BBNA will be raising funds and walking in the AHA Heart Walk on June 30th.” The National Tuskegee Airmen Scholarship Foundation, the Atlanta Tuskegee Airmen, Inc. Chapter and VITAS Innovative Hospice Care of Atlanta, hosted a Gold Medal Luncheon Tribute to the Tuskegee Airmen. The Red Carpet Affair was held on Saturday, March 31, 2012 in Atlanta, Georgia in recognition and honor of the 5th Anniversary of the Tuskegee Airmen receiving the Congressional Gold Medal. This national event was held around the country to raise awareness and provide support to the Tuskegee Airmen Scholarship Foundation’s continuing mission to assist financially disadvantaged and deserving students in pursuit of their college education. Deborah Andrews, president of BBNA, Deborah Thedford-Zimmerman and Marcia Lowe, MSN, RN, attended the event. The Birmingham Chapter received a gold medal award plaque for outstanding contribution. Nurses from Birmingham, Atlanta and the Tuskegee areas received Gold Medal replicas of what the Tuskegee airmen received. Dr. Holeman, Dean of Tuskegee University School of Nursing brought greetings on behalf of the President, Dr. Gilbert L. Rochon. 30 — NBNA.org MEMBERS on the MOVE Birmingham BNA Nurses: Impacting the HIV Epidemic with Education On February 11, 2012, Birmingham Black Nurses Association was represented by Estella Woods, RN, and Kim Rutley-Campbell, RN. These nurses conducted a Basic HIV Nursing “Train-the-Trainer” Program at the University of Alabama at Birmingham Hospital. The initial class for Birmingham, AL was held on November 4, 2011. Each attendee was provided with a flash drive of tools to facilitate their commitment of training ten additional nurses and then provide them with the same flash drive of tools to facilitate training other nurses, and as many people in their communities as possible. This training, sponsored by the Association of Nurses in AIDS Care (ANAC), was funded by the Elton John AIDS Foundation (ELAF) to train non-HIV specialist nurses in Alabama, Georgia, Tennessee, Florida, and Louisiana. ANAC mission is to promote the individual and collective professional development of nurses involved in the delivery of health care to persons infected or affected by HIV. The goal of this “Train-the-Trainer” program is to expand the number of nurses who are capable and willing to engage patients on topics related to risk and infection with HIV. This training was significant for nurses, considering the growing epidemic in the African American Community and Southern United States and given the fact that nurses frequently encounter patients at risk for or infected with HIV. Ultimately, as nurses, we can provide a safe and therapeutic environment for HIV risk assessment and education. Birmingham Black Nurses Association Nurse Setting Trends as Certified Transcultural Nurses: On February 13, 2012, BBNA nurses Kim Rutley-Campbell, RN, Olivia Bahemuka, RN, and Sophia Posey, RN, were part of a cohort of nurses nationwide who took and passed the first pilot exam for the Transcultural Nursing-Basic Certification (CTN-B). The exam was developed by an expert panel under the Transcultural Nursing Certification Commission (TCNCC) in 2011 and will be fully implemented in 2012. Certification in Transcultural Nursing demonstrates to nurse colleagues, patients, employers, and others, the knowledge, experience, and commitment to transcultural nursing. These nurses have demonstrated themselves to be knowledgeable and skilled transcultural nurses who are prepared to give safe professional care to people of diverse cultural life ways and accomplish quality research, teaching, practice, and other related roles. Moreover, transcultural nursing certification validates the ability to provide culturally competent and congruent care to clients, families, communities, and organizations. Lastly, this certification will assist the BBNA nurses in understanding the history of their own African American culture, African American health views, and their impact on the health ways and health care of African Americans. Each is challenged by the objective of “Each One Teach One.” CONTINUED ON PAGE 31 NBNA.org — 31 MEMBERS on the MOVE Kim R. Rutley-Campbell, BSN, RN, CRRN, CHPN, CTN-B, BA, MAE, CHES UAB Palliative Care and Comfort Unit Birmingham Black Nurses Association members attend the Birmingham Heart Walk Executive Breakfast. Members, left-to-right: Carthenia Jefferson, JD, RN, Candace Grimes, RN, Deborah ThedfordZimmerman, RN, and Deborah Andrews, MSHSA, RN, President BBNA. NBNA meets NSNA Members Jacinta Williams and Maisha Arnold Attending the National Student Nurses’ Association Convention in Pittsburgh, Pennsylvania, we were elated to see the National Black Nurses’ Association booth. We were impressed with the passion Marcia Lowe, MSN, RN, NBNA Board Member and Estella Lazenby, NBNA Membership Coordinator, had for the organization as they recruited new members to join. The information provided on membership, programs and events, scholarships, and involvement was very resourceful and motivated us to share with our peers to encourage them to join as well. We understand the importance of Black nurses empowering one another for the betterment of quality health care and addressing health disparities within our community. For this reason, we are committed to joining the efforts of the National Black Nurses Association in implementing strategies that ensure access to health care equal to health care standards of society. Jacinta Williams is a member of the Chicago Chapter National Black Nurses Association. She is currently a BSN student and the Project Manager for the Student Nurses’ Association at Resurrection University in Oak Park, IL and is expected to graduate in May 2013. Maisha Arnold is enrolled in the BSN program at Resurrection University located in Oak Park, IL. She is expected to graduate in May of 2013. Maisha is currently serving as VicePresident for Resurrection University’s Student Nurses’ Association (RUSNA). CONTINUED ON PAGE 32 32 — NBNA.org MEMBERS on the MOVE NBNA meets NSNA Members (continued) Estella Lazenby, Membership Services Manager for NBNA and NBNA membership chairperson, Marcia Lowe, MSN, RN, NBNA Director, participated as vendors at the National Student Nurses’ Association 60th Anniversary Convention & Alumni Reunion. The convention was held in Pittsburgh, PA, at the David L. Lawrence Convention Center from April 11-15, 2012. The theme of the convention was, “Spanning the distance: 60 years of the Evolving Nurse.” This was the first time that NBNA had an opportunity to participate as a vendor. Students from all over the United States participated in the conference and visited the booth. Many of the students stated that they did not know there was a National Black Nurses Association and many were curious to see how they could become a part. Many received literature to take home to become a member, how to start a chapter, and regarding the conference in Orlando, FL. Students were encouraged to share the information with their fellow colleagues as well. Students who joined on site received a NBNA pin, backpack or umbrella. Faculty of schools visited the booth and expressed an interest to have their students become involved. One myth that was dispelled was that students thought they had to be African American to join. Our participation in this conference is the beginning of many efforts to ensure that NBNA is visible among other organizations. So, here’s to a great partnership with the National Student Nurses Association. New York Black Nurses Association (NYBNA) NYBNA is collaborating with one of our new members, Courtney White, to work on a project to address obesity. The project is in its early stage and is called Healthier Nurse Campaign. It is a two part process influenced by Roy’s Adaptive Model Theory to ascertain if the appearance of an unhealthy nurse contributes to an ineffective adaption of the patient: Data will be collected from both the nurses and patients view-point, analyzed for any significant findings and recommend changes/implementations to aid with effective adaption. A four-phase weight-management program will be implemented and run concurrently to support any collected data. The 24th Annual National Black Nurses Day Celebration was held at the Hospital for Joint Diseases at NYU Langone Medical Center in New York City. The theme was, “Nurses Alleviating Global Health Crises.” Rev. Dr. Rose EllingtonMurray received chapter’s service award. Dr. Deidre Walton, President NBNA was in attendance. Jackie Rowe-Adams was the recipient of the Community Award. Sponsors of the event included Theta Chi Chapter of Chi Eta Phi Sorority, Inc., New York Black Nurses Association, Inc., Queens County Black Nurses Association, Inc., Kappa Eta Chapter of Chi Eta Phi Sorority, Inc. and the Caribbean American Nurses Association, Inc. NYBNA members attended the 24th Annual Black Nurses Day on Capitol Hill: Bernice Headley, RN, Hayward Gill, Jr., RN, Imani Kinshasa, RN, and Mirian Moses, RN. Members of NYBNA attended the 9th Annual UFT Heritage Committee Dinner Dance Members included Bernice Headley, Marcia Skeete, Jean Straker, Susan Thompson (President), Jasmin Waterman and Jacquetta Miller Whaley, RN. Mirian Moses, MS, RN, and Jacquetta Miiler Whaley, RN, attended the NYU College of Nursing 21st Annual Estelle Osborne Recognition Ceremony. Miriam also attended the National Black Nurses Celebration held by Chi Eta Phi Sorority and Northern New Jersey Black Nurses Association in Newark. C. Alicia Georges, EdD, RN, FAAN, Nursing Education Chair at Lehman College, was the keynote speaker at the first MSN graduating class of Lehman College in partnership with Bronx Lebanon Hospital. Dr. Georges was also honored as an “Exceptional Black College of Nursing Alumni” at Seton Hall University in Orange, NJ. Bernice Headley, RN, Miriam Moses, MS, RN, Joyce Fowler, RN and Yvonne Plummer, RN, attend the Hospital Auxillary Volunteer Achievement Award Ceremony held at The Waldorf Astoria in NYC. Etta White, RN, was honored at the National Action Network Women Auxiliary, NYC Chapter, 16th Annual “Woman of Excellence and Man of Vision” Award Ceremony and Luncheon. Etta also received the Philanthropic Award from the North Bronx Section for assisting college students with financial support. Etta was also presented with the Florence Nightingale Award for Leading and Advancing the Profession of Nursing by the James J. Peters Veterans Administration Medical Center Imani Kinshasa, RN, was honored at the Butler Memorial United Methodist Church 100th Anniversary Luncheon Celebration. MEMBERS on the MOVE NBNA.org — 33 Council of Black Nurses, Los Angeles (CBNLA) South Eastern Pennsylvania Area Black Nurses Association (SEPABNA) Eric J. Williams DNP, RN, was appointed to the California Action Coalition fun development committee. The responsibility of the coalition is to secure funding for the activities of the coalition. Dr. Williams was a speaker at the Chi Eta Phi Southwest Regional conference. The theme was, The Importance of Education for the Improvement of Quality Patient Care. The IOM report and social determinants of health integration into nursing curriculums was a major focus of the presentation. Dr. Williams was selected by the Assembly of Men in Nursing to serve as a mentor for a male nursing student in a Bachelor of Science in Nursing program. This pilot program identified twenty mentors and mentees across the United States to participate in a year-long program prior to full implementation of the program. Dr. Williams was also appointed to serve on the board of directors of the Rainbow Academy Foundation. The Academy offers a culturally relevant curriculum and serve many economically disadvantage children. “Dr. Williams’ cultural competence background and educational leadership experience will complement the board’s mission and objectives,” stated the president of the Rainbow Academy Foundation. The founder of the South Eastern Pennsylvania BNA, Dr. Lucy E. Yates, was among those who supported the Black Women’s Health Alliance during an informational session with Secretary of Human Services, Kathleen Sebelius, at the African American Museum, Philadelphia, PA. The focus was an in depth testimony of the positive impact of the Health Care Act of a variety of community members. Denise Pinder, RN, Vice President SEPABNA, and Dr. Yates conducted mental health screenings while collaborating with the Chester Alumnae Chapter of Delta Sigma Theta Sorority in Oakeola, PA. This powerful workshop entitled, “My Cry in The Dark” upholds the premise that mental health is real health. As a part of Black History Month, Dr. Yates presented, “Heart Healthy African American Women” for the Good Neighbor Senior Center, Darby Twp. PA. She also led a lively multifaceted health awareness discussion with the women of 2nd Baptist Church of Media, PA. Minie Murphy, RN, Treasurer SEPABNA, Gerri Yancey, RN, and Dr. Yates participated in a Career Day event at the Global Learning Academy Charter School, Philadelphia, PA. Nevada Black Nurses Association (NBNA) Congratulations... Congratulations to chapter member, Mary Derrickson Johnson, RN, who resides in Palmer, AK, for successfully completing a parish faith based program for registered nurses; Juanita Jones, MS, RN, President SEPABNA, who graduated from the Master in Management program at GwyneddMercy College, Gwynedd Valley, PA; and to Karen King Shannon, BSN, RN, Immediate past president SEPABNA, who graduated from Gwynedd-Mercy College with a Bachelor of Science in Nursing. Memphis Riverbluff Black Nurses Association (MRBNA) Debra A. Toney, PhD, RN, FAAN, NBNA Immediate Past President, was selected to serve as chair of the Nevada Action Coalition. Dr. Toney was the speaker at the White House African American Policy Forum. She presented on the topic, “What the Affordable Care Act Means to African Americans: Identifying Issues Critical to the African American community and the nation.” Dr. Toney was also elected treasurer of the RWJ Executive Nurse Fellows Alumni Association. Dr. Toney was selected to carry the Olympic Flame in recognition of her personal and professional dedication to promoting healthy lifestyles and for empowering civic engagement in communities. Rosie Curry Connard, RN, retired on April 4th after working at Baptist Hospital for 44 years. She started her nursing career as an LPN. Rosie is retiring as a Nursing House Supervisor. Dorothy Hall, RN, is a retired nurse. She was presented with the the Community Volunteer Award of the Year for 20102011. Dorothy is a community health advisor and works with Community Action Team of Shelby County (CATS). CATS is a community outreach program that supports the fight against breast and cervical cancer in African American women by providing education and increase screening resources. 34 — NBNA.org MEMBERS on the MOVE Northern New Jersey Black Nurses Association (NNJBNA) Norma L. Rodgers, BSN, RN, CCRA, recently won the election for the New Jersey State Nurses Association (NJSNA). Norma is President-elect. She was the President of the NJSNA Region 3. Norma is currently the Senior Site Manager for ReSearch Pharmaceutical Services. The NNJBNA presented an educational session titled, “How to Effectively Conduct Chapter Meetings and other Business.” The session presenter was Ronnie Ursin, DNP, RN, NEA-BC, NBNA Parliamentarian and President of the Black Nurses Association of Baltimore. The chapter and invited guested had an engaging dialogue on facilitating meetings, rules of debate, constructing amendments, voting, bylaws, and more. Rosemary Allen-Jenkins, MSN, RN, (right) was elected as the President of NNJBNA. (above) Dr. Ronnie Ursin, NBNA Parliamentarian, with members of the Northern New Jersey BNA. (below) Northern New Jersey Black Nurses Association members in attendance at their educational session on, “How to Effectively Conduct Chapter Meetings and other Business” presented by Dr. Ronnie Ursin, with Rosemary Allen-Jenkins, newly elected President (sitting center left) and Sandra Baker, Immediate Past President (sitting center right) MEMBERS on the MOVE NBNA.org — 35 Black Nurses Association of Greater Washington DC Area (BNAGWDCA) The BNAGWDCA held their 32nd Annual Salute to the Black Nurse of the Year and Scholarship Awards Luncheon at the Martins’ Crosswinds in Greenbelt, MD. The theme of the program was, “Perspectives on Nursing: A Past to Remember, A Future to Shape.” Over 400 guests attended the luncheon to include many chapter Founders and Lifetime Members, active duty and retired members of the Army and USPHS, Dr. Bernadine Lacey, and faculty and students from Delaware. The keynote presenter for the program was Dr. Barbara L. Nichols, CEO of Barbara Nichols Consulting, former CEO of the Commission on Graduates for Foreign Nursing Schools (CFGNS) and past ANA President. The 2012 Nurse of the Year was Ottamissiah Moore, BS, LPN, WCC, CLNI. Ottamissiah was the first LPN to receive this annual chapter award. Tricia K. Baptiste, SN, was the recipient of the 2012 Johnella Banks Memorial Scholarship. Appreciation to Howard University Hospital Division of Nursing for providing the continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Ottamissiah Moore, BS, LPN, WCC, CLNI Patricia Tompkins, RN, Past president of BNAGWDCA, represented the chapter on the DC Tobacco Free Coalition, met with other coalition members and the American Lung Association to launch Tobacco Control Advocacy Day on March 23, 2012. Advocacy Day participants met members of the DC City Council to drive support for tobacco funding during a week when the City Council was reviewing the 2013 Budget. Patricia Tompkins also discussed, “Age Proof Your Brain: Ten Easy Ways to Stay Sharpe Forever” at the Gethsemane Baptist Church, Washington, DC, Praise Luncheon for Seniors on April 2, 2012. As part of the chapter’s 2012 HIV/AIDS training agenda and in partnership with Simply Speaking HIV, eight BNA GWDCA members attended an outstanding CE program by Richard Elion, MD, entitled, “Understanding HIV/AIDS Testing and its Impact on Treatment.” The event was held on March 28, 2012 at the Channel Inn, Washington, DC. Julia Ugorji, MSN, RN, recently received the master of science in nursing degree in nursing education from the Grand Canyon University. Ms Ugorji has been an active member of the chapter since she joined in 2008. She currently serves on the community service and scholarship committees. Julia attended the National Health Promotion Summit in Washington, DC that was held April 10-11, 2012. Barbara Baskerville, RN, Lillian Wade, RN, Barbara Patterson, RN and Patricia Tompkins, RN, attended the 2012 Congressional Black Caucus Spring Health Braintrust/ National Minority Quality Forum 9th Annual Leadership Summit and Awards Dinner held April 23-24, 2012. Lois Bowman, RN, Doris Hughes, RN and Margaret Pemberton, RN, continued a long standing effort to share the goals of the BNAGWDCA Make a Difference: Choose Nursing Program with the Washington Middle School for Girls. These members meet with the students at least three times each school year to talk about the profession of nursing, what nurses do and what it takes to become a nurse. Beverly Dandridge, MSN, FNP, MSAJS, CCHP, CAPT USPHS, participated with the 21st Annual USPHS Nursing Recognition Day program on May 4, 2012 at the Natcher Conference Center on the NIH campus in Bethesda, MD. The theme for the conference was, “Nursing on the Forefront: United in Health.” CAPT Dandridge presented a poster entitled, “Affordable Care Act: What Does It Mean for Correctional Health?” Sonia Swayze, RN, Vice-President BNAGWDCA, was the recipient of the USPHS 2012 Rear Admiral Julia R. Plotnick Publication Award for Health/Nursing policy for her article, “Promoting Safe Use of Medical Devices.” The article was co-authored and published in OJIN on October 17, 2012. The award was presented on Friday, May 4, 2012, at the Natcher Conference Center, on the National Institutes of Health Campus, Bethesda, MD, during the USPHS Annual Nurse Recognition Day (NRD) program. During Nurses Week 2012, Velma Henderson, RN, presented, “Embracing Transition” at Saint Elizabeth’s Hospital in Washington, DC, “Caring for Self” at United Medical Center, Washington, DC, and “Nurse to Nurse Violence” at Prince Georges Hospital, Cheverly, MD. All presentations were in conjunction with the 2012 Nurses Week. Dr. Eva Stephens, former faculter member at Howard University, was awarded the Dr. Montague Cobb Award for her community service work to eradicate health disparities in the black community by the NAACP. The award was presented at the NAACP 102nd National Convention in Los Angeles, CA. This award is given to those that have a special achievement in social justice, health justice, health education /promotion, fundraising and research. Dr. Stephens implemented a research study on obesity with the BNAGWDCA. Dr. Stephens is a certified Family Nurse Practitioner, accepted a position as Associate Professor at University of Texas Medical Branch-Galveston, TX. She has recently accepted a promotion as “Nurse Educator Track Administrator” effective the fall 2012. 36 — NBNA.org MEMBERS on the MOVE Fort Bend County Black Nurses Association (FBCBNA) Fort Bend County Black Nurses Association Board of Directors Fort Bend County Black Nurses Association held a successful 11th President’s Scholarship & Awards Ball. Dr. Deidre Walton, NBNA President, and members of the Black Nurses Association of Greater Houston were in attendance. Dr. Alma A. Allen, Texas State Representative, was the mistress of Ceremonies. Dr. Mary Ellen Ross, Scholarship Chairperson, presented four $1,000 scholarships to the following nursing students: Tina Battle, Danielle Davis, Brittany Leffall, and Jacqueline Wilmore. The Lifetime Achievement Award recipient was JoAnn Goodie, RN. Janice Sanders, RN, was name Nurse of the Year. Dr. Ahia Shabass, was name Volunteer of the Year. Ethelene Wilmore, RN, was recognized as Board Member of the Year. Bessie Trammell, RN, received the award for Recruiter of the Year. The FBCBNA event was faciliated by Yvonne Olusi, RN, President, Lola Denise Jefferson, BSN, CVRN, NBNA 2nd Vice President, and Octavia Sherman, RN, Chair of the President’s Scholarship and Awards Ball. (left) Dr. Mary Ellen Ross, Chair, with scholarship winners Danielle Davis, Tina Battle, Britany Leffall, Jacqueline Wilmore, and Alma Allen, Texas State Representative. Greater Gainesville Black Nurses Association Vonchea Bushea, RN, President, Greater Gainesville BNA Atlanta Black Nurses Association (ABNA) Patty Palmer, RN, NBNA Student Representative Nurses Advocating, Leading, and Caring The Greater Gainesville Black Nurses Association held numerous activities during the 2012 Nurses Week to celebrate the many contributions that nurses make to the profession everyday. The week long activities were attended by many and included a Proclamation from the city of Gainesville at the City Hall, a prostate cancer workshop in conjunction with the Relay for Life, the annual scholarship and awards luncheon held at Gainesville Public Library, worship service at Mt. Olive A.M.E. Church, and a student reception and membership drive at the Broadmoor Club House, Gainesville, FL. Dr. Deidre Walton, NBNA President, NBNA Board of Directors, Laurie C. Reid, MS, RN, Atlanta BNA President, and the officers and members of the Atlanta Black Nurses Association congratulates Patty Palmer on successful completion of the RN program at South Georgia College. Patty graduated May 3, 2012. She was also successful on the NCLEX. Patty is currently working as an RN in the Orthopedics Department at Tift Regional Medical Center, Tifton, GA. NBNA.org — 37 MEMBERS on the MOVE Black Nurses Association, Miami The First Annual Professional Nursing Organization’s Day In an effort to find out what nursing organizations a group of on-line Transitional RN-BSN students at Miami Dade College belonged to, I posed the question, “What professional nursing organizations do you belong to, why or why not?” I was totally shocked to learn that only about seven out of 65 students belonged to any professional nursing organization. Of course, students had good legitimate reasons for not belonging or associating with these organizations. Some of the common reasons centered around 1) finances, 2) time, 3) child care, 4) confusion about which organization to join and 5) too many family responsibilities. I then asked a second on-line group of Transitional RN-BSN students the same questions, and received very similar responses. As a recent member of the Florida Nurses Association (FNA), and the current President of the Miami Chapter of the National Black Nurses Association (NBNA) here in Miami, Florida, I wondered if it was possible to develop a collaboration between the two organizations to see how we could help the students. The Black Nurses Association (BNA) has also been struggling with how to increase its’ membership. One of the organization’s National goals is to increase the membership in the organization. While a goal of the Miami Chapter BNA is to build useful collaborations with other nursing organizations. To help the students learn about the various organizations, including the Black Nurses Association, I thought it was imperative to do something right away that was drastic and that made people stand up and take notice. After pondering for weeks over this, I decided that I needed to collaborate with many nursing organizations and allow the students to become aware of some of the benefits afforded to them by their membership. Hence, the “First Annual Professional Nursing Organizations’ Day” was developed. I invited the presidents and a representative from eight different professional nursing organizations in the South Florida area to attend an event. The event was held in conjunction with Miami Dade College’s School of Nursing program. Miami Dade College was able to sponsor the entire event. The groups invited included: Florida Nurses Association (FNA), Haitian American Nurses Association (HANA), National Hispanic Nurses Association (NAHN), Philippine Nurses Association of South Florida (PNASF), Jamaican Nurses Association of South Florida (JNASF), Miami Dade College, Student Nurses Association (MDC-SNA), Indian Nurse Association of South Florida (INASF), and the Black Nurses Association (BNA). The groups were asked to come together for one day to inspire and encourage nursing students to learn what these organizations were all about. Each President or a representative from the various groups was asked to talk about what their organization was doing for nurses in the areas of mentoring and leadership. Students and faculty from Miami Dade College, Barry University, Florida International University, University of Miami, Broward College and all Registered Nurses and Advanced Registered Nurse Practitioners from the South Florida area were invited. The event allowed participants to talk with each of the groups and gather information. The guest speaker for the event was Ms. Willa Fuller, Executive Director of Florida Nurses Association, Dr. Georgia Labadie, Professor Emeritus, from the University of Miami, and Ms. Annette Gibson, Professor from Miami Dade College’s School of Nursing. The event was extremely successful. Over 200 participants (standing room only) came out to learn about the organizations. The organizations were prepared with pamphlets, newsletters, and of course applications for membership. This turned out to be a win-win situation for all involved. I was overwhelmed with the responses from students, nurses and faculty. I am sure that each organization was able to gain some new members from this wondrous event. In fact, before the event was over, students and nurses asked if we could have the same event every year, but in a bigger auditorium. Columbus Georgia Metro Black Nurses (CBNA) CBNA participated in the Annual Health Fair sponsored by St. Mary Road United Methodist Church on April 21, 2012. CBNA provided Emotional Vital sign screening and the results were reviewed with participants. CBNA hosted the Annual X-cellence Award Banquet at Regimental Hall in Fort Benning, GA on May 19, 2012. This annual event is in recognition of Nurses Week and provides scholarships to aspiring nursing students. Florence Miller, MSN, RN, completed the third level of the Healing Touch program from April 21st to 22nd. Florence has used the concepts/skills in the program to provide healing touch sessions at her church and at local health events. Stephanie Gordon, BSN, RN, successfully completed her nursing training at Columbus State University in Columbus, GA. Stephanie has been accepted into the Master in Nursing Program at Columbus State University in Columbus, GA. She accepted a position as an RN at St. Francis Hosital. Stephanie is also a member of Sigma Gamma Rho Sorority, Collegiate Women of Wisdom and is the Student Nurse Recruiter for CBNA. Eileen Albritton, MSN, RN, retired from the Columbus Health Department after 34 years of service as the District Nurse and Clinical Director for the Columbus Georgia Health Department. Eileen currently provides training on Effective Interviewing Skill and is working to develop an outreach ministry program at her church. Georgia Stampley, RN, has been recognized by the Central District Lay Organization for over 20 years of service. Georgia was selected and received the Outstanding Senior Distinction Award honor on May 26, 2012 by the J.U.G.S. International Organization at the Green Island Country Club. Agnes Shelton, RN, and Gwendolyn McIntosh, RN, are members of the Domestic Violence Round table. Gwendolyn is the representative for CBNA. 38 — NBNA.org MEMBERS on the MOVE Bay Area Black Nurses Association ABOVE: The Steptoe Group, Dr. Debow, Dr. Shirley Evers-Manly, Congresswoman Donna Christensen, Congresswoman Barbara Lee, & Kim Scott, Bay Area BNA President and members. Kimberly Scott, MSN, MBA, RN, Bay Area BNA President at the Flo Stroud Conference with high school students from Bishop O’Dowd High School in Oakland, CA. The Bay Area Black Nurses Association (BABNA) held their 2nd Annual Florence Stroud Black History Conference Series in February, 2012. The title was, “Joining Forces: Answering the Call to Support Military Families.” The chapter partnered with the University of San Francisco’s (UCSF) Department of Nursing. Congresswomen Barbara Lee, CA (D) and Donna Christensen Virgin Islands (D) were the Keynotes. Dr. Shirley Evers-Manly was the producer of the conference. She is the Associate Dean of Academic Affairs of the nursing school at UCSF and a member of BABNA. The discussion focused on how the BABNA, with community partners, could support military families. A panel discussion of Veterans, counselors, and family members of veterans was held to understand the challenges that are faced and how the community (i.e., BABNA) can support men and women as they adjust back into civilian life. The chapter was enlightened on the how to get funds to help support military families in the community. The discussion helped to develop a task force of interested individuals to answer the call. The chapter also had the opportunity to share with the two Congresswomen the need for jobs and new graduate training programs in the acute care settings in California and across the US. They were eager listeners. They voiced how they were not aware of the issue, and actually shocked that there aren’t many jobs for the new graduate nurse. They reported that they would take this information back to the White House/ Congress. Since the conference, Barbara Lee has asked the BABNA for more information on this topic when she went to the Appropriations Committee Hearing with Secretary Sebilius. The IOM report was discussed with the congresswomen. The chapter was encouraged to write legislative representatives informing them how the community is affected. There were over 200 in attendance. The Air Force, Navy, and Army had exhibit tables. South Bay Area of San Jose BNA members, Dr. Irene Daniel-Lewis, NBNA Treasurer and Sandra McKinney, RN, and Sharon T. Smith, RN, San Diego BNA President, were in attendance. Greater Gainesville Black Nurses Association (GGBNA) Greater Gainesville BNA was mentioned in a local newspaper for assisting in the community FluMist program that was recently recognized as the most effective flu prevention program in the nation. MEMBERS on the MOVE NBNA.org — 39 NBNA Member Highlights in Photos Members of the Black Nurses Association of Greater Washington DC Area participate in the 32nd Annual Salute to the Black Nurse of the Year and Scholarship Awards Luncheon Military personnel in attendance at the Black Nurses Association of Greater Washington DC Area 32nd Annual Salute to the Black Nurse of the Year and Scholarship Awards Luncheon 40 — NBNA.org NBNA Chapter Websites Alabama Birmingham BNA.......................................www.birminghambna.org Arizona Greater Phoenix BNA................................www.bnaphoenix.org California Council of BN, Los Angeles......................www.cbnlosangeles.org Inland Empire BNA....................................www.iebna.org San Diego BNA..........................................www.sdblacknurses.org S. Bay Area of San Jose BNA...................www.sbbna.org Colorado Eastern CO Council of BN (Denver)..........www.coloradoblacknurses.org Connecticut Northern Connecticut BNA.......................www.ncbna.org Southern Connecticut BNA.......................www.scbna.org District of Columbia BNA of the Greater DC Area.....................www.bnaofgwdca.org Florida BNA, Miami................................................www.bna-miami.org Central Florida BNA...................................www.cfbna.org First Coast BNA.........................................www.fcbna.org St. Petersburg BNA...................................www.orgsites.com/fl/spnbna Georgia Atlanta BNA...............................................www.atlantablacknursesassociation.com Concerned BN of the Central Savannah River Area.................www.cncsra.org Savannah BNA...........................................www.sb-na.org Hawaii Honolulu BNA............................................www.honolulublacknures.com Illinois Chicago Chapter BNA...............................www.chicagochapternbna.org Indiana BNA of Indianapolis...................................www.bna-indy.org Kentucky KYANNA BNA (Louisville)..........................www.kyannabna.org Louisiana New Orleans BNA......................................www.neworleansbna.com Shreveport BNA.........................................www.sbna411.org Maryland BNA of Baltimore.......................................www.bnaofbaltimore.org Massachusetts New England Regional BNA......................www.nerbna.org Michigan Greater Flint BNA.......................................www.gfbna.org Mississippi Mississippi Gulf Coast BNA......................www.mgcbna.org Missouri Greater Kansas City BNA..........................www.gkcblacknurses.org Nevada Southern Nevada BNA..............................www.snbna.net New Jersey Concerned BN of Newark.........................www.cbnn.org Northern New Jersey BNA........................www.nnjbna.com New York New York BNA...........................................www.nybna.org Queens County BNA.................................www.qcbna.com North Carolina Central Carolina BN Council.....................www.ccbnc.org Ohio Columbus (Ohio) BNA...............................www.columbusblacknurses.org Youngstown-Warren BNA.........................www.ywobna.org Oklahoma Eastern Oklahoma BNA............................www.eobna.org NBNA.org — 41 PENNSYLVANIA South Eastern PA Area BNA.....................www.sepabna.org Tennessee Nashville BNA............................................www.nbnanashville.org Texas BNA of Greater Houston...........................www.bnagh.org Metroplex BNA (Dallas).............................www.mbnaofdallas.org Wisconsin Milwaukee Chapter NBNA.........................www.mcnbna.org screening (continued from page 8) Conclusion The American Cancer Society (2012) reports African American women are more likely to die from breast cancer than any other ethnic group. Consequently, it is imperative that African American women become more informed about breast cancer. African American women must be educated about the risk factors, the deterrents to breast cancer screening, and the strategies necessary to prevent, detect, and treat breast cancer. It is critical that more research and education be conducted to provide the support and resources needed to reduce the mortality and prevalence of breast cancer in African American women. References American Cancer Society. (2012). Cancer facts and figures. Atlanta, GA: Author. Baskin, M. L., Gary, L. C., Hardy, C. M., Yu-Mei, S., Scarinci, I., Fouad, M. N., & Partridge, E. E. (2011). Predictors of retention of African American women in a walking program. American Journal of Health Behavior, 35(1), 40-50. Kelley, M. (2011). Recruitment of African American women for research on breast cancer early detection: using culturally appropriate interventions. Southern Online Journal of Nursing Research, 11(1). McCaskill, J. (2006). African American women, self-breast examination and Health Belief Model: implications for practice. JOCEPS: The Journal of Chi Eta Phi Sorority, 52(1), 33-37. Phillips, J., & Cohen, M. Z. (2011). The meaning of breast cancer risk for African American women. Journal of Nursing Scholarship, 43(3), 239-247. doi:10.1111/j.1547-5069.2011.01399.x Ravert, P., & Huffaker, C. (2010). Breast cancer screening in women: An integrative literature review. Journal of The American Academy of Nurse Practitioners, 22(12), 668-673. doi:10.1111/j.1745-7599.2010.00564.x United States Census. (2010). Population by sex and age. Retrieved on May 11, 2012 from http://2010.census. gov/2010census/ Charlotte M. Wood is a PhD candidate. She is an assistant professor in the College of Health Professions, Helene Fuld School of Nursing at Coppin State University. Dr. Joan S. Tilghman is Professor and Associate Dean, Helen Fuld School of Nursing at Coppin State University. She earned her Ph.D. in Transcultural Nursing at the University of Miami in Coral Gables, Florida. Dr. Tilghman is a nationally certified Women’s Health Nurse Practitioner. call to action (continued from page 15) n Developing strategies aimed at increasing breastfeeding initiation and duration among African American women that are culturally sensitive and appropriate, recognizing that there are historical contexts that may act as deterrents for breastfeeding. n Supporting workplace initiatives for breastfeeding, specifically where many African American mothers work such as service settings, factories or other work place settings which have traditionally posed major obstacles for women desiring to maintain exclusive breastfeeding for 6 months. n Ensuring that our NBNA members who work in settings that provide care for mothers and possess the basic skills and competencies advocated by the USBC: Breastfeeding Competencies for Health Care Professionals n Encouraging NBNA members should consider achieving certification as lactations specialist, increasing the diversity among lactation specialist , thus making services more available to women of color as well as lend itself to the development of more culturally relevant strategies to increase the initiation and duration of breastfeeding. References American Academy of Pediatrics (2005). Policy statement: Breastfeeding and human milk. Pediatrics, 115(2), 496-506. Health and Human Services (2011). Executive Summary: The Surgeon General’s Call to Action to Support Breastfeeding. Washington, D.C., Office of the Surgeon General. Chung, S., Raman, G., Chew, P., Magula, N., DeVine, D., Trikalinos, T., & Lau, J. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report/Technology Assessment. (133). Prepared by Tufts New England Medical Center Evidenced based practice center, AHQR Publication No. 07-E007, Rockville, MD. Patton, L.M., Alexander, J.L., & Nowson, C.A.,(2003). Pregnancy and lactation have no long term deleterious effect on measures of bone mineral in healthy women: a twin study. American Journal of Clinical Nutrition, (77), 707-714. Sharps, P. (2009). Breastfeeding: A strategy for preventing maternal and child health disparities. Medications and More. 3(10), 3-4. Voices for American Children (2010). A Call to Action On Breastfeeing. Retrieved on May 11, 2012 from http://www.voices.org. Dr. Phyllis W. Sharps is Professor and the Associate Dean, Community and Global Programs at Johns Hopkins University School of Nursing in Baltimore, MD. Dr. Sharps is the NBNA Representative to United States Breastfeeding Committee. NBNA CHAPTER PRESIDENTS ALABAMA BIRMINGHAM BNA (11) Deborah Andrews Birmingham, AL MOBILE BNA (132) Dr. Yolanda Turner Mobile, AL MONTGOMERY BNA (125) Tonya Blair Birmingham, AL ARIZONA GREATER PHOENIX BNA (77) Dr. Monica Ennis Phoenix, AZ ARKANSAS LITTLE ROCK BNA OF ARKANSAS (126) Cheryl Martin Little Rock, AR CALIFORNIA BAY AREA BNA (02) Kimberly Scott Hayward, CA COUNCIL OF BLACK NURSES, LOS ANGELES (01) Joyce Spalding Los Angeles, CA INLAND EMPIRE BNA (58) Sandra Waters Riverside, CA SAN DIEGO BNA (03) Sharon Smith San Diego, CA SOUTH BAY AREA BNA (San Jose) (72) Sandra McKinney San Jose, CA COLORADO EASTERN COLORADO COUNCIL OF BLACK NURSES (DENVER) (127) Chris Bryant Denver, CO CONNECTICUT NORTHERN CONNECTICUT BNA (84) Lisa Davis Hartford, CT SOUTHERN CONNECTICUT BNA (36) Katherine Tucker New Haven, CT DISTRICT OF COLUMBIA BNA OF GREATER WASHINGTON, DC AREA (04) Diana Wharton Washington, DC FLORIDA BIG BEND BNA (Tallahassee) (86) Hester O’Rourke Blountstown, FL BNA, MIAMI (07) Lenora Yates Miami Gardens, FL BNA OF TAMPA BAY (106) Rosa Cambridge Tampa, FL BNA OF THE TREASURE COAST (122) Felicia Stewart Vero Beach, FL BROWARD COUNTY FLORIDA BNA (120) Cornell Hampton Hollywood, FL CENTRAL FLORIDA BNA (35) Constance Brown Orlando, FL CLEARWATER/LARGO BNA (39) Audrey Lyttle Largo, FL FIRSTCOAST BNA (103) (JACKSONVILLE) Pearl Rigby Jacksonville, FL GREATER GAINESVILLE BNA (85) Voncea Brusha Gainesville, FL PALM BEACH COUNTY BNA (114) Louise Aurelien RoyalPalm Beach, FL ST. PETERSBURG BNA (28) Janie Johnson St. Petersburg, FL GEORGIA ATLANTA BNA (08) Laurie Reid College Park, GA COLUMBUS METRO BNA (51) Gwendolyn McIntosh Columbus, GA CONCERNED NATIONAL BLACK NURSES OF CENTRAL SAVANNAH RIVER AREA (123) Beulah Nash-Teachey Martinez, GA SAVANNAH BNA (64) Lou Roberson-Harris Savannah, GA HAWAII HONOLULU BNA (80) Angelo Moore Aiea, HI ILLINOIS CHICAGO CHAPTER BNA (09) Carolyn Rimmer Chicago, IL INDIANA BNA OF INDIANAPOLIS (46) Sandra Walker Indianapolis, IN NORTHWEST INDIANA BNA (110) Mona Steele Merrillville, IN KANSAS WICHITA BNA (104) Peggy Burns Wichita, KS KENTUCKY NEVADA PENNSYLVANIA KYANNA BNA, LOUISVILLE (33) Virginia Bradford Louisville, KY SOUTHERN NEVADA BNA (81) Ann Hall Las Vegas, NV LOUISIANA NEW JERSEY ACADIANA BNA (131) Jeanine Thomas Lafayette, LA NEW ORLEANS BNA (52) Trilby Barnes-Green New Orleans, LA SHREVEPORT BNA (22) Dr. Katheryn Arterberry Shreveport, LA NEW ENGLAND REGIONAL BNA (45) Margaret Brown Roxbury, MA WESTERN MASSACHUSETTS BNA (40) Gloria Wilson Springfield, MA CONCERNED BLACK NURSES OF CENTRAL NEW JERSEY (61) Sandra Pritchard Neptune, NJ CONCERNED BLACK NURSES OF NEWARK (24) Lynda Arnold Newark, NJ MID-STATE BNA OF NEW JERSEY (90) Rhonda Garrett Somerset, NJ NEW BRUNSWICK BNA (128) Barbara Burton New Brunswick, NJ NORTHERN NEW JERSEY BNA (57) Sandra Baker Newark, NJ SOUTH JERSEY CHAPTER OF THE NBNA (62) Gail Edison Williamstown, NJ PITTSBURGH BLACK NURSES IN ACTION (31) Diana Byas Pittsburgh, PA SOUTHEASTERN PENNSYLVANIA BNA (56) Juanita Jones Philadelphia, PA MICHIGAN NEW YORK DETROIT BNA (13) Nettie Riddick Detroit MI GRAND RAPIDS BNA (93) Earnestine Tolbert Grand Rapids, MI GREATER FLINT BNA (70) Darnita Evans Flint, MI KALAMAZOO-MUSKEGON BNA (96) Birthale Archie Kentwood, MI SAGINAW BNA (95) Archia Jackson Saginaw, MI NEW YORK BNA (14) Susan Thompson New York, NY QUEENS COUNTY BNA (44) Chidimma Azoro Cambria Heights, NY WESTCHESTER BNA (71) Altrude Lewis-Thorpe Yonkers, NY MARYLAND BNA OF BALTIMORE (05) Patricia Medley Baltimore, MD MASSACHUSETTS MINNESOTA NORTH CAROLINA CENTRAL CAROLINA COUNCIL (53) Helen Horton Durham, NC OHIO GREATER KANSAS CITY BNA (74) Jean Winfield Kansas City, MO AKRON BNA (16) Cynthia Bell Akron, OH BNA OF GREATER CINCINNATI (18) Jennifer Pearce Cincinnati, OH CLEVELAND COUNCIL BNA (17) Peter Jones Cleveland, OH COLUMBUS BNA (82) Stephanie McCoy Columbus, OH YOUNGSTOWN WARREN BNA (67) Lynn Hines Youngstown, OH NEBRASKA OKLAHOMA OMAHA BNA (73) Aubray Orduna Omaha, NE EASTERN OKLAHOMA BNA (129) Wendy Williams Tulsa, OK MINNESOTA BNA (111) Shirlynn LaChapelle Minneapolis, MN MISSISSIPPI MISSISSIPPI GULF COAST BNA (124) Charlotte Gore Gulfport, MS MISSOURI SOUTH CAROLINA TRI COUNTY BNA OF CHARLESTON (27) Debbie Bryant Charleston, SC TENNESSEE MEMPHIS-RIVERBLUFF BNA (49) Linda Green Memphis, TN NASHVILLE BNA (113) Shawanda Clay Nashville, TN TEXAS BNA OF GREATER HOUSTON (19) Ruth Caggins Houston, TX FORT BEND COUNTY BNA (107) Yvonne Olusi Missouri City, TX GREATER EAST TEXAS BNA (34) Pauline Barnes Tyler, TX GALVESTON COUNTY GULF COAST BNA (91) Patricia Toliver Galveston, TX METROPLEX BNA (DALLAS) (102) Tonya Hill Dallas, TX SOUTHEAST TEXAS BNA (109) B. Midge Jacobs Port Arthur, TX VIRGINIA BNA OF CHARLOTTESVILLE (29) Randy Jones Charlottesville, VA CENTRAL VIRGINIA BNA (130) Janet Porter Richmond, VA NBNA: NORTHERN VIRGINIA CHAPTER (115) Joan Pierre Woodbridge, VA WISCONSIN MILWAUKEE BNA (21) JoAnn Lomax Milwaukee, WI RACINE-KENOSHA BNA (50) Gwen Perry-Brye Racine, WI DIRECT MEMBER (55) *IF THERE IS NO CHAPTER IN YOUR AREA