˜e Oﬃcial International Publication of PNAA on Nursing ... · Thomas Edison State College School...

Spring-Summer 2010THE JOURNAL

OF THE

PHILIPPINENURSES

ASSOCIATION OF AMERICA

�e Official International Publicationof PNAA on Nursing Practice,

Education, Administration and ResearchVolume 2 • Number 1

Promoting Heart Health for Filipino-American Families

in HawaiiPreventive Care Paradigm:

Advance Practice Nurses as Partners

�e Impact of a Community Follow-up Program in the Management of CHF in the Elderly

Bringing Care to the Community: Primary Care on Wheels

Re�ections of PRISM: Achievements and Future Directions

715

2226

27

The Journal of the Philippine Nurses Association of AmericaEDITORIAL BOARDNelson Tuazon, MAEd, MSN, MBA, RN, NEA-BC, CPHQ, FACHERWJF Executive Nurse Fellow 2008 Editor-in-ChiefAssociate Chief Nursing ExecutiveBaptist Health System, San Antonio, [email protected]

Remedios A. Solarte, DNP, RN, NP, Executive EditorProfessor Emeritus, Oakland Community College, Waterford, Michigan

Sofy Bole, BSN, RN, CCRN, Managing EditorSenior Clinical Nurse, Critical Care Services, Saint John Macomb HospitalWarren, Michigan

Rose P. Estrada, DNP, RN, BC, CPN, On-Line EditorAssistant Professor, Track Coordinator, Nursing Informatics MSN ProgramUniversity of Medicine and Dentistry of New Jersey, School of NursingNewark, New Jersey

EDITORIAL STAFFContributing EditorsVictoria B. Navarro, MAS, MSN, RN, Director of Nursing, The Wilmer Eye Institute at Johns Hopkins, Baltimore, MD, Eastern Region; Josephine F. Villanueva, BSN, MA, NEA-BC, RN-BC, Chief, Mental Health, Patient Care Services, Veterans Affairs Health Care System, Long Beach, CA, Western Region; Merlita A. Velasquez, BSN, RN, Administrator Nursing Resource Home Health Services, Houston, TX, South Region; Matilde S. Upano, MSN, RN, FNP-BC, Nurse Practitioner – Anesthesia Perioperative Area, Riley Hospital for Children, Indianapolis, IN, North Central Region.

Feature EditorsBrenda Cohen, BSHS, RN, RNFA, CNOR, Legislative; Sarla F. Duller, MN, RN, CCRN, APN-BC, Nurse Practitioner/Liver Transplant Program Coordinator, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, Advanced Practice; Peregrin C. Francisco, BSN, MSA, RN, Manager, Sentara Healthcare, Virginia Beach, VA; Member, Virginia Board of Nursing, Regulatory; Marlon G. Saria, MSN, RN, AOCNS, Clinical Nurse Specialist-Oncology/BMT University of California, San Diego Medical Center-La Jolla, La Jolla, CA, Continuing Education; Lorraine Steefel, DNP, RN, CTN, Adjunct Professor, UMDNJ School of Nursing, Newark, NJ, and Kean University, School of Nursing, Union, NJ, Cultural Diversity.

For Advertising InquiriesSusan G. Castor, MSN, RN, CCRN, Administrative DirectorCommunity Medical Center, Toms River, New Jersey(732) [email protected]

ADVISORY BOARDAraceli D. Antonio, MS, RN, Director of Health Services, Channing House, Palo Alto, CaliforniaConsultant, NCP College of Nursing, South San Francisco, CaliforniaPresident, Philippine Nurses Association of America FoundationLolita B. Compas, MA, RN, CEN, Nursing Organizer,Economic & General Welfare Program, New York State Nurses Association, Latham, New YorkLeticia Hermosa, Ph.D., MS, JD, RN, Program Manager, Professional Development, Quality and Informatics, New England Baptist HospitalBoston, MassachusettsAttorney and Counselor-at-Law, Commonwealth of MassachusettsMay Mayor, MA, RN, Special Assistant to the Medical Center Director, Department of Veterans Affairs, James J. Peters, Bronx VAMCBronx, New YorkBetty F. Miranda, MSN, MA, RN, FAAN (Retired), Past President,Philippine Nurses Association of America, St. Pete Beach, FloridaCora Muñoz, Ph.D., RN, Professor, Capital University, School of NursingColumbus, OhioDula F. Pacquiao, Ed.D., RN, CTN, Associate Professor and Director,Center for Multicultural Education, Research and Practice CoordinatorPhD in Urban Health, University of Medicine and Dentistry of New JerseySchool of Nursing, Newark, New JerseyAmpy A. de la Paz, MSN, RN, Project Manager, Quality Management Department, HCA Bayshore Medical Center, Pasadena, TexasGayle A. Pearson, Ed.D., RN, Assistant Dean, Rutgers the State UniversityCollege of Nursing, Center for Professional Development, Newark, New Jersey Pamela E. Windle, MS, RN, NE-BC, CPAN, CAPA, FAAN, Nurse Manager,St. Luke’s Episcopal Hospital, Houston, TexasKatherine Abriam-Yago, Ed.D., R.N., Professor, San Jose State University School of Nursing, San Jose, California

INFORMATION FOR AUTHORS

STYLEThe preferred writing style for the Journal is formal. The manuscript will follow the APA style when citing references. A reference list should be provided at the end of the article with cited materials listed alphabetically.

FORMATFeature articles should be between 2,000 to 2,500 words. Manuscripts should be in Word Document. Only manuscripts submitted electronically will be accepted.

GRAPHICSAppropriate graphics will be accepted to enrich the manuscript submitted. JPG, TIF, EPS and PDF formats are acceptable for figures and photos. Specific resolutions requirements are available upon request.

COPYRIGHTUpon acceptance of submitted articles, authors agree to sign a copyright transfer form assigning all rights to the Philippine Nurses Association of America. Authors agree to obtain permission to use copyrighted materials including photos, artwork, tables etc.

RELEASEAuthors agree to obtain release from their organization or agency if mentioned in the accepted manuscripts. Authors also agree to obtain written permission from individuals included in the photographs.

DISCLOSUREManuscripts submitted to the Journal should not be under consideration by other journals. Authors must adhere to the disclosure policy of PNAA. They must disclose their relationship – financial or otherwise – with companies, agencies, facilities or organizations mentioned in the manuscript.

INTEGRITYAuthors assume full responsibility for the integrity of the facts, data and information included in the manuscript. The Journal asserts that the authors bear sole responsibility for their opinions, statements and work and that these do not represent the opinion of the PNAA or editor.

AUTHOR IDENTIFICATIONThe full credentials of the author will be included beginning with degrees, licensure, certifications, and fellowships. Multiple authors will be listed alphabetically unless otherwise specified by the authors. As appropriate, the authors’ affiliation and location will be included.

EDITINGAll manuscripts submitted will be subject to editing to meet the editorial needs and style of the Journal.

INQUIRYThe Journal encourages letters of inquiry, although unsolicited manuscripts are entertained. Due to the anticipated volume of submissions, the Editors do not guarantee editorial feedback or comments on all submitted manuscripts.

HOW TO REACH USPhone: 1-888-PNAAORGFax: 1-248-267-1187Website: www.mypnaa.orgAddress: 5113 Longview Drive

Troy, Michigan 48098-2374

The official international publication of the PNAA on nursing practice, education, administration and research.

SPRING/SUMMER 2010 • Vol. 2, No. 1 • The Journal of the PNAA2

5 Editorial Transforming Care Beyond the Four Walls of the HospitalNelson Tuazon, MAEd, MSN, MBA, RN, NEA-BC, CPHQ, FACHE

6 Op-Ed Intersectionality: A Paradigm to ConsiderYvonne Wesley, PhD, RN, FAAN

COVER STORY7 Lola’s Life Lessons: Promoting Heart Health for Filipino-American Families in Hawaii

Anne R. Leake, PhD, Venus C. Bermudo, PhD, and Marianela R. Jacob, MSN, RN

11 Presidential Perspectives The Legacy of PRISMLeo-Felix Jurado, PhD (c), RN, NE-BC, APN

12 SPECIAL FEATURE PNAA Foundation Fellow ReportSodium Restriction for Weight ReductionTess Laoruangroch, MSN, RN, FNP-BC, CCRN, MPH

FEATURE STORIES15 Preventive Care Paradigm: Advanced Practice Nurses as Partners

Rebecca Graboso, MSN, RN, CCRN, APN

22 The Impact of a Community Follow-up Program in the Management of CHF in the ElderlyDawn M. Zimmerman, MSN, RN-BC, APN, and Rosemarie Rosales, BSN, MPA, RN, CCRN, CPHQ

26 Bringing Care to the Community: Primary Care on Wheels: A nurse managed mobile healthcareAriel Almacen, PsyD, MSN, DNP(c), EdD(c), RN, APNC, FNPBC

27 CONVENTION REPORT Reflections of Prism: Achievements and Future DirectionsPerlita Capili Cerilo, MSN, MSHA, CCRN, CPAN

DEPARTMENTS Sofy Bole, BSN, RN, CCRN, Editor

31 Advanced Practice Sarla Duller, MN, RN, CCRN, APN-BC, Editor Advanced Practice Nurses in Today’s Global Healthcare Jennifer Aying, MSN, RN, ACNP-BC and Sarla Duller, MN, RN, CCRN, APN-BC

32 Regulatory Perry C. Francisco, MSA, RN, Editor Regulation of Simulation in Nursing Education Perry C. Francisco, MSA, RN

33 Legislative Brenda Cohen, BSHS, RN, RNFA, CNOR, Editor Health Care Reform: Implications for Nurses Charlotte C. Qualls, MA, RN

34 Education CE Offering

Marlon G. Saria, MSN, RN, AOCNS, Editor

Health Status of Filipino WWII Veterans Romanitchiko Samiley, MSN, RN, FNP-BC

Vol. 2 • No. 1

The Journal of the Philippine Nurses Association of America

Spring/Summer 2010contents

MISSION…To promote scholarly discourse with the ultimate aim of promoting culturally competent nursing care for clients and their families and enhancing professional development of nurses.

VISION…To be the influential voice for the professional excellence and contribution of nurses to healthcare and society.

VALUES…A set of core SERVICE values underlies the activities of the JPNAA. Through the editorial staff and its representatives, the JPNAA: Promotes high quality Standards. Focuses on promoting Excellence. Fosters Relevance in the healthcare community. Values transparency, humility, caring, compassion, integrity, and dedication. Espouses Inclusiveness of diverse cultures. Assures Credibility of discipline-specific concepts and content. Supports Exceptional leadership.

35 Cultural Diversity Lorraine Steefel, DNP, RN, CTN-A, Editor

Creating a Climate of Cultural Competency: One Hospital’s Journey Theresa Macalalad, MSN, MBA, RN, CCRN, RN-BC

REGIONAL REPORTS Remy Solarte, DNP, RN, NP, Editor

39 Medical Mission: The Art of Giving Back Merlita A. Velasquez, BSN, RN

41 Feeding Program with Moringa Elizabeth B. Rosas, BSN, RN, HNC, and Matilde S. Upano, MSN, RN, FNP-BC

44 PNASC: Healthy Families Start Here Emma Cuenca, MSN, RN, CCRN, CS

45 PNAA Nurses: Making a Difference in Global Health Victoria B. Navarro, MAS, MSN, RN

SPRING/SUMMER 2010 • Vol. 2, No. 1 • The Journal of the PNAA 3


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editorial


Transforming Care Beyond the Four Walls of the HospitalNelson Tuazon, MAEd, MSN, MBA, RN, NEA-BC, CPHQ, FACHE

oriented health care organizations are

guided by their mission statements that

focus on the health of the community.

These mission-driven healthcare facili-

ties commit resources for community

programs and services that address the

health needs of the communities they

serve. z

Nurse in preventive care.

An effective disease management ap-

proach integrates in-patient and outpa-

tient strategies. An integrated approach

may result in a 3% reduction in re-ad-

mission rate for cardiovascular diseases, a

12% reduction in all-cause re-admission,

and 18% reduction in combined event

of re-admission or death. Home visit

and home visit with follow up telephone

call could result in a 21-24% decrease

re-admission. Zimmerman and Rosales

(starting on page 22) chronicle some of

the initiatives of an integrated approach

in the management of Congestive Heart

Failure and Almacen (starting on page

26) highlights a community-based clinic

through a Primary Care on Wheels

program.

Healthcare organizations continue

to face decreasing reimbursements and

revenues. Community-based programs

have become promising strategies to

refocus healthcare delivery systems to-

ward preventive care. Healthcare leaders

recognize the influence of community

outreach programs to increase name

recognition for prospective clients and to

build loyalty among current customers.

Through strategic-planning, community-

Selected References:

Krieger, N., Chen, J., Waterman, P., Rehkopf,

D., & Subramania, S. (2005). Painting a

truer picture of US socio-economic and

racial/ethnic health inequalities: The public

health disparities geocoding project. American

Journal of Public Health, 95(2), 312-323.

Rathore, S., Lenert, L., Weinfurt, K., Tinoco,

A., Taleghani, C., Harless, W. et al. (2000).

The effects of patient sex and race on medical

students’ ratings of quality of life. American

Journal of Medicine, 108(7), 561-566.

Rogers, R., Hummer, R., & Nam, C. (2000).

Living and dying in the USA: Behavioral,

health, and social differentials of adult mor-

tality. San Diego, CA: Academic Press.

Smedley, B., Stith A., & Nelson, A. (eds.).

(2003). Unequal treatment: Confronting racial

and ethnic disparities in health care. Com-

mittee on Understanding and Eliminating

Racial and Ethnic Disparities in Health Care,

Board on Health Sciences Policy, Institute

of Medicine, Washington, DC: National

Academies Press.

Tuazon, N. (2010). Community Outreach

Beyond Hospital Walls. Nursing Managment,

41(5), 32-36.

T

he relationship between the

fundamental social causes and

socio-demographic differences

in health has been widely examined. The

notion that the associations between

socio-demographic variables and diseases

are predictable and perhaps unavoidable

has also been advanced. It is believed

that a reduction in social inequalities

would lead to a reduction in health

inequalities. In 2002, the Institute of

Medicine report, Unequal Treatment:

Confronting Racial and Ethnic Disparities

in Health Care, highlighted the sig-

nificant variations in healthcare quality

based on race of patients with compa-

rable insurance status, income, age and

severity of conditions.

Healthcare disparities, compounded

by the lack of access to healthcare, are

prevalent among minorities across all

settings. This issue of the Journal of the

Philippine Nurses Association of Ameri-

ca features examples of community-based

health programs. Leake, Bermudo, and

Jacob (starting on page 7) present their

findings on the Healthy Heart, Healthy

Family project in Hawaii. Graboso

(starting on page 15) makes a compelling

case on the role of the Advanced Practice

op-ed


Intersectionality: A Paradigm to Consider

T

he intersection of race/ethnicity, gender and class has been over-looked within much of the nurs-

ing literature. In a time when evidence-base nursing practice is crucial, evidence is scarce in the realm of intersectionality. Despite writings in public health and global human rights journals, a literature search in databases geared towards nurses has failed to provide an in-depth look at intersectionality.

Canadian authors Hankivsky and Christoffersen (2008) highlight how the intersection of complex lived experiences and concomitant factors of social ineq-uity, interact and affect health inequities. Particularly, these authors write about gender. The role of women versus that of men globally has been shown to pro-duce health inequities.

A closer look at the United States reveals numerous health disparities over the years. Very common are the racial/ethnic disparities in health outcomes

in America. Items joining together to formulate class, such as education and in-come, have also been a recurring topic in public health data analysis presentations. However, publications that comment on the intersection of health, race/ethnicity, gender and class are rare.

Interestingly, Cummings and Jack-son (2008) reported that Black women with college degrees report poorer health than White men, White women, and Black men with high school diplomas. As these authors set out to examine the intersection of race, gender and socio-economic status using the General Social Survey (GSS) data from 1974 to 2004, they found that the gender gap in self-assessed health narrowed significantly over the past 30 years. However, Black women continue to report the lowest levels of perceived health in 2004.

To gather a better understanding of Black women’s health, I offer a new book with contributing authors (Wes-ley, 2010). The book is envisioned as a ‘must have’ for professional audiences and especially, nursing, and social science students interested in Women’s health, Cultural diversity, and/or Health dispari-ties.

Specifically, focusing in on Black women’s health, the book provides the reader with theoretical and practical aspects of minority health issues and the ways in which research can contribute to positive outcomes. The book also covers many health related issues that African American women face. For example, the book delves into topics such as postpar-tum depression, stress, genetics, blind-ness, pet attachment, personal percep-tions of health, aging, alternative medical treatments, disabilities and inequities in

Yvonne Wesley, PhD, RN, FAAN

healthcare. Acknowledging the intersection of

numerous factors that contribute to poor health outcomes is essential to strength-en nursing practice. Nurses of all ethnic and racial backgrounds can take an opportunity to add to the body of knowledge that governs nursing practice. Use the book to develop research ques-tions and explore health from a different paradigm.

To improve the health of women and specifically women of color, unique approaches to capture their lived experiences are required. Intersection-ality seeks to capture both structural and dynamic consequences due to the intersection between two or more forms of bias, discrimination and/or subordina-tion (Nsiah-Jefferson, 2009). It is my opinion that nursing needs to look at new paradigms to solve old problems. z

References:Cummings, J. L., & Jackson, B. P. (2008).

Race, gender, and SES disparities in self-

assessed health, 1974-2004. Research on Aging,

30 (2), 137-68.

Hankivsky, O., & Christoffersen, A. (2008).

Intersectionality and the determinants of

health: A Canadian perspective. Critical Public

Health, 18 (3), 271-83.

Nsiah-Jefferson, L. (2009). Inequities in health

care and African-American women: Intersec-

tional applications of research and policy. In Y.

Wesley (Eds.), Black women’s health: Challenges

and opportunities (pp 1-56). New York, NY:

Nova Science Publishers Inc.

Wesley, Y. (2010). Black women’s health: Chal-

lenges and opportunities. New York, NY: Nova

Science Publishers Inc.


Abstract:This case study describes the Healthy Heart, Healthy Family demonstration project of a cardiovascular disease

prevention program culturally tailored for Filipino-Americans. Social networking through churches was used

to identify five sites where eight educational sessions were conducted. Thirty-eight lay and health professional

educators were trained and taught as volunteers at four of the sites. Over 200 Filipino-American adults participated

with 38% attending four or more sessions, and 40% of the frequent participants reduced their risk by the six-month

measurement. Maintaining the gains and sustaining this volunteer effort are areas for further research.

Background

F

ilipino Americans (FAs) have disparate prevalence and mortality for cardiovascular disease (CVD).

In California, 26.6% of FA adults have hypertension compared to 24.4% of whites and 33.8% of African Americans (AAs) (Leonard, Ira & Felton, 1983; Stavig, Ira & Leonard, 1988). For men age 18 to 49 and women age 50 and old-er, rates of hypertension for FAs exceeded those of AAs (30.5 v. 28.5% and 65.2 v. 63.1% respectively) (Leonard et al, 1983; Stavig et al, 1988). In Hawaii, FAs have the highest mortality from CVD of all the ethnic groups (396 per 100,000 popu-lation) with Native Hawaiians second (313 per 100,000 population) (Balabis, Pobutsky, Baker, Tottori, & Savail 2007). To address these health disparities, the National Heart, Lung and Blood Institute (NHLBI) of the National Institute of Health (NIH) culturally-tailored their cardiovascular disease prevention cur-riculum for Filipino-Americans in 2008. The process of cultural tailoring of this curriculum has been described elsewhere (Wallace, Fullwood & Alvarado, 2008). The curriculum for FAs teaches by telling

the story of a family with Lola (grand-mother) as the central character. The curriculum was named Healthy Heart, Healthy Family (HHHF).

A community health center (CHC) in urban Honolulu conducted a demon-stration project of HHHF funded by the Health Resources and Services Admin-istration (HRSA H80CS00776-06-03), teaching the eight-session curriculum over three months, followed by monthly Heart Clubs to promote maintenance of healthy behaviors. A train-the-trainer approach was used to train both lay lead-

ers and health professionals. This article describes the methods used to conduct this community-based project, the factors contributing to its success, and the lessons learned.

Theoretical FrameworkSeveral theories served a framework

for this project and its curriculum. Adult learning theory dictated a program that was relevant, goal-oriented and practi-cal. The Health Belief Model guided the content about perceived risk and severity of CVD among FAs, barriers and benefits of a healthy lifestyle, and elements to

Lola’s Life Lessons:Promoting Heart Health for Filipino-American Families in Hawaii

Anne R. Leake, PhD, Venus C. Bermudo, PhD, and Marianela R. Jacob, MSN

increase self-efficacy (Becker, 1974; Rosenstock, 1974). The Theory of Rea-soned Action contributed to the emphasis on behavioral attitudes and peer group norms to bring about behavior change (Ajzen, 1985).

Social networking was used to identify sites for HHHF and participants for the train-the-trainer program. Social networking is often used in community-based interventions (Hawe & Ghali,

Cover Story

1979-1981


Lola’s Life Lessons: Promoting Heart Health

Table 1.

Timeline of Project Activities

Site Approach Start Date End Date

Church # 1 AL contacted minister February 2008 July 2008

Train-the-Trainer AL contacted PNAH, School of February 2008 July 2008

Nursing community health faculty,

Staff at CHC, parish nurse

organization. VB recruited trainers

from church # 1

Church # 2 AL contacted church president. VB February 2008 July 2008

Contacted Catholic Clubs,

Approached clients waiting for

Food bank services

Train-the-Trainer AL assigned training for 8 September 2008 September 2008

community nursing students. RA

recruited trainees from Church

# 2 participants

Train-the-Trainer AL offered training to another September 2008 September 2008

section of 8 community health

Students at the request of their

instructors

CHC AL/VB partnered with staff for October 2008 March 2009

recruitment

Church # 3 Minister and his wife trained in April 2009 September 2009

May 2008, asked VB for support

In teaching HHHF to their

Congregation

Church # 4 VB made multiple contacts during November 2009 May 2010

2008. In 2009 a new minister involved

nurses from the congregation in

implementation

2008). With this framework, strategic connections to community members are used to conduct and sustain health pro-grams (Shediac-Rizkallah & Bone, 1998).

MethodologyHHHF Participants and Sites

HHHF was conducted at four churches and the CHC. Three of the four churches had majority Filipino congrega-tions, and FAs were the majority ethnicity served at the CHC. The sites and timeline for the HHHF programs are summarized

in Table 1 above. Recruitment

The minister and moderator of church #1 agreed to have HHHF after service on Sunday afternoon during weeks when no other after church activity was planned. Church #2 was AL’s church, located in the same neighborhood as the CHC and of the same denomina-tion as church #1. Sessions at church #2 were scheduled on a weekday morning immediately after food bank and free

store hours to enhance participation. The Research Associate (RA) [VB] approached the clients, interacted with them and offered blood pressure measurement. VB also approached another neighbor-hood church and was directed to their Catholic Club. Four participants learned about HHHF from the leaders of their parish’s Catholic Club that was interested but unable to sponsor due to planned renovations of their church resulting in no available space. These four participants went to Church #2 to participate and



learn how to conduct HHHF at their own church in the future.

The next church #3 had a new minister who was a participant in the first offering of HHHF. His was the first church to request HHHF without being approached. A Filipino-American LPN on the CHC staff taught this group in ses-sions immediately after worship service. Church #4 was initially approached by VB at the onset of the project, and was contacted again after a new minister was

installed. This church had an active health ministry for elderly parishioners, led by a retired FA public health nurse and a younger FA nursing student. They chose to offer the curriculum once a month with longer sessions on Saturday morn-

ings to streamline transportation for elders, and because Sundays after church were busy with other church activities.

Train-the-Trainer Participants and Sites

From the first offering of HHHF, eight people volunteered to be trained as trainers. Social networking was also used to recruit trainers. AL contacted her own networks with the number responding following each network in parentheses:

staff at the CHC (4), members of the PNA of Hawaii (2, MJ and her daughter), a graduate nurse from an NCLEX review class sponsored by FA nurses (1), the local parish nurse organization (1), and the community health faculty at the nursing school (3). There were three train-the-trainer sessions. Eight of the previously trained trainers participated in teach-ing the sessions at Church #2. The next train-the-trainer session included the four women from the Catholic Club plus eight of AL’s nursing students. Those 12 leaders taught the next HHHF to patients at the CHC. The final train-the-trainer included

eight Community Health Nursing stu-dents and their instructor.

Before the HHHF curriculum began, AL and VB addressed the congregations to explain the purpose of the project. Baseline measurements of blood pressure, pulse, height and weight, and waist size were made and given to participants to assess CVD risk. A Tanita Scale model BWB-800 and an Omrom Blood Pressure Monitor HEM-907XL were used for valid and reliable repeated measures. Teams of nursing students did the baseline mea-surement as part of their clinical hours for their community health course. AL was present at the measurement sessions to advise participants about abnormal blood pressure or pulse measurement. VB provided interpretation and operational support.

The HHHF Curriculum and Heart Clubs

Using principles of social marketing

The curriculum content was presented as a story

of a Filipino-American family, with Lola as the central character who

works with her family to promote their health after

her husband’s death.

Participants in the Healthy Heart, Healthy Family demonstration project held in a community health center in Honolulu, Hawaii, have their blood pressure checked as part of the cardiovascular disease prevention program that was culturally tailored for Filipino-Americans.

Participants in the cardiovascular disease prevention demonstration project undergo baseline measurements. Blood pressure, pulse, height, weight and waist measure-ments are taken in an effort to assess their CVD risk before beginning the program.


sional kick boxer to lead them in exercise. The participants from Church #2 and from the CHC joined an ongoing educa-tion and support group for people with chronic illness as their Heart Club, meet-ing monthly on a weekday morning, at the same time that their HHHF sessions had been held.

ResultsParticipants totaled 214 in five sites

over a two-year period, of which 100 (48%) completed four or more of the eight sessions. A total of 38 people com-pleted the train-the-trainer sessions, and all but one led one or more sessions in the subsequent programs as a condition of enrollment in the training. The majority of those trainers were health professionals and nursing students (75%), and many (42%) spoke at least one Filipino dialect.

Biometric measures were made at two or more points in time (baseline, three months and six months) for 59 of the 100 participants attending regularly, and 44 were measured at all three points in time. Among the participants who had baseline and 6-month measurements,

40% improved in at least one risk factor (weight, waist, pulse or blood pressure). In the pre-test/post-test survey, partici-pants commonly reported changes in food choices when shopping and cooking, using different cooking methods, decreas-

found effective for Filipino groups (Viana, 2003), the RA and subsequent trainers created a festive, welcoming and visually interesting environment with a banner, colorful names tags, three dimensional heart and blood vessel displays, and ar-rangements of healthy foods used in teaching the sessions. The majority of lay trainers and half of the health professional trainers were bilingual and taught in Eng-lish with Ilocano, Tagalog and Visayan dialect interspersed as needed. A health professional was available at each session to answer questions the lay trainer could not answer and to teach sections of the curriculum if requested.

The intervention was conducted in two phases. The first phase was eight sessions scheduled over three months. The sessions were weekly or bi-weekly to accommodate other planned activities for the congregation or the site. The curricu-lum content was presented as a story of a Filipino-American family, with Lola as the central character who works with her family to promote their health after her husband’s death. The structure for each


session was consistent, starting with a Fili-pino proverb to introduce the new con-tent, a review of the previous session, new content presented in a simplified manner using hands on activities, games, visual demonstrations, role playing, and tasting new foods and recipes. The content was followed by a summary called Lola’s Life Lessons, using verbal persuasion and role modeling as ways to increase participants’ self-efficacy for a healthy lifestyle. The sessions closed with participants taking a pledge to adopt one or more behaviors re-lated to the content during the next week.

The second phase was a three-month maintenance phase of once a month ac-tivities called Heart Club. Each site chose different Heart Club activities based upon the participants’ interest. Some churches chose very active outdoor activities and some chose doing hula or stretching and warm up exercise. Healthy food choices were served at all Heart Clubs. One church with a large number of youth held all their Heart Club gatherings in different parks in Honolulu, and invited a nurse aerobics instructor and a profes- continued on page 20

For the health professionals

working in acute and long term care settings, it was

an opportunity to experience how

nurses can impact the health of a community.

Participants attend educational programs geared at helping them adopt healthier eating habits, including learning new ways to shop and cook nutritious meals. The programs were both educational and social in nature incorporating fun activities, games and demonstrations to keep participants engaged and entertained.


Presidential

Leo-Felix Jurado, PhD (c), RN, NE-BC, APN

The Legacy of PRISM

perspectives

T

he PRISM PNAA term of office has ended but its reflections con-tinue to shine and are indelibly

etched in PNAA’s historical legacy. The PRISM served as an outstanding concep-tual framework through which programs and initiatives were organized through-out the term and at all levels - national, chapters and subchapters. The PNAA Executive Board worked synchronously with the chapters to accomplish the projects that were originally proposed and those that emerged along the way. It was evident that there was an over-drive energy, solid camaraderie, strong stewardship and united visioning among officers and members.

What have we achieved as an asso-ciation with the PRISM framework? We have established stronger Professional Linkages in many fronts. Our 7th Inter-national Conference that was held at the Waterfront Hotel in Cebu City, Philip-pines (the first venue outside Manila and the US) continued to galvanize our relationship with the Philippine Nurses Association of America Foundation (PNAAF), the Philippine Nurses As-sociation (PNA) and the Association of Deans of Philippine Colleges of Nursing (ADPCN). The President of the Philip-pine Nurses Association of United King-dom represented his PNAUK family in this venture. During this conference, we conducted the second Balik Turo Program (Giving Back) where content experts from the United States shared their talents to hospitals and schools of nursing in multiple sites in Cebu, Bohol, Iloilo, Bacolod, Baguio City and Manila City.

Our presence with the National

Council of Ethnic Minority Nursing Association (NCEMNA) is strong with our past president Mila Velasquez as the current Vice President. We were rep-resented not only at the national level but also at the chapter levels to many ethnic association conferences, meetings and gatherings such as our involvement with the American Association of Indian Nurses, Arab National Nurses Associa-tion, Black Nurses Association and the Hispanic Nurses Association. Through a grant funded by the Union Internatio-nale Contra de Cancer in Switzerland, a very successful End-of-Life Care program was conducted at Makati Medical Center for the very first time in partnership with PNA and the Association of Physicians in Pain Management. This grant was written and coordinated by our Execu-tive Director Remedios Solarte.

Although our Regulatory and Legislative presence could be stronger in some fronts, we have made an impact as an association. PNAA is one of the professional nursing organizations that joined the “Nursing Community” which served as a watchdog in making sure that nurses’ concerns were addressed with the newly legislated Health Care Reform. As President Barack Obama himself stated at the ANA delegate convention that “the passage of the Health Care Reform could not have happened without the strong support of nurses.” We have done letter writing campaign to make sure that the Title VII Nursing Workforce Develop-ment Program under the Public Health Service Act is reauthorized. We rallied our support for PNA Virginia in its quest for the removal of CGFNS examination requirement for foreign educated nurses

prior to taking the National Council Licensing Examination. We sent letters to the Virginia Board of Nursing in support of this rule making as PNAVA officers and members did the state level maneuvering. On the other hand, PNA Indiana officers continue to follow-up similar legislation pending approval of Indiana governor.

We have mastered the art of Inter-agency Collaboration during the past two years. Our working relationship with the Migrant Heritage Commission in assisting a Filipino-American RN to be released from jail being entangled with illegal recruitment was undoubtedly one of the highlights of this administration. PNAA chapters came into the rescue to help raise legal funds once again as it did with the accused Sentosa 27+ Nurses. We celebrated with the Avalon 11 (part of the Sentosa 27) victory with community supporters such as the National Alliance for Filipino Concerns, Philippine Forum, “Anakbayan,” Migrante International, New York State Nurses Association,1199 Service Employees International Union, Legal Aid Society, New York Committee on Human Rights in the Philippines, “Kinding Sindaw,” St. Vincent’s Hospi-tal, friends and families of these nurses on March 23, 2009 at Jing Fong Res-taurant, New York. In connection with all these illegal recruitment issues, the Human Rights committee created and distributed a Human Rights Handbook to serve as a guide in dealing with similar issues. The committee also drafted a Po-sition Statement on Ethical Recruitment of Foreign Educated Nurses which was approved by the PNAA Executive Board

continued on page 19


Special Feature

Sodium Restriction for Weight ReductionIntroduction

S

odium restrictions and weight reductions have positive effects in disease prevention. Sodium

restriction reduces high blood pressure and cardiovascular risks (Strazzulo, et al, 2009; Young, et al, 1987). Reducing the amount of salt in the daily diet by one gram would prevent new cases of heart disease and death particularly among Black-Americans, women and young people under 65 years old (Bibbins-Domingo, et al, 2010).

The ProblemIn 2008 the American Heart As-

sociation reported that cardiovascular disease such as hypertension is the number one killer of women in the US with one death every minute (Adams, et al, 2006). Women have a greater risk for heart disease after age 55, partly due to low estrogen level (Baker, et al, 2003; Rexrode, et al, 2003).

Despite evidence linking high salt intake to hypertension and cardiovascu-lar disease and with several government individual-level initiatives to lower salt intake for over 30 years, salt consump-tion has not changed and would likely increase with availability of processed and fast foods (Appel & Anderson, 2010). Americans are consuming seven to ten grams of salt daily compared to the recommended intake of less than five grams (Bibbins-Domingo, et al, 2010).

Obesity is a major health epidemic in the US, and excess body weight is an independent predictor of disease risk particularly during midlife (Adams, et al, 2006; Banks, 2008). Women with a body-mass index (BMI) of 23-24.9 have been found with higher risk of coronary heart disease (Stampler, et al, 2000).

Studies have shown that Filipinos have a high risk of developing coronary heart disease, hypertension, and diabetes at midlife and old age (Anderson, 1983; Garde, Spangler, & Miranda, 1994; Ger-ber, 1980; Hackenberg, Gerber, & Hack-enberg, 1978). Hypertension is lower for Asian descent, but the Filipinos lead the Asian-Pacific group with the high-est prevalence of hypertension (Frerichs, Chapman, & Maes, 1984; McBride, Mariola, & Yeo, 1995; Nora, & Mc-bride, 1996). Filipino-Americans follow Blacks with highest prevalence of adult onset hypertension. Dietary noncompli-ance has been reported to be a contribut-ing factor (Klatsky & Armstrong, 1991). Filipino women are vulnerable to obesity and hypertension as they reach meno-pause (Boren, 1994).

Study AimHigh salt intake and overweight are

both health risks. There is no current literature on the effect of sodium restric-tion on weight reduction. Although nurses are aware of the health risks of high salt diet and being overweight, their attitudes and behaviors towards dietary salt restrictions are unknown. In addi-tion, there is no reported study that has been done on Filipino women regarding their weight and dietary sodium intake. This study aims to determine if limit-ing dietary sodium will lead to weight reduction, and to determine the nurses’ behavior and attitudes towards dietary sodium restriction.

Methodology

This is a pilot study utilizing a combined experimental and quantitative descriptive exploratory study with a tar-get sample of 20 Filipino women nurses,

but only 15 volunteers signed up. Due to exclusion/inclusion criteria only eleven participants (n=11) were included in the study (Table 1 on page 13). Participants were instructed to limit their sodium intake to below 2400 mg per day, and record their sodium intake and weight daily on the logbook provided. Partici-pants were provided with instructions on how to monitor their sodium intake and literature on recipes and tips to lower so-dium intake. Incentives were also utilized such as $50.00 for the participant with the most weight loss, or with the best low sodium Filipino or Asian recipe. Movie tickets were offered to participants who completed the study.

The study was conducted over a two-month period. Baseline and post-study data that included blood pres-sure, weight, and exercise regimen were obtained. Participants were also asked if they have diabetes. A ten-item post-study survey was conducted to determine their behavior and attitudes towards sodium restriction.

ResultsData analyses reflect the reported

responses. Frequencies were used to categorize variables in the responses. The participants had a mean age of 54 years old and BMI of 25.1. More than half walk at least two to three times per week for thirty minutes, and 72% reported normal blood pressure. Three partici-pants have diabetes and take oral medi-cations. Two of the participants with elevated blood pressure did not complete the study. All participants joined the study to lose weight.

Of the eleven study participants, only three completed the study with the group’s average weight loss of eight

Tess Laoruangroch, RN, MSN, FNP-BC, CCRN, MPH

PNAA Foundation Fellow Report


Sodium Restriction for Weight Reduction

pounds. Review of their logbooks showed that they consumed an average of 2400-2600 mg sodium intake daily. They reduced consumption of Chinese food, and processed and canned foods. In addition, they also ate smaller serving sizes and will continue to eat food low in sodium. No participant was able to maintain the study’s recommendation of less than 2400 mg daily sodium intake. Only one participant recorded her weight daily.

Participants who were not able to complete the study reported that tak-ing daily weight reading, determining sodium content of food, and recording sodium intake daily was difficult to per-form, especially if they were away from home. More than 50% of the partici-pants found difficulty in preparing food especially Filipino dishes that are low in sodium, due to lack of Filipino recipes (and literature) showing sodium content of food. They also indicated that their favorite dishes were high in sodium.

About 45% of the participants reported that they are more aware of so-dium content of food. A smaller number (36%) responded that they had shared the benefits of reduced sodium intake with others and that commitment is needed to follow a low sodium diet. One fourth of the study participants reported the desire to buy a Filipino cookbook that shows nutrition information, if available.

ConclusionsThe study showed that there was

a modest weight reduction by limiting sodium intake below 2600 mg daily. The study also showed inconsistent attitudes and behaviors towards sodium restriction. However, due to the small sample size the results cannot be general-ized. Although there are no compelling conclusions that can be drawn from this study, the findings revealed the following implications:

1. Nurses were aware of the health risks of overweight and high salt intake but they were not learners and doers with their own health regimen;

Table I.

Inclusion and Exclusion Criteria for Participation

Inclusion Criteria Exclusion Criteria• Women > 40 years old

• No increase in current exercise

program during the study

• Stable diuretic regimen

• On dietary or herbal weight

reduction program.

• Uncontrolled hypertension

requiring diuretic adjustment

2. Participants were more likely to reduce their sodium intake for weight reduction, but not to reduce their cardiovascular risks; and

3. New healthy habits can be learned, if there is commitment.

RecommendationsReview of current and published

research studies in the US showed that there are only a few studies addressing the health needs of the Asian-American population, particularly women. In ad-dition, there are few organizations that address this disparity. The Center for Asian Health at Temple University aims to reduce or eliminate health disparity in Asian Americans particularly in prevent-ing cardiovascular disease.

The PNAA is in a position to undertake research using its members as participants. The study findings have the potential to reduce the healthcare disparity for Filipinos and other ethnic minority groups that remain under-represented in clinical trials and in the health care delivery systems. PNAA has researchers who are greatly capable to modify and improve this study to allow greater participation. The following are other compelling reasons to replicate this study with a larger population:

1. African American, Hispanic, and Asian women are less likely to be aware that cardiovascular disease such as heart attack is the leading cause of death, compared with white women (Mosca, Mochari-Greenberger, Dolor, Newby, & Robb, 2010).

2. Asian-American women particularly the Filipinos are increasingly getting heavier. Over 40% of Asian American

males and 30% of females in California are overweight (California Department of Health Services, 2004).

3. Children have increased BMI, which increases their risk of coronary heart disease in adulthood (Baker, Olsen, & Serensen, 2007; Franks, et al, 2010).

4. There is a growing push to enforce a public approach to reduce salt intake. The Food and Drug Administration (FDA) is taking action regarding sodium level content in processed food because of strong evidence of the health risk of high dietary sodium intake.

5. The changing US demographics is showing growth in the minority popula-tion that will surpass the majority popu-lation in two decades.

6. As health care providers, nurses have the responsibility not only to educate but also develop evidence-based preventive strategies.

7. There is opportunity to publish results of this study to enhance visibility of PNAA.

8. Studies that can be done with Filipino women as subjects have the potential to change the landscape of health care for the following reasons: Women in general are living longer than men; as nurturers, caregivers, and mothers, women impact family’s health; women as health and food preparers/consumers impact health promotion; majority of Filipino nurses are women; and women have increased vascular risks and Filipino nurses’ health will impact the nursing shortage. z


Sodium Restriction for Weight Reduction

ReferencesAdams, K., Schatzkin, A., Harris, T., Kipnis, V., Mouw, T., et al. (2006). Overweight, obesity, and mortality in a large prospective cohort of persons 50-71 years old. Retrieved on May 3, 2010 from http://content.nejm.org/cgi/content/full/355/8/763.American Heart Association. (2008). Heart and stroke statistical update. Retrieved on May 3, 2010 from http://www.americanheart.org/downloadable/heart/1200078608862HS_Stats%202008.final.pdfAnderson, J. (1983). Health and illness in Filipino immigrants. Western Journal of Medicine, 1939 (6), 811-819, 1083.Appel, L. & Anderson, C. (2010). Compelling evidence for public health action to reduce salt intake. Retrieved on April 28, 2010 from http://content.nejm.org/cgi/content.Baker, J., Olsen, L., & Serensen, T. (2007). Childhood body mass index and the risk of coronary heart disease in adulthood. Retrieved on May 3, 2010 from http://content.nejm.org/cgi/content/full/357/23/2329.Baker, L., Meldrum K, Wang, M, Sankula R, Vanam R, Raiesdana A, et al. (2003). The role of estrogen in cardiovascular disease. Journal of Surgical Research, 115, 325–344.Banks, A. (2008). Women and heart disease: Missed opportunities. Retrieved on October1, 2008 from http://www.medscape.com/viewarticle/579945.Bibbins-Domingo, K., Chertow, G., Coxson, P., et al. (2010). Projected effect of dietary salt reductions on future cardiovascular disease. Retrieved on April 23, 2010 from http://content.nejm.org/cgi/content.Boren, D. (1994). Value orientation, barriers and benefits, and cardiovascular disease risk in young Filipino women (Master’s Thesis). Available at Stitt Medical Library, Bethesda, Maryland.California Department of Health Services (2004). Cancer Surveillance Section, California Behavioral Risk Factor Survey, 2004.Franks, P., Hanson, R., Knowler, W., Sievers, M., Bennett, P., & Looker, H. (2010). Childhood obesity, others cardiovascular risk factors, and premature death. Retrieved on May 3, 2010 from http://content.nejm.org/cgi/content.Frerichs, R., Chapman, J., & Maes, E. (1984). Mortality due to all causes and cardiovascular diseases among seven race-ethnic populations in Los Angeles County. International Journal of Epidemiology, 13 (3), 291-298.Garde, P., Spangler, Z., & Miranda, B. (1994). Filipino –Americans in New Jersey: A health study. Final Report of the Philippine Nurses Association of America to the State of New Jersey Department of Health, Office of Minority.Gerber, L. (1980). The influence of environmental factors on mortality from coronary heart diseases among Filipinos in Hawaii. Human Biology, 52 (2), 269-278. Hackenberg, R., Gerber, L., & Hackenberg, B. (1978). Cardiovascular disease mortality among Filipinos in Hawaii: Rates, trends, and associated factors. Re-search and Statistics Office, Hawaii State Dept of Health.Klatsky, A., & Armstrong, M. (1991). Cardiovascular risk factors among Asian Americans living in Northern California. American Journal of Public Health, 81 (11), 1423-1428.McBride, M., Mariola, D., & Yeo, G. (1995). Aging and health: Asian Pacific Islander American elders. Stanford, CA: Stanford Geriatric Education Center.Nora, R., & Mcbride, M. (1996). Health needs of Filipino Americans. Asian Pacific Islander American Journal of Health.Mosca, L., Mochari-Greenberger, H., Dolor, R., Newby, K., & Robb, K. (2010). Twelve-year follow-up of American women’s awareness of cardiovascular disease risk and barriers to heart health. Retrieved on March 3, 2010 from http://circoutcomes.aha.org.Rexrode, K., Manson, J., et al. (2003). Sex hormone levels and risk of cardiovascular events in postmenopausal women. Circulation, 108:1688-93.Stampler, M., Hu, F., Manson, J., Rimm, E., & Walter, W. (2000). Primary prevention of coronary heart disease in women through diet and lifestyle. Retrieved May 3, 2010 from http://content.nejm.org/cgi/content/full/343/1/16.Strazzulo, P., D’Elia, L., Kandala, N., & Cappucio, F. (2009). Salt intake, stroke, and cardiovascular disease: Meta-analysis of prospective studies. Retrieved on April 24, 2010 from http://www.bmj.com/cgi/content.Young, F., Lichton, I., Hamilton, R., Dorrrough, S., & Alford, E. (1987). Body weight, blood pressure, and electrolyte excretion of young adults from 6 ethnic groups in Hawaii. American Journal of Clinical Nutrition, 45 (1), 126-130.

Author Affiliation Tess Laoruangroch, RN, MSN, FNP-BC, CCRN, MPH is a Fellow of the Philippine Nurses Association of America Foundation.

About the PNAAF The Philippine Nurses Association Foundation (PNAAF),

a 501 c 3 non-profit nursing organization,

is the philanthropic arm of PNAA. PNAAF was formed in 2001.

The Trustees are dedicated and committed to meet its mission and objectives.

PNAAF promotes and provides opportunities for philanthropy in support of the professional

advancement of Philippine American nurses, and health for all through nursing care, education,

management, and research.


AbstractThe United States spends twice as much per capita on healthcare as other industrialized countries, yet falls behind those nations on key determinants of health.The World Health Organization ranks the U.S. 37th in overall world health systems performance – below Costa Rica, Chile and Saudi Arabia. In the U.S., people of certain ethnic background and socio-economic status experience worse health leading to increased morbidity and mortality compared to other races. Excessive health care spending, poor quality and health disparity call for a new paradigm of health care delivery – one that focuses on health promotion, disease prevention and chronic disease management. As the Obama administration works on overhauling the healthcare system to give access to 46 million uninsured Americans, the fact remains that there are not enough primary care physicians to meet current needs. Advanced practice nurses (APNs) are uniquely prepared to meet the demands of a restructured healthcare system and fill gaps in primary care left by an increasing shortage of physicians, a problem that would intensify if Congress extends health insurance to millions more Americans.

The United States spends twice as much per capita on healthcare as other industrialized countries, yet falls behind those nations on key determinants of health.The World Health Organization ranks the U.S. 37th in overall world health systems performance – below Costa Rica, Chile and Saudi Arabia. In the U.S., people of certain ethnic background and socio-economic status experience worse health leading to increased morbidity and mortality compared to other races. Excessive health care spending, poor quality and health disparity call for a new paradigm of health care delivery – one that focuses on health promotion, disease prevention and chronic disease management. As the Obama administration works on overhauling the healthcare system to give access to 46 million uninsured Americans, the fact remains that there are not enough primary care physicians to meet current needs. Advanced practice nurses (APNs) are uniquely prepared to meet the demands of a restructured healthcare system and fill gaps in primary care left by an increasing shortage of physicians, a problem that would intensify if Congress extends

Preventive Care Paradigm: Advanced Practice Nurses as PartnersRebecca Graboso, MSN, RN, CCRN, APN

Health Care Cost

A

ccording to the Congressional Budget Office (CBO) (2009), the Unites States (U.S.) spent

$2.4T in healthcare spending in 2008, representing 16.2% of gross domestic product or $7,681 per person - more than any other country in the world - and by 2018, U.S. healthcare cost will go up to $4.4T. Yet, the U.S. ranked 37th in The World Health Report 2000, Health Systems: Improving Performance, ranking lower than many developed countries in key determinants of health like infant mortality and life expectancy (Doe, 2009).

Kaiser Family Foundation (2009) reported that in 2008, about 46 mil-lion individuals in the United States are without health insurance, representing 15.8 % of the population. The uninsured

costs the government $43 B in 2008, and in that same year, individuals, hospitals, and state governments account for $86 B in healthcare spending for the uninsured (KFF, 2009). Without health insurance and the resulting ability to seek primary care, the uninsured individual is more likely to be hospitalized for prevent-able acute health problems, and thereby suffer poorer outcomes as they are more likely to be diagnosed in the late stages of the disease (Tallon, 2006). Hospi-tal emergency departments across the country are facing overcrowding because they serve as the main source of health care for a growing number of the U.S. population that lacks adequate access to primary care. In one study, Pitts (2008) reported that emergency department vis-its increased from 90.3 million in 1996

to over 119 million in 2006, represent-ing a 32 % increase. In that same year, the percentage of non-obstetric hospital admissions that came through emergency departments jumped from 36 % in 1996 to 50 % in 2006; suggesting that a lot of non-emergency diagnostic testing is being performed in the emergency room, thereby prolonging emergency depart-ment wait times. The findings strongly suggest that the increasing use of emer-gency departments is directly related to the shortage of primary care physicians and lack of health insurance. Without ac-cess primary care, people are more likely to turn to the emergency departments for treatment. The Emergency Medical Treatment and Active Labor Act (EM-TALA) implemented in 2004, opened a window of providing primary care for the

Feature Story


Advanced Practice Nurses as Partners

uninsured (CMS, 2006). According to data compiled by the American Hospital Association, over 118 million individu-als were treated in emergency rooms in 2006, the latest year for which statistics are available, and hospitals provided $31B in care for which no payment was made (Winn, 2009).

Health DisparityAfrican-Americans (Blacks) bear a

disproportionate burden of cardiovascu-lar disease (CVD) morbidity and mortal-ity. CVD is the leading contributor to all-cause mortality and accounts for one third of the excess mortality experienced by blacks (Wong, Shapiro, Boscardin, & Ettner, 2002). About 80% black women are overweight and they have 70% chance of being obese compared to whites. Black children (ages 6-17) are also heavier than their white counterpart having 1.3 times chance of being over-weight (CDC, 2009). Increase in obesity has led to multiple comorbidities, such as hyperlipidemia, high blood pressure and diabetes, all risk factors that lead to heart attack and stroke. When compared to the two other leading causes of death, (heart disease and cancer), the stroke rate ratio of black mortality is highest for stroke when compared to whites (Gore-lick, 1998; Morgenstern, 1997). Stroke recurrence is also considerably higher in African-Americans compared to other races. A 12-month study of 164 patients showed that stroke recurrence rate for African- Americans was 31% versus 5 % for whites (Weisberg & Black, 1996). CDC (2009) reported that in 2006, Hispanics were 1.7 times as likely to start treatment for end stage renal disease related to diabetes and were 1.5 times as likely to die from diabetes compared to non-Hispanic Whites (CDC, 2008). People of ethnic origin are significantly less likely to have health insurance cover-age and more likely to be uninsured than whites. MacLean (2004) reported that blacks are 1.5 times more likely and Hispanics 2.3 times more likely to be uninsured compared to whites.

Lack of Access: the Underinsured and Uninsured

Kaiser Commission on Medicaid and the Uninsured reported that non-elderly Americans (ages 19-54) represents 73% of the uninsured, and although 50% of them have full-time jobs and 18% work part-time, their employers do not provide health insurance coverage (KFF, 2009). Furthermore, over half of the uninsured young adults have fam-ily income below 150% of the federal poverty level (FPL) which is $18,310 for a family of three in 2009; only 6% of them have incomes at or above 400% FPL (Schwartz, 2010). This suggests that many of the uninsured non-elderly are not eligible for Medicaid benefits because they are over the eligibility cutoff, and yet, their salary does not allow them the flexibility of purchasing health benefits from private insurance companies due to unaffordable premiums and pre-existing conditions. Consequently, the steep rise in health insurance costs is driving many employers to offer packages with fewer benefits, leaving employees with less coverage and higher out-of-pocket costs, preventing many from seeking health care. Contributing to the numbers of the uninsured are the illegal immigrants. It is widely known that ten states (New Jersey, New York, Georgia, Texas, California, Florida, Illinois, North Carolina, Arizo-na, and Ohio) account for well over 50% of the uninsured in the United States (Kaiser Family Foundation, 2009), and this is due, in large part, to the high con-centration of undocumented individuals that live in these states. Lack of health insurance is associated with increased risk of subsequent mortality. A study found that nearly 45,000 people die each year because of lack of health insurance, and the likelihood of mortality is 40% greater for individuals under the age of 65 because of lack of coverage (The Health Care Advisory Board, 2009).

Health Care QualityAccess to care, exorbitant cost

and poor quality of health care in the U.S. have led to racial, ethnic, socio-

economic, disability-related and gender-based disparities. Infectious disease epidemics, though a dominant public health concern for prior generations, have been replaced with an epidemic of chronic disease that threatens the health of not only adults and the elderly, but children as well. Notwithstanding the cost in human suffering, the financial resources to support the management of chronic disease for the millions of affected Americans are unsustainable under the current healthcare delivery system. Larson (2010) estimated that 45% of the United States’ population and 83% of those 65 years and over have one or more chronic disease. According to Murray, Frenk and Phil (2010), 1.5 million preventable deaths annually are associated with modifiable risk factors like smoking, hypertension, physical inactivity, diabetes, and hyperlipidemia. Health screening, preventive services and health education during early adulthood greatly reduce health risk, thus reduc-ing many health problems in later life (Bodenheimer, Wagner, & Grumbach, 2002). Fourteen percent (14%) of unin-sured young adults suffer from a chronic illness, which usually requires follow-up care and although periodic continuing care is fundamental in sustaining and improving health condition, more than 50% of uninsured young adults have no primary care providers (Schwartz, 2010). In addition, 12M seniors (the largest growing group in the population) lack access to primary care providers (due to shortages in their communities) resulting in less efficient and more expensive treat-ments (HRSA, 2009).

Access to care is one of the leading health indicators of Healthy People 2010 and underpins its two overarching goals: Increasing quality and years of healthy life and eliminating health disparities (HP, 2010). Affordable health insurance, availability of healthcare and a culturally competent workforce provide access to health care for all, which, when properly administered, delivered, and evaluated, have the potential to confer quality health outcomes and decrease healthcare disparities.



consumers.The health care of our popula-

tion must evolve with a focus on health promotion, disease prevention and management of chronic diseases. With the shortage of healthcare profession-als, the aging of the population, and the continued growth in technology, APNs must innovate for quality and efficiency in health care delivery. Access to health-care for the underserved, uninsured and underinsured can be achieved with APN leadership and/or participation in the many outpatient care models supported in the health care reform proposals (i.e., Nurse-Managed Clinics, Federally Quali-fied Healthcare Centers, Community-based Primary Care practices, Medical Homes, and Chronic Care Management Models). Eliminating health inequities and better healthcare outcomes can be achieved through APN’s participation in team-based, culturally-competent training and care models; community and hospital-based medication and safety initiatives; promotion of wellness and expansion of prevention programs; coor-dination of care throughout the health-care continuum, assisting the healthcare system to adapt to an aging population; and comparative effectiveness research and community and institutional-based participatory research. These strategies are consistent with the APN philosophy of holism and patient-family-community centered care and dovetail nicely with many provisions of the current Health Reform Agenda - responding to a crisis in the healthcare system and the econo-my. z

Author Affiliation Rebecca Graboso, MSN, RN, APN is the Stroke Nurse Prac-titioner at Riverview Medical Center, Red Bank, New Jersey.

ReferencesBodenheimer, T., Wagner, E. H., & Grumbach, K. (2002). Improving Primary Care for Patients With Chronic Illness: The Chronic Care Model, Part 2. JAMA, 288(15), 1909-1914.Brown, S., & Grimes, D. (1995). A Meta-Analy-sis of Nurse Practitioners and Nurse Midwives in Primary Care. Nursing Research, 44(6), 332-339.

However, health promotion and maintaining health require much more than insurance expansion. For example, disease prevention programs encourage healthful behaviors, expand the use of preventive services, provide high-quality health education, and institute policies that promote good health. The success of these programs depends on thorough monitoring; evidence-based outcomes; public and professional education; targeted efforts; and effective communi-cation among providers, advocates, and consumers. Given the vast number of preventable diseases and deaths associat-ed with unhealthy lifestyle and increased access to primary care, there is a huge opportunity to decrease the overall mortality and lower health care cost. A 15% increase in primary care doctors in a given metropolitan area would reduce ED visits by 10.9%, reduce the number of surgeries by 7.2%, and decrease in-patient admissions by 5.5% and outpa-tient visits by 5% (Kravet, et al, 2008). The proposed bonuses for Medicare primary care practitioners that establish their practice in areas with a shortage of primary care providers (including nurse practitioners, clinical nurse specialists, and physician assistants) support the initiative of increasing health care access in the rural areas and racially segregated communities.

Shift to Preventive MedicineThe U.S. healthcare system that is

too costly, fragmented and lacking in overall quality calls for a new paradigm of health care delivery that focuses on primary care utilizing competent primary care providers to deliver cost-effective, culturally-competent and evidenced-based care. The Association of American Medical Colleges estimates that there will be a shortfall of as many as 46,000 primary care physicians by 2025 (Dill & Salsberg, 2008), and with plans to ex-pand health insurance coverage to more Americans, there will be a 25% increase in demand for provider services (Derksen & Whelan, 2010).

Advanced practice nurses (APNs) are uniquely prepared to meet the quality

and cost-effective mandates of such a re-structured healthcare system., a problem that would intensify if Congress extends health insurance to millions more Ameri-cans.

As defined by Sherwood, Brown, Fay and Wandell (1997), APNs are prepared for this challenge by virtue of knowledge and skills obtained through advanced practice program of study acceptable to the State Board of Nurse Examiners. APNs consist of nurse prac-titioners (NPs), nurse midwives (NMs), nurse anesthetists and clinical nurse specialists. They practice in an expanded role in hospitals, community health centers, occupational health, institu-tions, schools, community agencies and private practice. In New Jersey, there are 4,000 APNs in 17 specialties; they have prescriptive authority and a collaborat-ing agreement with a licensed physician (New Jersey Board of Nursing, 2010, March). They are skilled to perform comprehensive health assessment aimed at health promotion and disease preven-tion, manage stable conditions with referrals as appropriate. Patient outcomes comparing the care between APNs and physicians are comparable. A meta-analysis of 38 NPs and 15 nurse midwife (NMs) studies conducted by Brown and Grimes (1995) evaluating health outcomes of NPs and NMs in primary care setting showed a greater patient compliance with treatment recommen-dations and greater patient satisfaction and resolution of pathological conditions with NPs than with physicians; NMs achieved neonatal outcomes equivalent to those of physicians.

Since 1999, the total number of NPs in the United States has increased by 83%, from 76,306 to 139,520 (Lugo, Grady, Hodnicki, & Hanson, 2007) and they are uniquely prepared to meet the increasing demands for primary care. APNs should be mindful of every open window to broker their uncompromis-ing professionalism and unique skill set toward the goals of demonstrating improved access to healthcare, achiev-ing optimal healthcare outcomes and decreased healthcare disparities for all


Nursing Practice, 1(2) ). http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol1n2/scope.xmlSchwartz, K. S., T. (2010). Executive Summary. Uninsured Young Adults: Who TheyAre and How They Might Fare Under Health Reform. Kaiser Commission on Medicaid and the Uninsured.Tallon, J. R., D. (2006). The Uninsured: A Prim-er Key Facts About Americans Without Health Insurance. Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org/uninsured/upload/7451.pdf Weisberg, L. A., & Black, W. F. (1996). Racial differences in stroke recurrence rate following initial lacunar infarct. [doi: DOI: 10.1016/S1052-3057(96)80008-5]. Journal of Stroke and Cerebrovascular Diseases, 6(2), 85-88.Winn, P. (2009, November 23). While There Are About 12 Million Illegal Aliens in U.S. Today, CBO Estimates That Senate Health Reform Would Leave About 8 Million Illegals Uninsured. http://www.cnsnews.com/news/article/57538.Wong, M. D., Shapiro, M. F., Boscardin, W. J., & Ettner, S. L. (2002). Contribution of Major Diseases to Disparities in Mortality. N Engl J Med, 347(20), 1585-1592.


CBO. (2009). Cost Estimate of Senate House Reform Bill. Retrieved, from http://www.scribd.com/CBO-Cost-Estimate-of-Senate-Health-Reform- Bill/d/22764207CDC (Centers for Disease Control and preven-tion),(2009). Health United States, 2008,Table 54 Retrieved, from http://www.cdc.gov/nchs/data/hus/hus08pdfCMS. (2006). Discharges, Total Days of Care, and Program Payments for Medicare Beneficia-ries Discharged from Short-Stay Hospitals, by Principal Diagnoses Within Major Diagnostic Classifications (MDCs). Centers for Medicare & Medicaid Services. Health Care Financing Review: Medicare & Medicaid Statistical Supple-ment. Table 5.5 Baltimore, Md: Centers for Medicare and Medicaid ServicesDerksen, D. J. & Whelan, E-M. (2010, January 15). Closing the Healthcare Workforce Gap. Reforming the Federal Healthcare Workforce Policies to Meet the Needs of the 21st Century. Retrieved, from http://www.americanprogress.org/issues/2010/01/health_workforce.html Dill, M., & Salsberg, E. (2008). The Complexi-ties of Physician Supply and Demand:Projections Through 2025. Association of American Medical Colleges. Center for Work-force Studies.Doe, J. (2009). WHO Statistical Information System (WHOSIS). Geneva: World Health Organization. September 2009.Gorelick, P. B. (1998). Cerebrovascular Disease in African Americans. Stroke, 29 (12), 2656-2664.HP (Healthy People). (2010). Healthy People 2010 Midcourse Review. Access to Quality Health Services http://www.healthypeople.gov/data/midcourse/pdf/FA01.pdf.HRSA (Health Resources and Services Admin-istration).(2009, April). Shortage Designation: HPSAs, MUAs & MUPs. Retrieved January 18, 2010, from http://bhpr.hrsa.gov/shortage/ KFF (Kaiser Family Foundation). (2009). Kaiser Commission on Medicaid and the uninsured. Urban Institute Analysis. http://facts.kff.org/chart.aspx?ch=477.Kravet, S.J., Shore, A.D., Miller, R., Green, G.B., Kolodner, K., Wright, S.M. (2008). Health care utilization and the proportion of primary care physicians. American Journal of Medicine, 121, 142-8. Retrieved on May 1, 2010 from http://www.ncbi.nlm.nih.gov/pubmed/18261503.Larson, M. (2010 February 9). New Payment Model Redefine Payment Performance. Sg2Health Care Intelligence. Retrieved, from http://members.sg2.com/content-detail standard/?Cont

entID=4944534778878704848Lugo, N., Grady, E., Hodnicki, D., & Hanson, C. (2007). Ranking State NP Regulation: Practice Environment and Consumer Health-care Choice. The American Journal for Nurse Practitioners 11(4), 8-24.MacLean,V. (2004-8-14). “Social Inequalities in Access to health Care Among African-Americans, Latinos, and Caucasians” Paper presented at the annual meeting of the Ameri-can Sociological Association, San Francisco, CA. Retreived, from http://www.allacademic.com/meta/p10884p108847_indexMorgenstern LB, S. W., Goff DC, Grotta JC, Nichaman MZ. (1997). African Americans and women have the highest stroke mortality in Texas. Stroke, 28, 15-18.Murray,CJ, Phil, D, Frenk,J.(2010 January 6). Ranking 37th-Measuring the Performance of the U.S. Health Care System. NJEM Online. Retreived, on http://healthcarereform.nejm.org/?p=2610New Jersey Board of Nursing (2010 March 9) . Advanced Practice Nurse facts. Retreived, from http://www.state.nj.us/oag/ca/nursing/apncert.htmSherwood, G., Brown, M., Fay, V., & Wardell, D. (1997). Defining Nurse PractitionerScope of Practice: Expanding Primary Care Services . The Internet Journal of Advanced

It has been a pleasure to serve with

the PRISM President, Mr. Leo-Felix Jurado.

Thank you for your STEWARDSHIP!

To the Editorial Staff of

The Journal of Philippine Nurses Association of America,

thank you for making this publication a REALITY!

Jovita Solomon-Duarte, MSN, RN

Executive Secretary (2008 - 2010)

Philippine Nurses Association of America, Inc.


The Legacy of PRISM

and now available in the PNAA website.The Services and Programs of-

fered to our membership are top notch. We now have a website that has many capabilities including committee chat rooms, availability of conference docu-ments, ability to access executive board-, committee-, and chapter-reports and minutes, online membership, online shopping and more. We now have a peer reviewed journal, The Journal of PNAA that we can showcase to our membership and other stakeholders. We have organized the Forum of Advanced Practice Nurses to address the needs of APNs among our membership. We have conducted leadership training that were co-sponsored by the PNAAF, Western Union, The Methodist Hospi-tal in Houston, TX and the ABS-CBN International. The first year focused on Value Chain Leadership, Leadership Suc-cession, and Impression Management. The second year focused on Appreciative Inquiry, Subchapter Formation, Nuts and Bolts of Hosting a Conference, Budget 101, Naming Your Chapter’s Brand, Health Care Reform, Hallmarks of Effective Leadership and Strategic Planning Imperatives. We have con-ducted eight regional conferences, two national conventions and an internation-al convention with continuing education awarded through PNAAF. We continued to award Scholarship grants, Excellence awards, and PRIDE Newsletter awards to recognize our members and chapters.

We now have a PNAA Gawad Kalinga Village comprising of at least 25 houses for the underprivileged situated in Piel, Baliuag Bulacan.We have concret-ized the Kababayan Emergency Prepared-ness Fund (KEPF) that came in handy to help our countrymen during the calami-ties of “Ondoy and Peping” and was also accessed by our members whose families were affected by these disasters. Many of our chapters went home to our native country to do medical missions while other chapters conducted health fairs and free clinics in their own locales here in our adapted land. In connection with all these, the PNAA Executive Board approved the formation of Community

continued from page 11

Outreach Adhoc Committee to oversee all these altruistic activities.

In the past two years, we Managed our Resources Effectively, Efficiently and Ethically. The implementation of the Inaugural Regional Vice President Roles proved that this was an excellent idea. The Vice Presidents performed their roles to the fullest; they were excellent and supportive of the President’s role. They truly functioned as Chief Operat-ing Officers in their respective regions with the unceasing collaboration of the regional Circle of Presidents’ representa-tives. All the meetings were conducted through a teleconference except dur-ing the two national conventions. The Dimdim teleconference proved itself as an efficient method to conduct busi-ness not only by the executive board but was also used by many committees regularly. Thanks to Dr. Rose Estrada for introducing this technology as well as serving as the webmaster throughout these two years. At the 30th National Convention in Baltimore, MD, we have introduced a paperless executive board meeting, educational convention and general membership meeting. We have “gone green” for the very first time and was repeated in the succeeding regional conferences and at the Miami, FL 31st National Convention.

We have achieved the highest membership in PNAA history in the past two consecutive years with more than 4,600 members. At the beginning of the PRISM term, we have approved the formation of subchapters in chapters where it is viable and applicable. PNA New Jersey as the pioneering chapter to have this structure added Union and Gloucester counties to its existing count making it 11 subchapters by June 2010. PNA Virginia formed the Richmond subchapter. PNA New England orga-nized the Rhode Island Subchapter. PNA Maryland followed suit with Southern Maryland subchapter. PNA Ohio formed two subchapters in a very short period of time, namely, the Cincinati-Kentucky and Central Ohio subchapters. PNA Metropolitan Houston created Golden Triangle subchapter in Beaumont, TX.

And finally, PNA Arizona made sure that they had one too- the East Valley subchapter. Aside from the creation of subchapters, quite a few chapters were added to the existing PNAA roster. We revived PNA Central Florida after we lost them prior to the PRISM term. Through the effort of Alberto Espinas, PNA Greater Sacramento was added to the PNAA map. Chit Abriam and Jeanette Livelo worked overtime to form PNA New Hampshire while Victoria Navarro and Fracel Solar delivered Alaska, the last frontier while the PNAA Executive Board meeting is in session at the Miami National Convention. PNAA now boasts to have 41 chapters and 18 subchapters.

The PNAA name and Logo are now registered with the US Patent & Trademark Office (USPTO). The PNAA Theme Song that was conceived before the PRISM term which was written by Dr. Luzviminda Llasos was put into lyrics by no other than Ryan Cayabyab at the beginning of the term and was sang for the very first time at the 30th National Convention. At this convention, we had the highest attendance ever to a national convention - more than 400 participants and greater than 300 members attend-ing the general membership meeting. The Time Capsule ceremony which was the brainchild of Victoria Navarro was absolutely one of the most phenomenal events at this convention. Memorabilia such as the incorporation paper, current bylaws, the JPNAA cover page, current list of members, attendees at the confer-ence, PNAA pin and many more were deposited into a capsule, sealed and was wheeled by children of PNAA members. An exhibit of “Kasaysayan ng Tagumpay” (Story of Success) through the years featuring all the PNAA past and current presidents was coordinated flawlessly by Antonio Jayoma.

Indeed the PNAA PRISM adminis-tration accomplished beyond what it set out to do at the beginning. This could not have happened without the spirited PNAA Executive Board, Committee Chairs, Advisory Council, Chapter officers and all members who worked harmoniously while demonstrating the




The Legacy of Prism continued from page 19

finest execution.So, what’s PNAA Future Directions?

All past PNAA presidents have laid the groundwork. Membership expansion should be at the top of the priority list. Continued efforts should be made to es-tablish networks in states where a PNAA chapter is not available. There are head-ways with Minnesota, New Mexico, and Alabama in the past few years. Aggressive follow-up on these states as well as other places is the key. Subchapter formation should be explored in chapters where it is feasible.

Strengthening the current infrastruc-ture is a must. The Project Development Office that has been conceived should continue to look at the short and long term range goals of the association. The Ways and Means committee need to continue activities such as the 5K walk that was put together by Ernesto and Elizabeth Rosas to raise funds for the noble initiatives of the PNAA. The Building Fund Campaign of the PNAAF should be promoted to all members and other supporters in order to realize our dream that someday, PNAA will have a building that we can call home office and

where we can keep our important organi-zational documents and mementos.

Membership engagement should be sustained as the PNAA Executive Board designs activities and membership perks that appeal to most members. Mentor-ship programs, leadership development institutes and educational conferences that are meaningful and more grassroots activities should be made available.

And last but not the least, com-munity outreach programs here in the United States and in the Philippines that attract the very core nature of Filipino-American nurses desire to help should be encouraged and organized more collab-oratively.

PNAA is in good hands because of the many talented and above all commit-ted leaders in our midst. As long as we all look towards that vision of making PNAA as the premier ethnic association in the USA, we will continue to grow in leaps and bounds. Margaret Meade state-ment should be our guide and inspira-tion when she said, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it’s the only thing that ever has.”

The past two years was fruitful, engaging and promising. I have gained lasting friendships in many of you. The support I received from top to bottom was overwhelming. My true mentors came out for me without counting the cost.

Leading this organization did not allow me to have dress rehearsal. I know that as a leader, I was always put on a stage as people watched how I acted and how I responded. I dealt with almost everything head on knowing that my imperfections made me even stronger as a leader. As I was on the stage, it became an exhilarating experience for me to no-tice that many of you joined me on the stage, in fact it was almost full. I know for sure that this leading experience will be added to the list of the golden moments in my book of life and I hope you do too. It was truly an exceptional opportunity to serve you. To sum it all – it is PRICELESS and always will be. The PRISM legacy has changed the PNAA landscape forever. Godspeed everyone and thanks! z

ing serving size and increasing physical activity.

DiscussionChurches as Community

Working with clergy and church leaders to introduce health promotion required that project staff be comfortable in a church environment. Both VB and AL were sensitive to the issues involved in holding a program in a church. Choosing churches as a site for health promotion for FAs seemed natural due to the high rate of church attendance among FAs (Abe-Kim, Gong & Takeuchi, 2004). Flexibility was critical as each church chose a time and day for HHHF to suit their needs. These choices were Sunday

afternoons for three of the five sites, and one site each for weekday mornings and Saturday mornings.

The social networking approach was successful for recruiting both sites and participants in the neighborhood surrounding the CHC, a similar find-ing from a church-based cancer screen-ing study with older FAs in Los Angeles (Maxwell, Bastani, Vida & Warda, 2007). Three of the four churches in the same denomination heard about HHHF from the denomination’s newsletter. The RA spoke two Filipino dialects, and her recent immigration gave her a common bond with many of the participants.

The CurriculumThe trainers experienced the cur-

riculum as fun for them and for partici-

pants. The content was presented in a simple way and focused on sugar, salt, fats, fruits and vegetables, and physical activity. The repetition of content over several sessions was thought to be effective in learning, and participants could learn about a healthy lifestyle even if they did not attend all eight sessions. The exten-sive number of handouts and activities allowed trainers to choose from among options to best reach their audience.

As a demonstration project HHHF proved to be feasible, effective, and easy to teach. The FAs among the trainers



Feature Story

Introduction

A

t a time when hospitals are faced with the challenge of improving their core measures for conges-

tive heart failure (CHF), East Orange General Hospital (EOGH) was one of ten hospitals in New Jersey that received a two-year grant for $180,000 from the New Jersey Health Initiatives (NJHI) Expecting Success: Excellence in Cardiac Care, funded by the Robert Wood John-son Foundation. EOGH implemented the grant-funded project IMPACT (Integrated Management of CHF thru Patient And Caregiver Team) aimed at improving the quality of care provided to African-American and Hispanic/Latino patients with CHF. In 2007, the baseline data from chart reviews for all CHF discharged patients showed 70% compli-ance with the core measures indicators. In addition, the 30-day readmission rate for these patients was 18% with the length of stay of seven days. The literature has demonstrated that compre-hensive discharge planning and post-discharge support may reduce readmis-sion rates by 25%, reduce mortality rates by 13%, and improve quality of life and

Dawn M. Zimmerman, RN-BC, MSN, APN and

Rosemarie Rosales, BSN, MPA, RN, CCRN, CPHQ

health outcomes (Philips, et al, 2004). In a prospective, randomized clinical trial, Naylor, et al (1999) found marked re-ductions in the hospital readmission rates of elderly patients after a comprehensive, multidisciplinary discharge-planning program.

A Community Hospital Addresses Healthcare Disparities

EOGH is a 211-bed community hospital with a unique patient popula-tion: 90% of the patients are Blacks/Af-rican, African Americans, Haitians, and West Indian Blacks, 2.2% are Hispan-ics, and about 2% are Whites. About a quarter of all admissions at EOGH are related to Heart Failure (HF). CHF is the number one cause of hospitalization for the elderly (Anderson & Steinberg, 1984; Fisher, et al, 1994; Krumholz & Parent, 1997). CHF is a complex disease that requires an integrated and multidisciplinary approach to treatment. EOGH has a large community outreach and volunteer department that provides services to the city of East Orange and the neighboring communities. While

some community outreach services are provided at the hospital, a greater volume is provided in the commu-nity at schools, churches, nursing homes, and senior housing complexes. These services include education-al sessions, blood pressure and diabetes screenings, food and clothes drives and distributions, to mention a few.

Project IMPACTThe IMPACT project team is a mul-

tidisciplinary group that consisted of the Chief of Cardiology, a Nurse Practitioner (NP) with specialty in cardiology, Clini-cal Educators, CHF staff nurses, and rep-resentatives from quality improvement, case management, health information management, cardiology services, nutri-tion services, pharmacy and community outreach. Guided by a Gantt’s Chart, the team outlined the timelines and planned activities with specific goals and respon-sibilities delegated to the members. The NP met with all CHF in-patients and sought their permission for follow up at home.

The IMPACT project received funding for two years. The goal for the first year was to improve compliance with CHF core measures to greater than 95% for all heart failure admission. The indicators were ACE/ARB at discharge for ejection fraction less than or equal to 40%; evaluation of left ventricular ejection fraction (LVEF); discharge instructions; and smoking cessation counseling. During the second year of the program, the IMPACT project aimed to enroll at least 30% of the heart failure admissions, which were approximately 350 patients a year (from a total of 1578 hospital discharges with ICD-9-CM codes of Heart Failure). Participants to this change project were selected by the Systolic Dysfunction criterion, which is defined as patients with LVEF of 40% or less. The objectives of the project were to improve the Quality of Life for all hospi-talized CHF patients and to decrease the 30-day readmission rate by 20 percent

The Impact of a Community Follow-up Program in the Management of CHF in the Elderly


and decrease the length of stay (LOS) by one day.

One major challenge for the IMPACT Project was the enrollment of adequate numbers of clients that fit the criteria for home visits. Although EOGH admits several hundreds of clients with CHF diagnosis annually, the majority of clients with an ejection fraction of less than 40% were from nursing homes. Those clients who met the criteria and lived in the community were not physically able to perform the tasks of BP and weight monitoring, and care for themselves physically. Thus, the project was modified to include anyone with the diagnosis of CHF regardless of ejection fraction.

Conceptual Models IMPACT incorporated several

processes that required collaboration amongst various departments. The CHF Nurse Champion Model was imple-mented first to streamline the process of achieving 100% compliance with the core measures. CHF nurse cham-pions assisted with the development of the CHF order set that included the core measure indicators, a preprinted discharge instruction, and a process for identifying all heart failure charts using blue dots on the spines of the charts.

The rapid cycle chart audit and the development of the Appropriate Care Measure (ACM) team were instituted to ensure all core measures were carried out prior to patient discharge. Team mem-bers met weekly to trace and discuss each admitted patient from the Emergency Department. Patients were followed-up throughout the continuum of care until discharge to ensure the appropriate treat-ments were instituted before and at the time of discharge.

Interdisciplinary Approach throughout the Continuum

The Heart Failure patients were educated in the hospital and community settings about the disease and ways to manage it at home successfully. The IMPACT team developed culturally ap-

propriate patient education resources. All clients enrolled for community follow-up received an automatic blood pressure (BP) monitor, a digital weighing scale, a calendar/journal, a measuring cup, and printed information about diet and exercise.

With the assistance of the certified nursing assistants (CNAs), clients were instructed on the usage of the automatic BP monitor and digital weighing scale while in the hospital. The CNAs and the patients were instructed to retake high-blood pressure readings within one-hour and to call the result to the NP. The calendar/journal includes graphics, photos and other illustrations depicting culturally appropriate dietary prefer-ences, recipes, food-drug interactions, and activities that are appropriate to the Black/African American and Hispanic/Latino populations. Information on important signs and symptoms to moni-tor and contact numbers to call when medical help is needed were included in the calendar. The clients recorded daily blood pressure, weight, and other information about how they were feel-ing. The project team also developed laminated placemats featuring culturally appropriate reminders on healthy and unhealthy food choices, fluid restrictions, weight and blood pressure. Often times, CHF clients were admitted with fluid overload. Noncompliance with fluid intake remained a challenge for practitio-ners. All clients were given a lightweight, plastic measuring cup that can be read from above unlike the common measur-ing cups that needed to be read at eye level and from the side. Clients loved the measuring cups because they can follow up how much liquids they drink daily.

Each CNA and community out-reach workers followed up with a group of clients biweekly in their homes and monitored their BP, weight and di-etary intake. The community outreach workers who are certified mental health screeners listened to the clients’ psycho-social problems that affect compliance with treatment regimens. The NP or the patient’s cardiologist addressed medical-

related issues such as elevated BP, weight gain, and edema. The community outreach workers addressed psychosocial issues such as depression, lack of food, or lack of electricity. Depression has been shown to worsen the prognosis in heart failure patients (Bero, 1991; Freeland, 1991).

Staff EducationEducation was critical in ensuring

that information about the processes established for the successful compli-ance with the core measures was com-municated to all members of the team. All personnel including nurses, CNAs, physicians, ancillary departments, and caregivers were educated about CHF treatment guidelines, identification of charts by placing a large blue dot on the spine of the charts, completion of ACM tool, completion of CHF order proto-col, the importance of obtaining daily weights, discharge instructions, smoking cessation counseling, and documenta-tion in the Interdisciplinary Education Record for each patient. The Cardiolo-gist Champion and the Clinical Educa-tor provided collaborative educational sessions with CEU hours for nurses.

Community Outreach Programs

Some of the community activities that the IMPACT team hosted include biannual health fair on the hospital grounds for the community where several vendors and hospital physicians, nurses and volunteers provided educational sessions about various diseases. They also provided for screening sessions such as BP and cholesterol monitoring, and risk assessments. There were monthly Senior Bashes, which took place in the hospital cafeteria. Seniors were educated about cardiovascular diseases, healthy nutri-tion, and exercise. They also engaged in fun activities such as BINGO and other games.

Other community activities included live healthy cooking sessions that were provided by the hospital chef in the cafeteria for the participants and


Management of CHF in the Elderly

Management of CHF in the Elderly

their significant others. The Physician Champion provided lectures about CHF and how to prevent and/or treat the disorder. The NP taught clients about fluid measurement using the easy-to-read measuring cup, and about salt or sodium measurement by showing them how much two grams of Sodium looked like by pouring a teaspoonful of salt in the palm of her hand. This was a revela-tion for the participants because they understood how much two-grams of sodium should be. A dietitian explained how to read labels on food packages for sodium and how to choose healthy foods especially when shopping for low cost foods. Everyone received a $10 super-market card to kick-start the healthy food program.

Home VisitsHome-based intervention has the

potential to decrease the rate of readmis-sion, prolong survival, and improve qual-ity of life in CHF patients (Stewart, Mar-ley & Horowitz, 1998). The President and Chief Executive Officer, the Chief Nursing Officer (CNO) and the NP made home visit to a few clients to have a first hand look into the world of the patients. The CNAs and NP recognized that some clients do not have healthy foods in their homes. Occasionally, bags healthy choices of groceries were brought for the clients to educate them on proper food selection. Referrals were also made to the community outreach and the vol-unteer departments where a coordinated effort was made to arrange for assistance for these clients. As a result, the clients became active players in taking their medications and in monitoring their BP and weight.

On occasions, the clients did not an-swer their phone or returned phone calls about follow up visits. In one instance, the community outreach worker, who is also a mental health screener, visited one client at home. After spending three hours with the client, the outreach worker made a referral to the Medical Director of the in-patient Behavioral Health Department. The client was

placed on medications for depression and home visits were continued.

Program Outcomes and Evaluation

An evaluation of the program has demonstrated that compliance with the core measures for CHF increased to over 96% and has been sustained. EOGH received the 2008 American Heart Asso-ciation Get With the Guidelines Bronze Award, and the 2009 Silver Award for Best Practices and was cited in the US and World News.

The evaluation of the impact of this program was based on the four levels discussed by McNamara (2005). The program has demonstrated positive patient outcomes, which included lower total heart failure readmission rates, fewer hospital days and improved quality of life. In spite of the limitations of the project, the positive outcomes should be considered although it difficult to generalize the findings due to the small number of participants.

Many of the clients have expressed positive impressions of the program. Some clients have requested low sodium information from the dietitian and their behaviors have improved significantly with regards to following the treatment regimen, appropriate diet and exercise. However, this is still an uphill battle because noncompliance continues to be a problem. This program has been dem-onstrated as effective in supporting the clients as they learn new strategies and change behaviors.

The 30-day readmission rate for CHF clients has decreased to less than 6% and the length of stay has decreased by one day. Presently, there are 10 clients in the home follow up program after a few succumbed to the disease and a couple refused to answer their phones or doors. Although it is difficult to measure quality of life using a quantita-tive approach, clients were encouraged to document on how this follow up program affected them both positively and negatively so as to provide qualita-tive data. One client wrote, “I like this

program because it helps me to stay focused on my health. Last year I was admitted to the hospital over five times; but since this program started I have only been admitted two times. My health and my weight was an issue but now it is not. The equipment you gave me and the follow up shows me this hospital really cares for my health and well be-ing.” Another client documented, “This program helped me maintain and control my blood pressure and weight. Before I started this program, I would worry and stress over my weight, but now the dietitian is working on my diet and helps me plan meals for me. I have no worries now with my weight and blood pressure and I have not been in the hospital as often as before.”

ConclusionProject IMPACT has been dem-

onstrated that an integrated approach involving a patient-centered multidisci-plinary team streamlines the processes for all CHF patients. With the increasing incidence of heart failure, healthcare providers are urged to evaluate their HF programs and to incorporate an integrated approach that encompasses a multidisciplinary team to promote health and improve outcomes. Current practice guidelines provide a basis for the treat-ment of patients with heart failure. A well structured and consistent follow up program with Nurse Practitioners, nurs-ing assistants and community outreach workers could be a viable approach to providing psychosocial support and in-terventions that could decrease readmis-sions of CHF patients to the hospital. z

Author Affiliation Dawn M. Zimmerman, RN-BC, MSN, APN is Clinical Educator and Rosemarie Rosales, BSN, MPA, RN, CCRN, CPHQ is Director of Education and Infection Control at East Orange General Hospital, East Orange, New Jersey.


Project IMPACT is funded in part by the New Jersey Healthcare Initiative

Expecting Success: Excellence in Cardiac Care through the Robert Wood Johnson

Foundation.

Board of Trustees 2009 - 2011

Trustee Officers President: Araceli D. Antonio, MS, RN Vice President: Ernesto Rosas, BSN, RN Secretary: Amuerfina Castro, MA, RN Treasurer: Martha Cabarios, BSN, RN Executive Director: Pete Calixto, BSN, CNN, RN Advisor: Phoebe Andes, MA, RNLegal AdvisorsLeticia Hermosa, PhD, JD, RN Linda Simunek, PhD, JD, RN

TrusteesLolita Compas, MA, CEN, RNLeda Layo Danao, PhD, MPA, RN Perry Francisco, MSA, RNGilda Lauchli, BSN, RNSheila Marcelo, MBAArnedo Valera, EsquireMila Velasquez, MN, CS, APRN, RNAniceta Vista, PhD, RN

The Philippine Nurses Association of America Foundation (PNAAF) is a non-profit organization that is tax exempt under Section 501(c)(3) of the Internal Revenue Code. It is also an approved provider of continuing education courses by the California Board of Registered Nursing.

As the major development collaborator of the Philippine Nurses Association of America or PNAA, PNAAF provides the structure and mechanisms that facilitate philanthropy among nurses and their supporters. The resources generated through these efforts are allocated to scholarship, continuing education, and research programs that are offered and conducted in collaboration with the PNAA and PNA Chapters. These programs are designed to promote the professional development of nurses and health for all.

PNAAF FOUNDING MEMBERS

Philippine Nurses Association of America Foundation

Phoebe Andes – New JerseyAraceli D. Antonio – Northern CaliforniaLoida Chua – New YorkJosefina Jimenez – IndianaLeo, Nini, & Jilleanne Jurado – New JerseyGilda Lauchli – IndianaLuz Newell - Central Valley CA

Remedios & Dr. Cesar Solarte - MIAsteria Vargas – Rio GrandeMerlita Velasquez – HoustonAniceta & Denis Vista – Michigan PNA Michigan PNA Southern California

Platinum Founding Member

Gold Founding MemberKathy Abriam-Yago - Northern CaliforniaSally Ani – South CarolinaLeila Busch – MissouriMartha Cabarios – MichiganBrenda Cohen – Southern CaliforniaLolita Compas – New YorkMarie Couper - FloridaLeda Layo Danao – Southern CaliforniaAmparo dela Paz – HoustonCecilia Estrella – OhioAlicia Eclevia - IllinoisJose Jacob – HawaiiRedempta Knotts – IndianaFilipinas “PI” Lowery – New York

May Mayor – New YorkDula Pacquiao – New JerseyErnie Rosas – Greater Kansas City Elizabeth Rose – Arizona Bessie Schiroky – OhioElaine Soliven – San DiegoCrispina Unabia - IllinoisEmma Tolentino – IndianaGlorieta Vain – No. CaliforniaMila Velasquez – So. California PNA IllinoisPNANE FloridaPNA South Carolina PNA Tampa Bay



Nursing, this initiative uniquely creates public-private partnerships with the mutual goal of improving access to care for urban at-risk populations.

The broad objectives of this nurse-faculty managed mobile healthcare project are to screen identify and provide health promotion/disease manage-ment services for at-risk populations; to foster community involvement in the health assessment and referral process; and to provide culturally and linguisti-cally sensitive health promotion/disease management health education. The need for the mobile healthcare is well sup-ported by the morbidity and mortality data and health indicators from local, state and national sources that document the health disparities in the underserved regions in the state of New Jersey. z

Author Affiliation Ariel Almacen, RN, Psy.D., MSN, DNP(c), Ed. D(c), APNC, FNPBC, is a faculty member of the School of Nursing at the University of Medicine and Dentistry of New Jersey, Newark, New Jersey.

References

Cunningham, P. (2007). Overburdened and overwhelmed: The struggles of communities with high medical cost burdens. Retrieved on May 1, 2010 from http://www.commonwealth-fund.org/usr_doc/Cunningham_overburdene-doverwhelmed_1073_ib.pdf.Fronstin, P. ( 2007 ). Sources of health insurance and characteristics of the uninsured: Analysis of the current population survey. EBRI Issue Brief No. 310. Employee Benefit Research Institute: Washington, D.C.HRET. (2001). New study maps access of New Jersey residents to primary healthcare services. Health Research & Educational Trust of New Jersey: Shaping Healthier Tomorrow, 3 (1), 2-8.

Bringing Care to the Community:Primary Care on WheelsA nurse-managed mobile healthcare

T

he number of individuals without medical insurance is increasing exponentially. The current data

shows that 16. 7 percent of the people in the United States are uninsured which translates to about 47 million. The nationwide financial burden of medical care expenses for U.S. families is increas-ing because of the growth in the number of uninsured people and greater out-of-pocket costs for health insurance, as well as sluggish income gains. This burden varies considerably across the country because of differences in rates of health insurance coverage, family incomes, and the generosity of public and private health insurance benefits. Thus, some communities are more likely than others to experience extremely high levels of medical cost burdens. These high costs threaten the financial well being of U.S. families and can lead to delays in receiv-ing health care (Cunningham, 2007).

The lack of national consensus on how to solve the uninsured problem con-tinues even as the number of uninsured increases. A high proportion of people with high cost burdens in some commu-nities may in part reflect greater need for care because of either a larger number of elderly people and/or greater morbidity in the population. Higher need for care would increase demand for and use of health care services, which would likely increase out-of-pocket expenses for those services (Frostin, 2007).

Among the barriers to accessing healthcare were identified by a study of the Health Research and Educational Trust of New Jersey (HRET, 2001). These include insufficient number of physicians caring for the poor, incon-venient clinic locations, lack of trans-portation, language barriers, and lack of cultural sensitivity. Given these findings

Ariel Almacen, RN, Psy.D., MSN, DNP(c), Ed. D(c), APNC, FNPBC

the study suggested the following recom-mendations: Create more neighborhood-based health clinics and mobile units, use more nurse practitioners and physician assistants in primary care offices, provide evening and weekend hours, provide staff training in cultural sensitivity, provide patient education in self care manage-ment, and develop educational tools in languages other than English and Span-ish (HRET, 2001).

Bringing primary care services to the population that needs much needed services could resolve barriers to health-care services, particularly access and the burden of cost. The University of Medicine and Dentistry of New Jersey School of Nursing (UMDNJ-SN), in a collaborative joint partnership initiative with the Children’s Health Fund, has implemented a nurse-faculty managed Mobile Healthcare Project, designed to reduce the morbidity and mortality of the medically underserved residents of four cities in northern and central New Jersey: Newark, Elizabeth, Irvington and New Brunswick. The primary purpose of this nurse-faculty managed mobile healthcare project is to improve access to care for urban, underserved, at-risk population.

This grant-funded project, which has been in operation for nearly 36 months, utilizes an interdisciplinary collaborative approach and outcomes-oriented focus for a nurse-faculty man-aged, university-based mobile healthcare project. The project cost-effectively utilizes faculty-supervised student nurses, medical students and an interdisciplinary mobile health team staff, in collaboration with the clinical affiliates of UMDNJ, community-based organizations (CBOs), and faith-based healthcare initiatives. Situated within the UMDNJ School of

Feature Story

Convention Report

Reflections of PRISM:Achievements and Future DirectionsPNAA Holds Conference and Convenes Members in Miami

T

he 31st PNAA Annual Conven-tion was held last June 23-27, 2010 at the Hotel InterConti-

nental, Miami, Florida. It was indeed a successful and fruitful convention of the year! Delegates from different states came to attend the convention. The theme for one-week convention was Reflections of PRISM: Achievements and Future Directions. PRISM stands for Profes-sional Linkages, Regulatory and Legisla-tive Agenda, Interagency Collaboration, Services and Program Development, and Managing Organizational Resources.

Day 1 - June 23, 2010 More than 200 delegates and their families at-tended the Welcome Night at the Grand Ballroom of the Hotel InterContinental. Portraying Miami at its best and in the PNAA tradition, guests were entertained with different presentations through various talents in singing, dancing, and playing of musical instruments by our youth and nurses from local hospitals in Miami. The Welcome Night contin-ues to be a most memorable event for attendees to reconnect with old friends and colleagues, renew acquaintances, and build new relationships and networks.

Day 2 - June 24, 2010 Close to 190 delegates attended the Leadership Institute from all the PNAA chapters. As a benefit to the officers and future leaders of the PNAA chapters, the Leadership Institute serves as the official kick-off for the educational program of the conven-tion. Penny Patallitan, PNASF Education Chair served as the Program Moderator. Josephine Villanueva, PNASF President,

Perlita Capili Cerilo, MSN, MSHA, CCRN, CPAN, PNA South Florida, Education Co-Chair

the Host Chapter, and Gloria Beriones, PNAA Education Chair opened the Leadership Institute with their remarks.

The theme of the Leadership Insti-tute reflects the culmination of the manta of Leo-Felix Jurado, the out-going PNAA President. PRISM and Beyond: A Lead-ership Perspective brought experts in the field of leadership and included promi-nent Filipino-American nursing leaders. Leo-Felix Jurado, PhD(c), MA, RN, NE-BC, APN, chronicled the achievements and accomplishments of PNAA through PRISM with his presentation Leader-ship at its Best. Divina Grossman, PhD, FAAN, ARNP, Vice President of Engage-ment, Florida International University, delivered an inspiring presentation of the Hallmarks of Effective Leadership. Nel-son Tuazon, MAEd, MSN, MBA, RN, NEA-BC, CPHQ, FACHE, Associate Chief Nursing Executive, Baptist Health System, San Antonio, Texas and Editor-in-Chief of the Journal of the Philippine

Nurses Association of America engaged the attendees with his presentation on Strategic Planning Imperatives: Creativ-ity, Innovation, and Risk Taking. Rey Rivera, DNP, RN, CCRN, NEA-BC, in-coming PNAA President presented his mantra for administration, Engage and Make a Difference. Rose Estrada, DNP, RN, BC, CPN, on-line Editor of the Journal of the Philippine Nurses Associa-tion of America provided the state of the art PNAA Website with her presentation on the Bells and Whistles of the PNAA Website were inspiring.

Penny Pattalitan, MSN, FNP-BC, RN-BC, PNASF Education Chair and the Moderator for the Leadership Insti-tute, summarized the event by encourag-ing the future and seasoned leaders to DREAM to be a leader, BELIEVE in their own capabilities, and ASPIRE to reach higher and make a difference by doing their best as a leader.

Day 3 - June 25, 2010 The Educa-

More than 350 delegates from across the country attended the 31st Annual PNAA Conference held at Miami’s Hotel InterContinental.


Reflections of PRISM

tion Day theme was inspired by PRISM: Reflections and Future Directions, at-tended by 334 delegates and moderated by Gloria Beriones, PNAA Education Committee Chair. The Keynote Ad-dress was delivered by PNAA President Leo-Felix Jurado, PhD(c), MA, RN, NE-BC, APN on Reflections of PRISM: Achievements and Future Direction. The Vice-Presidents from the four regions showcased the achievements of the PNAA. The speakers were Merlita Velas-quez, RN, BSN, (South Central Region), Josephine Villanueva, BSN, MA, NEA-BC (Western Region), Sofia Bole, BSN, RN, CCRN (North Central Region), and Victoria Navarro, MAS, MSN, RN (Eastern Region).

The education day was packed with state-of-the-art presentations and filled with timely and evidence-based topics. Connie Barden, RN, CNS, CCRN, CCNS, eICU Director of Baptist Health System spoke on Nurses Bold Voices. Margarita Camacho, M.D. FACS, Saint Barnabas Heart Center in New Jersey highlighted different mechanical valves and Left Ventricular Assist Devices (LVAD) and shared her expertise on the latest trends in cardiovascular innova-tions with her presentation Mechanical Gift of Life: Artificial Heart Devices. Jerry Ochoa Ciocon, MD, FACP, AGSF, FACA, Medical Director, Department of Geriatric Medicine at Cleveland Clinic in Florida presented a very informative topic on the Management of Diabetes Mellitus. Luz Porter, PhD, ARNP, FNP, FAAN, Professor, College of Nursing and Health Sciences, Florida Interna-tional University shared her expertise in her presentation on Advanced Practice Nursing (APN): Service, Program, and Research Development.

Along with the podium presenta-tions, nine poster presentations were on display during Education Day. All


Leo-Felix Jurado, outgoing PNAA President, is pictured on right with PNAA past presidents at the Annual Convention.

Incoming PNAA President, Rey Rivera, DNP, RN, CCRN, NEA-BC, celebrates the beginning of his tenure with past presidents of the PNAA.

Leo-Felix Jurado recognizing the Regional Vice Presidents during the convention.

abstracts went through a rigorous screen-ing process using the rubrics developed by Dr. Daisy Cioco, and Dr. Luz Porter from PNA South Florida. Final judging was done by the PNAA Education Com-mittee headed by James Puspos, PNA SCR, Education Committee. The posters received positive feedback from the at-tendees. All poster abstracts have been posted on the PNAA website with their corresponding authors and co-authors.

The afternoon sessions of the Education Day enlightened the attendees with various trends and issues in health-care. Dula Pacquiao, Ed.D, RN, CTN, Associate Professor and Director, Center for Multicultural Education, Research and Practice, University of Medicine and Dentistry of New Jersey School of Nurs-ing, delivered a powerful presentation titled, Using PRISM to achieve Social Justice and Population Health Glob-ally. Leticia Hermosa, MS, JD, PhD, RN, PNAA Legal consultant, discussed Global Health Economics: Emerging Trends and Implications for Nursing. As the endnote of the program, Joyce Fitzpatrick, PhD, RN, FAAN, Profes-sor at Elizabeth Brooks Ford, School of Nursing, delivered a challenging address related to Engage and Make a Differ-ence. Overall, the Leadership Institute and the Education Day proved to be very enriching, revitalizing and fulfilling for all attendees.

The International Year of the Nurse, 2010 was also celebrated during the convention. The parade of nurses wear-ing international costumes made the Networking Night colorful and fun.

After a long stretch of educational activities, seven limousines awaited the delegates outside the Hotel InterConti-nental for an evening of dinner shows at South-Beach Mangoes. Some delegates decided to listen to the South Beach music and engaged in dancing, while

others simply enjoyed the breeze and the moonlit sky at the beautiful South Beach bay.

The memorable Gala ceremony was the culmination of the convention. PNAA recognized the excellent con-tributions of the outstanding nurses in different fields of Education, Research, Informatics, and Community Service. The speeches of the out-going PNAA President Leo-Felix Jurado and the in-coming PNAA President Dr. Rey Rivera brought excitement and inspiration to the attendees. Josephine Villanueva, President of PNA South Florida, host chapter of the 31st PNAA Convention bequeathed the responsibility to the new host chapter, Cherina Tinio, PNA Northern California.

Indeed, the 31st PNAA Annual Convention was a huge success! The spirit of teamwork, networking, collabo-ration, and cohesiveness were evident during the entire convention. The PNAA and the hosting PNASF did an excellent job in creating and delivering scholarly, high quality education for the attend-ees. The experiences of the attendees in Miami Convention will be cherished. PNAA will strive hard to deliver qual-ity education and activities to promote excellence in nursing and clinical practice.z

See you all during the 32nd PNAA Annual Convention to be held in San Francisco, California

in 2011!


Reflections of PRISM


Advanced Practice Nurses in Today’s Global HealthcareJennifer Aying, MSN, RN, ACNP-BC and Sarla Duller, MN, RN, CCRN, ANP-BC

The Philippine Nurses Association of America, Inc.Advanced Practice Nurse Forum

Formed in July 2009 during PNAA President Leo-Felix Jurado’s term of office, the Advanced Practice Nurse Forum (APNF) is one of the segments of the Practice Committee that had made progress in attaining its goals. Its mission is to galvanize Master’s prepared nurses within the PNAA through collaboration, advo-cacy, and innovative thinking. The APNF actively promotes scholastic research, advances nursing clinical practice, enhances the standard of care for patients and promotes the Filipino culture. Its ultimate goal is to inspire all Filipino-American APNs to attain the highest potential as a professional nurse.

Within a short time since its inception, the APNF has launched its first membership survey, identified short and long-term goals, and designed its logo and theme. The APNF has supported the PNAA’s educational and Balik-Turo programs as speakers to the regional, national, and international conferences; contributed scholarly articles to the Journal of PNAA, participated in the CARE award, and provided updates to other APN colleagues on the current issues in the healthcare arena. During the PNAA 31st National Convention 2010 in Miami, Florida, the APNF launched its first sunrise program on Updates on the Consen-sus Model, President Obama’s Health Care Reform, and Ethno-pharmacology and Sedation.

Jenny Aying, MS, RN, ANP-BC and Rolly Perea, MS, RN, ANP-BC, serve as Co-Chairs of the Advanced Practice Nurses Forum of the PNAA.


advanced practiceSarla Duller, MN, RN, CCRN, APN-BC, Editor

G

lobally, advanced practice nurses (APNs) add value to healthcare through health promotion and

disease prevention programs geared towards the population they serve. His-torically, the APN role in the U.S. has evolved through the years because of the need for qualified healthcare clinicians to maximize consumer access to care in one of the established roles, either as certified nurse anesthetist (CRNA), certified nurse midwife (CNM), clinical nurse specialist (CNS), or registered nurse practitioner (NP). Today, APNs who at the mini-mum being master’s degree prepared, are recognized as experts in health promo-tion, disease prevention and rehabilita-tion, and are able to diagnose and treat common illnesses across life span.

The common denominator among countries to develop and expand the nurses’ role is in response to scarcity of physicians to provide primary care to the underserved rural areas in a cost effective manner. Consequently, these shortfalls opened an opportunity for the nursing profession to expand its role, and the APNs’ significant and sustained contri-butions are now recognized internation-ally.

However, the definition of the APN role varies from country to country. Ac-cording to the study by the International Nurse Practitioner/Advanced Practice Nursing Network (INP/APNN) of the International Council of Nursing, 14 out of 18 countries (78%) have issues related to scope of practice, education, titling, credentialing, legal status, and regulation that still need to be addressed and re-solved. In the Philippines, for example, nurses perform in an advanced level of

practice but are legally not recognized as APNs the way their U.S. counter parts are. On the other hand, in South Korea, the title APN has acquired legal protec-tion (Schober, 2004).

Moreover, in Canada and United Kingdom, there is role confusion among other higher-level practitioners, no clear authoritative guidelines working along-side with medical profession, as well as lack of integrity of the educational sys-tem. Australia and New Zealand Trans-Tasman Mutual Recognition Agreement explores the development of dual country NP standards and competencies (Schober & Affara, 2006). In contrast, in the Ca-ribbean, APNs are the main health care

providers to every citizen. In summary, considering differ-

ences in role definition, the impact of APN as clinicians is well documented in the literature: decreased cost of medical care, decreased frequency of emergency room visits, increased continuity of care, increased pain management practices as well as increased patient satisfaction with health care. z

*References available upon request.

This paper was presented during the 7th PNAA International Nursing Conference,

Cebu City, Philippines, January 7-9, 2010.

regulatory updateRegulation of Simulation in Nursing Education

Perry C. Francisco, MSA, RN, Editor

S

imulation is defined as the

imitative representation of the

functioning of one system or

process by means of the functioning of

another - usually a device, a computer or

both. The need for nurses continues to

grow and the demand for nursing educa-

tion proportionately increases to support

this growth. Along with the diminishing

clinical nursing opportunities in hospi-

tals, nursing homes and other clinical

facilities, academicians are pressured to

meet the required clinical hours to com-

plete a nursing program. Furthermore,

this is impacted by the lack of faculty to

meet these educational demands.

Technological advances have allowed

opportunities to augment the need for

educational resources. The use of simula-

tion is a growing trend. There is an in-

creasing body of evidence indicating that

simulation and use of simulators have a

place in the education of nurses. This

advancement in technology while helpful

is not the singular answer to the clini-

cal practice needs of nursing students to

meet their clinical requirements, but an

adjunct to clinical practice.

In a recent survey by the National

Council of State Boards of Nursing

(NCSBN) of the Boards of Nursing on

October, 20, 2009, NCSBN found that

18% of the respondents have rules that

address simulation, 62% are examining

simulation for consideration, and 6% are

Perry C. Francisco, MSA, RN

requiring limit on the use of simulation.

The Boards of Nursing and educators are

all waiting for more research on simula-

tion especially on teaching outcomes to

determine the direction they will take.

The Virginia Board of Nursing

(VA BON) is at the forefront of nursing

regulation on the use of simulation. Dr.

Paula B. Saxby, PhD, RN, in the Fall

2009 issue of NCSBN Leader to Leader

publication wrote on the Development

of Guidance Documents within Nursing

Education Regulation. These documents

are available on-line at www.dhp.virginia.

gov/nursing. The purpose of these docu-

ments is to assist the nursing schools in

preparing their nursing graduates to be

qualified and stay within the bounds of

the Board of Nursing regulations.

The challenges of clinical settings

and use of simulation compel nursing

education to redefine new innovative

approaches that focus on content and

process. Ultimately, the aim is to provide

seamless transition for the learners to

There is an increasing

body of evidence

indicating that simulation

and use of simulators

have a place in the

education of nurses.

assimilate, adopt, practice and apply.

In their article titled, Seamless Simula-

tion for Undergraduate Pedagogy and

Practicum Alignment, Allen D. Hanberg,

Ph.D, RN and Katie Baraki, MSN,

RN describe a model that supports the

development of critical thinking as an

essential part of nursing practice by prac-

tical utilization of the nursing process.

The goal for the learning experiences is

to help student nurses develop criti-

cal thinking applicable to safe patient

practice.

The early utilization of simulation

and parallel development of the complex-

ity of care in the laboratory and clinical

environment support the growth and

development of the students. This kind

of balanced education will address and

enhance the caliber of nursing graduates

who will truly practice using holistic and

evidence-based approaches.z

Selected References

Jefferies, P.R. (Ed.) (2007). Simulation in Nursing Education: From Conceptualization to Evaluation. New York, NY: National League for Nursing.Kyle, R. R., & Murray, W.B. (Eds.) (2008). Clinical Simulation: Operations, Engineering and Management. Burlington, MA: Academic Press. Medley, C., & Horne, C. (2005). Using simulation technology for undergraduate nursing education. Journal of Nursing Education, 44(1), 31-34Parr, M., & Sweeney, N. (2006). Use of human patient simulation in an undergraduate critical care course. Critical Care Nursing Quarterly, 29(3), 188-198.


Brenda Cohen, BSHS, RN, RNFA, CNOR, Editor

legislative updateHealth Care Reform: Implication for Nurses

Introduction

R

ising costs of health care, high percentage of underinsured, and inadequate access to quality,

affordable health care pressed President Obama to push Health Care Reform a priority. The House passed H.R. 3962: Affordable Health Care for America Act on November 7, 2009 and the Senate passed H.R. 3590: Patient Protection and Affordability Act. Both H.R. 3962 and H.R. 3590 hopes to attain access for all Americans, affordable and quality health care, examines waste and overpay-ment, improving medical malpractice, increase transparency, enhance patient-centered care, and reduce deficit over a ten-year period. These pose implications for health care providers especially nurses considered pivotal in the health care reform discussions especially in areas of research, education, preventive care, management of chronic illnesses, access to primary care in underserved popula-tions, and information technology. How-ever, nurses need to take a proactive role to change these bills into laws. Nurses have the obligation to stay informed and be ready to take the issues beyond afford-ability, accessibility, and health insurance coverage.

Health Care Reform: What Every Nurse Should Know

The United States spends most of its financial resources on health care. According to the World Health Orga-nization, the United States ranks in the low 37th in the international health care performance (Peter, 2009). The United States government and its citizens face concerns for the rising costs of health care especially for chronically ill patients,

Charlotte C. Qualls, RN, MA

effective health care, quality, and consis-tency of care. Approximately 45 million of the 300 million Americans have no health insurance coverage and another 25 million are underinsured (Carter, 2009; Dean, 2009; Meier & Beresford, 2009). Many Americans obtain health care insurance through their employers. The current recession with high unemploy-ment rate only exacerbated the problem of inadequate insurance coverage. Some personal bankruptcies are due partially to medical bills (Dean, 2009).

Furthermore, this country needs adequate health care workers who can provide care for its ageing population (Kendall-Raynor, 2009). It is for this reason that President Barack Obama, the 44th president of the United States and one of the four administrations in the last 60 years besides Truman, Nixon, and Clinton, to consider reforming health care the highest priority (Feeg, 2009; Kendall-Raynor, 2009; Nickitas, 2009).

H.R. 3962: Affordable Health Care for America Act

House of Representatives passed H.R. 3962: The Affordable Health Care for America Act on November 07, 2009 after escalating political conflicts that veered more toward disagreements. Speaker Nancy Pelosi (D-CA), Speaker of the House of Representatives, introduced the Health Care Reform on October 29, 2009 and Representative John D. Dingell (D-MI) sponsored the proposal on October 29, 2009. The Senate has to pass the document and the President of the United States to consider it before the document becomes law. The last health care reform enacted in 1965 was

the Social Security Amendment Act that created Medicare and Medicaid (Gard-ner, 2009).

The three principles President Obama hopes to attain with the Health Care Reform are: Access for all Ameri-cans, quality health care, and affordable health care without waste and overpay-ment (Gardner, 2009; Meier & Beres-ford, 2009). The reform also includes concepts of increasing access, improving medical malpractice, increasing transpar-ency, enhancing patient centered care, and shared decision-making. Other key concepts include: Health care delivery reform in which primary practitioners receive pay for comprehensive manage-ment including prevention and coordina-tion of care by specialists; Coordination and prevention of chronic illnesses such as diabetes, hypertension, pulmonary disease, and the effects of obesity and smoking as major drivers of rising health care costs (Meier & Beresford, 2009, p. 593); Payment reform such as pay for performance - episode-based or bundled care payments; Research, outcomes, qual-ity measurement, and public reporting of inequalities of utilization, costs, and quality; and Health information technol-ogy including federal support for quick implementation of integrated electronic health records (Meier & Beresford, 2009, p. 594).

H.R. 3590: Patient Protec-tion and Affordability Act

H.R. 3590: The Patient Protection and Affordable Act, a Senate health care bill introduced on September 17, 2009, is a related legislation to H.R. 3962.



the Congressional Hearing of the House of Repre-sentatives, April 28, 1999. Kincheloe, J. L., & McLaren, P. L. (1994). Rethink-ing critical theory and qualitative research. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of Qualitative Research. Thousand Oaks: Sage.Mill, J. E., Allen, M. N., & Morrow, R. A. (2001). Critical theory: critical methodology to disciplinary foundations in nursing. Canadian Journal of Nursing Research, 33(2), 109-127.Nyamathi, A. (1989). Comprehensive health seeking and coping paradigm. Journal of Advanced Nursing, 14: 281-290. Nyamathi, A., Sands, H., Pattatucci-Aragon, A., Berg, J. Leake, B., Hahn, J.E., & Morisky, D. (2004). Perception of health status by homeless US veterans. Family and Community Health, 27(1), 6-74. Nyamathi, A., Koniak-Griffin, D., & Greengold, B.A. (2007). Development of nursing theory and science in vulnerable populations research. Annual Review of Nursing Research, 25: 3-25. Ray, M. A. (1992). Critical theory as a framework to enhance nursing science. Nursing Science Quarterly, 5(3), 98-101.Rodgers, B. L. (2005). Interpretive inquiry: The mirror cracked. In E. Kors (Ed.), Developing Nursing Knowledge: Philosophical Traditions and Influences. Milwaukee: Lippincott Williams & Wilkins.Vance, A. R. (1989). Filipino Americans. In: J. Giger and R. Davidhizar (Eds.), Transcultural nurs-ing: Assessment and intervention. Mosby-Year Book, Inc.: St. Louis.Weaver, K., & Olson, J. K. (2005). Understand-ing paradigms used for nursing research. Journal of Advanced Nursing, 53(4), 459-469.

Filipino veterans.

• The factors that contribute to the

vulnerability of a population group in-

clude environmental resources, human

capital, and social status.

• Lack of resources in vulnerable popula-

tions has a greater influence on illness

and premature death than the presence

of risk factors.

• The concept of health varies among dif-

ferent cultures.

• The health status of a community

maybe reflected in the availability of

healthcare resources.

• Filipino immigrants are at-risk for post-

traumatic stress disorder, diabetes, and

clinical depression. z

Selected ReferencesAnderson, E., & McFarlane, J. (1996). Community as partner: Theory and practice in nursing. Lippincott: Pennsylvania.Booth, K., Kenrick, M., & Woods, S. (1997). Nurs-ing knowledge, theory and method revisited. Journal of Advanced Nursing, 26, 804-811.Browne, A. J. (2000). The potential contributions of critical social theory to nursing science. Canadian Journal of Nursing Research, 32(2), 35-55.Campbell, J. C., & Bunting, S. (1991). Voices and paradigms: Perspectives on critical and feminist theory in nursing. Advanced Nursing Science, 13(3), 1-15.Clark, M. (1999). Nursing in the community: Dimensions of community health nursing. Appleton & Lange: Stamford.Flaskerud, J. H., Lesser, J., Dixon, E., Anderson, N., Conde, F., & Kim, S. (2002). Health disparities among vulnerable populations. Nursing Research, 51(2), 74-85. Gilman, B. (1999). Legislation to provide veterans health care benefits to members of the Philippine commonwealth army and the members of the special Philippine scouts, H. R. 1594. Remarks presented in

Abstract

F

ilipino World War II Veterans

living in the United States are

considered as one of the vulner-

able categorical groups, along with the

poor, persons subjected to discrimination

and those who are politically marginal-

ized, disenfranchised and denied human

rights. They were introduced into politi-

cally marginalized groups because of a

legislation that took away their veteran

benefits. This CE offering will show the

importance of studying the health status

of Filipino World War II Veterans from a

vulnerable population perspective.

Highlights• Filipino World War II Veterans com-

prise a group of Filipinos who fought

under the United States Forces in the

Far East in World War II.

• Filipinos were considered nationals of

the United States from 1898 to 1946

and were afforded the rights of citi-

zenship except the right to vote, own

property, or marry.

• The US Congress passed the GI Bill of

Rights on June 22, 1944, providing full

benefits to all who served during World

War II irrespective of race, color, or na-

tionality. Under this law, soldiers from

66 countries who fought in the war

were given full benefits, but excluded

Editor’s Note:For instructions,

fees and other details on this

Continuing Education Offering, please go to

www.mypnaa.org.


educationHealth Status of Filipino WWII VeteransRomanitchiko Samiley, MSN, RN, FNP-BC

Marlon G. Saria, MSN, RN, AOCNS, Editor

CE OFFERING

T

oday’s healthcare is constantly evolving. Patient populations have become increasingly diverse,

new and complex diseases have emerged, and technology is continuously being improved. Medical and nursing practices are changing to meet the needs of the growing ageing population and the chal-lenges brought by healthcare. Nursing is changing as well. Nurses work, look, and think differently today. More men are entering nursing in greater numbers. In some situations, nursing is losing women to newer work opportunities in diverse disciplines and professions. Older and second career students are choosing nurs-ing as a career.

According to the U.S. Census Bureau (2000), one of every three persons in the US (more than 30% of the population), is comprised of various ethnicities other than non-Hispanic whites (Maier-Lorentz, 2008). The differences in demographics also reflect variations in basic values, beliefs, and behaviors. Cultural diversity refers to the variations and differences among and be-tween cultural groups due to differences in life ways, language, values, norms, and other cultural aspects (Leninger, 1995). Although race and gender are often considered centerpieces of cultural identity, diversity broadly encompasses age, socioeconomic class, physical differ-ences, educational background, ethnicity, religion, and national origin. Ultimately, diversity refers to characteristics that help shape a person’s attitudes, behaviors, and perspectives.

Raritan Bay Medical CenterRaritan Bay Medical Center

(RBMC) is a 501-bed Central New Jer-sey medical center with hospital divisions

located in the city of Perth Amboy and the town of Old Bridge. RBMC is ac-credited by The Joint Commission (TJC) and designated as a Magnet Hospital for Nursing Excellence by the American Nurses Credentialing Center (ANCC). As a Magnet hospital, the medical center is committed to providing professional, compassionate, and quality health care to all patients and to meeting the changing health care needs of the community. The workforce consists of 2,040 medical/nursing and ancillary staff representing diverse ethnic groups.

The populations living in the RBMC catchment areas of Perth Amboy and Old Bridge are very different. According to the US Census Bureau (2000), the city of Perth Amboy is made up of the following ethnic groups: white (46.4%), African American (10%), Asian (2.1%), and Latino (69.8%). In contrast, the town of Old Bridge is composed of white (79.5%), African American (5.3%), Asian (10.8%), and Latino (7.6%). The influx of patients from varied cultures has led RBMC to evaluate the care and services offered to patients. As the number of people from diverse sociocultural backgrounds grows, so does the intricacy of patient care needs. To address these needs, RBMC began a journey toward cultural competency by incorporating culture in day-to-day patient care and by planning programs to help eliminate health disparities among minorities.

The Road to Cultural Competency

Cultural competence is the adapta-tion of care that is congruent with the patient’s culture (Black, 2008). It is a dynamic and continuous process wherein

the healthcare provider and the patient agree on strategies to meet the patient’s needs based on cultural knowledge, attitudes, and behavior. Being aware of one’s own heritage and then appreciating the behaviors of others are the first steps towards cultural competency.

RBMC started its journey towards cultural competency in 2000. Senior leadership agreed that to maintain excel-lent medical and nursing care RBMC must recognize and maintain its aware-ness of all ethnic groups. RBMC believes that nurse leaders who are sensitive to specific issues resulting from diversity are able to implement effective management and leadership strategies to enable staff to collectively meet the desired goals of the work setting. Leaders who are competent in handling diversity issues encourage employee team-building that is sensitive to the barriers and strengths associated with various cultures.

Cultural competency education was included in the hospital’s strategic plan. The first step taken at RBMC was to plan for hospital-wide diversity aware-ness. Policy and procedures were created and revised to reflect changes in the delivery of care. Cultural competency became a requirement in the annual performance evaluation. All employees participated in an annual online continu-ing education on valuing diversity. Addi-tionally, all employees and administrators attended a series of programs on cultural diversity. Nurse educators from the Staff Development Department provided the educational program upon hire, annually, and as needed.

Diversity education included age- and population-specific considerations, which were also incorporated in interdis-ciplinary educational programs such as


cultural diversityCreating a Climate of Cultural Competency: One Hospital’s JourneyTheresa Macalalad, MSN, MBA, RN, CCRN, RN-BC

Lorraine Steefel, DNP, RN, CTN-A, Editor

increasingly diverse, nurses need to continue to develop skills to effectively care for patients from a variety of racial and ethnic backgrounds. Nurses need to determine when barriers to learning and communication are rooted in individual attitudes and perceptions or when such difficulties stem from cultural barriers or biases within the organizational systems. As agents of change, nurses are in a posi-tion to integrate diversity throughout the healthcare organization. Undoubtedly, nurses must be competent in handling issues on diversity.

As healthcare organizations merge, leaders are faced with the challenge of combining cultures. Today’s world and workplace are more diverse than ever. Although diversity can be divisive, it can also be enriching. We need to be aware of our own biases and recognize that we may have misconceptions about vari-ous groups of people. The best way to address these misconceptions is to first be aware of these biases. We need to be cognizant of how and what we do or say affects others. Ultimately, cultural understanding, as a hallmark of cultur-ally competent care, should focus not so much on what one says, but how one acknowledges another person’s reactions and responses. z

Author Affiliation Theresa Macalalad, is Staff Development Educator at Raritan Bay Medical Center, Perth Amboy Divi-sion, New Jersey.

References

Black, P. (2008). A Guide to providing culturally

appropriate care. Gastrointestinal Nursing, 6(6),

10-17.

Gerish, K., Husband, C., & Mackenzie,J. (1996).

Nursing for a multi-ethnic society. Buckingham:

Open University Press.

Leininger, M. (1995). Transcultural nursing: Con-

cepts, theories, research, and practices. Columbus,

OH: McGraw-Hill.

London, F. (2008). Meeting the challenge:

Patient education in diverse America. Journal for

Nurses in Staff Development, 24(6), 283-285.

Maier-Lorentz, M. (2008).Transcultural nursing:

Its importance in nursing practice. Journal of

Cultural Diversity, 15(1), 37-43.

nursing forums and quarterly age-specific updates and publications. Quarterly pub-lications and programs related to food preferences, health beliefs, and death and dying based on the top four ethnic groups that RBMC serves: Hispanic and Latino; Polish, Russian and Portuguese; Asian; and African and Caribbean Island-ers. Employees from different cultural backgrounds served as panelists during annual programs. The Food and Nutri-tion Department participated and served ethnic foods several times every year.

Nursing RoleCultural competency is required

throughout the patient assessment pro-cess and is included in the development of the plan of care and patient/family education. Nursing assessment includes questions on cultural preferences, i.e. re-ligious beliefs, food preferences, medica-tions and herbs, or any cultural practices that the patient may want the healthcare provider to be aware of during hospital-ization. Cultural diversity concepts are taught during nursing orientation, and culturally competent care is included in discussions during interdisciplinary rounds. Nursing care plans are modi-fied to represent changes in patients’ conditions and to meet patients’ cultural values and beliefs. Documentation of patient education reflects how well the

Cultural Diversity

nursing assessment and the plan of care are individualized. The hospital’s nursing care delivery model - Patient Family Centered Care - focuses on the nurse-patient relationship. Collaborating with the patient and the family on cultural and patient care needs permits the nurse to determine the best intervention for the best patient outcomes.

RBMC has made a commitment to promoting communication and provid-ing information on diversity by recogniz-ing the cultural and language differences in the population it serves. The medical center allows the patient to exercise cultural and spiritual beliefs that do not interfere with the well-being of others or the plan of care.

The provision of care and com-munication with patients who speak little or no English has ethical, legal, and professional implications for both the healthcare provider and the patient. Delays in effective communication for non-English speaking patients can result in patients feeling frightened, frustrated, and angry (Gerrish et al, 1996). Be-cause the patient’s cultural views may be best expressed and communicated in the language of the culture (London, 2008), RBMC offers classes on language interpretation. Employees who wish to volunteer attend a two-day class offered by the Staff Development Department. Interpreters can also be accessed us-ing telephonic technology through the Foreign Language Line Services. The language line offers interpreters from 150 different countries and is utilized for patient assessment, discharge instructions and education.

The Deaf Talk Video Sign Language Interpreting Services is another method of technology that deaf and hard-of-hearing patients can use to access a sign language interpreter in a timely manner. Every patient care unit/department in the medical center is wired for use of Deaf Talk Video Sign Language Inter-preting Services. Appropriate signage for interpretation for the needs of patients is displayed in public areas of the hospital.

The Challenge Continues

As the US population becomes


Sponsored by Representative Charles Rangel (D-NY), the bill passed the House on October 8, 2009 and passed the Senate on December 24, 2009 with a vote of 60-39. Resolution of differences in the bill will occur before President Obama can sign H.R. 3590 into law (OpenCongress, 2010).

Cost-controls, funding, and direc-tives incorporated in the Patient Protec-tion and Affordable Act will increase health care coverage to 39 million unin-sured Americans (OpenCongress, 2010). The cost of approximately $848 billion over a period of 10 years stays under President Obama’s limit of $900 billion. New taxes and revenues will make up for the cost and would reduce the deficit by $132 billion over the ten-year period (2010 – 2019) (Democratic Policy Com-mittee, 2010; U.S. Senate Republican Policy Committee, 2010). The Demo-cratic staffs in the Congressional Budget Office (CBO) conclude that the bill will provide coverage for 94% of Ameri-cans and lessen deficit by $132 billion (Democratic Policy Committee, 2010). Republican members of the CBO, on the other hand, claim that the major provi-sions will not take effect until January 1, 2014. This means that the bill will use 10 years of revenue for six years of cover-age and have an estimated total spending that would exceed $2.5 trillion over a period of 10 years (U.S. Senate Repub-lican Policy Committee, 2010). The Republicans also claim that the bill will increase taxes by $493.6 billion to pay and reduce Medicare spending by $464.6 billion for the expansion of insurance coverage. The bill would cut $120 billion from Medicare Advantage, $14.6 billion from nursing homes, $42.1 billion from home health agencies, and $7.7 billion from hospices (U.S. Senate Republican Policy Committee, 2010, para. 5).

The Patient Protection and Af-fordable Act ensure access, affordable and quality health care coverage for all Americans and provide cost-control

Legislative Update

changes in the health care system. Some of the major tenets of H.R. 3590 are (Democratic Policy Committee, 2010; U.S. Senate Republican Policy Commit-tee, 2010): Health insurance companies will change the way they do business to provide better preventive coverage and protect consumers from discrimi-natory practices based on pre-existing conditions, gender, and health status; Mandates all lawful citizens to purchase qualified health insurance or pay $750 penalty starting 2014 and phased in over three years; Funding to Commu-nity Health Centers will provide health care in communities that need care the most; Increase by 40% Medicaid cover-age to include non-elderly Americans with income below 133% of the Federal Poverty Level (FPL); Maintain fund-ing for the Children’s Health Insurance program (CHIP) for another two years until 2015; Strengthen and sustain the Medicare Program for seniors and people with disabilities; Eliminate co-pays and deductibles for women’s preventative care and improve education on disease prevention and public health; Address shortages in primary care by investing in the health care workforce through schol-arships, loan-repayment programs, and incentives for primary care practitioners who choose to work in underserved ar-eas; Transparency of physician ownership of hospitals, nursing homes, and medical equipment; This bill is fully paid for and reduces deficit in the next 10 years by tightening incentives on current health tax, collection of industry fees, and increase in Medicare Hospital Insurance tax for individuals with income of more than $200,000 and couples with income of more than $250,000; and Provide tax credit for individuals between 133% and 140% of the FPL, approximately $28,333 - $88,000 for a family of four, to help them buy insurance coverage.

Nursing ImplicationsThe country’s nurses have the obli-

gation to stay informed and be diligent with the progress of President Obama’s Health Care Reform to improve the U.S. health system. Health Care Reform will bring to reality what is best for the 2.9 million nurses and their patients (ANA, 2010a). Nurses need to be ready to take the discourse beyond issues of affordabil-ity, accessibility, and competitions in cov-erage (Nickitas, 2009, p. 361). Nursing organizations such as the ANA and 43 other nursing associations need to take an active role for the passage of Health Care Reform into law (ANA, 2010b). Nurses help reduce cost and clinical stud-ies show evidences that nurses make bet-ter patient outcomes (McNamara, 2009). Understandably, Obama has kept nurses in the center of discussions on health care reform. New opportunities for nurs-ing may emerge as the search continues for new ways of providing essential care while reducing cost. Nurses can play a vital role toward research, outcomes, quality measurement, and public report-ing of inequalities of utilization, costs, and quality. Nursing informatics can cer-tainly assist and collaborate with quick implementation of integrated electronic health records. Primary care and disease prevention are areas of inaccessibility in the U.S. Advanced Practice Registered Nurses, especially Nurse Practitioners and Certified Nurse Midwives, can facilitate care in underserved areas with the aid of federal and public funding supported by the Health Care Reform for the management and coordination of care for patients with chronic illnesses.

As a senator, Obama supported The Safe Nursing and Patient Care Act, a bill that limits mandatory overtime. His plans require health care facilities to monitor nurse-patient ratios. Nursing in-put on safe staffing is vital. Nurses need to work with health care organizations to increase efforts toward safe staffing legislation. ANA presents more detailed key nursing provisions of H.R. 3962 and H.R. 3590 (ANA, 2010c).



stay informed and ready to take the issues beyond affordability, accessibility, and health insurance coverage.z

Author Affiliation Charlotte C. Qualls, RN, MA is Administrative Coordinator at St. Clare’s Health System, Dover, New Jersey.

RecommendationsNurses can take grassroots action

to facilitate H.R. 3962 to become law. Some examples include:

1. Key talking points that contains essen-tial information enabling nurses to speak to policy makers in a single voice with available handouts.

2. Build alliances among the 43 nursing organizations that promote Health Care Reform (ANA, 2010c).

3. Stay informed of Congressional proposals, debates, and negotiations relevant to nurses as professionals and citizens. The Kaiser Family Foundation website (http://www.kff.org) includes an excellent tutorial on the legislative process necessary to pass Health Care Reform into law. The ANA (http://www.nursingworld.org) has a section dedicated to their agenda for health care reform and provides policy information nurses can use to communicate with their local representatives (ANA, 2010d).

ConclusionThe passage of Health Care Reform

H.R. 3962: Affordable Health Care for Americans Act through the House of Representatives is a historical event. For the first time, the House and the Senate are in position to negotiate and make

it possible for President Obama to turn H.R. 3962 and H.R.3590 to become law. This milestone in health care reform promises control of health care costs, access to all Americans to affordable quality health care, and expansion of health insurance coverage. Nurses will play a very important role in the discus-sions and imperatives of the Health Care Reform. President Obama placed nurses in the center of health care reform dis-cussions and the American public is well aware of nursing insights and knowledge of managing diseases and health care problems. Nurses have the obligation to

References

American Nurses Association (ANA). (2010a). Health System Reform. Retrieved March

10, 2010 from http://nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/HealthSys-

temReform.aspx

American Nurses Association (ANA). (2010b). Constituent Member Associations.

Retrieved on March 10, 2010 from http://www.nursingworld.org/FunctionalMenuCategories/Abou-

tANA/WhoWeAre/CMA.aspx

American Nurses Association (ANA). (2010c). Key Provisions Related to Nursing:

House (H.R. 3962) and Senate (H.R. 3590). Retrieved on March 13, 2010 from http://www.rnaction.

org/site/DocServer/Key_Provisions_Related_to_Nursing-House_and_Senate.pdf?docID=981

American Nurses Association (ANA). (2010d). Health Care Reform Toolkit. Retrieved on

March 13, 2010 from http://www.rnaction.org/site/DocServer/Key_Provisions_Related_to_Nursing-

House_and_Senate.pdf?docID=981

Carter, P. (2009). Voices. Nursing Standard, 23 (19), 24. Retrieved on March 5, 2010 from Academic

Search Complete.

Dean, E. (2009). A man with a vision: President Obama’s fight to reform American health care.

Nursing Standard, 23(50), 12-13. Retrieved on March 5, 2010 from Academic Search Complete.

Democratic Policy Committee (2010). The Patient Protection and Affordable Care Act.

Retrieved on March 11, 2010 from http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm

Feeg, V. (2009). From the editor. Pediatric Nursing, 35(4), 213-214. Retrieved on March 2, 2010 from

Academic Search Complete.

Gardner, D. (2009). The evolving voice of nursing in Health Care Reform. Nursing Economics, 27(4),

255-259. Retrieved on February 12, 2010 from Academic Search Complete.

Govtrack (2010). H.R. 3590: Patient protection and Affordable Care Act. Retrieved on March 12,

2010 from http://www.govtrack.us/congress/bill.xpd?bill=h111-3590

Kendall-Raynor, P. (2009). US nurses call for urgent healthcare reform as new president takes office.

Nursing Standard, 23 (19), 15. Retrieved on March 5, 2010 from Academic Search Complete.

McNamara, M. (2009). Media Briefs. The American Nurse, 41 (4), 15. Retrieved on March 4, 2010

from Academic Search Complete.

Meier, D.E. & Beresford, L. (2009). Palliative care seeks its home in national health care reform.

Journal of Palliative Medicine, 12 (7), 593-597. Retrieved on March 12, 2010 from Academic Search

Complete.

Nickitas, D,M. (2009). Moral courage or moral imperative: Which is it? Nursing Economic$, 27 (6),

361-362. Retrieved on March 6, 2010 from Academic Search Complete.

OpenCongress (2010). H.R. 3590: Patient Protection and Affordable Care Act. Retrieved on March

12, 2010 from http://www.opencongress.org/bill/111-h3590/show

U.S. Senate Republican Policy Committee (2010). H.R. 3590: The Quality, Affordable Health Care

for all Americans Act. Retrieved on March 13, 2010 from

http://rpc.senate.gov/public/_files/L28HR3590HealthCare120209ac.pdf.


Legislative Update

Remedios A. Solarte, DNP, RN, NP, Editor

regional reports


Medical Mission: The Art of Giving BackMerlita Velasquez, BSN, RN

T

his article describes the Medical

Missions in the Philippines by

the 12 chapters of the PNAA

South Central region. The history,

preparation and activities related to

the Medical Missions are presented. In

particular, the spirit of volunteerism is

explained and the motivation of PNAA

members to engage in hectic, demanding

and expensive trips to the Philippines is

presented.

According to the World Health

Organization (WHO) (2005), Medical

Missions are advocacy groups comprised

largely by compassionate volunteers

who perform a humanitarian service

by donating their time, expertise and

resources in service of others. The

primary objective of medical missions is

to give medical and surgical services to

poor populations especially in the third

world countries who may not otherwise

have access to these services. Volunteers

also provide education and other services

to eradicate disease and improve health

practices of individuals and families

in communities. Religious and church

organizations and non-profit foundations

conduct medical outreach or missions

as part of their mission and/or minis-

try based on the Christian practice of

stewardship (Personal Communication.

Calvary Baptist Church, 2007).

Many Filipino-American healthcare

professionals, especially doctors and

nurses support and participate in Medi-

cal Outreach Medical Missions as a re-

sponse to the WHO Constitution, which

states, “The enjoyment of the highest

attainable standard of health is one of

the fundamental rights of any human

being” (2005 WHO Summit Outcome,

GA, res .60/1). Medical Missions are

organized with various Medical Associa-

tions in local cities or towns of origin of

participants who collaborate and advance

the health-related concerns of their fel-

low men by providing direct services and

supplies to poor communities with little

to no access to needed healthcare. Medi-

cal Missions go to poverty-stricken and

underserved regions in the Philippines

to give free medical-surgical services that

include medical and surgical and other

medical specialty care. These services

include major, minor and reconstructive/

plastic surgeries, general medical and

family practice, and specialty services as

Pediatrics, Cardiology, Oncology and

dentistry. The Missions also provide free

medicines, medical supplies and minor

medical equipment. Missioners conduct

teachings on health promotion and

provide appropriate educational pam-

phlets and brochures to the local people.

They coordinate with local medical and

nursing schools that to provide student

volunteers to support the mission’s com-

munity services. These students found

the experience to enhance their knowl-

edge and skills. Students were apprecia-

tive of these opportunities.

The PNAA Medical MissionDuring the disastrous eruption of

the Mayon Volcano in Tabago, Albay in

the early part of 2006, the PNAA part-

nered for the first time with the Medical-

Surgical Mission of Texas (MSMT) by

providing funding for the “PNAA Love

Package,” consisting of five kilos each of

rice, sugar and powdered milk for some

200 affected families. Phoebe Andes,

PNAA Foundation President, together

with the author of this article, imple-

mented this initiative. Three big canvas

tents were used as makeshift classrooms

to conduct educational programs for the

participants after the medical mission.

In collaboration with regional medi-

cal groups, the South Central Regional

Chapters co-sponsor and organize medi-

cal missions to the Philippines every year.

These medical groups include the fol-

lowing organizations and coordinators:

PNA Georgia (Ed and Beth Villanueva),

PNANE Florida (Romy de Vera), PNA

Rio Grande Valley (Ted and Luz Llasos),

PNA Cameron County (Sandy Lalata),

and PNA Metro Houston (Merlita

Velasquez and Cleo Robinett). PNA

of Metro Houston is also a member of

the Medical-Surgical Mission of Texas, a

private Foundation based in Port Arthur,

Texas.

The 12 PNAA Chapters from the

South Central Region are committed to

the principles posited by Rick Warren’s

(2005) The Purpose Driven Life. Many


Philippines. Orientation of volunteers

includes physical, emotional and profes-

sional preparation. Volunteers who speak

the dialect and know the health practices

of the region are recruited and assigned

as interpreters and lead resource persons.

The PNAMH-MSMT mission is

composed of at least 40 volunteers, 2/3

of whom are physicians; the rest are

comprised of nurses and spouses of vol-

unteers. Volunteers come from different

parts of the US and belong to different

ethnic and racial background.

The SCR Medical Missioners’ in-

spiration in helping and giving back lies

deeply in the Filipino cultural and moral

heritage of generosity and hospitality to-

wards disadvantaged members of society.

This spirit is embodied in the Filipino

values of pakikisama (a Filipino trait used

as a facility to form and maintain good

relationships) and pakikipagkapwa (a

Filipino trait that reflects shared iden-

tity). Many participants consider the

experience as a spiritual renewal and self-

fulfillment. The SCR Medical Missioners

are touched and satisfied with the result

of their discipleship work in progress

and are determined to go back and do it

again as long as they can. z

References

Calvary Baptist Church Medical Outreach.

(2007). Personal Communication.

Velaquez, M. A. (2007). Personal Communica-

tion. MSMT testimonials 2007 Velasquez, M.A.

Medical

Mission Testimonials, Medical-Surgical Mission

of Texas, 2007.

World Health Organization, United Nations

Publications. Accessed on April 1, 2010 from

http://www.who.int/whr/en/index.html.

Warren, R. (2005). The Purpose Driven Life. Ac-

cessed on May 30, 2010 from

http://www.purposedrivenlife.com/en-US/Abou-

tUs/AboutTheBook/AboutTheBook.htm.

members are motivated by the desire to

give back and share their expertise and

goodwill with their fellow countrymen.

Volunteers pay for their own expenses,

donate their services and seek donations

of supplies and services for the mission.

The chapter members’ involve-

ment includes assisting doctors in many

capacities as anesthesia nurse, surgi-

cal assistant, recovery nurse, filling up

prescriptions, giving health instructions,

organizing the flow of clinic activities,

record keeping, or running errands. Ev-

eryone works as a team, fully contribut-

ing in whatever way to achieve the goals

of the mission. Medical and surgical clin-

ics begin from 7:30 am until everyone

who showed up for the day is seen and

treated. Thousands of patients are served

daily. Between 50-60 surgical procedures

(major, minor, and reconstructive/plas-

tic) are performed for the duration of the

mission, which is about four to five days.

Thousands of medications and supple-

ments are dispensed freely including

vitamins, iron supplements, analgesics,

antipyretics, antitussives, purgatives anti-

hypertensives, anti-diabetics, anti-cho-

lesterol pills and antibiotics. Powdered

formulas, baby soaps, lotions, first aid

kits and other supplies including school

supplies for children are provided at no

cost. Missioners are happy and satisfied

when they have addressed the communi-

ties’ needs and emptied their supply box-

es. They find enjoyment in their Filipino

lunches and meriendas (snacks) in return

for much hard work and generosity. Each

day culminates with volunteers physically

exhausted but spiritually rejuvenated.

They are then transported back to their

hotel rooms in local jeepneys (a type of

Regional Reports

public transport common in the Philip-

pines). After dinner, they go to bed early

to re-charge for the next day.

Preparing for the Medical Mission

The host/venue province, town

or barrio is selected using established

criteria based on local census data and

poverty level of the population. The

safety of volunteers is considered in

selecting the venue. Venues are sched-

uled two to three years ahead of time.

Volunteers finance their own travel and

accommodation, and procure their own

passport and travel clearance documents.

Physicians are required to be creden-

tialed and granted a temporary permit by

the Philippine Medical Association. The

PNA in the Philippines recognizes and

supports the collaboration with PNAA.

The volunteer group solicits donors

and conducts fundraising campaigns

to buy medicines and supplies, which

are shipped four to five months before

the scheduled medical mission date.

Electronic and face-to-face quarterly

meetings are held to coordinate the

volunteers from different states and

communicate with local partners in the

Missioners are

happy and satisfied when

they have addressed the

communities’ needs and

emptied their supply boxes.

Each day culminates with

volunteers physically ex-

hausted but spiritually

rejuvenated.

Regional Reports


T

his article presents the local

practices that integrate nutri-

tional programs among the Aetas

and Unats in barrio (town) Buhawen,

Zambales, Philippines. The feeding

program highlighted in this article was

established through pioneering spirits of

the Kansas City World Outreach Lions

Club (KCWOLC) under the leader-

ship of the author (EBR), a Founding

Officer of KCWOLC. In collaboration

with, and strong support by Philippine

Nurses Association of Greater Kansas

City (PNA-GKC), the Feed the Hungry

Moringa Project became a reality.

IntroductionAccording to the United Nations

World Food Programme (WFP, 2010),

good nutrition in the early years of life is

critical for human growth and mental de-

velopment. Thus, a large part of WFP’s

nutrition programmes is directed towards

young children and mothers. Despite

these efforts, there are 1.02 billion un-

dernourished people in the world. This

equates to nearly one in six people who

do not get enough food to be healthy

and lead an active life. Hunger and

malnutrition are the number one risk to

health worldwide (Harohall & Grigsby,

2009). These figures on these condi-

tions are greater than AIDS, malaria and

tuberculosis (WFP, 2010).

MalnutritionIn 2003, the results of the Sixth

National Nutrition Survey (6th NNS)

conducted by the Food and Nutrition

Research Institute – Department of Sci-

Feeding Program with MoringaElizabeth B. Rosas, BSN, RN, HNC and Matilde S. Upano, MSN, RN, FNP-BC

ences and Technology (FNRI - DOST)

conducted in the Philippines showed

that protein-energy malnutrition (PEM)

and micronutrient deficiencies continue

to prevail as the leading nutritional

problems in the Philippines. This is

despite efforts to control and eliminate

this nutritional problem. Over three

million (27%) children between the ages

of 0-5 were underweight-for-age, close

to 3.5 million (30%) children of same

age were short for their age, and over half

a million (5.5%) children were thin or

wasted - an indicator of acute or current

under-nutrition (Pedro, et al, 2003).

Malnutrition in the Philippines is

caused by a number of interrelated fac-

tors: Health, physical, social, economic

and others. Food supply, distribution

and consumption by Filipinos have

consequent impact on nutritional status.

Although reports indicate that there

is enough food to feed the country,

many Filipinos continue to go hungry

and become malnourished because of

inadequate intake of food and nutrients.

Except for protein, the typical Filipino

diet was found to be grossly inadequate

for energy and other nutrients. In order

to compensate for the inadequate energy

intake, the body makes use of protein as

energy source. This results in the con-

tinuing PEM problem in the Philippines

(FAO, 2001).

The current economic situation

in the Philippines further aggravates

the malnutrition problem with ap-

proximately 28 million Filipinos unable

to buy food to meet their nutritional

requirements and basic needs (FAO,

2001). In 2003, about 18% of children

skipped/missed meals because there was

no money to buy food, 8.2% experi-

enced not eating for a whole day because

there was no food or money to buy food,

and 15.1% went hungry and did not

eat because there was no food or money

to buy food. According to the World

Health Organization (WHO) Statistical

Information System, children in the Phil-

ippines are suffering from the effects of

malnutrition: 33% of children under five

years of age are stunted for age compared

to 3% in the US; 20.7% are under-

weight for age compared to 1.1% in the

US; and 20% of newborns are with low

birth weight compared to 8% in the US

(Pedro, et al, 2003).

MoringaMoringa oleifera Lam. (Moringa-

ceae) is commonly known as moringa,

drumstick tree, kelor, marango, mlonge,

mulangay, nebeday, saijhan, and sajna

(Fahey, 2005; Mahajan & Mehta 2007).

In the Philippines, it is locally known

as malunggay. Moringa is an edible tree

found worldwide in the dry tropics. Its

nutrient-dense leaves are high in protein

quality, thus it is widely used by doctors,

healers, nutritionists and community

leaders to treat under-nutrition and a

variety of illnesses (Thurber & Fahey,

2009). Trees for Life, Church World

Service, and Educational Concerns for

Hunger Organization are three non-

governmental organizations (NGOs) that

have advocated moringa as natural nutri-

tion for the tropics. Reportedly, moringa

leaves can be eaten fresh, cooked, or


Regional Reports

stored as dried powder for several months

without refrigeration, without losing

its’ nutritional value. It is especially

promising as a food source in the tropics

because the tree is in full leaf at the end

of the dry season when other foods are

usually scarce (Fahey, 2005).

In the Philippines, the Moringa

plant can be propagated by seed or by

planting limb cuttings one to two meters

long, preferably from June to August.

The plant bears pods for several years

starting about six to eight months after

planting. Moringa’s acceptance as a

nutritional supplement or a food addi-

tive in undernourished populations is

compatible in cultures like the Philip-

pines that currently use green leafy plant

sources in traditional dishes. In addition,

since households can produce their own

Moringa or find it in local markets, they

are able to use it just as they would with

other locally grown foods such as grains,

legumes, root and tubers (Thurber &

Fahey, 2009).

Moringa Feeding ProgramIn January 2009, the Moringa

Feeding Program was implemented

in Barangay (village) Buhawen, San

Marcelino, Zambales, Philippines where

indigenous Aetas, also known as Unats,

live. The Aetas, distinguished by their

small structure, kinky hair, flat nose and

black skin, were the earliest inhabitants

in the Philippines. The Aetas are situated

in Zambales, Tarlac, Bataan and Nueva

Ecija (Negritos, 2010). Due to very

limited resources and their reluctance to

mingle with the mainstream, the Aetas

have many health problems that are

caused mainly by malnutrition and lack

of knowledge.

Collecting and counting pennies

and coins may not be the most popular

way of raising funds specially if one is

thinking of big projects, but for Kansas

City World Outreach Lions Club and

PNA Greater Kansas City, saving those

pennies and coins have enabled them to

feed a village of Aetas and others.

Members of PNA-GKC and KC-

WOLC traveled 5,000 miles from Kan-

sas City, USA, then ventured on another

three-hour land trip over mountainous

rugged roads to the foothills of Mount

Pinatubo, where the Aetas were displaced

after the eruption of Mount Pinatubo

in 1991. They fed these people a feast

consisting of tinola, a traditional chicken

dish consisting of chicken in a broth

with Moringa leaves, steamed rice and

Moringapan or pandesal, a Filipino roll

made of Moringa flour.

Fahey (2005) reports that for hun-

dreds of years, traditional healers have

prescribed different parts of Moringa to

treat skin diseases, respiratory illnesses,

ear and dental infections, diabetes, and

cancer treatment. It has also been used

for water purification. These uses for

Moringa started as traditional practice

and knowledge. However, these are now

being disseminated by international aid

agencies, health care workers, and the

private sector to educate people globally

as sustainable innovations to combat

under-nutrition including micronutrient

deficiencies (Thurber & Fahey, 2009).

Results on the bioavailability trials of

beta-carotene from fresh and dehydrated

moringa leaves in a rat model imply

that beta-carotene from moringa leaves

was effective in overcoming vitamin A

deficiency. This study concluded that in

developing countries like India, sources

of vitamin A such as Moringa leaves are

valuable in overcoming the problem

of vitamin A deficiency (Nambiar &

Seshadri, 2001).

Global Implications of Moringa

Trees for Life, an NGO based in the

United States, has promoted Moringa’s

nutritional benefits. Moringa’s nutritional

comparison has been widely copied and

taken on faith by many: Gram for gram,

the fresh leaves of Moringa have four

(4) times the vitamin A of carrots, seven

(7) times the vitamin C of oranges, four

(4) times the calcium of milk, three (3)

times the potassium of bananas, three-

fourths (¾) the iron of spinach, and two

(2) times the protein of yogurt (Trees for

Life, 2005).

Moringa is an example of a nutrient

source that can be grown and used at the

individual or societal level. Partnerships

with appropriate educational modali-

ties to describe its uses and nutritional

benefits will enable communities around

the world to participate directly in de-

creasing the world’s hunger in half and in

improving nutritional deficiencies. The

evidence provided by Thurber and Fahey

(2009) based on the five attributes of the

diffusion theory supports the adoption of

Moringa as a nutrient supplement. How-

ever, many gaps in the data will keep

large policy advocates and international

groups from recommending adoption.

The anecdotal evidence and the currently

existing data suggest that even without

an appropriately controlled clinical study,

various organizations and individuals will

continue to use and promote Moringa.

Call to ActionAccording to Thurber and Fahey

(2009), conventional macro- and micro-

nutrient supplements have well-proven

Regional Reports


efficacy and Moringa is not a likely

suitable replacement of these dense

supplements. However it is a sustainable

and economically sound nutrient-rich

food option for populations who suffer

from chronic or seasonal micro- and

macronutrient deficiencies. The Moringa

tree costs little to plant. PNA-GKC and

KCWOLC donated Moringa seedlings

to the San Marcelino Municipal Health

Center and utilized pamphlets to encour-

age the Aetas and Unats to cultivate

Moringa trees as a source of nutrient

dense leafy vegetables and livelihood.

The authors received an approval from

the Lion’s club to continue this project

to improve the process and incorporate

assessment of the families and the com-

munity prior to the feeding program.

The focus of the next phase includes

evaluation, improvement of program,

follow-up teaching, and future healthy

nutrition and feeding programs.

SummaryPNA-GKC, in collaboration with

KCWOLC, shows how NGOs are

exerting efforts to provide nutrition

interventions utilizing Moringa - a low

cost, locally available, nutrient dense

produce in its Feeding Program. Moringa

could be used as either a palliative or

long term measure towards achieving the

Millennium Development Goal target

of decreasing child under-nutrition by

fifty percent. So far, PNA-GKC and

KCWOLC have fed about 300 Aetas

and Unats in Barangay Buhawen in San

Marcelino, Zambales. The Moringa

tree costs little to plant. PNA-GKC and

KCWOLC donated Moringa seedlings

to the San Marcelino Municipal Health

Center and utilized pamphlets to encour-

age the Aetas and Unats to cultivate Mo-

ringa trees as a source of nutrient dense

leafy vegetables and livelihood.

By distributing piggybanks to mem-

bers of different organizations, the com-

munity financially supported this initia-

tive and became partners in reducing

malnutrition and poverty in the region.

Proper nutrition of mothers and infants

results in a healthier community, reduces

occurrence of chronic diseases, increases

individual productivity, and contributes

to a self- sufficient community. Preven-

tion is far cheaper than seeking a cure or

treatment. By sharing their knowledge,

skills, and services, PNA-GKC and

KCWOLC are making a difference by

reducing malnutrition of the Aetas and

Unats in Zambales, Philippines utilizing

a locally available, inexpensive nutrient

dense food such as Moringa. PNA-GKC

plans to continue this feeding program

and improve the process by incorporat-

ing an assessment of the families and

the community prior to the feeding,

evaluating the outcomes, and instituting

improvements and providing education

on healthy nutrition.

Author Affiliation Elizabeth B. Ro-sas, BSN, RN, HNC, is with Reliable Healthcare Services, Inc. Greater Kansas City, Missouri. She is a Founding Officer of KCWOLC. Matilde S. Upano, MSN, RN, FNP-BC is with Clarian Health - Riley Hospital for Children, Indianapolis, Indiana.

References

Fahey, J. W. (2005). Moringa oleifera: A review

of the medical evidence for its nutritional,

therapeutic, and prophylactic properties. Part 1.

Trees for Life Journal,1:5. Retrieved on April 6,

2010 from http://www.TFLJournal.org/article.

php/20051201124931586.

FAO. (2001). Nutrition Country Profile –

Philippines. Nutrition Country Profile of the

Philippines. (ESNA-FAO). Retrieved on April

6, 2010 from ftp://ftp.fao.org/es/esn/nutrition/

ncp/phi.pdf

Harohall, R.S. and Grigsby, D. G. (2009).

Malnutrition. Retrieved on March 29, 2010

from http://www.emedicine.medscape.com/

article/985140-overview.

Nambiar, V. S., & Seshadri, S. (2001). Bioavail-

ability trials of beta-carotene from fresh and

dehydrated drumstick leaves (Moringa oleifera)

in a rat model. Plant Foods for Human Nutrition,

56 (1):83-95.

Negrito. (2010). Retrieved on March 9, 2010

from http://library.thinkquest.org/C003235/

negrito.html.

Pedro, M.R.A., Cardena, C.M., Molano, W.L.,

Constantine A., Perlas, L.A., Palafox, EF.,

Patalan, L., Chavez, M., Madriaga, J., Castillo,

E., & Berba, CVC. (2003). Retrieved on March

2, 2010 from http://www.fnri.dost.gov.ph/files/

fnri%20files/abstracts31st/posters/6thnns.pdf.

Thurber, MD., & Fahey, J. (2009). Adoption

of Moringa oleifera to combat under-nutrition

viewed through the lens of the diffusion of inno-

vations theory. Ecology of Food and Nutrition, 48,

212-225. doi: 10.1080/03670240902794598.

Trees for Life Moringa Brochure. 2005. Retrieved

on March 2, 2010 from http://www.treesforlife.

org/documents/moringa/moringa_bro_copy.txt/

view

United Nations (2010). World food programme:

Fighting hunger worldwide. Retrieved on March

2, 2010 from http://www.wfp.org.

Mahajan, SG., & Mehta, AA. Anti-Arthritic

Activity of Hydroalcoholic Extract of Flowers of

Moringa oleifera Lam. In Wistar rats. Journal of

Herbs, Spices & Medicinal Plants, 15:149-163.

doi: 10.1080/10496470903139363.

WHO Statistical Information System (2010).

Retrieved on April 6, 2010 from

http://apps.who.int/whosis/database/core/

core_select.cfm

(AHA) to hold a Train-the- Trainer

Course on Healthy Heart Hearty Family

(HHHF). Led by past PNAA President

Mila Velasquez, Chair of the AHA Asian-

Pacific Islander Task Force and Donna

Lew of AHA, 15 PNASC members were

trained in January 2009. The training

enhanced the participants’ knowledge

and skills in promoting a culturally ap-

propriate outreach program to help the

Filipino community fight heart disease

and stroke. The program framework was

based on the 2008 Heart Health Manual

for the Filipino Community created by

the National Heart, Lung and Blood

Institute at the National Institutes of

Health, U.S. Department of Health and

Human Services.

Within the next few months after

the class, the trainers went back to their

respective communities holding classes

among church groups, community

organizations, and adult day care centers

C

ardiovascular diseases, which

include coronary heart dis-

ease, hypertension, stroke and

congestive heart failure, remain as the

number one killer in America. In fact,

one in every three Americans has one

or more forms of cardiovascular disease

costing the U.S almost $500 billion a

year (AHA Heart Disease and Stroke,

2010). Hence health promotion and dis-

ease prevention has become the number

one priority among healthcare providers

and organizations in the U. S. today.

Health promotion is the art and

science of helping people discover the

synergies between their core passions

and optimal health. Optimal health is a

dynamic balance of physical, emotional,

social, spiritual, and intellectual health.

This balance can be achieved through

lifestyle change and facilitated through a

combination of learning experiences that

enhance awareness, increase motiva-

tion, build skills and, most important,

through the creation of opportunities

that open access to environments that

make positive health practices the easiest

choice (O’Donnell, 2009).

This spirit fueled the collaboration

between the Philippine Nurses Associa-

tion of Southern California (PNASC)

and the American Heart Association

– places where older Filipino Americans

get together on a regular basis. To date,

through this program alone, PNASC has

reached out to more than 500 Filipino-

Americans increasing their awareness on

heart disease, hypertension and diabetes.

Inspired by this significant contribu-

tion, PNASC is committed to sustain

this health promotion initiative by

incorporating this activity with PNASC

programs.

On March 18-20, 2010, during the

11th PNAA Western Regional Confer-

ence held in Long Beach, California,

PNASC held a pre-conference featuring

the HHHF Train-the-Trainer Class. Pre-

sented by Mila Velasquez, Sarla Duller

and Donna Lew, the class produced an

additional 12 trainers from both local

and out-of-state PNAA affiliated chapter

members. They too, will go back to their

communities and spread the word about

HHHF. PNASC will go down in PNAA

history to have held the first pre-con-

ference during its Regional Conference

ever! To quote past PNAA President Pete

Calixto, “the sun rises in the East but it

sure does shine brighter in the West”.

Indeed, because healthy families start

here! z

Health promotion is the

art and science of

helping people discover

the synergies between

their core passions and

optimal health.


(AHA) to hold a Train-the- Trainer

Course on Healthy Heart Hearty Family – places where older Filipino Americans

PNASC: Healthy Families Start HereEmma Cuenca, MSN, RN, CCRN, CS

Regional Reports

PNAA Nurses: Making a Difference in Global Health

T

his year marks the centennial of the death of the founder of mod-ern nursing - Florence Night-

ingale (1820-1910). To commemorate this event, the 2010 International Year of the Nurse (2010IYN) was established to actively involve the world’s nurses - estimated to be more than 15 million - in a celebration of commitment to bring health to their communities, locally and worldwide.

During the United Nations Mil-lennium Summit in 2000, world leaders made a historic promise to the world by signing a Millennium Declaration to uphold the principles of human dignity, equality, and equity at the global level (2010IYNurse, 2010). As such, IYN em-barked on the collaborative, grassroots, global initiative honoring nurses’ voices, values, and wisdom to act as catalysts for achieving a healthy world.

The IYN initiative was well sup-ported by PNAA’s 15th President Leo-Felix Jurado and formally approved by the PNAA Executive Board. PNAA community outreach programs promote the IYN with its Medical Missions, Balik Turo Program and the Gawad Kalinga program soon to morph into Gawad Kalusugan (Gawad Kalusugan, 2010).

PNAA Medical Missions have existed for years with numerous mem-bers bringing back technology and state of the art clinical care to areas where medical care is wanting. Alice Andam, PNA Metro DC President was awarded ABSCBN International Gawad Geny Lopez Jr. 2009 Bayaning Pilipino Award in recognition of her medical mission to 30,000 indigent patients with the cost per patient of $3.62.

Going beyond the medical missions, the Nurse Balik-Turo Program conceived

and established in 2006 by 14h PNAA President Rosario May Mayor for nurses who work in the United States to come ‘home’ to teach and impart knowledge to our compatriots. With this program, executed by PNAA Executive Director 2006-2010 and 6th PNAA President, Remedios Solarte, the PNAA has become the conduit between the Subject Mat-ter Experts (SMEs) and collaborative partners, nursing schools and hospitals in the Philippines. Two successful tours occurred in conjunction with the Philip-pine International Nursing Conferences in 2008 and 2010.

Several PNAA chapters and indi-vidual members have given donations to Gawad Kalinga (GK), a Philippine-based poverty reduction and nation-building movement launched by Couples for Christ (CFC), a Catholic lay commu-nity. The main goal of GK is to care for Filipinos in need and survivors of natural disasters. In 2010, PNAA had its groundbreaking ceremony for its own village spearheaded by the GK Task Force. The co-chairs of the Task Force are Guia Caliwagan and Ferdie Luyun and their members include Beth Rosas, Alice Andam, Tita Ravi, Gilda Lauchli, and Vicky Navarro. The most important thrust of the GK program is its offshoot health services arm, Gawad Kalusugan (GKal), focusing on seven public health concerns that have burdened the Philip-pines for so long. These public health issues, dubbed as TWINRPD include:• T-Tuberculosis Program• W-Eliminate water-borne diseases• I-Complement the government’s im-munization program

• N-Promote proper nutrition• R-Responsible parenthood through natural family planning

Victoria B. Navarro, MAS, MSN, RN, Eastern Region Vice President

• P-Universal health insurance through Phil-Health

• D-Dental health promotion GKal will also be rich environ-

ment for nursing research in community health and tropical diseases with PNAA’s Advanced Nursing Forum chaired by Jennifer Aying-Ramos, PNA New Eng-land for education and practicum.

PNAA was represented during the 2010 IYN Commemorative Global Service Commemorative Global Service, National Cathedral in Washington DC, on April 25, 2010 by Vicky Navarro, Eastern Region Vice President and Dino Doliente, Chairperson of the Circle of Presidents.

The following PNAA educational programs have been dedicated to the IYN: PNA South Florida President, Ana Javellana’s 2010 Diversity Multicultural Extravaganza; PNANY President Leonila Mariazeta, had a joint education confer-ence with the Panamanian Nurses As-sociation, Indian Nurses Association and New York Healthcare Harbor System Patient Service; the 31st PNAA Conven-tion in Miami, Florida; and lastly Nelson Tuazon, Editor-in-Chief of the Journal of the PNAA has declared Health Promo-tion as the theme of the Spring/Summer 2010 issue. z

References:

2010IYNurse. (2010). Nurses making a dif-

ference in global health: UN Millennium

Development Goals. Retrieved on June 1, 2010

from http://www.2010iynurse.net/UNMille-

nium_Goals.aspx.

Gawad Kalusugan. (2010). Retrieved on June

1, 2010 from http://www.gawadkalusugan.org/

gkal-programs-health-systems-development

Regional Reports




thought the most powerful messages for the FA audiences were making the connection between high blood pressure and stroke, providing motivation to take action, and providing participants with their measurement results and normal ranges. Giving participants the tools to make healthy choices for themselves and their families was empowering and valued by both participants and trainers.

Train-the-trainer Approach in Health Promotion

In Year-Two HHHF relied on the trainers to present the curriculum. Lay trainers who taught eight sessions received an honorarium, while the health profes-sional trainers volunteered to attend one session as a consultant to the lay trainer. The health professionals did not have to prepare for the session and were available for questions. As reflected by their high

rate of participation, the trainers enjoyed the training and the opportunity to prac-tice teaching the curriculum soon after the training. For the health professionals working in acute and long term care set-tings, it was an opportunity to experi-ence how nurses can impact the health of a community. The community health nursing students learned how to teach a high quality curriculum. With ongoing coordination for organizing trainers and


Social networking was utilzed at

the outset of the project to recruit

a volunteer force who were then

trained by the trainers. This

approach was used for both lay

leaders and health professionals.

The volunteers then delivered

their message of health and

wellness over an eight-session

curriculum to the Filipino-

American participants during a

three month period.

The second phase of the program

included the Heart Club, a

three-month maintenance phase.

Each site chose different Heart

Club activities based on their

interests. The church group

pictured here maintains a large

youth population and held their

Heart Club gatherings in parks

throughout Honolulu, with a

nurse aerobics instructor and

professional kick boxer leading

them in exercise.


supplies, this project was sustainable with minimal funding.

Cultural Tailoring

Bringing the curriculum to the com-

munity at convenient times and locations

was effective because it allowed partici-

pants to learn together with people they

know. This social aspect to the program

was very important for FAs whose culture

is collectivistic. The intergenerational

family story telling was an effective ap-

proach to engage all ages of participants.

The characters were authentic, and it was

easy to get participants to volunteer for

role-playing these characters.

Healthy recipes for traditional Filipi-

no foods were included and tasted by par-

ticipants with favorable results. Displays

of locally available familiar and unfamiliar

food items engaged participants to read

the food labels and to purchase healthy

products. In Church #1 the congrega-

tion had a potluck once a month and the

contributions became visibly healthier

over the months when they were involved

with HHHF.

LimitationsMost of the participants in this

demonstration project were first genera-

tion immigrants. The cultural tailoring

of the curriculum may be more appealing

for this group than for later generations of

FAs. Hawaii’s climate that allows year-

round outdoor activity may have enabled

participants to engage in physical activity

more easily than in other parts of the

U.S. HHHF was a demonstration project

rather than a research study. Participants

were encouraged to be measured, but not

required. It was likely that participants

who had improved their diet and physi-

cal activity were more likely to agree to

a repeat measure at three or six months,

creating bias in the risk factor reduction

results.

Lessons LearnedWhen relying on volunteers to teach

health promotion, it was essential that the

coordination function be performed well

by a person culturally competent to work

with FA community leaders and commu-

nity members. Finding sites, transporting

materials, and communicating logistics

with participants, and coordinating

volunteers required more hours than the

actual teaching of the curriculum, at a

ratio of about 5:1. In the first year of the

project the PI was funded at 15% FTE

and the RA at 50% FTE. In the second

year after sites and materials were secured,

only the RA was funded at 20% FTE.

Participants who knew their lab

values for lipid panels and glucose were

motivated by this information. Even with-

out this information, the simple measures

of blood pressure, pulse, waist and hip

measurements, and BMI were reasonable

to assess risk. These measures can be more

easily performed and used at community-

wide screenings and in health promotion

programs as repeated measures, greatly

reducing costs and effort.

ConclusionsThe train-the-trainer approach and

using social networking to find sites and volunteer trainers were successful with the Filipino community. HHHF can be a sustainable, low-cost way to promote and improve cardiovascular health among FAs. Methods for supporting the maintenance of healthy behaviors among participants, and for sustaining the volunteer network, are areas for future research. z


Author Affiliation Anne R. Leake, Ph.D., Assistant Professor, School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI; Venus C. Ber-mudo, Ph.D., Research Associate, Kalihi Palama Health Center, Honolulu, HI; and Marianela R. Jacob, MSN, Vice-president, Philippine Nurses Association of Hawaii.

ReferencesAbe-Kim, J., Gong, F., & Takeuchi, D. (2004). Religiosity, spirituality and help seeking among Filipino-Americans: Religious clergy or mental health professionals? Journal of Community Psychology, 32(6), 675-689.Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckman (Eds.), Action-control: From cognition to behavior (pp. 11-39). Heidelberg: Springer.Balabis, J., Pobutsky, A., Kromer Baker, K., Tottori, C., & Salvail, F. (2007). The Burden of Cardiovascular Disease in Hawaii 2007. Hono-lulu: Hawaii State Department of Health.Becker, M.H. (Ed.). (1974). The health belief model and personal health behavior. Health Education Monographs, 18, 324-473.Hawe, P., & Ghali, L. (2008). Use of social network analysis to map the social relationships of staff and teachers at school. Health Education Research, 23(1), 62-69.Leonard, A.R., Igra, A., & Felton, P.G. (1983). California’s approach to hypertension control: An overview. Western Journal of Medicine, 139, 388-394.Maxwell, A. E., Bastani, R., Vida, P., & Warda, U. S. (2005). Strategies to recruit and retain older Filipino-American immigrants for a cancer screening study. Journal of Community Health, 30(3), 167-179. Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Mono-graphs, 2, 328-335.Shediac-Rizkallah, M. C., & Bone, L. R. (1998). Planning for the sustainability of community-based health programs: Conceptual frameworks and future directions for research, practice and policy. Health Education Research, 13(1), 87-108. Stavig, G., Igra, A., & Leonard, A. R. (1988). Hypertension and related health issues among Asians and Pacific Islanders in California. Public Health Reports, 103, 28-37.Viana, F. (2003). Philippine Culture 101. Presentation to Asian Business Association, Inc. in December, 2003. Retrieved from http://ceslou.multiply.com/journal/item/27/Focus_on_Fili-pino_Americans_The_Best_Kept_Secret.Wallace, M. F., Fulwood, R, & Alvarado, M. (2008). NHLBI Step-by-step approach to adapt-ing cardiovascular training and education cur-ricula for diverse audiences. Preventing Chronic Disease, 5(2). Retrieved from http://www.cdc.gov/pcd/issues/2008/apr/07_0201.htm.

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Thank You!The Editorial Staff and Editorial Board of the

Journal of Philippine Nurses Association would like to thank the following for the design of

the JPNAA covers:

Fall 2009 – Inaugural Issue Cover,

Volume 1, Number 1Bel Nieves

Senior Graphic Designer Edge Direct, LLC

Through: Fe Nieves-Khouw, MSN, RN PNA Maryland

Spring-Summer 2010Volume 2, Number 1

Jeannette Livelo, MS, MBA, RN

PNAA Assistant Treasurer 2000-2010

PNA New England

Center for Professional Development

Congratulates The Philippine Nurses Association of America, Inc.

on the success of The Journal of the Philippine Nurses Association of America, Inc.

“W i th s p e c i a l a p p r e c i a t i on f o r y ou r c on t inu ed s u p p o r t o f The C en t e r f o r P ro f e s s i ona l D eve l o pmen t p r ograms”

Dr Gayle A Pearson, Assistant Dean TJPNAA Advisory Board • PNANJ Honorary member

Email: [email protected] Website: http://nursing.rutgers.edu • Phone: 973-353-5895

THE JOURNAL OF THEPHILIPPINE

NURSES ASSOCIATION OF AMERICA

Thanks Our Sponsors!

Global Caring Nurses Foundation

Cristina BarisoSusan CruzEmy Pierrel

The Journal of the Philippine Nurses Association of America

encourages potential authors to submit manuscripts that are relevant to the Mission, Vision and Values of the PNAA.

Themes for Upcoming Issues:

Fall-Winter 2010 - Workforce Diversity (Submission Date: October 15, 2010)

Spring-Summer 2011 - Leadership (Submission Date: January 15, 2011)

Other topics of interest to JPNAA include manuscripts from a wide range related to Nursing Practice, Administration, Research and Education.

Non-PNAA members are strongly encouraged to submit articles. There is no set deadline for articles submitted.

Although not required, editorial inquiries provide the editorial staff to indicate interest on the topic.

Please send queries to Nelson Tuazon, Editor-in-Chief at [email protected].

Dear Editor,

Greetings from the Sunshine State, Florida!

Congratulations to all for our first edition of the Journal of the Philippine Nurses Association of America. I would like to thank all those who took part of publishing great informative articles for all PNAA members. We, from the PNA Gulfcoast Florida, are really proud of this accomplishment. I know these articles will be included with PNAA archives and I would like to make a correction on Lolita Compas section (Honoring the Past, Celebrating the Future on page 16). One of the chapters formed during 1998 to 2000 was Gulf Coast Florida and not East Coast Florida. As a founding President who personally brought our PNA all the way to Indianapolis, we like to memorialize the effort of our chapter for becoming a PNAA chapter.

Thank you and best regards to everyone.

Sincerely,

Merly Santos LlantoFounding President, PNA Gulf Coast Florida

Erratum



PNAA Executive Board PNAA Executive Board

20082008 -- 2010 2010

Leo-Felix Jurado President

Reynaldo Rivera President-Elect

Victoria Navarro VP for Eastern Region

Josie Villanueva VP for Western Region

Sofy Bole VP for North Central Region

Merlita Velasquez VP for South Central Region

Jovita Solomon-Duarte Secretary

Victoria Berbano Asst. Secretary

Aster Vargas Treasurer

Jeanette Livelo Asst. Treasurer

Beth Rose Auditor

Carmina Bautista Gloria Beriones Susan Castor Mary Joy Garcia Beth Rosas Board Members

Remedios Solarte Executive Director

Leticia Hermosa Parliamentarian/Legal Adviser

Linda Simunek Legal Counsel

Dino Doliente Leila Busch Cherina Tinio Romy de Vera Circle of Presidents (2009 - 2010)

Madelyn Yu Mattie Upano Greta Pardue Lucy Laeser Circle of Presidents (2008 - 2009)

VJ2009

AT SIGNS AND PRINTS

PRINTING • COPYING• SIGNS • BANNERS

In today’s electronic world, it no longer matters where your printer is located. What matters is whether your printer can stand apart, delivering high quality print-ing and cost effective pricing. At ASAP, we can – and with today’s technology, no matter where you are in the USA, it’s as if we are right down the block! Find out what makes us stand apart… ‘stop in’ today and get a price quote on your next print job.

The World is Shrinking.

[email protected]: 732.557.9600 • fx: 732.557.9601

467 Lakehurst Road, Toms River, New Jersey 08753

A Proud Supporter of the PNAA for Over 20 Years!

Date post:	14-May-2020
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