Bridging the Gap: Finding Middle Ground

It is no secret that the COVID-19 pandemic has tainted the functionality of healthcare. Frontline workers have succumbed to physical and mental distress, facilities are exceeding volume capacity, and patients with non-emergent conditions are experiencing barriers to accessing treatment. My local community partner, Lincoln Community Health Center and the population that it serves has similarly been impacted. When my team and I began our research and quality improvement endeavors, we had a plan to engage with participants face to face for at least a portion of our involvement. As we brainstormed different modes of virtual and other non-contact interventions, impediments of social determinants of health became more evident. While attempting to modify our efforts to include telehealth, I’ve learned that while the burden of requiring transportation to receive care has been somewhat relieved for this population, it has only highlighted other imposing social factors.

Since my last post, I have been submerged in the process of developing a hypertension education class to supplement the medical care that my participants receive from providers at Lincoln. The first phase involved reaching out to the participants to obtain a sense of their perceived needs. In doing so, I found that the overwhelming number of daily stressors that a large amount of this population faces greatly affects the amount of attention and effort that they dedicate to health promotion.

For example, when attempting to recruit one of my previous participants as an attendee for my class, he detailed multiple other aspects of his life that were seemingly more prioritized. He described his struggle to care for his uneducated, unemployed son and his mandate to attend consequential virtual rehabilitation classes. In this case, the potential impact of socioeconomic status on the health of both this individual and his generational offspring are evident. As I continued to converse with him, I found that his story seemed all too familiar. His words triggered my reflection of my own mother’s circumstances. She too suffers from uncontrolled hypertension but struggles to devote time and energy to implement beneficial behavioral change – not because it is not important, but because the stress of fighting an uphill battle against poverty, mental anguish and ineffective coping mechanisms, limited employment opportunities, etc. can outweigh an intangible health condition. As I gain this new perspective, I have learned the significance of meeting individuals where they are. In nursing school, I was taught to assess for readiness to change prior to intervening and to treat the patient using a holistic approach. I have learned that applying these principles to our project can increase the chances of achieving our goal.

While the previous anecdotes represent common circumstances experienced by this population, our efforts have yielded differing perspectives as well. I have noted that after relieving the barrier of obtaining resources such as blood pressure home monitoring systems (our previous intervention), many of our participants have taken the strides to improve their blood pressure. I have found that not only have many acquired the habit of daily quantitative monitoring, but they have also begun to distinguish patterns relating to their health. For example, I recently followed up with a participant who was surprised to find that he obtained higher blood pressure readings when he did not get adequate amounts of sleep and when he consumed fatty meals. Initially, I felt a huge sense of joy, pride and gratification – the work that I was doing was working! However, the unfortunate thought associated with this milestone is that this awareness was established following the development of unfavorable conditions, surpassing opportunities for prevention. Nonetheless, our goal is to continue to educate, improve health literacy and optimize health.

In the next phase of my hypertension education class development, I will be utilizing obtained feedback and data to develop a presentation that will be most effective and appropriate for this population. Health literacy is defined by the U.S. Department of Health and Human Services as the degree to which individuals have the ability to obtain, process, and understand basic health information and services needed to make appropriate health care decisions. Furthermore, research by Du et al., has found that low health literacy is recognized as a major risk factor in blood pressure control and has adverse effect on health outcomes. With this knowledge, it is anticipated that this class can have a strong impact on the health of this community.

Unique Whitehurst is from Long Beach, CA. She is a member of the Duke University School of Nursing’s MSN-NP class of 2023 specializing in psychiatry and mental health. Unique is a recent December 2020 graduate of Duke’s ABSN program where she was recognized as an executive board member for DUSON’s Active Minds organization, an inductee of Sigma Theta Tau International Honor Society, and the selected student speaker and exemplar of excellence at the annual Commitment to Excellence Ceremony. Unique is a current member of the American Psychiatric Nurses Association and serves as a graduate student research leader at Duke. Her research interests center around improving health outcomes for minority populations. Her current research efforts involve collaborating with community partners to decrease the burden of hypertension in African American males here in the Durham County area.

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