The Importance of Nursing in Identifying and Reducing Risk Factors of Heart Disease in America

With the need of Americans to be bigger and better we are getting bigger, but not necessarily better when it comes to our health. Our high tech, fast paced lives promote less physical activity and ingestion of convenient foods that can be loaded with sugar and fat. These behaviors can lead to and exacerbate health problems such as high cholesterol, diabetes and obesity, all of which are risk factors for heart disease.
With the need of Americans to be bigger and better we are getting bigger, but not necessarily better when it comes to our health. Our high tech, fast paced lives promote less physical activity and ingestion of convenient foods that can be loaded with sugar and fat. These behaviors can lead to and exacerbate health problems such as high cholesterol, diabetes and obesity, all of which are risk factors for heart disease. Because of the increased prevalence of risk factors leading to heart disease, the #1 cause of death in America, it is important that nurses recognize and seize their many opportunities with the public for risk factor screening, educating our youth and heart disease patients in order to reduce this pandemic problem.
America is a great country, the land of the free, people free to make their own choices about most of what happens in their lives. Some of these choices turn into risk factors for heart disease, the number one cause of death in the US. Americans eat approximately 300 more calories per day now, than they did in the eighties. More than 50% of adult Americans are physically inactive. Obesity is pandemic; the majority of Americans (64.5%) are overweight (BMI>25) as cited in Stuart-Shor, 2004. Over 100 million Americans have borderline high level of total cholesterol and over 40 million have very high levels (White, 2005). Risk factors for adults such as high blood pressure, obesity, smoking and being inactive start in youth. In 1998, more than 21% of African American and Hispanic children and 12.3% of white children were considered overweight and over a third of new cases of diabetes in 12-18 year olds is type 2 diabetes (Harrell, Pearce, & Hayman, 2003). All of these risk factors are preventable in most people and nurses have the opportunity and the power to take heart disease out as the #1 cause of death in America.
Screening for risk factors where ever and when ever the opportunity arises is a key strategy for nurses to use in the fight against heart disease. One place nurses can start this implementation is in the hospital. Acute care nurses have a perfect opportunity for the screening of children and grandchildren of patients with heart disease and for the encouragement of patient interventions to be used for their families as well (Harrell et al., 2003). Providing opportunities for the families by asking them if they need help making appointments to be screened and informing them of how important it is to be screened for risk factors. The National Cholesterol Education Program recommends all adults have a cholesterol screening at least every 5 years and sooner if they are in a higher risk group (Nix, 2005). School nurses are in great position to observe for risk factors that affect the nation’s youth and set up individual screenings and conferences to approach the subject with the whole family. A school pilot program (Harrell et al., 2003), that used family trees with medical histories, to find individual children at risk for heart disease, found risk factors such as smoking and obesity within the 3 generations used in the study.
While recognizing our many opportunities for screening for risk factors is important, educating on those risk factors such as childhood obesity and high cholesterol is also key to ending unnecessary heart disease. Using school-based programs to educate children about healthy eating and physical activity and giving them the opportunity to achieve a healthy lifestyle is another strategy. School nurses are in a perfect place to help develop and implement classes about good choices concerning food, drug use, and physical activity alternatives for video games and television. The Cardiovascular Health in Children (CHIC) study (Harrell et al., 2003), used two different interventions, a population-based approach (preventions and recommendations that would be appropriate for all children) and an individual approach (used for high-risk individual children) in two schools and found positive outcomes of lower cholesterol and less body fat in the trial school children than in the “control schools” (Harrell et al., (¶15). The CHIC study used environmental interventions in the schools by changing the curriculum in the classroom as well as in physical education classes for 8 weeks.
Fighting the good fight for our children to reduce their risk factors for heart disease is important, but we also need to consider the entire population in the US. Education for those people who already have high risk factors and/or heart disease is another strategy that nurses everywhere can implement. Collaborative efforts of the interdisciplinary team of nurse and dietician can be implemented in order to educate their patients on the importance of a healthy diet. According to studies from the Archives of Internal Medicine and the American Journal of Clinical Nutrition, people whose diet consists of “fruits, vegetables, beans, fish, poultry and whole grains” have a lower risk of heart attack then those who follow a diet of fried, processed, and high-fat foods, a diet a fair share of Americans follow, (White, 2005). Nurses can further support their patients by referring them to programs that can serve them further in the management of their disease. According to an evidence-based nursing article, a 4-year study on the impact of nurse led secondary prevention clinics for patients with coronary heart disease suggests that patients attending nurse-run secondary prevention clinics have a better survival rate and fewer MI’s after 5 years compared to the control group (“The benefits of nurse led…” 2003).
Nurses everywhere need to recognize their opportunities when it comes to educating their patients. With heart disease as the number one cause of death in the US, nurses have their work cut out for them. Nurses from all settings need to recognize their opportunities to execute key strategies like risk factor screenings, implementing school based programs to educate children, and educational support for patients in order to treat them in a more holistic manner.

References
Harrell, J.S., Pearce, P.F., & Hayman, L.L. (2003). Fostering prevention in the pediatric
Population. (atherosclerotic cardiovascular disease). Journal of Cardiovascular
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Nix, S. (2005). Williams’ basic nutrition and diet therapy (12th ed.). St. Louis:
Mosby, Inc.
Stuart-Shor, E. (2004). A public health action plan to prevent heart disease and stroke:
the mandate for prevention across the continuum of care and across the lifespan.(Progress in prevention). Journal of Cardiovascular Nursing, 19(5), 354-
Retrieved October 20, 2006, from Expanded Academic ASAP database.
The benefits of nurse led secondary prevention clinics for coronary heart disease
Continued after 4 years. (Quality improvement). (2003). Evidence-Based
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White, L.B. (2005, August-September). Keep cholesterol in check. Mother Earth News,
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Intervention 1: Education and referral programs for current heart disease patients.
i. Disadvantage 1: Socioeconomic Status.
Education and referral programs for those populations who already have high risk factors and/or heart disease is a grand thought and wouldn’t it be great if everyone could be accommodated. But this whimsical way of thinking is not based in reality, there are people in this country who slip between the cracks because of their position in the lower income brackets; Programs for those of low socioeconomic status must first be approved by state and federal government. According to Christine Ferguson, a former public health commissioner and director of human services in two different states, and fourteen-year veteran of the legislative branch at the federal level, health care spending is a huge part of the annual budget and trying to find savings for the already overdrawn budgets is always on the agenda and fending off reductions or complete elimination of public and private programs is a struggle (Ferguson, 2007).
ii. Disadvantage 2: Discrimination
It is a sad fact that one of the greatest risk factors for heart disease in America, being overweight, is often thought of as self-inflicted and that this population should be able to help themselves by just acquiring a little bit of will power. Obesity is as epidemic in this country and these people need some help in finding the strength to do what it takes in order to lose weight and move forward into a more healthy life. According to Christine Ferguson, there is a “’Deserving vs. ‘Undeserving’” debate that goes on when allocating resources, both in the public and private forum. Populations who are overweight and obese are considered ‘undeserving’. “Services to help people control or lose weight are routinely excluded from coverage in public and private health plans”. One insurer has an exclusion clause for any treatment or supplies for the assistance of weight reduction, even if this reduction would help in the outcome of other health conditions of the insured. These sentiments “create a barrier to coverage for treatment”; even in the face of scientific evidence that suggests that even a small percentage of weight loss can have great ramifications on overall health and therefore savings of public and private monies (Ferguson, 2007).
Intervention 2: Healthcare Screening.
i. Disadvantage 1: Knowledge Deficits.
America is very diverse country, which brings cultural wealth but also knowledge deficits of the language and health concepts for immigrants and English speaking American health care providers. Non-English speaking residents may try to hide their knowledge deficits because of embarrassment; they may also have mistrust of the American health care screener and not want to disclose information because of previous discrimination. Health care providers may not understand the need of learning about the culture and medical concepts of the client in order to get a complete picture and failing to communicate with their clients can lead to unfortunate pain and suffering on the part of the client (Andrulis, 2007).
ii. Disadvantage 2: Socioeconomic Status.
Socioeconomic status plays a huge role in just about every aspect of a person’s life. From the values instilled at a young age, educational level, workload, healthcare access, choices of recreation and diet. “Access to healthcare and resources for CHD prevention is largely affected by poverty and social class stratification”. This means that early detection or prevention of heart disease is limited due to improper access to preventative screenings for persons of lower socioeconomic status. Health care prevention, particularly for women, takes a back seat to the immediate needs of the family and self such as food, shelter and clothing. Instead these women focus more on immediate medical symptoms when deciding when to seek medical attention. And according to Fleury, et al., that women of a higher socioeconomic status are more likely to use preventive health services than those of a lower socioeconomic status, even when those services are readily available (Fleury, 2000).
References:
Andrulis, D., & Brach, C. (2007, September). Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations. American Journal of Health Behavior, 31, S122-S133. Retrieved October 26, 2007, from Academic Search Premier database.
Ferguson, C.C. (September/October 2007). Barriers To Serving The Vulnerable:
Thoughts of a Former Public Official. Health Affairs. Chevy Chase, 26(5),
1358-1365. Retrieved October 26, 2007, from Proquest database.
Fleury, J., Keller, C., & Murdaugh, C. (2000, November). Social and Contextual Etiology
of Coronary Heart Disease in Women. Journal of Women's Health & Gender-
Based Medicine, 9(9), 967-978. Retrieved October 26, 2007, from Academic
Search Premier database.