Blogs as a Method of Undergraduate Health Care Education: Benefits to everyone (Examples of Student Webliographies)
Many undergraduate educators struggle with conveying two key concepts to their students: How to effectively communicate through written format and relevance of writing assignments. Likewise, many people who would benefit from access to students’ work cannot because access is restricted to the relationship between student and professor. Much of the hard work spent on undergraduate literature reviews, concept and theory overviews, evaluation of systems, case studies, community work, etc. is simply lost to the current formative and summative evaluation systems that higher learning has continued to use for centuries.
Blogs
Blogs offer a method for writing and critical thinking where students can begin to build portfolios of work, knowledge, and platforms that can benefit others through web connections. In a world where technology and information are changing rapidly, helping students to ‘publish’ without the constraints of time or the requirement of journal submission (many who won’t accept undergraduate work), blogs offer a way for students to disseminate what they know, ideas they have, or experiences in learning that might benefit the ones educating them. Not to forget that blogging expands their knowledge and use of social media.
Blogging also teaches students to write concisely (get to the point already) and clearly (a problem they often struggle with). One disadvantage to using blog assignments, as educators, is that ‘bleeding’ all over them with a red ink pin is difficult in web format. However, the resourceful instructor who edits can simply copy and paste and with the edition of track changes… and voila- you have feedback. Students also bear the disadvantage of their writing errors being accessible to the entire connected world, but this seems to be a motivator for good work. Below I offer a few tips, after piloting a class where I required the majority of journal writing to be in blog format. I have learned much in utilizing blogs to help educate and evaluate student work, and will continue to revise blogging assignments.
Tips for Teaching Through Blogging
1. The instructor needs to be very familiar with blogging platforms, design, and free access for students. This first recommendation is the most difficult at times. Many faculty are not familiar with blogging, how to go about designing a blog, where to get a free blog, or the intricacies of blog tool bars, dashboards, and simple tasks like creating active links within posts.You don’t need to know HTML code to work free blog creators such as WordPress or Blogger
2. The instructor needs to create a time to work with students on developing an initial blog. Whether you teach online or in a traditional seated class you need to set aside some class time (not extra work time for the students) to help them create a blog. Take them to the computer lab and help them sign in and navigate design, telling them advantages of having widgets or three columns, etc… If you teach in an asynchronous online format I would suggest audio recording along with a visual presentation (maybe you want to use Screencast or Slideshare to accomplish this… if your university doesn’t have a great format like WIMBA or Elluminate… however, Skype or TokBox work great as well).
3. Assign writing that is currently relevant to the student and the profession, but give them some freedom in choosing topics. If students find the writing assignment tedious, boring, or irrelevant to themselves they are not going to enjoy writing, nor will they continue blogging beyond your class; the idea is to help them create a medium that they can continue to write through long after your course is over.
4. Explain rules of etiquette in online communication, professionalism, and how taking up time and internet space with irrelevant words is irritating 
. A gentle but clear discussion with students about how naming fellow students, co-workers, employers, teachers, without permission is not professional writing. Likewise, ranting is not ideal in a course or professional blog. Create a grading rubric that addresses this as part of the final grade. Further, the world is full of useless words and distractions. Remind students that their blog should not be an addition to the junk and noise on the web, but a clear and concise offering that will contribute to the knowledge-base of their profession or to others who will read their blog. Grade them based on this aspect as well.
5. Support your students through promotion of their work. One of the best ways to spur on excellence is to support students work within other student circles, faculty, and professional groups of the students’ primary degree area. If you twitter, tout students’ work with links or shout outs. Present students’ work as part of accreditation visits, at conferences, and to other classes.When students know that others will be reading their work, with their name on it, they often are motivated to make corrections and to make their initial product of much higher quality.
Creating Webliographies
On a final topic note, blogs are a great way for sound webliographies on health care issues to be created. By creating webliographies students are forced to learn what are reliable and valid internet sources, creating knowledge they can transfer to others and their patients in a world full of incorrect information. They also create a single source for several reviewed internet resources on a single topic. Webliographies are great additions to student blogs and assist them in building sound knowledge on a single subject and begin their journey into being content experts or into specialization.
I have included some of my students’ blogs and webliographies below. Yes, typo’s grammatical errors, broken links, etc. are present, but for a first attempt at such an assignment and a pilot project (without them having the benefit of all the tips I have offered to you above) they have done fairly well. They have at the very least compiled valid resources for patients. Check them out and happy blogging!
Preventing Risks of Central Line Infections – http://stephaniern.wordpress.com/
Health Care DPOAs – http://mommycmsrn.wordpress.com/
Alzheimer’s Disease – http://movinonup09.wordpress.com/
Testosterone deficiency vs. Depression in men – http://scotchtwin18.wordpress.com/
Childhood Onset Schizophrenia – http://erjunky.wordpress.com/
Meningitis – http://rain029.wordpress.com/
Knee Replacement Recovery – http://orthonurse.wordpress.com/
I am so proud of them and their work. Good job Nurses. http://nursing.advanceweb.com/Editorial/Content/Editorial.aspx?CC=208098
I was reminded this week, by one of my students that happened into my office, how busy nurses and nursing students are. She is not even aware that she raised this issue of ‘busyness’ with me; it is only by the chance wandering of her into my office that triggered this post. This particular student is a full-time nurse, has children, and is going back to school to get a bachelor’s degree in nursing, something we should have given to her with her original nursing degree… but that is another soapbox and post.
Not only is she working 40+ hours per week, married, raising children, and taking a full-time load of college courses (with clinical requirements mind you)… she also serves as part of our national guard. Did I mention that her husband is in school full time too? Yet, she appeared in my door way chipper, encouraging, and ahead on her reading and assignments in class. Her dedication is apparent. I had to wonder… How does she do it?
Just as she happened by I was brooding, self-pitying, and thinking about complaining about the demands of my educator job and my personal schooling (which are both Wonderful… but at that moment I was groaning like a spoiled child). However, in light of her schedule and yet her personal choices to be positive and head of the ‘game’, I had to choose to squelch my complaining and consider taking her approach to encouraging others.
To you student nurses and nurses who are going back to school to advance your knowledge I want to encourage you. The path you are taking is the ‘one less traveled’ and it will make all the difference for your patients, for your profession, for your ability to lead and mentor. Hang in there and take Robert Frost’s analysis to heart.
Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;
Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,
And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.
I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I–
I took the one less traveled by,
And that has made all the difference
…Robert Frost
Hang in there and call me if you need a pep talk.
Prompted by a press release of a new article in the Journal of Internal Medicine, a high familial risk of cardiovascular disease, interest by my friends at Askinosie Chocolate (www.askinosie.com) and my own personal curiosity I have decided to investigate the strength and claims of the health affects of chocolate!!!! Yes, I know you all are terribly excited about the prospect of your health care provider writing a prescription, at your next visit, for daily consumption of chocolate. I must admit that after doing the research I may be doing just that… (along with my prescriptions for daily naps, weekly massages and a good vigorous stroll around the block every day)…
Chocolate. You know it, you love it. Chocolate was first discovered by the Myan civilizations in Mexico and Central America between 250-900 B.C. When the Spanish invaded, chocolate was brought to Europe in 1528 where it spread through the upper classes. The first house of chocolate was built in London in 1657 but chocolate did not become widely available in the U.S. until the 1800’s. Actually we can thank the U.S. government and WWI for the big uptick in American chocolate, as chocolate was provided to U.S. soldiers as part of their rations… interestingly it resisted spoilage which is now attributed to ‘flavonoids’, which we will be discussing in a minute. (Engler, 2006)
The Power of Chocolate. Chocolate derives its healing power from its FLAVONOIDS. These are micronutrients that are derived from plants (think green tea, red wine, etc…) and help prevent oxidation by radicals on cells in the body. Put simply, they prevent destruction and attack on cells. Apparently chocolate’s specialty is cardiac related cells…. I found four things over and over and over in the literature that chocolate flavonoids do….
1. They decrease platelet aggregation (meaning your platelets don’t stick together and cause clots.. that might clog arteries and vessels)
2. They cause dilation of cardiac vessels (which means more blood to the heart… and that is GREAT)
3. They also dilate other arteries causing decreases in blood pressure
4. They decrease the levels and effects of bad cholesterol (also known as LDL cholesterol).
5. They do it quickly. Most of the effects were noted in as little as 2 hours, lasting about 8 hours total, and most of the research only had people treated for 2-4 weeks to note changes in LDLs! (but you have to do it everyday…. the effect was usually a daily dose)
(Allen et al., 2008; Engler et al., 2006; Flammer et al., 2007, Hermann et al., 2006; Janszky et al., 2009; Strandberg et al., 2008).
The Evidence. I was literally overwhelmed by the amount of evidence supporting chocolate, mostly dark with 70% or greater coco content, as an improver of cardiac health. Below is just an overview of a few of the articles with their target population and effects.
—- Allen et al., (2008) —- This research, published in the Journal of Nutrition, was the mother of all research experiments, the Randomized Controlled Trial that was Double Blinded (for those of you who are into that research thing out there… I am sure you are impressed). 49 men and women between the ages of 24-70 were fed dark chocolate twice daily for 2 weeks and then serum cholesterol was retested. The decrease in serum cholesterol was significant with the dark chocolate group experiencing a 2-5% decrease in LDLs over the control group and a decrease in systolic blood pressure of nearly 6 mmHg. For you doubters out there, all were placed on an American Heart Association style diet for 2 weeks prior to research to help with controls.
—-Engler et al., (2006) – This is a terrific overview article published in Nutrition Reviews. Engler and colleagues reviewed over 20 different articles on all work done up to 2004 on chocolate for the effects of chocolate on cardiac function. Yes indeed, chocolate had a strong antioxidant affect in 9 different studies, vasodilation in 6 different studies, decrease in blood pressure in 3 different studies, and decreased platelet aggregation in 6 different studies.
—-Flammer et al., (2007) – In this article, published in Circulation, 22 post heart transplant patients were placed into a double blind randomized controlled trial for the effects of dark chocolate on coronary vasomotion (heart vessel size that can be related to spasm/dilation) and reaction of endothelial cells of heart vessels. They found that in the dark chocolate group there was a significant increase in the dilation of heart vessels, the ability of endothelial cells to cause dilation of vessels, and decreases in platelet adhesion.
— Hermann et al., (2006) – In an excellent article published in Heart Hermann and colleagues looked at 25 male smokers for the effect of 74% dark chocolate on cardiac function. In the end, the dark chocolate group had increase in antioxidant status, decrease in platelet function, and increase in cardiac vessel dilation.
—Janszky et al., (2009) – As noted previously, this latest research looked at the LONG-TERM effects of chocolate… not something everyone else is doing. They also looked at all chocolate, not just dark, but you have to understand that within their study population even milk chocolate is about 30% coco… not so in the U.S.. The large sample of 1169, non-diabetic, patients who had been hospitalized a heart attack, looked backward at chocolate consumption the previous 12 months before heart attack. The results were impressive. As the frequency of chocolate consumption went up, the risk of death from MI went down…. the lowest risk group were those who had consumed chocolate 2 times a week or more. (If you are into epidemiology statistics the risk ratio went like this (less than one is considered a protection from disease)…. 0.73 – < 1 time/month, 0.56 – 1 time/week, 0.34 – 2 time/week or >)
—Hamed et al., (2008) – Examined healthy subjects in relation to the effects of dark chocolate and found that after 7 days of dark chocolate once per day that their LDL count decreased by 6%, HDL count (the good cholesterol that protects your heart) increased by 9%, antioxidant levels were up and WOMEN had a decrease in serum CRP.
Chocolate might also be a great mood enhancer?—Strandberg et al., (2008) – This was one of the first studies to examine long-term chocolate consumption as it related to PSYCHOLOGICAL HEALTH…. In a long standing cohort, group of guys they had been studying since the 1960s, with a sample size of 1367 elderly men… they found that those who reported regular chocolate consumption were happier, had significantly less feelings of loneliness, less depression, and more plans for the future than those who did not like or eat chocolate.
Studies of the Future… Preeclampsia risk? — Triche et al. (2008) – In an impressive long-term research study of 2291 pregnant women between 1996-2000 it was found that women who reported chocolate consumption were less likely to develop preeclampsia and had higher cord blood levels of theobromine (a fancy chocolate derivative) and the higher these levels were the lower the risk of developing Preeclampsia. (Preeclampsia can be a deadly illness that develops in pregnant women near delivery and causes high blood pressure, liver malfunction, possible fetal death and seizure… http://www.preeclampsia.org/about.asp)
Now that you know…. So, now that you know how good chocolate is for you I suggest you eat some in small amounts (1-2oz), once to twice a day. I suggest that you visit your local chocolatier and buy some good dark chocolate. May I also suggest that you find a good bean-to-bar chocolate maker who buys chocolate beans at fair trade price from the farmers… then you will be doing good for yourself and others…. enough typing…. I am going to get mine now!
References
Allen et al., (2008). Daily consumption of a dark chocolate containing flavanols and added sterol esters affects cardiovascular risk factors in a normotensive population with elevated cholesterol. Journal of Nutrition, 138; 725-731.
Engler et al., (2006). The emerging role of flavonoid-rich cocoa and chocolate in cardiovascular health and disease. Nutrition Reviews, 64(3), 109-118.
Flammer et al., (2007). Dark chocolate improves coronary vasomotion and reduces platelet reactivity. Circulation.
2007;116:2376-2382.)
Hamed et al., (2008). Dark chocolate effect on platelet activity, c-reactive protein and lipid profile: A pilot study. Southern Medical Journal, 101(12) 1203-1208.
Hermann et al., (2006). Dark chocolate improves endothelial and platelet function. Heart 92, 119-120.
Janszky et al., (2008). Chocolate consumption and mortality following a first acute mycardial infaction: the Stockholm heart epidemiology program. Journal of Internal Medicine. doi: 10.1111/j.1365-2796.2009.02088.x
Strandberg et al., (2008). Chocolate, well-being and health among elderly men. European Journal of Clinical Nutrition. 62, 247-253
Triche et al., (2008). Chocolate consumption in pregnancy and reduced likelihood of preeclampsia. Epidemiology. 19, 459-464.
O.K. I am totally cheating and stealing from an e-mail conversation I had with my wonderful and brilliant sister who has been a Labor and Delivery nurse for 19 years. I know I am belaboring this, and I promise this is the last post, but seriously… American health care is broken and here are just a few reasons why.
She pointed to the need for tax breaks for small businesses to provide health care! I agree!!!!!
“Excellent point about tax breaks. however, businesses do get tax breaks, individuals who have to insure themselves don’t though (that is unfair).”
I have about 30% of my practice w/o insurance and most of them are self employed (farmers, truck drivers) and they can’t afford personal insurance (many with 1000$/month premiums)… I have one truck driver who has back pain and now weakness on his left leg, but he can’t afford a much needed MRI let alone surgery and soon suffers the risk of paralysis. He will never ever get insurance now because he has a pre-existing condition, even if he could afford it. I hate it for these people.
Insurance rates are climbing for businesses astronomically. Case in point, friend owns a business and feels it is his duty to insure his people, he has done this for 4 years… second year insurance company raised the business rates 30%, third year 40%, fourth year 40%, now they are going to drop it because they can’t afford it. Insurance is a problem. The employer I work for, just had United health care raise their rates 40% this year, so they are now have a different carrier, which was still a 20% increase. United is in trouble over how it pays CEO’s and possible fraud. Blue cross blue shield has other troubles. etc…
Drug and test costs are outrageous and the health care systems are to blame. There is no way a PET scan should cost $15,000 dollars (yes, you read that correctly) but it does. People should not be charged 200$ for a simple CBC when I know for a fact that a CBC costs to our clinic are $11 from the lab (and yes the lab is still making money and paying its employees). Health care providers should not be doing stupid crap and ordering stupid tests to prevent us from being sued (when they are not needed). Also, we should not be doing things that are not clinically proven to work. For example, the best research on laproscopic knee surgery for knee pain is as effective as placebo, yet it is usually the number 1 procedure done by health systems because it is billable.
Meds cost too much… capitalism works. I guarantee if all insurance, medicaid, medicare QUIT paying for medications that the prices would drop like a rock because pharm companies would want to continue to sell their medications. There is NO way lipitor should cost 200$ per month, it has been a round for 15 years, or that wellbutrin should cost this much (both generics and cheap to produce) but because insurance will pay for it… they do.
Patients are penalized for paying cash! Look, a check up with my old pediatrician, which we were paying out of pocket to see when our insurance changed was $135 per child (no vaccines, no blood work, no tests)… my past insurance paid $70 for the same exam. Yet, if I paid cash (which I did and which saved the office lots of time and money in billing) I was not allowed a cash discount at all because it would be “insurance fraud” the old health system we went to. WHAT???? Give me a break.
Laws governing nurses and preventing the church from stepping up are RIDICULOUS…. look, you and I both know that you as a nurse could do prenatal education or get the social worker or decide to give a patient TYLENOL without needing a physician. I could do asthma education, diabetes education, diabetic foot care, wound clinic, etc… and run businesses with access for all (because nurses are trained in these things) if it weren’t for stupid governmental oversight, fear of malpractice suits…. Also, the CHURCH who fixed the last health care crisis in America (remember when NUNs and nurses built hospitals for the right reasons)… is too scared of these things, too busy trying to fill their own pews and keep people out… to care whether the woman down the street will get a mammogram this year. Jesus own ministry was healing.
We already have socialized medicine. Medicare, medicaid are both socialized programs. Honestly, the medicare system works pretty good but costs a lot because we have lots of baby boomers (wait… hold the press…. it is not the Baby boomers yet… just outrageous medical costs… see below comments so well put!). Most brits get pretty good coverage with their system, seriously… there are always cases where this doesn’t happen, but I have tons of cases where I have patients who have no access to proper care, right here in America. We do not have the best system in the world.
The system is too focused on medical model/ after the fact treatment instead of prevention. Look, if my patients could get their gym membership and dietary counseling paid for many of them wouldn’t have diabetes. We spend millions of dollars providing chemotherapy to 85 year old people, keeping people with no chance of survival alive… instead of providing dental care (which is a huge factor in overall cardiac and physical health), letting young working people get physicals and blood work, or paying for mammograms before the age of 50. For example, I have a strong family history of heart disease (mom with MI and open heart surgery at 41), but my insurance will not pay for cholesterol screenings but once every 5 years and only after age 40… all this time we could be monitoring and preventing.
Bottom line – the entire system is broken, but it is a very complex issue and just having insurance won’t solve it.
There will always be those among us who cannot provide for themselves, I am not talking about those who can and choose not to because they are lazy… they will always be around too… Jesus did say “what every you do for the least of these you do for me”… this is why I am a nurse. I see every patient through the same lens regardless of insurance status. Nursing is such a noble art because of this.
I had to post something. This blog post on the New York Times is so well written and provides a human and nursing face to health care reform. I urge you to go and read it for yourself. She says it so well. Thank You Theresa Brown!!!!
http://well.blogs.nytimes.com/2009/08/19/a-nurses-view-of-health-reform/
Nursing Leadership, Health Care Reform, Chocolate, Sleeping In, Blogs… and other random thoughts
My blog… how I have missed you… today as I write I feel guilty about all of the things I am NOT doing. I am NOT currently rewriting my Health Assessment course material that got lost in our downgrade (a downgrade after an upgrade) in ANGEL (for those of you who don’t know that is a university computerized learning platform). I am NOT currently writing on my comprehensive exam final… just thinking about that thing makes me want to vomit. I am NOT at the grocery store, cleaning my house, or helping with the finishing touches on our bathroom remodel that took place 6 weeks ago (yes… there is still more to do). I WANT (and am) to be back in bed, eating Askinosie Chocolate (http://www.askinosie.com), with the covers pulled over my head… trying to make all of the things I am NOT doing go away. Hiding doesn’t make things go away very well, but stepping back, resting and reevaluating does help… We have to reevaluate and rest in our own way; mine involves my bed, my pajamas and chocolate.
I AM thinking about Nursing. Nursing is my favorite profession and the light of health care in the U.S. and around the world. As I hide this morning… I wonder sometimes why, as a nurse, I am doing all these things that make me want to hide? I am writing blog posts, twittering, working on revamping my courses to make them better (something I have no time to do with my gazillion advisees and trying to finish school), leading a local nursing organization, pursuing a PhD of nursing…. Why? … I could just clock in and out of some clinic somewhere and see 40 patients a day and make twice the money I am making and come home and rest… Why don’t I do that???… (I am not telling you this to boast or brag. Please hear me honestly.)… I am seriously wondering why I don’t do that?
Then, I read two great blog post by my friend Lee Weeks on her Facebook page (yes, she is bloging there because she currently has blog difficulty)… the posts were about nursing and health care reform. I wish you could have read them. She writes so well… moves the audience… brings people to the point without showing them she is taking them there…. Anyway…
One of her posts asked for comments from nurses to give their stories of health care and why or why not they feel reform is needed. Many of her posts get comments, but this one laid silent. I wondered why? Then the thought hit me… maybe nurses (on the whole) don’t see problems with health care because we are too busy caring for all patients at the bedside and we could give a flip less about someone’s insurance status! Nurses just do it. Nurses don’t see the patient through bills, rejection for medical tests or referrals, etc. Nurses don’t see patients this way because we generally don’t bill or refer… we simply care for the patient…any patient… regardless. How nurse-like of us. If only the entire medical system worked this way… just cared for patients?
That led me back to think about why I am doing all of these insane things with my nursing career…. is it for me? For fame? For some administration position or lead research role somewhere? … I have to say no. I don’t want to be director of a program, or an administrator with lots of meetings,… I want to keep on nursing… and teaching other nurses how precious and valuable they are… to do this well requires something from me I guess… persistence. (Why did I go here? Uhg… my jammies are getting sweaty and I start to squirm… I thought this post was going to talk me out of these insane things….)
More Thinking… about nurses….When I look at the world of nursing from under my covers I see that NURSES can change health care precisely because of who we are. Thinking of this in my P.J.’s, with the covers pulled up to my chin… I yell SWEET! (and I am not talking about my Akinosie chocolate)…. Nurses provide the kind of health care our world needs every minute of every day (when they are not busy charting what administrators want in 17 different places)…Whenever a nurse encourages a laboring patient, takes the time to teach a heart attack survivor about their new medications, teaches a class of baby sitters CPR, administers a pain medication, hugs a dying patient’s spouse, … they are changing the world. Servant leadership is nursing…. and I, little old no one from the Midwest, with an average IQ and a big mouth…., I get to be a part of this… I get to call myself NURSE! What an honor!
Yet, the nurses and the nurse leaders I listen for are silent about how wonderful Nursing is. Why? I don’t think they realize how big of an impact they make every day and I think they are too busy to involve/invite the outside world and media into their profession. Nurses are all down right busy! This busyness is keeping our good secret a secret. Right now, that is not good.
Maybe it is time for nurses and the profession of nursing to step back from the chaos of overtime, understaffed, big-business model hospitals, argumentative health care debates and just hide under our covers, in our pajamas with some chocolate and think….
From my spot in my bed I see that health care reform is nothing to be feared, it is a golden opportunity for all of us… particularly nursing. From my comfortable nest among my covers I see that NURSING is how health care reform should be viewed…. a paradigm for how to do it… with hard work, determination and our patients in mind (all of our patients… no matter their ability to pay or not)…. Nurses have seen the best and the worst of what access to care can cause in/do to patients, yet we still care for the patients no mater what brought them to us; changing one life at a time and doing it for everyone that is assigned to us. So, nurses are silent in the health care reform debate because we are busy taking care of what we have to take care of… patients and bringing up new nurses to help us in our work…. also because mostly we are the quiet unassuming ones in the back ground who don’t get asked to the big dance because we are too busy working.
My advice to leaders everywhere… First of all, get your own nurse and make friends with them... you will want one when you go to the hospital… THEN, step back from health reform and take a day off, under your covers, with chocolate (or whatever) and with the people you love around you, and rest. Then….(People out there in health care reform meetings)…. get some nurses off of work for a day and invite them to your meeting and ask them about the work they do every day…. or better yet, follow them around for a day (wow what an eye opener that would be)…
My advice to nurses… take the day off, in your jammies, under the covers and then think about who you can show/share your career with that is not a nurse. Then, just like your work…. do it.
My advice to myself.… keep plugging along…. these things I do… are because I love nursing, because I have the honor of being a nurse. Through all of the patients I have watched be born, die, be healed, learn about themselves and their uniqueness…. through all of the nurses I have been HONORED to teach and now call peers….. I promise to keep doing my job as a nurse, a nurse educator, a nurse practitioner, to ensure that nurses know how precious they are and so patients continue to have access to good care. To the people I know who are nurses… THANK YOU! You inspire me and you are the reason I am going to get out of my bed and start working on rewriting my health assessment class and my comprehensive exams…. I think I am going to keep on the pajamas though!
Health Care Reform: Our responsibility… could we do it without government intervention?
The U.S. health care system is the most expensive in the world (Univ. of Maine, 2001). Interestingly about 20% of that cost is due to administrative expense. For example, your health care provider’s office would be much less expensive if they did not have to hire extra people to help with coding, billing, and insurance claims. Likewise, the expense of health care education, malpractice claims, and staggering pharmaceutical charges are also driving the system costs up. The bottom line: There are millions of Americans without insurance, the system is too complex for even its own employees to navigate, and even for the insured access to care is limited. We all know something has to be done, the question is… how can we fix it?
I appreciate that the answer is complex and that it requires much thought, but there are so many people afraid of government intervention and the complexities that will accompany it, look how simple they keep the federal tax code, that I am wondering if there are some changes that could be made to the system to cover those uninsured while keeping the government out?… IF there are not MAJOR changes then the government needs to step in and fix things, but how long should we wait to see if the private sector will make any changes? Here are a few facts about the current INSURANCE driven system:
- Even with 46 million uninsured, we still spend more than any nation on health care. (National Coalition on Health Care, 2009).
- The annual premium a health insurer charges an employer for a family of four averaged $12,700, 2008 (National Coalition on Health Care, 2009).
- The U.S. is the onlyindustrialized country in the world that does not provide access to care for all of its citizens, besides South Africa (Maine, 2001).
- The U.S. infant mortality is 26th out of industrialized nations in the world (Main, 2001).
- Under the WHO category “Fairness in Financing” the U.S. was lowest of all industrialized nations in the 2000 WHO evaluation of health care systems. (Maine, 2001)
Some Things That are Right
Some things have changed for the better in the last several years, improving cost and access. Although there are some professional organizations that do not like these changes, they are increasing affordability and access to those without and therefore cannot be ignored.
- The Walmart 4$ list (forced many retail pharmacy chains to also develop a low cost drug list). Although the lists are not complete for treating all major illnesses, they are a good starting point for many patients. http://www.walmart.com/4prescriptions
- Medical Walk-in clinics in retail stores. I can hear the critics already…. saying a medical home is best and ‘doc-in-the-box’ is bad. I agree, but the reality is that many people can afford to pay lower out-of-pocket costs to be seen in these types of clinics, that they decrease Urgent Care and ER over crowding, they are available when other offices are not, and they offer at least SOME place that those without insurance can be seen without an outrageous bill.
- NP owned and run clinics. Although there is much regulation in many states (that I feel should be reconsidered…. see my post on nurse changes to health care reform http://nursestory.wordpress.com/2009/06/11/considering-nursing-and-health-care-reform-what-nurses-could-be-doing/) NP run clinics are cheaper, can be independent and still function without a Health Care system backing them. They also offer affordable health care access (and more importantly PREVENTION measures). If any of you want to argue the effectiveness or safety of NP’s see my post on NP care compared to physician care at http://nursestory.wordpress.com/2008/06/10/np-care-cost-effective-and-on-par-with-physician-care-according-to-research/.
- The Church. Although many churches could still care less about the health of their neighborhoods, are focused on filling pews and paying for buildings… some are ‘getting it’. For example, The Church Health Center (found at http://www.churchhealthcenter.org/) is fulfilling their mission of faith and caring for the sick. If this would occur more, then health care reform would be much less needed (see post on Churches and Health Care http://nursestory.wordpress.com/2008/12/14/where-is-the-church-a-reflection-on-the-healthcare-crisis-christianity-and-organized-religion/)
What Can We Do
The average citizen feels helpless/powerless in this confusing, bureaucratic health care debacle, but we do have a voice. Below is a list of things that could be done to change health care and to give voice to those who feel disenfranchised. Maybe you do not feel disenfranchised, but would you be willing to speak for someone who is?
- Prescription Drug Costs: I am throwing this out there and many will balk at it, but what if no one paid for prescription drugs (when I say no one I mean no insurance companies…) How would the free market change the cost of health care if no one paid for drugs anymore? Would Wellbutrin still cost $200/month for 60 pills? How fast would the price drop if people were paying out of pocket? (then…. we would look at some charitable foundations that would help pay the bill for prescription drugs or maybe the government would provide a stipend to each person to pay for their own drugs….? Just throwing it out there as an alternative… something to consider.
- Nurses, nurses, nurses: If nurses were utilized more, particularly in preventative health care capacities (Which is what nurses are very very good at) then would costs be so high? What if someone with asthma could go and get asthma education and an asthma action plan without having a physician referral? What if nurses provided contraception education, diabetic foot clinic, immunizations, diabetes education, obesity prevention or weight loss clinics, etc…. how would the costs of health care be affected?
- Read and be knowledgeable: The best action for any citizen is to be informed of the truth (not the politics surrounding the issue). Politics, is a power game where our congress women and men could care less about our individual welfare and more on being reelected/retaining power. Don’t believe any of them. Instead I would read reputable health organization research like from the NIH, WHO, etc…
- Call or Write: At least provide a record of your opinions to someone. Call and write your state and national congressman (don’t just say you should… do it)… Also, write to an organization, join the cause, motivate your fellow civic and church group members to care…
- ACT: How would the world change if we all took some personal responsibility in this mess? Nurses, buy a blood pressure cuff and a good scale and be the neighborhood blood pressure/weight personnel. Citizens, join your church in a health fair or donate to an organization that provides free health care. Likewise, all of us should strive towards financial freedom and responsibility. If we were not living pay check to pay check or in mounds of debt… how different would our society be? The government cares NILL about debt, but what if we as citizens began to care. Don’t go out to eat as often, pay off your car, check out Dave Ramsey….these small things give us more freedom to act where WE want to, not where others tell us we should. If we could act instead of being taxed into action, would that be better?
- The Church: Should be involved. This is exactly what the mission of Jesus was about, healing (often physical). If the church doesn’t care about people (more than their memorization of scripture and Sunday morning attendance) who will?
The time is now. We have waited too long to help those who have no access or insurance. I see them everyday I go to clinic, where about 30% of the patients have no health insurance (that is why they come and see the NP and pay out of pocket). Many of them are putting off needed surgeries, treatments, medications… these people are real and there is very little to no help out there for them. I hate seeing people that I can not help because of financial difficulties. We are citizens of a free and amazing nation. We can make change.
References
The Church Health Center found at: http://www.churchhealthcenter.org/
The National Coalition on Health Care (2009). Health Insurance Costs. Found at: http://www.nchc.org/facts/cost.shtml
University of Maine (2001). The U.S. Health Care System: The best in the world or just the most expensive? Found at: http://dll.umaine.edu/ble/U.S.%20HCweb.pdf
