Following an acute MI (AMI), blacks are more likely to develop significant angina, experience a poorer quality of life over the next year and die within 2 years than whites. When UC Irvine researchers asked why, they found the disparate outcomes occur primarily because blacks are sicker before the cardiac event, with higher rates of diabetes, chronic renal failure, hypertension, heart failure and history of stroke. In addition, primary care providers for blacks were often not board-certified; they tended to see larger numbers of patients and report they didn't have the time they needed to deliver quality care. (Spertus, J.A., et al.  2009, March 3. Annals of Internal Medicine, 150,314-324.)   

Incredible Impact

Brenda McCulloch, MSN, RN, clinical nurse specialist with the Sutter Heart & Vascular Institute, Sutter Medical Center, Sacramento, noted, "This study identifies an area where nurses can have an incredible impact! We provide patient teaching and home care instructions in the hospital setting, as well as education in the community and doctors' offices. Nursing is one of the most trusted professions, and what we do very well is establish rapport with the people we serve. When you connect with people, you can have a good two-way conversation and read between the lines of what they're saying to identify their issues."

Sutter Health nurses serve communities with an identified need for blood pressure screening, cholesterol testing, blood sugar testing and preventive health education. "We go to local schools to provide information not only for the children to use, but for them to share with their parents and other family members as well," McCulloch said. "We've gone to churches and apartment complexes in under-served areas and we work with some of the large employers in the area to provide screening and education. We've gone to Downtown Plaza to offer screening for women's heart health, and one of the most interesting places we went was a local casino.

"Nurses can do a general health assessment, chat with people about their risk factors and do some basic testing," McCulloch continued. "There's a real absence of information in many segments of the population, and we need to bring that important information to them where they live. People don't want to come to the hospital unless they absolutely have to; in their own settings, people are less stressed and can better hear the message we want to share."

A Two-Pronged Approach

St. Joseph Hospital, Orange, offers a comprehensive educational program with a focus on primary and secondary interventions to promote healthy lifestyles and keep people from becoming statistics. "We firmly believe hospitals have the obligation to step outside their doors and reach out into the communities they serve to improve the health status of the population," said Sue Henke, RN, manager of the cardiac and vascular programs. "It's difficult to educate patients and families during a hospital stay, when they're dealing with pain, illness and anxiety."

A two-pronged approach can be highly effective. "Acute care nurses can introduce healthy lifestyle options as part of discharge teaching and encourage patients to attend community-based programs," Henke said. "Nurses in the community can educate clients about choices around lifestyle issues such as diet and exercise at a time when they're more able to listen and learn."

Nurses are in an ideal position to educate, inform and empower the individuals they serve. "We have the responsibility to . act as patient advocates to ensure people are being seen by qualified healthcare providers and receive early and regular preventive care," Henke said. "We need to educate people about what to look for in terms of quality primary care, and reinforce their right to access that care."