Practice Matters: Hypertension

Hypertension remains a significant public health concern in the United States, affecting over 110 million adults, nearly half of the adult population. As a major contributor to cardiovascular diseases, including heart disease and stroke, hypertension accounts for a large number of deaths annually. Many individuals with hypertension remain undiagnosed and undertreated, leading to increased healthcare costs. Recognizing the importance of addressing this widespread issue, the healthcare community, including Faith Community Nurses (FCNs), has played an essential role in the prevention and management of hypertension. While pharmacological interventions are common, lifestyle changes have demonstrated their effectiveness in reducing blood pressure and enhancing the impact of medications. Emphasizing lifestyle modifications has become a cornerstone in recent hypertension guidelines aiming to optimize treatment outcomes and achieve target blood pressure values. These guidelines recognize the need for personalized care, considering factors like age, cognitive impairment, comorbidities, and orthostatic hypotension. Numerous guidelines have been written to direct the care of hypertensive patients, such as those by the American College of Cardiology/American Heart Association and the European Society of Cardiology/European Society of Hypertension. While they share common principles, they differ in blood pressure classifications and initiation thresholds for antihypertensive medications. Faith Community Nurses, as respected health professionals, play an integral role in hypertension prevention and management through community support and lifestyle guidance. Collaborating with healthcare institutions and local health departments, FCNs can actively participate in initiatives to promote healthier lifestyles to manage hypertension effectively

Can Follow Up Phone Calls Decrease Complications of Chemotherapy Toxicities In Adults?

Approximately 22% of all cancer patients in the United States receive chemotherapy. Older adults account for 60 % of new cancer diagnoses in the United States. The aging process is associated with comorbidities that potentially can increase toxicities associated with chemotherapy. These include coronary artery disease, hypertension, and diabetes. Monitoring for toxicities during treatment and intervening when needed allows patients to move forward in their treatment plan. Interruptions in the treatment plan have the potential to adversely affect treatment goals. The purpose of this study is to determine if patients receiving phone calls on predetermined days had fewer days of treatment delay related to toxicities before proceeding to cycle 2 of chemotherapy and a decrease number of emergency department visits/hospitalizations related to toxicities. The study also followed those patients that received education from the nurse practitioner to determine if they had fewer days of treatment delay related to toxicities compared to those patients that did not have treatment delays. Sixty one participants were in the treatment group and 60 were in the control group. A statistical significance of .043 was found with patients receiving phone calls after starting treatment. There was no statistical significance in telephone calls affecting emergency department visits. There was no statistical significance in education by the nurse practitioner. Sample population was a limited in number but broad in diagnoses. Future research could benefit from following this topic in a larger metropolitan area where there are sufficient numbers of patients to follow with similar diagnosis

Patient and Provider Communication Regarding Exercise during Pregnancy in a Rural Setting

International Journal of Exercise Science 13(3): 1228-1241, 2020. Women in rural settings are at increased risk for adverse pregnancy outcomes. One potential way to improve pregnancy outcomes in rural settings is through physical activity promotion. However, given the disparities in prenatal care, women in rural areas may not receive information from their health care provider regarding physical activity during pregnancy. Therefore, the purpose of this study was to examine patient and provider communication in a rural setting (both patients’ and providers’ perspectives) regarding physical activity during pregnancy. A mixed methods study was performed among patients and providers in an obstetrical practice in a rural setting. During early pregnancy, patients were asked questions about their current physical activity levels and intentions for physical activity during their pregnancy. During late pregnancy, patients completed a survey regarding communication from their obstetric provider about exercise during pregnancy. Providers responsible for the patients’ prenatal care were surveyed regarding communication with patients about physical activity. Seventy-one pregnant women and five providers participated. 58.2% of patients reported their provider did not discuss physical activity during pregnancy with them at all. Meanwhile, all providers (100%) reported discussing physical activity with all of their patients. Similarly, only 21.8% of patients reported their provider discussed the benefits of exercise during pregnancy, while 100% of providers reported telling their patients about the benefits of exercise during pregnancy. Our study suggests ineffective patient-provider communication regarding physical activity during pregnancy in a rural setting. Improved communication strategies could reduce disparities in health outcomes among pregnant women in rural settings

Practice Matters: Prevention and Care of Individuals with Type 2 Diabetes

A Faith Community Nurse (FCN) is tasked with promoting health within a faith-based community. As with any nursing role, the FCN must keep abreast of current issues and be aware of informational resources to keep his/her practice relevant. The area of focus in this issue is type 2 diabetes. During 2014, the global prevalence of diabetes among adults was estimated at 9%. There are numerous risk factors for type 2 diabetes including both modifiable and non-modifiable. The diagnosis of diabetes can be made based on plasma glucose or Hemoglobin A1C (A1C) criteria.Prediabetes and type 2 diabetes affect many people globally. It is important for FCNs to be able to teach others about the disease process, how to check blood glucose, and why adherence to the medication regimen is important. Furthermore, the patient should understand other actions they can take for a healthier life by eating well and exercising regularly

Nursing Alumni: Continuing Education Preferences

The Bureau of Labor Statistics reports that there are 2.9 million registered nurses in the U.S who practice in a variety of settings including faith communities. The faith community nurse blends care of the spirit along with physical health to prevent or decrease illnesses. To stay informed of the latest evidenced-based practice, continuing education is essential. Due to many factors; work schedules, family, and location, meeting educational needs can be a challenge. The aim of this study was to examine nurses’ preferences related to delivery methods and day/time as well as topics of interest that influence nurses’ decisions when choosing educational opportunities

Metabolic Flexibility and Weight Status May Contribute to Inter-Individual Changes in Breastmilk Lipid Content in Response to an Acute Bout of Exercise: Preliminary Findings from a Pilot Study

International Journal of Exercise Science 13(2): 1756-1769, 2020. The purposes of this pilot study were to describe changes in breastmilk lipid content in response to an acute bout of moderate intensity exercise and to explore maternal metabolic health factors, including metabolic flexibility, which may impact this change. A cross-sectional, observational, pilot study design was performed in 14 women between 4 and 6 months postpartum. Whole body fasting lipid oxidation was assessed, a standardized high-fat breakfast was consumed, and lipid oxidation was again measured 120-minutes post-meal. Metabolic flexibility was determined by comparing the change in lipid oxidation before and after the meal. Women completed 30-minutes of moderate intensity treadmill walking 150-minutes post-meal. Breastmilk was expressed and analyzed for lipid content before and after exercise. Overall, there was no significant difference between pre- and post-exercise breastmilk lipid content (pre-exercise 59.4±36.1 g/L vs. post-exercise 52.5±20.7 g/L, p=0.26). However, five (36%) women had an increase in breastmilk lipid content in response to the exercise bout, compared to nine (64%) that had a decrease in breastmilk lipid content suggesting inter-individual variability. The change in breastmilk lipid content from pre- to post-exercise was positively correlated to metabolic flexibility (r=0.595, p=0.03). Additionally, post-exercise lipid content was positively correlated with body mass index (BMI), body composition, and postpartum weight retention. Preliminary findings from this pilot study suggest that metabolic flexibility and maternal weight status may help explain the inter-individual changes in breastmilk lipid content in response to an acute bout of moderate intensity exercise

Elevated Lipid Oxidation Is Associated with Exceeding Gestational Weight Gain Recommendations and Increased Neonatal Anthropometrics: A Cross-Sectional Analysis

BACKGROUND: Deviations from gestational weight gain (GWG) recommendations are associated with unfavorable maternal and neonatal outcomes. There is a need to understand how maternal substrate metabolism, independent of weight status, may contribute to GWG and neonatal outcomes. The purpose of this study was to explore the potential link between maternal lipid oxidation rate, GWG, and neonatal anthropometric outcomes. METHODS: Women (N = 32) with a lean pre-pregnancy BMI were recruited during late pregnancy and substrate metabolism was assessed using indirect calorimetry, before and after consumption of a high-fat meal. GWG was categorized as follows: inadequate, adequate, or excess. Shortly after delivery (within 48 h), neonatal anthropometrics were obtained. RESULTS: Using ANOVA, we found that fasting maternal lipid oxidation rate (grams/minute) was higher (p = 0.003) among women with excess GWG (0.1019 ± 0.0416) compared to women without excess GWG (inadequate = 0.0586 ± 0.0273, adequate = 0.0569 ± 0.0238). Findings were similar when lipid oxidation was assessed post-meal and also when expressed relative to kilograms of fat free mass. Absolute GWG was positively correlated to absolute lipid oxidation expressed in grams/minute at baseline (r = 0.507, p = 0.003), 2 h post-meal (r = 0.531, p = 0.002), and 4 h post-meal (r = 0.546, p = 0.001). Fasting and post-meal lipid oxidation (grams/minute) were positively correlated to neonatal birthweight (fasting r = 0.426, p = 0.015; 2-hour r = 0.393, p = 0.026; 4-hour r = 0.540, p = 0.001) and also to neonatal absolute fat mass (fasting r = 0.493, p = 0.004; 2-hour r = 0.450, p = 0.010; 4-hour r = 0.552, p = 0.001). CONCLUSIONS: A better understanding of the metabolic profile of women during pregnancy may be critical in truly understanding a woman\u27s risk of GWG outside the recommendations. GWG counseling during prenatal care may need to be tailored to women based not just on their weight status, but other metabolic characteristics

Bibliography

Bibliography of publications by Maire Blankenship

Osteoporosis Education: Success in a Community Setting

The purpose of the quasi-experimental study was to examine the effect of a community educational offering on attendees’ knowledge of osteoporosis as measured by the Osteoporosis Knowledge Test. A statistical significant difference was noted between the pretest and post-test means (p = .000). The findings demonstrate that a brief educational session can increase knowledge regarding osteoporosis. Development of partnerships with community populations to provide opportunities for health education can be valuable in promoting healthy behaviors

A Pilot Study on the Impact of the BumptUp^® Mobile App on Physical Activity during and after Pregnancy

To combat maternal morbidity and mortality, interventions designed to increase physical activity levels during and after pregnancy are needed. Mobile phone-based interventions show considerable promise, and BumptUp® has been carefully developed to address the lack of exercise among pregnant and postpartum women. The primary goal of this pilot study was to test the potential efficacy of BumptUp® for improving physical activity among pregnant and postpartum women. A randomized controlled clinical trial was performed (N = 35) with women either receiving access to the mhealth app or an educational brochure. Physical activity and self-efficacy for exercise data were collected at baseline (in mid-pregnancy) and at three additional timepoints (late pregnancy, 6 and 12 weeks postpartum). For moderate-to-vigorous physical activity, a clear trend is observed as the mean estimated difference between groups increases from −0.35 (SE: 1.75) in mid-pregnancy to −0.81 (SE: 1.75) in late pregnancy. For self-efficacy for exercise, the estimated difference of means (control–intervention) changed from 0.96 (SE: 6.53) at baseline to −7.64 (SE: 6.66) in late pregnancy and remained at −6.41 (SE: 6.79) and −6.70 (SE: 6.96) at 6 and 12 weeks postpartum, respectively. When assessing the change in self-efficacy from mid-to -ate pregnancy only, there was a statistically significant difference between groups (p = 0.044). BumptUp® (version 1.0 (3)) shows potential for efficacy. Pilot data suggest key refinements to be made and a larger clinical trial is warranted