Judith Aponte

Community as Client: Reaching an Underserved Urban Community and Meeting Unmet Primary Health Care Needs

In a collaborative effort to address the health disparities within 1 urban underserved community, the Hunter-Bellevue School of Nursing, Hunter College, and the Mount Sinai Medical Center organized a health fair. Nursing faculty worked side by side with undergraduate nursing students to offer several health promotion activities, screening, and educational sessions for residents of East Harlem, New York. In addition, nursing students provided individual patient education on nutrition, hand washing hygiene, medication review, and glucometer usage. Educational materials on lifestyle issues (sample meals, maintaining normal blood glucose, blood pressure, cholesterol levels, and smoking cessation) were provided. To help bridge the gap between health education and health promotion activities, nursing students, many of whom were bilingual, served as translators for non-English speaking Spanish and Chinese residents. In addition to the new professional partnerships developed, new clinical placements for nursing students were established.

Diabetes‐Related Risk Factors Across Hispanic Subgroups in the Hispanic Health and Nutritional Examination Survey (1982–1984)

OBJECTIVE The Hispanic Health and Nutritional Examination Survey (HHANES) was utilized to examine diabetes-related risk factor variables between and among 3 Hispanic subgroups. DESIGN The study design that was conducted was descriptive using the HHANES secondary data set. SAMPLE The sample included individuals between 20 and 74 years of age, self-identified as Mexican American, Puerto Rican, and/or Cuban American and had been told by a doctor that they had diabetes. MEASUREMENTS The 5 diabetes-related risk factor variables were obesity measured by body mass index (BMI), hypertension by systolic blood pressure (SBP) and diastolic blood pressure (DBP), hyperlipidemia by cholesterol and triglyceride levels, renal insufficiency by blood urea nitrogen (BUN), and creatinine and fasting plasma glucose. RESULTS This study demonstrates significant differences between specific subgroups through chi-square. SBP in Cuban Americans was significantly higher than that of Puerto Ricans (28.39 mmHg) and of Mexican Americans (25.94 mmHg). Cuban Americans also had significantly higher cholesterol values than Mexican Americans (88.49 mg/dL) and Puerto Ricans (84.49 mg/dL). The only significant difference for triglyceride was between Mexican Americans and Puerto Ricans (37.25 mg/dL). For BUN, there were significant differences when Cuban Americans (9.06 mg/dL) and Mexican Americans (2.20 mg/dL) were separately compared from Puerto Ricans, and Cuban Americans had significantly higher creatinine values than Puerto Ricans (0.38 mg/dL) and Mexican Americans (0.25 mg/dL). Through linear regression, significant differences for the association of each diabetes-related risk factor and the risk for diabetes complications were computed for each subgroup. For Mexican Americans and Puerto Ricans there were significant differences in overweight BMI (25.0-29.9 kg/m2) and obesity (> or =30.0 kg/m2); for Mexican Americans, Puerto Ricans and Cuban Americans in elevated SBP (130-139 mmHg) or elevated DBP (80-89 mmHg), for high SBP (> or =140 mmHg) or high DBP (> or =90 mmHg), and for high glucose (> or =126 mg/dL); and for Mexican Americans in elevated triglyceride (> or =150 mg/dL), elevated BUN (> or =21 mg/dL), and elevated creatinine (> or =1.5 mg/dL). CONCLUSION The findings of this study will add to the diabetes and Hispanic literature highlighting the need to evaluate Hispanic subgroups in future health behavior and outcomes research.

The prevalence of peripheral arterial disease (PAD) and PAD risk factors among different ethnic groups in the US Population

The National Health and Nutrition Examination Survey (NHANES) 2003-2004 data set was utilized to examine and compare trends and differences in PAD-related risk factor variables among 5 different ethnic/racial groups. The sample included individuals 40 years and older with PAD and of the ethnic/racial groups: Mexican American, Other Hispanic, Non-Hispanic White, Non-Hispanic Black, and Other/Multiracial. Two demographic variables (age and gender) and 4 PAD-risk factors (hypertension [HTN], systolic blood pressure [SBP], and diastolic blood pressure [DBP]), dyslipidemia, high-density lipoprotein [HDL] and low-density lipoprotein [LDL], diabetes, and cigarette smoking) were examined for each group. The study design conducted was descriptive using the NHANES 2003-2004 secondary data set. Raw data were weighted. Descriptive statistics were measured, Chi-squares were compared, and Phi-coefficients were measured for association using SAS version 9.1 and SUDAAN 10.0. The group with the highest prevalence of PAD are females 40-50 years of age, and the ethnic group with PAD who have the highest risk for PAD-related risk factors are Non-Hispanic Black. Through Chi-square significant differences (P=0.00001-0.03874) between specific ethnic groups for all four PAD-related risk factors (i.e., HTN, dyslipidemia, diabetes and cigarette smoking). All of the associations between the prevalence of HTN, dyslipidemia, diabetes, or cigarette smoking and ethnicity were statistically significant (P=<0.0001). Overall differences exist among the different ethnic groups.

Cultural competency in baccalaureate US nursing education: hybrid course.

The ability to appropriately care for diverse populations is an expected competency of the graduated Bachelor of Science in Nursing (BSN). To provide effective materials to ensure this competency is met, the American Association of Colleges of Nursing developed the Toolkit of Resources for Cultural Competent Education for Baccalaureate Nurses. The toolkit provides information on cultural competency models and teaching strategies nurse educators can use to facilitate student learning in cultural sensitivity and competency. This article demonstrates how one model in particular, Campinha-Bacotes Model of Cultural Competence, was utilized for 15 weeks in an undergraduate BSN nursing course for a student population in an urban school of nursing to effectively provide students with the skill set needed to give culturally competent care. This article will provide the methods and strategies used to teach cultural competency as based on Campinha-Bactotes Model in an undergraduate nursing course.

Prevalence of normoglycemic, prediabetic and diabetic A1c levels.

AIM To investigate normoglycemic, prediabetic and diabetic A1c levels in those with prediabetes; and prediabetic and diabetic A1c levels in those with non-prediabetes. METHODS The National Health and Nutritional Examination Survey (NHANES) 2007-2008 and NHANES 2009-2010 were utilized to examine and compare trends and differences among five different ethnic groups (Mexican Americans, Other Hispanics, Non-Hispanic Whites, Non-Hispanic Blacks, Other/Multi-racials) with normoglycemic, prediabetic and diabetic A1c levels with self-reported prediabetes and prediabetic and diabetic A1c levels in those with self-reported non-prediabetes. Sample participants of the five ethnic groups were limited to those 20 years of age and older, who had completed the diabetes questionnaire and had A1c measured. Descriptive statistics were computed for all variables. χ(2) were performed on all five ethnic groups to examine significant differences of normoglycemic, prediabetic and diabetic A1c levels in those with self-reported prediabetes, and prediabetic and diabetic A1c levels in those with self-reported non-prediabetes. RESULTS This study demonstrates that of the five different ethnic groups from NHANES 2007-2008 to NHANES 2009-2010, Non-Hispanic Whites (6.5% increase) and Non-Hispanic Blacks (0.2% increase) were the only two groups with an increase in the number of self-reported prediabetes. Although the overall percentage of Mexican Americans who self-reported prediabetes had remained the same (5%) from NHANES 2007-2008 to NHANES 2009-2010, χ(2) analysis showed significant differences when examining the different ranges of A1c levels (normoglycemic, prediabetic and diabetic). Among Mexican Americans who self-reported prediabetes, normoglycemic (P = 0.0001) and diabetic (P = 0.0001) A1c levels from NHANES 2007-2008 to NHANES 2009-2010. For Non-Hispanic Whites who self-reported prediabetes, prediabetic (P = 0.0222); and diabetic (P ≤ 0.0001) A1c levels from NHANES 2007-2008 to NHANES 2009-2010. For Non-Hispanic Blacks who self-reported prediabetes, there were significant differences (P = 0.0001) for all A1c levels (normoglycemic, prediabetic and diabetic A1c levels). For Other/Multi-racials with self-reported prediabetes there was significant differences in those with normoglycemic (P = 0.0104) and diabetic (P = 0.0067) A1c levels from NHANES 2007-2008 to NHANES 2009-2010. For all combined ethnic groups who self-reported not having prediabetes (non-prediabetes), 19.9% of those in NHANES 2007-2008 and 22.4% in the NHANES 2009-2010 showed to have prediabetic A1c levels. When separately examining each of the five ethnic groups who self-reported not having prediabetes, all showed an increase in those with prediabetic A1c levels from NHANES 2007-2008 to NHANES 2009-2010. Through χ(2) analysis, all five ethnic groups who self-reported not having prediabetes showed significant differences (P < 0.0001) in all A1c levels (normoglycemic, prediabetic and diabetic) from NHANES 2007-2008 to NHANES 2009-2010. CONCLUSION The findings highlight the need of prediabetes awareness and of education in the community as ways to reduce the number of people with prediabetes.

Partnership among a faith-based organization and community.

In a collaborative effort, a community-based participatory research approach was used to address the holistic health needs of a community while including a multilanguage view, a faith-based organization, The Legacy Center Community Development Corporation, and several health agencies partnered in organizing and conducting a health fair in West Central Queens. Health awareness and health promotion activities were provided through presentations, health screenings, and education materials (on diabetes, hypertension, nutrition, cholesterol, and heart disease). To meet the needs of community and/or faith-based organization members, translation services were available: nurses translated for non–English-speaking participants in Spanish, Mandarin, or Cantonese, and sign language interpreters used American Sign Language to translate for deaf participants.

The prevalence of asymptomatic and symptomatic peripheral arterial disease and peripheral arterial disease risk factors in the U.S. population.

The National Health and Nutrition Examination Survey 2003 to 2004 data set was utilized to examine trends and differences of individuals with asymptomatic and symptomatic peripheral arterial disease (PAD) and PAD risk factor variables, determined by Ankle-Brachial Index measurement. A descriptive secondary data analysis was conducted by using the variables age, gender, hypertension (ie, systolic blood pressure and diastolic blood pressure), dyslipidemia (ie, high-density lipoprotein and low-density lipoprotein), diabetes, and cigarette smoking.

A school of nursing-wellness center partnership: creating collaborative practice experiences for undergraduate US senior nursing students.

As there is a global drive for schools of nursing (SONs) to increase enrollments and as there is a strain in the number of placement sites available to nursing students, SONs need to think innovatively about creating new collaborative partnerships that can serve as placement sites. A collaborative US intrainstitutional partnership was developed between an urban college wellness center (WC) and a SON that met the following needs: (1) it provided a community/public health nursing clinical practice site for undergraduate, senior-year baccalaureate SON students and (2) it enhanced and expanded WC services for the college community. During 7-week clinical sessions, nursing students provided holistic nursing care through screenings, health promotion activities, and educational meetings. Having the WC as a clinical site allowed the students to assess, integrate, and synthesize didactic knowledge and critical thinking skills into the clinical setting while providing critically needed holistic nursing services to their college community. Further, the collaboration created an ongoing partnership that bridged the service and academic needs of both entities.

Teaching home care electronic documentation skills to undergraduate nursing students.

ABSTRACT Although there is general consensus that nursing students need knowledge and significant skill to document clinical findings electronically, nursing faculty face many barriers in ensuring that undergraduate students can practice on electronic health record systems (EHRS). External funding supported the development of an educational innovation through a partnership between a home care agency staff and nursing faculty. Modules were developed to teach EHRS skills using a case study of a homebound person requiring wound care and the Medicare‐required OASIS documentation system. This article describes the development and implementation of the module for an upper‐level baccalaureate nursing program located in New York City. Nursing faculty are being challenged to develop creative and economical solutions to expose nursing students to EHRSs in nonclinical settings.

Mentoring Hispanic undergraduate and graduate research assistants: building research capacity in nursing.

BACKGROUND This article discusses and describes the experiences of five Hispanic bilingual (English and Spanish) research assistants (RAs) who were undergraduate and graduate nursing students and who were part of a research team. METHOD A capacity-building framework was used, which has six guiding principles: a whole-system approach; accommodating diversity; reducing barriers to participation; enabling collaboration; mentoring; and facilitating networking. In addition, mentorship and peer learning were essential components of building research capacity. RESULTS Reflections of the five RAs highlighting how these principles were applied are described. The experiences of the five Hispanic RAs and the outcomes of the projects are also described. CONCLUSION These experiences demonstrate the importance of involving undergraduate and graduate nursing students in research, which can build research capacity and increase the number of Hispanic nurses in the workforce.