Environmental Scanning: Staying Current with Public Health Trends in Ohio – Post Test and Evaluation

Learner Outcome: Learners will demonstrate an increased knowledge of the current state of health concerns in the State of Ohio.

0.8 Contact Hour will be awarded with successful completion.

Criteria for Successful Completion: Read study and pass the post-test with a score of 70% or greater.

Expiration: 2/1/2021

There is no conflict of interest among anyone with the ability to control content of this activity.

The Ohio Nurses Association is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. (OBN-001-91)

This study was written by Jessica Dzubak, MSN, RN and Brittany Turner, MSN, RN

Despite its many hospitals and resources, Ohio continues to be plagued by many public health issues. Regardless of where they practice, Ohio nurses have many opportunities to make an impact on many of these serious issues through strong collaboration and partnerships, patient and family education, and clinical screenings. Staying abreast of the issues facing the citizens of Ohio should be part of every Ohio nurse’s professional development, living up to Provision 2 of the ANA Code of Ethics, “The nurse’s primary commitment is to the patient, whether an individual, family, group, community or population” (American Nurses Association, 2015, pg. v).

Heart Disease: Heart disease remains the number one leading cause of death in Ohio, with a rate higher than the national average. In 2017, Ohio ranked 12th in the nation, an increase from 2016 when it ranked 13th (Ohio Department of Health [ODH], n.d.-a). The CDC estimates the cost of heart disease to be around $21 billion a year (based on data from 2014-2015) (Centers for Disease Control and Prevention, 2019). Healthcare professionals know the risk factors, such as smoking and obesity, yet gaps and disparities still exist.

Data shows that older adults and those with lower education levels have an increased prevalence of heart disease. As nurses we can help citizens understand the connections between diet, exercise, and lifestyle of risk of disease as well as the risks of under-treating things like hypertension. 2016 data shows that 73% of Ohioans with heart disease also had hypertension (ODH, n.d.-a). Genetics play a role in the risk of developing heart disease, and it is important to help patients understand their potential risk and what screenings may be beneficial to them at all points of life. Gender also appeared to play a role in heart disease deaths in Ohio. The Ohio Department of Health reported that men were 61% more likely to die from heart disease than women (ODH, n.d.-a).

Impact of Nurses:
Nurses in all practice settings can have an impact on heart disease. Nurses play a role in prevention, risk assessment, identification and treatment of all stages of heart disease – from identifying someone at risk to being a part of the cath-lab team during an acute cardiac intervention. Part of the nurse’s role in education and risk assessment involves the assessment of health literacy.

Health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (US Department of Health and Human Services, n.d., para. 1). Before any patient or family teaching can begin, healthcare providers must determine the level of health literacy to ensure the teaching and materials will be meaningful for the patient or family member. Admitting to a low level of health literacy can be embarrassing and patients may not be forth-coming when they do not understand what medical professionals are telling them. One study reported that as many as 88% of American adults have limited health literacy (Loan, et al., 2018).Ohio has collaborative organizations such as Ohio Health Literacy Partners, which work to promote health literacy for patients by training and educating providers (Ohio Health Literacy Partners, n.d.).

Nurses can meet patients where they are and help make health promotion and prevention empowering, rather than overwhelming and confusing. Dr. Sandra Cornett, PhD, RN made a tremendous impact on health literacy in Ohio throughout her career. She developed and presented patient education materials at appropriate reading levels, as well as established a patient and family library at The Ohio State University Medical Center in 1996. Through her training and direction of nurses and other health professionals, she gave clinicians the tools to educate their patients in a more effective way (The Ohio State University College of Medicine, 2014).

To prevent and manage conditions like heart disease, patients must be equipped with the appropriate resources and knowledge, as well as be actively engaged in their care. Nurses can educate, empower, and engage all of their patients towards a healthier life.

Infant Mortality: One statistic that is trending down in Ohio is the rate of infant mortality. However, the problem still exists in rates greater than the national average. In 2017, the infant mortality rate for Ohio was 7.2 (deaths per 1,000 live births), comparing to a national average of 5.8 (Centers for Disease Control and Prevention, 2018). According to CDC data, Ohio ranks 8th in the nation for infant mortality (Centers for Disease Control and Prevention, 2019). Within these statistics, socioeconomic and racial disparities are apparent.

Mothers of Black and non-hispanic/unknown ethnicities had higher rates of infant mortality than whites (Ohio Department of Health, 2018). ODH reports, “in 2017, black infants died at nearly three times the rate of white infants” (Ohio Department of Health, 2019, para. 1). Additionally, mothers who resided in Ohio Institute for Equity in Birth Outcomes (OEI) counties* had higher rates of neonatal abstinence (NAS) births (Ohio Department of Health, 2018).

Neonatal abstinence syndrome remains another concern among Ohio infants. Almost 3,000 Ohio infants were hospitalized in 2018 for exposure to opioids and/or hallucinogens (Ohio Department of Health, 2019). Some national studies report a five-fold increase in NAS discharges over the last few years, while in Ohio the current NAS rate is 7.1 times the rate in 2006 (Ohio Department of Health, 2019). Approximately 142 births per 10,000 were discharged with NAS.

Impact of Nurses:
Many of the recommendations for preventing and managing NAS can be carried out by nurses. Maintaining competency in NAS screenings with standardized tools, providing high-quality patient education, and careful clinical monitoring are all essential components that nurses should be practicing and promoting (Ohio Department of Health, 2019). Not only does NAS require clinical assessment and treatment, but it can be an extremely emotional and stressful experience for families. Nurses must communicate in an honest, compassionate manner, without judgment. These families often may benefit from resources and referrals; which nurses can provide or initiate.

*The Ohio Institute for Equity in Birth Outcomes, a collaboration between ODH and local partners, uses population data to target areas for outreach and services. These counties have been identified as having the largest disparities. (Ohio Department of Health, 2019)

Obesity: Unfortunately, the problem of obesity has increasingly impacted children. The current obesity rate for children ages 10-17 years if 17.1%, ranking Ohio 10th in the nation (Robert Wood Johnson Foundation, 2019). Research suggests that being obese as a child can increase your risk of obesity as an adult, which carries its own risks for other co-morbidities (Llewellyn, Simmonds, Owen, & Wollacott, 2015). Here in Ohio, collaborative efforts are being made to combat the childhood obesity epidemic, including the Early Childhood Obesity Prevention Program at the Ohio Department of Health and Ohio Healthy through the Ohio Child Care Resource and Referral Association (Ohio Department of Health, n.d.; Ohio Child Care Resource and Referral Association, n.d.).

Impact of Nurses:
The National Association of School Nurses (NASN) published a position statement titled, “Overweight and Obesity in Children and Adolescents in Schools – The Role of the School Nurse”, recently revised in 2018. In it, NASN describes the impact school nurses can have on children both at risk for and currently suffering from obesity (National Association of School Nurses , 2018). One study refers to school nurses as an “overlooked resource in reducing childhood obesity”, stating that school nurses “can play a key role in implementing sustainable, effective school-based obesity interventions” (Schroeder, Travers, & Smaldone, 2016).

Vaping/Tobacco: The United States Surgeon General has designated the use of nicotine products among adolescents as a national epidemic (Huey & Granitto, 2019). Legislators and healthcare professionals alike are seeking ways to decrease the use of vaping products, in response to the increase in illnesses and deaths. Vaping, an alternative to cigarettes for many, carries many risks in addition to the harmful effects of the nicotine itself (Ohio Department of Health, 2019). The aerosols in e-cigarettes may contain dangerous carcinogenic chemicals, and the devices themselves carry a fire and explosive risk if they are defective.

“As of October 17, 2019 it is illegal to give, sell, or otherwise distribute cigarettes, other tobacco products, or alternative nicotine products like e-cigarette/vaping products to any person under the age of 21” (Ohio Department of Health, 2019, para. 1).

Ohio received $1.8 million from the CDC in 2018 for “tobacco prevention and control activities” (Centers for Disease Control and Prevention, 2019). Because of these continued efforts, Ohio noted an 84% increase in the number of incoming calls to the quit smoking “quitline” during a campaign (Centers for Disease Control and Prevention, 2019).

According to the CDC (2019),
“Evidence-based, statewide tobacco control programs that are comprehensive, sustained, and accountable have been shown to reduce the number of people who smoke, as well as tobacco-related diseases and deaths. For every dollar spent on tobacco prevention, states can reduce tobacco-related health care expenditures and hospitalizations by up to $55.”

Impact of Nurses:
As with many other public health crises and epidemics, nurses can utilize their encounters with patients as opportunities for education, outreach and support for smoking cessation. Connecting patients with available resources can make all the difference. Education and prevention efforts are critical not just for patients themselves, but for families, especially parents of adolescents (Huey & Granitto, 2019). Honest conversations with adolescents about the very real risks of e-cigarette use and vaping are critical. As healthcare professionals, nurses have a responsibility to education these children and young adults, as many do not fully comprehend the risks.

Drug Overdose: Death from unintentional drug poisoning became the leading cause of accidental death in Ohio in 2007, and this has remained true since (Ohio Department of Health [ODH], 2020). What has changed is the type of substances most linked to fatal overdoses. In 2018, fentanyl was involved in 73% of overdose deaths in Ohio; compared to only 38% in 2015 (ODH, 2020). Further, fentanyl is likely to mixed with other drugs, contributing to overdoses from those substances (ODH, 2020). For example, in 2018 almost 80% of all heroin-related overdose deaths had fentanyl involved. Fentanyl involvement was also seen in 67% of psychostimulant/methamphetamine-related deaths and 74% of all cocaine-related overdose deaths in 2018 (ODH,2020).

Impact of Nurses: Nurses have the opportunity to educate, advocate, and offer referral information about local programs who aim to decrease unintentional overdose deaths in Ohio. Nurses’ interactions with patients, patient families, community members, and professional peers all offer avenues for nurse impact in this area.
Becoming aware of the various programs and projects supported by the Ohio Department of Health, as well as initiatives sponsored by the nurse’s local counties and communities should be explored by individual nurses looking to meet Provision 2 of the ANA Code of Ethics (American Nurses Association, 2015).

In summary, the nurses and patients of Ohio face many challenges. All public health crises affecting Ohio can be impacted by the thoughtful actions of nurses. Maintaining a working knowledge of what Ohioans are facing can help nurses identify those at risk or currently struggling with these serious conditions. Compassionate care along with appropriate education and referrals can improve the quality of life of many Ohioans.

Environmental Scanning: Staying Current with Public Health Trends in Ohio

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American Nurses Association. (2015). Code of Ethics for Nurses With Interpretive Statements. Silver Spring, Maryland, USA. Retrieved from https://www.nursingworld.org/coe-view-only

Centers for Disease Control and Prevention. (2018, April). Stats of the State of Ohio. Retrieved January 8, 2020, from National Center for Health Statistics: https://www.cdc.gov/nchs/pressroom/states/ohio/ohio.htm

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National Association of School Nurses . (2018, January). Overweight and Obesity in Children and Adolescents in Schools – The Role of the School Nurse. Position Statements. Retrieved January 10, 2020, from https://www.nasn.org/nasn/advocacy/professional-practice-documents/position-statements/ps-overweight

Ohio Child Care Resource and Referral Association. (n.d.). Ohio Healthy programs. Retrieved January 8, 2020, from OCCRRA: https://occrra.org/ohp/

Ohio Department of Health. (2020). Drug Overdose. Retrieved from https://odh.ohio.gov/wps/portal/gov /odh/know-our-programs/violence-injury-prevention-program/Drug-overdose/

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Ohio Department of Health. (2019, December 13). Neonatal abstience syndrome (NAS) hospital reporting in Ohio. Retrieved January 8, 2020, from Ohio Department of Health: https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/violence-injury-prevention-program/resources/nas_hospital_reporting_in_ohio

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Ohio Health Literacy Partners. (n.d.). Home. Retrieved January 17, 2020, from Ohio Health Literacy Partners: http://www.ohiohealthliteracy.org/home.html

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Schroeder, K., Travers, J., & Smaldone, A. (2016, May). Are school nurses an overlooked resource in reducing childhood obesity? A systematic review and meta-analysis. The Journal of School Health, 88(5), 309-321. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939612/

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