Community Teaching Plan

I will be teaching clients about the danger of having an elevated blood pressure (hypertension) and the significance of maintaining their blood pressure within normal limits. I will conduct the teaching session at the Stein Senior Center located at 245 East 17^th Street, New York, N.Y.

Hypertension is sometime called “the silent killer” because people who have it are often symptom-free.  As a Community Health Nurse, it is imperative that I educate members of the community about the danger of this disease and most importantly, ways in which this condition can be prevented, detected, and controlled.

Elevated blood pressure can be viewed in three ways: as a sign, as a risk factor for atherosclerotic cardiovascular disease, or as disease.  As a sign, nurses and other healthcare professionals use blood pressure to monitor a patient’s clinical status.  Elevated blood pressure may indicate an excessive dose of vasoconstrictive medication or other problems.  As a risk factor, hypertension contributes to the rate at which atherosclerotic plaque accumulates within arterial walls.  As a disease, hypertension is a major contributor to death from cardiac, renal, and peripheral vascular disease.  Hypertension is defined as a systolic blood pressure greater than 140 mm Hg and a diastolic pressure greater than 90 mm Hg (Smeltzer, Bare, Hinkle, & Cheever, 2008).

It is important that I develop a teaching plan using the nursing process that addresses the related issues of hypertension that has affect this segment of the community.  In order to do this I must take into consideration the level of education, willingness of members to learn, the domain in which learning takes place. The domains of learning includes cognitive, affective and psychomotor. The cognitive domain deals with the recall or recognition of knowledge and the development of intellectual abilities and skills. The affective domain includes emotion, feeling or affect. This kind of learning deals with changes in interest, attitudes and values. The psychomotor domain includes visible, demonstrable performance skills that require some kind of neuromuscular coordination. For learning to take place in this domain the nurse must be certain that the client is physically, intellectually and emotionally capable of performing the set skills (Allender, Rector, & Warner). As a community health nurses I need to ensure that the environment where learning takes place is conducive to learning and easily accessible. The planned duration of my teaching will be about an hour with a fifteen minute break with light refreshments served to community members. My teaching methods will include discussions, role-playing and the use of visual aids and printed materials.

Diagnosis for this community includes:

1. Deficient knowledge regarding the relationship between the treatment regimen and control of the disease process or related to lack of information.
2. Noncompliance with therapeutic regimen related to side effect of prescribed therapy

Collaborative problems and potential complications

Based on the assessment data, potential complications that may develop include the following.

• Left ventricle hypertrophy
• Myocardial infraction
• Heart failure
• Transit Ischemic Attacks
• Renal insufficiency and failure
• Retinal hemorrhage (Smeltzer, Bare, Hinkle, & Cheever, 2008)

I will have a dietitian and a physical therapist on hand to provide pertinent information to the clients on ways they can control the disease along with medical therapy.

I will conduct a pre-test and a post-test survey to gauge the clients’ knowledge of the disease.

Planning and Goals

The major goals for the patients include understanding of the disease process and its treatment, participation in a self-care program, and absence of complication.  I would also use researched literature and the information obtained from surveys to establish realistic goals for community members. Short-term and long-term goals for this community include:

1. Short-term goal: Community members will be able to verbalize three ways to prevent/control hypertension at the end of the teaching event

Long-term goal: At least half the community members will report control of their disease in six months.

1. Short-term goal: community members would be able to verbalize the importance of physical activity and healthy eating habits at the end of the teaching session.

Long-term goal: at least fifty percent of members will report engaging in physical activities at least two to three times a week and making healthier food choices within six months.

Implementation

My interventions will be based on the nursing diagnosis or the selected problem of the community. I will use lecture, discussion, demonstration, and role-playing as my teaching methods. Power point will be utilized as a presentation tool for effective teaching and learning. For ineffective control of hypertension related to deficient knowledge about the disease as evidenced by lack of BP control, interventions are:

A. Engage the audience to speak by asking them to verbalize what they know

about hypertension. I will give improve their knowledge of the disease process through power point presentation.  Define hypertension, its various stages, signs and symptoms, and potential damage to significant organ systems.

B. Engage the audience to participate in role-play to demonstrate how hypertension can be controlled through the use of medication, diet, and exercise.

C. Discuss the available resources that are present in the community such as hotlines, support groups, and internet resources that are recognized and reliable. Provide them written information in     (5^th grade level) that community members can refer to at their convenience (centerfordiseasecontrolandprevention.gov, 2012).

With regard to noncompliance with therapeutic regimen related to side effect of prescribed therapy, interventions are:

A. Explain how the client can lower and control the blood pressure without side/adverse effect of medication and if they experience this, talk to their provider to change the medication to one that works well for the patient without the side effect.

B. To achieve these goals, I will teach the clients to adhere to the treatment regimen by implementing necessary lifestyle changes, taking medications as prescribed, and scheduling regular follow-up appointments with health care provider to monitor progress or identify and treat any complication of disease therapy.

C. Discuss unhealthy eating habits and strategies to reduce sodium intake.  Show a            short (10-15 minutes) video about ways to make healthier food choices, and to

combine physical activity and healthy eating habits. Exercise and diet can be used to control weight and promote a healthy lifestyle thus preventing/controlling hypertension.

D. Discuss the role of regular exercise in weight control and weight loss.    Encourage the audience to keep a record of physical activity to track the regularity, intensity, and duration. Also encourage them, to keep a food diary that would allow them to examine and change unhealthy eating habits.

E. Give the audience the opportunity to identify ways or habits they can change to `          promote a healthier lifestyle. Discuss lifestyle and behavioral modification         strategies that promotes successful blood pressure and control.

F. Provide the community members with written information (in 5^th grade level) about healthy eating habits, regular exercise, health problems associated with hypertension, hotlines, support groups, and creditable websites that can be accessed for information at their convenience.

 

Evaluation (expected patient outcome)

1. 1.      Maintains adequate tissue perfusion:
   1. Maintain blood pressure at less than 104/90 mm Hg (or less than 130/80 mm Hg for people with diabetes mellitus or chronic kidney disease) with lifestyle modifications, medications or both.
   2. Demonstrate no symptoms of angina, palpitations, or vision changes
   3. Has stable blood urea nitrogen and creatinine levels
   4. Has palpable peripheral pulses
2. Complies with self-care programs:
   1. Adheres to dietary regimen as prescribed: reduces caloric, sodium, and fat intake; increases fruit and vegetable intake
   2. Exercises regularly (at least 30 minutes of brisk walk three to four times weekly)
   3. Takes medications as prescribed and reports any side effects
   4. Measures blood pressure routinely
   5. Abstains from tobacco and excessive alcohol intake
   6. Keeps follow-up appointments
3. Has no complications:
   1. Reports no change in vision
   2. Maintains pulse rate and rhythm and respiratory rate within normal ranges
   3. Report no dyspnea or edema
   4. Maintains urine output consistent with intake
   5. Has renal function test results within normal range
   6. Demonstrates no motor, speech, or sensory deficits
   7. Report no headaches, dizziness, weakness, change in gait, or falls (Smeltzer, Bare, Hinkle, & Cheever, 2008)

 

The patient and caregivers should be cautioned that hypertensive medications can cause hypotension.  Low blood pressure or postural hypotension should be reported immediately.  Elderly people have impaired cardiovascular reflexes and thus are more sensitive to extracellular volume depletion caused by diuretics and to the sympathetic inhibition caused by adrenergic antagonists (Smeltzer, Bare, Hinkle, & Cheever, 2008).   It is then my responsibility to teach patients to change positions slowly when moving from a lying or sitting position to a standing position.  It is my responsibility to also counsel elderly patients to use supportive devises such as hand rails and walkers as necessary to prevent falls that could result from dizziness.

Monitor and manage potential complications:   

Symptoms suggesting that hypertension is progressing to the extent that target organ damage is occurring must be detected early so that appropriate treatment can be initiated.  When the patient goes for follow-up care, all body systems must be assessed to detect any evidence of vascular damage.  An eye exam with an ophthalmoscope is particular important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system.  The patient should be question about blurred vision, spots in front of the eye, and diminished vision acuity.  The heart, nervous system, and kidneys are also carefully assessed.  Any significant findings are promptly reported to determine whether additional diagnostic studies are required.  Based on findings, medications may be changed to improve blood pressure.

I will observe, document, and analyze the audience’s responses during the health-related events. I will assess their level of understanding on the information provided base on the questions they ask or whether they still need clarification. The place and environment needs to be evaluated too if it is convenient and suitable for learning. I will get feedback from the questionnaires provided at the end of the event. It would be useful to know if the audience learned, or if the teaching was effective or not, or if they found it interesting, what they do like and did not like and any suggestions about the event. Their feelings and reactions about the event was also included in the questionnaire to also know if they would attend another health-related event and invite someone to come with them. It is very important to hear back from them. I am hoping that at least 30% of the community members leave the health event inspired to make lifestyle changes that would allow them to live a healthy life that will control the disease and share the knowledge they gained from this event with someone they know who has hypertension.

 References

Allender, J. A., Rector, C., & Warner, K. D. (2010). Community health nursing: Promoting & protecting the public’s health (7^th ed.). 530 Walnut Street, Philadelphia, PA: Lippincott Williams & Wilkins.

Center for Disease Control and Prevention. (2012). Classification of disease, functioning and disability. Retrieved from http://www.cdc.gov

Sandra, M. A. (2009). Lippincott manual of nursing practice (9^th ed.). Philadelphia, PA: Lippincott-Raven.

Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2008). Brunner & suddarth’s: Textbook of medical-surgical nursing (11^th ed.). 530 Walnut Street, Philadelphia, PA: Lippincott, Williams, & Wilkins.

 

Meeting Human Responses in the Spiritual Domain Assignment 2

There are many definition of spirituality, one of which is, the basic incorporation of a transcendent dimension in life, usually, but not always, involving faith and religion (Ferrell & Coyle).  Spirituality refers to the energy in the deepest core of the individual.  It is the integrating life force that allows us to transcend our physical being and gives us ultimate meaning and purpose in life (Conrad, 1985).

In the face of suffering, fear, despair, and all the physical/emotional/social/spiritual trials of dying, being present on a consistent basis through the process of dying is primary spiritual care and addresses the most fundamental spiritual need-the need for transcendence (Ferrell & Coyle, 2006).

It is impossible to come up with one definition of spiritual care that we all agree with, and if you think about it, that makes sense, because we are all coming from different places.  We all have different life experiences and understandings of spirituality and spiritual care. Not being able to define it and fix it into a nice conceptual box is actually a good thing, because there is more space to see what it is in the moment, with the person we are with, rather than our concept of what it should be.  Nevertheless, although it can be difficult to find a common definition, one way of understanding spiritual care is that it responds to basic universal human needs-needs that are not necessarily religious, nor limited to end-of-life concerns.

Because spirituality means different things to different people, providing spiritual can be a very difficult and daunting task.  To provide spiritual care, one must first understand his/her own spirituality, and then have knowledge of the patient spirituality to provide competent care.  Spiritual needs are much less tangible than physical needs, because they are often abstract, complex and more difficult to measure.  These more intangible needs have frequently been given a much lower priority than needs which are more obvious and more easily measurable.  Spiritual needs, if expressed outside of a religious framework, are very likely to go unnoticed.  So if we are to identify spiritual needs and provide spiritual care, it is first necessary to have some understanding of the nature of spirituality and how it may be expressed by different individuals.  When the provider is ignorant to the spiritual needs of the patient, care can be impacted negatively, so it is expected of the provider to be verse and if not obtain the pertinent information so as to provide the required care.

Culture and/or religion can affect spirituality and are intertwined, and with the vast difference in belief, there can be misunderstanding among patients and professionals. Among these misunderstandings are: (a) communication or language barriers; this may lead to bidirectional misunderstanding and unnecessary physical, emotional, social, or spiritual suffering.  It is therefore to avoid medical jargon, make language simple, check for understanding or hire a trained interpreter.  (b) There may also be differences in religion in spirituality, which may create a lack of trust between the patient and professional from different backgrounds.  To create a sense of connection, healthcare professionals need to ask about religious or spiritual beliefs and practices and how the patient could be supported in addressing spiritual and religious needs (Ferrell & Coyle, 2006,), and (d) culture can “hollow out” the spiritual content of religion and fill it, instead, with other things, including materialism, nationalism and fanaticism.  Another metaphor is of religion as a vessel or jug, the spiritual contents of which can become spoiled or adulterated by other belief systems.  Religion can still function as a source of social support and meaning under these circumstances, and provide incentives to lead to healthy lifestyle (Eckersley, 2007).

Spirituality and religious beliefs are intertwined and influence culture.  Religion is a formal organized system of belief, values, and ideologies that are shared by an identifiable group as an expression of spirituality.  Spirituality is a broader belief system and not the same as religion.  It is a part of a person’s being and plays an important role in one’s life journey.  Spirituality gives a person transcendence and connects the person with a higher being or other entity.  This connectedness bridges to one’s faith system.  Although these are overlapping concepts, spirituality and religiosity is unique to the individual.  A person can be spiritual without ascribing to a specific faith belief or religion; thus it is important to ascertain the person’s religion or spiritual faith and practice.

Spirituality and religious are not stagnant; they evolve over time.  One’s spiritual or religious beliefs may be challenged or become more important and relevant when a person has a life-threatening illness.

When you are caring for a dying patient, one should cater to the patient in a holistic way.  That is, tender to the patient’s physical and spiritual needs.  Caring for the dying person is the ultimate act of love, whether you are a member of the medical profession or a family member.  Being a care giver for someone with a chronic or life-limiting illness is stressful, exhausting, and at times confusing, but yet, can be usually quite rewarding as well.  Once the ill person starts the dying process, the task becomes more demanding and the emotions more intense.  You may find yourself wondering if you’re doing the right thing, saying the right thing, and even thinking the right thing.  As a member of the medical team, it is expected of you to solve all problems, to be the super hero and the task can be daunting; even then, one should ascribe to do their best to satisfy the need of the person and family.

As a caregiver, you may need to care for not only the patient, but the patient’s family as well.  People who are very ill or near the end-of-life have complex needs so it is important to know various ways to provide supportive care.

It is very important for you to ask the person you are caring for if they are comfortable.  As the health care provider, you need to know if the person is experiencing physical pain, breathing problems, confusion or other symptoms so you can work to ease the distress.  Having this information, pain medication and other therapies can be provided to achieve a level of comfort.  Throughout the day, ask the person if they are comfortable.  If they are experience pain ask them to describe the pain, rate it on a scale of 0-10.  Provide medication to alleviate any discomfort the person is experience.  If there is a problem that you as the provider cannot solve, get help from someone who is more experience.

In addition to physical pain, the person and family experience emotional and spiritual pain.  They are experiencing many losses including the loss of control over their own life.  It is important for you to continue to explain what is happening with the person condition and any changes the person is experiencing.  Be an active listener, be a companion, and be in tuned to subtle changes; as these are some of the things that are expected of you.  Offer the services of spiritual counselor, in some religion/culture, this service is welcome.

Spiritual awareness increases as one faces imminent death.  While some may experience spiritual distress or soul pain, others may have a spiritual transformation or experience spiritual growth or health (Matzo & Sherman, 2010). A spiritual history or assessment should be completed with each new patient visit and on annual examination, as a part of taking routine history taking and not just at the end-of-life.  The following is a spiritual assessment that can be incorporated into an end-of-life plan of care for a dying client.  Use the acronym FICA: “F” refers to the faith as identified by the question “What is your faith of belief and do you consider yourself religious or spiritual?” “I” refers to influence which is assessed by the question “How does your faith and spirituality influence your medical decisions?”  “C” refers to community and is related to the question “Are you a part of a spiritual or religious community?” “A” refers to addressing spiritual concerns as exemplified by the question “Would you like someone to address your spiritual needs or concerns (Matzo & Sherman, 2010)?”

Another approach uses the letters from the word SPIRIT to remember question appropriate to a spiritual interview/assessment, specifically: “S” Spiritual belief system (religious affiliation); “P” Personal spirituality (beliefs and practices of affiliation that the patient and family accepts); ”I” Integration with a spiritual community (role of the religious/spiritual group; individual’s role in the group); “R” Ritualized practices and restrictions (beliefs that healthcare providers should remember during care); “I” Implication for medical care; “T” Terminal events planning (impact of beliefs on advance directives; contacting the clergy) (Ferrell & Coyle, 2006).

Spiritual assessment further includes assessment of personal beliefs, sources of meaning and hope, values, belief in and after life, ad sense of connection to self, other, nature, and God.  Healthcare professionals begin to address spirituality by asking such questions as “How are your spirit?” “How do you define your spirit?” “What nourishes your spirit?” or “How have you relieved your spiritual pain in the past (Matzo & Sherman, 2010)?” For adults with life-threatening of threatening illness, valuable questions to explore include the following: (a) Are you suffering in physical, emotional, social, or spiritual ways? (b) What is the meaning of illness and suffering? (c) Do you see purpose in your suffering? (d) Are you able to transcend your suffering? (e) Are you at peace, or feeling hope or despair? (f) Does your personal belief help you to cope with anxiety about pain, and death and provide a way for achieving peace (Matzo & Sherman, 2010)?

Konecny (2012) proposed that the most powerful caring intervention is to be a companion to the dying: The spirituality of those of those who are caring for the dying must be the spirituality of the companion, of the friend who walks alongside, helping, sharing, and sometimes just sitting empty-handed, when we would rather run away.  It is the spirituality of presence, of being alongside, watchful, available, being there… We who would be a companion to the dying therefore must enter into the darkness, go with them at least part of the way, along their lonely and frightening road… enter into the suffering and share in some small way their pain, confusion, and desolation (Konecny 2012).

According to Konecny (2012), there are several specific ways that can be used to foster the practice of this spirituality of the companion. Keep in mind the overall goal of fostering meaning, hope, connection, and recognizing transcendence.

Interventions identified as particularly important to accomplish the goals of hope, connection and transcendence includes, but not limiting to are: (a) Relief of physical discomfort, which permits refocus on the spiritual; providing relief from pain by offering pain medication as ordered being there for the patient, offering your present to be a distraction form physical discomfort.   (b) Fostering reconciliation; nurses often have the opportunity to suggest that individuals review their past and make needed reconnections with those they have lost and faith traditions they have neglected. Their goal is to come to some resolution of the past. By encouraging patient to tell the story of their lives, and to examine past pains that need healing is one way to achieve this goal. (c) Authentic, presence and being there; authentic presence becomes possible when nurses deliberately choose to keep their minds uncluttered by distracting thoughts and preoccupations so that they are able to pay full attention in caring relationships with their patients. (d) Referring the patient to spiritual counselor; these spiritual counselors must be able to provide spiritual support to people from a variety of faith traditions and from no identified tradition. The best spiritual counselors are able to listen and offer unconditional love, without focusing on evangelism. They offer religious teaching for those individuals from traditions similar to their own. An effective spiritual counselor will sit with the dying patient to help them discover their own spiritual end-of-life journey. Nurses should offer to call church, synagogue, temple, mosque for all patients who identify with a specific faith community. Clergy and designated laypersons should be available to offer the traditional end-of-life ministries of their religion.

It is vital to keep in mind that the critical and most fundamental intervention is to remain present (to watch through the night) in the face of suffering, fear, despair, and all the physical/emotional/social/spiritual trials of dying.  Being present on a consistent basis through the process of dying is primary spiritual care and addresses the most fundamental spiritual need (Ferrell & Coyle, 2006).  A second, fundamental intervention is prayer.  For many, prayer is deeply personal issue.  For a non-clergyperson, moving into the dimension of prayer may be a difficult step.  Knowing that somehow prayer would help, there still may be reluctance to (1) take the risk of spiritual rejection or (2) be put on the spat as a provider of frank spiritual care when there is certain knowledge of one’s personal spiritual inadequacies.  Yet we know that prayer can be comforting, cleansing, and transcendent (Ferrell & Coyle, 2006).

There are a number of ways the nurse can nourish his or her own spirit.  According to Konecny (2012), thinking about what gives your own life meaning and value helps in developing your spirituality and assists you in being able to support patients.   The following are ways to take care of tour own spiritual needs: (a) Finding quiet time for meditation and reflection; (b) keeping your own faith traditions; (c) Being with nature; (d) Appreciating the arts; (e) Spending time with those you love; (f) Journaling (Konecny, 2012).

  References

Conrad, N. L. (1985). Spiritual support for the dying. Nursing clinics of North America, 20(2), 415-425.

Eckersley, R. M. (2007). Culture, spirituality, religion and health: looking at the big picture. Medical Journal of Australia, 186(10), 54.

Ferrell, B. R., & Coyle, N. (2006). Textbook of palliative nursing (2nd ed.). New York, NY: Oxford University Press.

Matzo, M., & Sherman, D. W. (2010). Palliative care nursing quality care to the end of life (3rd ed.). New York, NY: Springer publishing company, LLC.

Lead Poisoning & The negative Impact on The Most Vulnerable Population: Children

Lead poisoning continues to be a major concern in many older cities such as New York, despite the 1960 ban on the use of lead paint, residents of these buildings continue to be exposed to lead and it adverse effects.  Lead paint poisoning occurs when there is a build-up of lead in the body (Mayo Clinic, 2011).  This occurs in both adults and children; however, children under the age of six are more vulnerable to the effects of lead in the blood.  It takes lead dust that is equal to a single grain of salt to result in elevated blood lead level in a child (NSC, 2011).  The most common avenues for lead exposure is through the ingestion of leaded paint chips or inhaling lead paint dust from deteriorating paint in older buildings (NY Voice, 2012, Mayo Clinic, 2011).

The purpose of this paper is to (a) highlight the ethnic and social disparities as it relates to lead poisoning, (b) identify the challenges and barriers associated with this issue, (c) discuss potential interventions, (d) identify stakeholders, and make policy recommendation.

Minorities and poor children are disproportionately affected by lead poisoning.  Studies since the 1970s consistently shows that lead poisoning kills more children and produces more harm in poor minority communities than other affluent communities (EJHU, n.d.).  According to reports, approximately four million residents have children living in them that are being exposed to lead.  There are about half a million children age 1-5 with blood levels about five micrograms per deciliter (µg/dL), the level at which the Center for Disease Control and Prevention (CDC) recommends public health actions be initiated (CDC, 2012).

Lead poisoning continues to disproportionately affect children of color.  According to a United States Census survey, the population in New York City, less than six years of age, was 35% Hispanic, 27% African-American, 9% Asian, and 24% White.  Of the 487 children newly identified with Elevated Blood Lead Levels (EBLLs) in 2003, 38% were Hispanic, 33% African-American, 17% Asian, and only 10% White.  Children residing in one of the borrows, Brooklyn are disproportionately affected by lead poisoning; 34% of children in NYC live in Brooklyn but 43% of children newly identified with EBLLs in 2003 were Brooklyn residents.  In 2003, of the 487 children less the six years of age newly identified with EBLLs; 67% were less than three years old; 88% were African-American, Hispanic or Asian, even though these groups represent 71% of the city’s population in 2000; 11% were foreign-born as compared to six percent of all NYC children; more than half lived in just 10 of 42 neighborhoods; and one third of the children living in those neighborhood live in poverty (New York City department of Health & mental Hygiene (NYCDOHMH), 2005).

Eliminating lead poisoning is the desired goal of all involved, but achieving this has been difficult because of bureaucratic red tape.  Identifying and repairing lead paint hazards in apartments that house young children can significantly reduce exposure to lead, but keeping the apartments lead-safe requires ongoing maintenance using desired work practice.  Efforts to provide enough supply of lead-safe housing for children are also complicated by the severe shortage of affordable housing and the high poverty rate among children less than six (6) years of age (NYCDOHMH, 2005).

There are other impediments to tackling this issue; one is that of a budgetary constraint.  Many landlords of older buildings cannot afford to rid these building of this hazard; therefore, children continue to be exposed to lead paint.  The lack of knowledge on the part of parents about the problem is also an impediment. Parents in poorer communities are not fully knowledgeable about this problem and the importance of getting their children tested early for lead in the blood, so that early intervention can be implemented.  There are no early warning signs to this problem, so many parents do not seek medical care until it is sometimes too late and significant damages have been done. Other impediments to eliminating this problem are (a) providers who do a poor job of follow up with identified cases. (b) State and Local Health Department who do a poor job of educating at risk population about the hazard of lead poisoning, and (c) landlord who fail to eliminate lead paint from older buildings or provide their tenants with information about the potential problem.

Most experts conclude that children less than three years of age are at greatest risk for lead paint exposure.  Their normal hand-to-mouth behavior can lead to ingestion of lead, if their hands, toys, bottle and pacifiers are contaminated with lead dust.  The percentage of ingested lead absorbed in the gastrointestinal tract is substantially higher in young children.  The neurotoxic effects of elevated blood lead levels (EBLLs) are greatest for younger children whose brains and bodies are still going through the rapid developmental stages (NYCDOHMH, 2005).

There is no safe level of lead, and the elimination of elevated blood lead levels in children is a healthy people 2020 objective.  During the four decades between 1970 and 2010, new state and federal regulations to control lead exposure were enacted and enforced, and has resulted in the reduction of blood lead levels.  The primary sources of lead exposure in preschool-aged children continue to be lead-based paint and lead-contaminated soil and house dust.  The critical age of exposure (or peak level) is thought to be between 18 and 36 months.  Levels generally begin to decline after three (3) years.  High blood levels of lead in children between six (6) and 24 months of age are correlated with lower IQ levels at older age (CDC, 2012).  Children who live in poverty and play in poor quality housing areas continue to be at risk for direct exposure to significant sources of lead.  For example, in Louisville, Kentucky, 25% of all children with high blood lead levels were found to live in just 75 housing units – represent less than one (1) percent of units in that community (CDC, 2012).

Poorer children are at greatest risk of exposure to lead poisoning.  Because poorer families have limited choice to housing, these families tends to live in older and deteriorating buildings.  Nationally, children 1-5 years of age who lives in older houses were four times more likely to have blood lead levels ≥ 10 µg/dL when compare to children in middle-income households.  Children of color are also disproportionately affected by lead poisoning, both nationally and in New York City (NYCDOHMH, 2005).

Many exposures to lead are from some toys, candies, cosmetic, traditional medicines, and eating or drinking implements imported from other countries.  Many of these have been tested and reveled to have high levels of lead.  Thirty five percent of children with elevated blood levels were found to have this type of exposure (CDC, 2012). Education and public awareness campaigns can help prevent this type of lead poisoning.  Poorer families are more likely to buy these imported toys candies and cosmetic products thereby increasing their chances of lead poisoning thus making them the most at risk groups.

One study pointed out that although the risks are greatest for low-income children living in older housing, all children should grow up in lead-safe homes.  Targeted education and training of painters, renovators, remodelers, maintenance workers, landlords, parents, and others, combined with tax or other financial incentives, can be used to protect children not directly served by federal grants and leveraged private financial assistance.  Promoting universal lead-safe remodeling and repainting work practices, occupant protection, cleanup, and dust testing can ensure that no child is exposed to lead paint hazard (CDC, 2000).

Developing a comprehensive lead poisoning prevention plan to eliminate childhood lead poisoning is a moral, ethical, and a public health necessity.  Lead safety and housing code enforcement, along with periodic monitoring to detect new lead hazards, can help prevent lead exposure.  Community health nurses, working together with environmental health sanitarians, should promote opportunities for blood lead screening, especially if it is suspected that children in certain homes, apartments, or neighborhoods are at risk for lead poisoning (Allender, Rector, & Warner, 2010).

A number of agencies (federal, state, and local) have enacted laws to prevent or eliminate lead poisoning.  These include demolition, renovation, regulation, and increased funding.  Additional efforts will continue to address exposures from other sources, such as lead in exterior soil and dust, drinking water, and air emissions (CDC, 2000).

Federal grants and leveraged private funding to identify and eliminate lead paint hazards in order to produce an adequate supply of lead-safe housing for low-income families with children; outreach and public education to increase awareness of lead hazards and how to address them; enforcement of lead safety laws and regulation is paramount to ensure the health of our children.  Lead poisoning in children can be eliminated through increased compliance with existing policies concerning blood lead screening. Increased coordination across federal state and local agencies responsible for outreach, education, technical assistance, and data collection related to lead screening and abatement is also important in eliminating lead poisoning in children (CDC, 2000).

Title X of the 1992 Housing and Community Development Act, otherwise known as the Residential Lead-Based Paint Hazard Reduction Act (Public Law 102-550), mandated the creation of an infrastructure that would correct lead paint hazards in housing.  Title X also redefined “lead paint hazards” and how they can be controlled.  Based on scientific research in the 1980s, Congress defined a “hazard” to include deteriorated lead paint and the lead-contaminated dust and soil it generates.  The infrastructure has been developed and includes the following: training of thousands of workers doing housing rehabilitation, remodeling, renovation, repainting, and maintenance to help them do their work in a lead-safe way: licensing of inspectors and abatement contractors; compliance with and enforcement of lead safety laws and regulations; disclosure of lead paint problems before sale or lease; national and local education and outreach programs; promulgation of federal standards of care; and workers protection regulation (CDC, 2000).

New low-cost methods are now available to identify and fix hazardous housing.  Field studies have shown that modern lead hazard control methods have been effective in reducing levels of lead-contaminated house dust by an average of 60%, with an average decline in blood lead levels of about 25%.  House dust is the most common exposure pathway through which children are exposed to lead paint.  Older housing is continually being demolished, renovated, or abated.  Current projections show that, without this further action, several million children would be poisoned over the next several decades (CDC, 2000).

According to the Housing and Urban Development (HUD), 2.3 million housing units will be at risk of lead paint hazards in 2010, if existing trends continue.  Direct federal financial assistance for houses occupied by low-income families is of significance now more than ever.  These funds can be used to leverage private recourses to create lead-safe housing.  In some jurisdictions, it may be possible to create enough lead-safe housing for families, yet not necessarily address all housing units with lead paint.  In other jurisdictions, virtually all housing will need to be lead-safe to protect children (CDC, 2000).

The primary stakeholders in this problem are: parents and children who live in older buildings; Federal, State, and Local authorities who police and provide funding to deal with this issue; health care and public health workers who educate and care for afflicted children; landlord who must provide safe housing; construction workers who may become exposed to lead dust while demolishing older building; maintenance workers who may have an increased workload due to regulations; and the manufacturers and distributors of leaded paint products.

To ensure the safety of children and reduce lead exposure, a number of recommendations have being proposed; they are as follows: (a) increase the availability of lead-safe dwellings by increasing federal funding of HUD’s lead hazard control program and by leveraging private and other non-federal funding. (b) Increase and enforce compliance monitoring of lead paint regulation. (c) Conduct ecological and educational intervention for families with children at high risk for potential lead poisoning. (d) Provide the necessary link between education and public health programs so that families have easy access to these programs.  (e) Conduct studies of lead hazards in child-care centers to determining if they are being exposed to lead hazard and if so, determine with approach to prevent lead poisoning in children while they are there.  (f) Explore the use of financial incentives (such as tax credits or deductions) of federal grants to control lead paint hazards in housing occupied by low and moderate-income families with young children not served by HUD grants.  (g) Support community-based outreach, education, and advocacy efforts for lead screening of Medicaid-eligible children.  Ensure compliance with Medicaid policy on case-management services and one-time on-site identification of the source of lead among Medicaid-eligible children with lead poisoning.  (h) Develop and evaluate new cost-effective lead paint hazard control technologies and techniques for evaluating exterior urban lead-contaminated soil and dust.  (I) Extend field-based housing studies on the longevity of lead paint hazard controls. (j) Determine the extent to which activities such as building demolition, aging paint deterioration, and removal from building and structures contribute to urban soil contamination and dust loadings (CDC, 2000).

Many families are misinformed or unaware of the danger of lead exposure and that is the most common environmental toxin affecting children.  Families rely on health care professionals to make available information on ways to avoid harm to their children and the necessary information that reflects the standards of care established by authorities and professional organization.  Identifying elevated blood levels in the most defenseless among us-our young children, is a vital way to make a difference in their lives and more than worth the time and distress to assure them a chance for a good future.  It is therefore our duty as healthcare professionals to advocate for the necessary chances to policy to ensure that those who are disproportionately affected by this neurotoxin get the help to correct this problem.

References

Allender, J. A., Rector, C., & Warner, K. D. (2010). Community health nursing: Promoting & protecting the public’s health (7th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.

Center for Disease Control and Prevention. (2012, October 21). Lead. Retrieved from http://www.cdc/nceh/lead

Centers for Disease Control and Development. (2000, February). Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards. Retrieved from http://www.cdc.gov/nceh/lead/about/fedstrategy

Environmental Justice & Health Union. (2011, August). Lead. Retrieved from http://ejhu.org/disp_lead.html

Mayo Clinic. (2011,Mar12). Lead Poisoning. Retrieved from http://www.mayoclinic.com/health/lead-poisoning/FL00068

NYCDOHMH. (2005, December). New York City Plan to Eliminate Childhood Lead Poisoning. Retrieved from http://www.nyc.gov/html/doh/downloads/pdf/lead/lead-plan.pdf

National Safety Council. (2009,April). Lead Poisoning. Retrieved from http://nsc.org/news_resources/Resources/…/Lead_Poisoning.pdf

Thirteen WNET NY Public Media. (2012, October). Lead Poisoning. Retrieved from http://www.thirteen.org/nyvioce/highlights/poison.html