The Centers for Disease Control and Prevention report that cardiovascular disease is the leading cause of death in the United States. While rates vary according to age, ethnicity and gender, one of the populations most affected by heart disease is Hispanic women. According to Erica Dees, a student in The University of Tulsa’s doctor of nursing practice (DNP) program and a critical care cardiology nurse at Saint Francis Hospital, “Hispanic women tend to develop heart disease 10 years earlier than Caucasian women. They also experience the lowest rates of health literacy for heart disease risk factors.”
As a Hispanic woman herself, Dees notes that she, too, possesses a number of those potentially threatening risk factors. More generally, studies on racial and ethnic disparities in health care access and utilization regularly identify Hispanics as one of the most disadvantaged ethnic groups in the country. “It is essential,” Dees said, “for communities to provide educational heart health promotion interventions that target this underserved population and, in particular, Spanish-speaking immigrant Latinas.”
Disease prevention through community-based education
As part of the DNP program’s requirements, each student must carry out an extensive research project focused on addressing a specific health issue. For her investigation, Dees will implement a pilot program involving a bilingual community-based disease prevention strategy. Dees’ program has three main objectives:
- To increase participants’ knowledge of heart disease risk factors
- To bolster their recognition of the importance of early treatment after the onset of heart attack or stroke symptoms
- To discuss with the participants and help them identify the symptoms of a heart attack and how they present in women.
At the center of Dees’ program is The Heart Truth®, a toolkit developed by the National Heart, Lung, and Blood Institute. In this resource are a PowerPoint presentation and fact sheets detailing heart-disease risk factors and stroke symptoms, as well as how to recognize heart attack symptoms.
“My plan is to deploy this toolkit in a six-week program comprising once-a-week sessions lasting 60 minutes each,” Dees said. “The sessions will comprise an interactive health lecture by me, followed by small-group discussions among the participants. My inclusion criteria are women who identify as Hispanic and are between the ages of 35 and 60, which is the age range when women are at most risk for heart disease. They must also be able to read, write and speak Spanish or English at a basic level.” Dees plans to measure the effectiveness of the training using the 25-item Heart Disease Fact Questionnaire (HDFQ), which she will administer before and after the intervention.
Commenting on Dees’ project, Director of the School of Nursing Sheryl Stansifer remarked, “Nurse practitioners are advocates for improving patient outcomes. Erica identified a need to improve cardiovascular health in migrant Hispanic women, and her project will empower this population to make informed decisions about their well-being.”
Community partnership
A core element of Dees’ research is the partnership she struck with YWCA Tulsa. Participants in her pilot program will be members, clients and guests from the organization’s health and wellness department as well as immigrant and refugee services department.
“We are proud to partner with Erica in her research,” said Lacey Thompson Caywood, the director of health and wellness at YWCA Tulsa. “We understand the value of the work she is doing and the impacts it can have on families and the Tulsa community at large.
“The need for this type of research is especially important for Oklahoma considering we have one of the highest rates of heart disease mortality in the country and many times signs and symptoms of heart attacks can look very different in women. Additionally, white adults in Tulsa are almost twice as likely to be insured as Hispanic/Latinx adults. Between these and other compounding factors, Erica’s work will benefit many Hispanic/Latina women and their families in Tulsa, and we are more than happy to assist in that mission any way we can.”
Next steps
“This is a disadvantaged but growing population, and I believe we have to do something to improve their health,” Dees observed. “I’ve had a lot of positive feedback on my project from Hispanic women in the community, the YWCA and faculty here at Oxley College. The DNP program has helped me to feel I can do something truly impactful.”
Now that her general plan and a project partner are in place, it’s down to the specifics. Dees expects to initiate her project during the fall of 2019. “I intend to begin implementing the interventions in March and then spend April analyzing and interpreting my data,” Dees said. She anticipates devoting May to final evaluation and documentation.
Becoming a nurse practitioner through TU’s doctor of nursing practice program is a three-year journey toward health care excellence. If you hold a BSN and would like to advance your knowledge and career as a nurse practitioner, TU offers two pathways that might interest you: family nurse practitioner and adult-gerontology acute care nurse practitioner. There is also a post-master’s pathway for advanced practice nurses.
“Schweitzer Fellows and alumni are talented, passionate individuals who do ground-breaking work to address health disparities,” said Rachel Gold, director of the 
Past projects include a concept developed by University of Tulsa clinical psychology doctoral student Danielle Zanotti, a member of the inaugural class of Tulsa Schweitzer Fellows in 2016. Zanotti implemented a program to help veterans strengthen parenting skills and gain developmentally appropriate knowledge about what to expect from their children. The community site was The Coffee Bunker — a place in Tulsa where veterans can connect. After her year of Schweitzer service, Zanotti was selected for an internship at a VA hospital in Houston and plans to return to Oklahoma to pursue her career in mental health and community leadership.
