Essay: Decreasing heart disease in US immigrant South Asian population

There are many different issues that immigrants have to face when they move to the United States. However, while dealing with all those problems they put their health last.  More than 60 percent of people who have heart disease are South Asian (Madhusoodanan, 2016).  South Asians include Indian, Pakistani, and Bangladeshi communities. Most people in these countries have diets that are rich in oils, protein, calories and meat is a huge part of the Asian culture. However, they also have jobs that require muscle strength and long hours which requires them to eat high protein, high calorie diets. Once these communities migrate to the United States, their occupation changes and does not require too much physical energy, but their diets stay the same. Which then leads to gaining weight, coronary artery disease and many other health issues including heart disease.  Not only is most of the South Asian community diagnosed with heart disease but diagnosed at a young age with a high death rate (Mahusoodanan, 2016).  Therefore, the prevention of heart disease amongst South Asians is vital to improve their quality of life.  The objective of this paper is to decrease the risk of developing heart disease in the South Asian community by increasing daily activities and exercise, improving their diet, decreasing stressors, and early detection.  The purpose of this aggregate-based scholarly paper is to: identify interventions to reduce the risk of heart disease among South Asian communities; to educate this population regarding healthy diet and daily physical activity to improve their health; identifying the barriers of heart disease; determine the economic, cultural, and biological variables that are associated with the increasing rate of heart disease. This paper will also identify leadership principles and legislation that are currently in place to help in preventing this disease. As so many people of this community are affected by this disease, it is important to guide them to appropriate resources located within the community.
Needs Assessment
A needs assessment for the South Asian community with heart disease is vital to identify the gaps between lack of knowledge about their diet and better health, many of the heart issues are caused by poor diet and lack of exercise. This lack of knowledge also prevents early detection of symptoms indicating the presence of a blocked artery which leads to heart disease. Due to this gap, the community suffers from severe heart issues not only in adults but also in young children. This paper will discuss possible interventions to help bridge this gap in the future.
Evidence Based Research (Current articles)
As mentioned above, one of the main causes of heart disease in this community is their diet. In 2014, a study was conducted which found that people from this community who had strong ties to their culture and food were at higher risk for heart disease than those who had weak ties. People who immigrated and became more westernized had a much more decreased risk (Mahusoodanan, 2016). Studies also show an increased risk factor as people get older and dietary changes are not made but physical activity patterns decrease (Zawar, Milton, Ali, Rahman, 2016).
Barriers
One major barrier that prevents South Asians from obtaining the knowledge needed to change their diets and increase physical activity is their fear of seeking medical attention and the lack of resources provided to them. Many of them are scared to go to the doctor and hear that something might be wrong with them, others do not have health insurance to go get check ups. Another barrier to achieving a healthier life style is their financial ability. Most often when people from these communities migrate to the United States they move with very little, when they arrive here they work minimum wage jobs and many of them do not offer benefits such as health insurance. Also making minimum wage and trying to feed an entire family is difficult with healthy fresh food, whereas going a fast food is easier and cheaper.
Vulnerable Population
South Asians are one of the most vulnerable populations that are affected by heart disease. They have a multiple number of challenges that they have to over come as immigrants. Many of them are very stressed because not only do they have to provide for the family in the United States but they also have to send money back home to support their families which is not only burdening them financial but also a major stress on their heart. Some migrate with their families, however most can only afford to come alone. The ones that come alone face the most stress because it’s a completely new country and there is no one they know. On the other hand the ones that come with their families face greater financial difficulties due to migrating with their entire family. “According to the World Health Organization (WHO), heart disease is the cause of 17.5 million deaths around the world in 2012, of which 80% occurred in low and middle income communities” (Fatema, Zwar, Milton, Ali, Rahman, 2016, Paragraph 1).
Cultural Diversity RT problem
Cultural diversity plays a major role in the deteriorating health of the South Asian population. Their entire diet and lifestyle contributes to the high incidence of heart disease in this community. Despite genetic factors being a risk factor, the physical inactivity and a diet high in fat and sugar contribute to most cases (Chapman, Qureshi, Kai, 2013). There is an immediate need of culturally appropriate interventions in this community to decrease the risk not only in adults but also the children. In the Asian culture eating and feeding come at the top of the list because many people back home struggled to eat one or two meals a day. When they migrate to the United States they believe they should not waste even a grain of rice. Which is why despite their stomachs being full they continue to eat until the food is finished. This is the main cause for obesity in this culture and community. However, being over weight is considered a sign of being healthy and wealthy which is why it is difficult to identify children and adults at risk because they do not come in until it is too late.
Economic Variables that impact issue
Economic variables are one of the main reason that heart disease is so high in the South Asian community. when people of this community migrate to America, they do so in the hope of a better life, more opportunities, and better resources. However, they do not receive these easily. Most immigrants have jobs that require intensive labor, yet there is less pay and no benefits such as health insurance. They benefit the economy of the United States but they are the ones at loss. Many of them are forced to believe that if they are ill and seek medical care they will be deported back, because of this, despite having severe chest pain and increased shortness of breath they continue to work everyday and avoid seeking medical attention.
How continuity of care effects problem
Continuity of care is when a client continues to see the same doctor or group of doctors for his or her care (Shin, Cho, Yang, Park, Lee, Kim, Oh, Hwang, Cho, Guallar, 2014).  However, because the health industry has become a business and certain providers only accept certain insurances it has resulted in patients changing their providers frequently. It is more often seen in communities that have migrated because they most often prefer to see a provider that understands and speak their language however because of the insurances changes or lack there of they have to see a provider who they may not understand. When they do not understand they tend to stop going because they feel embarrassed that they do not understand or they are afraid to ask questions.
Levels of Prevention (Rational & method of evaluation) 3 nursing interventions
As a nurse, it is our job to plan interventions to help prevent and care for heart disease in the South Asian community. There are three different levels of prevention, the first being primary prevention. Primary prevention is implemented to prevent the development of a disease. The most important intervention during this stage is education. The nurse should educate the community on the risks, complications, and ways to prevent the disease. Understanding the risk factors can help them identify signs of a myocardial infarction or other heart diseases and seek medical help immediately.  After the nurse educates the population it is vital that she evaluate the effectiveness of her teaching. Secondary prevention is implemented to detect and treat the disease with the goal to limit the severity and adverse effects. At this level it is important to screen people who are at risk for developing heart disease to prevent an occurrence or reoccurrence of a stroke, heart attack, or another cardiovascular event. The nurse can screen the clients for risk factors such as hyperlipidemia, hypertension, genetic dispositions, and other comorbidities that increase their chances of developing heart disease. After the screening, the nurse should individualize care according to the patient’s needs. Tertiary prevention is applied once the disease has occurred and the goal is to control the symptoms and enhance the quality of life. Interventions that the nurse can imply during this phase are encouraging exercise, educating on medications, and providing meal plans that include decreased sodium, and fats.
How Nursing advocacy can promote resolution
A primary part of a nurse’s job is to advocate for their patients. The nurse can spot changes in their patients throughout the care, changes that the doctor may not, which is why it is critical for the nurse to advocate for their patient. nursing advocacy plays a major role in preventing the patients from reaching a critical point and recognizing symptoms for early detection. Many times people from this population do not share their symptoms with the doctor because they feel as if they would be bothering them, this is when the nurse can advocate for the patient and repot the changes they see to the doctor.
Learning theory & styles included in heath education
Educating the patients is a vital part of preventing the progression of their disease. However, every individual has a different way of learning, some learn through seeing like a power point presentation or pictures, others learn through listening or having a discussion. The most popular learning style is tactile-kinesthic, in which the patient learns through doing. This is a more hands on approach. One specific learning theory that can be used in this population is behavioral theory. In this theory, learners use reinforcement methods to modify behaviors.
ANA Standards of Practice
Following the ANA standards of practice help ensure that patients receive the best quality of care so that they have the best quality of life. The ANA standards of practice include assessment, diagnosis, outcome identification, planning, implementation, and evaluation.  The ANA also enforces the nurse to evaluate her own nursing practice relating to professional practice standards and guidelines (ANA,2017). By doing this the nurse is able to provide the best care possible.
Healthy people 2020
When discussing cardiac health, the goal of Healthy People 2020 is to “Improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke; early identification and treatment of heart attacks and strokes; prevention of repeat cardiovascular events; and reduction in deaths from cardiovascular disease” (Healthy People 2020, P.1, 2017).
QSEN
Quality and Safety Education for nurses is in place to help healthcare workers focus on interventions that improve the quality and safety of the entire healthcare system. It is important for nurses to utilize patient- centered care and evidence-based practice when caring for the South Asian community because of their specific dietary and cultural needs. Teamwork and collaboration is also an important QSEN that the healthcare providers including nurses, and dietitions have to encorporate into the care of these individuals.
Leadership principles that facilitate implementation of interventions RT fixing issue
National Patient safety goals
National patient safety goals are derived from issues that have posed major risks to the health of the population. These goals help the nurse to develop interventions that promote the health of an individual. One goal that really benefits this specific community is the increase in schools with policies/practices to promote health. This benefits the youth of this community to be more active and have better diets to prevent the occurrence of a heart condition.
Technological advances that promote resolution
Technology continues to help improve lives each day. However, now it is also helping doctors and surgeons get better data and improve treatments through technology. Most individual with heart disease usually start off with an artery blockage for which they need a stent. A stent is a tiny mesh tube that releases drugs into the vessel to open it. However, eventually clots clots can form again. A new type of stent, called bioresorbable stent helps vessels gain back their ability to pass blood along (Harvard, 2015). This prevents the possibility of the stent dislodging and causing further complications.
Health policy that impacts this issue
South Asians do not only face heart disease but also many others such as diabetes, cancer, mental and reproductive disease. Being immigrants, restricts them from receiving benefits like medical coverage. “Over 20% of all South Asians lack health coverage plans making adequate healthcare out of reach” (Ivey,p.30,2002). Despite there being great health insurances an policies in the United States it is sad that so many immigrants do not benefit from them.
Global impact of problem
While health disease is seen as a common affliction in the United States it is also prevalent around the globe. According to the World Health Organization, Thirty-one percent of deaths around the world are related to cardiovascular issues (World Health Organization, 2017). Implementing the interventions mentioned earlier in this paper can have a significant impact on the quality of life around the world. As one of the rapidly increasing health issues educational programs and screenings can help health care professionals to stay one step ahead of the problem.