Heat Islands and Chronic Disease: Could African Americans Be More Vulnerable to Heat-Related Health Impacts?

Global warming and environmental heat stress are public health concerns. Urban heat islands, metropolitan areas with higher temperatures compared to their surrounding rural areas, compound the effects of increased environmental heat. In addition to acute heat-related illness, increased environmental heat is linked to exacerbation of chronic diseases. The purpose of this narrative review is to provide an overview of heat islands and how the effects of heat stress intersect with chronic diseases in the African American (AA) community. Across the United States, AAs are more likely to reside in heat islands, resulting in greater exposure to environmental heat. Unfortunately, chronic diseases exacerbated by increased environmental heat disproportionately impact the AA community. Due to the intersection of these disparities, heat-related health risks are likely higher for the AAs. The increased health risks posed by urban heat island exposure on AAs have significant implications for nursing practice, research, and policy.

Applying Lessons From Ars Moriendi to Foster Dying Well in Acute Care Settings.

Medical and technological advances have made it possible to keep people alive well beyond what was once possible, leading health care providers to focus on life-sustaining measures rather than questioning the futility of such measures and considering quality of life. In the midst of the struggle to foster dying well in a medicalized environment, acute care nurses may be challenged with shifting the focus to providing optimal end-of-life care because of lack of training, time, and resources. A remedy for the current western societal approach to medicalized dying is to look back in history to a time during the late Middle Ages, when death was an accepted part of medieval life. A literary genre called Ars Moriendi (translated "the art of dying") was written and illustrated to provide instruction on how to die well and how to care for the dying. Nurses can apply lessons from this text to fulfill the ethical obligation to practice with dignity and provide compassionate end-of-life care. These lessons include helping patients and families identify goals of care and accept finitude, encouraging the participation of loved ones at the bedside, and fostering reconciliation at the end of life.

Routine Depression Screenings for Advanced Cancer Patients: Reducing Disparities, Identifying Depression, and Improving Quality of Life.

Advanced cancer patients are at an increased risk of developing depressive symptoms, which can lead to major depressive disorder and a poor quality of life. It is important that symptoms of depression to be addressed early and frequently throughout the trajectory of the disease process. Depression is underdiagnosed and therefore undertreated in advanced cancer patients. Clinicians often fail to perform regular depression screenings as recommended by the National Comprehensive Cancer Network. Depressive symptoms are overlooked as they tend to overlap with the effects of disease progression and cancer treatments. Patients' complaints of anorexia, chronic pain, and sleep disturbances do not necessarily trigger practitioners to perform depression screenings. African Americans with advanced cancer are at a higher risk of developing depression, but may not identify as depressed due to the stigma of mental health in the black community. Screening tools such as the 2- and 9-item Patient Health Questionnaire, Beck Depression Inventory II, Hospital Anxiety and Depression Scale, and the Distress Thermometer and Problem List are common brief instruments that can screen for depression. Providing early symptom relief of depressive symptoms through psychotherapy and pharmacologic interventions will benefit the patient, family, and caregivers while improving the quality of life throughout the trajectory of the illness.