Clinical Research: Engaging with the Community

Welcome to Heart to Heart Nurses, brought to you by the Preventive Cardiovascular Nurses Association. PCNA’s mission is to promote nurses as leaders in cardiovascular disease prevention and management.  

Geralyn Warfield (host): I’d like to welcome our audience today to our conversation with Jo-Ann Eastwood. Jo-Ann, could you please introduce yourself to our audience? 

Jo-Ann Eastwood (guest): Hello, everyone. My name is Dr. Joanne Eastwood. And I recently retired from the UCLA School of Nursing where I was an Associate Professor and also Advanced Practice Director. 

I had the opportunity to do a research study that was funded by the American Heart Association on young Black women. And my focus was on prevention, mainly because women were coming through the door in the emergency [00:01:00] departments and they were having chest pain at 35, 40, 45 years old. These are women, young, Black women, and I wanted to see what I could do to make an impact and reduce the number of women coming in that already had, now, cardiovascular disease. 

Geralyn Warfield (host): So, when doing research, trying to find individuals to participate in the research studies is often the most challenging part of the actual project. Did you find that there were some traditional or maybe some non-traditional ways that you were able to develop that patient group that you were looking for, for this particular research that you were working on? 

Jo-Ann Eastwood (guest): Yes. I’m happy that you asked that because what happened was, I actually had to develop a relationship with the church beforehand. And I nurtured that relationship for a good year before I actually started any kind of recruitment.  

I immersed myself [00:02:00] into the church. I actually came and helped them on some of their volunteer projects. I brought my students who were advanced practice nurses to their fairs, did blood pressure testing, did counseling on blood pressure, to the entire community. And when they saw that I was engaged, then they drew me in and knew for sure that I wanted to be sincere and help them.  

 [00:03:00] So, what my focus was, was actually the women–especially mothers. Because mothers are at the helm of childhood health. And with the problems in obesity, and we really need to start younger. And as I said, looking at the women who came in the emergency department at 50 years old, those women had risk factors at 25 years old that were neglected because women between 20-50 years old only see their OB-GYN doctor. They do not go to a primary care physician, nor a cardiologist. And it was evident that these women needed to work on their risk factors at a much younger age.  

So, my age group was between 20 and 35, because I wanted [00:04:00] to be sure and capture premenopausal women and do the most good. 

And also, it’s known that the mothers have a huge impact on what the families eat, and this way it would roll down to the children. If I educated the mothers and they changed their behaviors and they changed what they fed their children, then it would affect the whole family. So that was my focus.  

The women attended six classes where I taught them and gave them booklets and pictures and slides (educational level of about fourth grade in reading).  

I taught them how to read labels, food labels. They were shocked because most of the foods that they eat, they fried. They also had trouble getting access to fresh fruits and vegetables in their area [00:05:00] where they lived. And they were unaware of fats, and what happens with fats as far as cholesterol is concerned, and what happens with cholesterol in the heart and in their vasculature. 

So, the focus of my study was to teach them in a classroom, draw blood work on them to begin with, and then also do body measurements—their weight, their BMI, their cholesterol level, their C-reactive protein, which is a level of inflammation, and also their waist and hip circumference.  

They attended six classes, which I taught and a physical therapist [00:06:00] taught, on behavior and lifestyle changes, reading food labels, learning what sodium was, learning what effect fats had on the body, and, basically how they can increase their physical activity. Especially because these women could not walk around the block like they’re told by their physicians to increase their activity. It was not safe where they lived, so we had to find other ways for them to work on this.  

We also added technology to this. What we did was we gave each of the women phones and we gave them a talking blood pressure machine. And the phones and the blood pressure machine were connected to UCLA. And [00:07:00] all their information was downloaded—how many steps they took, what their blood pressure was. We taught them, of course, how to take their own blood pressure and then how to stream it back to us at UCLA. So, all the data was collected on the server.  

And actually, the phones had prompts for the ladies. Also, the prompts were, and this is what I called coaching, the prompts were, “How many fruits have you had today?” And there’d be a cartoon picture of fruits, and then they would choose the number.  

And then, “How many steps have you walked today?” “It’s time to take your blood pressure.”  

So, at the end of the week, all this information came in on a master data sheet, and me and my assistants would look at the data sheets and see what kind of activities, the pattern of [00:08:00] their activities. 

And then if they were right on target, we sent them a positive note, either a text message, mostly if it was a positive, we send them a text message. 

If it wasn’t a positive and they kind of sloughed off, then we’d give them a call and talk to them personally.  

So, it was the encouragement, the positiveness, and the consecutive people speaking to these women, and they had a relationship with us. And that happened for six months. We did that for six months on 42 women.  

And then we also had a control group who we didn’t do anything except for take the measurements, take the blood, and we didn’t encourage them at all.  

And how we separated this—it was a double-blind kind of trial—was that one church was the experimental group (the larger church), and then [00:09:00] two smaller churches were the control groups.  

And what we found out at the end from all the coaching and whatever, that women, one, really changed the diets for their children. We had one girl who worked at LAX who cleaned toilets at night and she lost 30 pounds.  

Geralyn Warfield (host): Wow.  

Jo-Ann Eastwood (guest): So, it was amazing. It was in the LA Times and it’s a story that got picked up across the nation.  

So, we saw the effect on the children, also. There were a set of twins that were actually ostracized and bullied at school because they were 13 years old, and they were both so obese. And they said to their mom, “We want to eat what you’re eating” when they saw her losing weight. So, they tagged on, and they [00:10:00] lost weight, and they felt so much better about themselves.  

And we saw this over and over again with the women. And the women really, it built up their self-esteem also.  

Geralyn Warfield (host): So, I heard you describe in this research study, it was a lot about relationships. 

Jo-Ann Eastwood (guest): Mm-Hmm.  

Geralyn Warfield (host): So, there was the relationship initially to make sure that you and your team were seen as being invested in the community. And in the research that you actually did, you were invested in the women and their families as well.  

So, in many ways I can see the applicability of this kind of activity, even if you’re not doing a research study. It’s that investment in people, and allowing them to recognize your care for them and your interest in them is more than just fleeting. That this is a long-term kind of investment that you both are making into the relationship. And so that has clinical applications, even if you’re not trying to do a [00:11:00] double blind study.  

Jo-Ann Eastwood (guest): Right.  

Geralyn Warfield (host): I think that what you’ve described really has some great takeaways for all of us. And with that, we’re going to take a quick break, and we will be right back. 

Geralyn Warfield (host): We are back with Jo-Ann Eastwood. And we’re going to pivot just a little bit to talk about preceptors. And Jo-Ann, I’m going to let you take it away because you’ve got some great perspectives that I think we can take and use in practice this afternoon.  

Jo-Ann Eastwood (guest): Well, Geralyn, I really think that preceptors are the key to nursing education. 

As the advanced practice director in the Los Angeles area, we utilize many different places to place our students. And that’s where they really learned how to become a nurse practitioner. So huge shout out to the VA system, the community health system, the county health system, the Veterans Administration Hospital, or in the [00:12:00] underserved areas of Los Angeles, or in the community setting, was priceless. 

And the preceptors who take their time, share their experience, share their learning, share their education, and give it their all, they are the most invaluable piece of the nurse practitioner’s education.  

Geralyn Warfield (host): Definitely a shout out to those preceptors and a shout out to individuals like you that work with students at all parts of their career, but mostly as they’re transitioning into that nurse practitioner role and recognizing what it is that they need to be successful.  

So, to all of those who are listening, who have any role in educating their colleagues, their students, whoever it is, we are so grateful to you for your time. 

We’d really like to thank Joan Eastwood for sharing her expertise, and we also would like to thank our audience for being [00:13:00] with us today. This is Geralyn Warfield, your host, and we will see you next time. 

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