Author wants to share her knowledge to help keep people healthier and out of hospitals
I loved working at the bedside of a major hospital in Atlantic Canada, helping people when they needed it most. Now I want to help keep people out of hospitals in the first place. By becoming a freelance writer, I’m choosing to use the education and critical thinking skills nursing gave me to curate information that people can access as they wait to see a primary care provider or before they need hospital care. I want to reach as many people as possible with credible, evidence-based, scientific knowledge written in plain language that can help them understand their condition and then make better decisions for themselves.
The beauty of nursing is that there are so many ways to make a difference in people’s lives. I still see this new work as an extension of my work as a nurse, but in a way that’s more broadly accessible to people for the help and health they want.
My front-line nursing began in 2012, and most of it was spent in the post-anaesthesia care unit (PACU), or recovery room. There, I found a home that made sense to me and offered work that I excelled at. I enjoyed the team building, the speed of the work, and the feelings of accomplishment that came with receiving and discharging patients within a shift. Every day, we were “taking names and saving lives” — our jovial motto as we were assigned patients from the various operating services.
Four years in, I saw undeniable trends in the patients I cared for and the procedures they required. For example, surgeries were performed daily for what I came to refer to as “downstream effects.” These could be amputations secondary to poorly controlled diabetes, joint replacements secondary to poorly controlled obesity, or other cases that could have avoided surgery had the patient been reached “upstream” through better health literacy and access to primary care, and supports to make healthier decisions. I was disappointed in our health system’s inadequacy at providing preventive care and frustrated at how food marketing and food industry lobbying undermined people’s ability to make informed choices about what they eat.
While I was outspoken with my peers about my feelings and these worrying trends, there was little to be done within the recovery room to reverse them. The implicit beliefs that many health professionals carry can act as barriers to upstream solutions, namely, that it is beyond the front-line clinician’s scope to advocate for systemic change and that outside the hospital, patients are responsible for caring for themselves.
The first belief hides the unspoken fact that the prestige and livelihood of tertiary care, pharmaceutical care and medical interventions, where the bulk of health dollars go, rely on disease management (Raphael et al., 2019). Compounding that, primary care providers are not incentivized (i.e., reimbursed) to work with people to identify and eliminate upstream, societal causes of chronic illness.
The second belief reflects a widespread cultural insistence of individual accountability for health pushed by media and vested interests such as corporate wellness, convenience food and pharmaceutical distributors, declaring that health is easily and equally accessible to everyone as these industries make millions in product and service revenues (Alvaro et al., 2011; Raphael et al., 2019). Even organizations specifically designed to support research and knowledge translation related to chronic illnesses have executive boards populated with members from corporate industry who constitute its most prominent donors (Raphael et al., 2019). Despite advances in our understanding of the causes and remedies for these debilitating conditions, remission is not the mandate.
Knowledge provides the fundamental means for individuals to understand how to be healthier if they so choose
By late 2018, I applied for my master of nursing degree to better understand the contributing factors causing people to fall through the cracks of the health system and possible solutions. I learned that responsibility can’t be laid at a single doorstep. At the intersection of the social determinants of health and health inequalities (including income, social status, education and literacy, physical environments, healthy behaviours, access to health services, race, culture and more), negative downstream outcomes frequently manifest and persevere (Government of Canada, n.d.).
The one true hope for wicked problems such as these seems to be knowledge, which is where I see my potential role. Despite any and all social/societal factors that could be working against personal health, knowledge provides the fundamental means for individuals to understand how to be healthier if they so choose. Knowledge is not data, which is fragmented pieces of symbols and characters strung together, and it’s not information, otherwise known as refined data. Knowledge is information that people can use to take better care of themselves.
By 2020, the phenomenon of health misinformation or disinformation online came to my attention (Suarez-Lledo and Alvarez-Galvez, 2021). I had left the PACU at that point for a specialized position outside of front-line care and had consistent access to a computer for work. Health articles I found online would vary wildly in accuracy. As health writing is an unregulated industry, any freelance writer with no background in health sciences can create content for health blogs, social media, websites, newsletters or advertising online. Furthermore, they don’t actually have to be human. Artificial intelligence (AI) writing tools, also known as AI content writers, are pieces of software that generate human-like text based on user input powered by AI.
Casual readers may not have the experience or expertise to determine the validity of what they read online, leaving them exposed to incorrect or even harmful information. The most recent example is information related to COVID-19. Mid-degree at the time, writing an epidemiology paper on the virus, I was astounded by the flood of data arriving daily on the internet. In real time and on a global scale, we were accumulating information about transmissibility, virulence, necessary precautions and clinical outcomes. Not all of it would align or be accurate.
This was when online health misinformation really moved into the national spotlight in Canada. The anecdotes, conflicting ideas, conspiracy theories, fear-mongering and profiteering all played a role in shaping the “knowledge” individuals took from it. This phenomenon exploited the inclination of those who prefer information aligned with their political or ideological beliefs and to accept what they read without evaluation (Public Policy Forum, 2021). The notion of the internet as a benign source of wisdom was called into serious question.
While I remain confident that online platforms are useful for health promotion and still believe they are the most practical way to impart health knowledge to people looking for it, recent studies have suggested that false or misleading health information may spread more easily online than scientific knowledge (LaValley, Kiviniemi, & Gage-Bouchard, 2017). The Public Policy Forum report, Science and Health Misinformation in the Digital Age, recommends three approaches to this problem: controlling its spread, correcting its effects through debunking (fact-checking) or persuasion, and pre-emptive interventions that allow the public to resist misinformation they encounter (LaValley et al., 2017). I see a potential role for nursing here.
According to a Statistics Canada survey, as of 2020, over two-thirds of Canadians (69 per cent) used the internet to search for health information (Statistics Canada, 2021). The vast majority of information that was obtained came from commercial websites (defined as for-profit, private websites providing health information to engage users in e-commerce or require users to register in order to track their behaviour for resale to third parties or for future targeted advertisements). As noted in the article “Where People Look for Online Health Information,” “results for any given search for health information can be listed in order of popularity, frequency of prior access or commercial sponsorship, but not necessarily in order of relevance to the user or by scientific accuracy of content” (LaValley et al., 2017). As a profession, we must acknowledge that despite being one of the most trusted health-care professions, we are not as accessible as the results of a Google search. I see a role for nursing here as well.
Making a difference
Ten years into my nursing career, the next step in my journey is transitioning to freelance health writing. This makes sense for me personally because I want to help people promote their own best health by providing them with unbiased knowledge to improve their health literacy and inform their decisions. If people are going online with their health questions, then I will ensure that the content I write is factually correct, based on evidence and accessible for readers at any learning level.
I want to continue to research and stay abreast of the most current practices of care, to learn about more nursing topics than I might in any siloed care area, and to support organizations or businesses positively impacting Canadians. My expertise as a trained registered nurse allows me to understand complicated medical information and turn it into something appropriate for public consumption. The nature of the work means that I can arrange my writing time to suit what I can mentally handle on any given day, and the reduced work on my feet helps me manage my own chronic health condition.
There are drawbacks, of course. This is not a “get rich quick” scheme or even a secure job. There are no built-in sick days, vacation time or co-pays on my health insurance. I miss the co-workers, the patient and family interaction and the adrenaline rushes. Most of all, I miss the satisfaction of being present and providing effective, professional care to the vulnerable when they need it and seeing the results of my work. But there already aren’t enough beds or nurses to meet the tidal wave of patients requiring our knowledge and passion. Health writing is one of many approaches we can try to find upstream solutions. Other pathways can include advocacy, outreach groups, improved knowledge translation within primary care and any other way that you want to make a difference.
Mine is one path of many in this profession. Nursing is a unique career that requires exceptional people. Each nurse on every unit has the ability to change lives for the better.
Alvaro, C., Jackson, L. A., Kirk, S., McHugh, T. L., Hughes, J., Chircop, A., & Lyons, R. F. (2011). Moving Canadian governmental policies beyond a focus on individual lifestyle: Some insights from complexity and critical theories. Health Promotion International, 26(1), 91–99. doi:10.1093/heapro/daq052
Government of Canada. (n.d.). Social determinants of health and health inequalities. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
LaValley, S. A., Kiviniemi, M. T., & Gage-Bouchard, E. A. (2017). Where people look for online health information. Health Information and Libraries Journal, 34(2), 146–155. doi:10.1111/hir.12143
Public Policy Forum. (2021, July 21). Science and health misinformation in the digital age. Retrieved from https://ppforum.ca/publications/science-and-health-misinformation-in-the-digital-age/
Raphael, D., Chaufan, C., Bryant, T., Bakhsh, M., Bindra, J., Puran, A., & Saliba, D. (2019). The cultural hegemony of chronic disease association discourse in Canada. Social Theory & Health, 17(2), 172–191. doi:10.1057/s41285-018-0072-7
Statistics Canada. (2021). Canadian Internet Use Survey, 2020. Retrieved from https://www150.statcan.gc.ca/n1/en/daily-quotidien/210622/dq210622b-eng.pdf?st=fESQwcXh
Suarez-Lledo, V., & Alvarez-Galvez, J. (2021). Prevalence of health misinformation on social media: Systematic review. Journal of Medical Internet Research, 23(1), e17187. doi:10.2196/17187
Emily Durant, MN, RN, is the provincial transfusion coordinator for Nova Scotia Health. When she is not developing educational resources for nursing students and professionals, you can find her writing health content for her freelance business www.frontline2freelance.com or hiking trails around Halifax.