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Transportation is an element of the social determinants of health (SDOH) that affects people's well-being and lives, as Lathrop described in "When Healthcare Isn't Enough: A Christian Nursing Response to Social Determinants of Health" in this issue. People who lack transportation to medical care often forego routine medical visits or treatment for chronic conditions. Those who have no car or access to public transit can end up with poorer health and eventually require greater use of medical resources.

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In their examination of nonemergency healthcare transportation, Wolfe and McDonald (2020) noted that in 2017, 5.8 million people delayed their nonemergency healthcare because of a lack of transportation. Wolfe and McDonald documented innovative healthcare transportation that can shift this SDOH. The most common innovation they observed was healthcare providers/agencies engaging with transportation companies such as Lyft and Uber Health to serve patients. As part of this transportation method, HIPAA compliance was added to the digital ride booking process to preserve patient privacy while the agencies/providers covered the expense. Similarly, insurance companies are partnering with ridesourcing companies to provide rides for patients who need them.


Paratransit-buses or other vehicles dispatched to specific clients for door-to-door service-has become more frequently subsidized for clients, especially those with disabilities, who lack access to their healthcare provider or services.


Also noted in the study was a pilot collaboration between Massachusetts Bay Transportation Authority's successful paratransit service and ridesourcing companies, such as Uber, Lyft and Curb, for on-demand service to enrolled customers. This pilot project is being replicated in other states.


In addition to enabling more patients to receive ongoing health services, these transportation innovations are benefitting providers by reducing no-shows, improving treatment adherence, and saving money for healthcare service providers and insurers. Wolfe and McDonald (2020) also credit the evolution of electronic medical records that integrate ride requests and booking of ride services.


Wolfe M. K., McDonald N. C. (2020). Innovative health care mobility services in the US. BMC Public Health, 20(1), 906.[Context Link]



Chronic pain relief is more achievable now: Virtual reality has been shown to be a therapeutic, nonpharmacological option. Research in various countries is showing how people can control or reduce pain through a Virtual Reality (VR) intervention. Both laboratory and self-administered at-home interventions have proven effective.


Virtual Reality is a three-dimensional computer-simulated environment in which a user wears a headset that immerses the user in a multisensory experience that involves visual, auditory, and proprioception senses. One way that VR works to decrease chronic pain, say Lier et al. (2020), is by distracting the user from the pain.


A study in the Netherlands (Lier et al., 2020) introduced painful stimuli while individuals engaged in VR and measured via electroencephalograms how the brain reacted. Active VR significantly lowered pain, and the older VR users subjectively reported greater pain-relieving effects.


Darnall et al. (2020) performed a randomized control trial of VR to evaluate the efficacy of self-administered VR. Persons from ages 18 to 75 who used the VR intervention at home over a 21-day period reported being very satisfied with the pain relief from chronic nonmalignant low back pain or fibromyalgia.


One difference noted in the Darnall et al. study (2020) is the use of evidence-based cognitive behavioral therapy to reduce pain. The novel VR approach eliminates the need for a therapist to work with the patient to achieve pain control, allowing more people to possibly choose this method. This study also observed that VR helped reduce pain-related interference in activity, mood, sleep, and stress over the course of the 21-day treatment.

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Darnall B. D., Krishnamurthy P., Tsuei J., Minor J. D. (2020). Self-administered skills-based Virtual Reality intervention for chronic pain: Randomized controlled pilot study. JMIR Formative Research, 4(7), e17293.[Context Link]


Lier E. J., Oosterman J. M., Assmann R., de Vries M., van Goor H. (2020). The effect of Virtual Reality on evoked potentials following painful electrical stimuli and subjective pain. Scientific Reports, 10(1), 9067.[Context Link]



Bermuda's first nurse-led telehealth program launched in 2020 due to the work of Lunette Castillo, BSN, FNP-BC. The system provides Bluetooth vital signs monitoring, remote patient monitoring, care coordination, chronic disease management, medication adherence, COVID-19 monitoring, transitional care (i.e., hospital discharge), health education, and health coaching in Bermuda.

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TeleCare Bermuda provides evidence-based telehealth nursing services to residents regardless of socioeconomic status. A company spokesperson noted, "Our mission is to improve the health of all residents of Bermuda by delivering innovative telehealth services that are proven to reduce the burden of chronic disease." The vision is to transform community healthcare in Bermuda by incorporating telehealth technologies and to become the nucleus of chronic disease management in Bermuda's healthcare system.


Ber News. (2020, August 31). TeleCare: First nurse telehealth program.



Lysa TerKeurst, author, speaker, and Bible study scholar, writes from the pages of 1 & 2 Kings with authenticity regarding trusting God. Personal events causing deep pain led her to study and discover that distrust was an issue that resided beneath the surface in her life. Her words and the study of God's Word help us peel away layers of our own distrust.


God isn't after our earthly accomplishments. And He doesn't want us going through the motions of devotion. He's after our hearts. God wants to be our soul's sole desire. And the minute we turn our hearts away from God is the minute our intimacy with Him and our legacy begins to unravel.


Despite all the wisdom Solomon had been given, he still gave in to the sinful desires of his heart. The king, who prayed during the temple dedication that the Lord would turn the hearts of the people of Israel toward Himself (1 Kings 8:58), clung to his forbidden wives and ended up with his own heart being turned away from the Lord (1 Kings 11:2-3). Solomon's love, affection, and trust shifted from God to his wives and their gods.


One of the saddest sentences in 1 Kings may be the most overlooked sentence. First Kings 11:4b (ESV) says, "And his heart was not wholly true to the LORD his God, as was the heart of David his father." In this one sentence, we see that Solomon is one of many kings on a journey of half-hearted trust. Really, half-hearted trust is simply distrust.

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TerKeurst L. (2019). A study of 1 & 2 Kings: Trustworthy: Overcoming our greatest struggles to trust God. LifeWay Press.