Chapter 11: WORKING WITH VULNERABLE POPULATIONS Flashcards
Which one of the following is the designation given to groups at high risk of having poor health outcomes? a. Cumulative risk groups b. Health disparity groups c. Resilient populations d. Vulnerable populations
D
Specific populations who are more vulnerable—that is, at-risk populations who are more susceptible to poor health because of socioenvironmental factors—are often referred to as vulnerable populations.
Which one of the following is the best intervention a community health nurse (CHN) can initiate to increase lasting resilience among new immigrants?
a.
Directing clients to English-as-a-second-language courses
b.
Giving immigrant clients money to help them get settled
c.
Identifying areas in the city where housing is less expensive
d.
Soliciting donations for food, clothing, and other needs
A
Resilience refers to the ability of the client to successfully cope when faced with a threat or hardship. Individuals with low resilience are more inclined to have feelings of hopelessness and may choose suicide as a method to resolve these feelings. Support needs to be provided to those with decreased resilience in order to enhance problem-solving skills and give a greater sense of personal autonomy. When the CHN places emphasis on client strengths and assets rather than client deficits and susceptibility, resilience is more likely to increase.
Which of the following interventions by the CHN would best serve a vulnerable population?
a.
Addressing multiple health concerns, including preventive education, when clients present for treatment of an illness
b.
Establishing a system of networks so that clients may be referred to different services such as preventive care, acute illness care, and chronic treatment
c.
Providing acute care services that focus on the client’s main health concern and setting up appointments at discharge for other concerns
d.
Referring clients to specialists to address specific health concerns
A
When working with vulnerable populations, it is a good idea to arrange to have as many services as possible available in a single location and at convenient times. This “one-stop shopping” approach to care delivery is helpful for populations experiencing multiple social, economic, and health-related stresses. This becomes especially important if clients have problems accessing health care services.
Which definition accurately reflects the meaning of the term health inequities?
a.
Health inequities are the accumulation of multiple factors that lead to poor health.
b.
Health inequities occur when people are more inclined to become ill and usually do not seek appropriate care.
c.
Health inequities are unfair differences in health that could be avoided with reasonable action.
d.
Health inequities are wide variations in health status and services among certain population groups.
C
Health inequities refers to differences in health that could be avoided if reasonable action was taken, and therefore these differences are considered to be unfair and socially unjust.
Which of the following is a primary cause of vulnerability? a. Breakdown of family structures b. Poverty c. Prejudice d. Social isolation
B
Poverty is a primary cause of vulnerability. The lack of financial resources may cause some people to not seek preventive health services. This leaves them vulnerable and with increased risk of experiencing the effects of preventable illnesses.
Which level of prevention is a CHN practising when she offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Secondary and tertiary prevention
B
Screening homeless persons for TB and providing medications to those who test positive are examples of secondary prevention. The TB screening identifies the disease in its early stages. Medications work to prevent further development of the disease.
A CHN is orienting a new recruit to a health clinic that primarily serves vulnerable populations. Which of the following statements by the CHN indicates a need for additional information?
a.
“If a client who does not speak English comes in, you must obtain an interpreter right away.”
b.
“We try to take care of as many problems as possible in one visit, so when you check the client in, ask about additional concerns.”
c.
“You will like working with Filipino immigrants because they have close-knit family structures.”
d.
“You will need to assist the client by scheduling any referral or follow-up appointments.”
C
Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Both good and bad stereotyping can create problems. For example, even though Filipino families are generally close knit, by assuming that all Filipino families are this way, clinic care providers will likely miss recognizing such issues as family violence.
While screening for diabetes at a community clinic, a CHN found out that a new client had type 2 diabetes. The CHN then provided counselling, referred the client to an endocrinologist for initial assessment and treatment, helped with arrangements for financial assistance, arranged transportation, and booked a follow-up appointment. What role is this type of service most representative of? a. Case management b. Client advocacy c. Holistic care d. Wrap-around services
A
Case management involves linking clients with services and providing direct community health nursing services, including teaching, counselling, screening, and immunizing. Linking health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved.
CHNs at a clinic for homeless persons are concerned that clients rarely return for follow-up after their TB skin (Mantoux) tests. Which policy would be the most appropriate one for addressing this situation?
a.
Call all homeless clients 48 hours after testing to remind them to return to the clinic for follow-up.
b.
Have the homeless persons read the test result themselves and then mail in the results on a postage-paid card coded to protect privacy.
c.
Readminister the test if the client returns later than scheduled for follow-up.
d.
Routinely refer all homeless clients for chest X-rays.
B
Secondary preventive activities are aimed at reducing the prevalence or pathological nature of a condition. They involve early diagnosis, prompt treatment, and the limitation of disability. CHNs can work with homeless and near-homeless aggregates to provide education about existing services and strategies for influencing public policy that will provide more comprehensive services for homeless and near-homeless persons. If necessary, CHNs should develop a method for homeless individuals to read the reaction to the TB skin test themselves and send the results to the facility where the skin test was administered.
Which of the following actions should a CHN take when using the case management approach with vulnerable populations?
a.
Be willing to enter into a long-term relationship with families.
b.
Direct and control the client’s care because the CHN knows what is most needed.
c.
Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals.
d.
Rotate assignments periodically, to prevent attachment and codependency.
A
Case management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the CHN can offer the greatest benefit when she or he is willing to develop long-term relationships with the families served. Long-term relationships create trust and ensure continuity of care. Care involves a partnership between the CHN and the client. CHNs who direct and control the client’s care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control measures.
Which one of the following is an example of tertiary prevention by a CHN?
a.
Administering the Mantoux (skin) test to identify persons with TB
b.
Assessing for signs and symptoms of active TB
c.
Directly observing clients with active TB as they take their antituberculosis medications
d.
Interpreting TB skin test results
C
Tertiary prevention is implemented when CHNs provide directly observed therapy (DOT) to those with active TB.
Which one of the following is the cause of the greatest overall costs to the community for providing health care to the homeless?
a.
The need for increased preventive services to address the health conditions of the homeless population
b.
The need for more frequent clinic visits by homeless clients for multiple health problems
c.
The spread of contagious diseases by homeless people to those they pass on the street
d.
The fact that most of the care for homeless people takes place in hospital emergency departments
D
Homeless persons encounter the same problems accessing health care (e.g., lack of money, lack of housing, lack of transportation) that others do in impoverished conditions. Therefore, health care of homeless persons tends to be crisis oriented and sought in emergency departments. Low-income Canadians have the highest mortality rates and the highest rates of hospitalizations and emergency visits.
A CHN presents a proposal for a program for preventing teen pregnancy to a group of parents. In the discussion that follows the presentation, which of the following responses by a parent indicates the need for additional teaching by the CHN?
a.
“I do not know if my son is sexually active; however, I have decided that I am going to talk to him about birth control, just in case.”
b.
“I have found that being very strict and checking on my daughter whenever she is out are the best ways to prevent trouble.”
c.
“I plan to sit down with my daughter and have an honest talk about sexuality and potential risks.”
d.
“I will start spending more time with my teens when I get home from work.”
B
Parents who are extremely demanding and controlling or neglectful, and who have low expectations, are the least successful in instilling good values in their children. Children of parents who are neglectful are the most sexually active, followed by children of parents who are very strict. Furthermore, parents who discuss birth control, sexuality, and pregnancy with their children can positively influence delaying initiation of sexual activity and use of effective birth control. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and unwanted pregnancies.
By which of the following actions can the CHN best ensure long-term positive health outcomes in pregnant teens from low-income groups and their children?
a.
Help teen mothers learn about body changes during pregnancy.
b.
Develop programs that enable teen mothers to complete their education.
c.
Offer courses in proper care of babies.
d.
Monitor pregnant teens for early detection of problems in pregnancy.
B
Programs that enable the teen mother to complete her education increase her chances for a better future and improved health care over the long term, across the lifespan. Issues to discuss include education and career plans, family finances and qualifications for outside assistance, and personal values about pregnancy and parenting at this time in her life.
A CHN who works at a clinic for homeless persons wants to institute a more efficient treatment for chronic wounds. Which of the following actions offers the best way to improve outcomes for these clients?
a.
Administer antibiotics to all homeless persons with chronic, nonhealing wounds.
b.
Facilitate daily access to a room with soap, water, and bandages.
c.
Provide free bandaging supplies to clients at each clinic visit.
d.
Regularly monitor the wound condition of clients.
B
Health problems faced by homeless people often are related directly to poor access to preventive health care services. The CHN can implement tertiary prevention by designating a wound room in which clients can carry out wound care activities taught during clinic visits. Only infected wounds would need treatment with antibiotics, not all wounds. Free bandaging only addresses one part of the problem and monitoring does not improve outcomes; only treatment does.
