FINAL Flashcards
Differences in Rural Versus Urban
• Rural= Farm residency
• Urban= Nonfarm residence
• Rural-Urban Continuum
• Metropolitan Area
• Micropolitan Area
So getting married early, having children early
They tend to be poorer.
Higher risk would be underinsured or not insured at all. A lot of them are self-employed farmers. So there’s no reason for them to, they’re not being overlooked by a lot of other agencies.
Rural Population Characteristics and Cultural Considerations
• In general, a higher proportion of whites in rural areas
• Higher-than-average numbers of younger (ages 6-17 years) and older (older than 65
years) residents
• Persons 18 and older more likely to be or to have been married
• More likely to be widowed than urban counterparts
• Adults in rural areas tend to have fewer years of formal schooling than urban adults
• Tend to be poorer
•Higher risk for being underinsured or uninsured
Health Status of Rural Residents
• Generally have a poorer perception of their overall health and functional status
• Less likely to engage in preventive behavior • More likely to have one or more of the following chronic conditions: heart disease,
COPD, hypertension, arthritis and rheumatism, diabetes, cardiovascular disease, and
cancer
• Tend to have poorer health and are less likely to seek medical care
• Traveling time and/or distance to ambulatory care services affects access to care
/
- Poor perception of health and preventative behaviors
- Difficulty accessing medical care in rural areas
- Lack of symptoms for chronic conditions like hypertension leads to lack of screening and prevention
- Seasonal work inhibits ability to take time off for medical appointments
- Community events like church and school are crucial for reaching rural populations
- Emphasis on reaching individuals at social events such as school functions and Friday Night Lights football games
….
• Heath providers
– Often rural health professionals live and practice in the same
community for decades; they may provide care to people who live in several counties
– Sometimes one or two nurses in a county health department offer a
full range of services for all residents in a specified area, which may span more than 100 miles from one end of a county to the other
(They’d rather work with local people because you cant trust those outsiders. So when it comes to health providers, they usually live and work in the same factors for years.You can have one or two nurses that see an entire county, okay? It’s more than 100 miles away from one to the next. They usually have poorer women’s health, higher infant, and maternal mortality rates.)
Women’s Health in rural areas
• Overall, rural populations have higher infant and maternal morbidity rates
– HPSAs tend to have a high proportion of racial minorities and fewer specialists (e.g.,
pediatricians, obstetricians, gynecologists) available to provide care to at-risk populations
• Extreme variations in pregnancy outcomes from one part of the country to another,
and even within states
• Particularly at risk are women who:
– Live on or near Indian reservations
– Are migrant workers
– Are of African-American descent and live in rural counties of states located in the Deep South
/
- Disparities in pregnancy outcomes based on location and demographic factors
- Medical professional shortage in rural areas, with majority designated as medically underserved by federal government
- Aging workforce in rural healthcare leading to lack of new doctors entering the field
- Importance of considering unique health challenges in rural areas, such as those related to farming and specific communities like Indian reservations and migrant worker populations.
Health of Children in Rural areas
• School nurses play an important role in the overall health
status of children in the U.S.
• Availability of school nurses in rural communities varies from region to region
– Scarce in frontier and rural areas of the U.S. (there are not enough doctors in remote and rural areas of the United States.)
– Creative approaches enable counties to provide better health care
and school nursing services
Occupational and Environmental Health Problems in Rural Areas
• High-risk industries found primarily in rural areas:
– Pesticide exposure
– Forestry
– Mining
– Fishing
– Agriculture
• Lack of OSHA regulation for farming and ranching
• Common injuries
• Exposure to chemicals
High risk injuries and no OSHA regulates because they are very small enterprises; dont have to follow the same rules
Migrant Worker
• Unseen
• Unheard
• Poorly understood
• Excluded from many health programs
• Disenfranchised citizen- feeling of separation from the mainstream society
• Approximately 5 million migrant workers
We get to migrant workers. They’re here all over Long Island ….t are on farms and so on. There’s many of them out in Riverhead. There’s a lot of farms out there and they are working. We don’t see them. We don’t hear them. We don’t know anything about them.
Disenfranchised Citizen
feeling of separation from the
mainstream society
Think about how the experience of being a nursing student can feel isolating and disconnected from the typical college experience, as they have different priorities and schedules compared to mainstream students.
Issues in Migrant Health
• Lack of knowledge about services
• Inability to afford care
• Availability of services
• Transportation
• Hours of service
• Mobility and tracking
• Language barriers
• Discrimination
• Documentation
• Cultural aspects
• Dental disease
• Incidence of TB
• Incidence of HIV/AIDS
• Depression
• Anxiety-related disorders
• Domestic violence
• Children of migrant workers
/
- Limited resources, language, and skills
- Over two-thirds of individuals are under 35 years old
- Many face challenges with childcare, with some taking their children to work
- Health issues may be prevalent due to lack of access to services, limited office hours, and work schedules
- Limited access to healthcare due to financial constraints and lack of understanding of available services
- Transportation barriers hinder access to healthcare services
- Language barriers and discrimination are common
- Legal status may impact access to healthcare
- Cultural considerations and expectations may not be understood
- Poor access to dental healthcare even with insurance
- High incidence of TB, HIV/AIDS, depression, anxiety, and domestic violence due to living conditions and cultural factors.
Common Problems: Migrant
• Poverty
• Malnutrition
• Infectious and parasitic diseases
• Limited education
• Hazardous working conditions
• Unsafe housing
• Pesticide exposure
/
- Children walking barefoot in fields leading to parasitic infections
- Limited education resulting in low graduation rates
- Cycle of limited education opportunities perpetuating over generations
Lifestyle: Migrant
• Transient and uncertain
• Long hours
• Low wages
• Poor health care
• Stays 6-8 weeks before moving on
• Works 6 days/week from sunrise to sunset
• Entire family must work • May travel as family or as single men
• May earn 4 cents for 5- gallon bushel
• $100 on a good day
• Hindered by weather, poor harvest, injury, and disease
/
- Transient lifestyle and uncertainty for migrant families
- Children frequently changing schools, leading to interruptions in education
- Migrant tutors provided to support students but many struggle to keep up academically
- Low wages in healthcare based on crop production, with $100 considered a good day
- Pressure to work even when sick or injured due to financial concerns
- Occupational hazards include falls, sprains, repetitive motion injuries, allergic reactions, frostbite, heat stroke, and pesticide exposure
Occupational hazards: Migrant workers
• Falls, sprains, cuts, repetitive motion
• Allergic reactions
• Exposure to sun (heat stroke), cold (frostbite)
• Pesticide exposure
• Paid by piecework- work through illness, injury
• Children- physical injury, school failure- work on farm instead of going to school, moves frequently, poverty
Health Risk : Migrant Worker
• Life expectancy 49 (compared with 73)
• Infant mortality 125% higher than national average
• Death rate 40% higher from flu and pneumonia
• Parasitic infection 11-59 times higher than general population
• TB/communicable death rate- 25 times higher than general population
• Hospitalization rate is 50% higher than national average
• Poor nutrition- infant death, anemia, dental problems, poor mental and physical development in children
/
Big problem for them. Life expectancy is much lower, infant mortality is higher, higher death from fluid pneumonia, stuff that could be dealt with, but because they wait until too long to get to the hospital.
Barriers to Health Care
: Migrant workers
• Lack of knowledge about services
• Affordability
• Transportation
• Hours of service
• Mobility
• Discrimination
• Documentation
• Language barrier
• Cultural aspects
Nursing Care in Rural Environments
• Community-oriented nursing needs to vary by
community
• There is a prevailing need in most rural areas
especially for the following:
– School nurses
– Family planning services
– Prenatal care
– Care for individuals with AIDS and their families
– Emergency care services
– Children with special needs
– Mental health services – Services for older adults
• Case management and community health primary health care (COPHC):
– Define and characterize the community.
– Identify the community’s health problems.
– Develop or modify health care services in
response to the community’s identified needs.
– Monitor and evaluate program process and client outcomes.
Community Nurse
• Improve existing services
• Advocate
• Cultural sensitivity
• Use lay person for outreach
• Unique method of health care delivery
/
- Challenges in reaching migrant workers and rural communities for healthcare outreach due to lack of trust and reluctance to take time off work
- Need for creative solutions to reach these populations, such as mobile healthcare units or community health workers visiting worksites
- Rural populations have higher rates of smoking and other health risks, particularly impacting maternal health and children
- They have to work 60 hours to get over time vs here work 40 hours to get overtime
Vulnerability
susceptibility to actual or potential
stressors that may lead to an adverse effect
–Results from the interaction of internal and external factors that cause a person to be susceptible to poor health
Vulnerable populations
those groups with
increased risk for developing adverse health
outcomes
Are more likely than the general population to suffer from health disparities
• More likely to develop health problems as a result of
exposure to risk or to have worse outcomes from those health problems than the population as a whole
• More sensitive to risk factors because they are often
exposed to cumulative risk factors
• More likely to suffer from health disparities
• Vulnerability results from the combined effects of
limited physical, environmental, personal resources,
and biopsychosocial resources
Who are the Vulnerable?
• Racial & ethnic minority groups
• Uninsured/Underinsured
• Low income children
• Frail older adults
• Mentally disabled/ID/DD
• Homeless
• Physically disabled
• Rural Americans
• Immigrants/Migrant Farm workers
• People with HIV/AIDS
• LGBT
• Incarcerated
• Pregnant teens
• Veterans
What are Health Care Disparities?
Differences or inequalities in health care status due to gender, race/ethnicity, education, disability,
geographic location or sexual orientation.
• A goal in the United States is to eliminate health disparities by expanding access to health care for vulnerable or at-risk populations
/
Healthcare disparities refer to differences in access to and quality of healthcare services between different populations, often based on factors such as race, ethnicity, socioeconomic status, or geographic location. These disparities can result in unequal health outcomes for marginalized or underserved groups.
Health disparities:
the wide variations in health services and health status among certain
population groups
Example: Rural residents have more chronic conditions such as diabetes and are more likely to die of heart attacks.
What are the factors Contributing to vulnerability?
Social Determinants of Health:
Economic Status ( poverty, lack of insurance), Education, Environmental factors (access to health care), Nutrition, Stress, Prejudice
Health Status (Age & changes in normal physiology)
Assessment should include client evaluation of…
– – – – –
Socioeconomic resources
Preventive health needs Congenital and genetic predisposition to illness Amount of stress
Living environment and neighborhood surroundings
/
Okay, so when you’re doing an assessment, I mean, you really have to stop and think. Just take yourself for a second and put yourself in the doctor’s office. Have any of these things been addressed at work? Have you ever been asked? Right? So how are we going to help? We have to find out what they want to know, right?Somebody’s talking with the client. What questions do you have for the doctor? We’ve tackled the types of questions that you’re asking. Make sure you don’t use any derogatory terms. Don’t speak down to anybody. When you have a client, that might be your one and only chance to work with them. Once they leave, you might not see them again. So as the nurse find their strengths, try to help them find out what do they need. Maybe they’re too proud to ask for assistance. Working with people, creating a trusting environment. They’ve been let down and disappointed so many times in the past, why are they going to trust you?
Planning and Implementing Care for Vulnerable Populations
• Create a trusting environment
• Show respect, compassion, and concern
• Do not make assumptions
• Coordinate services and providers (Try and coordinate your services. Because once they’re there, that might be their one and only day. So you can help them coordinate services in any way, shape, or form._
• Advocate for accessible health care services
• Focus on prevention
• Know when to “walk beside” the client and when to encourage
the client to “walk ahead”
• Know what resources are available
• Develop your own support network
What are the four groups of people who represent members of vulnerable populations?
The poor, the homeless, pregnant teens, and those who are mentally ill—present complex nursing needs.
• Understand your own beliefs about these groups.
• Identify health care needs, barriers to care, and essential health care services for each of these groups.
Cultural attitudes
– Perspectives about individual responsibility for health and well-being are influenced by prevailing cultural attitudes.
Consider your personal beliefs and attitudes,
clients’ perceptions of their condition, and the social, political, cultural, and environmental factors that influence the client’s situation.
Cultural Sensitivity
- Consider cultural attitudes: Be mindful of cultural attitudes and beliefs in interactions with clients.
- Media influence: Reflect on how media messages may impact your perceptions and attitudes.
- Self-reflection: Consider your own personal beliefs and attitudes before engaging with clients.
- Awareness of biases: Be aware of potential biases and stereotypes that may influence your behavior and language.
- Communication cues: Clients can pick up on nonverbal cues, so be conscious of your facial expressions, language, and actions to ensure respectful and empathetic interactions.
Understanding Poverty
• Poverty and homelessness affect people’s health
status • To understand poverty, homelessness, mental illness,
and teen pregnancy, consider your personal beliefs
and attitudes, clients’ perceptions of their condition,
and the social, political, cultural, and environmental
factors that influence the client’s situation
/
So when you think about there are health problems that they really are a cause and effect type of thing, because you talk about homelessness. So homelessness, think about how many diseases can cause homelessness, and then you think about being homeless, how many diseases that you can get.
The federal government defines…
Poverty on the basis of income, family size, age of the head of household, and number of children younger than 18 years
– Those who are poor insist that poverty has less to do with income and
more to do with a lack of family, friends, love, and support
What are the causes of Poverty?
• Decreased earnings
• Increased unemployment rates
• Change in labor force
• Increase in female-head of households
• Inadequate education • Inadequate antipoverty programs
• Inadequate welfare benefits
• Weak enforcement of child support
• Dwindling Social Security payments
• Increase number of children to single mothers
/
Not enough anti-poverty programs, and add welfare benefits, child support, very difficult to enforce that. With social security, you look at seniors, there’s a number of people that are working with seniors. We know they are on a fixed income, okay? So when that doesn’t get increased, now what?
Examples of How Poverty Directly Affects
Health and Well-Being
– Higher rates of chronic illness
– Higher infant morbidity and mortality – Shorter life expectancy – More complex health problem
– More significant complications and physical
limitations resulting from chronic disease
– Hospitalization rates three times more than for persons with higher incomes
/
So poverty, higher rates of chronic illness, because they’re not going for regular checkups, right? So a simple thing becomes a chronic thing.
What are the two common ways to determine the number of people who are
homeless are
• Point-in-time-counts
• Period prevalence count
Conducting point-in-time counts and period prevalence assessments can help estimate the number of people experiencing homelessness, but may not capture the full extent of the issue.
Stewart B. McKinney Homeless Assistance Act (1994)
This legislation aims to provide assistance, protection, and improvement of the lives and safety of individuals experiencing homelessness, with a focus on children and families.
Homelessness and Support Services
Challenges with shelters: While homeless shelters exist as a resource, individuals cannot be forced to utilize them. Some may perceive shelters as more dangerous than sleeping on the streets.
Safety concerns: It’s important to address safety concerns in shelters and ensure that individuals experiencing homelessness have access to safe and supportive resources.
Comprehensive support: Efforts should focus on providing comprehensive support to individuals experiencing homelessness, addressing not only immediate needs but also working towards long-term solutions for housing stability.
How is Homeless defined?
*Lacks a fixed, regular and adequate night-time residence
• Has a primary night time residency that is:
– Supervised publicly or privately operated shelter designed to provide temporary living accommodations
– Institution that provide temporary residence
Education rights for homeless children
Federal law mandates that homeless children have the right to attend the public school district from which they moved or remain at their school of origin, with transportation costs covered.
Supporting Homeless Children in Education
- Addressing basic needs: When homeless children attend school, there may be challenges related to personal hygiene, access to clean clothes, and basic amenities that are typically taken for granted.
- Support from school staff: School nurses, teachers, and staff play crucial roles in supporting homeless students by providing access to showers, clean clothes, and other essential resources.
- Collaborative efforts: Schools can work with local organizations, community resources, and government agencies to ensure that homeless children have access to the support they need to thrive academically and personally.
- Advocacy and awareness: Continued advocacy for homeless children and families is essential to address systemic issues and provide meaningful support to those experiencing homelessness.
What are the factors Contributing to Homelessness?
– Increase in numbers of people living in poverty
– Diminishing availability of low-cost housing
– Increased unemployment
– Substance abuse
– Lack of treatment facilities for mentally ill persons
– Domestic violence
– Family situations causing children to run away
Crisis Poverty
• Lives are marked by
hardship and struggle
• Transient or episodic
• Brief stay in shelter
/
Crisis poverty refers to a temporary period of hardship or financial instability that is shorter in duration and typically triggered by a specific event such as a natural disaster.
Examples of crisis poverty may include situations where individuals are forced to seek shelter due to a sudden event like a hurricane, flood, or other natural disaster.
Individuals experiencing crisis poverty may find temporary refuge in shelters or emergency housing facilities as they navigate through the immediate aftermath of the crisis.
Persistent Poverty
Chronically homeless
• Many with mental
or physical
disabilities
• Disability often co-exist with alcohol/drug abuse • Chronic health problem
• Chronic family difficulties
/
Chronic homelessness is a persistent cycle of housing instability passed down through generations, often tied to factors like mental and physical disabilities, substance abuse, chronic health issues, and family conflicts.
Those experiencing chronic homelessness face social isolation, abandonment, and multiple barriers to accessing support and resources.
