Final exam - week 3 Flashcards
What are groups at greater risk for poor health outcomes because of some demographic factor (age, race, ethnicity, gender, income, sexual identity or orientation, language, immigration status, citizenship, geography, education/literacy, disability status, health care need or religion)?
vulnerable and marginalized populations
What are vulnerable and marginalized populations related to?
Related to realization, discrimination, isolation, and/or limited access to quality health care
What are examples of groups considered vulnerable and marginalized?
Racial/ ethnic/religious minorities* People living in poverty Migrant and/or seasonal farm workers (MSFW) Immigrants (legal or illegal)** People with SMI People who use [illicit]drugs (PWUD) People who abuse ETOH The uninsured People who are morbidly obese Sex Workers People with disabilities Frail older adults Refugees LGBTQ populations Rural populations Veterans People experiencing homelessness People who are/were incarcerated People living with HIV/AIDS Informal Caregivers (family & friends caring for older adults and children/adults with disabilities)
While racial and ethnic minorities are vulnerable populations in themselves, they are also what?
overrepresented in other marginalized and vulnerable populations
Subgroups of vulnerable populations may have what kind of vulnerability?
double vulnerability compounding their risk for poor health outcomes
What are examples of groups that have double vulnerability?
- Transgender African Americans
- Older adults living with poverty
- Homeless veterans with serious mental illness
- Muslim refugees
What are examples of vulnerable populations that are increasing in numbers?
- Some racial and ethnic minority populations
- People experiencing homelessness
- Refugees and immigrants
- Frail older adults
- People who abuse drugs and alcohol
- People living with serious mental illness
- The uninsured
- People living in poverty
What do vulnerable populations have greater of?
health needs
Vulnerability and equity cannot what?
co-exist
What 2 HP 2030 overarching goals address vulnerable populations?
- Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.
- Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.
Being in a vulnerable population does not necessarily mean what?
one is vulnerable
Viewing all individuals in a specific group as vulnerable can lead to what?
delivery of paternalistic care and services.
What is a greater incidence or prevalence of a illness, injury, disability, or mortality experienced by members of some groups as compared to another group such as the dominant group or general population?
health disparities
What are health disparities linked to?
marginalization, discrimination and/or limited access to care.
What are health disparities usually discussed in terms of? but also what?
race and ethnicity but exists as well in other groups which have been marginalized or discriminated against.
In the literature health disparities are reported as a comparison between what?
the VP and the general or dominant population
US Blacks have 2.1x greater chance of what?
2.1 x greater chance of dying from COVID-19 infections than US Whites (risk ratio)
Positive COVID tests among US Hispanics was what percent to what percent among non-hispanics?
18.8% compared to 8%
New COVID case rate for rural areas was what as compared to what in urban areas?
was 19.5/100,000 as compared to urban areas which was 10/100,000 (rate)
What are differences between groups in health insurance coverage, access to health care, care offered, care received, and quality of health care?
health care disparities
What are examples of health care disparities in vulnerable populations?
- Hispanics have the highest uninsured rates of any racial or ethnic group within the United States (OMH, 2019)
- In 2018, 39% of uninsured women had a mammogram in the past 2 years as compare to 75% of insured women (Susan G Komen, 2020)
- A smaller % of informal caregivers aged 45 years and older reported having had a routine checkup in the past year compared to the general population (CDC, 2019)
What are 4 contributing factors to health care disparities?
- Cost and insurance coverage
- Transportation
- Location, hours, and long waiting times
- Cultural competency
What is under cultural competency?
- Discrimination
- Unconscious bias and provider ignorance
- Limited diversity among health care providers
- Inability to navigate the health care system
- Linguistic competency
What is a set of behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations?
cultural competence
What is cultural competence necessary for?
providing quality care to diverse populations
Cultural competence is the ultimate what?
ultimate goal on a continuum; ongoing, evolving process
What is cultural competence an important step towards?
reducing disparities in health care delivery and decreasing vulnerability.
Cultural competency helps retain what?
vulnerable and marginalized populations in the health care system
Organizations that are truly competent involve?
clients and community members in identifying community needs, assets, barriers, and create appropriate program responses.
Clients and community members can play what?
an active role in community assessment, program development, implementation and evaluation.
What is an ongoing process of self-exploration and self-critique combined with a willingness to learn from others?
cultural humility
Cultural humility is a willingness to?
- Accurately assess yourself, identifying your culturally informed beliefs, attitudes, and biases
- Acknowledge your limitations in knowledge
- Open yourself to new ideas, contradictory information and advice
Cultural humility is understanding what?
Understanding and appreciating our own diversity
Cultural humility is being humble enough to what?
assess the cultural dimensions and experiences of patients/populations, and letting go of the false sense of security that stereotype brings
Cultural humility is the foundation of what?
The foundation of culturally sensitive practice and leadership, and the first step in lifelong journey of cultural competence
Culturally competent care considers what?
Respect Dignity Privacy Values Beliefs Health Illness Language Customs Health behaviors Lifestyle History Experiences Standards and expectations of health care providers
What are nursing interventions to promote health equity in vulnerable populations?
- Engage in process of cultural humility
- Have institutionalized cultural knowledge
- Value diversity
- Practice cultural self-assessment
- Be conscious of the dynamics inherent when cultures interact
- Adapt service delivery reflecting an understanding and valuing of cultural diversity
- Commit resources to culturally-specific services
- Maintain data about communities you serve
What are 4 other nursing interventions to promote health equity in vulnerable populations? - 2nd slide
- Facilitate ongoing educational opportunities with regard to cultural content for coworkers
- Facilitate opportunities to work with/learn from teams of diverse “others”
- Develop community partnerships with other teams/organizations working with same diverse populations
- Work towards a “just” health care system where there is an “equitable distribution of benefits and burdens in society”.
What are 4 other nursing interventions to promote health equity in vulnerable populations? - 3rd slide
- Engage in advocacy for vulnerable populations on both organizational and community level.
- Help draft social welfare and health policies promoting primary prevention to address SDOH
- Help draft social and health policies to address cultural barriers to influencing access to and quality of medical care.
- Participation of nurses in the shaping of health policy is critical for the future of the nation and the profession.
What percent of the US population has some degree of hearing loss?
6.25%
What percent of the US population cannot hear speech well enough for comprehension?
1%
What is a criteria for deaf culture?
become deaf prior to language acquisition (usually at birth)
How do people who are deaf communicate?
communicate primarily in American Sign Language
Being deaf is affiliated with what?
a cultural/linguistic minority which is a protective factor?
What do deaf people NOT feel?
like they are broken or need to fix the hearing loss
What is the incidence of sexual assault for deaf women?
is estimated to be 70% of culturally deaf women
What are the statistics of rates of sexual assault in the hearing population?
- 1 in 6 American women have been the victim of attempted or completed rape (16.7%)
- 1 of 33 American men have experienced an attempted or completed rape (3%)
true or false; the incidence of Sexual Assault is HIGHER in the Culturally Deaf population, which is a health disparity.
true
what are provider level barriers to health care disparities?
- Lack of Cultural Sensitivity / Deaf Culture knowledge - Alienation
- Lack of Communication Abilities with Deaf people –> Lack of Trust/Connection
- Lack of Knowledge about Ethical implications –> Care provided not ethically
What are patient level barriers to health care disparities?
Lack of accessible health education in ASL –> Low Health Literacy
What are system level barriers to health care disparities?
ASL interpreters VS Video Remote Interpreting VS Nothing –> Where is linguistically equivalent care??
What are examples of health care disparities?
- Compared to the hearing population, the deaf population has a lower rate of individuals accessing preventative services (Pick 2013).
- The Deaf population as a whole has lower health literacy than the hearing population due to limited access to information (Barnett et al., 2011).
- Adults who have been deaf since birth or early childhood are less likely to have seen a physician than adults in the general population (Barnett et al., 2011).
What are practice-based evidence for culturally sensitive care?
- self-assessment
- gather knowledge
- use effective communication strategies
- patient communication assessment
- obtain communication method and evaluate
In order to be therapeutic with the deaf population, we must do what?
we must self-assess our personal beliefs and bias around the Deaf
What are harmful stereotypes we believe about the deaf population?
ALL Deaf people know ASL
One method of communication works for ALL Deaf people
Anyone who knows ASL can be an interpreter
ASL interpreters are unnecessary
ASL is inferior to English
All Deaf people secretly wish to become hearing
Deaf people can’t _____________.
What is an important intervention for the deaf population?
gather knowledge
How can you strive to learn more about deaf culture?
- Interact with Deaf people socially
2. If you don’t know, ASK
How can you learn some basic ASL for your communication?
“Want interpreter???”
“Yes”
“No”
What are health care facilities required to do for the deaf population?
Health care facilities are required to provide credentialed ASL interpreters at no cost to the patient
What are questions of your facility to preparee for the encounter?
- What communication methods can we get for the Deaf here?
- VRI?? – Get trained on how to use it.
- Live interpreter? What number do I call?
what are effective communication strategies for the deaf population?
Adequate Lighting Speak slowly, NOT overly loud Facial expression conveys emotion in ASL Minimize reliance on lip-reading / pen & paper communication Be Direct Maintain Eye Contact Communicate first, Act second Check for comprehension
What are 2 things to do with a patient communication/cultural assessment?
- Ask the patient how they identify and use your assessment techniques!
- Ask the patient: What communication method do you prefer?
- Honor client preference and tailor environment for optimal communication
What are 3 things to obtain and evaluate communication method?
- Use of a QUALIFIED interpreter for medical appointments is required by the Americans with Disabilities Act
- Ensure an ASL interpreter is available for informed consent process to ensure ethically sound practices.
- Check the interpreters certification and determine if they are qualified to provide interpretation
a. Legal VS Medical VS
b. Educational ASL interpreters
Skill Level of interpreter???
