Module 13 Flashcards
Cultural Attitudes
Perspectives about individual responsibility for health and well-being are influenced by prevailing cultural attitudes
What things influence attitudes toward vulnerable groups?
Attitudes
Beliefs
Media communication
What sort of people ted to be at higher risk for health problems
lower incomes and less education (lower socioeconomic status)
What sort of topics are encompassed in US goals to include the elimination of health disparities by expanding access of healthcare to vulnerable or at risk populations
oral health
neglect and abuse
incarcerated
What is the main vision of HP2020
A society in which all people live ling, health lives
HP2020 overarching goals
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
Promote quality of life, healthy development, and healthy behaviors across all life stages.
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 adverse health outcomes
More likely than the general population to suffer from health disparities
Risk
is an epidemiologic term that means some people have a higher probability than others - like those with factors of:
poor or lacking policy
social hazards
environmental hazards
biological or genetic makeup
Health Disparities
the wide variations in health services and health status among certain population groups
What is the difference between Health and healthcare disparities
Health Disparity generally refers to a higher burden of illness, injury, disability, or mortality experienced by one population group relative to another group.
Health Care Disparity typically refers to differences between groups in health coverage, access to care, and quality of care
Disparities are commonly viewed through the lens of …
race and ethnicity
but it can occur across many dimensions like socioeco status, age, location, gender, disability status, sexual orientation, pregnancy
T or F: Health care disparity refers to higher burden of illness experiences by on population group relative to another group
False
Disparities in health and health care limit continued improvement in overall ___ ___ ___ and ___ ___ and result in ___ ___
disparities in health and health care limited continued improvement in overall quality of care and population health and result in unnecessary costs
Hp2020 social determinants of heatlh
Education
Economic Stability
Social and community context
neighborhood and built environment
health and health care
food
Examples of Vulnerable Populations
Homeless
Low Educational Attainment
People of Color
LGBTQ
Migrant Workers and Immigrants
Poor healthcare access
persons with communicable disease and those at risk
The poor
pregnant adolescents
malnourished
illiterate
developmentally delayed
those with severe mental illness
the uninsured
children
elderly
persons with substance abuse disorder
abused people
victims of violence
high exposure to toxins
incarcerated
those with chronic disease
Vulnerability results from the combined effects of…
limited physical, environmental, personal resources, and biopsychosocial resources
What sort of things are vulnerable people more likely to have occur or are sensitive to
More likely to develop health problems as a result of exposure to risk
More likely 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
Outcomes of vulnerability can be __ or __
negative or positive
it is positive if funding is coming in and aiding in issues
Cycle of Vulnerability
when sometimes when one problem is solved, another quickly emerges
leads to feelings of hopelessness
Poverty (Absolute Poverty/Destitution)
Poverty is the condition of lacking basic human needs such as nutrition, clean water, health care, clothing and shelter because of the inability to afford them. This is also referred to as absolute poverty or destitution.
Relative poverty
the condition of having fewer resources or less income than others within a society or country. In general, the U.S. has some of the highest relative poverty rates among industrialized countries, reflecting the high inequality of incomes.
How are poverty measures still gleaned?
amount of income spent on food
Why is the way poverty measured unfair?
its gone from 1/3 to 1/7 of average family expenses and has not adjusted for substantial variation in cost of living between areas and some income sources are or are not included unfairly (like assistance counts as income)
Factors affecting the growing number of poor persons
Decreased earnings
Increased unemployment rates
Changes in the labor force
Increase in female-headed households
Inadequate education and job skills
Inadequate antipoverty programs and welfare benefits
Weak enforcement of child support statutes
Dwindling Social Security payments to children
Increased numbers of children born to single women
How does poverty influence health across the lifespan
Higher rates of chronic illness
Higher infant morbidity and mortality
Shorter life expectancy
More complex health problems
More significant complications and physical limitations resulting from chronic disease
Hospitalization rates three times more than for persons with higher incomes
Persistent Poverty
county level measure where 20% or more of populations lives in poverty over the last 30 years, measured by the US census
Groups at disproportionate risk of health disparity
Hispanics
blacks
American Indians and Alaskan natives
low income individuals
uninsured whites
What are groups are disproportionate risk for health disparity exactly at risk for
being uninsured
lack access to care
receive poorer quality care
experience worse health outcomes
People of color frequently report higher prevalence of health conditions like …
diabetes, asthma, and heart disease
What are some health status indicators
Infant Mortality
Immunizations
Children with Oral Health Problems
Child and Teen Deaths
Life Expectancy
Mental Health
Mental Illness
Alcohol and Drug Use, Dependence, and Treatment
Opioid Overdose Deaths
Oral Health
Suicide
Education - on time high school graduation
Social Security Act of 1935
created largest federal support program for elderly and poor americans
Social Security act amendments of 1965, Medicare, and Medicaid
provided for health care needs of elderly, poor,. and disabled persons
health insurance portability and accountability act of 1996
intended to help people keep their health insurance when moving from one place to another
Title XXI of the social security act 1997
provides for the state children’s health insurance program (SCHIP) to provide funds to uninsured children
Balanced budget act of 1997
influenced the use of resources for providing health services
Patient protection and affordable care act of 2010
provision for reducing the growth of future medicare expenditures
The HHS Disparities Action Plan
establishes a vision of “a nation free of disparities in health and health care” and sets out a series of priorities, strats, actions, and goals to achieve the vision
the HHS Disparities action plan builds off of what
existing USDHHS initiatives such as health people
How does the ACA impact health and health care disparities
advances efforts to reduce disparities and to improve health and health care for vulnerable populations.
The ACA health coverage expansions will significantly increase coverage options for low- and moderate-income populations and particularly benefit vulnerable populations.
The ACA also includes provisions to strengthen the safety-net delivery system, improve access to providers, promote greater workforce diversity and increase cultural competence, strengthen data collection and research efforts, and implement an array of prevention and public health initiatives.
Current Trend in Nursing Approaches to Care in the community
trend toward providing more comprehensive family centered services when treating vulnerable population groups; family centered “one stop” services in locations where people live and work
Wrap Around Services
comprehensive health social and economic services either directly or through referrals
social and economic services that will help ensure effectiveness of health services are “wrapped around” clients in the community
What are comprehensive services
health services that focus on more than one health problem or concern
What are important nursing approaches to care in the community
Trends
wrap around services
comprehensive services
advocacy
social justice
culturally and linguistically appropriate health care
Assessment of vulnerable clients should include evaluations of..
Socioeconomic resources
Preventive health needs
Congenital and genetic predisposition to illness
Amount of stress
Living environment and neighborhood surroundings
What are some main tips to planning and implementing care for vulnerable populations?
Create a trusting environment.
Show respect, compassion, and concern.
Do not make assumptions.
Coordinate services and providers.
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 in your community.
Develop your own support and resource network.
Rural
communities having fewer than 20,000 residents or fewer than 99 persons per square mile
Urban
geographical areas described as non-rural and having a higher population density; more then 99 persons per square mile; cities with a population of at least 20,000 but fewer than 50,000
Metro Area
contains a core urban area of 50,000 or more population
Micro Area
contains an urban core of at least 10,000 (but less than 50,000_) population
Each metro or micro area consists of …
one or more counties containing the core urban area
Rural Urban continuum
residence ranging from living on a remote farm to a village or small town, or to a large town or city, or to a large metropolitan area with a “core inner city”
Frontier
communities having fewer than 6 persons per square mile
Why so many terms to describe rurality?
funding and research allocation
What are the Demographics of a Rural Area
Higher proportion of whites
Higher-than-average numbers of youth (6-17) and larger population of elderly (>65)
Elderly bring unique problems such as greater incidence chronic disease, disability, live alone
More likely to be married or widowed
Migrant workers
What are the Values and Beliefs of a Rural Community
Rural communities are slower to change traditional cultural values and are reluctant to adopt societal influences
Rural nursing concepts:
Work belief and health
Distance
Isolation
Hardiness
Self-reliance
Familiarity
Informal networks
Insider/outsider and old-timer/newcomer
Work Belief and health in rural areas
health is defined rurally in terms of ability to do work
they expect healthcare to get them back to working ASAP
orientation to healthcare is present time and crisis oriented rather than preventative
Distance in rural areas
adds burden to residents but is integrated in daily life
barrier to specialists
providers and people may have feelings of isolation with burden on healthcare
Isolation in rural areas
can be seen as Separation which is being divided from the rest physically
It is relative and based on personal perception
Hardiness in rural areas
can adjust to adverse situations and see exposure as a challenge or opportunity rather than a threat
Self Reliance in rural areas
capacity to provide for yourself often learned from families
Familiarity in rural areas
limited privacy exists in rural small towns
can be pos and neg:
pos - know a family and their history well and can give good personalized care
neg - limited privacy in small towns may impede health seeking behaviors
Informal Networks in rural areas
natural interpersonal linkages
a series of channels through which people request support and make demands
Insider
Member of a group
Has access to privileged information
An awareness of implicit assumptions and social context
A long time resident
Outsider
Differentness
unfamiliarity
unconnectedness
Old Timer
age
length of time in community
establishment of relationships within the community
Newcomer
newly arrived
unaware of history of area/institution
existence/presence may result in change
What may an old timer/insider look like
person who influences community with whom nurses need to work to make changes in that community
What may a newtimer/insider look like
A wife (newcomer) marries husband (insider), member of old-time family
Grandchild of old-timer family raised somewhere else comes to the community
What may an old timer/outsider look like
hermit
seasonal resident
return to community (old timer) after education (outsider)
What may a newcomer/outsider look like
newly graduated NP
What is the physical environment like in a rural area
As a result of their environment, rural residents are more likely to be called on to be independent and self-sufficient
Services are less available
Geographic isolation requires the assumption of multiple tasks
Of necessity, rural residents have to distinguish between those health impairments which, if left untreated, will impede functioning, from thoseq that can be tolerated for a period of time
What are some high risk industries found in rural areas and what may make them more high risk here than elsewhere?
forestry, mining, fishing, agriculture
lack of OSHA and separation may lead to more injuries and exposure to chemicals with limited employment opportunity
What is education like in rural areas
in general, lower education levels
fewer years of formal education
lower tax base for school funding
What are politics and government like in rural areas
Preference for less organized bureaucracy, valuing a locally focused government
Fewer special-interest organizations
Different voting pattern from metropolitan areas (red usually)
What is communication like in rural areas
internet not always available
texts, telehealth, telephone, and video conferencing are great ways to connect rural providers with resources outside the community
What are the economics like in a rural area
poorer population
higher unemployment rate from dependence on nature, employment ties to a single industry, and wide spread job losses in rural manufacturing
There is a net loss of populations in rural areas decreasing demand for jobs and quality of workforce available
What is insurance (economics) like in rural area)
more likely to be uninsured
underinsured, lack it, or cannot afford it due to self employment in family business, seasonal occupations, or pre existing health conditions
Persistent poverty (county level)
20% or more of populations living in poverty over the last 30 years as gathered by census buraeu
What is income disparity like in rural areas
there is a lower per capita income average than in urban areas
rural Americans more likely to live below poverty line
income disparity greater for minorities in rural areas
income disparity higher in urban areas though by a little bit overall
What areas tend to rely more on the individual insurance market?
rural residents
What is safety and transportation like in rural areas?
greater transp diff reaching health care providers
limited public transport
longer EMS response time (18 v urban 1 m)
emergency personnel are typically volunteers meaning there is a disparity for medical aid in emergencies
__% of population lives in rural areas, but ___% of providers practice in them
25% 10%
HPSA
Health professional shortage areas
2157 in rural areas and frontier vs in urban (910)
80% of rural areas are medically underserved!
Critical Access Hospitals
made by federal balanced budget act of 1997
assures medicare beneficiaries access to care in rural areas
allows more flexible staffing relative to community needs and different simple billing methods
must meet medicare conditions and get certification to get funding
Medicare conditions of participation for Critical Access Hospitals
no more than 25 inpatient beds
maintaining an annual average length of stay no more than 96 hours for acute inpatient care
offer 24 hour 7 day a week emergency care
located in a rural area at least 35 mile drive away from any other CAH or other hospitals
Summary: what are health and social services like in rural areas
low pop, isolation, and distance –> under service, lack of resources, difficulty recruiting health professionals
The rural pop is consistently ___ ____ ___ than the urban population in respect to health
less well off
(they have more heart disease, arthritis, diabetes, HTN, and mental disorders)
Things more common or unique to rural areas
Higher infant and maternal morbidity rates
Higher rates chronic illness
Unique health risks associated with occupations and environment
(Machinery accidents, Skin cancer from sun exposure, Respiratory problems from exposure to chemicals and pesticides)
Stress related health problems and mental illness (ex: suicide)
unintentional motor vehicle traffic related injuries
How much higher is CVA in rural areas than metropolitan areas
1.45x more likely
___ is higher in rural areas than urban areas
HTN!
Medicare patients with AMI treated in rural hospitals are…
less likely than those in urban ones to get recommended treatments
had higher death rates from all causes than in urban ones
Why is suicide in men significantly higher in rural areas (and women too as it grows larger)
delay seeking care
depression
poverty
geographic isolation
insufficient number of mental health services
focus on current moment care rather than preventative
domestic violence
alcohol, tobacco, and other substance use
How is maternal and infant health in rural areas
higher infant and maternal morbidity\
extreme birth outcome variations
particularly those at risk are migrants, native Americans, AA descent in the deep south, victims of sexual Assault
What is the youth like in rural areas
less likely to see pediatrician
more likely to see general practitioner
more likely to work on farms
more likely to smoke
more likely to get DUI
more likely to use Alcohol and drive
California Agricultural Strikes of 1933
depressions era - 30 strikes in cali involving 47500 workers
led to formation of workers rights including a minimum age
Transient
people who do not live in one area
Migrant Health Act of 1962
provides primary and supplemental health services to migrant workers and their families at migrant health centers
Migrant health Centers
154 centers in 42 states that serve migrant workers
(but amount goiing to them is low due to poverty, frequent moving/transientness, language barriers, lack of transportation)
What are some issues invoving/for migrant workers in rural areas?
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
Folk medicine traditions
Their children:
Malnutrition
Dental caries
Infectious diseases
Immunization gaps
Pesticide exposure
Injuries
Social and school disruptions
What about providers in regard to rural issues are imperative
attitudes
insights
knowledge
Nurses must design strategies and interventions that what in rural areas
mesh with a clients beliefs
To overcome rural barriers, a person must ask if health care and services are what in rural areas?
available
affordable
accessible
acceptable
What are some of the prevailing needs in rural areas in regard to healthcare
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
Fallen Leaves
seattle based homeless awareness and remembrance grassroots organization
What does homelessness mean?
Lacks a regular night time residence
Stays in supervisory temporary shelter or institution
Stays in public or private place not designed for human sleeping places
In what ways can homelessness impact health status?
Hypothermia
Infestations
Poor skin integrity
Peripheral vascular disease and hypertension
Diabetes and nutritional deficits
Respiratory infection and COPD
TB
HIV and AIDS
Trauma
Mental illness
Use and abuse of tobacco alcohol and illicit drugs
What are the 2 common ways to count homeless population?
- Point in time - number of agencies looking at those in shelters, under bridges, homeless areas for that day
- Period Prevalence Count - checking amount over a certain period of time
Prevalence Rate equation
number of homeless/state population x 100,000
What are some tertiary prevention for homelessness
emergency shelters and housing, soup kitchens, rescue missions, group homes
