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N322: Client System of Nursing > Module 13 > Flashcards

Module 13 Flashcards

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1
Q

Cultural Attitudes

A

Perspectives about individual responsibility for health and well-being are influenced by prevailing cultural attitudes

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2
Q

What things influence attitudes toward vulnerable groups?

A

Attitudes

Beliefs

Media communication

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3
Q

What sort of people ted to be at higher risk for health problems

A

lower incomes and less education (lower socioeconomic status)

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4
Q

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

A

oral health

neglect and abuse

incarcerated

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5
Q

What is the main vision of HP2020

A

A society in which all people live ling, health lives

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6
Q

HP2020 overarching goals

A

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.

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7
Q

Vulnerability

A

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

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8
Q

Vulnerable Populations

A

those groups with increased risk for adverse health outcomes

More likely than the general population to suffer from health disparities

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9
Q

Risk

A

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

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10
Q

Health Disparities

A

the wide variations in health services and health status among certain population groups

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11
Q

What is the difference between Health and healthcare disparities

A

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

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12
Q

Disparities are commonly viewed through the lens of …

A

race and ethnicity

but it can occur across many dimensions like socioeco status, age, location, gender, disability status, sexual orientation, pregnancy

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13
Q

T or F: Health care disparity refers to higher burden of illness experiences by on population group relative to another group

A

False

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14
Q

Disparities in health and health care limit continued improvement in overall ___ ___ ___ and ___ ___ and result in ___ ___

A

disparities in health and health care limited continued improvement in overall quality of care and population health and result in unnecessary costs

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15
Q

Hp2020 social determinants of heatlh

A

Education

Economic Stability

Social and community context

neighborhood and built environment

health and health care

food

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16
Q

Examples of Vulnerable Populations

A

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

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17
Q

Vulnerability results from the combined effects of…

A

limited physical, environmental, personal resources, and biopsychosocial resources

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18
Q

What sort of things are vulnerable people more likely to have occur or are sensitive to

A

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

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19
Q

Outcomes of vulnerability can be __ or __

A

negative or positive

it is positive if funding is coming in and aiding in issues

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20
Q

Cycle of Vulnerability

A

when sometimes when one problem is solved, another quickly emerges

leads to feelings of hopelessness

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21
Q

Poverty (Absolute Poverty/Destitution)

A

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.

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22
Q

Relative poverty

A

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.

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23
Q

How are poverty measures still gleaned?

A

amount of income spent on food

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24
Q

Why is the way poverty measured unfair?

A

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)

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25
Q

Factors affecting the growing number of poor persons

A

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

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26
Q

How does poverty influence health across the lifespan

A

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

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27
Q

Persistent Poverty

A

county level measure where 20% or more of populations lives in poverty over the last 30 years, measured by the US census

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28
Q

Groups at disproportionate risk of health disparity

A

Hispanics

blacks

American Indians and Alaskan natives

low income individuals

uninsured whites

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29
Q

What are groups are disproportionate risk for health disparity exactly at risk for

A

being uninsured

lack access to care

receive poorer quality care

experience worse health outcomes

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30
Q

People of color frequently report higher prevalence of health conditions like …

A

diabetes, asthma, and heart disease

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31
Q

What are some health status indicators

A

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

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32
Q

Social Security Act of 1935

A

created largest federal support program for elderly and poor americans

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33
Q

Social Security act amendments of 1965, Medicare, and Medicaid

A

provided for health care needs of elderly, poor,. and disabled persons

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34
Q

health insurance portability and accountability act of 1996

A

intended to help people keep their health insurance when moving from one place to another

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35
Q

Title XXI of the social security act 1997

A

provides for the state children’s health insurance program (SCHIP) to provide funds to uninsured children

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36
Q

Balanced budget act of 1997

A

influenced the use of resources for providing health services

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37
Q

Patient protection and affordable care act of 2010

A

provision for reducing the growth of future medicare expenditures

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38
Q

The HHS Disparities Action Plan

A

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

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39
Q

the HHS Disparities action plan builds off of what

A

existing USDHHS initiatives such as health people

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40
Q

How does the ACA impact health and health care disparities

A

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.

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41
Q

Current Trend in Nursing Approaches to Care in the community

A

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

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42
Q

Wrap Around Services

A

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

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43
Q

What are comprehensive services

A

health services that focus on more than one health problem or concern

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44
Q

What are important nursing approaches to care in the community

A

Trends

wrap around services

comprehensive services

advocacy

social justice

culturally and linguistically appropriate health care

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45
Q

Assessment of vulnerable clients should include evaluations of..

A

Socioeconomic resources

Preventive health needs

Congenital and genetic predisposition to illness

Amount of stress

Living environment and neighborhood surroundings

46
Q

What are some main tips to planning and implementing care for vulnerable populations?

A

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.

47
Q

Rural

A

communities having fewer than 20,000 residents or fewer than 99 persons per square mile

48
Q

Urban

A

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

49
Q

Metro Area

A

contains a core urban area of 50,000 or more population

50
Q

Micro Area

A

contains an urban core of at least 10,000 (but less than 50,000_) population

51
Q

Each metro or micro area consists of …

A

one or more counties containing the core urban area

52
Q

Rural Urban continuum

A

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”

53
Q

Frontier

A

communities having fewer than 6 persons per square mile

54
Q

Why so many terms to describe rurality?

A

funding and research allocation

55
Q

What are the Demographics of a Rural Area

A

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

56
Q

What are the Values and Beliefs of a Rural Community

A

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

57
Q

Work Belief and health in rural areas

A

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

58
Q

Distance in rural areas

A

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

59
Q

Isolation in rural areas

A

can be seen as Separation which is being divided from the rest physically

It is relative and based on personal perception

60
Q

Hardiness in rural areas

A

can adjust to adverse situations and see exposure as a challenge or opportunity rather than a threat

61
Q

Self Reliance in rural areas

A

capacity to provide for yourself often learned from families

62
Q

Familiarity in rural areas

A

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

63
Q

Informal Networks in rural areas

A

natural interpersonal linkages

a series of channels through which people request support and make demands

64
Q

Insider

A

Member of a group

Has access to privileged information

An awareness of implicit assumptions and social context

A long time resident

65
Q

Outsider

A

Differentness

unfamiliarity

unconnectedness

66
Q

Old Timer

A

age

length of time in community

establishment of relationships within the community

67
Q

Newcomer

A

newly arrived

unaware of history of area/institution

existence/presence may result in change

68
Q

What may an old timer/insider look like

A

person who influences community with whom nurses need to work to make changes in that community

69
Q

What may a newtimer/insider look like

A

A wife (newcomer) marries husband (insider), member of old-time family

Grandchild of old-timer family raised somewhere else comes to the community

70
Q

What may an old timer/outsider look like

A

hermit

seasonal resident

return to community (old timer) after education (outsider)

71
Q

What may a newcomer/outsider look like

A

newly graduated NP

72
Q

What is the physical environment like in a rural area

A

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

73
Q

What are some high risk industries found in rural areas and what may make them more high risk here than elsewhere?

A

forestry, mining, fishing, agriculture

lack of OSHA and separation may lead to more injuries and exposure to chemicals with limited employment opportunity

74
Q

What is education like in rural areas

A

in general, lower education levels

fewer years of formal education

lower tax base for school funding

75
Q

What are politics and government like in rural areas

A

Preference for less organized bureaucracy, valuing a locally focused government

Fewer special-interest organizations

Different voting pattern from metropolitan areas (red usually)

76
Q

What is communication like in rural areas

A

internet not always available

texts, telehealth, telephone, and video conferencing are great ways to connect rural providers with resources outside the community

77
Q

What are the economics like in a rural area

A

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

78
Q

What is insurance (economics) like in rural area)

A

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

79
Q

Persistent poverty (county level)

A

20% or more of populations living in poverty over the last 30 years as gathered by census buraeu

80
Q

What is income disparity like in rural areas

A

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

81
Q

What areas tend to rely more on the individual insurance market?

A

rural residents

82
Q

What is safety and transportation like in rural areas?

A

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

83
Q

__% of population lives in rural areas, but ___% of providers practice in them

A

25% 10%

84
Q

HPSA

A

Health professional shortage areas

2157 in rural areas and frontier vs in urban (910)

80% of rural areas are medically underserved!

85
Q

Critical Access Hospitals

A

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

86
Q

Medicare conditions of participation for Critical Access Hospitals

A

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

87
Q

Summary: what are health and social services like in rural areas

A

low pop, isolation, and distance –> under service, lack of resources, difficulty recruiting health professionals

88
Q

The rural pop is consistently ___ ____ ___ than the urban population in respect to health

A

less well off

(they have more heart disease, arthritis, diabetes, HTN, and mental disorders)

89
Q

Things more common or unique to rural areas

A

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

90
Q

How much higher is CVA in rural areas than metropolitan areas

A

1.45x more likely

91
Q

___ is higher in rural areas than urban areas

A

HTN!

92
Q

Medicare patients with AMI treated in rural hospitals are…

A

less likely than those in urban ones to get recommended treatments

had higher death rates from all causes than in urban ones

93
Q

Why is suicide in men significantly higher in rural areas (and women too as it grows larger)

A

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

94
Q

How is maternal and infant health in rural areas

A

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

95
Q

What is the youth like in rural areas

A

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

96
Q

California Agricultural Strikes of 1933

A

depressions era - 30 strikes in cali involving 47500 workers

led to formation of workers rights including a minimum age

97
Q

Transient

A

people who do not live in one area

98
Q

Migrant Health Act of 1962

A

provides primary and supplemental health services to migrant workers and their families at migrant health centers

99
Q

Migrant health Centers

A

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)

100
Q

What are some issues invoving/for migrant workers in rural areas?

A

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

101
Q

What about providers in regard to rural issues are imperative

A

attitudes

insights

knowledge

102
Q

Nurses must design strategies and interventions that what in rural areas

A

mesh with a clients beliefs

103
Q

To overcome rural barriers, a person must ask if health care and services are what in rural areas?

A

available

affordable

accessible

acceptable

104
Q

What are some of the prevailing needs in rural areas in regard to healthcare

A

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

105
Q

Fallen Leaves

A

seattle based homeless awareness and remembrance grassroots organization

106
Q

What does homelessness mean?

A

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

107
Q

In what ways can homelessness impact health status?

A

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

108
Q

What are the 2 common ways to count homeless population?

A
  1. Point in time - number of agencies looking at those in shelters, under bridges, homeless areas for that day
  2. Period Prevalence Count - checking amount over a certain period of time
109
Q

Prevalence Rate equation

A

number of homeless/state population x 100,000

110
Q

What are some tertiary prevention for homelessness

A

emergency shelters and housing, soup kitchens, rescue missions, group homes

N322: Client System of Nursing (13 decks)

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