Module 13 Flashcards

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
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
26
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
27
Persistent Poverty
county level measure where 20% or more of populations lives in poverty over the last 30 years, measured by the US census
28
Groups at disproportionate risk of health disparity
Hispanics blacks American Indians and Alaskan natives low income individuals uninsured whites
29
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
30
People of color frequently report higher prevalence of health conditions like ...
diabetes, asthma, and heart disease
31
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
32
Social Security Act of 1935
created largest federal support program for elderly and poor americans
33
Social Security act amendments of 1965, Medicare, and Medicaid
provided for health care needs of elderly, poor,. and disabled persons
34
health insurance portability and accountability act of 1996
intended to help people keep their health insurance when moving from one place to another
35
Title XXI of the social security act 1997
provides for the state children's health insurance program (SCHIP) to provide funds to uninsured children
36
Balanced budget act of 1997
influenced the use of resources for providing health services
37
Patient protection and affordable care act of 2010
provision for reducing the growth of future medicare expenditures
38
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
39
the HHS Disparities action plan builds off of what
existing USDHHS initiatives such as health people
40
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.
41
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
42
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
43
What are comprehensive services
health services that focus on more than one health problem or concern
44
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
45
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
46
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.
47
Rural
communities having fewer than 20,000 residents or fewer than 99 persons per square mile
48
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
49
Metro Area
contains a core urban area of 50,000 or more population
50
Micro Area
contains an urban core of at least 10,000 (but less than 50,000_) population
51
Each metro or micro area consists of ...
one or more counties containing the core urban area
52
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"
53
Frontier
communities having fewer than 6 persons per square mile
54
Why so many terms to describe rurality?
funding and research allocation
55
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
56
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 ```
57
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
58
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
59
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
60
Hardiness in rural areas
can adjust to adverse situations and see exposure as a challenge or opportunity rather than a threat
61
Self Reliance in rural areas
capacity to provide for yourself often learned from families
62
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
63
Informal Networks in rural areas
natural interpersonal linkages a series of channels through which people request support and make demands
64
Insider
Member of a group Has access to privileged information An awareness of implicit assumptions and social context A long time resident
65
Outsider
Differentness unfamiliarity unconnectedness
66
Old Timer
age length of time in community establishment of relationships within the community
67
Newcomer
newly arrived unaware of history of area/institution existence/presence may result in change
68
What may an old timer/insider look like
person who influences community with whom nurses need to work to make changes in that community
69
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
70
What may an old timer/outsider look like
hermit seasonal resident return to community (old timer) after education (outsider)
71
What may a newcomer/outsider look like
newly graduated NP
72
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
73
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
74
What is education like in rural areas
in general, lower education levels fewer years of formal education lower tax base for school funding
75
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)
76
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
77
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
78
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
79
Persistent poverty (county level)
20% or more of populations living in poverty over the last 30 years as gathered by census buraeu
80
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
81
What areas tend to rely more on the individual insurance market?
rural residents
82
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
83
__% of population lives in rural areas, but ___% of providers practice in them
25% 10%
84
HPSA
Health professional shortage areas 2157 in rural areas and frontier vs in urban (910) 80% of rural areas are medically underserved!
85
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
86
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
87
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
88
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
89
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
90
How much higher is CVA in rural areas than metropolitan areas
1.45x more likely
91
___ is higher in rural areas than urban areas
HTN!
92
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
93
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
94
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
95
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
96
California Agricultural Strikes of 1933
depressions era - 30 strikes in cali involving 47500 workers led to formation of workers rights including a minimum age
97
Transient
people who do not live in one area
98
Migrant Health Act of 1962
provides primary and supplemental health services to migrant workers and their families at migrant health centers
99
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)
100
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 ```
101
What about providers in regard to rural issues are imperative
attitudes insights knowledge
102
Nurses must design strategies and interventions that what in rural areas
mesh with a clients beliefs
103
To overcome rural barriers, a person must ask if health care and services are what in rural areas?
available affordable accessible acceptable
104
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 ```
105
Fallen Leaves
seattle based homeless awareness and remembrance grassroots organization
106
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
107
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 ```
108
What are the 2 common ways to count homeless population?
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
Prevalence Rate equation
number of homeless/state population x 100,000
110
What are some tertiary prevention for homelessness
emergency shelters and housing, soup kitchens, rescue missions, group homes