Module 3 (Ch. 23, 26, 27)

Question 1

Working with vulnerable populations

Answer 1

1. Vulnerability
2. Socioeconomic resources
3. Human vs Social vs Environmental
4. Relative Risk

Question 2

Human Capital

Answer 2

Jobs, income, knowledge, housing, skills

Question 3

Social Capital

Answer 3

people you have around you (social ties)

Question 4

Environmental

Answer 4

Access to and quality of health care

Question 5

Who is considered vulnerable?

Answer 5

• Usually a subpopulation or smaller group of a large population susceptible to poor health.
• Why?
  Higher morbidity and mortality rates
  Less access to health care
  Shorter life expectancy
  Overall diminished quality of life

Question 6

Factors that are related to vulnerability - Poverty

Answer 6

Stress; leads to unhealthy choices (smoking, drinking, etc)

Question 7

Factors related to vulnerability - uninsured/underinsured

Answer 7

less likely to go to the doctor and then it leads to more medical bills in the future

Question 8

factors related to vulnerability - Race/ethnicity

Answer 8

HIV, preterm birth, infant mortality, heart failure, and hypertension

Question 9

Social Determinants of health

Answer 9

everything around you; education, health care environment, social/community, economic/income

Question 10

Socioeconomic gradient of health

Answer 10

Adequate resources your health will be better

Question 11

Inequality in health care - health disparities

Answer 11

Access to care 
quality of care 
cultural barriers 
quantity of disease
burden of disease
adverse health conditions

Question 12

Role of community/public health nurses

Answer 12

Empowerment
facilitating external support
using evidence to reduce vulnerability
- improvement of: 
    * Health literacy 
    * Access to nursing services 
    * Health and public policy

Question 13

U.S. Department of Housing and Urban Development - Homeless

Answer 13

Those living on the streets, in vehicles, in shelters or transitional housing, or facing immanent eviction.

Question 14

Definition McKinney-Vento Homeless Assistance Act - Homeless

Answer 14

A person who lacks a fixed adequate nightly residence; homeless children are abandoned in hospitals, awaiting foster care placement, share housing, living in motels, RV trailer parks, or campgrounds.

Question 15

Scope of the problem (Homelessness)

Answer 15

Point in time - number on a specific night at a specific time
Period Prevalence - Prevalence measured over time.

Question 16

Homelessness Demographic Characteristics

Answer 16

Age: 88% are adults over 24 years old
Gender: 61% are male
Ethnicity - based on geographic location (usually white males)
Families - 33% of homeless population are families with children

Question 17

Predisposing Factors

Answer 17

• Poverty
• Lack of affordable health care
• employment
• domestic violence
• mental illness
• addiction disorders

Question 18

Subpopulations of homelessness- men

Answer 18

Single, chronically homeless, more likely to be treated with disdain

Question 19

Homeless subpopulations - women

Answer 19

lead most homeless families as a single parent, caused by domestic violence

Question 20

homeless subpopulations - children

Answer 20

more likely to become ill, experience emotional/behavioral disorders, have development delays and learning disabilities. Have compromised educations.
1 in 30 children are homeless

Question 21

Homeless subpopulations - youth

Answer 21

run away or evicted by parents, resort to survival sex (sex for money)

Question 22

homeless subpopulations - veterans

Answer 22

9% of homeless adults, US department of Veteran Affairs working to end

Question 23

Homeless subpopulations - rural

Answer 23

likely to be living in cars, standard housing, or “ doubling up”

Question 24

Homeless subpopulations - Older adults

Answer 24

4.7% 62 y/o, live on a fixed income

Question 25

Homeless subpopulations - LGBTQ

Answer 25

may experience difficulty finding accepting shelters, more likely to be victim of violence, abuse or exploitations (also use survival sex)

Question 26

Health care and the homeless

Answer 26

- HIV/AIDS, diabetes, and heart disease are 3-6 times more prevalent - Higher rates of oral disease - Difficult to adhere to complex treatment plans

Question 27

Resources to combat homelessness - public

Answer 27

- McKinney-Vento Homeless Act - US Department of Housing and Urban Development (HUD) - Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH)

Question 28

Resources to Combat Homelessness - Private

Answer 28

- Effort made to organize communities against homelessness by forming coalitions, alliances, and memberships

Question 29

Role of Community/Public Health Nurses

Answer 29

- Comprehensive and holistic approach - Primary Prevention: advocating for affordable housing, employment opportunities, and better access to health care. - Secondary: early detection and treatment of adverse health conditions - Tertiary: attempt to limit disability and restore maximum function As a nurse: - no bias - seek homeless out - be trustworthy

Question 30

Definition of Rural

Answer 30

- US Department of Agriculture - Nonmetropolitan area as a combination of: * Open countryside * Towns fewer than 2,500 residents * Urban areas with 2,500 to 49,999 residents - Text * Communities with fewer than 10,000 residents and country population density < 1,000 person/square mile

Question 31

Frontier area - Varied Definitions

Answer 31

- Sparsely populated, < 6 people per square mile - > 60 miles/minutes to nearest 75 bed hospital - level based on good/services available - health issues increased by: * health professional shortage areas * Medically underserved area * Medically underserved populations

Question 32

Population characteristics

Answer 32

- 16% of population is rural areas - lower poverty rates, less likely to have bachelors degree - decreased access to broadband - higher % of elderly and chronic illness - poor access to health care

Question 33

Rural Health Issues

Answer 33

- Built environment - barriers to health care access - major health problems: * Cardiovascular disease, diabetes, COPD

Question 34

Approaches to Improve Health Care Access in Rural Areas

Answer 34

- insurance, managed care, and health care services: * Fee for service * Use of family practice clinics * Rural health clinics - Faith-based nursing - Mobile health clinics - School based clinics - Telehealth

Question 35

Role of C/PHN in Rural Setting

Answer 35

- advocate - coordinator/case manager - health teacher - referral agent - mentor - change agent/researcher - collaborator - activist

Question 36

Migrant Lifestyle

Answer 36

Migrant- person who moves from one place to another usually to find work or better living conditions Demographics - Mobile population; 33% are U.S. citizens, mostly male; rely on farm labor for survival Lifestyle - Many are unauthorized or illegal immigrants - Afflicted by poverty, poor nutrition, substandard housing, extended working hours, grueling/unsafe working conditions - Varied economic, cultural, and language barriers

Question 37

Health problems and issues in the migrant population

Answer 37

``` Most common diagnoses include hypertension, diabetes, otitis media, depression/mode disorders Occupational hazards Pesticide exposure Substandard housing, crowding Poor sanitation Poor nutrition, overweight, obesity Risks to social, emotional, and behavioral health Intimate partner violence Infectious diseases ```

Question 38

Methods to improve health care in the migrant community

Answer 38

Improving existing services Advocating and networking - Migrant education programs Utilizing unique methods of health care delivery - Mobile health vans with bilingual nurses - Peer-led health instruction/coaching via charlas Improved health data information systems Practicing cultural sensitivity Using lay personnel for community outreach

Question 39

Community health nursing in Urban areas

Answer 39

Benefits - Higher salaries - More opportunities for advancement, education - More nurses, schools of nursing, recruitment - Diverse work settings Roles: advocate, collaborator, educator, partner, policy-maker, and researcher Self-assessment Improving access Strengthening communities