Module 3 (Ch. 23, 26, 27) Flashcards
Working with vulnerable populations
- Vulnerability
- Socioeconomic resources
- Human vs Social vs Environmental
- Relative Risk
Human Capital
Jobs, income, knowledge, housing, skills
Social Capital
people you have around you (social ties)
Environmental
Access to and quality of health care
Who is considered vulnerable?
- 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
Factors that are related to vulnerability - Poverty
Stress; leads to unhealthy choices (smoking, drinking, etc)
Factors related to vulnerability - uninsured/underinsured
less likely to go to the doctor and then it leads to more medical bills in the future
factors related to vulnerability - Race/ethnicity
HIV, preterm birth, infant mortality, heart failure, and hypertension
Social Determinants of health
everything around you; education, health care environment, social/community, economic/income
Socioeconomic gradient of health
Adequate resources your health will be better
Inequality in health care - health disparities
Access to care quality of care cultural barriers quantity of disease burden of disease adverse health conditions
Role of community/public health nurses
Empowerment
facilitating external support
using evidence to reduce vulnerability
- improvement of:
* Health literacy
* Access to nursing services
* Health and public policyU.S. Department of Housing and Urban Development - Homeless
Those living on the streets, in vehicles, in shelters or transitional housing, or facing immanent eviction.
Definition McKinney-Vento Homeless Assistance Act - Homeless
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.
Scope of the problem (Homelessness)
Point in time - number on a specific night at a specific time
Period Prevalence - Prevalence measured over time.
Homelessness Demographic Characteristics
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
Predisposing Factors
- Poverty
- Lack of affordable health care
- employment
- domestic violence
- mental illness
- addiction disorders
Subpopulations of homelessness- men
Single, chronically homeless, more likely to be treated with disdain
Homeless subpopulations - women
lead most homeless families as a single parent, caused by domestic violence
homeless subpopulations - children
more likely to become ill, experience emotional/behavioral disorders, have development delays and learning disabilities. Have compromised educations.
1 in 30 children are homeless
Homeless subpopulations - youth
run away or evicted by parents, resort to survival sex (sex for money)
homeless subpopulations - veterans
9% of homeless adults, US department of Veteran Affairs working to end
Homeless subpopulations - rural
likely to be living in cars, standard housing, or “ doubling up”
Homeless subpopulations - Older adults
4.7% 62 y/o, live on a fixed income
Homeless subpopulations - LGBTQ
may experience difficulty finding accepting shelters, more likely to be victim of violence, abuse or exploitations (also use survival sex)
Health care and the homeless
- HIV/AIDS, diabetes, and heart disease are 3-6 times more prevalent
- Higher rates of oral disease
- Difficult to adhere to complex treatment plans
Resources to combat homelessness - public
- McKinney-Vento Homeless Act
- US Department of Housing and Urban Development (HUD)
- Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH)
Resources to Combat Homelessness - Private
- Effort made to organize communities against homelessness by forming coalitions, alliances, and memberships
Role of Community/Public Health Nurses
- 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
Definition of Rural
- 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
Frontier area - Varied Definitions
- 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
Population characteristics
- 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
Rural Health Issues
- Built environment
- barriers to health care access
- major health problems:
- Cardiovascular disease, diabetes, COPD
Approaches to Improve Health Care Access in Rural Areas
- 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
Role of C/PHN in Rural Setting
- advocate
- coordinator/case manager
- health teacher
- referral agent
- mentor
- change agent/researcher
- collaborator
- activist
Migrant Lifestyle
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
Health problems and issues in the migrant population
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
Methods to improve health care in the migrant community
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
Community health nursing in Urban areas
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
