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NRSG111 - Foundations of Health > Module 5: Key Populations and Healthcare Challenges > Flashcards

Module 5: Key Populations and Healthcare Challenges Flashcards

1
Q

CHN is an abbreviation for what type of nurse?

A

Community health nurse

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2
Q

What is your understanding of structural vulnerability and who is impacted by structural vulnerabilities (with examples)?

A

Structural vulnerability is risks for negative health outcomes because of the interface of socioeconomic, political, and societal hierarchies of dominance and oppression

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3
Q

Define health disparities

A

Health disparities are wide variations in health services and health status among certain populations defined by specific characteristics

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4
Q

define structural violence

A

Experiences of unequal power, restricted access to resources, and oppression from a system-level approach resulting in the denial of basic needs are referred to as structural violence

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5
Q

name some practices that can be used to mitigate against structural violence

A

Practices such as harm reduction and trauma-informed care, and policy are some of the vehicles used to mitigate structural harms to both individuals and communities.

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6
Q

describe trauma-informed practice

A

Trauma informed care is an approach that recognizes the impacts of previous violent arid traumatic events on current health and mental health situations. This approach concentrates on relationship building, engagement and choice; awareness; and skills building across individual, interpersonal, and system levels of health service. As was discussed in Chapter 14, a key aspect of trauma-informed practice is understanding how trauma can be experienced differently by different populations

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7
Q

define resiliency

A

Resiliency refers to the capacity of people, communities, and organizations to cope effectively when faced with considerable adversity or risk. It is not simply a matter of resources

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8
Q

would adding extended funds/ resources to a struggling community increase resiliency? why or why not?

A

It would not help much because resiliency it is helping the community or individual on educate themselves on how to best utilize the resources they have at the moment.

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9
Q

define poverty, absolute poverty, relative poverty and subjective poverty

A

absolute poverty (life threatening), relative poverty (deprivation in relation to what others have), subjective poverty (perception that there is insufficient funds to meet needs)

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10
Q

what is Canada’s poverty line and what does LICO mean?

A

Canada, in contrast to the United States, does not have an official poverty line. Instead, Canadian researchers use Statistics Canada’s before-tax low income cut-offs, or LICOs, to determine poverty status. LICOs are “income thresholds below which a family will likely devote a larger share of its income on the necessities of food, shelter and clothing than: the average family

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11
Q

what is the impact of poverty on children?

A

Poverty affects child growth, development, and well-being in ways such as increased chronic illness and accidental injury, as well as low birth weight, and decreased language acquisition and reading development. Poverty also leads to longer-term problems with diet and mental health

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12
Q

what is hidden homelessness in relation to women and domestic violence

A

Many women experience what is referred to as hidden homelessness because they prefer to avoid the shelter system and the streets, even if it means staying in dangerous situations. Including ones where there is domestic violence.

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13
Q

Note the factors contributing to homelessness

A
  • Lack of affordable housing
  • Low income or poverty
  • Mental heath issues
  • Substance use unemployment or underemployment
  • Immigration
  • Violence and criminal history
  • Family conflict
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14
Q

What are community foundations

A

charitable organizations dedicated to improvising communities in specific geographical areas

(E.g. Central Okanagan Foundation pools charitable gifts of donors to create endowment funds and using the investment income to make grants)

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15
Q

What does PiT count coordinator work for

A

plan and implement the Kelowna PiT count, in consultation with the PiT Count Committee
- counts the homeless populations; estimate of people experiencing homelessness in a community on a single night to better understand that population

3 datasheets: tally, survey, and systems data
- enumerations
- surveys
- systems data
- PiT Count Data

BC Provincial initiated response housing rather than federal

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16
Q

3 types of homeless

A

1) ‘system’ sheltered homeless
: emergency shelter, domestic violence shelter, hotel/ motel, temporary, transitional

2) Unsheltered/absolute homeless
: vehicles, encampments, designated outdoor sheltering sites

3) Hidden homeless
: typically sheltered with associations, friends or family on a day-to-day short-term temporary basis

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17
Q

Committee of PiT

A

To develop and support the point in time count and provide excellence in data collection to inform homeless serving systems in compassionate ways

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18
Q

Principles of PiT

A

Accuracy: must leverage every resource to accurately tally those experiencing homelessness

Compassion: listen and respond to info and experience carefully

Value: must produce value for those in service, and real change for those experiencing homelessness

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19
Q

Why does language matter?

A

To avoid further stigmatization or marginalizing of others

Vulnerable Populations or Populations at Risk = Key Populations or Priority Populations
Addict = Person with Substance Use
Former Addict = Person in Recovery
Lapse or Relapse or Slip = Experienced a Recurrence or Resumed
At risk = generally affordability related
Provisionally Accommodated = living with others, short-term rental, institutional care
Emergency Sheltered = ex. Gospel mission and Kelowna Women’s shelter
Unsheltered = public space, vehicles

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20
Q

Who is at greatest risk of health conditions?

A

Exclusion
Barriers related to access of dependency
SDOH: socioeconomic status, literacy, social inclusion or exclusion

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21
Q

High priority populations?

A

People who are in:

Poverty and homelessness
Abusive relationships
Chronic conditions and disability
High risk behaviours

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22
Q

What are key populations?

A

Key populations are those populations that are more likely to experience health problems
as a result of:

Excessive risk taking
Barriers when attempting to access health care
Dependent on others for care

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23
Q

What are the Social Determinants for Health that are most impactful and create vulnerabilities in key populations?

A

poverty, literacy, social inclusion

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24
Q

What are the types of homelessness?

A

Absolute homelessness
Sheltered homelessness
Hidden homelessness

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25
Q

What is absolute homelessness?

A

Refers to those that are perpetually homeless, sometimes referred to as chronic homelessness

  • May be experiencing mental or physical challenges
  • Mental or physical challenges may coexist with substance use, severe mental illness, chronic health problems, chronic family difficulties
  • Lack money and family support
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26
Q

What is sheltered homelessness?

A

Regular or occasional use of shelters for sleeping

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27
Q

What is hidden homelessness?

A

Sleeping in vehicles, couch surfing (temporary transient poverty)

  • Lives are generally marked by hardships
  • Homelessness is often transient or episodic
  • Living in places not fit for habitation
  • Due to job loss, domestic violence, lack of employment opportunities, choice
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28
Q

What are contributing factors leading to homelessness?

A
  • Lack of affordable housing
  • Low income or poverty
  • Mental health
  • Substance use
  • Unemployment or underemployment
  • Immigration
  • Violence and criminal history
  • Family conflict

Underemployment – working many jobs.
Minimum wage not enough for housing. Even though jobs are available.
Holding a job.
Newly immigrated – at first report great health….this slowly erodes and within months report less healthy.
Women big part of homeless due to bad (violent) situations at home. Or they stay in violent situations and are the hidden homeless.
Also called houseless – not homeless because the street may be their home.

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29
Q

What is the leading factor leading to homelessness?

A

Poverty (absolute poverty, relative poverty, subjective poverty)

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30
Q

What is poverty?

A

Refers to having insufficient financial resources to meet basic living expenses: food, shelter, clothing, transportation and medical expenses

1) absolute poverty - deprivation of resources that is life threatening
2) relative poverty - deprivation in relation to others that have more
3) perception that there is sufficient funds to meet needs

the mentioned article
: 7.6 % “working poor” - jobs but poor hours, not stable, unpredictable hours, few benefits

31
Q

What aspects of poor overall health might populations experiencing homelessness be more susceptible to?

A

High levels of morbidity and mortality
Alcohol and illicit drug use
Infectious diseases (HIV/AIDS, Hepatitis C, TB)
Chronic health problems

32
Q

Morbidity vs Mortality

A

Morbidityrefers to any condition that isn’t healthy.Mortalityrefers to death.

33
Q

What is co-morbidity?

A

Co-morbidity means that a person has more than one illness. Co-morbid conditions don’t always have the same cause, but they may occur together and worsen each other.

For example,obesity,depression, anddiabetesare often co-morbid. But these health conditions don’t necessarily have the same cause.

34
Q

What is the difference between mental illness and mental health

A

Remember that mental health and mental illness are different – mental health is much like physical health. Mental illness is can defined broadly or specifically dependent on the need for the diagnosis. Mental health policy is spaced by the definition so a broad definition meets the needs best for putting resources in place.

Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and an ability to adapt to change and to cope with adversity. …Mental illness is the term that refers collectively to all diagnosable mental disorders. Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning (pp. 4–5)

35
Q

How does mental illness affect youth?

A
  • 15-34 2nd leading cause of death is suicide
  • Approximately 20% of Canadian youth are affected by mental illness/disorder
  • 11% of 15-24 year olds depressed
  • ⅕ children get help for mental illness
  • Systemic inequalities can affect racism
36
Q

What population/group is considered to be the fastest growing in Canada?

A

Youth between ages 16-24 are considered to be the fastest growing segment of the population experiencing homelessness in Canada

37
Q

What are the barriers preventing youth from finding shelter?

A
  • Many landlords will not rent to youth on welfare
  • Alternative and affordable housing option are viewed as unsafe
  • Domain of adults
  • Youth who engage in substance use are disadvantaged as many shelters require abstinence
38
Q

What mental health challenges might homeless youth face?

A
  • Depression
  • PTSD - requires trauma informed practice (TIP) where you have to understand the experienced trauma
  • Suicidal thoughts and behaviours
  • Mortality is 11-40 times higher than that of the general population of the same age
  • Leading causes of death = suicide and drug overdose
39
Q

In what state are homeless youth constantly in? (mode)

A

Constantly in survival mode

Youth who have grown up in unsupportive, neglectful or abusive family environments may resort to homelessness as an escape from their adverse living situations. Once on the street, they may be more susceptible to negative influences, as they have not developed the social support, coping skills or resources to protect them from adverse health consequences (phac2006b; Tyler 2006; Tyler et al. 2004). In one qualitative study, many participants reported parental substance misuse and criminal activity (Tyler 2006). Childhood abuse and neglect are also identified as primary reasons for leaving home (Ringwalt, Greene and Robertson 1998; Tyler 2006).

40
Q

What is conduct disorder?

A

Conduct disorder(CD) is a mentaldisorderdiagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated. These behaviors are often referred to as “antisocial behaviors.“

Conduct disorder is asevere condition characterized by hostile and sometimes physically violent behavior and a disregardforothers.Children withCD exhibit cruelty, from early pushing, hitting and biting to, later, more than normal teasing and bullying, hurting animals, picking fights, theft, vandalism, and arson.

41
Q

How do:

depressive symptoms
conduct disorder
substance abuse

affect sexual health in homeless youth?

A

Depressive Symptoms: are a risk factor for sex trading among homeless youth

Conduct Disorder: is associated with a range of high-risk behaviours including sex trading, multiple sexual partners, and drug use (to numb); disorder developed in childhood

Substance Abuse: will increase the odds of engaging in survival sex

42
Q

What is survival sex?

A

Survival sexis a form prostitution engaged in by a person because of their extreme need. It describes the practice of people who are homeless or otherwise disadvantaged in society, tradingsexfor food, a place to sleep, or other basic needs, or for drugs.

43
Q

Poor Sexual Health Risk and Behaviours: female homeless youth are more likely to report:

A
  • childhood sexual abuse and sexual victimization– this can lead to homelessness and can happen while homeless – vicious cycle
  • low in relationship power
44
Q

Poor Sexual Health Risk and Behaviours: male homeless youth are more likely to be:

A
  • identify as gay or bisexual
45
Q

What poor sexual health risk and behaviours do homeless youth experience:

A

All homeless youth:
- engage in more unprotected sex with a higher number of partners
- engage in sexual activity with high-risk sexual partners (STIs)
- have higher STI prevalence
- less likely to report consistent condom use
- more likely to report sex trading
- more likely to report having had a sexual partner with STI history

46
Q

What are the stages of street exiting?

A

Stages of Street Exiting: (TTM)

Precipitating factor - experiencing a traumatic event, experiencing boredom in street life, etc

Courage to change - increased responsibilities, having family or friend support, being motivated and committed, etc

Seeking support - using services, searching for jobs/apartment, etc

Transitioning - increase in self-esteem, missing street life, slowly cutting ties to street culture, etc

Restructuring/Change in routine - employment, school, apartment, happier, healthier, more driven, etc

Successful exiting - having stability, being in control, feeling proud, being able to take care of themselves. increase in self-esteem, etc

47
Q

What affects do Mental Health Challenges and Drug Use result in or affect Poor Oral Health Care?

A
  • A chaotic lifestyle
  • Low priority for oral healthcare
  • Cravings for sugar and tobacco
  • Dry mouth is aside effect of many medications used to treat mental health challenges
  • Homelessness individuals are at greater risks of trauma to the mouth and teeth

Frequent substance use can suppress dental pain and therefore mask awareness of dental problems which explains why the self-assessed need for dental care is usually low in this population

Mental health and Drug Addiction and Homelessness – big issues with dental care. Dental care is so important. Poor dental care = systemic bacteria
Trauma leading to dental issues.
Linked to health cancer and diabetes.

48
Q

What challenges are present that might bar homeless people from seeking dental care?

A
  • High levels of dental anxiety
  • Chaotic lifestyle - keeping appointments is a challenge
  • A wide gulf of distrust between people living in poverty and the system of dental care around them
  • A perception among homeless people that dentists will not accept them as patients
  • Being very critical of dentists
  • Prefer community dental clinics rather than private dental practices
49
Q

What is mental health?

A

Positive mental health and well-being;

Mental health is more than the absence of mental health condition or illness; it is a positive sense of well-being, or the capacity to enjoy life or deal with the challenges we face

  • Mental health impacts each and every one of us. We all have mental health, just as well all have physical health
50
Q

Mental health continuum

A

From positive and functioning/flourishing in life to languishing/severe mental illness causing distress

mental health disorder or an overall distressed state is referred to as ‘languishing,’ whereas, a more positive and content state is called ‘flourishing.’

Minimum and Maximum Mental Illness
Minimal and Optimal Mental Well-being

4 Quadrants:

Minimum Mental Illness (+) and Optimal Mental Well-being (+) (BEST):
-ideal state of functioning where person experiences happiness with no mental illness

Minimum Mental Illness (+) and Minimal Mental Well-being (-):
-subjective of grief or unhappiness that a person experiences in the absence of any noticeable mental health disorder

Maximum Mental Illness (-) and Optimal Mental Well-being (+):
-individuals have a high sense of subjective well-being despite suffering from a mental illness

Maximum Mental Illness (-) and Minimal Mental Well-being (-) (WORST):
-lowest level of functioning where a person feels languishing and has significant mental illness

51
Q

What is stigma?

A

Stigma: a mark of disgrace associated with a particular circumstance, quality , or person. Stigmatization results in either:

Enacted Stigma: Where individuals are actively discriminated against

Perceived or Felt Stigma: Where stigmatized individuals internalize negative beliefs

52
Q

What are the 5 components of mental health?

A
  1. Ability to enjoy life
    2.Dealing with life’s events
  2. Emotional well-being
  3. Spiritual well-being
  4. Social connections and respect for culture, equity, social justice, and personal dignity
53
Q

What is harm reduction and its focuses?

A

An umbrella term for programs, policies, and practices that aim to reduce the negative consequences associated with behaviours that are typically considered high risk

Focused on increasing safety and minimizing injury, disease and death related to behaviours typically considered high risk

54
Q

What is Trauma?

A

Trauma can be defined as experiences that overwhelm an individual’s capacity to cope.

55
Q

What are the influences/causes of trauma?

A

Influencers: magnitude, complexity, frequency, duration, and whether it comes from an interpersonal or external source

Trauma is not only caused by big catastrophes and single events, it can be caused by everyday occurrences such as sexual harassment or bullying

56
Q

ACE - Adverse childhood experiences

A
57
Q

What are nurses roles in healthcare? (7)

A

Nurses Role in Health Care:

  • Advocacy
  • Awareness– marginalized groups
  • Knowledge of the healthcare system and how to help
  • Creating safe space
  • Outreach resources, street level nursing
  • Policy development (change happens upstream), political
  • Research
58
Q

How can we create safe spaces?

A

Through advocacy, awareness and knowledge we can learn and improve the nursing profession

Do NOT be the expert – practice with cultural humility and safety

Implement trauma informed practice and harm reduction

59
Q
A
60
Q

who are the people considered in the high-priority populations?

A

persons with no fixed address are more likely to..

  • be impacted by SDOH- live and work in high-risk environments, less safe/ secure food access, experience inequities from universal healthcare (extended coverage)
  • have limited access to transportation and childcare
  • have increased stress, incidents of MH challenges and addictions (leading to substance use)

This all impacts access to disease prevention strategies, worsening health challenges

61
Q

How can you describe the poor overall health of populations experiencing homelessness

A
  • High levels of morbidity and mortality

morbidity vs. mortality

  • high levels of alcohol and illicit drug use
  • high levels of infectious diseases (HIV/AIDS, hepatitis C, TB)
  • high levels of mental illness (stats next slide)
  • chronic health problems
    (diabetes, cardiovascular disease, respiratory illness
62
Q

How does mental illness impact youth?

A
  • 15-34 2nd leading cause of death is suicide
  • app 20% of Canadian youth are affected by mental illness/ disorder
  • 11% of 15-24 year olds depressed
  • 1/5 children get help from mental illness
  • systemic inequalities can affect racism

Youth between ages 16-24 are considered to be the fastest growing segment of the population experiencing homelessness in Canada

63
Q

Who is affected by mental health issues?

A

mental health stats:

  • 1 in 5 people in Canada will personally experience a mental health problem or illness
  • by age 40, about 50% of the population will have or have had a mental illness
  • mental illness affects people of all ages, education, income levels, and cultures:
    => however, systemic inequalities such as racism, poverty, homelessness, discrimination, colonial and gender-based violence, among others can worsen mental health and symptoms of mental illness, especially if mental health supports are difficult to access
  • major depression affects app 5.4% of the Canadian population, and anxiety disorders affect 4.6% of the population
64
Q

Maslow’s Hierarchy of Needs

A

From the bottom to the superficial
1) physiological: breathing, food, water, sex, sleep, homeostasis, excretion
2) Safety: security of body, of employment, of resources, of morality, of the family, of health, of property
3) Love/ belonging: friendship, family, sexual intimacy
4) Esteem: self-esteem, confidence, achievement, respect of others, respect by others
5) self-actualization: morality, creativity, spontaneity, problem-solving, lack of prejudices, acceptance of facts

64
Q

Remember not to misunderstand and label the behaviours and responses of those with trauma experiences in stigmatizing and deficit-based ways

A

Unfortunately, the behaviours and responses of those with trauma experiences are often misunderstood and labelled in stigmatizing and deficit-based ways (e.g., something is missing or wrong with the individual).

All staff play an important role in offering another way of understanding responses as normal attempts to cope and adapt to the overwhelming impact of trauma. This reframing serves to empower individuals and de-stigmatize their experience.

65
Q

The trans-theoretical model of change

A

“I have never considered this behaviour before”

1) Pre-contemplation: no recognition of the need for or interest in change
=> “I have never considered this behaviour before”

2) Contemplation: thinking about changing
=> “I have started to consider carrying out this behaviour”

3) preparation: Planning for change
=> “I will try out this behaviour soon”

4) Action: adapting new habits
=> “I have started adopting this new behaviour”

5) Maintenance: ongoing practice of new, healthier behaviour
=> “I carry out this behaviour regularly”

66
Q

Trauma Informed Practice

A

Substance + Mental Illness + Violence = Trauma

The strong link that exists between trauma and substance use means that clients accessing services will have improved outcomes with a trauma-informed approach.

Trauma can be experienced differently by specific populations, such as women, men, children, aboriginal peoples or refugees.

67
Q

The tips to consider when engaging in client interactions

A

1) remember that there is a common connection between substance use and trauma
2) recognize the range of response people can have to certain situations
3) remember that the development of trusting relationships can be difficult for people who have experienced trauma - it takes time
4) Disclosure of trauma is not required - treat all clients in a way that creates safety and understanding with the awareness that it is possible, perhaps likely, that a person has experienced trauma
5) learn to recognize when someone might be responding to the effects of their trauma
6) Working in a trauma-informed way requires a shift in thinking and language

67
Q

Importance of Language

A

Uses the word of person - do not determine the person with the condition
1) “Use people-first language”
(good) a person who uses opioids
(bad) opioid user OR addict
=> e.g. person experiencing homelessness, substance use

2) Use language that reflects the medical nature of substance use disorders
(good) a person experiencing problems with substance use
(bad) abuser or junkie

3) Use language that promotes recovery
(good) a person experiencing barriers to accessing services
(bad) unmotivated or non-compliant

4) Avoid slang and idioms
(good) positive test results or negative test results
(bad) dirty test results or clean test results

68
Q

What is Canada doing about homelessness?

A

Canada’s homelessness strategy (prevent & reduce homelessness)
=> outcomes-based
=> knowledge
=> safe & affordable housing

69
Q

What is Canada doing about homelessness? (Outcomes-based)

A

=> Outcomes-based
- community-specific needs
- current and comprehensive access

70
Q

What is Canada doing about homelessness? (Knowledge)

A

Knowledge
- immediate access to HCP
- Resources
- Public knowledge

71
Q

What is Canada doing about homelessness? (Safe & affordable housing)

A
  1. immediate access
  2. consumer choice
  3. recovery-oriented
  4. individualized
  5. social/ community integration

NRSG111 - Foundations of Health (6 decks)

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