Vulnerable Populations 8/30 Flashcards
Core concept of health?
-Good, fair, poor
-Demographics: age, sex, race, current and past condition
-Societal, economic conditions, geographical location, environmental effects
-Wellness, illness, disease, disability, and functioning
Major paradigms (examples) in concepts of health:
-Wellness - illness spectrum perspective
-high level wellness -> depletion of health
-quality of level -> disability, adaptation, loss of functions
-ongoing outcome of interactions between person and environment; complex biologic and social system
Developmental models of health:
-Social ecological model, includes view of individual, family, community, society
-Social determinants of health
-Adaptation and flourishing (self-actualization)
-Foundation for healthy people 2020/2030
Meaning of health:
-Philosophy of care (health promotion, health maintenance)
-System of care (health care delivery)
-Practice of care (evidence-based practice)
-Behaviors (personal health behaviors)
-Costs (health care costs)
-Insurance (Uninsured healthcare)
Historical Perspective: Before 1940
-Health = absence of disease
-infectious diseases prominent
-Physician: independent primary practitioner
-Government: start public health/welfare
Historical Perspective: 1940 to 1950s
-Health = ability to fulfill roles
-Physical for fitness
-Physicians linked to hospital services
-Increased federal role: hospital expansion, federal programs
Historical Perspective: 1960s to present
-Health = adaptation to environment
-Disease prevention/health promotion
-Emphasis on individual responsibility/lifestyle choices
-Advance practice nurses became health providers
-Government: control costs
-Quality of life seen as component of health
-Person/family perception important
-Person-centered care
Models of Health: Clinical
Absence sign/symptoms disease; prevention not emphasized
Models of Health: Role performance
Health based on whether person can perform societal roles
Models of Health: Adaptive
Ability to adapt positively to change
Models of Health: Eudaimonistic model
Exuberant well-being: interaction and interrelationships in multiple aspects of life; interdisciplinary focus
Eudaimonistic
a system of ethics that bases moral value on the likelihood that good actions will produce happiness.
Eudaimonistic model
-Aspects predate clinical model
-Congruent with integrative modes of therapy
-Address more complementary and alternative medicine (CAM)
-Health is more broadly defined and can encompass more individuals and more diverse life circumstances
High-Level Wellness
-Wellness is positive state with increases in health beyond midpoint continuum
-Dunn (1961) expanded concept of health to include favorability of environment
-Progression toward a higher level of functioning
-Emphasizes interrelationship between environment and health on personal and societal level
Health Ecology
-Interconnection of people with physical/social environments
-Gordon’s functional health patterns
-Multidimensional - extending from person -> community -> society
-Systems approach - one aspect of the system can affect other aspects of the system
Key Health Concepts: Functioning
Level reflected in terms of performance/social expectations; loss is indicator of need for nursing intervention
Key Health Concepts: Health
-State of physical, mental, spiritual, and social functioning within developmental context
-Both individual and societal responsibility
Key Health Concepts: Disease
-Failure of adaptive mechanisms
-Results in functional or structural disturbances
Key Health Concepts: Illness
Subjective experience of individual and physical manifestation of disease– psychological, spiritual, and social components
Planning for Health
-Previous focus was disease prevention
-Over past 30 years promotion of health has become the driving force
-Healthy people initiative started in 1979 by US Department of Health, Education, and Welfare
-Call to action to set goals for next 10 years
-Interest became weaker during 1980s
-Healthy People 2000–renewed interest–became landmark document (initiated 1990)
Healthy People Initiative: Healthy People 2000
-Increase the span of healthy life
-Reduce health disparities
-Create access to prevention services for all
-Set 22 areas of achievement but by 1995, 30% of the goals lacked progress, worsened, or lacked data
Healthy People Initiative: Healthy People 2010
-Increase quality and years of healthy life
-Eliminate health disparities
-23% of objectives met, 48% showed progress, 24% worse, 5% no change
Healthy People Initiative: Healthy People 2020
-National Guidelines to Promote Health
-Define national emphasis for health-promotion and disease prevention efforts
Healthy People 2020 Four overarching goals
-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
Healthy People 2030
-Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury, and premature death
-Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being for all
-Create social, physical, and economic environments that promote attaining full potential for health and well-being for all
-Promote healthy development, healthy behaviors, and well-being across all life stages
-Engage leadership, key constituents, and the public across multiple sectors to take actions and design policies that improve the health and well being of all
Primordial Prevention
-Newer level of prevention
-Original three levels developed in 1945s to 1950s
-Reflects policy-level intervention
-Aimed at affecting health before at-risk lifestyle behaviors are adopted
-Occurs at national, state, community levels
-Examples: healthy eating school-based programs, reduction of sodium in food supply, creating bike/walking paths
Primary Prevention
-Precedes disease/dysfunction
-Interventions–health protection
-Health promotion (ex education
-Specific protection (ex immunization, reducing exposure to carcinogens, occupational hazards)
-Focus: maintain/improve general individual/family/community health
-Passive–not personally involved
-Public health efforts–clean water/sewer
-Active–personally involved
-Lifestyle changes
Secondary Prevention
-Screening
-Goal: identify individuals in early, detectable stage of disease
-Treating early stages of disease
-Limiting disability
-Interventions similar to primary prevention but applied to individuals/ populations with disease
Tertiary Prevention
-Defect/disability permanent or irreversible (ex stroke)
-Minimizing effect to prevent complications/deterioration
-Objective: return to useful place in society, maximize remaining capacity
-Example: stroke patient
-Rehabilitate to highest level of function
-Teach lifestyle changes to prevent future strokes
-Prevent complications of stroke
Quaternary Prevention
-Address over medicalization of care recipients
-Prevention of doing harm from
-Over diagnosing
-Over treating
-Engage in ethical, socially responsible decisions with patients as patients as partners in care
Nurses Role
-Advocate
-Case manager
-Consultant
-Deliverer of services
-Educator
-Healer
-Researcher
Improving Prospects for Health: Population effects
-Increased diversity
-Changes in age distribution (older population)
-Health-promotion approaches may need to adapt
Improving Prospects for Health: Shifting problems
-Environmental pollution
-Stress
-Lifestyle (obesity, substance abuse)
-Increase in chronic conditions
Improving Prospects for Health: Moving toward solutions
-Individual involvement (lifestyle changes, motivation)
-Governmental involvement (legislation and financing)
Data show racial and ethnic minorities compared with whites/caucasian have:
-less access to healthcare
-receive lower quality health care
-higher rates of illness, injury, premature death
-disparities associated with many factors outside person’s control
Vulnerable Populations experience disparities to health care access:
-Cultural needs
-Language barriers
-Discrimination
-Racism
-Lack of financial resources
-Loss of access to full range of primordial and primary prevention
Culture and Language may have impact on people’s:
-Health
-Healing
-Wellness belief systems
-Perceived causes of illness and disease
-Behaviors of seeking health care
-Attitudes towards health care providers
-Cultural and linguistic competency is one of the major elements in eliminating health disparities
Folk healing practices
-Reflected beliefs, values, treatment of cultural group
-Unlicensed: lay midwives, herbalists, spiritualists
Nurses must avoid ethnocentrism:
-Viewing other ways as inferior or unnatural
-Obstacle in therapeutic provider-patient relationships
Holistic approach:
-Incorporates family and support and system in care
-Considers patient viewpoint
Arab Americans Health Concerns:
-Adult-onset diabetes mellitus
-Coronary artery disease
-Role of acculturation
-Mental health
-Teenage smoking
Again Americans Health Concerns:
-Hesitancy to seek early diagnosis/screening
-Higher rate of tuberculosis
-Mental health problems due to adjustment issues
-Lower rate of obesity, hypertension
Native Hawaiians and Pacific Islanders Health Concerns:
-Cancer
-Heart disease
-Stroke
-Diabetes
Latino and Hispanic Americans Health Concerns:
-Cardiovascular disease
-Cancer
-Unintentional injuries
-Stroke
-Diabetes mellitus
Black African Americans Health Concerns:
-Cancer deaths
-Hypertension
-HIV/AIDS
-Obesity
-Diabetes
American Indians and Alaskan Natives Health Concerns:
-Linked to social and economic conditions
-Smoking, substance abuse
-Deaths: unintentional injuries, liver disease, cancer, suicide, pneumonia, diabetes, stroke
Homeless Health Concerns:
-Basic survival issues
-Pneumonia, TB, HIV diseases are widespread
-Dental and vision problems
-Mental health issues significant contributing factor
-Substance abuse: both cause and consequence
American Nurses Association (ANA)
-ANA code of ethics
-Commitment to provide service regardless of background or situation
-Nurses are responsible to provide for culturally competent care
-ANA sponsored Ethnic-Minority Fellowship Program to support minority health
