Vulnerability

Assessment

- Healthy People 2020- began in the 1990s - FOCUS: improve the health of all Americans - Developed to reverse disparities - Significant and preventable threats to health are identified - New plan is developed every 10 years - Looks at major issues that effect the health of the population - Indicators are developed to help assess the population - The target 100% of people across the country are insured; only 80% are actually covered right now - 49% are insured for dental care - Indicators to reduce HIV infections in adults and teenagers - Positive parenting for parents with children under the age of 3 - DON'T NEED TO KNOW PERCENTAGES OR INDICATORS

Socioeconomic issues

- Job or Problems with Employment- these are individuals who are not promoted or not receive a raise - All of these cause a lot of stress in their life - Cant pay their bills and do not make enough money - Vulnerable individuals - Difficulty paying their bills - Job may be very boring, not getting satisfaction out of employment can make them frustrated and angry or they may be apathetic and just don't care - their job causes them a lot of stress which leads to them not going to work and unemployment

Factors to Assess

- Physical Health- this is a priority - Assess the physical health of the individual - Always remember Maslow's Hierarchy of needs - Bottom layer (basic needs) must be addressed before any other issues that are impacting them can be managed - Chronic conditions must be addressed - Obesity, smoking, limited activity, poor hygiene and nutrition

The outcomes of vulnerability

- Poor health creates stress - Managing their poor health without adequate resources - More stressed a person is and the longer the stress continues their coping decreases - This will lead them to develop feelings of hopelessness - With feelings of hopelessness they will begin to think they are never able to get out of their situation - Feelings of hopelessness lead to feelings of powerlessness - Social isolation will begin to develop - They become more and more withdrawn - Cycle of vulnerability- continuous and it never goes away - Factors that contribute to vulnerability never change and the health outcomes remain poor and they don't see any way out of their situation

Assessment Guidelines

- Set the Stage- we want to make sure whatever room we are assessing the vulnerable person is comfortable and non threatening - Set the stage so they trust you and you're able to develop a therapeutic relationship with them - Be aware of priorities of the individual and their family - Your priorities are not the same as them - Make sure you consider theirs first

Role of the Nurse

- Work with the group, individual, family, community to develop strategies to break the cycle or vulnerability - Give them strategies to overcome factors of vulnerability - Nurse/ client partnership (therapeutic relationship)- referrals and follow-ups, direct care, health teaching, counseling and health coaching, problem solving. - Branching off of the nurse/ client partnership- social services, clinical and physicians offices, medication assistance programs, preventive services, home care, hospital discharge planners - These are all done by using the nursing process- which a subconscious thing

Education

- the last significant component that contributes to vulnerability - Populations are able to have information on how to have a healthy lifestyle - Education language skills impact health literacy

HHS Poverty Guidelines - What does this mean financially for the family?

2009- 22,050 2010-22,050 2011-22,350 2012-23,050 2013-23,550 2014-23,850 $24,250/12 months= $2,020.83 per month $24,250/52 weeks= $466.34 per week • family of four

Vulnerability

Individuals who are more susceptible to the effects of risk factors than the remainder of the population - Who is at risk for illness/disease - Not every person at risk will develop health problems but there is a segment of the population that does EX: we are all risk for hypertension, but not all of us will develop the disease - We want to focus on those that are more susceptible; low threshold, cant fight disease/ any bacteria/fight organism - Equals poor health outcomes

Health Disparities

Those wide variations of health services and health status between population groups these disparities relate to their access, health care, health outcomes and how they all relate to their health outcomes - Due to racial or ethnic variations between groups and the quality of care

Disability

a person who is physically or mentally compromised - they have a chronic condition - this condition impacts their lives in a negative way - chronic conditions may prevent an active lifestyle, occupational or career opportunities, education, prevents performing of self care - is a person who is restricted or inability to perform any activity within a normal range for a human being during a specific age due to some factor

Cumulative Risk

combination of many risk factors; makes them more susceptible for adverse effects of the illness/disease - EX: old age and smoking

Migrant Workers

come to the US seeking employment - They are unable to have adequate jobs back at home so they come here - Send money back home - Employment is minimal and seasonal - Lack language skills, access to healthcare

Federal Poverty Level

condition in which a person or community is deprived of or lacks the essential for a minimum standard of wellbeing and life - Group individual to be at the poverty level- annual family income is less than the poverty line (determined by the federal government) - War on poverty- Linden Johnson - 3X the annual cost of a nutritionally adequate diet; varies by family size and is updated every year

Socioeconomic Issues

does the head of the household have a job - Is their financial state adequate - Are they able to meet the needs of themselves and their families? - Do they have equipment at home that they need? Are they not able to obtain them?

Lifestyle

does the individual smoke, practice safe sex, substance abuser?

Abuse

frustrations one may feel becasue they have a lack of insurance, change of living condition, children moved away, etc. can all cause an individual to abuse substances and those around them

Provider Factors

health care personal who unconsciously has a prejudice or stereotype of individuals - Attitude: those who can afford health care deserve it and those that cannot did this to themselves in some way and its their fault they are unable to attain health insurance

Environment

home assessment is important - Is there an air conditioning, water, noise level, leaded painted walls, smoke detectors, etc? - Does the home of the disabled individual have a ramp for the wheelchair; are they able to get around with a walker? - Does the disabled person fit their environment and does the environment fit - Education is very important - Communities must respond to the needs of the disabled - How to manage the child

Agent

host environment (triangle) - Agent- what causes the vulnerability - Host- who is at risk for illness/disease - Environment- where- external factors that cause vulnerability to happen or allow it to happen

Chronic Disease

illness or disease the person has is life long - Burden contributes to the disability - EX: heart disease, renal failure, traumatic injuries, blindness, deafness, etc.

Clinical Factors

inadequate or a lack of access to health care or an uneven health care that is not the same across the board - May be inappropriate or inadequate access to health care which all leads to poor health

Retirement

individuals income may become a significantly reduced - Social security is minimal compared to what they were making - Lack of insurance due to no longer being employed - Empty nest syndrome - Social issues

Psychological Issues

is the family healthy or dysfunctional due to this - Perception of themselves? Depressed, anxious, are they abused, do they abuse? - Families who are caregivers what kind of stress are they experiencing - Care giver burden - The disabled family, their perception of their child's disability - Positive perception= positive psychological - Negative= psychological issues for the family and the child - Positive perception of themselves they will not have any difficulties fitting into a group - Very important

Feminization of poverty

is the term given to the phenomenon in which women experience poverty at far higher rates than men. This trend is not unique to the United States; however, the United States has lagged behind other industrialized nations in using social policy to combat the tendency for women and their children to find themselves among the ranks of the poor.

Impairment

loss or abnormality of psychology, physiologic or anatomical (function changed that prevents them to perform an activity) - EX: Paralysis of the leg due to a stroke or heart failure

Biological Issues

nurse performing the comprehensive health assessment - Look at family history - Review of systems - Sociological issues - Comprehensive health history - This might be the appropriate time to do a genogram (suffice for family history)

Medically Indigent

people who do not have adequate medical care; uninsured or underinsured (some coverage, high deductibles, high out of pocket expenses) - Uninsured- "the working poor"

Comorbidities

person who has multiple health problems, stresses their immune system and interferes and further alters their functional health status

Health Literacy

persons ability to read, comprehend, respond to and act on the health care information - Looking at racial health care groups, ethnic groups, people with chronic illnesses - So they can change their health care behaviors - Any health care information must be discussed on a 6th-8th grade level with the patient - Look at groups that may have health iliteracy issues and discuss on their level

Developmental Disability

refer to a person who has a mental or physical impairment or a combination of both of them - This impairment - 22 years or younger is considered developmentally disabled- this impairment is lifelong - This is where a person has substantial functional limits or limitations of 3 or more areas of major life activity (self care, language (receptive or recessive), decision making, problem solving, ability to live independently)

Risk Marker

risk factor; non-modifiable or modifiable or modifiable factors that puts people at risk for illness, disease or poor health outcomes - Non-modifiable: gender, race, ethnicity, age - Modifiable: obesity, smoking, hypertension, cardiovascular disease, sedentary lifestyle, substance abuse, domestic violence, economic/social status

Risk

the determinacy that cause individuals to have a higher probability of illness, higher probably of disease and causes them to have poor health outcomes compared to everyone else in the population

Developmental Stifling

the developmental disabilities that occur separate from a physical or mental disability - Refers to parents who stifle or limit the intellectual because they view their child as being more vulnerable than their children really are - The child is unable to grow mentally, socially, etc due to this - Trying to protect and shelter their child - With children who have disability they have every opportunity to live to the fullest

Poverty

the number one cause of vulnerability; without money you have nothing

Differential Vulnerability Hypothesis

the persons who possess multiple cumulative risk factors; they are very sensitive to those risk factors - EX: obese, hypertension, diabetes, heart disease with homeless, malnourished, unemployed, uninsured, etc. - Women especially fall into this category because they don't have as many opportunities that males do or aids

Epidemiology

the study of factors that affect health and illness and populations - Serves as a foundation of public health nursing and public health medicine - Look at all the levels of prevention

Functional Limitation

these people need assistance with care - Person can just not function - These are individual who are unable to perform due to their disability - EX: diminished ability due to their problem, blindness, deafness, loss of strength in upper extremities - Life long care - Can become a very vulnerable person

Unemployment

those who do not have a job - No financial resources - They are considered poor - Without a job and money their living conditions become inadequate and may become homeless

Disadvantaged Populations

those who have minimal resources to promote health and receive health care

Barriers

unable to have transportation, inconvenient times for appointments, language

Social Determinants of Health

what are the causative factors; what determines if the person lives in poverty - Economic status- do they have a job, do they have insurance - Education- what is the educational level? Do they understand what is gong on in their situation? - Environment- Where do they live? Are they homeless? - Nutrition- malnourished - Stress- any kind; Spiritual, social, emotional, prejudice, etc

Family Dynamics

when role change occurs - Single parent who becomes the head of the household - More and more family households are run by women - Must still hold down a job and provide for her family - Causes a lot of stress - Family dynamic stress is then felt by the children

Patient Factors

when the patient mistrusts health care providers - Developing the therapeutic relationship with the patient - Trust is very important for proper health care to be given

Inadequate or Lack of Insurance

without a job they are unable to have health insurance - Job and insurance go hand and hand - Serious issues that are a cause of vulnerability - Inadequate insurance- under insured individuals (the job is unable to give them a full insurance package or they refuse the insurance) - Indigent (medically indigent)- those without insurance - Hard time accessing health care if they do not have insurance - Becomes a problem for those with chronic disease - They do not received appropriate care because they are uninsured