Lesson 17: At-Risk & Vulnerable Populations & Effect on Health

Mitigating Health Risk: Poverty

43 million Americans live in poverty increased risk for disease & premature death - poverty affects well-being & health of individuals Individuals from underrepresented racial & ethnic groups who live in poverty are also predisposed to adverse health outcomes, which can compound health disparities Individuals living in poverty experience: - higher rates of chronic illness, infant morbidity & mortality, shortened life expectancy, complex health problems, complications from chronic conditions, physical limitations from chronic conditions, & increased hospitalization rates Nurses play a key role in increasing the economic mobility of families by advocating for job-training programs & early education programs to help community alleviate negative effects of poverty - nurses should be aware of social assistance resources like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Medicaid programs, & community resources such as food banks & emergency shelters

Nurse Role to Address Poverty

- understand what resources are available for families to address food insecurity and housing insecurity. - learn about state social service programs. - engage in grassroots efforts to address health inequities. - collaborate with other professionals working in the social service sector. - display leadership traits such as confidence and honesty to establish rapport.

Categories of Social Factors Affecting Health

Education Poverty Housing Racial Inequities

vulnerable populations

Individuals who are at increased risk for having poorer health status & lack health care access high risk for having poor health outcomes because of limited resources - individuals have major disparities as it pertains to life expectancy, morbidity, & mortality

structural racism

The totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, & criminal justice

Populations faced with health disparities

are broader than racial & ethnic minorities & include: - underserved rural residents - populations with lower socioeconomic status (SES) - sexual & gender minorities these populations face discrimination & social disadvantages

health equity

attainment of the highest level of health for all people

Nurse's Role with Vulnerable Groups

nurse encounters vulnerable populations in all settings - must provide culturally sensitive care to support IMPROVED health outcomes Patient Advocacy!! - equal tx despite social factors understanding how to provide culturally sensitive care is important as it leads to better health outcomes Address SDOH nurses that are culturally sensitive understand this is a vital component of coordinating pt care, establishing rapport, making appropriate clinical judgments & ability to make appropriate dx through an understanding of the pts language related to health & illness nursing profession must work on viewing the responsibilities of nursing with respect to structural & individual determinants of health - all nursing roles can improve health outcomes & reduce health disparities in vulnerable populations

ANA Provision 8 of the code of ethics for nurses & interpretive statements

nurses are called to stand up for social justice & human rights as they work to address health disparities under this provision, nurses must advocate for all vulnerable groups to obtain equitable tx regardless of their socioeconomic status, immigration status, sexual orientation, gender identity, or any other factor that can lead to vulnerability

Overarching goal of HP2023 related to SDOH

"Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all"

Nurse Role to Address Mental Health Disorders

- assess and evaluate the client's mental health. - consult with members of the multidisciplinary team for implementation of the treatment plan. - support and educate the client and their family. - teach about the importance of medication compliance. - understand what community resources are available for this population. - display leadership traits that establish clear communication with the client.

Nurse Role to Address Veteran Needs

- collaborate with other disciplines & other treatment settings. - identify community resources to coordinate the full spectrum of client care. - gain advanced knowledge of combat injuries. - increase emotional intelligence to address PTSD clients. - display leadership traits such as confidence & honesty to establish rapport

Nurse Role to Address Substance Use Disorder

- collaborate with varied teams of professionals to address crisis situations. - identify rehab services found in the community to address substance use disorders. - organize support groups. - teach & lead educational workshops on the recovery process. - display leadership traits such as confidence & honesty to establish rapport.

Nurse Role to Address Disabilities and Chronic Illness

- collaborate with varied teams of professionals to address diagnosis. - conduct research frequently to better understand the various diagnoses that lead to chronic illness & disability. - never assume that a client is not competent enough to handle their own medical care. - ask questions when a condition is not fully understood. - display leadership traits that establish clear communication with the client.

Nurse Role to Address LGBTQIA Needs

- demonstrate open-mindedness toward these populations. - consistently learn & educate others about these populations. - use language that is non-gendered when discussing relationships. - never assume a client's gender or sexual orientation. - remain current in the literature about the populations. - display leadership traits such as confidence & honesty to establish rapport.

Nurse Role to Address Houselessness

- identify referral sources for clients who are without housing or those at risk of being without housing. - advocate for legislation to address housing issues. - understand that widespread knowledge helps both the prevention of houselessness and crisis management. - display leadership traits such as confidence and honesty to establish rapport.

Nurse Role to Address Adolescent Pregnancy Needs

- remain up to date with local data. - conduct a self-reflection on personal thoughts about adolescent pregnancy issues. - remain up to date on state-specific legislation on contraceptive methods, adolescent pregnancy resources, & availability of STI testing. - provide non-judgmental support. - display leadership traits such as confidence & honesty to establish rapport.

Nurse Role to Address Individuals with Justice System Involvement

- stay current on research on incarcerated individuals relating to the effects of psychological & physical trauma. - collaborate with the multidisciplinary team & correctional officers to ensure health & safety. - provide non-judgmental support. - display leadership traits such as confidence & honesty to establish rapport.

Nursing Process Application

Assessment of community - Systems-based community asmt tools such as windshield surveys can assist nurses in gathering info about specific populations Planning & Implementing population-focused care - include the community in planning process to improve health outcomes!! steps used in program planning, & interventions appropriate for these populations should be evaluated consistently bc needs change quickly - collaborative interventions to address SDOH Health intervention plans will need to be modified as new info & research is available Vulnerable populations often experience cumulative risks, & are sensitive to effects of those risks - risks come from environmental hazards, social hazards, personal behaviors, & biological makeup

Mitigating Health Risk: Homelessness

Estimated 1.5 million people per year experience houselessness - individuals might be experiencing chronic homelessness, lost shelter temporarily, fleeing abusive relationships, or facing any other # of other issues Higher rates of: - HIV - Alcohol/drug use - Mental illness - Tuberculosis - Chronic illness/health conditions individuals face barriers to health care, lack of access to adequate nutrition, & limited resources, including social services - behavioral health issues such as depression or substance use disorder can develop or worsen Nurses working with pts living in poverty or homeless need to be aware of their own beliefs & biases of this populations since there is much stigma associated with these populations - perceived homelessness stigma may be a reflection of structural & interpersonal forms of discrimination, which in turn create an unhealthy environment individuals who are w/o housing experience more stigma, more psychological distress, had worse physical health outcomes, & had a greater tendency to avoid using services - Nurses need to be empathetic, inclusive, & flexible while working with these populations as they face huge health inequalities life expectancy of these populations is significantly lower d/t long-term stressors faced daily nurses must understand addressing basic needs is vital in this population - client with stable housing increases effectiveness of healthcare services - communities that invest in affordable housing incur lower overall public health costs, achieve better health outcomes, and work to prevent and end homelessness

Social Factors leading to Vulnerability

Factor Examples: - income inequality - education - employment - social status - housing - race - ethnicity - LOW socioeconomic status - stress (ACE's too) - poverty factors that affect social status: - personality - occupation - family - physical appearance - socioeconomic status - culture connection w/ mortality & income - life expectancy has continued to increase as income goes up Info regarding ACEs support premise that stress has harmful consequences on development via physiological adaptations that impair neurological, metabolic, & immunologic systems leading to vulnerability

Individual Factors leading to vulnerability

Factor Examples: - pre-existing illness & age - feelings of victimization or disadvantage - having limited control - being predisposed to risk factors - disenfranchisement Pre-existing illness & age - cancer, heart disease, & mental illness as a result of these factors, many individuals are unable to cope w/ the stress associated w/ their illness in comparison to the population as a whole

Social Factors Affecting Health: Housing

Factors: - Exposure to elements - Contaminated water supply - Overcrowding - Long-term stress - Homelessness People with limited financial resources typically face challenges with gaining access to safe & affordable housing Housing offers many benefits including: - limiting exposure to elements, safe storage of meals, & access to water & sanitation A common theme b/t those living in poverty is that their living arrangements can be overcrowded, which has both physical & mental health implications - physical implications include exposure to communicable diseases, conflict, & violence - mental health implications include long-term exposure to stressors associated with having limited resources - ex. individuals may face a looming fear of being evicted bc they are struggling to make ends meet Individuals w/o housing often do not have access to water, sanitation, & food, which can increase their risk of disease

Social Factors Affecting Health: Racial Inequities

Factors: - associated with vulnerability - higher illness & death rates Systemic racism is discrimination based on race & ethnicity - inequalities in housing, education, employment, & wealth are rooted in the nation's history Racial inequality negatively affects the mental & physical health of millions, which prevents them from attaining their highest level of health - historically marginalized racial & ethnic groups mistrust the medical system - vaccine hesitancy is prominent in Blacks as a result of a hx of racism in medical research Some illnesses that these groups face in disproportionate #s include COVID, DM, HTN, obesity, asthma, & heart disease

Social Factors Affecting Health: Poverty

Higher income & SES are associated with better health Factors:: - Poor health outcomes - Hazardous living environments - High-risk jobs - Lack of health care access Chronic stress of poverty can lead to maladaptive physical responses & diseases - people who live in poverty are more likely to live in hazardous & overcrowded environments, work higher risks jobs, have less access to nutritious diets, & have more stressors d/t lack of resources to manage unexpected crises - poverty also reduces an individual's access to healthcare Barriers to healthcare make resources hard to obtain - some individuals prefer not to seek healthcare at all d/t negative past experiences Groups of people who live in poverty often have limited economic resources, high rates of uninsured individuals, cultural differences (including language barriers), & low education & literacy levels

Mitigating Health Risk: Veterans

Historically this population has poor health outcomes, increased risk for chronic conditions, lower health-related QOL, & higher utilization of health care overall this population has significant mental health concerns such as depression, PTSD, & anxiety PTSD shows Increased risk for: - higher rates of depression - substance abuse (alcohol use disorder) - physical diseases - somatic complaints - pain - impaired functioning nurses must utilize strategies that are targeted to improve chronic health outcomes when working with this population - use a team-based approach focused on improving pt outcomes Veterans Affairs (VA) health system access - although veterans have access to healthcare via the VA healthcare system, research has found black & Hispanic veterans have reported more negative healthcare experiences than whites, which leads to vulnerability

Mitigating Health Risk: Substance Use Disorder

Many w/ this disorder develop tolerance, & in the absence of the substance, they experience withdrawal symptoms growing problem in the US - according to WHO, 7.4% of the U.S. pop has alcohol use disorder, which is the 3rd leading cause of preventable death often an emotional & uncomfortable topic for nurses bc society & media portray these individuals in a negative light Stereotypes are common & include: - being unreliable, emotionally volatile, dependent on other individuals for things like living expenses, & feeling self-pity public's feelings toward this population include anger, pity, & disgust - negative stigma about this group, making them vulnerable to discriminatory behaviors by the public - perception they shouldn't work in childcare, or public office d/t posed risk to public safety may experience negative health care interactions as HCP have been known to hold stigmatizing attitudes & withhold care or pharmacy services even when they are seeking tx for their disorder Nurses have an obligation to provide education on substance use & implement strategies to support those who are experiencing negative substance use-related conditions - be aware of importance of screening so interventions can be targeted toward unhealthy alcohol or substance use - nurses should seek referrals for tx for pts whose screenings have found potential for substance use disorder Screening, Brief Intervention, & Referral to Treatment (SBIRT) - EB tool that a healthcare team can use to prevent substance use disorder & reduce harm among pts & their families

Socioeconomic Status

Measurement of education, occupation, &/or income of an individual or group. low status leads to discrimination & challenges increasing an individuals vulnerability behaviors that are unhealthy, such as tobacco use, consumption of alcoholic beverages, sugary beverages, & unhealthy snacks, tend to be more common in low-status groups low status negatively impacts access to promising employment opportunities, education, & healthcare

Mitigating Health Risk: Mental Health Disorders

Nurses working w/ pts w/mental illness will be exposed to a wide variety of disorders that fall under the umbrella of mental illness - range from mild to severe serious mental illness is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment that interferes with an individual engaging in major life activities - may experience disturbances in their thoughts & behavior, which impacts their ability to cope with ordinary life situations HP2030 has objectives aimed at prevention, screening, assessment, & tx of mental health disorders nurses need to understand that certain populations are more impacted than others & about 1/2 of indv. dx w/ mental health disorders actually get the tx they need nurse needs to understand underlying issues with mental illness, such as traumatic life experiences that involve abuse, neglect, or violence - genetic predispositions or chemical imbalances, can also contribute to mental illness nurse must understand importance of developing a therapeutic relationship advocate for access to affordable, ongoing care that provides pt w/ mental illnesses the therapy & meds they need to manage their mental health disorders utilize primary, secondary, & tertiary prevention

health disparities

Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.

vulnerability

Results from individual & social factors result of a combo of factors such as limited physical, personal, environmental, & biopsychosocial resources - doesn't mean individuals lack skills- just not served equitably d/t many factors Increases risk of developing health problems & poor health outcomes - predisposed to heart disease, DM, obesity, & disabling circumstances Increased risk of health disparities & sensitivity to risk factors important to understand the nursing role to meet the health needs of a vulnerable population to improve health outcomes

diversity awareness

acknowledgement & appreciation of differences in attitudes, beliefs, thoughts, & priorities in the health-seeking behaviors of different client populations awareness & respect when embracing diversity of human beings

Community health nurses

are invested in communities & work in an array of settings where vulnerable groups will be encountered - manage programs aimed to improve health of the population provide education to the public, create policies, strengthen partnerships, & build rapport with individuals & leaders at the local level - understand significance of people's backgrounds, experiences, & social factors that impact their health & can empathize instrumental in promoting health equity for all groups

Mitigating Health Risk: Adolescent Pregnancy

associated with increased risks for adolescent mother & baby - lack of prenatal care or late PNC, leading to harmful conseq. - higher risk for high BP in pregnacy - premature birth - low-birth-weight infants SDOH such as low educational level & low SES may contribute to high adolescent birth rates adolescents in foster care are more than 2x as likely to become pregnant Nurses should be prepared to discuss all options - termination, adoption, parenthood, foster care Nurses working with adolescents should educate & counsel youth about STIs, contraception methods, & reproduction - nurses play critical role in reducing adolescent pregnancy stats nurses can develop & implement community-based adolescent pregnancy prevention programs centered around abstinence - can assess needs & resources in their communities to prevent adolescent pregnancy - can help identify where adolescent pregnancy & sexual risk behaviors are most prevalent - can help identify which risks & protective factors are most associated with adolescent pregnancy & sexual risk behaviors in the community assessing community risk & resources available helps nurse reduce risk by referring adolescents to resources - Nurses can promote sexual education programs in an effort to improve adolescent decision-making pertaining to sex & other life skills birth rate for Hispanics & blacks is 2x white adolescents & birth rate for indigenous americans is the highest of all adolescent groups

culturally sensitive care

care that requires an awareness of cultural diversity, including how culture may influence patients' values, beliefs, & attitudes, & involves acknowledging & respecting individual differences Nurses who want to become more culturally sensitive should utilize EB resources such as the CDC & WHO Cultural sensitivity involves understanding a client's cultural needs as it pertains to health & illness

Certain individual & social factors

contribute to vulnerability, & as a result of these factors, these groups tend to develop health problems & have worse health outcomes in comparison to the population as a whole.

Disenfranchisement

deprivation of, or failure to provide, basic civil rights or privileges - such as voting - to an individual based upon factors such as race, history of civil offenses, or other factors - dangerous situation & can impact vulnerable groups significantly For example: - individuals who are undocumented experience poorer health outcomes d/t the inability to access federal insurance programs which results in delays in seeking needed medical care

Social Factors Affecting Health: Education

education & health go hand in hand - usually a requirement for higher income jobs that provide access to resources like health insurance Factors: - Early childhood experiences influence school readiness & educational completion - Low-income children lack the skills needed for success in self-regulation, language, & literacy Education equips an individual with skills (such as problem-solving) & basic knowledge necessary to live a productive life & make healthy choices Vulnerable populations are impacted more directly & disproportionately in terms of access to education - If schools in their community are lacking in funding & resources, students might miss learning essential life skills, such as financial literacy

Social Determinants of Health (SDOH)

environment & condition where an individual is born, works, & lives that impact a wide variety of health outcomes & risks include intangible factors such as: - education, stress, economic status, environmental factors, nutrition, & prejudice - accessibility to health care, education systems, safe environmental conditions, well-designed neighborhoods, & availability of nutritious foods Contribute to health inequities, health disparities, & overall poor health Socioeconomic status is major factor linked to disparities

Mitigating Health Risk: Incarceration

face many health risk such as mental illness, physical conditions, & long-term disabilities - mental health disorders common in prisons Other risk factors d/t exposure: - violence - crowded living conditions - limited programs & treatment options - find themselves in dangerous situations on a daily basis Nurses have an obligation to respond to ALL pts professionally & respectfully & to care for ALL pts in ALL settings—including correctional facilities—with dignity - have an ethical mandate to treat all people with respect & compassion Nurses must maintain professionalism & care w/o unconscious bias - care for this population can be very difficult for nurses Nurses working with this population should provide care while maintaining safety & security strategies to maintain a safe environment

Population-based community health nursing practice

focuses on the health of entire populations - includes everyone in a population who is actually or potentially affected by a health concern ______-______ public health nursing interventions are not restricted to individuals who seek services - interventions when working with these groups are guided by asmt of needs & considerations of SDOH ______-______ practice also needs to be reflective of the various priorities that the community identifies

Nurses must collaborate with stakeholders & community organizations

in order to promote the health of vulnerable groups For example: - a nurse might collaborate with a food bank or a shelter for people without housing

Mitigating Health Risk: Underrepresented Populations

include individuals who experience discrimination based on gender, sexual orientation, disability, age, race, ethnicity, education, & other factors - nurses encounter ppl from various backgrounds, & every interaction can be critical in developing diversity awareness to mitigate health risks for this population, nurses must understand importance of effective communication - nurses should have a clear understanding of their pts & demographics to effectively communicate nurses need to advocate for social justice, breaking down stereotypes, promoting inclusion, & providing culturally sensitive care - nurses working w/ these pops will play a role in acknowledging history of racial inequality within the profession & health care overall & help mitigate effects of discrimination & implicit bias on health have an obligation to address structural racism, cultural racism, & discrimination in their efforts to promote health equity

Mitigating Health Risk: Urban Populations

nurse strives to address health challenges that focus on environmental & social determinants while also understanding the complicated interactions b/t the determinants Nurses can partner w/ community agencies to identify root causes of poor population health & inequity, & work to enhance well-being of those living in the community - implementing policies & programs helps identify promising solutions that promote health within the community Threats to this Population's Health: - Natural hazards (floods, landslides, earthquakes, & fires) - Technological hazards (toxic elements, pipelines, waste & transportation hazards) - Socially generated hazards (quality education, limited employment options, gender inequality, discrimination, & lack of access to quality healthcare) nurse working w/ this pop advocates for critical public health programs, such as vaccine clinics, access to maternal care, & access to yearly physical exams nurse needs to be engaged with policy processes, complete asmts when the community is ready to change, & participate in the planning process to build resilient health care systems in urban areas - in order for this to take place, nurses need to diversify in other roles & work with other stakeholders to build the foundation of communities that are resilient

individual's genetic & behavioral risks

operate within various social, political, & environmental conditions factors can affect an individual's access to resources, such as: - nutritious foods, safety, resources targeting finances, high-quality education, & employment opportunities for example: obesity & T2DM disproportionately affect racial & ethnic minority communities & low-income populations

Mitigating Health Risk: Rural Populations

population of < 20,000 or < 99 residents per square mile less likely to take part in behavior aimed at prevention - have a poorer perception of overall health & functional status more likely to have: - COPD, HTN, heart disease, DM, & cancer - Higher incidence of chronic illness - higher infant & maternal morbidity rates & pregnancy complications such as stillbirth - higher levels of depression d/t social isolation - exposed to harmful chemicals (pesticides) many occupations in rural areas are labor intensive so pts present w/ frequent injuries, like fractures & sprains from falling off equipment, back issues from prolonged stooping & heavy lifting, amputations, & deaths & crush injuries from large machinery Less likely to seek healthcare - TELEHEALTH provides care & incr. health outcomes! nurses in this setting are often the medical lifeline for these communities d/t no close providers offices - nurses working w/ rural populations strive to ensure pts have resources needed to achieve the best health outcomes Nurses should advocate for healthcare access in rural areas - advocating for team-based care models that focus on collaborating with members of various specialties & telehealth platforms - advocate for improving gaps in health to address higher rates of cigarette smoking, high BP, & obesity nurses need to advocate for programs that address common risks, such as health screenings, education on cancer prevention & early detection, education on exercise & healthy diets to reduce obesity, smoking cessation, mental health support, & education on motor vehicle safety nurse works to implement programs aimed to increase nurses in school setting, services to address family planning, prenatal services, care for pts communicable diseases, emergency care services, mental health services, & resources for older adults

Mitigating Health Risk: LGBTQIA+ Populations

populations youth are 3x more likely to experience depression & anxiety disorders Adults in this population are predisposed to higher rates of: - substance use disorders - serious mental illness - STIs - suicide, depression, & anxiety Improving health of LGBTQIA remains a goal of HP2030 - nurses must advocate for these pts - ANA condemns discrimination based on sexual orientation in all healthcare settings Nurses must understand this group is susceptible to many adverse health outcomes, & understand their negative experiences in healthcare, to be sensitive to their feelings of mistrust to improving their health & well-being Serious need for improved cultural sensitivity when treating this population or other vulnerable communities Nurses need to provide culturally sensitive care that is safe, ethical & inclusive of ALL populations - increasing knowledge by targeting interventions aimed to improve provider-pt interactions is vital to decreasing health disparities among this group nurse plays a critical role in encouraging inclusiveness & equitable access in all healthcare settings while advocating for this population & addressing specific health concerns - Nurses have an ethical obligation to safeguard human rights & equity, & advocate for the improvement in QOL for all individuals they serve

primary goal of making communities healthy

recognizing SDOH to improve the health status of individuals & populations through the use of strategies such as public health planning, implementation, & evaluation - multiple strategies have been developed in collab b/t the CDC, communities, & citizens to address issues such as community design, housing, healthy environments in which to live, grow, & learn as well addressing health disparities, & other areas that impact the health & well-being of all individuals

Mitigating Health Risk: Disabilities & Chronic Illness

role of the nurse requires being a member of the multidisciplinary team to advocate for health care transformation that is pt-centered & affordable Working with pts who have disabilities provides nurse with the opportunity to advocate for safe, comprehensive care bc pts who have disabilities may have cognitive, physical, or communication challenges, the nurse must be aware of the needs across all age spans & be ready to provide support - support may also be needed for the family, caregiver, & the community Nursing care for pts who have chronic conditions or disabilities needs to focus on the individual's strengths & needs, instead of the dx or stigma associated with their condition

Unconscious biases

social stereotypes about certain groups of people that individuals form outside their own conscious awareness - every single person holds unconscious beliefs about various social & identity groups

Community-based participatory research

supports collaborative interventions that includes researchers & community members to address diseases & conditions disproportionately affecting health disparity populations - recognizing strengths of each participant is critical in order to collab effectively, conduct a needs asmt, & engage in community-level interventions Community members can include: - school representatives, community agency representatives, local law enforcement, local fire personnel, business owners, health care representatives, local elected officials, & community members Input from diverse community members should be sought when analyzing data to determine what the dx will be & how to prioritize, plan, identify outcomes, & evaluate

Mitigating Health Risk: Migrant Populations

vulnerable d/t a variety of factors that include higher frequencies of workplace injuries, illnesses, & deaths - nurse should work to promote/improve health through better understanding this populations circumstances Risk factors Affecting this Population: - poverty - limited access to healthcare - hazardous working conditions - lack of regulations Focus on infection prevention - often live in crowded spaces - nurse can implement public health interventions centered around vaccine efforts & parasitic tx programs to prevent infectious disease & advocate for basic health screenings Many migrant indiv move from 1 location to another to find work, which poses additional challenges when trying to access healthcare Since these individuals tend to have temporary/provisional status, their employers are not required to provide health insurance - undocumented migrant workers are typically not eligible to receive health insurance in the US Barriers to access to care: - remoteness, scarcity of resources, shortages in the health care setting, & isolation nurse should consider importance of utilizing resources such as mobile health clinics & tapping into federally funded clinics to improve health outcomes & provide quality health care