vulnerable populations

culturally sensitive

- aware> sensitive> knowledge> skills

poverty

-According to the U.S. Census Bureau, 43 million Americans live in poverty. The Office of Disease Prevention and Health Promotion (ODPHP) has indicated that "In spite of the differences in definition between poverty and socioeconomic status, researchers agree that there is a clear and established relationship between poverty, socioeconomic status (family income level, education level, and occupational status), and health outcomes including increased risk for disease and premature death". Individuals from underrepresented racial and ethnic groups who live in poverty are also predisposed to adverse health outcomes, which can compound health disparities. Poverty affects the well-being and health of individuals. Individuals living in poverty experience higher rates of chronic illness, infant morbidity and mortality, shortened life expectancy, complex health problems, complications from chronic conditions, physical limitations from chronic conditions, and increased hospitalization rates. -Nurses play a key role in increasing the economic mobility of families. Nurses can advocate for job-training programs and early education programs to help the community alleviate the negative effects of poverty. Furthermore, nurses should be aware of social assistance resources like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Medicaid programs specific to the state they practice in, and community resources such as food banks and emergency shelters.

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 veterans needs

-Collaborate with other disciplines and 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 and honesty to establish rapport.

nurse role for substance use disorder

-Collaborate with varied teams of professionals to address crisis situations. -Identify rehabilitation services found in the community to address substance use disorders. -Organize support groups. -Teach and lead educational workshops on the recovery process. -Display leadership traits such as confidence and honesty to establish rapport.

nurse role for disabled ppl

-Collaborate with varied teams of professionals to address diagnosis. -Conduct research frequently to better understand the various diagnoses that lead to chronic illness and 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 for lgbt needs

-Demonstrate open-mindedness toward these populations. -Consistently learn and 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 and honesty to establish rapport.

education

-Education and health go hand in hand. Education is typically a requirement for jobs associated with higher income and access to additional resources, such as medical insurance. Early childhood experiences influence readiness for school and educational completion. Research has shown that "substantial amounts of children from low-income backgrounds arrive at school lacking skills in self-regulation, expressive and receptive language, and literacy". Education equips an individual with the skills (such as problem-solving skills) and basic knowledge necessary to live a productive life and make healthy choices. -Vulnerable populations are impacted more directly and disproportionately in terms of access to education. These groups may lack a basic knowledge skill set, which has lasting consequences on their futures. If the schools in their community are lacking in funding and resources, students might miss learning essential life skills, such as financial literacy. Research has found, for example, that basic education on finances obtained in high school is associated with higher credit scores and fewer defaults on loans among young adults.

equitable

-Having or exhibiting equity; dealing fairly and equally with all concerned.

poverty

-Higher income and SES are associated with better health. Conversely, poverty coincides with poor health outcomes. The chronic stress of poverty can lead to maladaptive physical responses and diseases. People who live in poverty tend to live in environments that are hazardous and crowded, and they typically work in higher-risk jobs. Furthermore, these people tend to have less access to nutritious foods and have more stressors due to lack of resources needed to address unexpected crises. Poverty also reduces an individual's access to health care. Barriers to health care make resources hard to obtain, and some individuals prefer not to seek health care altogether due to negative past experiences in health care. -Poverty can be a barrier to an individual's access to primary care. Groups of people who live in poverty often have limited economic resources, high rates of uninsured individuals, cultural differences (including language barriers), and low education and literacy levels. According to the World Health Organization (WHO), barriers to health care include affordability of health services and limited availability of services.

veterans

-Historically, veterans have poor health outcomes, increased risk for chronic conditions, health-related quality of life that is ranked lower, and a higher utilization of health care overall. Research has indicated that veterans have significant mental health concerns such as depression, post-traumatic stress disorder (PTSD), and anxiety. Veterans who have PTSD are associated with having higher rates of depression and increased risk for alcohol use disorder, and research has shown that individuals who have PTSD are at increased risk for physical disease, somatic complaints, pain, and impaired functioning. When working with veterans, nurses need to utilize strategies that are targeted to improve chronic health outcomes. The nurse needs to advocate for utilizing a team-based approach that focuses on improving client outcomes for this population. Nurses can operate as effective change agents with members of the multidisciplinary team to target the chronic health issues among the veteran population. Although veterans have access to health care via the Veterans Health Administration, research has found that Hispanic and Black veterans report more negative health care experiences than their white counterparts, which leads to vulnerability.

nurse role to address homelessness

-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.

individuals with justice system involved

-Individuals who are incarcerated face many health risks, such as mental illness, physical conditions, and long-term disabilities. Research has found that one in four individuals who are incarcerated "meet the criteria for a current mental health diagnosis". Individuals in this setting are vulnerable not only due to risk factors, but also because they are exposed to violence, crowded living conditions, and limited programs and treatment options available to them. These individuals find themselves in dangerous situations on a daily basis. -Caring for individuals who are incarcerated in federal or state correctional facilities can be difficult for many nurses. Nurses have an obligation to respond to all clients professionally and respectfully and to care for all clients in all settings—including correctional facilities—with dignity. Nurses might be challenged in not understanding how to provide care for clients who are in unfamiliar situations, which can lead to unconscious bias. Unconscious biases are social stereotypes about certain groups of people that individuals form outside their own conscious awareness. Every person holds unconscious beliefs about various social and identity groups. Nurses working with this population should provide care while maintaining safety and security strategies. Furthermore, nurses need to know general information about the health status of individuals who are incarcerated and their legal rights to health care. Lastly, nurses working with all populations, including individuals who are incarcerated, have an ethical mandate to treat all people with respect and compassion. Nurses need to be aware of this ethical mandate, as inmates often are viewed as undeserving of compassion and respect.

the near poor

-Individuals who earn slightly above the poverty level are known as the near poor. These individuals face additional barriers since their income is inadequate. They are ineligible for Medicaid or other social services because they do not meet the income guidelines, but their income is still low enough to cause health disparities, lack of access to resources, and other negative health outcomes. ​​​​​​​

case study p4

-Janine has been called to a classroom by a teacher who has a student health concern. Janine is encountering a student that appears to be under the influence of an illicit substance. Janine requests that the student follow her to the health office. Upon arrival at the office, the student is exhibiting bloodshot and glassy eyes. The student has a delayed reaction time and is requesting to eat snacks. Janine understands that the student is more than likely exhibiting signs of ecstacy intoxication. -Janine utilizes the SBIRT tool to help determine if the student is at risk for substance use disorder. After completion of the tool, it is determined that the student is at risk for substance use disorder.

case study

-Janine is adjusting to her new position as a school nurse. She is shocked to discover how many students come to the health office on a daily basis. She is finding that several of the students she encounters face the same challenges, such as adherence to their long-term asthma medication in the home setting and not having health insurance to follow up frequently with a health care provider. As a result, they come to the health office more frequently for their inhalers, missing out on valuable instructional time.

disabilities and chronic illness

-Many Americans are faced with disabilities and chronic illness. The United States spends the most money on health care in comparison to any other developed nation. The role of the nurse requires being a member of the multidisciplinary team to advocate for health care transformation that is client-centered and affordable. Working with clients who have disabilities provides the nurse with the opportunity to advocate for safe, comprehensive care. Because clients who have disabilities may have cognitive, physical, or communication challenges, the nurse must be aware of the needs across all age spans and be ready to provide support. Support may also be needed for the family, caregiver, and in some instances, the community. Nursing care for clients who have chronic conditions or disabilities needs to focus on the individual's strengths and needs, instead of the diagnosis or stigma associated with their condition.

substance use disorder

-Many clients with substance use disorders develop a tolerance, and in the absence of the substance, they experience withdrawal symptoms. Substance use disorder is a growing problem in the United States. According to WHO, 7.4% of the U.S. population has alcohol use disorder, which is the third leading cause of preventable death. -Substance use disorder is often an emotional and uncomfortable topic for nurses because society and the media typically portray these individuals in a negative light. Stereotypes about this population are common, and language that contributes to stigmas include "habit", "abuser", "dirty", and "crazy". Research from Johns Hopkins Bloomberg School of Public Health indicate that housing and employment policies benefiting people with substance use disorders are not supported by the general public. -Clients who have substance use disorders may experience negative health care interactions. Health care workers who have had minimal or poor education about working with clients who have substance disorders may hold stigmatizing attitudes and create barriers to health care. It is inappropriate to withhold care to any client regardless of their diagnosis. -The nurse working with clients who have substance use disorders can use evidence-based interventions to treat these individuals so that they can obtain optimal health. Nurses have an obligation to provide education on substance use and implement strategies to support those who are experiencing negative substance use-related conditions. Nurses working with this population need to be aware of the importance of screening so that interventions can be targeted toward unhealthy alcohol or substance use behaviors. Furthermore, nurses should seek referrals for treatment for clients whose screenings have found potential for substance use disorder. Nurses need t

lgbt

-More than 4% of American adults currently identify as lesbian, gay, bisexual, or transgender. LGBTQIA individuals are at risk for several health issues. Research has indicated that LGBTQIA youth are three times more likely to experience depression and anxiety disorders in comparison to heterosexual and cisgender youth. Adults in this population have high rates of depression, anxiety, and other mental health conditions, which are attributed to experiences with bullying, violence, discrimination, and rejection. The lifetime risk for suicide in individuals who are in the LGBTQIA population is 2 to 6 times greater than the general population. -It is likely that nurses will care for LGBTQIA clients during their career. Improving the health of LGBTQIA people remains a goal of Healthy People 2030. The ANA condemns discrimination based on sexual orientation in all health care settings. Nurses need to advocate for LGBTQIA clients in all roles and settings. Nurses need to provide culturally sensitive care that is safe, ethical, and inclusive of all populations. Increasing knowledge by targeting interventions aimed to improve provider-client interactions is vital to decreasing health disparities among this group. LGBTQIA adults report alarming rates of identity-based discrimination in health care settings: The American Heart Association reports that 56% of adults in the LGBTQIA population, including 70% of transgender or gender non-conforming adults, have reported experiencing abusive language and other forms of discrimination from health care professionals. Health disparities that affect the LGBTQIA community also contribute to higher rates of STI, substance use, obesity, and some cancers. -Research has indicated a need to improve cultural sensitivity among health care workers who serve vulnerable communities. Implementing inte

more on teen pregnancy

-Nurses working with adolescents must ensure that they are sensitive to ethnic and cultural beliefs. The nurse must understand the cultural groups most impacted by adolescent pregnancy. The birth rate for Hispanic adolescents (25.3) and non-Hispanic Black adolescents (25.8) is twice the rate of non-Hispanic white adolescents (11.4). The birth rate for Indigenous American adolescents (29.2) is the highest of all adolescent groups. The nurse working with the pregnant adolescent must be prepared to discuss all options, including termination and adoption. This can place nurses in uncomfortable situations because of strong personal and political discourse on topics like adolescent pregnancy, birth control, abortion, and adoption. Therefore, self-reflection is critical for the nurse working with this population.

housing

-People who have limited financial resources typically face challenges with gaining access to safe and affordable housing. Housing offers many benefits, including limiting exposure to the elements, safe storage of meals, and access to water and sanitation. As mentioned previously, a common theme among those living in poverty is that their living arrangements can be overcrowded, which has both physical and mental health implications. Some physical implications include exposure to communicable diseases, conflict, and violence. Mental health implications include long-term exposure to stressors associated with having limited resources. For example, these individuals may face a looming fear of being evicted because they are struggling to make ends meet. They are exposed to long-term stressors such as deciding which bills to pay while figuring out how to take care of basic needs. Individuals who are without housing often do not have access to water, sanitation, and food, which can increase their risk of disease.

Primary, Secondary, and Tertiary Interventions for Adolescent Pregnancy

-Primary: Education programs focusing on reproductive health and initiatives to promote the completions of formal education -Secondary: Focuses on the prevention of adolescent pregnancy by promoting contraception for adolescents who are sexually active -Tertiary: Targets the prevention of morbidity in adolescent parents and their baby/child through appropriate prenatal care and follow up

nurse role for teen 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, and availability of STI testing. -Provide non-judgmental support. -Display leadership traits such as confidence and honesty to establish rapport.

more abt it

-Research has shown how an individual's genetic and behavioral risks operate within various social, political, and environmental conditions. These factors can affect an individual's access to resources, such as nutritious foods, safety, resources targeting finances, high-quality education, and employment opportunities. For example, according to one study, "obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations," and challenges in implementing successful interventions remain. All of these issues shape health outcomes over the lifespan. -Furthermore, years of research have indicated that physical environment, economic status, education, access to food, and social environments are compelling factors that help determine an individual's health before health care is acquired. For example, antibiotics are of little to no assistance to those who do not have access to fresh drinking water and are subjected to drinking contaminated water. -SDOH contribute to poor health, health disparities, and inequities. For example, individuals who do not have access to local grocery stores with fresh fruits and vegetables are less likely to have adequate nutrition. This raises their risk of health complications such as heart disease, diabetes, and obesity. -Recognizing SDOH to improve the health status of populations is the primary goal of making communities healthy. Multiple strategies have been developed in collaborations between the Centers for Disease Control and Infection, communities, and the citizens to address issues such as community design, housing, healthy environments in which to live, grow, and learn as well addressing health disparities, and other areas that impact the health and well-being of all individuals. SDOH impact everyone. One of the five o

role of nurse in mitigating health risks for rural pop

-Rural residents in the United States face several health disparities in comparison to those living in urban areas. According to Statista, "in 2020, there were approximately 57.23 million people living in rural areas in the United States, compared to about 272.91 million people living in urban areas". Rural residents generally have a poorer perception of their overall health and functional status. Furthermore, they are less likely to take part in behavior aimed at prevention and are more likely to have COPD, hypertension, heart disease, diabetes, and cancer. -Rural residents have poorer health status overall and are less likely to obtain medical care in comparison to people living in urban areas. Travel time and/or distance to specialty health care providers impacts access to care. Rural residents experience higher infant and maternal morbidity rates, as well as pregnancy complications such as stillbirth. Rural residents are often faced with higher levels of depression due to social isolation. Because many occupations in rural areas are labor intensive, residents present with frequent injuries, such as fractures and sprains from falling off equipment, back issues from prolonged stooping and heavy lifting, amputations, and deaths and crush injuries from large machinery. All populations living in these areas are faced with being exposed to harmful chemicals, such as pesticides. -Nurses play a large role in making sure rural areas have access to health care. Many of these isolated areas lack health care facilities, health care providers, and access to proper care. As a result, nurses working in this setting are often the medical lifeline for these communities. Nurses working with rural populations strive to ensure that clients have the resources needed to achieve the best health outcomes. -Nurses can lead their rural

social factors

-Social factors that lead to vulnerability include income inequality, education, employment, social status, housing, race, and ethnicity. Factors such as personality, occupation, family, physical appearance, socioeconomic status, and culture affect social status. -Extensive research exists linking income and mortality. Research has shown that life expectancy has continued to increase as income goes up over the past several years in the U.S. It also showed a significant difference in life expectancy between the lowest- and highest-income quartiles—the top and bottom 25 percent of income. Behaviors that are unhealthy, such as tobacco use and consumption of alcoholic beverages, sugary beverages, and unhealthy snacks, tend to be more common among low SES groups. Access to promising employment opportunities, education, and health care can be negatively impacted by one's SES. Furthermore, being exposed to poverty as a child may have a long-lasting impact on overall health throughout an individual's lifetime. Information regarding Adverse Childhood Experiences (ACEs) support the premise that stress has harmful consequences on development via physiological adaptations that impair neurological, metabolic, and immunologic systems.

nurse role for incarcerated individuals

-Stay current on research on incarcerated individuals relating to the effects of psychological and physical trauma. -Collaborate with the multidisciplinary team and correctional officers to ensure health and safety. -Provide non-judgmental support. -Display leadership traits such as confidence and honesty to establish rapport.

adolescent pregn

-The U.S. adolescent pregnancy rate has been declining since 1991, but it is still much higher in comparison to other Western developed nations. Adolescent pregnancies are associated with increased health risks for both the pregnant client and baby. Pregnant adolescents do not typically get prenatal care soon enough, which can have harmful consequences. These adolescents are at higher risk for high blood pressure related to being pregnant, and there are several risks for the infant, including premature birth and low birth weight. SDOH such as low educational level and low SES may contribute to high adolescent birth rates. Adolescents who are in foster care are more than twice as likely to become pregnant in comparison to those not in foster care. -Nurses play a critical role in reducing adolescent pregnancy statistics. Nurses working with adolescents in general can educate and counsel youth about sexually transmitted infections, contraception methods, and reproduction. Furthermore, nurses can develop and implement community-based adolescent pregnancy prevention programs centered around abstinence. Nurses can assess the needs and resources in their communities to prevent adolescent pregnancy. Nurses can help identify where adolescent pregnancy and sexual risk behaviors are most prevalent. Furthermore, nurses can help identify which risks and protective factors are most associated with adolescent pregnancy and sexual risk behaviors in the community. By assessing the community resources that exist in the community, the nurse can help reduce adolescent pregnancy by referring adolescents to resources that address risk behaviors. Nurses can promote sexual education programs in an effort to improve adolescent decision-making pertaining to sex and other life skills.

role of jurse in mitigating health risks for urban populations

-The nurse working with urban populations strives to address health challenges that focus on environmental and social determinants, while also understanding the complicated interactions between the determinants. Researchers have found that implementing policies and programs helps identify promising solutions that promote health within the community. Nurses can partner with community agencies to identify the root causes of poor population health and inequity, as well as work to enhance the well-being of those living in the community. -Natural hazards and socially generated hazards are threats to the health of individuals living in urban areas. Natural hazards include floods, landslides, earthquakes, and fires; technological hazards include toxic elements, pipelines, and waste; and transportation hazards. Socially generated hazards in urban areas include quality education, limited employment options, gender inequality, discrimination, and lack of access to quality health care. Both of these hazards are responsible for the risks in this community. -The nurse working with this population advocates for critical public health programs, such as vaccination clinics, access to maternal care, and access to yearly physical exams. Health care for illness that goes beyond primary prevention to tertiary interventions is also needed on a large-scale basis to mitigate health risks. Leadership starts with nurses educating themselves and those they serve. The nurse needs to be engaged with policy processes, remembering that even small measures can have a huge impact. For example, a nurse might get involved in policy development at the local level to address barriers associated with health care access. Local-level readiness is meaningful, and the nurse can make assessments when the community is ready to change. Nurses can help with the p

homelessness

-Thousands of individuals in the United States are without housing. It is estimated that 1.5 million people per year experience houselessness. These individuals might be experiencing chronic houselessness, have lost shelter temporarily, are fleeing abusive relationships, or are facing any other number of issues. Being without housing impacts health significantly. Research has found that individuals who are without housing experience higher rates of HIV infection, alcohol and substance use disorders, mental illness, tuberculosis infection, and several other health conditions. -Having a stable home provides safety and is also a place to rest and heal from illness. Without this, many individuals lack a safe area to store medications, or they might lack access to medications altogether. These factors may result in worsening chronic health conditions among houseless individuals. Behavioral health issues such as depression or alcohol or substance use disorder can develop or worsen among individuals in these difficult housing situations. These individuals face barriers to health care, lack of access to adequate nutrition, and limited resources, including social services. -Nurses can play an integral role in providing care for these populations. Nurses must understand that working to address basic needs is vital. When a client has stable housing, health care services are more effective. According to the National Health Care for the Homeless Council, "communities that invest in affordable housing incur lower overall public health costs, achieve better health outcomes, and work to prevent and end homelessness". Nurses can advocate for resources and collaborate with multiple agencies to bring much-needed services to these populations. The nursing approach when working with these populations should focus on holistic, client-ce

nurse role in mitigating health risks for underrepresented populations

-Underrepresented populations include individuals who experience discrimination based on gender, sexual orientation, disability, age, race, ethnicity, education, and other factors. Nurses encounter people from various backgrounds, and every interaction can be critical in developing diversity awareness. The ANA defines diversity awareness as "acknowledgement and appreciation of differences in attitudes, beliefs, thoughts, and priorities in the health-seeking behaviors of different client populations". -To mitigate health risks for underrepresented populations, nurses must understand the importance of effective communication. Nurses should have a clear understanding of their clients and the demographics to effectively communicate. Furthermore, nurses need to advocate for social justice, breaking down stereotypes, promoting inclusion, and providing culturally sensitive care. According to Hassmiller, "nurses working with these populations will play a pivotal role in acknowledging the history of racial inequality within the profession and health care overall and help mitigate the effects of discrimination and implicit bias on health". Nurses working with all populations have an obligation to address structural racism, cultural racism, and discrimination in their efforts to promote health equity.

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.

nurse advocates for what in urban areas

-Universal vaccinations -Health promotion programs -Access to prenatal, maternal, and neonatal care -Access to annual checkups

Factors That Make Migrant Populations Vulnerable

-Worker-related injuries -Higher illness and fatality rates -Poverty -Limited access to health care -Hazardous working conditions -Lack of workplace regulations

social determinants of health

-economic stability -neighborhood and built environment -access to and quality of education -access to and quality of food -social and community context -access to and quality of healthcare

decision-making model

-how can a nurse use this model in a situation with teen pregnancy -Step 1: Have the pregnant adolescent define the problem. In this example, the problem might be, "I am pregnant, but I am afraid of what this entails." -Step 2: Consider all options. What are all the options? Adoption, keeping the baby, foster care, or having an abortion to terminate the pregnancy. Nurses have an ethical obligation to discuss all options. -Step 3: Consider the repercussions of each option. What are all the repercussion? Are there any positive outcomes associated with the potential decision? For the pregnant adolescent, it is vital to consider time frames: current, 5 years, and 10 years. -Step 4: Consider your values. Understand that values help shape choices. Personal values need to be identified, and it needs to be understood that close family members might not agree with those personal values. This doesn't mean that personal values are wrong. In an adolescent pregnancy scenario, it is important to stress that the client must decide on the basis of what is right for them. They need to consider their own personal values, as they define and interpret them. -Step 5: Consider the impact on other individuals. People will be affected by the various scenarios: parents, family members, partners, and others. The impact they experience may not be the reason a decision is made, but it is an important factor to consider and impacts the circumstances that follow that particular choice. -Step 6: Choose an option. After weighing out all options, think through alternatives and choose one that seems most appropriate based on the following factors: one's own values, both positive and negative outcomes, goals for the future and present, and the impact on others. -Step 7: Apply the decision. Take the necessary steps to make the decision. Make sure r

intervention levels with activities matching

-primary: providing education on stress reduction techniques, mental health awareness week in schools -secondary: crisis intervention teams, suicide risk assessment -tertiary: mental health support groups, education on med compliance

diversity awa

Awareness and respect when embracing the diversity of human beings.

culturally sensitive care

Care that requires an awareness of cultural diversity, including how culture may influence patients' values, beliefs, and attitudes, and involves acknowledging and respecting individual differences.

health di

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

more...

Community health nurses are invested in communities and work in an array of settings where vulnerable groups will be encountered. Community health nurses make a difference when they collaborate with various community agencies. Community health nurses manage programs aimed to improve the health of the population. Furthermore, they provide education to the public, create policies, strengthen partnerships, and build rapport with individuals and leaders at the local level. Community health nurses also understand the significance of people's backgrounds, experiences, and social factors that impact their health and can empathize. -Community health nurses have been instrumental in promoting health equity for all groups. To further impact communities across the United States, steps need to be taken, which include investing in resources and funding to increase the public health nursing workforce, especially those who serve diverse communities of color, low-income communities, rural areas, LGBTQIA populations, and other diverse communities with complex health care needs.

case study

Gina is a nurse working in the county public health clinic. She is working with a 16-year-old who has indicated that she is sexually active. The client has come to the clinic because she has not used condoms consistently and is afraid that she may have contracted a sexually transmitted infection. She is alone for today's visit. Current medications include: daily multivitamin Family history is unremarkable. Social history: Client indicates that she lives with her mother, father, and brother aged 12. She does not have a good relationship with her parents and has indicated that parents are very strict and she is not comfortable talking to them about sexual reproductive health. The father works in construction and the mother is a homemaker. Medical History: The client is a healthy adolescent who does not have any medical issues. She does not have any medication allergies. The client had surgery when she was 5 years old due to a left arm fracture. Vital Signs: blood pressure, 125/70; heart rate, 62 beats/min and regular; respirations, 19/min; lung sounds clear (within normal limits) Gina: "Thank you for coming into the clinic today. You have indicated that you are sexually active and have not used condoms consistently, whoa that is dangerous! Can you tell me what some of the challenges have been for not using condoms consistently?" Client (with hesitation and apprehension): "Um, you know what, maybe I over exaggerated when I said we didn't use condoms frequently. It has only been like maybe one time." Gina: "Oh I see. I will go ahead and update your intake form then." Client: "Okay thank you. I am just curious, what would happen if I wasn't using condoms regularly?" Gina: "Well, you said that wasn't an issue and you only had one instance where you didn't use a condom, so we aren't going to s

migrant pop

Groups of individuals who do not have a permanent residence so that they are able to seek employment in agricultural work.

social determi

In order to comprehend individual and social factors, it is important to have a good understanding of the social determinants of health (SDOH). They include factors such as education, stress, economic status, environmental factors, nutrition, and prejudice. They also include factors such as access to health care, safe neighborhoods, and access to nutritious foods. For more information, see Foundations of Community and Public Health Nursing.

individual factors

Individual factors that lead to vulnerability include pre-existing illnesses and age. Some examples include cancer, heart disease, and mental illness. As a result of these factors, many individuals are not able to cope with the stress associated with their illness in comparison to the population as a whole. Other individual factors include feelings of victimization or disadvantage, having limited control, being predisposed to risk factors, and disenfranchisement. Disenfranchisement is a dangerous situation and can impact vulnerable groups significantly. For example, individuals who are undocumented experience poorer health outcomes due, in part, to the inability to access federal insurance programs which results in delays in seeking needed medical care. The very young and the very old represent vulnerability, because they are often not able to physiologically adapt to stressors. For example, infants and older adults are considered vulnerable due to safety threats and a lack of independence.

case study part 5

Janine has taken an interest in addressing some of the challenges that her community faces. Janine has decided to start by identifying data driven national objectives to improve health and well-being over the next decade by visiting the Healthy People 2030 website. Janine has located leading health indicators associated with children and has identified objectives associated with children. Children Objectives: Increase the proportion of students with disabilities who are usually in regular education programs — DH-05 Increase the proportion of children aged 3 to 5 years who get vision screening — V-01 Reduce the rate of deaths in children and adolescents aged 1 to 19 years — MICH-03 Reduce the proportion of children with a parent or guardian who has served time in jail — SDOH-05

case study p3

Janine understands that a nurse is continuously learning and evolving. Because she is encountering diverse students, she wants to learn more about becoming a culturally sensitive nurse. Janine understands that being a culturally sensitive nurse will lead to better health outcomes for her clients.

socioecon

Measurement of education, occupation, and/or income of an individual or group.

poverty/homelessness

Nurses working with clients who are living in poverty or who are without housing need to be aware of their own beliefs and biases as well as the stigma associated with these populations. Perceived houselessness stigma may reflect structural and interpersonal forms of discrimination, which in turn create an unhealthy environment. Research has found that individuals who are without housing experienced more stigma, reported more psychological distress, had worse physical health outcomes, and had a greater tendency to avoid using services. Nurses need to be empathetic, inclusive, and flexible while working with these populations. These individuals face huge health inequalities. The life expectancy of these populations is significantly lower due to long-term stressors. However, not all clients who are living in poverty or without housing are affected in the same way by their circumstances.

mental health disorders

Nurses working with clients who have a mental illness will be exposed to a wide variety of disorders that fall under the umbrella of mental illness. These disorders can range from mild to severe. Mental illness is defined as any behavioral, emotional, or mental disorder. According to the National Institute of Mental Health, "serious mental illness is defined as a mental, behavioral, or emotional disorder that results in serious functional impairment, which in turn interferes with or limits an individual from engaging in major life activities". Nurses typically encounter these individuals in a community setting, with clients living in their own homes and receiving mental health services in local clinics, private practices, and mental health facilities. Clients who have mental illness may experience disturbances in their thoughts and behavior, which impacts their ability to cope with ordinary life situations. About half of all who reside in the United States will be diagnosed with a mental health disorder at some point in their lives. Healthy People 2030 has objectives aimed at prevention, screening, assessment, and treatment of mental health disorders. -Because mental illness affects people of all ages, races, and ethnicities, nurses need to understand that certain populations are more impacted than others and that about half of individuals diagnosed with mental health disorders actually get the treatment they need. Because mental and physical health are closely associated with one another, mental health disorders such as depression and anxiety can impact people's capacity to participate in behaviors that are healthy, which places them at risk for adverse health outcomes. -The nurse needs to understand the underlying issues associated with mental illness, such as traumatic life experiences that involve abuse, negl

more on nursing process

Planning for and implementing health care that is population focused for these communities leads to improved health outcomes. The steps used in program planning, and interventions that are appropriate for these populations should be evaluated consistently because needs change quickly. Health intervention plans with these populations will need to be modified as new information and research become available. It is important to include members of the community in as many steps in the process as possible in order to effectively implement change. Community members can include an array of individuals, such as school representatives, community agency representatives, local law enforcement, local fire personnel, business owners, health care representatives, local elected officials, and community members. Community-based participatory research methods should be utilized. -According to the National Institute of Minority Health and Health Disparities, "Community-based participatory research supports collaborative interventions that includes researchers and community members to address diseases and conditions disproportionately affecting health disparity populations". Under this research method, recognizing the strength of each participant is critical in order to collaborate effectively, conduct a needs assessment, and engage in community-level interventions. Input from diverse community members should be sought when analyzing data to determine what the diagnosis will be and how to prioritize, plan, identify outcomes, and evaluate. -Nurses must collaborate with stakeholders and community organizations aimed to promote the health of vulnerable groups. For example, a nurse might collaborate with a food bank or a shelter for people without housing. Population-based community health nursing practice focuses on the health of entire

cultural racism

Prejudice and discrimination that is a result of cultural differences between racial/ethnic groups.

health dispar

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

nurses role

Researchers have identified certain areas where the nursing profession should work to meet the challenges of the future. This involves viewing the responsibilities of nursing with respect to structural and individual determinants of health. Nurses have different roles in various health care settings where they can influence social or medical factors. These roles can improve health outcomes and reduce health disparities in vulnerable populations.

racial ineq

Systemic racism is discrimination based on race and ethnicity. It takes many different forms in the United States. Inequalities in housing, education, employment, and wealth are rooted in the nation's history. Racial inequalities are associated with vulnerabilities. Historically marginalized racial and ethnic groups experience higher rates of illness and death in comparison to their white counterparts. According to researchers, historically marginalized racial and ethnic groups mistrust the medical system. Vaccine hesitancy is prominent in the Black community and is the result of a history of racism in medical research. For more information, see Epidemiology. -In recent years, racism and its effects on both economic and social factors has resulted in COVID-19 disproportionately affecting Black people. Racism affects Black, Indigenous Peoples, and people of color (BIPOC) in varying ways. Other illnesses that communities of color face in disproportionate numbers include diabetes, hypertension, obesity, asthma, and heart disease.

importance of telehealth

Telehealth allows for providers to provide health care to those who are faced with barriers in accessing health care.

What agency should Janine start with to identify evidence-based culturally sensitive information for nurses? (Click this card to reveal the answer.)

The CDC is a comprehensive resource on cultural sensitivity in the U.S. Department of Health and Human Services. It is a great starting point for new nurses seeking information about reliable training resources.

health eq

The attainment of the highest level of health for all people.

disenfr

The 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.

social determinants of health

The environment and condition where an individual is born, works, and lives that impact a wide variety of health outcomes and risks.

nursing process

The first step of the nursing process is assessment. Therefore, nurses working with vulnerable populations need to understand the basics of community assessment. Systems-based community assessment tools such as windshield surveys can assist nurses in gathering information about specific populations. Vulnerable populations often experience cumulative risks, and they are sensitive to the effects of those risks. Risks come from environmental hazards, social hazards, personal behaviors, and biological makeup.

Although Gina addressed the chief complaint of needing STI testing, the client felt rushed and judged. Was a teaching opportunity missed? What strategies could Gina have implemented as it pertains to nonjudgmental, therapeutic communication? (Submit your response to compare it to an expert response.)

The nurse should have used therapeutic communication with the client to establish rapport and should not have added her own personal opinion when interacting with the client by saying, "Whoa, that is dangerous." Instead, the nurse should have taken this opportunity to provide primary prevention intervention strategies, such as education on safe sex measures. The nurse needs to gain the knowledge and skills to ensure that adolescent clients have necessary resources for reproductive and sexual health care. Nurses can use their knowledge and skills to implement evidence-based interventions to improve health outcomes.

role of nurse in mitigating health risks for migrant populations

The nurse working with migrant populations should seek to promote and improve health outcomes through better understanding of their circumstances. Migrant populations are vulnerable due to a variety of factors that include higher frequencies of workplace injuries, illnesses, and deaths. Nurses should understand the effects that poverty, lack of access to health care, hazardous working conditions, and a lack of regulations have had on migrant populations. Many migrant individuals move from one location to another to find work, which poses additional challenges when trying to access health care. Since these individuals tend to have provisional status, employers are not required to provide health insurance. Undocumented migrant workers are typically not eligible to receive health insurance in the United States. -n order to mitigate health risks for migrant populations, the nurse must understand the importance of infectious disease prevention. The nurse will typically encounter these individuals in a rural setting. The nurse can implement public health interventions centered around vaccination efforts and parasitic treatment programs to prevent infectious disease and advocate for basic health screenings. Nurses working with this population will need to consider several factors that may act as barriers to access, such as remoteness, scarcity of resources, shortages in the health care setting, and isolation. The nurse should consider the importance of utilizing resources such as mobile health clinics and tapping into federally funded clinics to improve health outcomes and provide quality health care.

nursing approach for homeless individuals

The nursing approach when working with these populations should focus on holistic, client-centered care to address the tie between physical and mental health problems.

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, and criminal justice.

nursing role

Under the American Nurses Association (ANA) provision 8 of the code of ethics for nurses and interpretive statements, nurses are called to stand up for social justice and human rights as they work to address health disparities. Under this provision, nurses must advocate for all vulnerable groups to obtain equitable treatment regardless of their socioeconomic status, immigration status, sexual orientation, gender identity, or any other factor that can lead to vulnerability. The nurse encounters vulnerable populations in all settings. Having a good understanding of how to provide culturally sensitive care is important in health care and leads to better health outcomes. Nurses who want to become more culturally sensitive should utilize evidence-based resources such as the CDC and WHO. Nurses who are culturally sensitive understand that this is vital when coordinating client care, establishing rapport, and making appropriate clinical judgments. Cultural sensitivity involves understanding a client's cultural needs as it pertains to health and illness.

vulnerable pop

Vulnerability results from individual and social factors. It is the result of a combination of factors such as limited physical, personal, environmental, and biopsychosocial resources. Vulnerable populations have a higher risk of health problems and poor health outcomes in comparison to nonvulnerable populations. For example, vulnerable populations may be predisposed to heart disease, diabetes, obesity, and disabling circumstances. These individuals are more likely to experience health disparities and have increased sensitivity to risk factors. Furthermore, these individuals face significant challenges, including racism and discrimination, when race, age, and ethnicity are taken into consideration. Individuals who have low socioeconomic status (SES) and lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual (LGBTQIA) individuals may also encounter discrimination and additional challenges, which increases their vulnerability.

Based on the objectives that Janine has located, which objective is the most important to address first? (Submit your response to compare it to an expert response.)

When using the greatest risk priority framework, the nurse should recognize that the reducing the rate of deaths in children and adolescents aged 1 to 19 years should be addressed first. Children are among the most vulnerable groups due to safety threats and lack of independence.

q2

Which of the following actions should Janine take as the school nurse to address the issue of students not having access to insurance? A Write to local lawmakers about challenges clients face with insurance access. B Call the student's parents to educate them on the importance of having medical insurance. C Seek prescription assistance programs and resources for those who are not insured. D Exclude the students from school until they are able to provide evidence of insurance.

q1

Which of the following actions should Janine take as the school nurse to address the issue of the student being at risk for substance use disorder? A Refer the student to a local community treatment center that works with adolescents. B Explain to the student that they are throwing their life away by using ecstacy. C Send the student to the school counselor to begin counseling sessions. D Alert the student's teachers that the student has substance use disorder.

q1

Which of the following actions should Janine take as the school nurse to address this issue? A Scold the students for not being compliant. B Call the student's health care provider to increase the frequency of the inhaler. C Collaborate with the parent to assess the challenges faced in the home setting. D Alert the teachers that asthmatic students are missing instruction time to address health needs.

culturally sensitive care

leads to better health outcomes