Health Care: Pop and Context Chapter 21

A staff member is orienting a new nurse to a health clinic that serves primarily vulnerable populations. Which of the following statements indicates a need for additional staff education?

A: "You will like working with Hispanic immigrants because they have close-knit family structures." Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Any stereotype, positive or negative, can be problematic. Even though Hispanic groups, as a whole, do have close-knit family structures, by assuming that all Hispanics are this way, staff members are less likely to be open to the possibility of issues such as family violence.

Which of the following bills would the nurse lobbyist, who believes strongly in social justice, encourage legislators to support?

A: A bill that promotes universal health insurance coverage Social justice refers to providing humane care and social supports for the most disadvantaged members of society. Nurses can be advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health. Promoting universal health insurance for all would be a step toward providing humane care for those who might not otherwise be able to receive care.

Which of the following statements best describes an outcome of the Balanced Budget Act of 1997?

A: A prospective payment system for home health services was created. The Balanced Budget Act of 1997 had some shifts in payment with the stipulations related to home health. In an attempt to curb the rapid growth in spending on home health and financial fraud in that industry, the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services [CMS]) instituted prospective payment for home health services. The Health Insurance Portability and Accountability Act of 1996 was intended to help people keep their health insurance when moving from one place to another as well as provide privacy and security of personal health information. The State Children's Health Insurance Program (SCHIP) was created by Title XXI of the Social Security Act in 1998.

Nursing students have been assigned to set up a health fair for the homeless population in a large urban setting. Without any funds to pay for space, where should the health fair be located, assuming that all of the following sites are available at no cost?

A: At the city's homeless shelter, which is, by policy, vacant during the day The most convenient place for the clients would be the homeless shelter, where transportation and lack of comfort in an unfamiliar place would not be issues. It is helpful to provide comprehensive services in locations where people live and work, including schools, churches, neighborhoods, and workplaces. Thus, for the homeless population the homeless shelter would be an appropriate location. Homeless persons would probably avoid the police station, and many may not wish to go to the medical center—also, there would be transportation issues. Depending on the location of the community college, there may also be transportation issues.

A nurse is working as a case manager with a vulnerable population. Which of the following actions should the nurse do when providing care?

A: Be willing to enter into a long-term relationship with families. Case management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the nurse can be of greatest benefit if he or she is willing to develop long-term relationships with the families served. This increases trust as well as continuity of care. Care involves a partnership between nurse and client. Nurses who direct and control the client's care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control.

A homeless family brought their father to the public health clinic after he reported bleeding when he went to the bathroom. Which of the following nursing actions would be most appropriate?

A: Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night. It is important to provide comprehensive, family-centered, "one-stop" services. Providing multiple services during a single clinic visit is an example of one-stop services. If social and economic assistance are provided and included in interdisciplinary treatment plans, services can be more responsive to the combined effects of social and economic stressors on the health of special population groups. If the family is referred to a different provider or agency, it is likely that this follow up will never occur. Only addressing the urinary infection, and not the homeless status of this family, does not provide the comprehensive services that are expected from a public health clinic.

A community health nurse would like to implement an intervention to increase lasting resilience among new immigrants. Which of the following actions should be taken by the nurse?

A: Direct clients to English-as-second-language courses.

A community health nurse is implementing a tertiary prevention activity related to tuberculosis. Which of the following interventions is the nurse most likely completing?

A: Directly observing clients with active tuberculosis as they take their antitubercular medications Tertiary prevention is exemplified when nurses provide directly observed medication therapy for people with active TB. Administration of skin tests, assessing for signs and symptoms, and interpreting tuberculosis skin test findings are all examples of secondary prevention as these interventions are all focused on screening or the follow up on a screening test.

Nurses at a homeless clinic are concerned that homeless clients rarely return to have the nurses assess the findings of their tuberculosis (TB) skin tests. Which of the following is the most appropriate policy for the clinic to have regarding the screening test findings?

A: Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy. Nurses should develop a way for homeless individuals to read their TB skin test, if necessary, and give them a self-addressed, stamped card they can return by mail with the results. Homeless people often do not have a way to receive telephone calls. Additionally, they usually face numerous barriers to return to the clinic. These issues often require deviation from strict policies, especially strict policies that are not working.

Which of the following factors predisposes many migrant farmworkers to disenfranchisement?

A: Short length of time in the community Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or the larger society. For migrant workers who are frequently moving, the short length of time they stay in the community does not allow for the development of social ties. Being a minority group member would not by itself cause disenfranchisement if the minority group member lived in a community with persons from similar ethnic and cultural backgrounds. An inability to attend religious services or previous physical abuse are not specifically related to disenfranchisement of the population of migrant farmworkers.

A large financial grant was being offered to whichever health facility wanted to accept the responsibility for giving care to local vulnerable populations. Which of the following actions would most likely be taken by the local medical centers?

A: Strongly consider not applying, because this population will be expensive to treat. Many agencies do not wish to provide services to vulnerable populations. Vulnerable populations are more expensive to treat because they have multiple, cumulative risks and require special service delivery considerations (e.g., to help overcome transportation problems or provide culturally competent care). Because of the major costs associated with providing care to this population and risks related to reimbursement, it would not be in the best interest of the agency to want to eagerly apply to provide care to this group.

A nurse who is providing diabetes screening at a community clinic discovers that a new client has type 2 diabetes mellitus. The nurse provides counseling, refers the client to an endocrinologist for initial assessment and treatment, arranges for the client to see someone regarding financial assistance, contacts the mobile van to arrange transportation, and sets up a follow-up appointment. Which of the following types of service do these actions represent?

A: case management Nurses often function as case managers for vulnerable clients, making referrals and linking them with community services. Case management services are especially important for vulnerable persons because they often do not have the ability or resources to make their own arrangements. Linking clients with health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved. Client advocacy refers to actions taken on behalf of another. Because of the variety of actions being taken by the nurse, the nurse is functioning in a larger role than simply advocating for the client. Holistic care addresses providing care for phyicial as well as emotional and spirtiual needs. The nurse is not addressing all of these aspects of care through this coordination. Wrap-around services refers to when comprehensive health services are available and social and economic services are "wrapped around" these services. These services are not being necessarily all being provided by the same clinic.

Which of the following is the primary cause of vulnerability to health problems?

A: poverty People with lower incomes and less education tend to be at higher risk for health problems. Poverty is a primary cause of vulnerability. Breakdown of family structures, prejudice, and social isolation may all influence vulnerability to health problems, but have not been identified as a primary cause.

A nurse offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive for TB. Which of the following levels of prevention is being used?

A: secondary prevention

Which of the following terms is used to describe aggregates who are at high risk for having poor health outcomes because of limited resources?

A: vulnerable populations Vulnerable populations are groups (aggregates) with an increased risk to develop adverse health outcomes. Families are a subgroup of populations and do not appropriately fit the definition of "aggregates". Resilience refers to the ability to resist poor health outcomes, not to succumb to them.