POP Exam 4
Characteristics of Disability
Americans with Disabilities Act (ADA) of 1990 and Rehabilitation Act of 1973 defined disability according to limitations in a person's ability to carry out a major life activity. ➢ Major life activities: ability to breathe, walk, see, hear, speak, work, care for oneself, perform manual tasks, and learn U.S. Census Bureau (2006) defines disability as long-lasting physical, mental, or emotional condition that creates a limitation or inability to function according to certain criteria. Physical disabilities Sensory disabilities Intellectual disabilities Serious emotional disturbances Learning disabilities Significant chemical and environmental sensitivities Health problems
WHO International Classification of Functioning, Disability, and Health
Disability is an umbrella term covering impairments, activity limitations, and participation restrictions (individual level). An impairment is a problem in body function or structure—activity limitation or participation restriction (micro level). A handicap is a disadvantage resulting from an impairment or disability that prevents fulfillment of an expected role (macro level).
Recommendation for the Nurse
Listen to parental concerns ➢ "Something is not right" ➢ Establishes an important bond with parents ➢ Nurse can serve as an intermediary Regularly assess for key developmental milestones ➢ Compare with predicted values ➢ Work with team of resource providers on IEP Be cognizant of disability within the context of culture and aging
Medicalization issues
Nurse's interaction with PWD and families ➢ Approach on an eye-to-eye level ➢ Listen to understand ➢ Collaborate with the person/family ➢ Make plans and goals that meet the other's needs and draw on strengths and improve weaknesses ➢ Empower and affirm the worth and knowledge of the person/family with a disability ➢ Promote self-determination and allow choices
Health Disparities among rural americans
Only 10% of U.S. physicians practice in rural areas Ratio of physicians in rural population is 36:100,000 (nearly double in urban settings) More often assess their health as fair or poor More disability days resulting from acute conditions More negative health behaviors (untreated mental illness, obesity, alcohol, tobacco, and drug use) that contribute to excess deaths and chronic disease and disability rates Higher number of unintentional injuries
Defining Rural Populations
Population size ➢ Rural = towns with population of less than 2500 or in open country [farm/nonfarm] Density ➢ Rural = fewer than 45 persons per square mile ➢ Frontier = less than 6 people per square mile Differ in complex geographical, social, and economic areas Disparities include key indicators of health: ➢ Employment ➢ Income ➢ Education ➢ Health insurance ➢ Mortality ➢ Morbidity ➢ Access to care
Measurement of Disability
Survey of Income and Program Participation (SIPP) ➢ Functional activities ➢ Activities of daily living (ADLs) ➢ Instrumental activities of daily living (IADLs) American Community Survey (ACS) ➢ Surveys for disability limitation in six areas that affect function or activity (sensory, physical, mental/emotional, self-care, ability to go outside the home, employment) Other organizations also collect disability data
Rural Populations
The largest rural population in history of United States is now. 75% of counties are classified as rural; they contain only 20% of the U.S. population Number/size of rural counties are highest ... ➢ in the South (35%) ➢ in the Midwest and West (23%) ➢ in the Northeast (19%) Census data ➢ 20% of nation's children under 18 ➢ 15% of nation's elderly ➢ More than 50% of nation's poor Economic base is shifting ➢ Agriculture is the "food and fiber system" ➢ All aspects of agriculture (core materials to wholesale and retail and food service sectors) are included ➢ Poverty in rural areas greater than in urban areas Poverty continues to be greater in rural America than in urban areas. Aging-in-place, out-migration of young adults, and immigration of older persons from metro areas. Greater diversity among residents: a country of immigrants historically and today. Health disparities exist—rural population more likely to be older, less educated, live in poverty, lack health insurance, and experience a lack of available health care providers and access to health care
Doing a self-assessment
What comes to mind when you think of someone with a disability? Picture yourself as a person with a disability. Imagine yourself as a nurse with a visible disability, or a client receiving care from a nurse with a disability. Think about living in a family affected by disability. What is the experience of living with disability within your community?
Ms. L is being treated for depression. Which of the following statements by her indicates a need for further education?
"My medication will cure me of my depression."
Which of the following statements describes the social construct paradigm for disability (as opposed to the medical model)?
1. It focuses on the modification of attitudinal, architectural, sensory, and economic barriers in the environment.
Factors that contribute to homelessness
1. Shortage of Affordable Housing Housing is considered affordable when it costs the resident 30% or less of their total income. There has been a dramatic increase of persons who pay half or more on rent. HUD offers assistance to low income families. The demand for this assistance has far exceeded the supply. 2. Income Insufficiency Average poverty threshold was 23,021 for a family of four in 2011, 44% of the poor were living below half of their threshold. The federal minimum wage is 7.25/hr. In many areas, wages need to be 3-5 times higher than this to afford the available housing. Much of a person's income is spent on rent leaving little for all the other necessities of life. 3. Inadequacy of supportive services
In which era were people with mental disabilities labeled as "feebleminded" because they could not reach the minimum educational level?
19th century
Rural residents in the United States compose more than __% of the nation's poor.
50
Which of the following would be considered a long-term disabling condition in which the person must learn to incorporate the modifications required for living into daily living and identity?
A cardiovascular accident (CVA) with paralysis to the right side of the body
What group of homeless individuals is known for their involvement in survival sex?
Adolescents
The landmark civil rights legislation that uses the authority of the federal government to guarantee equal opportunities for people with disabilities related to employment, transportation, public accommodations, public services, and telecommunications is the:
Americans with Disabilities Act (ADA). The ADA is landmark civil rights legislation that provides a clear and comprehensive mandate against discrimination toward people with disabilities in everyday activities. The IDEA addresses the educational needs of children with disabilities. The TWWIIA reduced people with disabilities' disincentives to work by increasing access to vocational services and provided new methods for retaining health insurance after returning to work. The Civil Rights Act prohibits discrimination based on race, ethnicity, religion, and sex.DIF: Cognitive level: KnowledgeREF: Page 414
Based on the Department of Housing and Urban Development (HUD) definitions of homelessness, which one of the following individuals would be considered homeless?
An individual who spends most nights at public or private places not designed for regular sleeping accommodations
People with Disabilities 7
Barriers can be transportation, costs, appointment challenges, insurance issues...many PWD have many services needs such as prescriptions, therapies, devices, cares, etc. The costs can be unaffordable, even to those with insurance or those in middle to upper middle class. Caring for a child with a disability can have all these challenges and more with finding appropriate care Disparities are caused by ... ➢ Differences in access to care ➢ Provider biases ➢ Poor provider-patient communication ➢ Poor health literacy Persons with disabilities experience ... ➢ Higher rates of chronic illness ➢ Increased risks for medical, physical, social, emotional, and/or spiritual secondary issues People with intellectual disabilities are ➢ Undervalued and disadvantaged
Mr. H is a patient in the primary care center where you work as a staff nurse. He tells you that he is currently participating in a stress management program. You know that this is a form of which of the following?
Behavioral therapy
People with Disabilities 13
Children and disability- is imperative that community health nurses use their expertise in listening to parents voice concerns about their child. Addressing concerns and working with the family towards goals , not merely reassurance , regarding a concerned parent.
People with Disabilities 10
Children with disabilities can be at an increased risk for bullying or teasing in school, whether this is an apparent or hidden disabilities. This can add to the already challenging condition. Depression, anxiety, health complaints and decreased academic achievements are among the effects of bullying.
Based on the common illnesses and risky health behaviors among farmers, the community health nurse should implement which of the following health promotion activities?
Collaborate with health care providers and provide support and education for farmers with respiratory conditions and their families.
3. Analyze three factors that contribute to homelessness Ch 22
Contributing factors to homelessness are complex and varied. They include poverty, changes in the labor market (i.e., shift to a service-based economy and a labor market that demands an educated workforce), lack of affordable housing, deinstitutionalization of persons with mental illness, and heavy use of alcohol and illicit drugs (particularly crack cocaine).
What official national organization provides financial housing assistance to low-income families?
Department of Housing and Urban Development (HUD)
Mr. S was recently hospitalized for a stroke. While in the hospital, he was also diagnosed with diabetes. As his nurse, you know he is at risk for which of the following?
Depression
Which of the following statements best describes the demographics of rural America?
Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy.
People with Disabilities 8
Differentiating illness and disability- nurses have to remember that these often are or can be separate. An illness is not necessarily related to the disability or vice versa. Be careful to not put PWD into the "sick role" but always ask the client if they want assistance, clarify goals with the person or family, that way, as a nurse you know the best way to help. Listen, collaborate with the person and family, make plans and goals that meets the person's wants and needs...empower the person and family by collaborating with them. Promotion of self-determination fosters personal values and preferences.
People with Disabilities 4
Disabilities can be outwardly visible and apparent such as someone in a wheelchair or less obvious such as a person with hearing loss or Autism. Learning disabilities and other unapparent disabilities to the outside view maybe termed as hidden disabilities.
People with Disabilities 11
Disability harassment is a prohibited behavior under section 504 and title II of the Americans with Disabilities Act.
People with Disabilities 3
Each person is very unique and has their own experience, goals and knowledge- PWD cannot be lumped into one group.
You work in a community clinic that specializes in pediatric mental health. Joy, age 12 years, has been diagnosed with depression. You know a major risk factor for depression in childhood is which of the following?
Family history of depression
People with Disabilities 1
First- Stop and think- what would it be like to live with a disability? What if one of my loved ones was affected by a disability? What would it be like to live and work in my community and environment with a disability?
Healthy People 2020 and Homelessness
Healthy people 2020 Social determinants of health to be considered are poverty, employment status, access to employment, housing stability, access to health services and access to primary care. ■ New goal: to "Create social and physical environments that promote good health for all" ■ New topic area: Social Determinates of Health (SDH) ■ Five broad dimensions of SDH are defined within Healthy People 2020 as: 1. Economic Stability 2. Education 3. Social and Community Context 4. Health and Health Care 5. Neighborhood and Built Environment
1. Discuss various definitions of homelessness. Ch 22
Homeless refers to an individual who lacks a fixed, regular, and adequate nighttime residence or who has a primary nighttime residency that is either a shelter or an institution that provides a temporary residence or a public or private place not ordinarily used for sleeping.
People with Disabilities 14
IEP individualized education plan- specific to child with a disability - using a team approach and variety of resources to meet developmental milestones and educational needs. Progress should be monitored to see that goals are met and changes should be made accordingly. Parents have a right to request a change in this plan.
Which of the following statements is true concerning the Individuals with Disabilities Education Act (IDEA)?
It provides federal funding through state-administered programs from preschool through secondary education for children with disabilities. .
Services for homeless
Some of the services need to prevent homelessness include job placement assistance, housing assistance, mental health services, Chronic disease management, substance abuse treatment, income assistance- just to name a few. There is a lack of these resources One thing that needs to be available to all persons is access to affordable health care 25% of those with an income below $25,000 had no health insurance.
People with Disabilities 17
Strategies for the nurse 1. do not assume anything 2. Adopt the client's perspective 3. Listen and learn from the client; gather data from the perspective of the client and family 4. Care for the client and the family, not the disability 5. Be well informed about community resources 6. Become a powerful advocate 7. Look at the person and family as unique 8. Collaborate in health care planning with the individual or family
People with Disabilities 2
Terminology- PWD- people with disabilities Thought to be the largest minority group in America. Some do's and don'ts when interacting with PWD. Don't- Be afraid of joking, be afraid to ask questions, focus on differences, lean on or move the persons wheelchair, assume a blind person know who is speaking to them, grab the arm of a blind person, repeat loudly what you want to say, pet a service dog. Do- treat everyone with respect as with any social or professional relationship, recognize educating others helps remover barriers so asking questions is ok, seek out similarities and interests, respect a wheelchair as a part of a person personal space, speak to individuals at eye level, inform the person who you are talking to is present and say goodbye when you are leaving, let the person take your arm instead, face the person you are speaking to, speak distinctly and slightly more slowly, do not interrupt the service dogs work.
Which of these statements is true regarding income insufficiency in the United States?
The poverty rate increased between 2007 and 2010.
Which statement regarding the impact of managed care on rural public health departments is true?
The role of rural public health departments may increasingly narrow into areas that are currently without any type of reimbursement.
According to the vulnerability index, the individual at highest risk for death is:
a 60-year-old person who has been homeless for 9 months.
The U.S. Department of Education defines a homeless child as:
a child abandoned in a hospital.
Ms. W, 18 years old, presents at a community clinic describing vague complaints. She explains that she recently dropped out of high school and is having trouble keeping a job. She notes that she has difficulty concentrating and has used drugs (i.e., marijuana and alcohol) when riding motorcycles with friends. When conducting the initial assessment, the RN should include questions and tools that would screen for:
attention-deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD).
Nurses can help parents and family members adjust to a child with a disability by:
establishing a partnership between the parent and health care team.
The Brown family is being evicted from their home and will be moving into a homeless shelter in 3 days. Under the Department of Housing and Urban Development (HUD) definition, the Brown family is:
in imminent risk of homelessness.
The number one health concern identified by the majority of rural health care leaders is:
lack of health insurance.
One strategy for the community health nurse in caring for people with disabilities is becoming a powerful advocate. This involves:
providing information but allowing the person to make the decision.
Migrant and seasonal farm workers constitute a high-risk population due to their low income and migratory status. These workers lack adequate access to preventive services. The most important role of the rural community health nurse in meeting the health care needs of this vulnerable population is to:
serve as an advocate working to gain health care access for these farm workers.
The greatest promise for improving health outcomes for rural residents is:
the increase in distribution of technology, providing more education and health services.
In contrast to people who live in urban areas, rural residents frequently describe their health by their ability to:
work and be productive.
Which of the following are appropriate when working with people with disabilities? Select all that apply.
~ Asking a wheelchair-dependent person if he or she needs help and how you can assist. ~ Sitting or kneeling at eye level whenever possible when talking with someone who is wheelchair dependent. ~Speaking distinctly and a little slowly to someone who is hearing impaired.
People with Disabilities 18
~Adjustment to the disability occurs in 4 phases Ostrich, special designation, normalization and self actualization. 1. Ostrich: when parents do not deny a disability but also do not fully realize its impact 2. Special designation: when parents begin to realize their child has a special need and seek help 3. Normalization: when parents try to make the differences between their child and children without disabilities less apparent and may actually request a reduction in services 4. Self actualization: when parents view being different as not better or worse, just different, and support their child in learning about his or her disability, along with ow to be a self- advocate
Public health policy in the United States is influenced by two types of justice, market justice and social justice. Examples of market justice include which of the following?
~All people are entitled to the status they create for themselves. ~All people are entitled to happiness if they put forth enough effort. ~All people are entitled to the income they work for.
Mr. B has been diagnosed with a severe mental illness. The nurse may expect Mr. B to exhibit which of the following?
~Low self-esteem ~ Difficulty forming relationships
3. Compare and contrast short- and long-term, health-related, disabling conditions.
~Temporary disability ~Permanent disability from accident or disease ~Disability from progressive decline of a chronic illness The onset of a disability is unique as well. This may be something that happened at birth, a gradual onset, with aging or a sudden unexpected event, such as a trauma or accident. Think of how this adaptation would be different for the person and the family.
A community health nurse is concerned about reducing the fatal injuries to America's rural children. To address this problem, the nurse organizes a community of solution (see Chapter 1). For this group, it would be important to have representatives from all of the following groups or organizations:
~the Department of Public Highway and Safety. ~emergency department staff (both doctors and nurses) from local hospitals. ~teachers and coaches from area schools. ~city or county government.
2. Describe historical attitudes and perspectives surrounding disability that have contributed to devaluation and disempowerment of people with disabilities.
• Beginning in the 1990s, media images of the disabled became more positive. Emphasis has been on inclusion, normalization, and deinstitutionalization of people with disabilities, and people with disabilities are increasingly being seen as "normal."
2. Describe biological, social, and political factors associated with mental illness. Ch 24
• Biological factors associated with mental illness include genetic factors, neurotransmission, and brain structural and functioning abnormalities. • Social factors can contribute to the etiology of mental illness. • Political factors can dramatically influence how mental disorders are managed.
Effects of disabilities
• Cost of chronic management • Decreased employment rates • Decreased household income and increased poverty rates • Decreased opportunity for physical activity • Isolation and possible self-image issues • Possible altered roles of family members • Increased risk for abuse • Possible inability to live independently • Presence of comorbidities
Model of Justice- Homelessness
■ Social justice system - Belief that all people are equally entitled to key ends (e.g., access to health care and minimum standards of income) - Says all members of society must accept collective burdens to provide a fair distribution of these ends - A foundational aspect of public health - Supports upstream thinking
2. Identify demographic characteristics of the homeless population and subpopulations. Ch 22
Lack of a permanent mailing address, problems with distance and transportation, and lack of money all contribute to problems of access to health care for homeless populations ■ More men than women ■ Women head up more single families ■ Younger than general population ■ Minorities were overrepresented ■ Disability rate twice that of all families ■ Veterans were primarily male • Adults who are unemployed, earn low wages, or are migrant workers • Female heads of households • Families with children (fastest-growing segment) • People who have a mental illness (large segment) • Veterans • People who have substance use disorders • Unaccompanied youth • Adolescent runaways (high incidence of lesbian, gay, bisexual, and transgender [LGBT] adolescents) • Intimate partner abuse survivors • People who have HIV or AIDS • Older adults who have no place to go and no support system
You are working in a mental health facility as a nurse. You are involved with patients who have varied diagnoses. One of your patient's family members asks what biological problem causes all of these people to have mental illness. You respond that most experts believe which of the following?
Many factors cause the problem Information from studies to date is insufficient to establish a definitive biological cause for mental illness. Scholars have concluded that mental disorders are multifactorial, complex physiological phenomena
Mental illnesses adversely affect achievement of social justice. Which of the following statements related to marginalization of some populations because of mental illness is FALSE?
Most mental illnesses are caused by genetic factors; therefore, problems associated with them persist across generations and among certain racial and ethnic groups.
According to the ICF (International Classification of Functioning, Disability, and Health), which of the following would be classified as a disability?
Need to use a powered wheelchair
What is the purpose of the Homeless Information Management System (HIMS)?
Obtains national data on homeless individuals
People with Disabilities 9
PWD have been abused, segregated, and disrespected as humans throughout history. The deinstitutionalization movement in the 60's and 70's stimulated community based independent living centers for PWD. Care in institutions have improved in the twentieth century.
People with Disabilities 16
Parenting, family response to a child with a disability ~Affects all family members. Redefining parental roles, expectations and image of the child, marital partners, members of culture and society are all redefined. Grieving the loss of the idealized child is expected. Likely caregiver role strain will be experienced, often straining relationships, can result in divorce. Nurses can help the family adjust by educating based on readiness to learn, referrals to case managers, support groups, empowering the parents to make decision on the child's behalf and establishing a strong partnership between the parent and the health care team. ~A PERSON LIVING WITH A DISABILITY IS THE EXPERT ON KNOWING WHAT WORKS BEST FOR THEIR BODY. Collaboration and care planning needs to take place between the nurse and the client.
Agricultural workers are at high risk for occupational injuries and illnesses. To reduce the most common cause of fatalities among youth on farms, which of the following is the most important strategy for the community nurse to implement?
Partnering with the county extension agent to offer tractor safety classes
People with Disabilities 15
Policy and Disability ~Individuals with Disabilities Education Act ensures a free public education to children with disabilities based on their needs in the least restrictive setting preschool through secondary ~Americans with Disabilities Act Landmark civil rights legislation- prohibits discrimination against PWD in everyday activities. This meant equal opportunities for employment , transportation, public accommodations, public services and telecommunications. ~Gaps- PWD are less likely to be employed, have lower income, education, access to transportation.....equates most likely to live in poverty compared to someone without a disability. PWD also more likely to have chronic health conditions
A community health nurse is reviewing the results of SIPP (Survey of Income and Program Participation) used by the U.S. Census Bureau to collect disability data. Which of the following will the nurse find classified as an instrumental activity of daily living?
Preparing meals
People with Disabilities 12
Prevalence - 56.7 million people (ages 5 and up ) in the US with a disability Of those 56 million, 38 million are considered to have a severe disability About 15% of households have at least one child with a special health care need 1 in 88 children are on the autism spectrum 5 times more boys than girls- many of these children have ongoing behavioral, emotional or developmental conditions Disability affects one out of 5 Americans
People with Disabilities 5
Primary prevention are those actions that involve the manifestations of the disability itself. Examples include prenatal care and immunizations for mothers and newborns ~Secondary prevention focuses on preventing secondary conditions that are related to the disability such as obesity prevention in someone with impaired mobility. ~Tertiary prevention focuses on preventing a functional limitation from progressing into a disability. An example is a customized education plan for someone who has learning disabilities.
People with Disabilities 6
Quality of life issues- overcoming of environmental and social barriers to attain needed services can be some of the biggest challenge for PWD and their families.
Tony, age 16 years, comes to see you, the school nurse, with complaints of abdominal pain. You note that Tony exhibits signs and symptoms of depression, states he wishes he did not wake up today, and exhibits signs of anxiety. You would do which of the following?
Refer him immediately for evaluation.
Mr. T has been admitted to the mental health floor for evaluation. You, the nurse, note that he has displayed hallucinations, disorganized thinking and speech, and bizarre behavior. He has a flat affect, lack of energy, and poor attention. You know that these are symptoms of what disorder?
Schizophrenia
Which model supports upstream thinking with the purpose to improve homelessness through reduction of structural conditions contributing to homelessness?
Social justice
Definitions, prevalence and characteristics of homelessness
• Counting the homeless and defining who is actually considered homeless is a daunting task. Keeping this in mind, we really only have a rough estimate of the homeless in America. Those who are sheltered are easier to account for, but there are many, many more hidden - physically or living in cars, doubled up with other families or in abandoned buildings. • The estimate is 633,782 total homeless- but the number is thought to be much higher • Among sheltered homeless adults (not in a family) 72% are men and 28% women, the majority of these were between ages 31 and 61 • Other than individuals, the government also looks specifically at families and Veterans ■ Point-In-Time (PIT) count of sheltered homeless people on a single night in late January of every year and submit this data to HUD—use data to prepare an Annual Homeless Assessment Report (AHAR) ■ Department of Education includes youth and families for services through Education for Homeless Children and Youth (ECHY) program ■ Conference of Mayors' Hunger & Homelessness Survey gathers data for their cities each year
3. Identify factors that place farmers and migrant workers at risk for illness and accidents. Ch 23
• Farmers and their families have been found to have excess risk for conditions associated with hearing loss, respiratory illness, nonfatal accidents, and chemical hazards. • Limited availability and accessibility of formal health care resources, combined with self-reliance and self-help of rural residents, have resulted in the development of strong informal care and social support networks in rural communities.
Health Status and Homeless Populations
• Homeless adults suffer at rates higher than the general populations from- Acute Illness- respiratory infections and trauma. Chronic illnesses- Hypertension, musculoskeletal, GI disorders, Asthma, COPD, seizures and poor dentation. Other diseases such as serious mental illness and substance abuse occur more frequently as well. The overall morbidity and mortality rates are higher also. • Women- Higher rates of pregnancy, preterm and low birth weight babies. Compared to homeless men, women report having higher rates of stressful life events, foster care, domestic violence and hospitalization for psychiatric problems. Violence can often be a cause of homelessness in women. Once a woman is homeless, she is at much higher risk to be the victim of violence or assault. • Families- Children in homeless families have higher rates of asthma, iron deficiency anemia, obesity, mental health problems, developmental delays and behavior issues- as well as a higher risk for educational/ school issues such as lower test scores, repeating grades and bullying. • Youth- All youth are at risk for STD's, substance use and abuse, depression and suicide, but homeless youth have higher rates than the general population. Other problems occurring more in homeless youth include skin problems, anemia, unintentional injury and physical and sexual abuse. Those homeless youth at an especially high risk are those who are pregnant, identify as LGTBQ, and engage in prostitution or "survival sex" and those with a history of foster care. • Chronically homeless suffer often from severe mental and substance abuse disorders.
4. Identify major health problems among various homeless aggregates. Ch 22
• Homeless children experience more immunization delays, upper respiratory tract and ear infections, asthma, skin disorders, diarrhea, anemia, and hunger. They also experience high rates of mental health problems and developmental delays as well as depression, anxiety, and withdrawal. • Homeless men experience higher rates of acute physical health problems such as respiratory infections, trauma, and skin disorders. • Homeless women have health problems that typically cluster around problems of substance use and abuse, mental illness, history of violence, and childhood risks.
1. Explain the concepts of community mental health and discuss the importance of community mental health promotion in special populations. Ch 24
• Mental health refers not only to the absence of mental disorders but also to the ability of an individual to negotiate daily challenges and social interactions of life without experiencing cognitive, emotional, or behavioral dysfunction, violence, fear, or intellectual inadequacy. • Mental illness refers to maladaptive responses to distress and an inability to mobilize resources.
Agricultural Workers
• Migrant and seasonal workers have the poorest health of any aggregate in the country, and the least access to affordable care • They are high risk for accident and injury on the job • Higher rates of acute and chronic respiratory illness • At risk for acute pesticide poisoning - s/s headache, nausea, diaphoresis, vomiting- can also cause neurological symptoms and more serious breathing difficulty / bronchospasm ➢ Musculoskeletal discomfort, acute and chronic respiratory conditions, hearing loss, hypertension • Barriers to health in migrant workers- language, unaware of services, short stays and frequent relocation, trust issues, economics, fear of losing their job or deportation • Needs- preventative care, dental care, prenatal care, child health care, vaccinations • Solutions to needs of the seasonal or migrant worker- Mobile clinics, interpreters on site, multiple services available at once to take care of social as well as health needs, evening hours, transportation to non-mobile clinics
Nursing in the Rural Community
• Nursing shortage in rural areas, declining school enrollment, increased population of elderly- all make for a more critical need. Rural nurses earn less than urban nurses. A grow their own strategy is in place in some rural areas to encourage and support local citizens to pursues nursing and work in the area after completion of school. People who study nursing locally are more apt to remain in the area. • Positives to being a rural nurse- ability to really get to know your patients, provide holistic care, more autonomy and intensity of purpose, challenging
Recent Efforts to Count Homeless
■ Homeless Information Management System (HMIS) - Directed by Congress to gather homeless data ■ Continuum of Care (CoC) concept - One-night point-in-time (PIT) count - Annual estimate based on reports of service use - A "snapshot" picture of the homeless population ■ National Alliance to End Homelessness (NAEH) and Housing and Urban Development (HUD) ■ U.S. Conference of Mayors
Definition of Homeless Student
■ McKinney-Vento Homeless Education Assistance Improvements Act of 2001 ensures that each child and each homeless youth has equal access to the same free, appropriate public education, including a public preschool education, as provided to other children and youths. ■ Includes children and youth who are: - Sharing the housing of other persons (frequently referred to as "doubling up") - Abandoned in hospitals - Awaiting foster care placement
Health and social issues in the rural population
• Obesity • Sedentary lifestyle • Tobacco use- higher rates of tobacco use in rural men and women • Unintentional injury- higher rates related to more dangerous occupations and high risk behaviors, lack of emergency services- esp. for trauma ~Lack of access to emergency care due to : low population density, large, isolated, or inaccessible areas, severe weather, poor roads, lower density of telephone/communication methods • Mental illness- higher suicide rates, fewer mental health services (75% of counties do not have a psychiatrist, 95% do not have a child psychiatrist) stigma attached to mental illness and seeking out help for services • Suicide- is the second leading cause of death in rural areas, sometimes being 800% higher than the national average in certain areas, Alaska being the highest • Access to Care- un or underinsured, few doctors and nurses, especially family practice, closure of hospitals, long distances to receive care, emergency care access may be more than an hour or two away, barriers in mobility and transportation, Only 10% of physicians in the U.S. practice in rural settings. • Poverty- few job options, lower education levels, lower income levels. Higher poverty rates in rural areas when compared to urban areas • Preventative / primary care- prevention screening less likely to occur, few primary care doctors, fewer options for clinics and hospitals, un or underinsured • High risk behaviors- lower use of seat belts, more tobacco use, driving longer distances on poor road conditions, more use of ATV's , much higher rates of unintentional injury overall • Education- lower education levels overall, lack of educational opportunities, poverty creates a barrier
2. Discuss barriers on the health of rural aggregates and the impact those have on the population. Ch 23
• Personal barriers to health care among rural residents include lower income levels, higher unemployment, and higher poverty rates than those of urban dwellers.
Strategies for preventing homelessness and assisting individuals who are homeless
• Prevent individuals and families from becoming homeless by assisting them in eliminating factors that can contribute to homelessness. • Refer those who have underlying mental health disorders to therapy and counseling. • Enhance parenting skills that can prevent young people from feeling the need to run away. • Assist homeless clients in locating temporary shelter. • Assist clients in finding ways to meet long-term shelter needs. • If homeless shelters are not provided in the community, work with government officials to develop shelter programs.
1. Describe features of the health care system and population characteristics common to rural aggregates. Ch 23
• Residents of rural communities have health patterns and problems related to demographic and geographic patterns (i.e., age, gender, occupation, race and ethnicity, availability of health information, preventive and illness services, sewage and water systems, and transportation).
4. Describe the characteristics of rural community health nursing practice. Ch 23
• Rural nurses practice professional nursing within the physical and sociocultural context of sparsely populated communities and include aspects of maternity, pediatric, medical and surgical, and emergency nursing.
Rural and Migrant Health
• The Midwest is second next to the South in Rural population density. 50% of the poor in America live in a rural area. Rural America is a diverse population. • Some areas in the south and west are growing in population, but many rural areas are seeing a decline in younger people, due to a lack of employment opportunities. In these areas, this leaves an increasingly aging and isolated population. Aging in place, immigration of older persons into rural areas and migration of younger persons to urban areas puts a lot of stress on communities that already struggle to provide adequate health care, transportation and housing to the residents.
Learning Focus 1 Ch 24
• The history of community mental health has included the Age of Confinement, mental health reform, medicalization of mental illness, deinstitutionalization, and Decade of the Brain.
1. Differentiate between medical model and social construct definitions for disability.
• The medical model prescribes interventions designed to remedy or ameliorate functional limitations of the person who is seen as ill. • In the social construct paradigm, disability is the result of failure of the social environment to adjust to the needs of persons with disabilities.
4. Describe some of the most common types of mental illnesses encountered in community settings. Ch 24
• The most common types of mental illnesses are depression, schizophrenia, anxiety disorders, eating disorders, and attention deficit hyperactivity disorder.
Learning focus 2 ch24
• The primary roles of mental health nurses in the community are educator, activist, practitioner, and coordinator.
4. Discuss key federal legislation applicable to people with disabilities.
• Three key pieces of federal legislation were enacted that have had a dramatic impact on persons with disabilities. They are the Individuals with Disabilities Education Act, the Americans with Disabilities Act, and the Ticket to Work and Work Incentives Improvement Act.
Health Issues of Homeless Populations
• Upper respiratory disorders • Tuberculosis • Skin disorders (athlete's foot) and infestations (scabies,lice) • Substance use disorders • HIV/AIDS • Trauma • Mental health disorders • Dental caries • Hypothermia and heat-related illnesses • Malnutrition
HUD legal definitions in the United States
■ Category 1. Literally Homeless. Individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an individual who resided in an emergency shelter or a place not meant for human habitation and who is exiting an institution where he or she temporarily resided ■ Category 2. Imminent Risk of Homeless. Individuals and families who will imminently lose their primary nighttime residence ■ Category 3. Homeless Under Other Federal Statutes. Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition ■ Category 4. Fleeing/Attempting to Flee Domestic Violence (DV). Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member.
