Discussion1:Analyze the direct effect poverty and homelessness has on health and well-being across the lifespan.Differentiate between crisis and persistent poverty.Examine the extent of the problem...

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Foundations of Nursing in the Community: Community-Oriented Practice, 2nd Edition Chapter 21 Vulnerability and Vulnerable Populations: An Overview All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Define the term vulnerable populations and describe selected groups who are considered to be vulnerable. Describe factors that led to the development of vulnerability in certain populations. Examine ways in which public policies affect vulnerable populations and can reduce health disparities in these groups. Examine the individual and social factors that contribute to vulnerability. Describe strategies that nurses can use to improve the health status and eliminate health disparities of vulnerable populations. Objectives * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. People have different genetic compositions, social and environmental resources, skills, support systems, and access to health services. People with lower incomes and less education tend to be at higher risk for health problems. A goal in the United States is to eliminate health disparities by expanding access to health care for vulnerable or at-risk populations. Introduction * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Vulnerability: susceptibility to actual or potential stressors that may lead to an adverse effect Results from the interaction of internal and external factors that cause a person to be susceptible to poor health Vulnerable populations: those groups with increased risk for adverse health outcomes More likely than the general population to suffer from health disparities Vulnerability: Definition and Influencing Factors * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Health disparities: the wide variations in health services and health status among certain population groups Vulnerability: Definition and Influencing Factors * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. More likely to develop health problems as a result of exposure to risk or to have worse outcomes from those health problems than the population as a whole More sensitive to risk factors because they are often exposed to cumulative risk factors More likely to suffer from health disparities Vulnerability results from the combined effects of limited physical, environmental, personal resources, and biopsychosocial resources Vulnerable Populations * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Social Determinants of Health Economic status Poverty Lack of health insurance Education Environmental factors Access to health care Nutrition Stress Prejudice Health Status Age Changes in normal physiology Factors Contributing to Vulnerability * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Social determinants of health are factors such as economic status, education, environmental factors, nutrition, stress, and prejudice that lead to resource constraints, poor health, and health risk. Nursing interventions are designed to help vulnerable populations gain the resources needed for better health and reduction of risk factors. * Negative or positive Vulnerable populations often have worse health outcomes than other people in terms of morbidity and mortality Cycle to vulnerability Sometimes when one problem is solved, another quickly emerges Leads to feelings of hopelessness Outcomes of Vulnerability * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Outcomes of vulnerability can be negative, such as lower health status, or they may be positive with effective interventions Often there is a cycle to vulnerability Sometimes when one problem is solved, another quickly emerges Leads to feelings of hopelessness * Social Security Act of 1935 Social Security Act Amendments of 1965, Medicare, and Medicaid: Title XXI of the Social Security Act (1997) State Children’s Health Insurance Program (SCHIP) Health Insurance Portability and Accountability Act of 1996 Balanced Budget Act of 1997 Patient Protection and Affordable Care Act of 2010 Public Policies Affecting Vulnerable Populations * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Social Security Act of 1935: created largest federal support program for elderly and poor Americans Social Security Act Amendments of 1965, Medicare, and Medicaid: provided for health care needs of elderly, poor, and disabled people Title XXI of the Social Security Act (1997) provides for the State Children’s Health Insurance Program (SCHIP) to provide funds to uninsured children The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was intended to help people keep their health insurance when moving from one place to another. Balanced Budget Act of 1997: influenced the use of resources for providing health services The Patient Protection and Affordable Care Act of 2010 has provisions for reducing the growth of future Medicare expenditures. * Trend toward providing more comprehensive, family-centered services when treating vulnerable population groups; family-centered “one-stop” services Wrap-around services Comprehensive services Advocacy Social justice Culturally and linguistically appropriate health care Nursing Approaches to Care in the Community * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Trend toward providing more comprehensive, family-centered services when treating vulnerable population groups; family-centered “one-stop” services Wrap-around services: available comprehensive health services, and social and economic services also provided, either directly or through referrals; in this way, social and economic services that will help ensure effectiveness of health services are “wrapped around” health services Comprehensive services: are health services that focus on more than one health problem or concern It is helpful to provide comprehensive services in locations where people live and work Advocacy Social justice Culturally and linguistically appropriate health care * Objectives emphasize improving health by modifying the individual, social, and environmental determinants of health. Having a primary care provider who coordinates health services and provides preventive services Healthy People 2020 * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Primary Influenza vaccinations Secondary TB screening Tertiary Therapy group for severely mentally ill adults Levels of Prevention * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Assessment should include client evaluation of: Socioeconomic resources Preventive health needs Congenital and genetic predisposition to illness Amount of stress Living environment and neighborhood surroundings Assessment Issues * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Nurses work as partners with vulnerable clients to identify client strengths and needs and develop intervention strategies designed to break the cycle of vulnerability * Create a trusting environment. Show respect, compassion, and concern. Do not make assumptions. Coordinate services and providers. Advocate for accessible health care services. Focus on prevention. Know when to “walk beside” the client and when to encourage the client to “walk ahead.” Know what resources are available. Develop your own support network. Planning and Implementing Care for Vulnerable Populations * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. * Foundations of Nursing in the Community: Community-Oriented Practice, 2nd Edition CHAPTER 25 Violence and Human Abuse All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. OBJECTIVES Discuss the scope of the problem of violence in American communities, and describe at least three factors in most communities that encourage violence and human abuse. Identify common predictors of potential child abuse and indicators of its presence. Define the four general types of child abuse: neglect, physical, emotional, and sexual. Discuss the dynamics and signs of female abuse by male partners. Describe the growing community health problem of elder abuse. Analyze the nursing role in working with survivors of violence. Discuss forensic nursing and its relationship to public health nursing. * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. INTRODUCTION Violence Significant mortality and morbidity result from violence Nurses often care for the victims, the perpetrators, and those who witness physical and psychological violence Nurses can also take an active role in developing community responses to violence through working on public policy and needed resources * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Violence: nonaccidental acts, interpersonal or intrapersonal, that result in physical or psychological injury to one or more of the people involved Violence is a community nursing concern; significant mortality and morbidity result from violence Nurses often care for the victims, the perpetrators, and those who witness physical and psychological violence Nurses can also take an active role in developing community responses to violence through working on public policy and needed resources * SOCIAL AND COMMUNITY FACTORS INFLUENCING VIOLENCE The following slides will discuss: Work Education Media Organized religion Population Community facilities * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. SOCIAL AND COMMUNITY FACTORS: WORK Work can be fulfilling and contribute to a sense of well-being; it can also be frustrating and unfulfilling, contributing to stress that may lead to aggression and violence. This frustration and resentment may contribute to violent behavior. Workers may have difficulty separating feelings generated at work from those at home. People hesitate to give up jobs even if they are frustrating, boring, or stressful. Particularly true in times of economic downturns * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. SOCIAL AND COMMUNITY FACTORS: EDUCATION In recent years, schools have assumed many responsibilities traditionally assigned to the family (sex education, discipline). Spanking Bullying School can be a powerful contributor to nonviolence. * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Schools are often places where the stressors and frustrations that can contribute to violence are abundant, and violence is learned rather than discouraged. * SOCIAL AND COMMUNITY FACTORS: MEDIA Television programs and print articles can inform and increase public awareness about family violence. Abused women and rape victims benefit from media attention. The media can indirectly lead people to choose violence * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. Abused women and rape victims benefit from media attention, which tends to lessen the stigma of such victimization and publicize available services. The media can indirectly lead people to choose violence Advertisements for nonessential items = frustration/ unfilled dreams/ unmet wishes Portraying the world as a violent place Poor role modeling of anger management * SOCIAL AND COMMUNITY FACTORS: ORGANIZED RELIGION Religion generally teaches nonviolent conflict resolution. However, historically, a seemingly contradictory relationship exists between abuse and religion. Victimization of women * All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. All items and derived items © 2014, 2010, 2006, 2002 by Mosby, an imprint of Elsevier Inc. SOCIAL AND COMMUNITY FACTORS: POPULATION A