AT RISK POPULATIONS + VIOLENCE AND ABUSE

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vulnerable populations

individuals who are at increased risk for having poorer health status and lack health care access. these individuals have major disparities as it pertains to life expectancy, morbidity, and mortality. experience adverse health outcomes in comparison to the general population due to both internal and external factors.

vulnerability

exists as a result of a combination of factors such as limited physical, personal, environmental, and biopsychosocial resources. individuals who fall within this distinction are more likely to experience health disparities and have increased sensitivity to risk factors.

social determinants of health (SDOH)

the environment and condition where an individual is born, works, and lives that impact a wide variety of health outcomes and risks. contributes to health inequities and disparities alongside SES. recognizing these to improve the health status of populations is the primary goal of making communities healthy.

education factors

early childhood experiences influence readiness for school and the completion of education. those from low-income backgrounds tend to arrive at school with lower levels of the skills needed for success. vulnerable groups may lack a basic knowledge skill set, which has lasting consequences on their futures.

poverty factors

coincides with poor health outcomes. the chronic stress of this can lead to maladaptive physical responses and diseases. these people tend to live in environments that are hazardous and crowded, and they typically work in higher-risk jobs. this also reduces an individual’s access to healthcare.

housing factors

those in poverty tend to have overcrowded living arrangements, which increases risk of exposure to communicable diseases, conflict, and violence. issues with this puts an individual at risk for long-term stress. those who are homeless often do not have access to water, sanitation, and food, all of which can increase their risk for disease.

racial inequities

are associated with vulnerabilities, as historically marginalized groups experience higher rates of illness and death in comparison to their white counterparts. these groups can also show a mistrust in the medical system.

nurse’s role with vulnerable groups

nurses are called to stand up for social justice and human rights as they work to address health disparities. nurses must advocate for all vulnerable groups to obtain equitable treatment regardless of their SES, immigration status, gender identity, or another other factor that can lead to vulnerability. important to practice culturally sensitive care as well. working to address SDOH is important as well.

veteran populations

this population often has poor health outcomes, increased risks for chronic conditions, a health-related quality of life that is ranked lower, and a higher utilization of health care overall. depression, PTSD, and anxiety are common in these individuals. they are also at an increased risk for substance abuse, physical diseases, and somatic complaints. VA provides healthcare for these people, but hispanic and black members of this group report more negative health care experiences than their white counterparts, which leads to vulnerability.

LGBTQIA+ populations

the youth within this population are three times more likely to experience depression and anxiety disorders than their counterparts who are not within this population. this can be attributed to experiences with bullying, violence, discrimination, and rejection. lifetime risk for suicide in this population is 3-6x more greater than the general population. they are also at risk for substance abuse and STIs. research has indicated a need to improve cultural sensitivity among health care workers who serve this population.

pregnant adolescent populations

a high-priority population that shows an association with increased health risks for both the pregnant client and the baby. prenatal care is often omitted or pursued late, and adolescents are at risk for HTN. the baby is at risk for premature birth and LBW. SDOH such as low educational levels and a low SES may contribute to incidences of this. those in foster care are more than twice as likely to become pregnant in comparison to those who are not in foster care. nurses can develop and implement community-based adolescent pregnancy prevention programs centered around abstinence. the nurse working with this population must be prepared to discuss all options, including termination and adoption.

incarcerated population

a high risk population that is at risk for mental illness, physical conditions, and long-term disabilites. are also exposed to violence, crowded living conditions, and limited programs and treatment options available to them. 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 have an ethical mandate to treat all people with respect and compassion

homeless populations

those in this population face barriers to health care, lack of access to adequate nutrition, and limited resources, including social services. these people tend to have higher rates of HIV, alcohol/drug use, mental illness, TB, and other chronic illnesses. life expectancy of these populations is significantly low due to long-term stressors. nurses can advocate for resources and collaborate with multiple agencies to bring much-needed services to these populations. approach when working with these populations should focus on holistic, client-centered care to address the tie between physical and mental health problems.

rural populations

these individuals face several health disparities in comparison to those living in urban areas. generally have a poorer perception of their overall health and functional status. 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. often have other labor intensive injuries (fractures and sprains, back issues, etc.). nurses working with this population should strive to ensure that clients have the resources needed to achieve the best health outcomes. telehealth can address barriers related to distance and lack of access for these clients

migrant population

groups of individuals who do not have a permanent residence so that they are able to seek employment in agricultural work. at risk for poverty, lack of access to healthcare, hazardous working conditions, and a lack of regulations. employers of these populations usually are not required to provide health insurance, or the workers themselves may not be eligible to receive health insurance in the US. in order to mitigate health risks, the nurse must understand the importance of infectious disease prevention. nurse can implement public health interventions centered around vaccination efforts and parasitic treatment programs to prevent infectious disease and advocate for basic health screenings.

nursing process

assessment is the first step and involves the nurse gaining an understanding of the community’s needs; can be done via windshield survey. planning population focused care improves health outcomes and should involve the community itself. collaborative efforts should be made to address SDOH.

nurse’s role in recognizing violence

nurses should analyze client behaviors and observe nonverbal cues and risks related to possible exposure to violence and can utilize screening tools. if an individual is determined to be at risk, the nurse will prioritize care based on the client’s assessed risks for immediate harm. plan of care should involve the implementation of a safety plan or referral to community resources for counseling and support. nurse should also act as a mandatory reporter for child or elder abuse.

violence prevention

starts with addressing interrelated environmental factors that influence risk for violent behaviors. nurse can promote life skills such as positive parenting, healthy relationships, and conflict resolution. nurses can also lead to refer families and individuals to programs that strengthen caregiver parent/child relationships. seeking to understand policies that may contribute to risks in clients is also essential.

child abuse assessment findings

nurse may observe signs of abuse such as unexplained bruises/bites/burns/broken bones/faded bruises; anxiety, fearfulness, a sense of withdrawal, aggression, and fear of the caregiver within the child; a change in eating or sleeping, and missing school. a combination of these findings prompts for mandatory reporting.

child neglect assessment findings

nurse may observe signs of neglect such as delayed health care and immunizations, frequent school absences, poor hygiene, inappropriate clothing, instances of the child being home alone without adequate supervision, and low weight gain or delays in development.

nursing interventions for child abuse

nurse should establish safety for a child in acute danger and contact police if the child is in immediate danger. a referral to CPS should be done as established by the agency or state, along with referring the child to counseling or school support. collaboration with the other professionals on the healthcare team is essential.

elder abuse

the intentional harm or failure to provide care to people over the age of 60. can be single or repeated acts of maltreatment in any relationship between an older adult and a person from whom trust is expected. financial abuse is common. those who are female, living with few social contacts, and those with multiple chronic diseases are high risk, along with those who have cognitive and physical disabilities. rates increase in institutional settings (assisted living, long-term care, nursing homes, etc.).

elder abuse assessment findings

nurse may observe patterns of injury (bruising, abrasions, tenderness in head, etc.), signs of neglect (poor hygiene, missed appointments, poor nutrition/dehydration or weight loss), abuse risk factors (social isolation, mental illness, dependency, etc.), fear/distress and anxiety within the client, and caregiver role strain.

IPV risk factors

includes individual factors (those who are young, unplanned pregancies, low income/education, exposure to violence and poor parenting as a kid, those who are LGBTQIA+, etc.), relationship factors (conflicts, ending of a relationship, dysfunctional family relations, and friends who perpetrate/experience this), and community factors (poverty, belief in harmful gender roles, etc.).

human trafficking risk factors

high risk factors include those who are migrant workers, youth without housing, people with disabilities, LGBTQ+ individuals, those with substance use disorders, and indigenous peoples.

human trafficking assessment findings

nurse may observe evidence of physical bruising, a client who is fearful/submissive/anxious, client being accompanied by an older individual who is controlling, poor hygiene, untreated medical conditions, sleep deprivation, and fatigue. client may also be unaware of their current location.

youth violence

occurs when individuals between the ages of 10 and 24 use physical force to harm or threaten others. can be perpetrated against peers or unrelated individuals. can include physical harm and bullying/cyberbullying. victims are at increased risk of becoming bullies themselves, depression, anxiety, and self-harm.

firearm violence

males between the ages of 15 and 34 account for the highest rates of this kind of violence. perpetrators may have a history of exposure to guns, mental health disorders, substance use, and access to f1rearms. environmental risks can include high poverty rates, dilapidated properties, high rates of illicit drug use, illegal gun possession, and a lack of trust in police protection within the community.

firearm violence interventions

important to educate caregivers about gun safety and securing access to firearms in the house, creating gun safety programs in collaboration with the community, and advocating for safe neighborhoods, housing, and education in high-poverty communities. mental health services should be provided for clients at risk for suicide.