Care of Vulnerable Populations--Community Nursing

what do community health nurses identify?

vulnerable populations and implement measures to improve health through direct care or improving health care access, and by changing the physical environment, health care culture, and health policies

factors that threaten health

low income

difficulty accessing health care, uninsured or underinsured

poor self-esteem

young/advanced age

chronic stress

environmental factors

presence of communicable diseases

racial and ethnic minority status

disparities

discrimination

vulnerable populations include individuals who are subject to issues like

violence

substance use disorders

mental health issues/illnesses

poverty and homelessness

rural residency

migrant employment

veteran status

disability

social determinants of health

• Shaped by money/power/resources

• Local/national/global

• Born/Grow/Work/Live/Age

• Impact disparities

• Quality/access/outcomes

• Healthy People 2030

health inequities

• Systemic

• Avoidable

• Unjust disparities: health status/mortality rates

• Availability /accessibility

• Nursing interventions

• Epigenetics /genomics links

health disparities

significant differences in health status and access to health services across varied groups

health personnel and health disparities

• Core function: Assurance

• HPSA's

• MUA's

• MUP's

• Rural geopolitical areas

substance use

Alcohol/ illicit drugs/nonmedical use of prescription medications

illicit drugs

cannabis/cocaine/ heroin/hallucinogens/ inhalants/ methamphetamine

nonmedical prescription medications

pain relievers/ tranquilizers/ stimulants/ sedatives

abstinence

No use of illicit substances or alcohol in the preceding 12 months

substance use disorders involve...

maladaptive use of substances resulting in threats to an individual's health or social and economic functioning

gateway effect theory

a comprehensive catchphrase for the often observed effect that the use of a psychoactive substance is coupled to an increased probability of the use of further substances.

dependence

pattern of pathological, compulsive use of substances and involves physiological and psychological dependence

cardinal indicators of dependence

manifestations of tolerance and withdrawal

primary indication of dependence

denial

denial includes

defensiveness

lying about use

minimizing use

blaming or rationalizing use

intellectualizing

"going with the flow"

behaviors linked with substance abuse

problems at work, school, home

problems with family, friends

physical danger

trouble with the law

substance use prevalence rate factors

age

gender

race

socioeconomic level

urban/rural level

environmental factors of substance abuse

poverty

lack of access to health care services

capacity of law enforcement to constrain supply

contribute to disproportionate burden of harm among

native americans

alaskan natives

african americans

what is the most commonly used substance in the US?

alcohol

alcohol

a depressant, dulls the senses to outside stimulation and sedates the inhibitory centers in the brain

direct effect of alcohol is determined by what?

blood alcohol level

body processes alcohol dependence on several factors

size and weight

sex (affects metabolism)

carbonation (increases absorption)

time elapsed during alcohol consumption

food in the stomach

emotional state

type of alcohol

excess alcohol that is not metabolized

circulates in the blood and affects the central nervous system and the brain

alcohol withdrawal

appears within 4-12 hours

manifestations of alcohol withdrawal

irritability

tremors

nausea/vomiting

headaches

diaphoresis

anxiety

sleep disturbances

tachycardia

elevated blood pressure

what is the most preventable cause of death in the US?

tobacco use

nicotine

stimulant that temporarily causes a feeling of alertness and energy; repeated use to avoid the subsequent "down" that will follow this period of stimulation that leads to a vicious cycle of use

tolerance to nicotine develops how fast?

quickly

physical assessment findings on substance use disorder

disheveled with unsteady gait

pupils are dilated or pinpoint red, and with poor eye contact

diaphoretic, cool, clammy

needle track marks or spider angiomas may be visible

runny, congested, red or cauliflowered shaped nose

fine or coarse tremors

national alliance for the mentally ill (NAMI)

advocacy group that works to reduce stigma and provide services for clients who have mental health disorders and their families

characteristics of mental health disorders

occurs across the lifespan

high risk of substance use disorder

high suicide risk

increased occurrence of chronic disease

factors affecting mental health

- Individual coping abilities

- Stressful life events (exposure to violence, disasters)

- Social events (divorce, death, separation)

- Chronic health problems

- Stigma associated with seeking mental health services

migrant employment

- Seasonal and migrant workers are employed in farming

- Employment occurs during the time period required for caring for and harvesting crops

- Migrant workers make temporary homes during employment at a specific location, and can be paying for their family to live in a different, permanent home at the same time

agriculture workers are not covered under common labor laws

minors under 12 and older are not covered under the child labor act and can work alongside family members, even in hazardous condition

Migrant Health Act

funding for migrant health centers across the US which serve about one-fifth of the migrant worker population

who has regulations regarding standards for migrant and seasonal agricultural workers?

department of labor

health problems of migrant workers

dental disease, TB, chronic conditions, mental health, leukemia, iron deficiency anemia, stomach/uterine/cervical cancers, lack of prenatal care, higher infant mortality rates, STIs, HIV/Aids

pesticide exposure

significant problem among migrant workers

pesticide exposure subjective findings

headache, dizziness, dyspnea, nausea, abdominal cramps, poor concentration, eye irritation

pesticide exposure objective findings

confusion, irritability, muscle weakness and twitching, nasopharyngeal irritation, vomiting, rash

complications of pesticide exposure

long-term exposure is linked to cancer, reproductive problems, Parkinson's disease, liver damage, and behavioral issues

impaired fetal development can occur among pregnant women exposed to pesticides, even from secondary exposure (contaminated clothing from a family member)

issues in migrant health

food insecurity, inconsistent income, poor and unsanitary working/housing conditions, exposure to chemicals, limited access to health care, language barriers, discrimination, immigration status

veterans health administration

responsible for purchasing coverage and delivering health care to veterans and dependents

the nation's largest integrated health care system

veterans health administration inpatient and outpatient services

hospitals

outpatient clinics

home health services

hospice and palliative care services

nursing homes

residential rehab treatment programs

readjustment counseling centers

veteran health issues

mental health (PTSD, depression)

substance abuse

suicide

infectious disease

exposure to toxins

traumatic brain injuries

spinal cold injury

traumatic amputations

sexual trauma

hearing or visual impairments

cold injury

strategies for veteran health care

- coordinate referrals to available veteran resources

- advocate for continued strengthening of veterans

- assist in transition

- develop partnerships with local agencies to strengthen resources and achieve mutual goals

possible stakeholders for partnerships

-state and local veteran groups

-offices of rural health

-local aging services

-community service organizations

-state/local health departments

-faith-based organizations

-public safety departments

-various media outlets

-employment services

disability

a factor in the body, senses, or mind that affects the way a person interacts in the daily environment

americans with disabilities act

initial legislation to promote rights of individuals who have a disability

individuals with disabilities education act

promotes the rights of children who have disabilities and their parents

ensures free education and accomodations to prepare the child for independent living, assists with funding of the education, and evaluates the effectiveness of the education

effects of disability

cost of chronic management

decreased employment rates/household income

decreased opportunity for physical activity

isolation and possible self image issues

possible altered roles of family members

increased risk for abuse

inability to live independently

presence of comorbidities

nursing actions for disability

implement private prevention measures to prevent disability (responsible alcohol use to prevent liver damage)

identify disability and chronic disease as early as possible

connect clients with appropriate resources to promote maximum self-care ability

connect families with respite care and counseling

advocate for the rights of individuals, families, and groups dealing with disabilities

ensure public buildings are accessible to individuals who have a physical disability

implement programs to improve quality of life

immigrants

-often have a waiting period to receive financial assistance for medical care

-unauthorized immigrants are only eligible for immunizations, school lunch, treatment for communicable disease, and emergency care

nursing actions for immigrants

-use cultural competence when planning care

-identify risk factors specific to the culture and race

refugees

-forced to leave place of origin due to disaster, war, or threatening environment

-eligible for temporary assistance for needy families, medicaid, and supplemental security income

nursing actions for refugees

-assess mental health status and coping following crisis

-help individuals apply for assistance programs

pregnant adolescents

- Limited education and job opportunities

- Increased risk for poverty, homelessness, school problems, violence, and malnutrition

nursing actions for pregnant adolescents

· Assist with early ID of pregnant adolescents, including early initiation of prenatal care

· Provide counseling/encouragement

· Assist in applying for WIC

· Promote education about self-care during pregnancy

incarcerated populations

- increased rates of mental health disorders; the presence of major mental health disorders increases the risk for multiple incarcerations

- increased incidence of rape and assault in the prison system

- health care regulated through the Federal Bureau of Prisons (Department of Justice) to promote rights of inmates

- increased rates of chronic disease, when compared with the general population

nursing actions for incarcerated populations

· Health promotion & counseling

· Help with design of programs to re-integrate individuals into society

· Foster follow-up with community MH centers

· Provide transitional care to decrease risk of future violent behavior

individuals in sexual and gender minorities

- can face barriers to adequate health care

- state variations in rights for benefits and adoptions

- can have increased risk for psychological distress and substance use disorders

- can face social stigma and discrimination

- health disparities include poorer mental health, increased risk for disability, and increased risk for substance use disorder

HPSA (Health Professional Shortage Area)

Geographic area, population group, or medical facility with shortages of healthcare professionals that may not allow a full complement of healthcare services.

Medically underserved area (MUA)

Area that is determined through calculation of a ratio of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population aged 65 or older

Medically underserved population (MUP)

A U.S. federal designation for those populations that face economic barriers (low-income or Medicaid-eligible populations) or cultural and/or linguistic access barriers to primary medical care services.