NR 442 Week 5 Vulnerable Populations, Racial and Ethnic Equity, Homelessness in the Community, Mental Illness in the Community and Violence in the Community questions and answers + rationales for student success

What must nurses address first when caring for vulnerable populations?

Underlying social and support system issues.

Who are considered vulnerable populations?

Older adults, racial and ethnic minorities, the LGBTQ population, people experiencing homelessness, and veterans.

What risks are higher for the LGBTQ population?

Bullying, suicide, drug abuse, HIV, and chronic diseases.

Provision 1 of the Nursing Code of Ethics?

The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

Example of Provision 1?

The nurse allows a dying client's same-sex partner to assist with comfort measures.

Provision 2?

The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population.

Provision 3?

The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

Provision 8?

The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.

Provision 9?

The profession of nursing must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice.

Healthy People goal for older adults?

Improve Health and Well-Being for Older Adults.

Why are older adults at high risk for injury and death from falls, and what are prevention strategies?

Older adults have a high risk for injury and death from falls due to age-related changes and medication side effects. Prevention strategies include:

Increasing physical activity

Implementing safety interventions at home

Following prescribing guidelines to reduce medication-related risks

What oral health problems are older adults at risk for, and how can they be prevented?

Older adults are at higher risk for:

Untreated tooth decay

Tooth lose

Periodontitis

Prevention includes improving access to and education about regular oral health care.

What are older adults more likely to be hospitalized for?

Diabetes, dementia, urinary tract infections, and pneumonia.

What increases fall risk in older adults?

Lack of physical activity, unsafe environments, and inappropriate medications.

Common types of elder abuse?

Physical, psychological/emotional, financial or material exploitation, and neglect.

Elder abuse assessment questions?

Has anyone limited your daily activities?

Has anyone talked to you in a threatening way?

Has anyone forced you to give them money or sign strange papers?

Has anyone touched you without your consent or hit you?

What affects how veterans seek care?

Military culture: structure, uniformity, hierarchy, and reluctance to show weakness.

Who provides most of veterans' healthcare?

Veterans Health Administration (VHA).

Eligibility for VHA benefits?

Active duty for 24 consecutive months and non-dishonorable discharge.

Common veteran health risks?

TBI, amputations, PTSD, military sexual trauma, chronic pain, substance-use disorders, and suicide.

Veteran assessment questions?

When did you serve?

Did you serve in combat?

What was your job in the military?

Any injuries related to military service?

Exposure to noise, chemicals, gasses, or hazardous substances?

LGBTQ Healthy People objectives?

Reduce bullying

Reduce suicidal thoughts

Reduce drug use

Increase LGBTQ data collection

Reduce new HIV diagnoses and improve care

Nurse actions for LGBTQ students?

Encourage "safe space" classrooms

Assess school policy inclusivity

Promote LGBTQ student groups

Maintain confidentiality

Avoid generalizing one person's experience to the whole community

Programs supporting minority health?

REACH

National Breast and Cervical Cancer Early Detection Program

Ryan White CARE

National Institute on Minority Health and Health Disparities

The Racial and Ethnic Approaches to Community Health (REACH)

aims to support community strategies to eliminate health disparities in six priority areas: cardiovascular diseases, immunizations, breast and cervical cancer screening and management, diabetes, HIV/AIDS, and infant mortality.​

The National Breast and Cervical Cancer Early Detection Program

provides breast and cervical cancer screening, diagnosis, and treatment to low-income, medically underserved, and uninsured women, with a focus on minorities.​

The Ryan White Comprehensive AIDS Resources Emergency (CARE)

provides services to persons living with HIV, with a focus on minorities.​

The National Institute on Minority Health and Health Disparities

aims to lead research to improve minority health and reduce disparities.​

The Title VIII Nursing Workforce Reauthorization Act

aims to improve the healthcare workforce, not to improve the health of minority groups.​

What is social justice in healthcare?

Belief that every individual is entitled to fair and equal rights to healthcare.

Examples of social justice?

Nurse advocacy training

Multilingual staff

Virtual care access

Equal access health policies

What results from health disparities?

Higher chronic disease rates, mortality, poorer outcomes, and increased costs.

What is diversity and inclusion?

Diversity = appreciation and respect for differences

Inclusion = behaviors promoting belonging and value

Why is workforce diversity important?

Better care for minorities, improved satisfaction, communication, and access.

What is culture?

Learned knowledge, beliefs, values, and customs shared by a group.

Cultural assessment categories?

Attitude

Beliefs

Context

Decision-making style

Sample questions for cultural assessment?

"What does your sickness mean to you?"

"What is important for me to know about your faith?"

"What has your experience been since coming to the U.S.?"

"How are decisions about healthcare made in your family?"

Madeleine Leininger's Cultural Care Modes?

Preservation or Maintenance

Accommodation or Negotiation

Repatterning or Restructuring

Cultural Assessment: Attitude

What it is: How the client perceives illness, health, and healing.

Think: “How do they see what's happening to their body or mind?”

Key question to ask:

🗣️ “What does your sickness mean to you?”

Why it matters:

Their attitude toward illness will shape how they respond to treatment.

If someone believes illness is punishment, karma, or a spiritual test, they may not seek Western medicine right away.

Knowing this helps nurses provide respectful care and build trust.

💡 Example: A client might think their diabetes is a test of faith rather than a medical issue—so rushing into insulin teaching without understanding that belief may backfire.

Cultural Assessment: Beliefs

What it is: The client’s spiritual or religious values and how those impact care.

Think: “What should the nurse know to honor their spiritual world?”

Key question to ask:

🛐 “What is important for me to know about your faith or spiritual needs?”

Why it matters:

Spiritual beliefs often influence decisions around medications, blood products, food, prayer, and end-of-life care.

Clients may have specific rituals or restrictions we must respect.

💡 Example: A Jehovah’s Witness may refuse blood transfusions, or a Muslim client might need to pray five times a day—build care around that, not against it.

Cultural Assessment: Context

What it is: The bigger picture of their life—immigration story, language, cultural assimilation, community support.

Think: “Where are you from, and what’s your journey been like?”

Key question to ask:

🌎 “What has your experience been since coming to the United States?”

Why it matters:

Some clients may feel isolated or discriminated against.

Others may not speak English or feel confident navigating U.S. healthcare.

This affects trust, communication, and whether they even show up for care.

💡 Example: A recent immigrant might skip appointments due to fear of deportation or language barriers—not because they “don’t care.”

Cultural Assessment: Decision-Making Style

What it is: Who calls the shots in the family or cultural system.

Think: “Are decisions made solo or by the group?”

Key question to ask:

🧑‍🤝‍🧑 “How are decisions about healthcare made in your family?”

Why it matters:

In some cultures, the oldest male or eldest family member makes health decisions, even for adult women or children.

If we skip the decision-maker, we might unintentionally disrespect the family structure—and delay care.

💡 Example: A nurse telling a client her terminal diagnosis before the family is ready (in cultures where the family decides when to tell) could cause serious emotional and cultural harm.

Culturally competent practices nurses should follow?

Promote social justice

Reflect on values

Know cultures

Practice cultural care

Support system-level cultural needs

Advocate for cultural practices

Recruit multicultural staff

Train in culturally competent care

Communicate cross-culturally

Lead in culturally competent care

Develop inclusive policies

Use evidence-based practices

What is social justice in healthcare?

Social justice is the belief that every individual is entitled to fair and equal rights to healthcare.

What are the principles of social justice?

Equity

Access

Participation

Rights

What should nurses do about social justice?

Nurses should promote social justice and advocate for policies that are socially just.

What are some real-life examples of social justice in action?

Training nurses to advocate for client rights

Increasing diversity in healthcare staff

Expanding access through virtual care

Hiring multilingual staff

Supporting equal-access healthcare policies

What is Madeleine Leininger's Transcultural Nursing Theory all about?

It prioritizes understanding the cultural dimensions of human care and caring—because knowing cultural health beliefs = better nursing care.

What model supports culturally competent nursing decisions and actions?

Leininger’s Sunrise Model! It builds on the Transcultural Theory and includes three nursing care modes:

1. Culture care preservation and maintenance

2. Culture care accommodation and negotiation

3. Culture care repatterning and restructuring

What is Cultural Care Preservation or Maintenance?

Helping people of a culture retain their values to maintain well-being, recover from illness, or cope with death.

💡 Example: Administering normal saline—client keeps their values, and care still works!

What is Cultural Care Accommodation or Negotiation?

Helping clients adapt to or negotiate with others to reach a beneficial health outcome.

💡 Example: Administering a clotting factor—client adapts slightly but still gets positive results!

What is Cultural Care Repatterning or Restructuring?

Helping clients reorder, change, or modify their ways to achieve an improved health outcome.

💡 Example: Administering a blood transfusion—the client changes their belief to accept treatment.

What do health disparities result in?

Higher prevalence of chronic conditions

Higher mortality rates

Poorer health outcomes for minorities

Increased healthcare costs

What is health equity?

Attaining the highest level of health for all people—it is not an outcome of health disparity.

What are societal factors that contribute to homelessness?

Insufficient income

Shortage of affordable housing

Lack of support services

What are individual factors that may contribute to homelessness?

Addiction

Mental illness

Which groups of people are at risk of being homeless?

Adults who earn low wages

Families with children

People with mental illness

Veterans

People with substance use disorders

Adults who are unemployed

Older adults without support systems

What are these individual factors related to?

Societal factors like low income, lack of affordable housing, and lack of services.

What is a social justice model?

A social justice model is based on the idea that all people are equally entitled to key ends, such as access to health care and minimum standards of income.

➡️ Society must accept collective burdens to ensure fair distribution of these ends.

What are examples of social justice ideas?

Nurses being trained to be culturally competent

Everyone should have access to high-quality healthcare

Everyone should have access to quality education

Safe housing is a basic human right

What is a market justice model?

A market justice model is based on the idea that people are entitled to valued ends—like status, income, and happiness—based on their own individual efforts.

➡️ It stresses individual responsibility and minimizes collective burden.

What's an example of a market justice ideal?

A healthcare model without government involvement.

What defines individuals that are homeless?

They do not have a regular, stable, permanent nighttime residence.

This includes:

Living in a shelter or institution

“Doubling up” with friends or family

Living in their vehicle

What is a youth that runs away?

A person under the age of 18 who leaves home without family permission.

What is a youth that is homeless?

A person under the age of 18 who lacks a place of shelter where they receive supervision and care.

Why is the prevalence of homelessness likely inaccurate?

Because it is difficult to locate individuals that are homeless who may:

Be transient (only staying in an area for a short time)

Stay with friends

Reside in difficult-to-access locations

How is some homelessness data collected?

Health care providers who receive federal funding are required to collect, submit, and maintain data about individuals that are homeless.

What are general demographic characteristics of the homeless population?

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 LGBTQ adolescents)

Survivors of violence or neglect

People who have HIV or AIDS

Older adults with no place to go and no support system

doubling up

individuals who temporarily reside in a shelter or institution; staying with a series of friends or family

What is a consequence of the shortage of affordable housing and insufficient income?

An increasing number of low-income people end up paying more than 30% of their income for rent, which is more than they can afford.

What happens when people spend too much of their income on rent?

They often don’t have enough left for other necessities,

such as:

Food

Clothing

Health care

How does the lack of supportive services affect homelessness?

It can interact with and perpetuate the problems of income insufficiency and the shortage of affordable housing—because some people need services in order to:

Work

Earn money

Maintain housing

What kinds of supportive services might people need?

Income assistance

Health insurance

Behavioral or physical health care—especially for chronic mental health and/or substance abuse problems

What is the Healthy People objective for Mental Health and Mental Disorders?

Increase the proportion of homeless adults with mental health problems who get mental health services

What is the Healthy People objective for Social Determinants of Health?

Reduce the proportion of families that spend more than 30 percent of income on housing

What are Federally Qualified Health Centers (FQHCs)?

FQHCs receive federal funding to provide services for underserved populations, and some receive additional funding to provide primary health care and substance abuse services for the homeless.

When do individuals who are homeless often receive health care?

Usually only during acute exacerbation or crisis.

Where do many homeless individuals seek care?

A higher proportion report needing medical care and use hospital emergency departments as their usual sources of care.

What is the overall health status of the homeless population compared to the non-homeless population?

Worse health overall, with more:

Chronic disease

Mental health problems

Substance use problems

What health issues do homeless youth experience at higher rates than non-homeless youth?

Sexually transmitted infections

Physical and sexual abuse

Skin disorders (athlete's foot) and infestations (scabies, lice)​

Anemia

Drug and alcohol abuse

Unintentional injuries

What is "survival sex," and who is at risk?

Young women who are homeless may engage in survival sex (exchanging sex for money, food, lodging, clothing, or drugs) out of desperation to meet basic needs.

Which groups of homeless youth experience more health problems?

Youth who are pregnant

Youth who engage in prostitution

Youth who identify as gay, lesbian, bisexual, transgender, or queer (LGBTQ)

What should the nurse do when caring for a homeless youth client engaging in survival sex and showing signs of depression?

Refer the client to mental health counseling to address depression

Provide oral contraceptives and condoms to prevent unintended pregnancy or sexually transmitted infections (STIs)

Refer to homeless youth services for immediate needs and additional support

Refer to a food bank to help meet essential needs

What four major concepts should the nurse consider in the framework for community/public health nursing care for homeless populations?

Justice models

Thinking upstream

Social determinants of health

Public health interventions at all levels

What are downstream interventions?

They are aimed at treating or alleviating health care problems for individuals.

What are upstream interventions?

They are aimed at eliminating the primary contributors to homelessness,

including:

Lack of affordable housing

Inadequate income

Insufficient services

Why are upstream interventions important?

Because alleviating the upstream contributors will be more effective at reducing the overall homeless population.

What are the social determinants of health?

They are the circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness.

What are the five dimensions of social determinants of health?

Economic stability

Education

Social and community context

Health and health care

Neighborhood and built environment

Which two dimensions are key issues related to homelessness?

Economic stability

Health and health care

What is the Public Health Intervention Wheel and what does it provide?

The Public Health Intervention Wheel (Minnesota Department of Health, 2019) provides guidance in identifying interventions at the systems, community, and individual levels.

Where are interventions needed according to the Intervention Wheel?

Upstream at the community or systems levels

Downstream at the individual or family levels

What are examples of downstream interventions at the individual level?

Referring clients to a shelter

Referring clients to a soup kitchen

What are examples of upstream interventions at the community or system level?

Creating a voucher program for rental assistance

Creating new affordable housing inventory

Supporting legislation that increases the minimum wage

What is mental illness?

A condition that may disrupt activities of daily function.

What is schizophrenia, and what is it associated with?

Schizophrenia is one type of mental illness and is associated with auditory or visual hallucinations.

Can traumatic brain injury (TBI) lead to mental illness?

Yes—it can lead to mental illness, but it can also cause other symptoms and problems.

What is the primary cause of a mental health issue in a veteran?

Post-traumatic stress syndrome (PTSS)

What can PTSS lead to in veterans?

Substance use disorder

Major depressive disorder

What is the current basis for care of clients with mental illness?

Community-based treatment