- smoking to self-medicate
- familial vulnerability
- family
- vulnerability to stress when communicating with family due to shared genetic heritage
- think they are less vulnerable than their peers regardless of risk status
- marijuana use
- early usage in African American children
- familial use of alcohol
- children of alcoholics
connecting with the Disconnected
Lester
- high-risk populations
- "evidence that high-risk men tend to relapse into unsafe sex behaviors is provided in a longitudinal study of results of an intervention in which researchers were able to successfully predict relapse behavior"
- 50 year old woodworker from Colombia
- lived 20 years in US, refugee status
- suffered severe back injury
- needed food, worker at pantry convinces to get treatment
- build confidence with Reiki treatment
- body image problems
- gay men and heterosexual women
- gender and behavioral vulnerabilities
- girls: weight loss, dieting patterns, vomiting, diet pills
- risk factor tests
- CORE: Nurse-Patient relationship
- creating stories of hope through positive interaction
- listening to the root of the issues
- Treatments that integrate "evidence-based practice and herbal/folk remedies" encourage safe consultation through acknowledgment
(ex. Epsom salts, Reiki-energy healing, Pranic healing- Chakras)
- gender differences
- rise in adolescence
- more in girls after age 13
- attitudes
- "perfectionistic achievement attitudes"
- Alzheimer's
Familiarity and comfort in intimidating environment
Chapter 1 Discussion Question:
Will we ever successfuly minimize the amount of ethnic/racial minorities that find themselves in vulnerable populations?
Aday's Framework
Chapter 21
Undocumented Immigrants
Variables of access, cost, and quality are critical for understanding the nature of health care for vulnerable populations
- access: ability of people to find, obtain, or pay for healthcare
- cost: can be direct ( money spend on facilities) and indirect (losses resulting for decreased patient productivity ( eg absenteeism from work) )
- quality: relative inadequacy, adequacy, or superiority of services
Health Disparities
- Something is missing vs. What has already been done
- 11-18 million
- Fear of Apprehension, Detainment, Deportation
- US Immigration and Customs Enforcement
Chapter 1: Vulnerable Population
Roberto
- In 1998, Bill Clinton set a goal to reduce health disparities that disproportionately affect racial/ethnic minorities in US by 2010
Department of Health and Human Services targetted:
- infant mortality
- cancer screening and management
- cardiovascular disease
- diabetes
- HIV infections and AIDS
- immunization
Vulnerability- general concept meaning “susceptibility” and has a specific connotation in healthcare- “at risk for health problems”
Further Reasoning
2010 Priorities
1980- Cuba
- age 17 attended University in Germany
- returned to Cuba and mass emigration to US
- after 1 year involved in selling marijuana and federal prison
- released and turned over new leaf
- 2012 all I-94's deported (found due to fed record)
- in 1 year lost 65 lbs. depression in camps from Key West to Cuban prison
- model citizen who contributed to society
- high risk mothers and infants- of-concern
- chronically ill and disabled persons
- people with HIV/AIDS
- mentally ill and disabled persons
- alcohol and other substance abusers
- persons exhibiting suicide/ homocide-prone behavior
- abusive families
- homeless persons
- immigrants/refugees
Chapter 21
What can we do to bring health care into a positive light?
Some members of society are vulnerable in certain contexts
- nurses in ER: to violence
- hospital employees/visitors: to infection
- Vulnerable populations are at risk for poor physical, psychological, or social health
- to be a member of a vulnerable population does not mean a person is vulnerable
- many resist notion by focusing on strengths instead of weakness
CONSTANT FEAR AND DISTRUST
Bezruchka (2000, 2001) asserted that inequalities in wealth distribution are responsible for the state of health of US population
- economic structure of a country is the single most powerful determinant of the health of its people
Institute of Medicine
Models
of
Experimental Learning
Reasons for vulnerable populations
Models
of
Experimental Learning
Vulnerability to Specific Conditions and Diseases
- it is not enough to just read and write papers. experience is a must.
- nursing not only means curing and preventing illnesses, but also strengthening the patient's resources to make them less vulnerable.
Chapter 2
- take an individual approach to show how individuals respond to life stressors and how a condition can develop or continue
- successful experiences include opportunities for developing self-awareness, fieldwork, and chances that help them develop communication skills and interaction with people different from themselves.
- study the racial and ethnic differences in healthcare and find ways to eliminate health disparities
- "recommendations included specific legal, regulatory, and policy interventions that speak fairness in access; increases in the number of minority health professionals; and better enforcement of civil rights laws"
Chapter 2
Advocacy Role of Providers
- although each experience was challenging, overall, it was generally positive and life changing.
Why should healthcare professionals make decisions on behalf of the patient?
Duquesne Model
Kennesaw State University Model
Vulnerable populations are those with a greater than average risk of developing health problems by virtue of their marginalized sociocultural status, limited access to economic resources, or personal characteristics (age, gender)
Nurse-Managed Wellness Centers
- KSU emphasizes global learning
an outreach program that conducts health screening and health promotion activites
Center for International Nursing
students preformed multiple health assessments and conducted health fairs in counties like Nicaragua
- School of Nursing sends students to Mexico to live with families, learn Spanish and learn in local hospitals and communities.
Online Doctoral Program
an online and summer program to give nurses in developing countries a chance to earn PhD's from the university.
Seattle University
Model
- The College of Nursing has a mission to promote social justice by serving the poor
- Healthcare providers seem to think that they know best, but they don't always do things on behalf of the client
- They make decisions for the organization instead of the client.
- The roles of nurse and social worker cooperate to utilize their skills in order to help patients.
- In the BSN program, students do clinicals and conduct fieldwork in poor neighborhoods called 'garden communities'.
Review of the Nursing Literature
Members of ethnic minorities have traditionally been marginalized even when they are highly educated and earn good salaries
- Patient advocacy : conceptualization of advocacy and role functions of an advocate
- More patients make decisions about their own care because they distrust physicians and technology
- Nurses began to have a systemic perspective, rather than an individualist perspective
The Concept of Patient Advocacy
Why teach nursing students about vulnerable populations?
Laura
- because global demographics are changing and populations evolve and become more complex societies.
- nurses cannot be isolationistic when treating patients, families, and communities.
Ethnocentric bias
Chapter 30:
- 24 years old
- One child had cough and fever
- No insurance
- Nurse referred her to social worker
- Nurse thought her presence would make Laura calm about seeing a social worker
- Nurse referred her to a health clinic
- Social worker referred he to local housing authority, food bank, and employment support program
Teaching Nurses About Vulnerable Populations
Review of the Nursing Literature
is when one believes "one's own cultural beliefs, practices, folkways, values, and norms are the absolute right ones."
Review of the Social Work Literature
- the acknowledgment of one's one culture, values, traditions, beliefs, customs, and history while still accepting other's. The more that is acknowledged about themselves, the easier it is to push aside prejudices and stereotypes.
Combined Roles of nurse and social worker
- developed from one's own experience of living in their own culture.
- ethnocentric bias is not a good OR bad thing.
the key to providing culturally competent care is the ability to know yourself & to show respect.
- Civil War era and WWI-social work focused on work conditions and safety
- People came from rural areas in search of work in cities, but instead faced poor living conditions
- National Association of Social Workers continued to emphasize importance of advocacy for social workers
- The nurse as an advocate can help patients regain self-control
- Cultural beliefs can interfere with the nurse's view of treatment
- Patients can advocate themselves, such as researching about their own symptoms
- Patients thought care was good but not always
- Advocacy is a learned behavior
How do we deal with ethnocentric bias?
Brief History of Advocacy and Social Work
Self Examination.
- recognize the bias and examine our own values/beliefs in terms of how we see others.
- by applying the concept of equifinality.
equifinality - a theory concept that there are many paths to reach the same end.
Learning How To Show Respect.
Role of Patient Advocate
- it is common to spend lots of time and energy learning a culture quickly to act "appropriately"with superficial terms such as physical contact and eye contact.
- however, despite best intentions, this can be easily interpreted as mockery.
- The best way is to be yourself, yet showing the most respect according to your own cultural standards.
Nursing Presentation