Chapter 25 working with vulnerable people
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Chapter 25 Working with Vulnerable People. Vulnerable Populations. Heightened risk of adverse health outcomes Higher mortality rates Less access to health care; disparities in quality of care Uninsured or underinsured Lower life expectancy Overall diminished quality of life.

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Chapter 25 Working with Vulnerable People

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Chapter 25 working with vulnerable people

Chapter 25Working with Vulnerable People


Vulnerable populations

Vulnerable Populations

  • Heightened risk of adverse health outcomes

  • Higher mortality rates

  • Less access to health care; disparities in quality of care

  • Uninsured or underinsured

  • Lower life expectancy

  • Overall diminished quality of life


Models and theories of vulnerability

Models and Theories of Vulnerability

  • Vulnerable populations conceptual model: resource availability, relative risk, health status

    • Lack of resources increases population’s exposure to risk factors & decreases ability to avoid illness

    • Feedback loop from health status to resource availability as higher morbidity and mortality further deplete community resources (see Fig. 25.1)

  • Behavioral model for vulnerable populations: population characteristics to explain health behaviors and health outcomes; variables: demographic, social, and health beliefs

  • Framework for studying vulnerable populations: macro and micro perspectives; differential vulnerability hypothesis; social capital & human capital


Question

Question

Is the following statement true or false?

  • The vulnerable populations conceptual model includes demographic, social, and health belief variables.


Answer

Answer

  • False

    • The vulnerable populations conceptual model addresses resource availability, relative risk, and health status.


Prevalence of vulnerable populations causative factors

Prevalence of Vulnerable Populations & Causative Factors

  • Difficulty in measuring due to overlapping of populations

  • Root causes

    • Socioeconomic status/poverty

    • Insurance coverage: uninsured and underinsured

    • Race and ethnicity


Vulnerability and inequality in health care

Vulnerability and Inequality in Health Care

  • Social determinants of health

    • Acknowledged conditions associated with health outcomes (economic, social, environmental, genetic)

    • Socioeconomic gradient: inverse relationship between social class or income and health

  • Health disparities

    • Poor access to care; quality of care

    • Overt discrimination

    • Levels and types of care and care settings


Role of public health nurse

Role of Public Health Nurse

  • Effective caring: assisting clients to develop capabilities to take charge of life and make own choices

    • “Opening the door” is difficult because clients are often disenfranchised and fearful of others

    • Engagement and rapport essential

  • Empowerment: client-centered approach, trust, advocacy, teaching and role-modeling, capacity building

  • Making a difference: protective factors; resilience


Question1

Question

Is the following statement true or false?

  • Measuring the prevalence of vulnerable populations is difficult.


Answer1

Answer

  • True

    • It is difficult to measure vulnerable populations because the populations are not distinct and overlap.


Research with vulnerable populations

Research with Vulnerable Populations

  • Change in focus: need for research into mechanisms of health disparities, and among diverse populations

  • Need for strict adherence to guidelines; balancing act between accessing or recruiting vulnerable populations and protecting them

  • IRBs a must; populations requiring greater scrutiny and additional procedures

  • Research: often fragmented and isolated; ethical issues


Participatory action research

Participatory Action Research

  • Often used among vulnerable populations around the world; uses expertise and perspectives of the community in identifying needs and developing appropriate interventions

  • Iterative cyclical process: problem identification & problem solving via reflection and analysis to empower vulnerable disadvantaged people to effect change in their neighborhoods

  • Three main components

    • Problem inquiry

    • Organization of participants

    • Awareness and action


Question2

Question

Which of the following would most likely be included in participatory action research?

  • Problem inquiry

  • Empowerment

  • Participant isolation

  • Ethical conflicts


Answer2

Answer

  • Problem inquiry

  • Participatory action research involves three components: problem inquiry, organization (not isolation) of participants, and awareness and action. Ethical issues are often raised when any research is conducted. However, they are not a component of PAR.


Internet resources

Internet Resources

  • Centers for Population Health & Disparities: http://www.niehs.nih.gov/research/supported/centers/disparities/index.cfm

  • National Center on Minority Health & Health Disparities: http://ncmhd.nih.gov/

  • Office of Minority Health (USHHS/CDC): http://www.omhrc.gov/

  • Vulnerable Populations & Health Care Conference Proceedings: http://kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2287


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