Community Health Nursing and Vulnerable Populations (LA 8)

Health Disparities
Difference in health care that can be avoided if reasonable action is taken. wide variation in health services and status among population groups defined by certain characteristics. results from inequalities in distribution of underlying determinants of health across populations
-refers to wide variation in health services and health status among certain population groups defined by specific characteristics
-results from inequalities in distribution of underlying determinants of health across populations
-the terms disadvantaged, marginalized, hard to reach, vulnerable populations used to discuss health disparities: more likely to become ill and usually do not receive appropriate care

Health Inequities
differences in health that could be avoided if reasonable action was taken and therefore these differences were considered unfair and socially unjust
-the principal causes (direct or indirect) of health disparities are usually not within the typical domain of health, such as the social determinants (social, economic, cultural, political

Populations that have fewer resources for promoting health and treating illness than the average person in Canada has (Poor, Disabled, Rural communities)

treated as insignificant (homeless, women and children, first nations communities, immigrants, refugees)

Hard to Reach
individuals in rural areas that have difficulty accessing health care services. multiple/complex problems with substance use or mental illness, socio-economic disadvantages (homelessness, unstable housing, blood born diseases)

those groups who bear a greater ‘burden’ of illness and distress than other groups. are susceptible to negative events and at risk for health disparities

Cumulative risk
their health and healthcare problems intersect with social factors

ability to successfully cope when faced with a threat or hardship

Health challenges
Financial Insecurity
Family Responsibility

Vulnerable Population
Poor, homeless, immigrants, refugees, aboriginals,disabled persons, persons with stigmatizing conditions, elderly, children and youth in disadvantaged conditions, persons with low literacy skills, women, gays, lesbians, bisexuals, transgendered

Socioeconomic Status
Social Environment

Socioeconomic status
determined by income, employment, education, often results in poor health, they are more likely to live in unsafe environments, work at risky jobs, eat poorly nutritious food and have multiple stressors, they are often affected by low self-esteem, absence of life skills essential to making healthy choices, unhealthy physical environment…

older adult single women are more likely to be poor, men are 20% more likely to enrol in cardiac rehab programs

black immigrants are at an increased risk for mental health disorders, Aboriginals are at higher risk of poverty

Social Environment
food, income, social status, social support networks, unemployment, lack of social support groups among women linked with MI and stroke, those living in rural areas are at an increased risk of suicide

Nursing Care and VP
Dependent on
1) Good assessment skills to identify needs and barriers
2) Current knowledge of available resources
3) ability to plan care based on client concerns and receptivity to help
4) Establishing a trusting relationship with client
5) Co-ordinate services and providers
6) Advocate for accessible healthcare services
7) Focus on Prevention
8) Know when to ‘walk beside’ and when to encourage client to ‘walk ahead’
9) Encourage residence by identifying strengths, motivating, provide appraisals and feedback
10) Develop your own support networks

CHN Roles with VP
Case finder
Health educator
Direct care provider
Population health advocate
Community assessor and developer
Monitor and evaluator of care
Case manager
Health program planner
Participant in developing health policies

Sexual Orientation
refers to how we think of ourselves in terms of emotional, romantic, or sexual attraction to people of the same gender, the other gender, or either gender.

Gender Identity
One’s internal and psychological sense of oneself as female, male, both or neither

-fear, often irrational, of gay men and lesbian women on the part of heterosexuals
-Manifests in derogatory language, jokes and discriminatory treatment of those individuals perceived or known to be gay or lesbian
-may involve extreme violence towards those perceived to be homosexual

viewing the world through the lens of heterosexuality as the norm and a lack of realization or acknowledgement that alternatives to this exist

everyone deserves to be healthy physically, emotionally, sexually, psychologically and spiritually

LGBTQ Health
same health concerns, experienced differently or unique concerns
-more likely to be homeless
-high rates of suicide
-Relevant DOH:
1) Access to healthcare
2 )Negative past experiences
3) Equity
4) Income
5) Housing status
6) Education level
7) Social Exclusion

LGBTQ Mental Health
-Negative attitudes, discrimination and violence
-Emotional distress, impact on the self-esteem and self-identities
-Depression, anxiety and suicide at higher rates

Substance Abuse and LGBTQ
– more likely to use drugs and alcohol
– recreational drugs part of gay scene
– used to cope with discrimination, internalized feelings and depression

Tobacco Use and LGBTQ
-high rate of smokers
-stress, frequent bar socialization, higher rates of alcohol and drug use and targeted promotions by tobacco industry

Sexual Health
-Increased risk of HIV
-STI’s are transmitted easily between women
-risk because of shared needles to inject hormones or silicone and using drugs or alcohol during sex

Violence and Safety
-more likely to be physically and verbally victimized than the general population
-high rates of bullying and harassment in schools

Nutrition, Fitness and Weight
-Particular cultural norms about body weight and appearance
-gay men are more likely to have poor body image and more likely to have eating disorder
-lesbians are more likely to be overweight or obese, greater risk of heart disease and stroke as well as some other health conditions

Nurses and LGBT Health
-use inclusive language
-advocate for a confidentiality policy outlining what info is collected and how to share it
-Open and honest communication

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