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03.04 Care of Vulnerable Populations

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Overview

We will discuss the health issues and barriers to care of various vulnerable populations.

Nursing Points

General

  1. Elderly 
    1. Age 65+
    2. Safety becomes issue
      1. Overall 
        1. Physical 
          1. Mobility 
          2. Senses
          3. Gait changes
        2. Mental 
          1. Memory impairment
    3. Chronic diseases are problematic
      1. Decline in body systems
      2. Harder to fight infection/disease
      3. Frequent hospitalizations 
      4. Require more care
    4. Focus on maintaining quality of life
      1. NOT on education 
  2. Veters and Disabled
    1. Veterans
      1. Served in military
      2. Mental health issues
        1. PTSD/suicide
        2. Substance abuse
      3. Access to care issues
        1. Knowledge/awareness
      4. Homelessness 
        1. Unemployment 
          1. Injury
          2. Inability to re-integrate
    2. Disabled 
      1. Condition limits person 
        1. Physical impairment
        2. Mental impairment 
        3. Acquired
        4. Congenital 
      2. Unemployment issues
        1. Low income
      3. Access to care issues
        1. Insurance coverage 
  3. Rural population 
    1. Rural 
      1. Outside of urban areas 
      2. “Country”
    2. Access to care 
      1. Transportation/location 
      2. Financial means 
  4. Substance use disorders
    1. Abuse 
      1. Repeated use of mind altering substances
    2. Addiction
      1. Brain disorder
      2. Become reliant on substance
    3. Brain damage
    4. Heart disease
    5. Liver/kidney disease
  5. Poverty & Homeless 
    1. Access to care 
      1. Making choices
    2. Living conditions
      1. Increased risk of illness/injuries
      2. Safety concerns
    3. Homelessness 
      1. Cause disease
      2. Result of disease 
  6. Violence & Abuse
    1. Violence
      1. Extreme aggression 
    2. Abuse
      1. Misuse
    3. Health issues and social determinants
    4. Contribute to poor health
      1. Physical 
      2. Mental 
  7. Other Populations
    1. Assess needs/priorities 
      1. Incarcerated
      2. Immigrants & Refugees
      3. Pregnant teens
      4. Mental health 
  8. Solutions 
    1. Telehealth
    2. Walk in centers/clinics
    3. Take back programs 
      1. Prescriptions 
      2. Guns 
    4. Awareness/education 
    5. Support groups 

Reference Links

Video Transcript

Video Transcript

Hi guys! Welcome to the lesson on Care of Vulnerable populations. We’ve talked about some of the groups that make up a community but in this lesson we will focus on the  more vulnerable groups and the concerns they face when dealing with health as well. Let’s dive in!

The elderly population is a pretty large one. We have been seeing baby boomers hitting this stage of life, and people are living longer these days, so this particular group is only expected to keep growing. Anyone over the age of 65 is considered elderly. A little A&P here, what happens as we age? Our bodies start to deteriorate. We go through mental and physical declines. I’m not saying every elderly person does. I work with the elderly in the community daily and I’ve met some in their 80s and 90s that are still super sharp and active. Unfortunately they are the minority. So our bodies go through these changes and safety starts to become an issue. That doesn’t just mean physical safety, this group is also prone to scams and exploitation of their money. Does the Publisher’s Clearing house scam ring a bell? I can’t tell you how many clients get referred to me that have fallen, or take their meds wrong, or the ones that keep driving even though they aren’t legally supposed to be. Chronic diseases go kind of hand in hand with elder care. Remember we talked about home health care in the practice settings lesson and it was a lot of information because it’s a very important area. The elderly are less likely to have control over their medical conditions so they end up in the hospital more and require more care to avoid that. Also when we are talking about this population it’s important to understand that our focus here is moreso on maintaining quality of life than education.

Some other vulnerable groups are veterans and the disabled. I’m sure at some point you’ve come across stories about veterans committing suicide. This is just as alarming as the reasons behind it.  Most veterans have experienced combat and come home with some form of mental health issue, most commonly in the form of PTSD or substance abuse. Even more veterans have a hard time getting access to care because maybe they aren’t truly aware of the kinds of benefits they can receive on their return. Not everyone has good coping skills and when you don’t get the help you need, you find other alternatives.  Then there’s homelessness. Our veterans are homeless. More often than not it’s because they have a hard time finding work after deployment usually because they come back disabled with injury that prevents them from working or because they have a hard time being able to re-integrate back into the community, which kind of ties in to the mental health aspect doesn’t it? It’s kind of a chicken or egg situation. The disabled population has a condition that limits their physical abilities. These conditions can be physical or mental, and acquired or from birth. If you are recognized by social security as disabled, that’s what you are. So this population has problems with unemployment and access to care. Why? We have the American Disabilities Act which basically tells employers they can’t discriminate and have to make accommodations for employees with disabilities, but not everyone is able to work, so they live on limited fixed incomes based on what they are entitled to from social security. Access to care is a little bit harder. Before the Affordable Care Act, everyone had a hard time getting insurance with a pre-existing condition. Even with the Act it’s difficult because again with a fixed income it gets tricky paying copays and other bills.

Anyone who is abusing or addicted to substances is vulnerable. Why? Because the substance they are using alters the mind, and if you are dependent on that substance, you’re pretty much willing to do what you have to to get it. That’s what addiction is. Your brain and body become so used to a particular substance that when you don’t have it, you go through withdrawal symptoms and no one wants that feeling. What are the biggest substance issues right now? Opioids and alcohol. Think about what happens when someone is high or drunk. Inhibitions go bye-bye.  So risky behaviors become a true problem and pose a safety. But we want to look at the long term effects this has on the body. We are talking brain damage, heart disease and liver and kidney diseases. I’ll save you the A&P lesson here and tell you to check out those modules if you haven’t already and do it with this lesson in mind.

I think we can all agree on this next population being extremely vulnerable. Poverty and homelessness usually go together. Problems can vary a little with this population but as much as they change, their ability to access care and the risks they face in their living conditions is always a threat to their health. What I mean by access to care here is that typically those living in poverty have life choices to make daily that will squeeze out the option of going to the doctor. Parents have to choose their child’s next meal over a vaccine for example. The risks around living conditions include illness and injury. Homeless people stay in crowded shelters, on the street, abandoned homes. And these are not typically on the Upper East side in Manhattan, right? It’s likely they are in more desolate neighborhoods. Wherever they choose, they are at risk for violence. Now I’m painting an extreme picture because there are lots of people you wouldn’t necessarily know are homeless because they are making it work. Same thing with those living in poverty. We immediately think to the extreme pictures but regardless of the image, the health risks will always be the same. I also want to point out to you guys that homelessness can either cause disease or be a result of disease. Also, there’s this belief that those living in poverty or that are homeless are less educated. Let me tell you that’s not always true. If you’ve never seen The Pursuit of Happyness please watch it. It gives a clear idea of real challenges without painting the grim picture we often see when we hear poverty and homeless.

If you don’t think someone exposed to violence and abuse is vulnerable, I want you to change your thinking. They are absolutely vulnerable. Take a look at what violence and abuse are. Extreme aggression and misuse or mistreatment. These are most definitely social determinants and health problems in their own right. Remember, determinants of health include a social aspect and here we are looking at a social issue. Exposure to violence and abuse contributes to poor health both mentally and physically. Think about the abused woman. Don’t they blame themselves more often than not and explain away their injuries? Remember your body is taking a beating and the more you ignore it, the more damage you do each time. The body is not built to withstand frequent intentional harm. But abuse is not just physical. There are mental and emotional aspects that we often ignore and it takes double the time to reverse those effects as it does to inflict them.

Some other populations I want to highlight as vulnerable are the incarcerated, immigrants & refugees, pregnant teens and the mentally ill. I’m not going to go into detail here, but I just want you to remember that we should be consistent in assessing their needs and priorities as well. They will each have their own individual and group needs.

So, we’ve identified the vulnerable and their health concerns, what do we do about it? We utilize telehealth and walk in clinics for those with access issues. Lots of communities have created drug and gun take back programs no questions asked so that they are off the street and disposed of safely. Awareness and education in addition to support groups are available for any individual or loved one having to deal with being in any of these populations. As community nurses, we are involved in each of these. Remember, our goal is always to promote and protect wellness in the community. We can’t do that if we’re not directly involved.

Some key points. Each population although all vulnerable, has their own set of needs and priorities. Remember we are talking about populations but they are made up of individuals and we have to consider that. We should always take these differences into account. Now the one thing all these populations have in common is barriers to care. Each reason is different as well, but be mindful of this when you set out to assess any situation. Finally, no matter what the situation, the job of community nurses is to protect and promote the health of the community. As times change, so do the needs of the community and each population we serve. We have to make sure our initiatives toward that goal adapts to those changes.

So that’s all for the Care of Vulnerable Populations lesson. Make sure you check out all the resources attached to this lesson. Now go out and be your best self today. And as always, Happy Nursing!

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