(BQ) Part 2 book “Issues and trends in nursing” has contents: Cultural diversity and care, legal issues in nursing, healthcare policy and advocacy, rural and urban healthcare issues, nursing in the global health community,… and other contents.
Unit III: The Person in Health Care 13 Addressing Primary Prevention and Education in Vulnerable Populations 14 Cultural Diversity and Care 15 Ethical Decision Making and Moral Choices: A Foundation for Nursing Practice 16 Legal Issues in Nursing 17 Healthcare Policy and Advocacy Chapter 13: Addressing Primary Prevention and Education in Vulnerable Populations Brian W Higgerson Learning Outcomes After reading this chapter you will be able to: Define the term vulnerable population Identify what constitutes a health disparity Discuss at least three factors that contribute to health disparities Understand health behaviors that are classified as primary prevention Discuss how dietary practices, lack of exercise, and tobacco use may contribute to increased risk of developing major chronic diseases in the United States Provide examples of how health behaviors are distributed in vulnerable populations Identify three key approaches for educating and motivating clients to improve their health behaviors Discuss challenges for improving health behaviors in vulnerable populations The editors wish to acknowledge the contributions of Diane Baer Wilson and Lisa S Anderson to the previous edition of this chapter Introduction KEY TERM Vulnerable populations: Groups of individuals who are likely to have compromised access to health care and, therefore, are more likely to have poorer health outcomes, including higher mortality rates, compared to less vulnerable groups The increased prevalence of chronic diseases in the United States has a widespread impact on individuals as well as healthcare delivery systems A chronic disease is typically defined as diseases lasting more than 3 months—they are associated with decreased quality of life, increased financial burdens, and decreased life expectancy Although chronic diseases are increasing in numbers, many of these chronic conditions are completely preventable Recent data suggests approximately one half of all adults living in the United States have one or more chronic health conditions and one in four adults has two or more chronic diseases (Ward, Schiller, & Goodman, 2014) Heart disease, cancer, and diabetes continue to rank as the top three chronic diseases that are estimated to result in 1.2 million deaths a year (Centers for Disease Control and Prevention [CDC], 2015a) However, in learning more about the populations represented in these statistics, one might be surprised at the demographic trends Research reveals that poor, underserved, and minority populations have higher death rates across all of these diseases Furthermore, these individuals are also less likely to have health insurance and thus, they find it more difficult to access health care or receive high-quality health care in comparison with more affluent groups Chronic disease: A long-lasting disease that typically remains with a patient from onset to end of life and requires management of symptoms Chronic diseases typically last longer than 3 months Examples are cancer, cardiovascular disease, diabetes, and cerebrovascular disease According to the U.S Centers for Disease Control and Prevention (2015a), chronic disease is responsible for 7 out of 10 deaths in the United States The purpose of this chapter is to identify vulnerable populations and provide a discussion on why these frequently overlooked populations are at greater risk for poor health outcomes compared to other populations In addition, this chapter explores the role of disease prevention or risk reduction of chronic disease Three categories of prevention are aimed at reducing health risk outcomes: primary prevention, secondary prevention, and tertiary prevention Primary prevention refers to modifying health behaviors such as diet, sedentary behavior, or tobacco use to reduce one’s risk of developing chronic diseases such as heart disease, stroke, cancer, and diabetes Secondary prevention focuses on early detection of disease usually detected through early assessment findings or diagnostic tests or procedures, such as a prostatespecific antigen (PSA) test for prostate cancer or mammography to detect breast cancer The goal of tertiary prevention is to implement strategies that will slow disease progression, limit disability from a disease, and restore individuals to their optimal level of functioning (Nies & McEwen, 2014) Examples of tertiary prevention strategies include cardiac rehabilitation services following a myocardial infarction or a support group for newly diagnosed diabetic clients Primary prevention: Actions taken to modify health behaviors such as diet, sedentary behavior, or smoking toward preventing or managing a chronic condition such as heart disease or cancer An example is reducing one’s dietary fat intake to help lower cholesterol levels and prevent one from exceeding the recommended cholesterol guidelines Secondary prevention: Interventions focused on early detection and screening of disease, such as tuberculosis skin testing Tertiary prevention: Strategies that will slow disease progression, limit disability from a disease, and restore individuals to their optimal level of functioning The final part of this chapter details the nurse’s role as an advocate for individuals within these vulnerable populations Through education and support, nurses can play an instrumental role in encouraging vulnerable populations to participate in healthy lifestyle choices and ultimately reduce chronic conditions Defining Vulnerable Population Although a wide range of factors and income categories may be used to define poverty, a broad definition for poverty is when an individual or group of individuals lacks human needs because they simply cannot afford to meet these needs (Short, 2016) An unfortunate common consequence of poverty is inadequate health care or access to healthcare services Socioeconomic status and poverty rates have more of an impact on health status and mortality rates than any specific race or culture Over time, data have demonstrated that socioeconomic status is a strong and persistent predictor of health status For example, adults living in poverty report higher incidence of diabetes, kidney disease, liver disease, and chronic joint pains compared to adults who were not poor Moreover, a higher percentage of adults living in poverty reported more feelings of being hopeless, sad, or worthless compared to nonpoor adults (Blackwell, Lucas, & Clarke, 2014) A landmark study, published in 1967, examined this issue in the United States and Europe tracing back to the 17th century and reported better health and lower mortality rates were consistently associated with higher income and higher levels of education (Antonovsky, 1967) If one looks at any of several measures, the results are consistent in the relationship between socioeconomic status and mortality rates For example, life expectancy in 2013 was 52 years in Angola, which is a very poor country, compared to 79 years in the United States, a highly developed country (World Health Organization [WHO], 2015a) Poverty: When an individual or group of individuals lacks human needs because they simply cannot afford to meet these needs According to the U.S Census Bureau (2014), the nation’s poverty rate in 2014 was 14.8 percent, which translates to approximately 46.7 million people living in poverty A further examination of the data reveals the disproportionate prevalence of poverty among racial groups More African Americans (26.2 percent) and Hispanics (23.6 percent) live below the poverty line than Caucasians (10.1 percent) Likewise, according to the 2014 Census Bureau data, more African Americans (11.8 percent) and Hispanics (19.9 percent) are without medical insurance compared with Caucasians (7.6 percent) Alarmingly, the highest percentage of group of individuals living in poverty in the United States are children under age 18 (21.1 percent), followed by adults ages 18 to 64 years (13.5 percent) and older adults over the age of 64 (10 percent; DeNavas-Walt & Proctor, 2015) Approximately 6 percent of children in the United States under the age of 19 are without health insurance (Smith & Medalia, 2015) People with Disabilities Vulnerable populations may include people in additional groups, such as individuals with a disability Although many people with disabilities are fully functional, maintain employment, and have a high quality of life, some disabilities can make it more difficult for the individual to find employment or may limit some activities of daily living In addition, some disabilities may place individuals at greater risk for developing comorbidities For example, an individual with diabetes who does not control blood sugar levels is at greater risk for developing infection, having poor circulation, and developing heart disease Thus, people with diabetes serve as another example of a potentially vulnerable population Disability: Physical or mental impairment that substantially limits a person from completing activities of daily living Elderly and Young Children Age is also a factor that can be associated with poor health outcomes Both socioeconomic factors and physiological issues contribute to these groups being more at risk for poor health than individuals in other age groups Elderly people are often on a fixed income and may not have health insurance to supplement governmental health plans; thus they may not be able to afford medical procedures or medications that are not covered by Medicare Children are particularly at risk if they either are uninsured or have insufficient coverage for medical care because the lack of resources may lead to inadequate access to medical care Children with health insurance coverage have a higher percentage of their healthcare needs met Insured children are more likely to receive timely diagnoses of serious or chronic health conditions and thus have fewer avoidable hospitalizations (Price, Khubchandani, McKinney, & Braun, 2013) Physiological differences also contribute to vulnerabilities Older people, particularly those with less body mass, as well as very young children, do not tolerate extreme heat or cold temperatures For example, these two age groups are targeted in extreme heat warnings in the summer because they are more prone to dehydration and heat stroke Overall, however, individuals in these age categories tend to have a weaker immune response and they are often prioritized for public health initiatives such as influenza vaccination distribution, usually given in fall months The Interplay of Economic, Social, and Cultural Issues on Health Status How living in poverty actually affects health and health status turns out to be a complex issue Over the last decade, thinking has shifted from a primary focus on poverty as the prime factor related to health status to a broader focus In reality, there is no one reason that explains why those who live in poverty are more likely to become ill, suffer from chronic conditions, and more likely to die prematurely Many factors beyond income mission focus of, 110 (box 5-1) mission and impact of, 109–111 nature of, 108–109 reasons for joining, 111 (box 5-2) task forces and work groups, 116 authorship opportunities, 117 leadership, 116–117 liaison activity, 117 types of practice and educational resources from, 113 (box 5-3) proficient, defined, 130, 131t protected health information, 494 Protestant Sisters of Charity, 5 psychosocial integrity, NCLEX-RN client needs framework, 93 public health, 477–478 public health nurses, 236 public health nursing, origins of, 13–14 public health nursing, 445 Public policy, 399 Public Policy Advocacy Toolkit, 387 Q QIO See quality improvement organizations QSEN See quality and safety education for nurses QSEN, TJC, and other competencies, 133 (box 6-3) qualitative studies, 226 quality, defined, 195–197, 196 (sidebar 9–2) quality of health care, 196, 196 (sidebar 9–1) quality improvement, 125t organizations, 203 in rural nursing, 442–443 quality management, 198 quality measures healthcare outcomes, examples of, 195t history of, in health care, 197–198 quality and safety education for nurses, 123–124, 187 questions on NCLEX-RN examination types of, 96–99 exhibit items, 96, 97, 98 (box 4-6) fill-in-the-blank items, 96, 97, 97 (box 4-4) hot spot items, 96, 97, 98 (box 4-5) multiple answer/multiple response items, 96, 96 (box 4-3) multiple choice items, 96, 96 (box 4-2) sequencing/prioritizing test items (drag and drop), 96, 97, 99 (box 4-7) R race defined, 325 illness states and, 329 radiation events, 257–260 role of nurse in, 259–260, 259 (sidebar 11–12) randomized controlled trials, 219, 225, 226, 239 rapid response teams, 154 rating system for hierarchy of evidence, 222, 224t RCTs See randomized controlled trials Reason, James, 173, 178, 189 reckless conduct, 181 reduction of risk potential subcategory, NCLEX-RN client needs framework, 92 (box 4-1), 93 reflective thinking, 54 reform See healthcare reform registered nurses, 38, 134, 145, 272, 364 early licensure for, 15 research on work complexity and, 181–183, 184, 185 regulation See alsocertification; licensure of advanced practice registered nurses, 76–77 of nursing practice, 64–66 regulatory agencies, performance outcomes and, 198–205 regulatory efforts, for professional nursing organizations, 114 regulatory focus, on patient safety, 172–173 reimbursement for healthcare, pay-for-performance programs and, 211 religion, 329, 334 nursing and, 350 Render, M., 181 reporting systems, 172 researchers, 24 research findings, applying to practice, 226–227 research questions, social issues and, 228 research See alsonursing research resilience, 175 respondeat superior, 375 Reverby, Susan, 27 review products, preparing for NCLEXRN and, 99, 102 RHWP See Richmond Health and Wellness Program Richards, Linda, 12t Richmond Health and Wellness Program, 159–160 risk, defined, 237 RN license, protection of, 370 (box 16-3) RNs See registered nurses Robb, Isabel Hampton, 12t Robert Wood Johnson Foundation, 188 Leapfrog Group support and, 202, 202 (sidebar 9–5) Rockefeller Foundation, 22 Rogers, LinaRavanche, 14 Rogers, Martha, 25 role transition, 129–131 defined, 129 from novice to advanced beginner, 129–131 Roosevelt, Franklin D., 20 RRTs See rapid response teams rural community, 426, 428 (box 18-1) rural healthcare issues, 427–428 rural health problems, 432–436 rural hospitals, 437 rural nursing competencies for, 445 (box 18-7) implications of, 443–445 practice tips for, 444 (box 18-6) S safe and effective care environment category, NCLEX-RN client needs framework, 91–92 safer care environments, healthcare organizational efforts and, 186 (box 8-5) safety, 125t See also patient safety safety culture, 171 safety and infection control subcategory, NCLEXRN client needs framework, 92 Saffir-Simpson Hurricane Scale, 241–242, 241t St John’s Houses, nurses of, 5 St Thomas’ Hospital (London), 7 salaries, nursing, post-war, 21 Sandy hurricane, 236 SARS See severe acute respiratory syndrome satisfaction, defined, 121 Satterfield, Jason, 272 SBAR See Situation-Background-AssessmentRecommendation science, nursing and advances in, 13 scope of practice, 72 Scope and Standards of Nursing Practice, 79 SCT See Social Cognitive Theory secondary prevention, 292 second-degree nursing programs, 48 self-assessment, preparing for NCLEX-RN and, 100 self-determination, defined, 379 sensemaking, 178, 182 sensitivity training, 326 sequencing/prioritizing test items, NCLEXRN examination, 97, 99 (box 4-7) settlement houses, 14 severe acute respiratory syndrome, 235, 249 severe weather, 243 shared governance, 137–138 sharp end, 176, 179, 181, 182, 183, 189 Shewhart, Walter, 197 sickle cell disease, 329 Sigma Theta Tau International, 110 simulation, 55 situation-background-assessment-recommendation, 154 Six Sigma, 198 skills checklist and curriculum, 133 (box 6-3) slavery, 330, 333 sleep deprivation, 275 slips, lapses vs.,178 smallpox, 252–253, 252 (sidebar 11–7) Smith, Bill, 198 smoking, 304–305 SNRS See Southern Nursing Research Society SNS See Strategic National Stockpile Social Cognitive Theory, 306 social determinants of health, 295, 295 social groups, 332 social media, 414, 497 nurse–patient relationship, legal issues in, 387 social organization, geographic patterns of, 332 social policy, 399 social roles, 332 sociodemographics for nurses, changing, 120–121 socioeconomic status, 329 sources of law, legal issues, in nursing, 361–363 Southern Nursing Research Society, 112 Spanish-American War, 17 Special Survey on Vacant Faculty Positions, 120 specialty services, local, 437–438 stacking nursing education and, 187 RN work complexity and, 182 standard of care, defined, 371 Standard Curriculum for Schools of Nursing,37 standards of care, 79 defined, 77 legal issues, in nursing, 370–372 official resources for determination of, 80 for particular areas of nursing practice, 78–79 standards, development and availability of, 194 standards of practice, 109, 116, 122–126 Starck, P L., 43 State boards of nursing contact information for, 66 history and regulatory functions of, 67–68, 68 (box 3-1) State Children’s Health Insurance Program, 198 State departments of health, 199 State nurse practice acts, locating, 66–67 stereotyping defined, 326 errors of, 330 Stewart, Isabel Maitland, 12t Stimson, Julia, 18t Stock market crash (1929), 16 Strategic National Stockpile, 252 stress, decision making and, 177 strikes, 21 structural empowerment, 123 (box 6-1) STTI See Sigma Theta Tau International student labor, in early nurse training schools, 11 students, cultural competency and, 342–343 substance abuse, 329, 434 (box 18-3) substance-abusing nurse, signs and symptoms of, 284 (box 12-5) Surgical Care Improvement Project, Hospital Core Quality Measure sets for, 205 swing beds, 438 Swiss cheese model (Reason), complex system failures explained in, 173–176 systematic reviews, 221, 222 T Taft-Hartley Labor Act, 21 task forces, in professional nursing organizations, 116 Tay-Sachs disease, 329 Teachers College, of Columbia University, 19 teaching/learning, NCLEX-RN and, 91 teams, decision making and, 177 TeamSTEPPS, 157, 162 teamwork and collaboration, 125t technology culture and, 336–337 in curriculum for nursing education, 53 health, 442 teens, health problems for rural, 435 telehealth, 80, 441 telemedicine, 441 telenursing, licensure and, 70 tertiary prevention, 292–293 test anxiety, NCLEX-RN preparation and, 102 test plan defined, 91 obtaining copy of, 91 preparing for NCLEX-RN and, 101 tests See NCLEX-PN; NCLEX-RN tetanus, 245 therapeutic life style diet, 274 thinking practices, 54 time commitment, 133 (box 6-3) time management system, 140 taking NCLEX-RN and, 103–104 time pressures, decision making and, 177 timetable for review, preparing for NCLEX-RN and, 100–101 Titus, Shirley, 21 TJC See Joint Commission, The TLC diet See Therapeutic Life Style Diet To Err Is Human: Building a Safer Healthcare System (IOM), 79, 154, 194 tobacco free nurses, 275 tobacco use, 473 tornadoes, 242–243 Tort law, defined, 362 total quality management, 197 Toward Quality in Nursing, Needs and Goals (U.S Public Health Service), 24, 34t, 41 TQM See total quality management trade-offs, 175, 176 traffic accidents, 473 training schools, early, in United States, 11 transcendence, 335 Transcultural Nursing Society, 326 transformational leadership, 123 (box 6-1) transitional care program, 158 transition model, 128 translators, 326 Transtheoretical Model, 308 triage, 255 trust, 348 Tuberculosis, 452, 452t Tubman, Harriet, 9t Tularemia, 254–255 U UA See urban area UC See urban cluster United States effects of social change in, 8, 10 origins of professional nursing in, 8–13 universal healthcare access, 474 universal healthcare coverage, 473–478 universal healthcare system, 475–477 University of Colorado, 24 University of Minnesota, 37, 40 Upper Harley Street Hospital (England), 7 urban area, 426 risk factors of, 448–454 urban cluster, 426 urban healthcare issues, 445 urbanization, 332 USAMRIID See U.S Army Medical Research Institute of Infectious Diseases U.S Army Medical Research Institute of Infectious Diseases, 252 U.S Cadet Nurse Corps, 20 U.S Chamber of Commerce, 199 U.S Public Health Service, 18 V value orientations, culture and, 334–335 VA See veterans administration Vassar College, Vassar Training Camp program, 19 VCU See Virginia Commonwealth University vector, 252 veterans administration, 157 Virginia Commonwealth University, 157 visiting nurses, first, 4 voluntary accrediting agencies, 75 vulnerability, 237 nursing and, 348 vulnerable populations, 213–214, 213 (sidebar 9–12), 292 behavioral change plans, 308–311 client assessment, 309–310 defining, 293–298 disabilities, people with, 294 elderly and younger children, 294 gender and culture, 314 health behaviors, improving, 306–317 health disparities, 296–298 health status, interplay of economic, social, and cultural issues on, 294–296 language and literacy, 315 personal resources, 315–317 smoking and, 304–305 summary of, 298 W Wald, Lillian, 12t, 14 wartime, nursing and, 17–21, 18t websites, for state nursing boards, 66 weight watchers, 274 wellness, dimensions of, 271, 272 western dualism, 335 Western Nursing Research Society, 112 Whitman, Walt, 9t WHO See World Health Organization WHO framework for action on interprofessional education and collaborative practice, 161–163, 161, 162 (box 7-4) on interprofessional education and collaborative practice, 158 Wilderness First Aid, 260 WNRS See Western Nursing Research Society women in healing arts, 334 social role for, changes in, 333 women’s health, clinical questions in, 228 Women’s Hospital of Philadelphia, nurse training school of, 10 Woods, D D., 176, 177 Woolsey, Jane, 9t work complexity, for registered nurses, 181–185, 184 work groups, in professional nursing organizations, 116 workload management, complexity of work at point of care and, 176–177 workplace collaboration, strategies for Baby Boomers(1946–1964), 136t Generation X (1965–1980), 136t Generation Y or Millennials (1980–2000), 136t Silents Veterans (1925–1945), 136t workplace violence/safety, 281–282, 281 (box 12-3) World Health Organization, 248, 268 World’s Fair and Colombian Exposition (Chicago, 1893), 14 World War I, 17 World War II, 20–21, 22, 23, 136 X xenophobia, 331 Y years of life lost, 464 YLL See years of life lost Young Women’s Christian Association, 33 YWCA See Young Women’s Christian Association Z Zakrzewska, Marie, 11 Zidovudine, 219 Zika virus, 249 Zuni tribe, 4 ... stroke, and cancer—are all fueled by obesity and by being physically inactive In other words, if people would reduce their food intake and exercise in order to reach a body mass index (BMI) of 18 25 kg/m2, many heart attacks, strokes, and cancer diagnoses would... overweight and obesity are increasing not only in the adult population in the United States but among children as well In 20 11 20 12, approximately 17 percent of children and teenagers were obese and 31... percent were either overweight or obese Racial and ethnic inequities exist related to obesity in children According to Ogden, Carroll, Kitt, and Flegal (20 14), 22 percent of Latino children and 20 percent of African