Community Nursing Discussion Board

Chapter 18: Underserved Populations Chapter Highlights #1 ❖ Vulnerable versus underserved populations ❖ Social determinants of health/health disparities ❖ Genomics and underserved populations ❖ Health priorities in rural areas, particularly elders ❖ Health priorities in gay, lesbian, bisexual, and transgender people; in people in correctional institutions; and in people who are homeless Copyright © 2020 Wolters Kluwer · All Rights Reserved Chapter Highlights #2 ❖ Access to quality care ❖ Chronic disease management ❖ Veteran’s health ❖ Human trafficking ❖ Health personnel issues ❖ Risk, prevention, and health promotion in hard‐to‐reach populations Copyright © 2020 Wolters Kluwer · All Rights Reserved Context of Health Risks ❖ Vulnerability ❖ Social determinants of health and health disparities ❖ Genomics and underserved populations Copyright © 2020 Wolters Kluwer · All Rights Reserved Question #1 Which of the following are included in the notion of social injustice? A. Belief of those in power that others are inferior B. Denial of human rights to certain populations C. Disparities in access to services, such as healthcare D. All of the above Copyright © 2020 Wolters Kluwer · All Rights Reserved Answer to Question #1 D. All of the above Rationale: Social injustice involves the denial of economic, sociocultural, political, civil, or human rights of certain populations or groups based on the belief of those with power that others are inferior. In healthcare, it manifests as disparity in access. Copyright © 2020 Wolters Kluwer · All Rights Reserved Vulnerability ❖ Underserved populations o Subgroup of the population o Higher risk of developing health problems o Greater exposure to health risk because of marginalization ▪ Sociocultural status ▪ Access to economic resources ▪ Age ▪ Gender Copyright © 2020 Wolters Kluwer · All Rights Reserved Social Determinants of Health and Health Disparities ❖ High‐risk mothers ❖ Chronically ill and disabled people ❖ People living with HIV/AIDS ❖ Mentally ill people ❖ Substance abusers ❖ Homeless people ❖ Immigrants and refugees Copyright © 2020 Wolters Kluwer · All Rights Reserved Rural Populations ❖ Health personnel issues ❖ Morbidity and mortality issues ❖ Elderly people ❖ Occupational and environmental health problems Copyright © 2020 Wolters Kluwer · All Rights Reserved Question #2 Is the following statement true or false? Accessibility is insufficient number and diversity of formal services and providers, or lack of acceptable services and human service infrastructure to elders in rural areas. Copyright © 2020 Wolters Kluwer · All Rights Reserved Answer to Question #2 False Rationale: Availability—insufficient number and diversity of formal services and providers; lack of acceptable services and human service infrastructure. Accessibility—shortages of adequate, appropriate, and affordable transportation; cultural and geographic isolation. Copyright © 2020 Wolters Kluwer · All Rights Reserved Correctional Health: Underserved Populations in Jails and Prisons ❖ All levels of prevention need to be addressed for all people who end up in correctional facilities. ❖ Most inmates are males who are African American or Latino. ❖ The average age of inmates is 37 years. ❖ After release from incarceration, inmates often face social injustices and economic problems. Copyright © 2020 Wolters Kluwer · All Rights Reserved Gay, Lesbian, Bisexual, Transgender, and Queer Community #1 ❖ Four subgroups—gay, lesbian, bisexual, and transgender people—have unique needs. ❖ Few population‐based studies have been conducted in LGBT groups, with the exception of HIV‐related research, particularly in men who have sex with men. ❖ Specific questions on surveys related to sexual orientation are lacking. ❖ Recognition of same‐sex heads of households has not always been included in survey data. Copyright © 2020 Wolters Kluwer · All Rights Reserved Gay, Lesbian, Bisexual, Transgender, and Queer Community #2 ❖ More serious physical and mental health conditions, including interpersonal violence and substance addiction ❖ Particular health concerns from a prevention perspective include obesity, injury, violence, and access to healthcare facilities Copyright © 2020 Wolters Kluwer · All Rights Reserved Veterans and Health ❖ 2 million reintegrated veterans in the civilian sector ❖ 1 million veterans suffering from nonvisible or visible trauma ❖ Need for civilian nurses to understand military culture Copyright © 2020 Wolters Kluwer · All Rights Reserved Human Trafficking ❖ Recruitment and transportation of people for exploitation ❖ Nurse’s role of recognizing victims and responding based on approved protocol ❖ Maintaining safety of victim and healthcare personnel Copyright © 2020 Wolters Kluwer · All Rights Reserved Homeless Populations #1 ❖ Deinstitutionalization efforts of the 1960s to mainstream the mentally ill into society ❖ Unemployment and underemployment ❖ Domestic violence ❖ Abandonment ❖ Natural disasters and fires Copyright © 2020 Wolters Kluwer · All Rights Reserved Homeless Populations #2 ❖ Disability ❖ Substance abuse and addiction Community Nursing Discussion Board

❖ Immigration ❖ Political unrest and wars Copyright © 2020 Wolters Kluwer · All Rights Reserved Nurses’ Approach to Homeless People ❖ Show respect and use a positive approach, which builds trust. ❖ Support primary (advocacy), secondary (tuberculosis screening), and tertiary (“detox” treatment) prevention to make it easier to cope with difficult, challenging lives. Copyright © 2020 Wolters Kluwer · All Rights Reserved Key Nursing Considerations ❖ Recognize the biases and prejudices that can be barriers to understanding the needs of populations. ❖ Community and family assessments need to be grounded in trusting approaches. ❖ Allow nurses to do what they do best: heal, and not necessarily fix, healthcare situations Copyright © 2020 Wolters Kluwer · All Rights Reserved Chapter 19: Environmental Health Chapter Highlights #1 ❖ Human health and the environment ❖ Assessing contaminants in the environment ❖ Exposure pathways ❖ Assessing the environment of a community Community Nursing Discussion Board

❖ Planning interventions to make communities healthier Copyright © 2020 Wolters Kluwer · All Rights Reserved Chapter Highlights #2 ❖ Evaluating interventions ❖ Environmental epidemiology ❖ Working toward healthy communities ❖ Environmental justice ❖ Global environmental health issues Copyright © 2020 Wolters Kluwer · All Rights Reserved Question #1 Is the following statement true or false? Environmental health is the branch of public health science that focuses on how the environment influences chronic disease. Copyright © 2020 Wolters Kluwer · All Rights Reserved Answer to Question #1 False Rationale: Environmental health is the branch of public health science that focuses on how the environment influences human health, not chronic disease. Copyright © 2020 Wolters Kluwer ·

All Rights Reserved Human Health and the Environment #1 ❖ History of environment health o How do certain contaminants affect human health? o How do we assess exposures to contaminants? o How does the environment influence health? o How do we live as a population while maintaining a healthy environment? Copyright © 2020 Wolters Kluwer · All Rights Reserved Human Health and the Environment #2 ❖ Community environment ❖ Genetic and behavioral factors ❖ Nursing and environmental health Copyright © 2020 Wolters Kluwer · All Rights Reserved Assessment ❖ Assessing contaminants in the environment ❖ Exposure pathway o Source of contamination o Environmental media and transport mechanisms o Point of exposure o Route of exposure o Receptor population Copyright © 2020 Wolters Kluwer · All Rights Reserved Exposure History ❖ Present work ❖ Past work ❖ Home/residence ❖ Activities/hobbies ❖ Concerns Copyright © 2020 Wolters Kluwer · All Rights Reserved Question #2 What is bioavailability? A. Study of the adverse effects of chemical, physical, or biologic agents on people, animals, and the environment B. An estimate that determines a person’s level of exposure to a contaminant C. Amount of a contaminant that actually ends up in the systemic circulation D. Process of using medical tests such as blood or urine collection to determine if a person has been exposed to a contaminant and how much exposure he or she has received Copyright © 2020 Wolters Kluwer

· All Rights Reserved Answer to Question #2 C. Amount of a contaminant that actually ends up in the systemic circulation Rationale: Bioavailability is the amount of a contaminant that actually ends up in the systemic circulation. Toxicology is the study of the adverse effects of chemical, physical, or biologic agents on people, animals, and the environment. An exposure estimate determines a person’s level of exposure to a contaminant. Biomonitoring is the process of using medical tests such as blood or urine collection to determine if a person has been exposed to a contaminant and how much exposure he or she has received. Copyright © 2020 Wolters Kluwer · All Rights Reserved Determining the Health Impact of a Completed Exposure Pathway ❖ Toxicology is the study of the adverse effects of chemical, physical, or biologic agents on people, animals, and the environment. ❖ An exposure estimate determines a person’s level of exposure to a contaminant. ❖ Bioavailability is the amount of a contaminant that actually ends up in the systemic circulation. ❖ Biomonitoring is the process of using medical tests such as blood or urine collection to determine if a person has been exposed to a contaminant and how much exposure he or she has received. Copyright © 2020 Wolters Kluwer Community Nursing Discussion Board
· All Rights Reserved Proximity ❖ Proximity to a contaminant or hazard is not the only factor in determining whether there is a risk to human health. ❖ For a contaminant to pose a risk, there must be a completed exposure pathway. Copyright © 2020 Wolters Kluwer · All Rights Reserved Assessing the Environment of a Community ❖ When assessing a community’s environment, it is helpful to think about the whole environment to determine what components are influencing human health. ❖ Environmental justice is important to consider when looking at the impact of the environment on a community. Copyright © 2020 Wolters Kluwer · All Rights Reserved Assessment of Individuals: Taking an Exposure History ❖ Identify current or past exposures. ❖ Eliminate exposures. ❖ Try to mitigate or reduce a client’s adverse health effects from exposures. Copyright © 2020 Wolters Kluwer · All Rights Reserved Interventions ❖ Most often something designed to interrupt or break the exposure pathway Copyright © 2020 Wolters Kluwer · All Rights Reserved Evaluation ❖ Has the exposure pathway been interrupted? ❖ What does the community think about the intervention— are people satisfied? ❖ How has health improved? ❖ How many people did the intervention affect? ❖ Can the intervention demonstrate any cost savings? ❖ Is the intervention sustainable? Copyright © 2020 Wolters Kluwer · All Rights Reserved Environmental Epidemiology ❖ Epidemiology is a field of public health science that focuses on the incidence and prevalence of disease or illness in a population ❖ Environmental epidemiology o Field of public health science that focuses on the incidence and prevalence of disease or illness in a population from exposures in their environments Copyright © 2020 Wolters Kluwer · All Rights Reserved Major Challenges to Environmental Epidemiology Community Nursing Discussion Boar

❖ Limited availability of data on many contaminants and their effect on health ❖ Limited understanding about how exposures to multiple contaminants may sicken people ❖ Latency between exposure and illness can be very long. ❖ Time‐consuming to perform ❖ Resource intensive in terms of personnel and money ❖ Inconclusive in determining if X contaminant caused Y illness Copyright © 2020 Wolters Kluwer · All Rights Reserved Working Toward Healthy Environments ❖ Healthy communities ❖ Healthy homes Copyright © 2020 Wolters Kluwer · All Rights Reserved Children’s Health and the Environment ❖ Vulnerability o Body systems are still rapidly developing o Eat, drink, and breathe more in proportion to their body size than do adults o Breathing zone is closer to the ground compared with adults o Bodies may be less able to break down and excrete contaminants o Behaviors can expose them to more contaminants o Spending time outside home where environmental hazards may be present Copyright © 2020 Wolters Kluwer · All Rights Reserved Question #3 Is the following statement true or false? Environmental justice is the belief that no group of people should bear a disproportionate share of negative environmental health consequences regardless of race alone. Copyright © 2020 Wolters Kluwer · All Rights Reserved Answer to Question #3 False Rationale: Environmental justice is the belief that no group of people should bear a disproportionate share of negative environmental health consequences regardless of race, culture, or income. Copyright © 2020 Wolters Kluwer · All Rights Reserved Environmental Justice Environmental justice is the belief that no group of people should bear a disproportionate share of negative environmental health consequences regardless of the following: ❖ Race ❖ Culture ❖ Income Copyright © 2020 Wolters Kluwer · All Rights Reserved Global Environmental Health Challenges ❖ Clean water and sanitation ❖ Air quality ❖ Chemical and contaminant exposure ❖ Climate change Copyright © 2020 Wolters Kluwer · All Rights Reserved … Community Nursing Discussion Boar