Vulnerability and Vulnerable Populations

Foundations of Nursing in the Community: Community Oriented

Practice, 3rd edition.

Ashley Jarrell, RN, BSN, BA

Defined as a susceptibility to negative events Increased risk to develop adverse health

outcomes Often have multiple cumulative risks

Homeless-poor eating choices, lack of health care, lack of support, etc..

Resilience- the ability to resist effects of vulnerability

Who do vulnerable populations include?

Vulnerability

More likely than the general population to

experience health disparities Variations in health services and health

status Healthy People 2020

Why is this initiative important? Goal of HP 2020 Have fewer resources to treat illness and

promote health Ways to improve?... Affordable Care Act

Health Disparities & Vulnerable Populations

Specific areas of health disparities

Infant mortality, childhood immunization rates, disease-specific mortality..

Related to poverty and education level vs. race and ethnicity

Health Disparities & Vulnerable Populations

Feeling of a lack of power, limited control,

victimization, health risks, disadvantaged status

Limited availability in resources Physical resources Environmental resources Personal resources Biopsychosocial resources

Vulnerability results from..

Social and economic

Poverty (primary cause of vulnerability) Poverty defined as an income <$18, 400 for

a family of 4 Age –related

Very young and old less able to adapt to stressors Ability to care for themselves? Examples of stressors for young and old?

Predisposing Factors

Health-related

Less likely to seek preventative care r/t expense Not always chronic illnesses

Pregnancy, injury, acute illness Can affect ability to work, seek treatment?

Predisposition to disease (examples of health choices?)

Life experiences Abuse, trauma, life stressors Factors of chance and loss of internal locus of control

Predisposing Factors

Poor health outcomes

More likely to suffer negative health outcomes.. Why?

Cycle of vulnerability Without intervention, predisposing factors lead

to poor health outcomes, which in turn worsen predisposing factors

Difficult cycle to break without help Cycle can lead to chronic stress, isolation and

hopelessness--- making cycle worse

Outcomes of Vulnerability

Social Security Act of 1935

Largest federal support program for elderly and poor in American history. Ensured a minimal level of support for the blind, widowed, unemployed, maternal/child welfare, and elderly

Lump sum payments for widowed upon spouses death

State contributions for others

Policies for the Vulnerable

Social Security Act Amendment of 1965

Added Medicare, Medicaid for those with inadequate access to healthcare

Title XXI of Social Security Act Enacted State Children’s Health Insurance

Program (SCHIP) for uninsured children

Policies for the Vulnerable

Balanced Budget Act of 1997

Appropriated government spending by cutting federal budget and allotting more finances to aid the disadvantaged

More people eligible for aid who weren’t eligible for Medicaid

Helped provide more funding to welfare, children, immigrants

Policies for the Vulnerable

Vulnerable populations more expensive to treat

Cheaper to treat people who are not vulnerable Reimbursed based on keeping patients

healthy Medicaid accessibility is stringent

Leaving many uninsured/underinsured Costly co-pays

Roughly make less than $700/mo. for a family of 4 to be eligible in NC

Managed Care Effects

Growth of managed care (Medicare, Medicaid)

has reduced personal health services Clinics reimbursed for specialized services,

making it more lucrative Immunization clinics vs. primary care

Managed Care Effects

Making services accessible

Home visits Mass screenings Accessibility ease Combined services

Nursing Interventions

Create caring environment Respect, compassion, concern Advocate Help coordinate resources

Know resources available! Don’t make assumptions

Nursing Interventions

Child’s perspective of being poor

http://www.pbs.org/wgbh/pages/frontline/social-issues/poor-kids/seras-story/

Video Clip

Do you think Sera displays traits of resilience? What social/economic factors discussed in

lecture do you see in this clip? How might Sera and her sister end up in the

cycle of vulnerability? What is the probable health status of Sera and

her family? What resources has her mother utilized?

Discussion Questions