NUR4244 Public Health Nursing Deliverable 4 Scenario You are a new public health nurse working for the Department of Public Health, and you have been asked to create a report on one of the following vulnerable populations in your community: homeless population, ethnic or minority group, elderly, or pregnant woman and children in low socioeconomic areas. The report will provide your department with current information about your community as well as offer interventions for the selected vulnerable population within your community. Instructions Create a report on one vulnerable population in your community that: Part One – Vulnerable Population Selects one vulnerable population from below: Homeless population Ethnic or minority group Elderly Pregnant woman and children in low socioeconomic areas Describes the health determinants affecting the selected vulnerable population, including: Social and economic environment Physical environment Individual characteristics Behaviors Part Two – Public Health Nurse & Multidimensional Strategies Describes the role of the public health nurse in helping the selected vulnerable population. Develops two multidimensional strategies used as interventions for selected vulnerable population. Provides stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar in the report. Resources Library Databases Health Source: Nursing/Academic Edition Database FAQ Websites Policy Map United States Interagency Council on Homelessness United States Census Bureau Guides & FAQs Policy Map Tutorials Searching the Map Search by Census Tract and Block Group Data Layer Legend APA Guide Credible Sources FAQ Nursing Guide Rasmussen’s Answers/FAQs
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NUR4244 Public Health Nursing.
Grading Rubric
Social Determinant’ Effect on Vulnerable Population Health
Healthy People 2020 refers to social determinants of health (SDOH) as
those conditions in the environment in which people are born, live, work,
play, worship, and age that impact health status, health outcomes, and
quality of life.
Social determinants include transportation, housing or place of
residence, access and availability of services, education attainment,
employment, access to material goods, diet, discrimination by social
grouping, and social and environmental stressors. Lower education
levels, family dysfunction, poverty, and lack of social support all
contribute to the ability to self-care and gain access to health services.
Maryland’s Approach
Substance Abuse and Pregnant Women
One county decided to address the needs of women with substance
abuse disorders during pregnancy. This population often had several
social issues compounding their lives, including limited family support,
lack of economic independence, tenuous housing situations, and abusive
relationships. The community program focused on intensive case
management to address their direct health needs and multiple social
issues. Wrap-around services included medication-assisted treatment,
coordinated mental health services, early and consistent prenatal care,
smoking cessation support, social services, transportation to
appointments, parenting skills training, and domestic violence services.
The program worked with local law enforcement to identify and divert
women to the program. In the first two years of the program, 90% of the
babies were born free from drug withdrawal and with lower rates of lowbirth-weight babies. The county health department coordinates with local
pediatricians for well-child care and parenting support, as well as for
screening for post-partum depression. Follow-up treatment at substance
abuse treatment programs also includes public health nursing
involvement in family planning and sexually transmitted disease
prevention.
Diabetics in the Emergency Department
Another county health department in Maryland focused on developing a
partnership to reduce diabetes related emergency room (ER) visits and
the racial disparities in those rates. Many of these patients had no
regular primary care provider, lacked reliable transportation, and had
difficulty in affording medications and food for a diabetic-related diet.
Many of these clients relied on local food banks that lacked refrigeration
facilities required for fresh foods. Canned and packaged foods were high
in carbohydrates, mainly sugar. If food banks were low on supplies,
many patients lived on very high fat, high carbohydrate food from local
markets.
A public health nurse and social worker provided transitional care to
patients following their ER visit that included home visits, medication
reconciliation, coordination with primary care providers, and
individualized diabetes education. The team worked on finding financial
medication assistance, transportation to appoints, and help in signing up
for additional housing and energy benefits. The program resulted in an
85% reduction in diabetes related ER visits, better glycemic control
among participants, and better health outcomes in general. This
alternative use of financial resources reduced the hospital’s financial
burden for uncompensated care. This savings allowed the hospital to
continue the cost of the program after the initial grant funding.
Opioid Crisis
Another Maryland county was experiencing a growing opioid and
methamphetamine epidemic, evidenced by an increase in overdose
admission and deaths in local emergency rooms. There were no
treatment programs, halfway houses, recovery providers, or care
coordination in the county. Due to the geographic isolation, affected
individuals and their families had to travel 100 miles round-trip for
services, often in poor weather conditions. The county’s behavioral
health center used the grant money to collaborate with the University of
Maryland School of Medicine Department of Psychiatry to utilize
telehealth technology for patients who enrolled in outpatient treatment.
The physicians coordinated with public health nurses to administer
medication-assisted treatments, with both nurses and mental health staff
monitoring for compliance.
Innovation
This type of individualized public health approach supports innovative
ways to address the social factors that affect health access and
behaviors. The inter-professional collaboration across multiple systems
can provide a social safety net to improve the health of local underserved and vulnerable populations.
Source(s)
Maryland Rural Health Association. Social Determinants of Health and
Vulnerable Populations in Rural Maryland. Retrieved from:
https://www.mdruralhealth.org/wp-content/uploads/2015/11/MRHAWhite-Paper1-FINAL-.pdf
Interventions for Vulnerable Population
Vulnerable populations include individuals who face significant barriers to
better health and whose circumstances have made them susceptible to
poor health. Health status is significantly impacted by social conditions,
which may result in increasing the vulnerability of specific groups or
populations. Merely addressing the immediate healthcare need will not
lead to improved health status without addressing the environmental
factors. Using concepts and tools from sociology and psychology can
assist public health professionals in addressing the needs of vulnerable
populations. What follows are some comprehensive public health
programs for women and children.
The Problem of Prematurity
The United States continues to have poorer birth outcomes than many
other developed countries. One of the key contributors is a combination
of premature birth and low-birthweight babies. A program “The Centering
Pregnancy Program” was developed in the early 1990s by a nursemidwife where groups are formed between 12 and 16 weeks of
pregnancy and meet regularly throughout pregnancy. The groups are a
place to ask questions, get additional information on pregnancy and
parenting, and discuss expectations about birth and parenting. Groups
are generally between 8-12 women with similar due dates, and healthy
snacks and beverages are provided. The groups continue to meet
through the post-partum period, meeting very month for four months or
longer. These groups have shown better birth outcomes, more providerpatient contact, patient empowerment and learning, better self-care, and
support and friendship among group members.
The Health of Children
Public health policy has long recognized children and pregnant women
as a vulnerable population, thus providing a social safety net program for
health insurance for low-income women and children. Children are
eligible for Medicaid health insurance if they are 19 or younger and the
family income is 133% or less than the federal poverty level. The US
Department of Health and Human Services calculates this level every
year. Congress has supported additional legislation for those whose
families earn too much money to qualify for Medicaid through the
Children’s Health Insurance Program (CHIP). The Affordable Care Act
(ACA) sets the eligibility threshold for families up to 200% of the federal
poverty level. States can adjust this threshold up, depending on their
resources.
Comprehensive Health Services
The federal regulations mandate Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) that includes detailed history and
examination, dental care, hearing evaluations including cochlear
transplants and hearing aids, immunizations, and lead screening. This
treatment ensures that low-income children receive a comprehensive
approach to their overall health status. All CHIP programs cover physical,
occupational, and speech and language therapies for children with
special needs.
Women, Infant, Children Program
The Women, Infant, and Children Program (WIC) is administered through
the Department of Agriculture to provide supplemental food and nutrition
to pregnant women and children. This program recognizes the need for
good nutrition during key periods of fetal, infant, and child development.
Poor nutrition during pregnancy contributes to low-birthweight babies,
gestational diabetes, and neural tube defects. Children with poor nutrition
have both short and long-term effects. Short term, poor nutrition often
leads to obesity and an increased risk for diabetes, as well as dental
carries and calcium and iron deficiency. Poor nutrition is linked to
learning behaviors. Longer term, poor nutrition as a child carries over into
adulthood as a risk for diabetes, hypertension, and obesity.
This group of children is also eligible for the free lunch program at public
schools, recognizing the importance of nutrition in developing brains and
bodies. There is additional money for schools from the Department of
Education for those children with special needs. Many of these families
are also eligible for low-income housing through the Department of
Housing and Urban Development and for the Supplemental Nutrition
Assistance Program (SNAP) for food.
Children with Disabilities
The Centers for Disease Control and Prevention has provided five-year
grants to ten states to include those of all ages with disabilities in health
programs, activities for health promotion, disease prevention, wellness,
and disaster preparedness. The state of Florida has as one of their key
goals to improve access to physical activity, healthy food, and nutrition
through their Exceptional Student Education Schools. This goal is a
recognition that the disabled may need special support in their overall
well-being and their educational success. Florida is also prioritizing
training and technical assistance in cultural competency and health
equity for healthcare professionals and providers.
These are examples of how public health programs have designed
approaches to support the well-being of women and children who may be
affected by social determinants of health. Public and community health
nurses continue to be an integral part of these programs.
Source(s)
Paradise, J. (2014, July 17). The Impact of the Children’s Health
Insurance Program (CHIP): What Does the Research Tell Us? Retrieved
from https://www.kff.org/medicaid/issue-brief/the-impact-of-the-childrenshealth-insurance-program-chip-what-does-the-research-tell-us/
What Shapes Health-Related Behaviors? (2017, May 24). Retrieved from
https://www.rwjf.org/en/library/research/2011/03/what-shapes-healthrelated-behaviors—.html
Impact of Multidimensional Strategies
Multidimensional strategies that address the genetic, social, and
behavioral determinants of health are critical to the well-being of
vulnerable populations. Support for adequate shelter, food, nutrition, and
access to routine medical and dental care are foundational to health.
Communities must address the status of women to promote higher
educational levels, control over their reproductive decisions, better job
opportunities, and a higher educational level for their children. In
addition, the status of the elderly in society can significantly affect how
older adults are cared for and housed.
Nursing Theory
This type of multidimensional approach is consistent with nursing theorist
Nola Pender’s health promotion model. She believes that nurses need to
consider individual characteristics and experiences that shape behaviorspecific cognitions and effect. The nurse then could support changing
health beliefs and actions in ways that produce positive health behaviors.
For instance, someone who has never had access to routine dental care
would likely fear seeing a dentist for work that is reparative in nature.
Explaining that dealing with the dental issues will improve nutrition and
overall health and repairing work on the teeth may improve physical
appearance may encourage the client to take advantage of a free dental
clinic. Emphasizing routine care afterward should be a way to avoid
extensive and painful procedures in the future.
Pender describes personal factors as biological, psychological and sociocultural, factors that are predictive of a given behavior and shaped by the
nature of the target behavior being considered.
Changing Health Behaviors
Changing health behaviors requires that the individual perceive the
benefits and has the support to overcome barriers to health change.
Changing health behaviors may also involve understanding the negative
consequences of not changing behavior.
Changing lifestyle choices and maintaining them requires the
determination of the individual and the support of others. The public
health nurse can be a part of a team that provides education and
assistance in supporting a behavioral change in vulnerable populations.
Source(s)
National Center for Health Statistics. (2018, February 13). Retrieved from
https://www.cdc.gov/nchs/products/databriefs/db303.htm
Pender’s Health Promotion. (n.d.). Retrieved from
http://currentnursing.com/nursing_theory/health_promotion_model.html

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