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Vulnerable Populations - Questions
Vulnerability is a multifaceted concept which deals with risk assessment of special populations. The social determinants of health defined by WHO (2013) as 3 core factors such as the socioeconomic environment, the physical environment, and the person’s individual characteristics and behaviours, are the underlying reason of certain groups’ vulnerability (WHO, 2013).
The unequal distribution of resources and access to care between different health groups affects their health status. The unavailability of resources to satisfy the basic health needs (e.g. access to water or safe food), the low socioeconomic status (unemployment or poverty), and the absence of opportunities for high-quality education or job support make the certain population groups vulnerable. The comorbid or premorbid conditions which individuals may have, e.g. such communicable diseases as hepatitis B\ C or HIV, contribute a lot to their vulnerability. The synergy effect of all 3 vulnerability factors has a strongly negative impact on these individuals’ physical, psychological and social functioning.
The community health nurse role has always been coordinating services and developing interventions for the patients of high risk groups as their health status is always worse than in general population, due to the limited access to care (HP, 2015). In 1991, UN defined the care of vulnerable groups as fundamental role of community health nursing which should provide health education, screening and primary care to those people. Community health nurse can assess the impact of individual’s condition on the community level and initiate appropriate health promotion and primary prevention measures. As the number of population from vulnerable groups is expected to increase (HP, 2015), the role of community health nurse in educating, counselling, monitoring and evaluating results of the work with those individuals becomes vital.
Healthy People 2020 distinguish between several groups of vulnerable populations defining those as affected by health disparities such as race or ethnicity, religion and social status, mental and physical health, sexual orientation or any other characteristics related to discrimination (HP, 2015). One of the most vulnerable groups present in every community is elderly. The number of aging people will continuously increase, adding up to the total number of patients with chronic diseases. Apart from this, the elderly’s physical and mental health often leads to severe impairment of their functional status (Naik, Kunnik, Kassidi, Nair & Coverdale,2010) Some of them are being cared in long-term facilities which makes these individuals particularly vulnerable due to lack of home and family support. Poor nutrition, limited access to transportation and numerous social problems the elderly do not know how to address (e.g. social security) increase the vulnerability.
Another vulnerable group separately mentioned by Healthy People 2020 is pregnant adolescents. Apart from problems with home environment and educational level, as well as detrimental impact of early pregnancy on their physical and psychological status, they tend to have such additional vulnerability factors as poverty and substance abuse (Lee, Clernon, Kollins, Prybol &Fuemeller, 2013). Poor adolescents often lack knowledge about safe sex and familly planning and do not have full-scale adults’roles examples in their homes.The economic strains are also associated with early smoking and substance abuse (Lee et al.,2013) which affects both the young mothers-to-be and their babies.The available jobs are often of temporarily character and do not provide social security. As a result, such young mothers, with their poor money management skills, do not have funds to support both themselves and their children.
Rural health definition covers the concepts of demographics, geography, environment and economics. People living outside of the city in rural areas face other health problems than people in cities. They often have limited access to public transportation and thus to high quality healthcare services.Due to the limited number of inhabitants, consultations of some specialists may be unavailable in rural areas. People from rural areas are frequently exposed to chemicals and certain chronic diseases. The rural areas impose certain limitations to access to education and social services and are more susceptible to risk of healthcare services level decline if the total region income declines. All this enhances the importance of community nurse role in rural areas as educator and counsellor. The community health nurse gathers information, provides comprehensive assessments of rural population health needs, and provides educational expertise as a forefront of their roles (e.g. sharing knowledge of conventional medicines and their interaction with traditional rural herbal remedies)(Roberts, Hibberd & Lewis,2014). Four main areas define the community nurse contribution to rural health: population health status evaluation and developing appropriate criteria for referral, collaborative working, education, and advocacy roles (Roberts et al., 2014).
1. Lee, C., McClernon, J., Kollins, S.H., Prybol, K., &. Fuemmeler, B.F. (2013). Childhood Economic Strains in Predicting Substance Use in Emerging Adulthood: Mediation Effects of Youth Self-Control and Parenting Practices.J. Pediatr. Psychol., 38(10), 1130-1143.
2. Office of Disease Prevention and Health Promotion(HP) (2015). Healthy People 2020. Retrieved from: https://www.healthypeople.gov/
3. Roberts, D, Hibberd, P., Lewis, C.A, Turley, J. (2014).The unique contribution of community clinical nurse specialists in rural Wales. Br J Community Nurs.,19(12),601-607.
4. UN Children’s Fund (1991). A manual on community-based monitoring. Manila, UNICEF.
5. World Health Organization (WHO) (2013). The Determinants of Health. Retrieved from: http://www.who.int/hia/evidence/doh/en/
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