1. Foundations of Nursing in the Community: Community Oriented Practice, 3 rd edition. Ashley Jarrell, RN, BSN, BA

2.   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

3.   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

4.   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

5.   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..

6.   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

7.   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

8.   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

9.   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

10.   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

11.   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

12.   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

13.   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

14.   Making services accessible  Home visits  Mass screenings  Accessibility ease  Combined services Nursing Interventions

15.   Create caring environment  Respect, compassion, concern  Advocate  Help coordinate resources  Know resources available!  Don’t make assumptions Nursing Interventions

16.   Child’s perspective of being poor  http://www.pbs.org/wgbh/pages/frontline/social- issues/poor-kids/seras-story/ http://www.pbs.org/wgbh/pages/frontline/social- issues/poor-kids/seras-story/ Video Clip

17.   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