Vulnerable Population - Essay Example

Vulnerable Population Introduction Vulnerability and strength are universal features of the human condition. Everyone is vulnerable to some situation, ailment, or problem. Complex and interrelated social, political, cultural, and economic factors lead to greater vulnerability for some groups. In the health care arena, the vulnerable label applied to populations refers to those groups of persons whose vulnerability increases their potential to suffer health disparities. Aday (1994) in his discourse on health status of vulnerable populations explicitly talks about the notion of risk underlying the concept of vulnerability. This means that everyone is potentially vulnerable or at risk or at probability of developing health problems. The risk is greater for those with the least social status. This happens due to lack of social capital and human capital resources of this population to prevent and ameliorate the origins and consequences of poor physical, psychological, or social health. Perhaps the most common problems that may arise are problems associated with substance abuse and mental health problems, and these are more prevalent in lesbian, gay, bisexual, and transgender population. It has been suggested that amelioration of such problems would need a framework to assess the needs of these individuals, and this would, in turn, depend on the information concerning their physical, psychological, or social health. Deriving from this, it can be stated that an effective programme would need completeness and accuracy of information of a particular group. Methodological work is needed to derive standardized definition of terms, specify the content and timing for collecting information for minimum basic data sets, so a uniform standard for evaluating, reporting, and intervening on the health status of these vulnerable people can be developed (Aday, 1994). Gay Population Usually those populations that are vulnerable for health disparities are those that experience reduced resource availability, increased risk for health problems, and thus, impaired health status leading to increased morbidity and mortality. Beginning with Florence Nightingale, nurses have demonstrated dedication and aptitude for identifying persons, groups, and environments in need of intervention and new approaches to assessing and reducing vulnerability. Active partnerships between nurses and their intended intervention recipients can be used effectively to plan, implement, and evaluate research and intervention programs that truly address health care and education needs as perceived by the community. Such partnerships need to foster mutual commitment, trust, and respect. Equitable distributions of goal-setting and decision-making power evolve through shared responsibilities and mutual learning among partners. Nurses should move to the forefront in the important research needed to design and implement effective interventions with vulnerable populations capitalizing on their strengths to increase their resources, reduce their risks, and improve their health status with more equitable, quality health care. In this assignment, these issues from the context of gay people and their health care needs will be examined, where a conceptual framework will be utilized to examine the necessities and utilities of interventions designed to that end. The basic problems with the gay people are lack of recognition or acceptance by healthcare providers, homophobic attitudes, and an absence of awareness regarding the healthcare needs of this vulnerable population. They themselves experience lack of self-esteem, school truancy and drop out, runaway behaviour, and subsequent homelessness. Compounded to this, there is an enhanced incidence of drug and alcohol, abuse, prostitution and sexually transmitted diseases, depression, and suicide. Advanced practice nurses have the opportunity to improve the health of the gay youths through recognition, education, outreach, and advocacy. Shi and Stevens (2005) offer five reasons to focus national attention on vulnerable populations: these groups have greater health care needs; their prevalence continues to escalate; vulnerability is a societal issue; vulnerability and the nation’s health and resources are interrelated; and there is a growing emphasis on equality with respect to health. This is reflected in the demographic characteristics of the gay men. Although based on opportunistic samples, gay men have higher suicidal ideations, suicide attempts, and completed suicides. Lifetime prevalence rates of 24% to 41% suicidal ideations have been reported. The lifetime prevalence rates of serious suicidal attempts range from 7% to 20% among adult gay men. It has recently been found that 19.3% of men having sex with men would attempt suicide. It has also been found that there are higher rates of reported suicidal thoughts and attempts among adolescents reporting same-sex romantic attractions and romantic relationships. There are considerable social and cultural stressors in these people, which include stigmatization, victimization, and pervasive antigay hostility. The stresses related to antigay victimization may provoke emotional distress that can have both proximal and distal relationship to suicidality. These victimizations may be related to low self-esteem, substance abuse, and subsequent mood disorders that increase their lifetime vulnerability to suicide (Shi & Stevens, 2005). Health care disparity is inversely proportional to health status disparity among vulnerable populations; that is, the groups who receive less health care experience greater morbidity and mortality. National attention on vulnerable populations is clearly related to the growing evidence that vulnerable groups experience health disparities, which represent social injustice and bear economic costs to the United States. This is evidently multiplies by the societal stresses, which are not buffered by the family support systems, since many of these gay men would not disclose their sexual orientation to their family members. This would result in alienation and anomie experienced by gay people, and conventional constraints against self-destructive behaviours such as problem solving and social supports may be weakened. Gay men have been demonstrated in several studies to have demonstrated a high prevalence of illicit drug or alcohol use. The incidence of this problem is several-fold higher in gay men. Several complex psychosocial factors related to affiliation with gay culture have been associated with substance abuse. These include being "out" to others about having sex with men, effects of homosexuality on social roles such as occupational and residential status, and attending gay bars. Studies have found that various groups in the United States are disproportionately affected by infectious disease morbidity and mortality. HIV/AIDS and other STDs are among the various infectious diseases for which this health disparity has been found to be most outstanding. In fact, the Centers for Disease Control and Prevention (CDC) have identified men who have sex with men may have high incidence of HIV and other STDs. Intervention programs are in place to prevent HIV. These are related to factors such as longitudinal behavior change outcomes. It is difficult to determine the impact of each of these factors on sexual risk behaviors because of the comorbidity that exists among them. Research attempting to describe the specific role that each of these conditions plays on STD and HIV risks have had conflicting results. Several studies have determined that depression, especially serious depression, is strongly associated with drug use but not other STD and HIV risk behaviors. Other studies have concluded that mental illness is associated with a higher prevalence of risky sexual practices such as “knowing one’s sex partner for less than one day” or “feeling forced into sex.” Prolonged homelessness, when controlled for mental illness, has also been found to be a strong predictor of risky sexual behavior among men. Vulnerable Population Conceptual Model Although vulnerable populations have been a focus in nursing research for over 50 years, the theoretical foundation for studies has been varied and often drawn from other fields such as psychology, medicine, sociology, and public health. Most popular among the theoretical frameworks guiding studies involving vulnerable populations are social cognitive theory, the theory of reasoned action, and the health beliefs model. While these models are very useful, they were not specifically designed to address health and illness in vulnerable populations, nor do they draw upon existing knowledge or assess perceptions of these groups. Research has shown that the lack of resources, rather than the presence of risk factors, is the best predictor of illness and premature death in vulnerable populations. Review research on risk factors for disparities among vulnerable populations, emphasized the importance of viewing socioeconomic status and race as fundamental social causative factors that contribute to disparities through access to resources, avoidance of risks, and minimization of the consequences of disease. In designing health promotion and disease management interventions, nurse researchers need to consider how the availability of resources such as income, jobs, housing, and access to health care can impact risk factors, such as, behavioral or environmental, which, in turn, influence health status. The notion of risk underlying the concept of vulnerability was described in a multifaceted model developed by Aday (1994). She proposed that risk of vulnerability may be predicted by social status such as age, sex, race, or ethnicity, social capital such as family structure, marital status, voluntary organizations, social network, and human capital such as schools, jobs, income, and housing. Health disparities are perpetuated informally through social norms and behavioral expectations or cultural practices, or formally through legally endorsed differences in access to and quality of human resources. Social status and social capital of individuals or communities will affect the degree of investments made relative to schools, employment opportunities, housing, recreation facilities, neighborhood safety, and overall quality of life. In essence, vulnerability reflects the interaction effects of many factors over which individuals may have little control. Aday proposed that the interaction among individual assets, social assets, and demographic factors contributes to a higher likelihood of poor health in the United States. A major strength of Aday’s conceptualization is that it expanded upon earlier paradigms that provided individual-level explanations of how vulnerability affects health. Individual-focused models related risk of vulnerability to characteristics of persons such as age, race, socioeconomic level, education, belief systems, and knowledge. Aday included both individual and community level determinants of risk in a comprehensive interaction model (Aday, 1994). Flaskerud & Winslow (1998) developed a population-based framework known as the vulnerable populations conceptual model. It is specifically designed for clinical practice, research, and policy interventions aimed at impacting links between resource limitations and effects on relative risks and subsequent health outcomes. This proposes an interactive relationship among resource availability, relative risk, and health status of vulnerable populations. These three constructs by themselves represent neutral domains that could indicate adequate or limited strengths and resources, protection from or avoidance of risks as well as exposure or susceptibility to risk, and good health or poorer health. Vulnerable populations experience limited resources and, consequently, high relative risk for morbidity and premature mortality. Resource availability is viewed as the availability of human capital, such as, income, jobs, education, and housing; social status such as prestige and power, and social connection such as integration into society and social networks and environmental resources. Resource availability is determined on the community level (macro) by the quantity and quality of environmental resources, and on the individual level (micro) by social status. A critical aspect of resource availability is the ability to access the health care system. Access encompasses a wide range of issues, including financial and geographic barriers. A lack of resources increases relative risk, conceptualized as the ratio of the risk of poor health among groups who do not receive resources and are exposed to risk factors compared to those groups who do receive resources and are not exposed to these risk factors (Aday, 1994; Flaskerud & Winslow, 1998). In the late 1980s, Nyamathi developed the Comprehensive Health Seeking and Coping Paradigm (CHSCP; Nyamathi, 1989). A broad overview of coping is provided in this complex and multidimensional framework which proposes an interactive relationship existing among several components which tap into the clients’ environmental, personal, behavioral, sociodemographic, and health outcome spheres (Nyamathi, 1990). Using a nursing perspective, the health goals of the client are considered and, along with mutually designed nursing interventions, are focused on enhancing the clients’ motivation to attain and maintain health and function, to prevent disease, and to attain or retain the highest possible level of health, function, or productivity (Nyamathi, 1989). Components of the paradigm include clients’ situational factors such as length of time homeless and personal factors such as, perceived self-esteem, resources such as, social support, financial and spiritual security, and sociodemographic characteristics, including acculturation. Self-esteem, for example, has been noted to be associated with positive health practices such as adherence to treatment regimens (Golin, DiMatteo, & Gelberg, 1996), as well as reduction in drug and alcohol use (Nyamathi et al., 2003). Social support, on the other hand, has been positively correlated with active coping and less likelihood of reporting partners who use drugs (Nyamathi et al., 2003). Nursing goals and interventions are an integral part of this research- and practice-oriented paradigm that may directly influence health seeking and coping behaviors, cognitive appraisal, and health outcome. Cognitive appraisal involves consideration of threat perceived and resources available. Health seeking and coping behavior may involve problem-focused or emotion-focused coping. Conclusion The CHSCP provides a very useful framework for nurses interested in enhancing or promoting the health seeking and coping of vulnerable clients. For example, in-depth analysis of the risk and protective factors associated with ongoing drug use has revealed the interplay between support resources and psychological resources and has advanced the state of the science in the understanding of how drug use, drug problems, and drug dependence are related to social support, coping, and depression among gay men. Through this framework, vulnerability is shown to be influenced by individuals’ predisposing, enabling, and need attributes, and also influences risk factors at an ecological or community level. These attributes reflect risk factors for poor access to health care, poor quality of care, and poor health status, as well as possible discrimination. Individual predisposing attributes include demographic factors, inherited or cultivated belief systems, and social structural variables associated with social position, status, and access to resources. Individual need attributes include self-perceived or professional evaluated health status and quality-of-life indicators, whereas need attributes at the ecological level may include population health behaviors, population health status trends in mortality and morbidity, and health disparities and inequalities. Predisposing, enabling, and need attributes, at both the individual and ecological levels, may each independently influence vulnerability or interact with each other to cumulatively influence vulnerability, and thus intervention. References Aday, LA., (1994). Health status of vulnerable populations. Annu Rev Public Health; 15: 487-509. Flaskerud, J. H., & Winslow, B. J. (1998). Conceptualizing vulnerable populations health-related research. Nursing Research, 47(2), 69–78. Golin, C. E., DiMatteo, M. R., & Gelberg L. (1996). The role of patient participation in the doctor visit. Implications for adherence to diabetes care. Diabetes Care, 19(10), 1153–1164. Nyamathi, A. (1989). Comprehensive health seeking and coping paradigm. Journal of Advanced Nursing, 14(4), 281–290. Nyamathi, A. M. (1990). Assessing the coping status of spouses of critically ill cardiac patients: A theoretically based approach. Journal of Cardiovascular Nursing, 5(1), 1–12. Nyamathi, A. M., Stein, J. A., Dixon, E., Longshore, D., & Galaif, E. (2003). Predicting positive attitudes about quitting drug and alcohol use among homeless women. Psychology of Addictive Behaviors, 17(1), 32–141. Shi, L., & Stevens, G. D. (2005). Vulnerable populations in the United States. San Francisco: Jossey-Bass. Read More