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The vulnerable population is a certain population groups that require nursing’s special attention, care, and sensitivity regarding their healthcare needs to ensure that their needs are met. The vulnerable groups are at risk for health disparities include minority groups, those who are uninsured, those who live in poverty or who are homeless, those with chronic health problems and disabilities, immigrants, refugees, those with limited English proficiency, those who are incarcerated, and members of the LGBTQIA (lesbian, gay, bisexual, transgender, queer, intersex, asexual) community. Vulnerable groups experience greater risk factors, a lack of necessary access to care, and increased morbidity and mortality as compared with the general population. Nurses need to be aware that healthcare disparities exist and plan and provide care to prevent a disparity. Nurses also need to be aware of the most prevalent chronic health problems and infectious diseases in the United States and their associated risk factors. There are the following chronic health problems in the U.S. and risk factors:
- Heart disease.
- Cancer.
- Lung disease.
- Stroke.
- Alzheimer’s disease.
- Diabetes mellitus.
- Kidney disease. Risk factors:
- Tobacco use.
- Poor nutrition.
- Obesity.
- Lack of physical activity.
- Excessive alcohol use. Common infectious diseases in U.S.:
- Covid -19 (coronavirus).
- Sexually transmitted diseases (chlamydia, syphilis, gonorrhea, genital herpes, human papilloma virus, human immunodeficiency virus and acquired immunodeficiency syndrome).
- Influenza.
- Staphylococcus aureus.
- Escherichia coli.
- Herpes simplex 1, herpes simplex 2.
- Shigellosis.
- Norovirus.
- Salmonella.
- Pneumonia.
- Hepatitis C.
When performing assessments nurse need to screen for these health problems and their associated risk factors, and to determine necessary protective measures and support services for the individual or family. Then nurse need to plan appropriated educational strategies and teach about the measures that will either prevent or treat these health problems and infectious diseases and connect the client or family with identified support services. Minority groups are more often affected by health care disparities than nonminority groups. Some individuals in their groups may be less likely to have health insurance coverage or regular source of health care. The Native Hawaiians and other Pacific Islanders population is noted to have higher rates of smoking, alcohol consumption, obesity, and diabetes mellitus. Hepatitis B, human immunodeficiency virus (HIV), and acquired immunodeficiency syndrome (AIDS), and tuberculosis are more frequent diseases. Noted is that there is a high incidence of infant mortality and sudden infant death syndrome (SIDS) in this population. Obesity, diabetes mellitus, end-stage renal disease secondary to diabetes, and cervical cancer are more common among the Hispanic American/Latin population. In the Native American and Alaska Native populations, geographic isolation and income may be factors regarding receiving health care. Inadequate water supply and sewage disposal can be factor with infectious diseases. Smoking and the use of alcohol are more common, and diabetes mellitus, cancer, stroke, heart disease, and accidents are concerns. Additional concerns include mental health, sudden infant death syndrome, teenage pregnancy, liver disease, and hepatitis. Obesity, diabetes mellitus, hypertensin, heart disease, asthma, and cancer occur more commonly among African Americans, with leading causes of death being heart disease, cancer, and stroke. Cancer, tuberculosis, and hepatitis are more common health problems of Asian Americans, with leading causes of death being cancer, heart disease, and stroke. LGBTQIA group is represented by a wide range of varying characteristics. They may be less likely to access health care than other population groups due to fear of stigmatization and being viewed as different. Transgender individuals may be less likely than other groups to have certain screenings completed, such as mammograms, breast exams, cervical cancer screening, testicular cancer exams, and prostate screening. Sexually transmitted infections are concern in this population. Breast cancer and cervical cancer are concern, probably because of decreased screening and nulliparity. Depression and suicide are concern. Rejection from friends, family members, and social support systems may be a stressor. Teenage members of the LGBTQIA population are more likely to be threatened, bullied, injured, raped, and victimized. For these reasons, school absenteeism can be a problem. LGBTQIA youth are at risk for abuse by family members due to their sexual orientation.
Prisoners. Health concerns are asthma, diabetes, hypertension, heart disease, mental health problems, infectious and communicable diseases. Immigrants and refugees. Challenges include communication barrier, cultural barrier, economical and health issues. Individuals with chronic illness. In this group poor health outcomes and high health care costs are associated with chronic illness. Optimal care for individuals with multiple chronic illnesses may be limited because of the multiple health needs present. I worked with intellectually disabled individuals in a nursing home. Some clients were able to move but a few of them were paralyzed and spent time in a bed or in a wheelchair. Those who were able to move needed assistance to eat. None of them were able to speak. Mental and behavior issues make their emotions difficult to read. Very often CNAs makes decisions for them and claim that it those what clients want. Instead of providing calm and relaxing atmosphere CNAs would turn on the TV and loud music every day, overstimulating them. During this time some clients had seizures. Screaming and overstimulation during mealtime was a norm for this nursing home. In this nursing home clients did not receive adequate and timely treatment. For example, a client has possible lactose intolerance. He was vomiting all the time when he consumed milk. But instead of providing a test for lactose intolerance and changing the diet, administration still provided him a diet containing a milk. It is a breach of the following ethical principles: beneficence (action are taken to promote good) and nonmaleficence (actions are taken to avoid harm). The same is the example of providing a diet containing a lot of acidic products to the client with GERD. Next example is a Covid protocol. Over two months there were two cases of covid. I observed staff following poor hygiene, not using masks and gloves, close contacts with clients (kissing them and embracing). This is an example of breaching the following ethical principles: beneficence, nonmaleficence, utility (the good of the many outweighs the wants or needs of the individual). Another example was not treating the wound of tube fed client. The client during at least last 3 years had an open wound around her tube. Last month we brought her to wound care in hospital. The nurse suggested immediate surgery with tube replacement and treatment of the wound. She mentions that there is mistake with tube installation. Administration of nursing home decides to choose the option of the long way, not in interests of client: to inform the family, then found the surgeon who first to install this tube, then ask him to do new surgery. But they still not found who did those first surgery. The surgery done 8 or more years ago, and they lost the papers. Result: the client still has not received treatment. The wound is bleeding, the gastric juice is coming out and dissolve the skin. Nurse mention that it is probably give to the client pain. But client cannot speak, not express emotions. This is an example of breaching following ethical principles: beneficence, nonmaleficence, paternalism (one individual assumes the right to make decisions for another), utility.
