Working with vulnerable populations

• Vulnerable populations


  Specific, at-risk populations who are more susceptible to poor health because of socioenvironmental factors
• Examples of vulnerable groups in Canada

  • One-parent families
  • People with disabilities
  • Children
  • Visible minorities
  • Indigenous persons
  • Those with lower socioeconomic status
  • Older adults
• Health disparities


  Wide variations in health services and in health status among certain population groups related to key factors such as socioeconomic factors, education, employment, working conditions, food security, and genetics
• Health inequities


  Differences in health that could be avoided if reasonable action were taken (therefore, these differences are considered to be unfair and socially unjust)
• Marginalization


  The treatment of individuals or groups as outside, as insignificant or peripheral
• Sources of marginality


  • Gender
  • Physical fitness
  • Social status/class/income
  • Ethnicity
  • Skin colour
  • Religion
  • Martial status
  • Language
  • Age
  • Education/career
• Vulnerability


  Susceptibility to negative events
• Characteristics of vulnerable populations

  • Specific, at-risk populations who are more susceptible to poor health because of socioenvironmental factors
  • Those who tolerate a larger "burden" of illness and distress than that of others
  • Often experience multiple cumulative risks and are particularly sensitive to them
  • Are usually underserved and disadvantaged populations, with fewer resources for promoting health and treating illness than the average person
• Risk factors for vulnerable populations

  • Low income
  • Abused
  • Pregnant adolescents
  • Substance abusers
• Poverty


  Having insufficient financial resources to meet basic living expenses (e.g., food, shelter, clothing, transportation, and medical expenses)
• Approaches to defining poverty

  • Absolute poverty
  • Relative poverty
  • Subjective poverty
• Relative poverty


  Refers to individuals and families whose income is considerably less than that of their peers
• Subjective poverty


  Refers to individuals and families who perceive that they have insufficient income to meet their expenses
• Crisis poverty (temporary poverty)


  Homelessness is often transient or episodic
• Persistent poverty (chronic poverty)


  People are chronically homeless and may have mental or physical disabilities
• Poverty


  Major factor in health inequality
• Chronic conditions are more prevalent in poorer areas of the country
• Indigenous peoples more commonly have chronic diseases and conditions such as diabetes, heart problems, arthritis, cancer, and hypertension
• The poor have higher rates of infant morbidity and mortality, shorter life expectancies, and more complex health problems
• Poverty has a negative effect on women because they make up the greater part of the country's poor
• Poverty causes obstacles to accessing health care, for example, geographic location, language barriers, transportation difficulties, inconvenient clinic hours, and lack of information
• Homelessness


  Increasing globally, and in Canada it is following this same trend
• Estimated that in Canada 150,000 to 300,000 individuals are homeless
• Poverty can lead to homelessness
• People who live on the street are the poorest of the poor
• Types of homelessness


  • Absolute homelessness
  • Sheltered homelessness
  • Hidden homelessness
• Risk factors for homelessness

  • Lack of affordable housing
  • Loss of single room occupancy buildings
  • Low income or poverty
  • Mental health issues
  • Substance abuse or addiction
  • Unemployment or underemployment
  • Immigration
  • Violence
  • Being an ex-offender
  • Family conflict
• Health concerns for homeless people

  • Substance abuse
  • Mental illness
  • HIV/AIDS
  • Tuberculosis (TB)
  • Sexually transmitted infections (STIs)
  • Unplanned pregnancies
  • Seizures
  • Chronic obstructive pulmonary disease
  • Musculoskeletal disorders
  • Skin and foot problems
  • Malnutrition
• It is difficult for many homeless individuals to follow treatment regimens
• Homeless people spend a large portion of their time just trying to survive, and generally do not have the luxury of health promotion activities
• Community health nurses (CHNs) need to be aware of the unique needs of homeless clients at every age
• Homeless pregnant women in particular, are at high risk for complex health problems
• Community health nurses (CHNs) working with vulnerable populations

  Need well developed assessment skills, current knowledge of available community resources, and the ability to plan care based on client concerns and receptivity to help
• Street nurse - Cathy Crowe


  • Works as a nurse in Toronto as an advocate for homeless people
• What nurses should assess for vulnerable clients

  • Living environment
  • Neighborhood surroundings
  • Perceptions of their socioeconomic resources
  • Congenital and genetic predisposition to illness
  • Preventive health needs
  • Stress
• What nurses should do regardless of setting

  • Create a trusting environment
  • Show respect, compassion, and concern
  • Do not make assumptions
  • Coordinate services and providers
  • Advocate for accessible health care services
  • Focus on prevention
  • Know when to "walk beside" the client and when to encourage the client to "walk ahead"
  • Know what resources are available
  • Develop their own support network
• Primary preventive services


  • Affordable housing
  • Housing subsidies
  • Effective job-training programs
  • Employer incentives
  • Preventive health care services
  • Safer-sex education
  • Birth control services
  • Needle-exchange programs
  • Parent education
  • Counselling programs
• Secondary preventive activities


  Aimed at reducing the prevalence or pathological nature of a condition, involving early diagnosis, prompt treatment, and the limitation of disability
• Examples of secondary preventive activities

  • Supportive and emergency housing
  • Targeted case management
  • Housing subsidies
  • Soup kitchens and meal sites
• Tertiary prevention efforts


  Aimed at restoring and enhancing functioning