NUR 513 Topic 3 DQ 1 Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity

NUR 513 Topic 3 DQ 1 Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity

NUR 513 Topic 3 DQ 1 Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity

NUR 513 Topic 3 DQ 1

Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity. Discuss the contribution of your particular specialty to health promotion and disease prevention for this population. How do issues of diversity and global perspectives of care contribute to your understanding of health equity as it relates to this population?

Re: Topic 3 DQ 1

As an informatics nurse, my target population would be pediatrics. Children have been deemed a vulnerable population in our healthcare system because they cannot consent on their own and must deal with circumstances beyond their control (economic, financial, access to healthcare, abuse, exploitation, etc.). Because of the factors mention, there is an increased health risk associated with the lack of pediatric research (Presidential Commission for the Study of Bioethical Issues, 2016).

Pediatric populations are understudied because of the legality of consent, the willingness to participate in research, and being able to have the cognitive ability to understand any perceived risk associated with the research. Health determinates and measures of health within a population are critical indicators of how healthcare needs to evolve in terms of preventative measures and education (DeNisco & Barker, 2016).

This makes the quantification of the effectiveness of preventative health measures, programs, and education necessary (DeNisco & Barker, 2016). An informatics nurse can play a significant role in quantifying data, the improvement of technologies, and the distribution of health services (AMIA, 2020).

In terms of diversity and the global perspective, the United States continues to experience population growth and increasing diversity due to immigration. I work in California and predominantly work with Hispanic/Latino, Asian, and Middle Eastern ethnic minorities. I’m sure we’ve all experienced how this can create barriers to access to health care and how we deliver nursing care. DeNisco and Barker point out that minorities who are low income and/or have language barriers often have less access to healthcare and have poorer health outcomes (2016, p.580).

Health disparities among minorities become an even bigger issue when dealing with the already vulnerable pediatric population. In terms of health equity, we have made strides with things like the Affordable Care Act to help eliminate some disparities, but unfortunately, we have a long way to go. Western medicine is very focused on the physician model of care, where everything is diagnosis-driven. However, as our nation evolves, it speaks to the greater need for cultural competence and sensitivity and caring for the patient as a whole, including cultural and spiritual needs, not just their diagnosis (Watson, 2008).

NUR 513 Topic 3 DQ 1 Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity References

American Medical Informatics Association (AMIA). (2020, April 14). Nursing informatics in the times of COVID-19: Achievements, challenges, and new ideas. AMIA COVID-19 Webinar series. https://www.amia.org/sites/default/files/AMIA-COVID19-Webinar-Series-NIWG-ANI-Clinical-Informatics-3.pdf

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Jones & Bartlett Learning.

Presidential Commission for the Study of Bioethical Issues. (2016). Vulnerable populations in safeguarding children: Pediatrics medical countermeasure research.https://bioethicsarchive.georgetown.edu/pcsbi/sites/default/files/6%20Vulnerable%20Populations%20Safeguarding%20Children%209.30.16.pdf

Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed). Boulder, CO: University Press of Colorado.

RESPOND HERE (150 WORDS, 2 REFERENCES)

This is insightful, Gina; nurse informatics play significant roles in the management of pediatric care. Given that children are vulnerable to diseases and different complications, there is always the need to rely on the previous data and information to initiate effective care (American Nurses Association, 2015). Additionally, given that children cannot provide consent to the treatment processes, there is always the need to help them deal with circumstances beyond their control.

Children often need quality care, and this calls for specialized interventions coupled with research and evidence-based practices. Therefore, informatics nurses, with their high-level technical roles, are able to use data and technology to monitor, the program carefully, and develop effective patient care initiatives to enhance treatment and general care for the patients (Grover, Sharma, & Mehra, 2020).

Pediatric studies are critical, especially when it comes to the enhancement of primary care. However, in reality, pediatric populations are understudied due to the legality of consent and lack of cognitive abilities to understand any form of perceived risk associated with the research processes.

NUR 513 Topic 3 DQ 1 Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity References

American Nurses Association. (2015). Nursing informatics: Scope and standards of practice. Retrieved from: http://mtshohoe.edu.gh/library/index.php?p=show_detail&id=855&keywords=

Grover, S., Sharma, N., & Mehra, A. (2020). Stigma for Mental Disorders among Nursing Staff in a Tertiary Care Hospital. Journal of neurosciences in rural practice, 11(2), 237–244. https://doi.org/10.1055/s-0040-1702916

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Re: Topic 3 DQ 1

The population that is vulnerable to issues of health disparities that I would like to focus on is patients with mental health disabilities. As an advanced registered nurse focusing on health care quality and patient safety, it is my duty to address mental issues related to safety in the same degree as physical ailments. There are a lot of patients with mental illness that do not seek medical care because of fear of rejection. Among the various factors, which influence help seeking, stigma, discrimination, social prejudice, and negligence are considered to be important factors which prevent mental health care and treatment (Grover, et al., 2020).

In order to address the health promotion and disease prevention for this population, it is important to first eradicate the stigma towards them. Stigma toward mentally ill people not only originates in general public but also among health care professionals (Grover, et al., 2020). An example is when we had a homeless patient come in the hospital frequently asking for anxiolytics to help calm down. Some staff thought of this person as “drug-seeking”, but in reality, he suffered from anxiety disorder and PTSD from a prior traumatic experience.

This is a common misconception among psychiatric patients. In order to prevent worsening of symptoms, he should receive the appropriate care that he deserves. Incorporating quality of service such as medical screening evaluation performed by a qualified provider, educating him about his medical problems and prescribing medications appropriate for his symptoms and diagnosis are forms of health promotion. Prevention in this case includes suicide risk screening and providing resources for support groups.

Health equity should be globally addressed because every human deserves quality care and treatment. Though there may be diversities in socio-economic status, cultural background, religion, and ethnicity, there should be no room for inequity. It is every one’s fundamental right to achieve health and wellness. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care (Braveman, et al., 2017).

NUR 513 Topic 3 DQ 1 Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity References

Braveman, P. (2017). What is health equity? Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html

Grover, S., Sharma, N., & Mehra, A. (2020). Stigma for Mental Disorders among Nursing Staff in a Tertiary Care Hospital. Journal of neurosciences in rural practice, 11(2), 237–244. https://doi.org/10.1055/s-0040-1702916

RESPOND  HERE (150 WORDS, 2 REFERENCES)

This is insightful, Maria; there are increased cases of mental illnesses in the healthcare systems. In the United States, one in five adults suffers from mental health problems; in other words, over 43.8 million people are diagnosed with mental health problems every year (Hai et al., 2020). There are also serious cases of mental health problems where one in twenty-five people are affected in a given single year.

Also, there are many patients with mental illness who do not seek medical care because of fear of rejection. Advanced registered nurses, with their research skills, are able to undertake evidence-based practice processes to identify the best strategies that can be employed to enhance the management of patients suffering from mental health problems. Also, advanced registered nurses have the capability of reducing the stigma associated with mental health problems. Stigma toward mentally ill people not only originates in the general public but also among health care professionals (Shim & Compton, 2018).

NUR 513 Topic 3 DQ 1 Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity

NUR 513 Topic 3 DQ 1 Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity References

Hai, A. H., Lee, C. S., Oh, S., Vaughn, M. G., Piñeros-Leaño, M., Delva, J., & Salas-Wright, C. P. (2020). Trends and correlates of Internet support group participation for mental health problems in the United States, 2004–2018. Journal of psychiatric research, 132, 136-143. Retrieved from: https://www.sciencedirect.com/science/article/abs/pii/S0022395620310153

Shim, R. S., & Compton, M. T. (2018). Addressing the social determinants of mental health: If not now, when? If not us, who?. Psychiatric Services, 69(8), 844-846. Retrieved from: https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201800060

Re: Topic 3 DQ 1

The United States’ current focus in healthcare continues to be the curative model; one focused on disease treatment and cure of illness. This tends to be a physician-taught acute care approach to addressing the health of humans. Adjusting the perspective, the holistic model provides a balanced approach to considering the mental, social, spiritual health of a person in addition to the physical health.

Naturally, this leads the holistic practitioner to include preventative and maintenance care to the individual in addition to the curative portion of healthcare (Barker and DeNisco, 2016). One population that suffers tremendously from the curative approach is the uninsured population, which ranges from older adults to adolescents and newborns.

Due to the scarcity of health insurance as it relates to one’s ability to spend money on this economic “good”, the uninsured populations of our nation do not always have access to the best medical treatment, be it preventative, curative or maintenance (Barker and DeNisco, 2016). This vulnerable population in the acute care arena is certainly worthy of much deep consideration and thoughtful, strategic planning to ensure access to health care services when the inequalities of the uninsured sometimes feel insurmountable.

For the advanced practice registered nurse (APRN) who is a nurse administrator in the acute care arena, the uninsured patient population is a common customer in the hospital. With chronic conditions such as diabetes, heart failure and renal disease on the rise, and in turn, claiming the prize as the leading causes of death in the United States, nurse administrators are called to action now more than ever in effort to advocate and provide equitable care for these populations whilst maintaining a successful business model for the hospital to remain open and available to the public (Barker and DeNisco, 2016).

To successfully promote health and wellness as well as disease prevention to the uninsured, the nurse administrator must not only address the acute needs of patients entering their facility, but plan for preventing these sometimes acute-on-chronic conditions prior to their arrival.

According to the Office of Disease Prevention and Health Promotion (ODPHP), uninsured populations vary in age, race, and socioeconomic status. Still, this vulnerable population is more likely to make repeated visits to the emergency department, die prematurely, and have overall poor health status (2021). The nurse leader’s role is to advocate for medical provider accessibility for this population by ways of collaboration with policymakers, preventative services, and emergency medical services.

Though access to care is often rooted in deeper disparities such as residential location, the nurse administrator may advocate for an innovation like telehealth visits, with hopes to remove barriers preventing quality care from being provided (ODPHP, 2021).

Issues of diversity and global perspectives of care contribute to my understanding of health equity as it relates to the uninsured population in many ways. First, the concept of social justice on an international level views access to all areas of healthcare as a social resource that is a right to all humans. This includes a social approach to addressing the skyrocketing costs of medical care, using public health problem-solving measures to combat widespread chronic health conditions, and at its core, a collective agreement to work toward the greater good of our society (Barker and DeNisco, 2016).

Moving a step forward, emphasis on curative treatment and inpatient care does not impact total community health in a significant way, and therefore, a collaborative approach that involves all stakeholders – inpatient leaders, community health leaders, public policymakers, local leadership, and federal leadership – to come to the table repeatedly to discuss and execute the most meaningful way to improve the community’s quality of life, improve overall health and remain responsible stewards of fiscal resources (Barker and DeNisco, 2016).

NUR 513 Topic 3 DQ 1 Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity REFERENCES

DeNisco, S. M. & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 978-1284072570

Office of Disease Prevention and Health Promotion (2021). Access to health services. https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

RESPOND  HERE (150 W0RDS, 2 REFERENCES)

This is insightful, Kristi; the uninsured population often has difficulties in accessing quality medical services. In most cases, they have to pay more for the services being delivered to them. Health insurance is essential as it gives an individual opportunity to plan for their treatment plans. In the United States, most uninsured populations have atleast one worker in their families. Also, families with low incomes are most likely to be uninsured (Van Der Steen et al., 2015). Given that medical plans do not favor other populations, it is always necessary to develop new strategies on how to ensure that different populations are covered in the insurance plans.

Advanced registered nurses, with their advanced skills and knowledge in healthcare processes, are able to determine the best strategies on how to manage the population of uninsured patients. The uninsured populations vary in age, race, and socioeconomic status (Wouk et al., 2020). Still, this vulnerable population is more likely to make repeated visits to the emergency department, die prematurely, and have overall poor health status.

NUR 513 Topic 3 DQ 1 Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity References

Van Der Steen, A., Knudsen, A. B., Van Hees, F., Walter, G. P., Berger, F. G., Daguise, V. G., … & Lansdorp‐Vogelaar, I. (2015). Optimal Colorectal Cancer Screening in States’ Low‐Income, Uninsured Populations—The Case of South Carolina. Health services research, 50(3), 768-789. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.12246

Wouk, K., Morgan, I., Johnson, J., Tucker, C., Carlson, R., Berry, D. C., & Stuebe, A. M. (2020). A Systematic Review of Patient-, Provider-, and Health System-Level Predictors of Postpartum Health Care Use by People of Color and Low-Income and/or Uninsured Populations in the United States. Journal of Women’s Health. Retrieved from: https://www.liebertpub.com/doi/abs/10.1089/jwh.2020.8738

Beginning a new journey to obtain your MSN is exciting! Yet, it can be stressful and at times overwhelming. This week I invite you to reflect on Bible verses and their application to your journey towards your MSN degree. I hope that this allows you to reflect a little and find peace and joy as you continue through this first class. The following activity is not required, but substantial responses will count towards participation.

Review the following two Bible verses. Please apply at least one of these to your personal process of beginning your education journey and/or your role as an advanced professional nurse. If these two verses do not relate to you please feel free to share one that does and describe how it has impacted you.

Isaiah 28: 9-10 “Whom shall he teach knowledge? ……For precept must be upon precept, precept upon precept; line upon line, line upon line; here a little and there a little”

Matthew 7: 7 “Ask, and it shall be given you; seek and ye shall find; knock, and it shall be opened to you”

I look forward to reading your responses.

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You have a great response and input role as an APRN. As an Advanced Practice Nurse, I will strive to impact health promotion and disease prevention in racial and ethnic minorities, especially from rural areas in the community. I will work towards addressing cultural differences between patients and healthcare providers that can result in holistic care to diagnose and treat patients while improving the patient’s compliance.

Holistic care includes treating patients’ physical, mental, and cultural or ethnic parts of their health (cultural sensitivity) through awareness of patients’ differences that exist without assigning value to them (Tucker et al., 2019).

REPLY

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Matthew 7: 7 “Ask, and it shall be given you; seek and ye shall find; knock, and it shall be opened to you”

I love this Bible verse as it gives me strength and courage in my day-to-day life. This Bible verse always reminds me to continue trying to reach my goal. As it says prayer is a continuous process, it is not like you stop praying once you get your answer. This Bible verse related to my life because when I had obstacles immigrating to this country I never gave up, I seek and tried to pass those obstacles.

I failed many times, and I already knew this Bible verse. So, it gave me strength and courage and I believed that God would help me to reach my goal. God always sees our challenging work and struggles but it is not necessary to get the answer right away if you wait and try increasingly, you will find the way. Thank You.

REPLY

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My choice to return to school and pursue my Master’s degree was prompted by my desire to do more for the health and healing of people of all ages. While I know that I have an impact on patients’ lives in my current role as a bedside nurse, I feel a responsibility to do more and contribute to improving our health care system as a whole.

I take motivation from Phillipians 2:4, “Do not merely look out for your own personal interests, but also for the interests of others”. This verse motivates me in the same way as a quote by Roman philosopher Marcus Tullius Cicero, “Not unto ourselves alone are we born”. With this motivation in mind, I believe that I will persist in my endeavor to complete this program and balance it with my work schedule in order to meet my responsibility to others.

REPLY

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Philippians 4: 13 I can do all things through him who strengthens me.

This is one of my favorite verse from the Bible and I find my self reciting it daily in my head and out loud at times for it gave me confidence and assurance that everything will be ok no matter what the situation is. Coming to America with no family or close relatives to rely on was full of heartache and disappointment . Had to fend for myself as best as I possible could. Eventually with many nights of prayers I got settled and went back to school to peruse a new career path in nursing.

Working full time, going to school and balancing a family with three small children was no easy task with much trials and tribulations i graduated from nursing school. Soon after graduation i began working in the emergency room as a brand new nurse it was very challenging however i was able to over come all obstacles just by believing I can do all things through him who strengthens me.

Topic 3 DQ 1: Vulnerable Populations 

Advanced registered nurses serve many populations with varying needs. As professionally obliged, advanced registered nurses should explore different populations’ health and social needs and ensure they are adequately addressed. Vulnerable populations are unique since they are more susceptible to health disparities/inequities. Their healthcare issues and challenges experienced when seeking care are usually exacerbated by social factors.

Among many vulnerable populations, I am likely to serve the LGBTQ+ in routine care. Casey et al. (2019) found that approximately one in six LGBTQ adults avoid seeking health care services due to anticipated discrimination. The anticipation stems from the challenges they face due to their sexual orientation, including violence, sexual harassment, and slurs. There is also a lack of adequate resources and health professionals that specifically deal with the health care needs of sexual minorities. 

The routine role of an acute care nurse practitioner involves providing care for patients with aggravated chronic conditions or sudden illnesses and injuries. The fear of seeking medical assistance at the right time and the lack of adequate illness prevention programs targeting LGBTQ+ increase the risk of chronic conditions and intensify their severity (Kates et al., 2018). Such illnesses include obesity and cardiovascular disease.

Stigmatization also increases depression rates and susceptibility to substance abuse. As a result, acute care nurse practitioners must understand the barriers to care and implement evidence-based strategies and support to enhance healing and prevent disease progression to unmanageable states. They also need to design appropriate follow-up plans to promote adherence to medication and medical advice. 

Diversity issues and global perspectives of care contribute significantly to my understanding of health equity as it relates to LGBTQ+. In agreement with Sklar (2018), nurse practitioners must understand that health equity is not primarily achieved by treating illnesses. It is beyond and encompasses adopting interventions that address physical and social environments shaping health behavior. From a global perspective, LGBTQ+ is a unique population whose diversity should be respected. At all levels, nurses should adopt health prevention and treatment plans that promote respect, dignity, and equality without any regard for a patient’s sexual orientation. 

NUR 513 Topic 3 DQ 1 Identify a population that you will likely serve as an advanced registered nurse that you think is particularly vulnerable to issues of health disparities/inequity References 

Casey, L. S., Reisner, S. L., Findling, M. G., Blendon, R. J., Benson, J. M., Sayde, J. M., & Miller, C. (2019). Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Services Research, 54, 1454-1466. https://doi.org/10.1111/1475-6773.13229 

Kates, J., Ranji, U., Beamesderfer, A., Salganicoff, A., & Dawson, L. (2018). Heath and access to care and coverage for lesbian, gay, bisexual, and transgender (LGBT) individuals in the U.S. KFF. https://www.kff.org/report-section/health-and-access-to-care-and-coverage-lgbt-individuals-in-the-us-health-challenges/ 

Sklar, D. P. (2018). Disparities, health inequities, and vulnerable populations: Will academic medicine meet the challenge?. Academic Medicine, 93(1), 1-3. doi: 10.1097/ACM.0000000000002010 

I am currently employed as a Registered Nurse specializing in wound care for home health and hospice services. In this role, I have the privilege of serving a diverse community of individuals. The growing issue of population aging has resulted in an increase in the number of patients suffering from chronic diseases, placing a significant strain on public medical resources. To address this challenge, home care services have emerged as a viable solution, allowing patients to receive specialized nursing care in the comfort of their own homes. As a result, home care services have gained momentum and are increasingly being implemented and advocated for patients with chronic wounds.

According to Medicare, there are approximately 8.2 million individuals in need of wound care. This is primarily due to the rising prevalence of chronic diseases such as heart disease, which can lead to peripheral vascular disease, as well as diabetes, which often requires wound care for foot ulcers. These chronic wounds can create financial barriers to receiving care, such as transportation to doctor’s appointments. This is where home health advanced practitioners play a crucial role, as they are able to provide wound care services directly in the patient’s home, as they are able to provide wound debridement in the home versus the hospital and clinic promoting advance wound healing in the home.

During my visits with patients, I not only provide wound care but also focus on building relationships with them. I approach my work with compassion and strive to establish trust, which allows me the opportunity to educate patients throughout the treatment process. This includes educating them on disease processes and necessary lifestyle changes to prevent further progression of wounds and chronic diseases. Additionally, I address concerns and provide face-to-face guidance to patients and their families regarding nutrition for wound healing and preventive care, particularly for my diabetic patients.

I strongly believe that the work I am engaged in aligns with the Christian worldview, as it involves reaching out to those in need and less fortunate, just as Jesus would have done. The majority of home health patients I serve are low-income individuals residing in rural areas, who often lack access to doctors and transportation.

References 

CMO, J. M. (2021, March 29). Certified Wound Care Nurses needed for In-Home care. Vohra Wound Care. https://cert.vohrawoundcare.com/certified-wound-care-nurses-needed-for-in-home-care/

Luo, H., Sun, Y., Ge, Y., & Ruan, S. (2023). Prospects for the application of home care in chronic wound management. Journal of Family Medicine and Primary Care, 12(3), 422. https://doi.org/10.4103/jfmpc.jfmpc_1896_22