1. Definition/description of population.
Vulnerable population are the group of people who are susceptible to develop chronic health conditions, including severe mental illness as a result of low income, lack of education and disparity to other physical and social elements. Stanhope & LanCaster defines vulnerability population group “as a subgroup of people that is more likely to develop health problems as a results of exposure to risk and and to have worse outcomes compares to rest of the population group” (2014, p. 346). Vulnerable populations include the economically disadvantaged, racial and ethnic minorities, the uninsured, low-income children, the elderly, the homeless, the abused and neglected children and elderly, the disabled adults, the pregnant teen, and those with human immunodeficiency virus (HIV), and other chronic health conditions, including severe mental illness. In the 2010 U.S. census African Americans are defined as “people having origins in any of the Black race groups of Africa” (Rastogi, Johnson, Hoeffel, & Drewery, 2011). Most African American descendants came from sub-Saharan African and Sahelean cultures. They were brought to the U.S. as slaves in the 1800s. In this era they were segregated from the rest of the population, stripped from their cultural background and prohibited from getting any type of education. They retained some culture through the use of storytelling, dance and music. Soul cuisine evolved through the years and the African American people learned to eat mostly cheap cuts of meat and foods with high fat concentration.
2. What are the most common causes of morbidity & mortality associated with the population to include prevalence and incidence?
This specific population has endured many hardship, however they have learned to escape from cultural oppression. The years of slavery caused many changes in the African American culture, from music, folklore, cuisine to dance and language. Even though, they were oppressed for so many years they were able to make an impact in how the United States is shaped today. The political movements to free black slaves was historical. Through those years many lives were destroyed because of racism and segregation. Today, African Americans can vote just like the rest of the population, furthermore African Americans hold a variety of government positions. In 2008, Barack Obama became the 44th president of the United States, making him the first African American president. Many environmental factors we see today such as their cuisine, language and religion evolve from the slavery years. Recently, we have seen more televised racism across the country. From, mass killing of African American congregation to college students chanting racial slurs. Unfortunately, this era has demonstrated that America is still a racist country. Many people see the African Americans as lazy, unemployed and uneducated. Reality is that blacks are often a statistic of some kind. They suffer from socioeconomic, health and education disparities in comparison to other races. Community health nurses should focus attention on closing these disparities and collaborating with other stakeholders to provide a change to minorities’ inequality. “Public health professionals such as community/public health nurses and social workers working in the community are in a key position to serve as advocates for change. This approach will promote cultural competent treatment for community members” (Kennedy, 2013). In the United States, heart disease is the leading cause of death among African Americans. African Americans in 2009 had the largest death rates from heart disease and stroke compared with other racial and ethnic populations (CDC, 2015). In addition, the American Heart Association reports that, among non-Hispanic blacks age 20 and older, 44.4% of men and 48.9% of women have cardiovascular disease (2013). African Americans are more prone to hypertension, stroke, diabetes and coronary artery disease.
3. Describe and analyze major factors contributing to the vulnerability of the population.
The African American population is vulnerable to many inequalities due to poor socioeconomic status, lifestyle, environmental factors and access to healthcare. African American children are often less likely to finish high school, have less employment opportunities and in return less income. This disparity can cause the population to receive inadequate healthcare and poor health outcomes. Lifestyle choices such as physical inactivity, smoking and poor eating habits can precipitate unhealthier lifestyle; making them more vulnerable to chronic diseases such as diabetes, hypertension, and cardiovascular disease. Environmental factors play a role in the type of opportunities they receive, including living conditions, access to healthy foods and safer streets to live an active lifestyle. Furthermore, they are less likely to have access to preventative measures such as glucose screening, blood pressure and cholesterol checks
4. What are the treatment options of each of the three levels (primary, secondary and tertiary) of prevention for this vulnerable group?
Treatment option for this group of people includes following;
There are many resources available for the African American population to help reduce their risk for cardiovascular disease. Community based programs such a blood pressure screenings and heart nutrition classes are available in hospitals. Mountain View offers these free classes for individuals in the community. Saint Rose Dominican also offers dietitian led education and counseling programs to prevent cardiovascular disease. In addition, Sam’s Club offers health screenings every month. Testing includes A1C, glucose, cholesterol, HDL, risk ratio, blood pressure and body fat percentage. Fitness programs are also available across the Las Vegas Valley.
5. What are the possible interventions for the improvement of the population’s health (use EBP!)?
To guide implementation programs, evidence based practice must be analyzed. According to Melvin et al., “evidence-based approaches, whether derived from research synthesis or practice-based evidence should be considered ?rst when looking at options for disseminating and implementing approaches to reduce identi?ed CVD risk, including interventions to improve access to care” (2013). To implement the evidence based intervention, It is important to join and advocate for nationwide campaigns such as the Million Hearts initiative. Statewide, advocating for more financial assistance to support these campaigns and help with providing access to healthcare for this African American population. Furthermore, providing services such as blood pressure and cholesterol screenings locally to increase awareness about the diease. Provide resources to families with higher risks, educate about healthier eating choices, and provide education about smoking cessation. Although costly, multiple randomized studies have yield positive results in regards to nurses assessing African Americans blood pressure at home (Brennan et al., 2010). Programs like this can help this population comply with blood pressure medications and adhere to recommended treatment. Furthermore, the Center for Disease Control and Prevention (2015) developed the algorithm ABCS of cardiovascular and stroke prevention. First, individuals at risk for these diseases should take aspirin as directed by their health care provider. “B” stands for controlling blood pressure, “C” managing cholesterol and “S” avoid smoking. The Agency for Healthcare Research and Quality (AHRQ), recommends people with hypertension should be advised to reduce their salt intake as much as possible to lower blood pressure, all people who smoke should be advised to stop and offered support to help facilitate this in order to minimize cardiovascular and general health risks and physical activity should include occupational and/or leisure time activity and incorporate accumulated bouts of moderate intensity activities such as brisk walking (2011).
6. Describe the population’s access and barriers to care and healthcare.
African Americans received worse care than whites for 41% of quality measures and 32% of access measures (Rastogi, Johnson, Hoeffel, & Drewery, 2011). Access to health care is often limited due to socioeconomic barriers. Some barriers include lack of transportation to doctor’s appointments, less likely to follow up with treatment, lack of resources to pay for copays and minimal adherence to treatment regimen. African American’s neighborhoods have a higher density of fast food restaurants and fewer supermarkets in return this racial segregation affects access to healthy food and poor eating habits (Noia, Furst, Park & Byrd-Bredbenner, 2013, p.226). In addition, studies have shown that African Americans are less likely to proactively choose preventative measures for chronic conditions. The Affordable Care Act has enable 1.7 million African American to obtain healthcare. Although, disparities among minorities still exist, these disparities have diminished due to nationwide government efforts to close the gap between minorities.
7. Describe the potential nursing role in the care of the population.
The nursing role for caring for this population would be primarily to educate about the risk factors, encourage health screenings, advice about healthy eating and active lifestyle, provide resources to counseling and education programs available in the community. As a community we have to be aware of disparities among minorities so we can tackle them and close the gap. Some examples of interventions to help this vulnerable population includes health care promotion and prevention and public health nursing. Ultimately, the goal for individuals and communities is to live healthy and long life.