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Homelessness & Poverty.ppt
- 1. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 23
Homelessness, Poverty, Mental
Illness, and Teen Pregnancy
- 2. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 2
Introduction
Four groups of vulnerable populations—the poor, the
homeless, pregnant teens, and those who are
mentally ill—present complex nursing needs
Nurses must recognize their own beliefs about these
groups and understand the issues surrounding these
clients’ illness and/or personal situations
To interact effectively with these groups, the nurse
must identify health care needs, barriers to care, and
essential health care services for each client and, in
some instances, for the client’s family as well
- 3. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 3
Cultural Attitudes and Media
Communication as Factors
Cultural attitudes are the beliefs and perspectives
that a society values; perspectives about individual
responsibility for health and well-being are influenced
by prevailing cultural attitudes
The media communicate thoughts and attitudes
through newspapers, films, TV, art, and literature
To understand poverty, homelessness, mental
illness, and teen pregnancy, nurses must consider
their own personal beliefs and attitudes, clients’
perceptions of their condition, and the social, political,
cultural, and environmental factors that influence the
client’s situation
- 4. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 4
Defining and Understanding Poverty
Poverty and homelessness have significant
effects on health status
Definition of poverty varies depending on the
source
The federal government defines poverty on the
basis of income, family size, age of the head of
household, and number of children younger than
18 years
Those who are poor insist that poverty has less to
do with income and more to do with a lack of
family, friends, love, and support
- 5. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 5
Defining and Understanding Poverty
(cont’d)
Many complex, interrelated factors contribute to the
growing number of poor persons in the United States:
Decreased earnings
Increased unemployment rates
Changes in the labor force
Increase in female-headed households
Inadequate education and job skills
Inadequate antipoverty programs
Inadequate welfare benefits
Weak enforcement of child support statutes
Dwindling Social Security payments to children
Increased numbers of children born to single women
- 6. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 6
Poverty and Health:
Affects Across the Life Span
Higher rates of chronic illness
Higher infant morbidity and mortality
Shorter life expectancy
More complex health problems
More significant complications and physical
limitations resulting from chronic disease
Hospitalization rates three times that for
persons with higher incomes
- 7. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 7
Poverty and Health
Poor health outcomes are often secondary to
barriers that impede access to health care,
such as inability to pay for health care, lack of
insurance, geographical location, language,
inability to find a health care provider,
transportation difficulties, inconvenient clinic
hours, and negative attitudes of health care
providers toward poor clients
- 8. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 8
Effects of Poverty
Poverty has an especially negative effect on:
Women of childbearing age
Adolescent women
Children
Older adults
Both urban and rural communities
- 9. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 9
Concept of Homelessness
Difficult to know exactly how many people
are homeless; two common ways to
determine the number of homeless people:
1. Point-in-time-counts: counts the number of
people who are homeless on a given day or
during a given week
2. Period prevalence counts: counts the number of
people who are homeless over a given period of
time
Crisis poverty
Persistent poverty
- 10. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 10
Concept of Homelessness (cont’d)
Causes of homelessness
More people living in poverty
Fewer affordable housing units; gentrification of
neighborhoods and consequent increased costs
for housing
Loss of single-room occupancy buildings where
people can rent a room on a long-term basis
Emergency demands on income
Alcohol and drug addiction
Limited number of transitional treatment facilities
for deinstitutionalized mentally ill individuals;
important since a sizable number of homeless
people suffer from a significant mental illness
- 11. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 11
Concept of Homelessness (cont’d)
Effects of homelessness on health
Hypothermia and heat-related illnesses
Infestations and poor skin integrity
Peripheral vascular disease and hypertension
Diabetes and nutritional deficits
Respiratory infection and chronic obstructive
pulmonary diseases
Tuberculosis (TB)
HIV/AIDS
Trauma
Mental illness
Use and abuse of tobacco, alcohol, and illicit
drugs
- 12. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 12
Concept of Homelessness (cont’d)
Homelessness and at-risk populations
Pregnant women
Children
Adolescents
Older adults
- 13. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 13
Trends in Adolescent Sexual
Behavior and Pregnancy
The provision of reproductive health care services to
teens requires sensitivity to the special needs of this
age-group, including awareness of state laws about
confidentiality and services for birth control,
pregnancy, abortion, and adoption
Factors such as a history of sexual victimization,
family dysfunction, substance use, and failure to use
birth control can influence whether a young girl
becomes pregnant
The pregnant teen will need support during and after
pregnancy from her family and friends and from the
father of the baby
- 14. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 14
Trends in Adolescent Sexual
Behavior and Pregnancy (cont’d)
Background factors
Sexual activity, use of birth control, and peer
and partner pressure
Other factors
Young men and paternity
Early identification of the pregnant teen
Special issues in caring for the pregnant teen
- 15. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 15
Scope of Mental Illness in the U.S.
Prevalence rates for mental health problems are very
high, and people are at risk for threats to mental
health at all ages across the life span
Deinstitutionalization: moved many people from state
psychiatric hospitals to communities with the goal of
improving the quality of life for those persons;
however, community-based services were often not
in place and continuity of care became a problem
At-risk populations for mental illness
Low income and minority groups are often at increased risk
for mental illness because they may lack access to services
- 16. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 16
Levels of Prevention
Primary prevention
Affordable housing, housing subsidies, effective job-training
programs, employer incentives, preventive health care
services, multisystem case management, birth control
services, safe-sex education, needle-exchange programs,
parent education, and counseling programs
Secondary prevention
Reducing the prevalence of pathological nature of a
condition (supportive and emergency housing, soup
kitchens, screening for depression)
Tertiary prevention
Restore and enhance functioning (support of affordable
housing, promotion of psychosocial rehabilitation programs)
- 17. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 17
Role of the Nurse
Create a trusting environment
Show respect, compassion, and concern
Do not make assumptions
Coordinate a network of 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
Develop a network of support for yourself