This chapter focuses on women, who are HIV positive, from a global perspective. It illustrates more easily what makes groups of people, and in this case women, vulnerable and then consider vulnerability from a global health (GH) perspective using the chronic illness, HIV. The chapter presents some examples of situations that make women vulnerable to HIV and, once infected, vulnerable for life, and use a case-based approach to highlight women as a vulnerable population. It also focuses on the real ethical issues that occurred with each case, which one anticipate will help prepare the new GH nurse for practice in the global environment. The chapter demonstrates by using an exemplar of HIV-positive women, vulnerable populations exist both within and outside the United States. Reasons for vulnerability may include stigma, victimization, mental illness, migration, limited access to needed health care or food, or substance use.
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Healthy body image is critical to adolescent development, and teens often diet and worry about their weight and appearance. However, for some youth these concerns become fixed and distorted, resulting in psychopathology. Eating disorders, particularly binge-eating disorder, anorexia nervosa, and bulimia nervosa, are serious, complex chronic disorders, which can be life-threatening. Differential diagnoses for eating disorders include: cardiac valvular disease, malabsorption syndromes; inflammatory bowel disease; chronic infections; thyroid disease; hypopituitarism, Addison disease; central nervous system lesions; cancer; and other psychiatric disorders including depression, obsessive-compulsive disorder, anxiety, and substance abuse. Eating disorders are difficult to treat, especially when presenting with comorbid diagnoses, and treatment depends on the severity of the illness. Primary health care providers play a critical role in assessment, monitoring of treatment progress, screening for and managing medical complications, and coordinating care with psychiatric and nutritional professionals.
The initial recognition of the need for a genetics referral may arise when a nurse suspects a genetic contribution to disease because of personal or family medical history and/or findings from a physical assessment. Family history is a valuable and cost-effective tool that is often underutilized in clinical practice. Many common genetic conditions result from complex interactions between genetic and environmental factors. It is critical to collect information about potential environmental exposures to help inform a patient’s risk assessment. Health care professionals should become familiar about toxic environmental agents that are common in their specific geographic location. A growing number of Food and Drug Administration (FDA) approved drugs have labeling that includes pharmacogenomic information, which can be used to optimize drug dosage and prevent adverse and life-threatening drug reactions in a patient or family member.
Nursing practice is a symbiotic relationship between the art and science of professional care. One cannot exist in isolation from the other. Nurses are inclined to connect the art of nursing with terms such as compassion, caring attitudes, the therapeutic relationship, presence, professionalism, advocacy, and competence, otherwise known as the “soft or caring side of nursing”. The greatest threat to the disappearance of the art of nursing lies with the perceived “big three”: time, fiscal restraint, and failure of the system to support a full staff of nurses, so those employed are working at full capacity. It is important to recognize that different practice settings have varying needs. One size does not fit all. Yet the requirements for nursing assessments, developing a plan of care, coordinating care with other health care providers, implementing interventions, and evaluating care outcomes are a requirement of all.
This chapter focuses on office automation and systems that are useful in the mental health field, along with principles to be aware of when considering the use or purchase of such systems. Most managers have to rely on input from outside in order to form an opinion about how to resolve complex issues. The complexity of the issue increases significantly when the current federal health care laws are incorporated into the task of choosing appropriate clinical information management software. The significance of Health Insurance Portability and Accountability Act (HIPAA) would seem to dictate at least a brief foray into its content because it lays the foundation for virtually everything that is happening in the clinical information management (CIM) realm. The information provided in the chapter can give a backdrop by which current practices can be examined for goodness of fit with the available client information management systems.
The 19130 Zip Code Project at the Community College of Philadelphia (CCP) started as a curriculum innovation: the CCP Department of Nursing’s response to the national shift toward community-based health care. The project resulted in the refocusing of the nursing curriculum and the development of partnerships with CCP’s neighbors in the 19130 zip code. It also is an excellent example of a nurse-managed wellness center without walls. The Zip Code Project has put down deep roots in the neighborhood and in the nursing curriculum. It has produced a community-based model for educating local health professionals and a service-learning model for enhancing health service delivery by local agencies. The faculty arranged community-based clinical experiences for nursing students in the neighborhood surrounding CCP. Although CCP sits in the middle of the zip code, faculty knew little about community-based health care services in the community.
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Recommendations for Practitioners for Providing Competent Care to Gender and Sexual Minority Individuals
Research on the health and health care needs of gender and sexual minority (GSM) people is burgeoning, in part due to increased awareness of the importance of identifying the health care needs of these long-neglected populations. This increase in knowledge related to GSM health is a critical part of improving the quality of GSM people’s health and health care. This chapter considers how practitioners might integrate existing knowledge about GSM health into their clinical work to establish an affirmative context for GSM patients. More contemporary approaches take a more process-oriented view, focused on the appreciation of cultural differences at personal, professional, organizational, and societal levels. These approaches place greater emphasis on training clinicians to think critically about how patients’ cultural backgrounds and identities impact their life experiences. The authors draw on these approaches to provide practical recommendations for providers to deliver competent care to GSM individuals.
Certification and accreditation offer assurances to the public that an individual or institution provides accurate and reliable simulation instruction and evaluation. Achieving certification suggests that the individual is able to perform at a predetermined level of expertise, in order to provide simulation experiences or services in a consistent and accurate manner within the scope of simulation knowledge and competencies. The determination to obtain new knowledge may be daunting. Understanding the myriad options available to novice simulation users is important. Clarifying the differences among certification, fellowship, and certificate of attendance especially aids understanding. The process of certification sets rigorous and high standards for planning, implementing, and evaluating simulation experiences. Knowledge of the key aspects of simulation is essential for the certification of health care simulation professionals. Participant reflection enhances clinical judgment as part of the learning experience and is facilitated during the debriefing exercises that follow an instructional simulation.
Pediatric primary care providers (P-PCPs) are involved in the primary care of children and adolescents with developmental and behavioral issues. The purpose of ongoing developmental behavioral screening in a primary care medical home is to identify problems early. These early interventions improve the long-term outcomes for children and adolescents. This chapter focuses on some of the more common neurological and psychiatric disorders that are encountered by children and adolescents in the primary care medical home setting and the ways in which the P-PCP can better identify a mental health disorder as early as possible through screening and intercept the problem with evidence-based interventions to promote better behavioral health outcomes. However, even with early intervention, some of the mental health disorders are chronic, long-term disorders requiring lifelong attention and treatment. It covers bipolar I disorder, depressive disorder, conduct disorder, obsessive-compulsive disorder, schizophrenia, and trauma- and stressor-related disorders.
This chapter helps the reader to plan a health program in a faith community. The types and scope of health education programs depend upon the resources of the faith community. Types of programs include health screening, health monitoring, health education, health fairs, guest speakers, and support groups. Blood pressure screening and monitoring programs are often provided to faith communities by their nurses. Faith community assessment data provide direction for planning the content of health promotion and disease prevention programs. Screening and monitoring program reviews the faith community assessment data to determine risk for hypertension and the numbers of members who identify themselves as hypertensive. Health fairs are events that bring people and health professionals together to provide health education, screening, counseling and referral. The faith community nurse (FCN) should be responsible for choosing the theme of the health fair and for compiling a list of potential participating agencies and organizations.