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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In this chapter, the author began working in international medical humanitarian aid, with an organization called Medecins Sans Frontieres/Doctors without Borders (MSF). Pediatrics and Pediatric Intensive Care are where the author’s nursing career had started. With assignments in the Democratic Republic of the Congo (DRC), Haiti, and South Sudan, the author have provided care for people who have been displaced due to conflict, victims of war trauma, women with high-risk pregnancies, malnourished and critically ill children, and people with HIV and tuberculosis, and responded to outbreaks of preventable illnesses such as measles and cholera. MSF opened the Sibut project, with a focus on providing care for young children and women of child-bearing age. The security system includes daily contact with all of the village leaders in Sibut, including the Catholic priests, the imams at the Muslim mosque, the village elders, and the militia leaders.
The author worked in a public health research lab, after graduation from college. She liked the flexibility of nursing and the promise to always have a job. She was fascinated by the intricacy of the mind-body intersection and how horribly wrong things could get with seemingly small perturbations. She felt that nursing school discouraged any consideration of a career in psychiatric nursing, as a mentor shared a comment by one of her advisors years ago that “only the bad nurses go into psychiatry”. A common occurrence was the admission of patients with psychiatric needs in addition to medical comorbidities. She cared for patients who had anxiety as a consequence of hospitalization, depression due to chronic illness, persons suffering from acute delirium, as well as someone with dementia secondary to HIV. Later she accepted a job at a local community health center that serves a predominance of Latino immigrants.
This chapter explains the seminal Institute of Medicine (IOM) report: The Future of Nursing (
FoN): Leading Change, Advancing Health and the background organizations that wrote it. It demonstrates some key recommendations of FoN: Leading Change, Advancing Health report and its “fit” with Indian Country. The chapter differentiates between challenges in obtaining nursing education in Indian Country and those in dominant culture settings. The IOM’s effort with the Robert Wood Johnson Foundation (RWJF) on the FoN has been noticed by many, yet direct care nurses are largely unaware of the report. The chapter outlines the FoN recommendations into two groups: gaining education, practicing to its fullest scope, and pushing for more, including lifelong learning; and shaping policy, being at the table as full partners in health care redesign, and leading change. For American Indian/Alaska Native (AI/AN) nurses graduating from tribal colleges and universities (TCU), the majority will have an associate’s degree.
Nurses have a key role in the identification, treatment, and control of the transmission of infection within the correctional setting. The prevalence of infectious disease among the incarcerated has great impact on the safety and security of correctional facilities and on the public health. Nursing interventions that prevent communicable diseases such as ectoparasites, Human Immunodeficiency Virus, Methicillin-Resistant Staphylococcus aureus (MRSA), Sexually Transmitted Infections (STIs) include screening, patient education and counseling, immunization, monitoring treatment compliance, and symptom management. Handwashing, or hand hygiene, is arguably the best overall workplace practice for preventing spread of infection. Isolation procedures are used to control transmission of disease when treating patients with known or suspected transmissible infections. Nursing procedures involved in prevention and control of communicable diseases include medication administration, monitoring inmate adherence to the treatment plan, education, counseling to reduce risk of disease transmission, collaboration with public health organizations, and discharge planning.
Reformed churches are predominantly Presbyterian in polity, where the congregation is governed by a group of elected elders who are lay persons and a minister. Regional groups of churches form a Presbytery, and groups of Presbyteries form Synods that together form the national General Assembly. The Reformed Tradition is monotheistic, affirming one God, in three persons. The persons of the Trinity are God the Father, God the Son, and God the Holy Spirit. Reformed Christians are called, always and everywhere, to a committed pursuit of social justice and human wholeness. Disease, illness, suffering, and death, and indeed natural disaster as well, are a consequence of humankind’s choosing to go its own way and to live. Theologically, death is a consequence of human willfulness or going our own way in disobedience to God. Reformed Christian religious terminology reflects, in large part that found in mainstream Protestant Christian traditions.
The provision of end-of-life care to inmates with terminal illnesses is one of the distinguishing features of correctional nursing. Both the American Correctional Association (ACA) and the National Commission on Correctional Health Care (NCCHC) have established accreditation standards for end-of-life care. Aspects of pain management that are emphasized or unique in palliative care are that the pain will get worse, it is managed aggressively, and side effects must be anticipated. An oral health assessment should be included in the admission and periodic nursing assessment of inmates who are receiving end-of-life care in an inpatient setting. The results of the oral health assessment are used to develop a plan to maintain oral hygiene. The American Association of Colleges of Nursing has established competencies for nursing care of patients at the end of life that include assisting patients with emotional and spiritual issues, including distress.
Faith community nurses (FCNs) need to carefully assess literacy levels of printed health education materials and prepare their own user-friendly instructional materials based on the literacy levels and ages of those they instruct. FCNs also should carefully plan where, when, and how best to conduct instructional programs for members of the faith community to achieve positive outcomes. The American Medical Association (AMA) Website has an entire section on health literacy and its implications for health and compliance with medical regimes. If health screening activities are part of a planned program, privacy for actual screening procedures is required. Decisions about instructional methods should be made based on variables such as how active or passive the learner will be and how much control the teacher wants to have during the learning experience. The instructional methods include lectures, group discussions, games, and electronic resources.