Week 3– caring for a vulnerable population
Reply to two classmates. In the initial post, everyone discussed both strengths and weaknesses inherent to a specific vulnerable population. What steps would you recommend to ensure that your peer’s vulnerable group is ethically protected throughout the research as well as the participation element of a community-based participatory research project; that is, shelter services, food banks, case management, support groups, etc.? When replying to your peers, think about the ethical considerations related to research or working with a vulnerable population. Although the vulnerable share characteristics making them susceptible to health concerns, they remain unique.
REPLY TO CLASSMATES DISCUSSION POST BY SABRINA
The purpose of this post is to discuss a proposed Community-Based Participatory Research health promotion project with the combat veteran population of Western North Carolina. There are many factors that indicate combat veterans may be at risk for cardiovascular health. One predisposing factor is that veterans are more likely to be smokers than the general population (Centers for Disease Control and Prevention, 2018). According to the Department of Veterans Affairs (2016) only 32% of its enrolled population reports never smoking, while in the U.S. general population 57% report never smoking. One interesting finding discovered by Nieh et al (2020) is that veterans were more at risk to smoke while transitioning out of the military. Smoking places all individuals at higher risk of cardiovascular disease or event. But it is not just smoking that puts veterans in a higher risk category.
Post-traumatic stress disorder (PTSD), is a psychological diagnosis describing the long lasting effects that severe stress can place on the body and mind (U.S. Department of Veterans Affairs, n.d.). Combat veterans experience PTSD in higher percentages than the general population, although different wars and conflicts are associated with different percentages of those who suffer from PTSD (U.S. Department of Veterans Affairs). Studies have shown that veterans who have PTSD are more likely to suffer from coronary heart disease CHD, as evidenced by myocardial infarctions and abnormal electrocardiograph results (Roy et al., 2015). It is thought that hyperarousal, a cardinal sign of PTSD, contributes to nervous system effects that eventually have negative effects on cardiovascular health (Roy et al). Roy et al. conducted a study which found that veterans suffering from PTSD were at 50% higher risk for developing heart failure than veterans who did not have PTSD. While these two characteristics, smoking and occurrence of PTSD are high in the population of combat veterans, this population is also at risk from other factors similar to U.S. general population. The Journal of the American College of Cardiology provides guidelines to heart disease prevention including recommendations to exercise at moderate intensity at least 150 minutes weekly, control cholesterol with lifestyle and/or medication, and eat a diet rich in vegetables, fruits, whole grains and low in red meat (2019).
Given the above partial review of health problems that the vulnerable population of combat veterans are at risk for, I have decided to work with a Veterans Service Organization (VSO) to create a heart health wellness support group. VSO’s, like Veterans of Foreign Wars (VFW) and The American Legion, are groups created to by and for veterans to provide support, assistance and advocacy. Working with a VSO to create and disseminate this wellness support group will help connect with community in their own environment. According to Pender, Murdaugh, & Parsons (2015), “a community analysis performed with the community, and not on or for the community, increases the likelihood of success” (p. 98). The plan, therefore, is to meet with VSO administrators, leaders, and members to create a plan for this wellness support group devised to encourage heart health.
While combat veterans are at risk for cardiovascular disease, they also possess health assets which will support their success in becoming more heart health aware. One asset is the existence of the VSOs, organizations designed to support and advocate for veterans. The Veterans Affairs medical centers, where veterans can usually attain primary care services even if they do not have insurance are another health asset. It is worth noting, however, that a dishonorable discharge can limit a veteran’s ability to attain VA benefits like health care (Moulta-Ali & Panangala, 2015). Veterans also can often benefit from a team approach to health care changes. According to Ulrich & Freer (2020), service members are trained to “prioritize the team over the individual, push through adversity, value the importance of service to others, and endorse the belief that others’ distress should be prioritized over one’s own” (p. 907). Veterans are known to bond in groups over their shared experience of serving in the military (Perlman et al, 2010). These characteristics would seem to contribute to a strong potential for a Wellness support group to benefit combat veteran members.
The creation of a wellness support group for a veteran population is not a novel idea. In 2010, Perlman et al. devised a Wellness Program for veterans who had psychiatric conditions in addition to other chronic illness. This program demonstrated improvement for the majority, as evidenced by the SF-36 Health Survey among other metrics. Participants reported their subjective global wellness on a 10-point scale at each session and this improved on average over the course of the program. In fact, half of the participants decided to repeat portions of the program, and reported benefits from those repetitions (Perlman et al.). Using this program as a template while working with community members to individualize the program for the combat veteran population, this community based participatory research health promotion project would provide a starting point to effect health changes in this vulnerable population.
Centers for Disease Control and Prevention. (2018). Tobacco product use among military veterans: United States, 2010–2015. Morbidity and Mortality Weekly Report, 67, 7-12.
Department of Veterans Affairs. (2016, January 12). Tobacco use in VA. https://www.publichealth.va.gov/smoking/professionals/tobacco-use.asp
Nieh, C., Powell, T. M., Gackstetter, G. D., & Hooper, T. I. (2020). Smoking among US Service members following transition from military to veteran status. Health Promotion Practice, 21(1, Suppl), 165S–175S. https://doi.org/10.1177/1524839919881478
Journal of the American College of Cardiology. (2019). Primary prevention of CVD guideline hub. https://www.onlinejacc.org/guidelines/prevention.
Moulta-Ali, U. & Panangala, S.V. (2015). Veterans’ benefits: the impact of military discharges on basic eligibility. Congressional Research Service. https://fas.org/sgp/crs/misc/R43928.pdf
Pender, N., Murdaugh, C., Parsons, M.A. (2015). Health Promotion in Nursing Practice.(7th Ed.). Pearson Education, Inc.
Perlman, L. M., Cohen, J. L., Altiere, M. J., Brennan, J. A., Brown, S. R., Mainka, J. B., & Diroff, C. R. (2010). A multidimensional wellness group therapy program for veterans with comorbid psychiatric and medical conditions. Professional Psychology: Research & Practice, 41(2), 120–127. https://doi.org/10.1037/a0018800
Roy, S. S., Foraker, R. E., Girton, R. A., & Mansfield, A. J. (2015). Posttraumatic stress disorder and incident heart failure among a community-based sample of US veterans. American Journal of Public Health, 105(4), 757–763. https://doi.org/10.2105/AJPH.2014.302342
Ulrich, S., & Freer, B. D. (2020). From the military to college and beyond: Growing a culturally sensitive program to support veteran success. Journal of Clinical Psychology, 76(5), 905.
U.S. Department of Veterans Affairs. (n.d.). PTSD: National Center for PTSD. https://www.ptsd.va.gov/understand/common/common_veterans.asp
SECOND CLASSMATE POST ALANA
The purpose of this initial post is to consider the pros and cons of implementing a community-based participatory research (CBPR) health promotion project with the identified vulnerable group of pregnant women in the United States. American pregnant women described facing health disparities and inequities, such as maltreatment and neglect by their healthcare providers, during routine prenatal care visits and childbirth (Vedam et al., 2019). Pregnant minorities reported even higher rates of abuse, such as being yelled at, ignored, physically violated, or having their privacy disregarded (Vedam et al., 2019). Negative experiences with healthcare providers created mistrust and decreased the likelihood that pregnant women would engage in early prenatal care (Nypaver & Shambley-Ebron, 2016). As a result of such inequalities in healthcare, the United States ranked high amongst developed nations for infant mortality (Nypaver & Shambley-Ebron, 2016). Moreover, the rate of infant mortality nearly doubled if the patient was a minority (Nypaver & Shambley-Ebron, 2016).
Pender et al. (2015) described CBPR as a methodology whereby the examiner investigated inequalities and tactics to overcome them while simultaneously empowering the vulnerable community. The authors recommended utilizing a community-based approach to encourage commitment to collective transformations that extended beyond the individual level (Pender et al., 2015). Investigators found that pregnant women could take on an active role in health promotion by participating in CBPR projects using the photovoice method (Nypaver & Shambley-Ebron, 2016). The photovoice method entailed recruiting patients as photographers with an overarching theme related to specific health promotion goals (Nypaver & Shambley-Ebron, 2016). In this case, the subject would be the importance of prenatal care, especially early prenatal care (Nypaver & Shambley-Ebron, 2016).
Researchers identified engagement in prenatal care before the twelfth week of pregnancy as one modifiable risk factor that reduced rates of preterm labor, low-birth-weight infants, and infant death (Nypaver & Shambley-Ebron, 2016). Participating in the project would benefit vulnerable patients by promoting a shared knowledge of the barriers to accessing early prenatal care so that the community could partner with healthcare providers to plan targeted interventions (Nypaver & Shambley-Ebron, 2016). Taking an active role by capturing pictures of their experiences and community reinforcements or obstacles enabled participants to feel more connected to other women in their community (Nypaver & Shambley-Ebron, 2016). Furthermore, participation encouraged many of the participants to explore mentorship roles within their community (Nypaver & Shambley-Ebron, 2016). Following a review of the pictures captured, researchers worked with participants on goals, which included building confidence in the young women of the community (Nypaver & Shambley-Ebron, 2016). However, the disparities and inequities identified by participants could hinder the project’s success by calling attention to abuse and enhancing fear of mistreatment, which researchers found decreased care-seeking behaviors (Vedam et al., 2019).
In summary, the anticipated results would be to improve the health assets the community already had, to build on health-related views of the vulnerable people, and to decrease health behaviors that put the people in danger of unintended health consequences (Pender et al., 2015). In this example project, these goals were met through a photographic examination of barriers to care, which aided the community in developing plans that encouraged access to early prenatal care (Nypaver & Shambley-Ebron, 2016). Changes to accessing prenatal care would improve the quality of life and outcomes for both patients and their newborns by reducing rates of preterm birth, low-birth-weight babies, and the rate of infant mortality (Nypaver & Shambley-Ebron, 2016).
Nypaver, C. F., & Shambley-Ebron, D. (2016). Using community-based participatory research to investigate meaningful prenatal care among African American women. Journal of Transcultural Nursing, 27(6), 558–566. https://doi.org/10.1177/1043659615587587
Pender, N., Murdaugh, C., Parsons, M.A. (2015). Health promotion in nursing practice.(7th Ed.). Pearson Education, Inc.
Vedam, S., Stoll, K., Taiwo, T. K., Rubashkin, N., Cheyney, M., Strauss, N., McLemore, M., Cadena, M., Nethery, E., Rushton, E., Schummers, L., & Declercq, E. (2019). The giving voice to mothers study: Inequity and mistreatment during pregnancy and childbirth in the United States. Reproductive Health, 16(1), 1-18. https://doi.org/10.1186/s12978-019-0729-2
MY DISCUSSION POST
The purpose of this discussion is to consider the pros and cons of implementing a Community-Based Participatory Research health promotion project with uninsured individuals. Along with how the populations health disparities and health inequities benefit and/or hinder the success of this project. Uninsured individuals are exposed to a risk of a deteriorated health, due to negative health assets. These assets determine an individuals’ engagement in decision making and deliberation of health-related issues. For instance, negative emotions, pessimism, and lack of hope may lead to a lack of self-actualization, leading to adverse health outcomes (Pender, Murdaugh & Parsons, 2015). On the other hand, the health of uninsured individuals is equally affected by lifestyle strengths that are health-related such as, the variability of the heart rate and cardiorespiratory fitness. Depending on their situation and the reason they are uninsured can play I roll in lifestyle strengths and health related beliefs. For example, if the individual is uninsured due to low income it is possible they have life style strengths such as being more active due to not having a vehicle or form of transportation. Uninsured individuals also are affected by some health-related beliefs that affect how they perceive illnesses and their approaches to health promotion. Social integration and social support are the fundamental changes that can be used to improve the lives of the uninsured individuals.
According to De Chesnay & Anderson (2016), health promotion projects such as Community-Based Participatory Research has significantly improved healthcare credibility since it has enabled the understanding of health-related experiences. CBPR has facilitated the creation of appropriate services, such as free or cheap medical cover to the uninsured. Thus, it has been used to address health issues such as mental health, smoking cessation, and diabetes management, among others, within the uninsured group. According to Sered (2017), the government and health facilities need to offer free medical coverage to low-income earners and the unemployed as one way of enhancing health promotion. According to the World Health Organization, enabling people to gain control over and prevent diseases by insuring them is a significant way of addressing social health determinants. Therefore, the uninsured group should, on their side, develop positive relationships, and work together with involved stakeholders in health promotion, to achieve positive health outcomes. By participating in research community research programs, uninsured individuals can improve their modifiable risk behaviors.
Caulford, & Rahunathan (2019), suggest that the health differences and inequalities of the uninsured individuals significantly affect the financing of their medical covers by the government. It is found that the health disparities and inequalities are linked with massive medical bills, thereby making it hard for the government to offer free medical insurance to all the uninsured population.
Caulford, P., & Rahunathan, S. (2019). Caring for Refugees, New Immigrants, and Uninsured Women. Ethical Issues in Womens Healthcare, 45–62. doi: 10.1093/med/9780190851361.003.0003
De Chesnay, M., & Anderson, B. A. (2016). Caring for the Vulnerable: Perspectives in nursingtheory, practice, and research (4th Ed.). Burlington, MA: Jones & Bartlett Learning.
Pender, N., Murdaugh, C., Parsons, M.A. (2015). Health Promotion in Nursing Practice. (7th Ed.).Boston, MA: Pearson Education, Inc.
Sered, S. (2017). Uninsured in America. Unequal Coverage. doi: 10.18574/nyu/9781479897001.003.0007
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