Question one

Vulnerability is the degree to which individual populations cope or are unable to recover from the effects and challenges induced by a disaster due to the factors outside their control that make them lack similar opportunities as the rest of the population. According to Bracken-Roche, Bell, & Eric Racine (2016), the concept of vulnerability comes from the need to identify special groups within the society are likely to be harmed or exploited. This means that when accessing healthcare and other basic life opportunities, these people cannot compete like others. In healthcare, the health domains of vulnerable populations exist I three categories of physical, psychological and social which create the challenges that the people face.

Mental health people suffer from the psychological domain since they lack the mental capacity while those with disability suffer from physical vulnerabilities that create challenges in navigating their environment. People living with mental illness and disability are vulnerable because they present special needs that cannot be treated the same way as the rest of the population (WHO, 2019). The vulnerability mostly arises from the way the society treats them or subjects them to stigma and discrimination which is also seen in other restrictions that they face when seeking to access essential health and social care. 

Question two

Health disparities are differences that exist in the society which define the prevalence of diseases and opportunities that affect the ability of the individual to achieve optimal health (Dehlendorf, Bryant, Huddleston, Jacoby, & Fujimoto). According to Healthy People 2020 (2019), different health disparities affect different groups of vulnerable populations. One of the primary factors that contribute to mental illness disparity is stigma and discrimination. In most mental ill and disability populations, discrimination creates access difficulties since it creates a stigma that denies such people an opportunity to access healthcare. Stigma creates discouragement which limits the access to health-related opportunities. Stangl, et al. (2019) suggest that discrimination leads to subconscious treatment of individuals differently which leads to worse treatment of the mental health persons that make them different from others. 

Stigma is one of the biggest challenges to people mental health and disability since it worsens the problem and impedes the delay of getting treatment. Stigma leads to hurtful isolation of mentally ill people thus making it difficult for them to access healthcare. The prejudice and fear that the stigmatized population prevents these people from coming out to seek for healthcare and other needs (Tanaka, Tuliao, Tanaka, Yamashita, & Matsuo, 2018). In other cases, stigma creates difficult situations that deny the mentally ill opportunities by stopping responsible persons from offering the required services to the patient. 

Income is one of the primary factors that create disparities among the mentally ill and disabled populations. According to Singh, et al. (2017) income defines the nature and quality of healthcare that one can receive which can be seen like disparities that exist in the US. In countries that are funded by the medical insurance schemes, there are difficulties in the mental health patients accessing health insurance due to its cost. For example, Lake & Turner (2017) suggests that the current treatment model in the US does not cover the complexity of mental illness which affects the level of access to healthcare. The disparities are created by the different levels of income that affect the ability of the patient to afford the healthcare requirements.

Question three

Culture is an important element in the life of people and defines how people associate and relate with each other since it influences health access and its disparities. Culture defines how patients define or present their symptoms to the clinician (Srinivasan, 2016). These presentations vary from culture to culture and ethnicity. For example, Asian patients are comfortable reporting somatic symptoms but may not report emotional symptoms. This shows the selective presentation of symptoms in culturally acceptable ways (Stangl, et al., 2019). In other instances, the meanings imparted on the symptoms vary from different cultures and ethnicities which determine whether people are free to seek medical attention or not. This can also be seen in the type of treatment that they receive since culturally incompetent clinicians can develop attitudes towards mental health issues. 

Singh, et al. (2017) suggests that cultural and social factors can also contribute to the development of mental illness since they create a complex interaction of biological, psychological, social, and cultural elements of disorders. For example prevalence, bipolar, depression and other mental disorders have a similar pattern of causation that depends on cultural and societal factors (Lake & Turner, 2017). This is also seen in the manifestation of PTSD and suicide rates which vary across cultures and different US ethnic groups. This is because the culture is important in the social integration of people in the society which influences the way the exhibit mental disorder signs and symptoms and how the mental disorders are influenced across populations. 

Family factors have also been described as playing an important role in the psychological health of the individual and mental illness. These factors can promote or protect one against the risk of the disease. For example challenges in the family-like severe marital discord, social disadvantage and overcrowding play a major role in the onset of mental illness. This similarity is evident in children where conditions like child abuse, sexual abuse, and neglect contribute to the likelihood of the child developing mental illness (Piat, Sabetti, Fleury, Boyer, & Lesage, 2016). Family is supposed to offer a cultural element of protection to the individual especially in controlling and management of mental symptoms. Iseselo, Kajula, & Yahya-Malima (2016) add that cCoping strategies developed patients are also defined by the cultural characteristics that people face within society. Some families place a higher emphasis on suppression affect while other families provide an environment that calls for individual approaches to the management of symptoms. For example, African-Americans prefer facing their problems as compared to whites which increases their coping strategies. 

Question four

Effective communication forms an integral part of quality patient care since it defines the way the health professional relates to the patient to determine the best care that fits their needs. Furnes, Kvaal, & Hoye (2018) argue that effective communication enables nurses to encounter patient situations with sensitivity, empathy and moral accountability. This is reflected in the ability to communicate with people from different backgrounds with a range of personalities. Several strategies can be applied to deal with mental health patients. 

The first communication strategy is the ability to accommodate the demands and requirements of the patients. Mental illness patients exhibit many needs, wants and desires which requires that the nurse accommodates these needs.

If the mentally ill or disabled person is accompanied by a family member, the nurse is supposed to address the person with the disability rather than the family member.

When communicating, it is important to use the first language sine most people with mental disorders are not the total of the disorder but rather only the person with a disability. 

Listen closely and try to understand what they are communicating rather than interrupting them. 

Try and set limits in the conversation to ensure that the conversation does not go overboard. 

If the person has difficulty speaking, use the clarifying skill after they are done talking to confirm what they were saying. 

Respond to anger with quiet assurance and not making sudden moves

Give simple instructions for what you ask the other person

Be patient and keen on communication since they may tend to focus on a particular object.

If the person has paranoia or experiences hallucinations, try to acknowledge that these feelings are real. 

Question five

One strategy for incorporating the cultural information in the nursing process is to work with the patient in developing the nursing plan. This requires the nurse to seek clarification from the patient on the best appropriate way. Cultural issues vary from group to group and thus the nurse has to accommodate the cultural needs of the patient.

The nurse is also supposed to understand the cultural appropriate language of the specific group. Language is an element of culture that shapes the way people relate within clinical settings. This means that the nurse needs to understand the most appropriate language which is defined by the age of the patient, ethnicity or race, religion, and even social status. 

Question six

One major role of the nurse in reducing health disparities is through rebuilding the capacity to care for patients through transforming nursing education on the principle of mutuality (Edmonson, McCarthy, Trent-Adams, McCain, & Marshall, 2017). Nurses can develop clinical capabilities that allow people with mental health illness to relate well with them. This will enable them to rebuild their capacity in caring for people with different health disparities equally. 

Apart from dealing with patient-related issues, nurses can also take an active role in health disparity awareness creation by focusing on the training and education of other healthcare professionals. This entails assisting other professionals to develop an interpersonal approach to address health issues. Health campaigns and community education can be used to improve victim identification. 

Question seven

Srinivasan (2016) suggests that the cultural aspect of a nurse influences the type of care that patients receive. When working with vulnerable populations, cultural diversity is important in meeting the needs of vulnerable populations. These populations are not supposed to be treated like the general one since they present special needs that the nurse needs to consider. In this case, developing cultural diversity skills can be used to influence the quality of care that the vulnerable population receives through creating an environment that accommodates. Cultural diversity is the ability to work with people from different backgrounds and groups. 

On the other hand, the cultural background can also be a barrier to achieving quality care for different populations. This is seen from the fact that nurse’s background can affect the way they interact with patients thus making it difficult for the vulnerable populations to communicate the health problems that they have. Different societies have different definitions and attitudes towards healthcare groups which makes it difficult for them to achieve the required care. The environment that the nurse creates is supposed to define the way the nurse relates to the patients. This means that nurses from highly discriminative and stigmatizing populations can present barriers to healthcare which influence access to care for vulnerable populations.

References

Bracken-Roche, D., Bell, E., & Eric Racine. (2016 ). The “Vulnerability” of Psychiatric Research Participants. Canadian journal of psychiatry, 61(6), 335–339. doi:10.1177/0706743716633422

Dehlendorf, C., Bryant, A. S., Huddleston, H. G., Jacoby, V. L., & Fujimoto, V. Y. (n.d.). Health Disparities: Definitions and Measurements. American journal of obstetrics and gynecology, 200(3), 212–213. doi:10.1016/j.ajog.2009.12.003

Edmonson, C., McCarthy, C., Trent-Adams, S., McCain, C., & Marshall, J. (2017). Emerging Global Health Issues: A Nurse’s Role. The Online Journal of Issues in Nursing, 22(1).

Furnes, M., Kvaal, K. S., & Hoye, S. (2018). Communication in mental health nursing – Bachelor Students’ appraisal of a blended learning training programme – an exploratory study. BMC Nursing, 17(20).

HealthyPeople2020. (2019). Mental Health and Mental Disorders . Retrieved from Healthy People 2020: https://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-disorders

Iseselo, M., Kajula, L., & Yahya-Malima, K. I. (2016). The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based study in Dar es Salaam, Tanzania. BMC Psychiatryvolume, 16(146).

Lake, J., & Turner, M. S. (2017). Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care. The Permanente Journal, 21, 17-024.

Piat, M., SabettI, J., Fleury, M.-J., Boyer, R., & Lesage, A. (2016). “Who Believes Most in Me and in My Recovery”: The Importance of Families for Persons With Serious Mental Illness Living in Structured Community Housing. Journal of social work in disability, 10(1), 49–65.

Singh, G. K., Daus, G. P., Allender, M., Ramey, C. T., Martin, E. K., Perry, C., . . . Vedamuthu, I. P. (2017). Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016. International journal of MCH and AIDS, 6(2), 139–164. doi:10.21106/ijma.236

Srinivasan, M. (2016). Cultural Influences on Primary Care Delivery. Journal of General Internal Medicine, 31(11), 1265–1266.

Stangl, A. L., Earnshaw, V. A., Logie, C. H., Brakel, W. v., Simbayi, L. C., Barré, I., & Dovidio, J. F. (2019). The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicinevolume, 17(31). doi:https://doi.org/10.1186/s12916-019-1271

Tanaka, C., Tuliao, M. T., Tanaka, E., Yamashita, T., & Matsuo, H. (2018). A qualitative study on the stigma experienced by people with mental health problems and epilepsy in the Philippines. BMC Psychiatry, 18(325).

WHO. (2019). Mental health, poverty and development. Retrieved from WHO: https://www.who.int/mental_health/policy/development/en/