Academic journal article Nursing and Health Care Perspectives

Education of Advanced Practice Nurses Serving Vulnerable Populations

Academic journal article Nursing and Health Care Perspectives

Education of Advanced Practice Nurses Serving Vulnerable Populations

Article excerpt

Vulnerable populations are camouflaged, stigmatized, and often lacking in health care services. They may also be distrustful of assistance from traditional health care providers. To better serve vulnerable populations, professionals guiding intervention programs need specialized knowledge and skills as well as problem-solving abilities.

Community interventions that lack grounding in the epidemiological concept of risk underlying vulnerability cannot be effective. This Master's of Science in Nursing curriculum, leading to the designation Community Health Clinical Nurse Specialist (CNS) Among Vulnerable Populations was designed to develop professionals who will help meet the challenge of community intervention comprehensively and effectively. The curriculum reflects the philosophy that innovative educational programs emphasizing vulnerable groups are key to community wellness.

The decision to offer this degree grew from the educational mission of Seattle University and the need to address changes taking place in health care since the 1980s. The mission of the University, nourished by the religious heritage of Catholic, Jesuit vision and values, is to advance social justice and to address the concerns of the poor. This mission guides the development of academic programs (1,2). It is reflected in the School of Nursing's goal to educate leaders in nursing who advocate for those least able to speak for themselves and least able to obtain access to resources that are available to the majority of the population.

A large segment of Americans has been disenfranchised from advances in the health sciences -- namely, the poor, certain minority groups, the uninsured or underinsured, and many persons suffering from chronic poor health. Steps taken by health care providers and third-party payers to reduce expenditures and develop new models for cost-effective delivery practices have added stress to the system. Further, health problems have been associated with social phenomena, such as family violence, homelessness, drug and alcohol addiction, and AIDS.

Such socially related health concerns have compelled health care professionals and policymakers to reframe questions and to reconstruct the model of health to include sociopolitical factors. Examination of the nation's health status has revealed a deep chasm between the health of the more affluent, who have access to care, and those who are poor or without access; those who are white and those who are people of color.

For virtually all types of health risks, members of certain racial-ethnic groups, people of low income, and people with disabilities are most vulnerable (3). Poor people have twice the death rate of those with incomes above the poverty level, and poverty appears to be a predisposing factor to traumatic injuries, violence, and homicide. Higher rates of infant death, prematurity, and low birth weight frequently go hand in hand with social and economic inequities (4). At double jeopardy, then, are individuals who are both poor and of color, since a larger proportion of persons from African-American, Hispanic, Asian, Pacific Islander, and American Indian descent are at or near the poverty level.

For residents of Washington state, the barriers to health care are similar to those identified for the nation. Inability to obtain either health care insurance or public medical assistance are among the major barriers (5). In 1993, 13 percent of the state's population were uninsured or ineligible for Medicaid; 50 percent of all Medicaid recipients were children (6). As state legislators have sought ways to overcome financial barriers, actual costs for care have continued to rise and disparities in health outcomes have widened.

Assumptions and Definitions Underlying the Program This advanced practice nursing program offers a Master of Science in Nursing degree. The framework for the program is based on the assumption that an educational focus on any single level of client is insufficient to provide an adequate foundation for community specialists. …

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