Paper Format:Number of pages:Type of work:Type of paper:Sources neededAPA1 Double spacedWriting from scratchEssay2Subject NursingTopic Models and Frameworks for Studying the VulnerabilityAcademic Level: Bachelor Paper details Identify two models for studying vulnerability and compare and contrast differences when applied to the same population. Please address these objectives: Assimilate principles of epidemiology with scientific data necessary for epidemiologic intervention and draw appropriate inferences from epidemiologic data. (PO 1) Weekly Objectives Assess health and disease in vulnerable populations. Discern individual and multiple factors that contribute to vulnerable and high-risk status. 3 Synthesize ethical and legal principles regarding the collection, maintenance, utilization, and dissemination of epidemiologic data. (PO 1) Weekly Objectives Identify the protected health information in the at-risk population. Theorize the reasons that high risk populations are at increased risk for unethical treatment. Readings: Vulnerable Populations/High-Risk Populations This week, the readings focus on a variety of interrelated topics. As we build on some of the concepts of last week, we will explore the meaning of health, the concept of vulnerable and high-risk populations, and the frameworks and models developed to identify and intervene with these populations. We will look at health belief models that serve as the basis for many of our assumptions about health and disease. Also, we will investigate not only the DNP’s role when interacting with these groups, but the necessity of working interprofessionally with other healthcare providers. Health The concept of health itself has a plethora of definitions. In an attempt to secure a more standardized definition to use as a basis for assessment and evaluation, a variety of theoretical frameworks have been utilized to provide a more homogeneous description of the concept of health. The implications of health promotion and disease prevention become more evident when utilizing a variety of conceptual models and nursing theories. It is important for healthcare practitioners to recognize and reflect on their own preferences for the models and/or theories that guide their practice. The nurse’s familiarity with the different theories allows him or her to appreciate the patients' vantage points. All patients adhere to their own health belief models (whether they can articulate it or not). This knowledge can elucidate the meaning of health promotion and disease prevention of patients and why it may be limited and undervalued. Reflection How would you define the word health? Is there just one definition or many that come to mind based on the model or theory under consideration? Vulnerable Populations Vulnerability can exist at the individual or population level. For the purposes of this class, we will be examining the vulnerability of populations. As with the concept of health, definitions of vulnerable and high risk populations will vary. However, there seems to be a universal acceptance that these groups need special safeguards and protection. The United States Agency for Healthcare Research and Quality describes vulnerable populations in the Final Report of the President's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry Consumer (1998). The report describes vulnerable populations as "groups of people made vulnerable by their financial circumstance or place of residence, health, age of functional or developmental status or ability to communicate effectively and personal characteristics, such as race, ethnicity, and sex." Flaskerud and Winslow (1998) described vulnerable populations as "social groups who have an increased relative risk or susceptibility to adverse health outcomes. This differential vulnerability or risk is evidenced by increased comparative morbidity, premature mortality, and diminished quality of life" (p. 69). As you read through the literature addressing these groups, it becomes obvious that many groups and/or individuals will fit the definition of being vulnerable at some point in their lives. Examples of Vulnerable/High Risk Populations follow (Saunders & Valente, 1992): Children Disability or chronic illness Elderly Exposure to violence Homeless Illegal status Mentally ill Migrant workers Poor/working poor Prisoners Racial/ethnic minorities Substance abusers Socioeconomically disadvantaged Underinsured or no insurance Lesbian, gay, and transgender Many of these vulnerable patients and populations suffer from the frustration that often occurs with what is called the cycle of vulnerability. Frequently, these factors are concurrent and result in a cycle of vulnerability. One problem is solved but another problem quickly emerges. Vulnerability can result in marginalization, social isolation, and feelings of hopelessness. However, with interdisciplinary-appropriate interventions, these patients with adequate resources can demonstrate remarkable resilience to counteract their vulnerable status. Reflection Think about vulnerable populations that you encounter in your nursing practice. What makes them vulnerable? Models of Vulnerability In an attempt to come to some consensus on definitions and concepts, several models have been developed to serve as a framework to study vulnerable populations. Below are brief descriptions of several models. These are discussed in more detail in the readings. Models – Vulnerability Individual Determinants Model Individual Social Resources Model Individual Health Behaviors Model Individual Socioeconomic Status Model Community Social Resources Model Individual and Community Interaction Model Sinners and Victims Social Policy Model Click on the links on the left to learn more about this topic. Check your knowledge by clicking the interactives below: Healthy People 2020 PrintResetUse Keyboard Drag the terms at the bottom to their matching definitions below. Drop HereThere are groups of individuals who collectively believe that AIDS is the result of sinful sexual activity and do not believe that any of their tax dollars should be used for medications to alleviate symptoms associated with the disease. Drop HereMr. Jimmy Jones is obese and indulges in substance abuse. Drop HereMr. Tom Jones lives in a neighborhood with rampant crime. Although his health is good, he is afraid to walk in his neighborhood and is isolated. Drop HereCarla Smith is an 82-year-old uncontrolled diabetic with severe congestive heart failure. To get to her doctor's office she must take three buses and does not possess the stamina. She has no family support. Drop HereMs. Henry dropped out of high school in the 9th grade and has never resumed her education. She is unemployed, although she has applied for many positions but does not have any skills. Drop HereMr. Smith is an elderly 82-year-old who is targeted for a flu shot. Drop HereMs. Rodriguez is pregnant with no family or other social support. Individual Socioeconomic Status ModelCommunity Social Resources ModelIndividual Health Behaviors ModelSinners and Victims Social Policy ModelIndividual Determinant ModelIndividual Social Resources ModelIndividual and Community Interaction Model Now think of terms or descriptors that come to mind and type out your answer below. The Question Think of terms or descriptors that come to mind when you hear that someone belongs to a vulnerable population. Type them below, then click to view the expert’s answer. Your Answer Compare Answers Health Disparities According to Braveman (2006), although there is no one agreed upon definition for the term “health disparity” the definition she proposes is, “It is a difference in which disadvantaged social groups, such as the poor, racial/ethnic minorities, women or other groups who have persistently experienced social disadvantage or discrimination, systematically experience worse health or greater health risks than more advantaged social groups” (p.167). In Health People 2010, the government developed an initiative to eliminate racial and ethnic disparities in health (U.S. Department of Health and Human Services, 1979). In Health People 2020 the directive is much more expansive. The HP 2020 national goal is eliminating health disparities across all groups (Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020). According to Braveman (2014) a differentiation needs to takes place between the health disparities and health equity. Health disparities may not be due lack of health services but based on aspects of the host such as the elderly population. We all accept that the elderly have worse health than younger people. Also professional athletes have more injuries than their non-athletic counterparts. Although these two examples are a form of health disparities, they would not necessary become a priority for the development of interventions. The author describes health equity as “the principle underlying a commitment to reduce and, ultimately eliminate disparities in health and its determinants, including social determinants. Pursuing health equity mean striving for the highest possible standards of health for all people and giving special attention to the needs of those at greatest risk or poor health, based on social conditions” (p.5-8). The United States healthcare system is facing increasing health disparities among vulnerable/high risk populations. Between 2000-2010 (the latest statistics available), the prevalence of chronic disease and co morbidities has increased in several vulnerable populations. (Vanderbilt 2013). According to Freid (2012), the following increases in disparities have occurred in populations with chronic conditions. Prevalence of chronic disease morbidities 2000 2010 Hispanic 32.2% 42.4% African American 43.8% 51.6% 65 + living below 100% of the federal poverty level 42.5% 50% Interprofessional Teams for Improved Outcomes Over a decade ago the (Institute of Medicine) IOM proposed healthcare students and professionals work in an interdisciplinary manner to address quality issues that plague our healthcare system (2001). Not only does interdisciplinary collaboration improve health outcomes in populations with chronic conditions but has been instrumental in reducing medical errors (The World Health Organization, 2010). A strategy proposed in Healthy People 2010 was Objective 1.7, which reads, "Increase the proportion of the schools of medicines, schools of nursing, and health professional training schools, whose basic curriculum for healthcare providers includes the core competencies in health promotion and disease prevention" (Johnson, 2010). The Association for Prevention Teaching and Research sponsored the Institute for Interprofessional Prevention Education in 2008, for the distinct purpose of improving interprofessional prevention education approaches. Zenzano, et al. (2011) reports that most major clinical health professional organizations have embraced the concepts of health promotion education and disease prevention as part of their mission. As discussed in Lesson 1 the DNP prepared nurse is in a unique position to lead these interprofessional teams. The Role of the Federal Government Historically, the federal government has taken a leadership role in recognizing and intervening with vulnerable populations. Review the historical timeline below: Social Security Act TimelineList ViewPrint Roll over each date below for its events. Use the slider at the bottom to adjust the date range. 1935 1965 1997 2010 ACA Coverage: Ends pre-existing condition exclusion for children under 19 years old Keeps young adults covered under their parents’s healthcare plan up to age 26 Ends arbitrary withdrawals of insurance coverage Guarantees your right to appeal Ends lifetime limits on coverage Reviews premium increases Helps get the most money from premium dollars (Jacobi, J. V., Watson, S.D., Restuccia, R. (2011). Reflection Reflect on why expectations have not been met for including health promotion and disease prevention in the curricula of health professionals. Do you think that your program has placed an adequate amount of emphasis on these topics? Implications for the Nurse in Advanced Practice Historically, nurses in advanced practice roles have disproportionately cared for many of the vulnerable individuals and groups in our society. As we look toward the challenges of the future, we can anticipate that healthcare providers’ expertise will continue to be needed to optimize outcomes for these vulnerable and high-risk patients. Advanced nursing practice provides comprehensive healthcare that includes aspects of health promotion but also the concept of disease prevention. Nurses in advanced practice roles work as partners with vulnerable clients to identify clients' strengths and needs and develop intervention strategies designed to break the cycle of vulnerability. The assessment of clients should include, but is not limited to, an evaluation of socioeconomic resources, preventative health needs, congenital and genetic predisposition to illness, amount of stress and stressors, living environment, and neighborhood surroundings. Van Zandt, Sloand, and Wilkins (2008) speak to the special skill set for interacting with vulnerable populations in resource-scarce settings. Their recommendation to increase the sensitivity and skills include be conscious of creating a trusting environment; show respect, compassion, and concern; avoid making assumptions; coordinate services and providers; and, advocate for accessible healthcare services. References American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from Braveman, P. (2014). What Are Health Disparities and Health Equity? We need to clear. Public Health Reports (129) Supplement 2. Braveman, P. (2006). Health disparities and health equity: concepts and measurement. Annual l Review of Public Health, (27), 167–194. Consumer Protection and Quality in the Healthcare Industry. (1998). AHRQ. Retrieved from Ensor, T., Cooper, S., Davidson, L., Fitzmaurice, A. & Graham, J. (2010). The impact of economic recession on the maternal and infant mortality; lessons from history. BioMedCentral Public Health, 10, 727. Flaskerud, J., & Winslow, B. J. (1998). Conceptualizing vulnerable populations: Health-related research. Nursing Research, 47, 69–77. Healthy People 2020. (2010). U.S. Department of Health and Human Services. Retrieved from Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press. Johnson, K. (2010). Meeting Healthy People 2010, Objective 1.7 in Association of Schools of Allied Health Professions (ASAHP) programs. Journal of Allied Health, 39(3), 150–155. Nyamathi, A., Koniak-Griffin, D., & Greengold, B. (2007). Development of nursing theory and science in vulnerable populations research. Annual Review of Nursing Research, 25, 3–25. Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I Report: Recommendations for the Framework and Format of Health People 2020. U.S. Department of Health and Human Services. Health People 2010. Understanding and Improving Health. Washington, D.C.: US. Government Printing Office, 2000. Van Zandt, S., Sloand, E., & Wilkins, A. (2008). Caring for vulnerable populations: Role of academic nurse-managed health centers in education nurse practitioners. Journal for Nurse Practitioners, 4(2), 126–131. Zenzano, T., Allan, J., Bigley, M., Bushardt, R., Garr, D. Johnson, K., et al. (2011). The roles of healthcare professionals in implementing clinical prevention and population health. American Journal of Preventive Medicine, 40(2), 261–267.

Vulnerability Study Models


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All models of studying vulnerability strive to analyze factors that affect a population group considered to be vulnerable and ways of coping and recovering from those circumstances. The two models being considered are Individual Socioeconomic Status Model and Individual Health Behaviours Model.

Similarities and Differences

The ability of governments department to know the social economic status and health behavior of a population is important in planning and developing a perfect renounce to emergencies. According to Berkman (2014), the social economic status of an individual is directly related to their health behavior. It shows that vulnerability is more prevalent in areas that are economically poor. There is an interlink between education, income and income and health behaviour like substance use and alcohol consumption (World Health Organization, 2014)   The difference between these two models could arise in cases where the attitude of individuals toward health is dependent on social economic status, while health behaviours attitude could be associated with factors like personal beliefs and awareness level on importance of good healthy lifestyle.

All humans are vulnerable to disease but the risk factor is higher in a vulnerable population.  This is explained by the stress individuals get, Rios & Zautra (2011) found out that both educated and non-educated experience daily stress, but the problem was more severe among the less educated. Factors that cause high health risk include income level, accessibility to insurance and availability of health care.

Epidemiology plays an important role in coming up with facts, but several factors arise from the acquired data. Issues like confidentially and privacy of the people who take part in the research, presence of informed consent and exploitation of the vulnerable. The less educated in the community are more likely to take part in untested drug study without their knowledge than the educated.


















Berkman, L. F., Kawachi, I., & Glymour, M. M. (Eds.). (2014). Social epidemiology. Oxford University Press.

Rios, R., & Zautra, A. J. (2011). Socioeconomic disparities in pain: The role of economic hardship and daily financial worry. Health Psychology, 30(1), 58.

World Health Organization, & World Health Organization. Management of Substance Abuse Unit. (2014). Global status report on alcohol and health, 2014. World Health Organization.


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