Specific Core Nursing Content # 12: Vulnerable Population

Clinical Learning Outcomes

  • Define vulnerable populations by identifying the variables that put groups of patients at risk of being marginalized in psychiatric mental health treatment.
  • Recognize the multiple and complex care needs of the vulnerable populations.
  • Plan, implement, and evaluate care strategies that protect the rights and dignity of vulnerable populations.

Teaching Strategies

Classroom Teaching Strategies
  • Group exercise to define vulnerable populations: critical thinking about the term
  • Use of the Gelberg and Andersen Behavioral Model for Vulnerable Populations (Stein, Andersen, & Gelberg, 2007).
    • understanding of the variables related to high riskfor unmet mental health needs and health care utilization among vulnerable populations
  • Discussion of the relationship between stigma and access to mental health
    • Video – (2005). Shadow voices: Finding hope in mental illness [Documentary]. United States: Mennonite Media.
  • Prioritizing the care of vulnerable populations and unmet mental health needs.
    • Incorporating care of the vulnerable populations under each module or component of the syllabus.
  • Student group presentations – focus is on care of a specialized group of patients e.g. care of the homeless patient with severe mental illness.
    • Presentations must include a case study and NCLEX questions
  • Flipped classroom strategies to promote student discussion and active learning/critical thinking.
  • Journal articles to supplement text:
    • Lewis, V., Larson, BK, McClurg, A., Goldman, R., & Fisher, B. (2012) The promise and peril of accountable care for vulnerable populations: a framework for overcoming obstacles. Health Affairs, 31(8), 1777-85.
    • Stein, J, Andersen, R., & Gelberg, L. (2007). Applying the Gelberg- Andersen Behavioral Model for Vulnerable Populations to health service utilization in homeless women. Journal of Health Psychology, 12(5), 791-804. Doi: 10.1177/1359105307080612
    • Teaching About Vulnerable Populations: Nursing Students' Experience in a Homeless Center. Journal of Nursing Education. Mary Jo Stanley, PhD, RN, CNS, 2013; 52(10): 585-588
    • https://doi.org/10.3928/01484834-20130913-03
  • Assign students to answer questions from "A Starter Kit to Teaching Mental Health" focused on older adults. Found at http://www.nln.org/docs/default-source/professional-development-programs/ace-series/acexpress-mental-health-starter-kit.pdf?sfvrsn=2
Clinical Teaching Strategies
  • Students will present cases from their clinical day re: focus on unmet mental health needs of vulnerable populations i.e. children with history of trauma, homeless with major mental illness, elders
  • When reviewing the history of mental health care, review the history and current practice of incarcerating those with mental illnesses. Discuss treatment for the inmate population.
  • Assessment of a patient with the Behavioral Model for Vulnerable Populations to help the student identify risk factors, enabling factors that contribute to homelessness and underutilization of mental health system
  • Nursing care planning with focus on community resources
  • Interdisciplinary experience in the community (community health van or other experiences offered by community/public health faculty) that can focus on holistic nursing e.g. homeless,prison population
  • Conduct a brief interview with a member of another discipline (MSW, OTR/L, spiritual care, MD, or member of police department in the community). Submit as a written assignment. Strategies other disciplines use to engage with vulnerable populations.
  • Post conference discussion re: the unique challenges of caring and finding appropriate services for this population i.e. homeless clients can get meds and have them filled.
  • Discussion of the legal and ethical issues around these cases
  • Compile a list of local resources for homeless individuals or low socio-economic families and mental health services available to them.
  • Students define and give examples of concepts from The Stress Vulnerability Model.  See www.bhevolution.org/public/stress-vulnerability.page
  • From Hazeldon: provide students with interactive activities to understand key characteristics of mental illness and stigma.  See https://walkinourshoes.org/content/classroom_Lessons_Plans.pdf
Case Studies - examples
  • A 48 yr. old woman with Down Syndrome, residing in a group home, struggles with symptoms of OCD and cognitive decline
  • b. A 38 yr. old male, residing alone in a single room, struggles with auditory hallucinations and paranoid delusions associated with schizophrenia
Assignment: with Rubric
  • Attend MH support group and complete 1 page reflection paper about the experience [see appendix 13]
  • Patient with schizophrenia
  • Standardized patient is used, scripted case scenarios
  • Students are responsible for pre-simulation work with an interdisciplinary focus for the patient who is in the ED, is acutely psychotic, and is homeless
  • Simulation exercise day – student is responsible for assessment of the patient, including resources available for discharge planning. The faculty emphasize the interdisciplinary nature of the simulation.
Clinical Skills Checklist
  • Conduct a mental health assessment of elderly clients (Standard 1. Assessment)
  • Outline diagnostic criteria for specific mental health problems encountered in childhood (Standard 2. Diagnosis)
  • Devise a plan to help maintain mental health for a homeless person (Standard 5A. Coordination of care)
  • Evaluate effectiveness of care delivery for specific vulnerable clients encountered in clinical practice (Standard 6. Evaluation)
  • Discuss the challenges in promoting mental health in incarcerated populations (Standard 7. Ethics)
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