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Although many people are considered both ‘at risk’ and ‘vulnerable,’ there is a difference between the two. ‘At risk’ describes the level that someone could be exposed to an illness. A risk for sickness can be contributed to factors that include age, race, gender, and also how common specific diseases are within the community. In comparison, being vulnerable is the state at which people are unable to ‘anticipate, cope with, resist and recover’ from an impact (WHO, 2018). For example, there are many factors to consider why there are fewer influenza vaccinations received by Hispanics and African Americans than other groups; however, this places their community ‘at risk’ of contracting the virus (Rangel, Shoenbach, Weigle, Hogan, Strauss, & Bangdiwala, 2005).

When discussing vulnerable groups, children, the elderly, the poor, and minority groups are typically included. There are many reasons these people are susceptible: the poor population may be homeless, and among other causes, lack the finances to obtain health insurance; children are without the knowledge and voice; women may prefer and be unable to find female physicians; and minorities experience racism in healthcare as well as poverty because of inadequate education and economic opportunities (WHO, 2018).

These groups experience challenges in advocating for themselves due to the lack of either wisdom or fiscal resources; which are necessary to fight such vulnerabilities. Discrimination is the main ethical issue at hand. Although, some of the other fundamental concerns when advocating for these groups would include obtaining adequate access to health care and insurance coverage, in addition to helping them improve their literacy rates and financial positions for longevity.

As of 2016, the population of the U.S. was estimated at 326 million; of the reported, 12% live in poverty, 51% are female, 23% are children, and 41% are minorities (U.S. Census Bureau, n.d.). Proving that it is everyone’s responsibility to help make a difference in promoting wellness efforts in our communities.

References

Rangel, M. C., Shoenbach, V. J., Weigle, K. A., Hogan, V. K., Strauss, R. P., & Bangdiwala, S. I. (2005). Racial and Ethnic Disparities in Influenza Vaccination Among Elderly Adults. Journal of General Internal Medicine, 20(5), 426–431. http://doi.org/10.1111/j.1525-1497.2005.0097.x

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To adequately meet the needs of patients with diverse backgrounds, nurses much use methods that are culturally competent. In 1991, Madeleine Leininger published the The Transcultural Nursing Theory, establishing approaches such as cultural preservation, cultural accommodation, cultural repatterning, and cultural brokering (Andrews & Boyle, 2008, p. 62).

Cultural preservation entails a situation where the nurse supports the use of scientifically sound cultural practices of care by their patients (Stanhope & Lancaster, 2014, p. 78). An example would include agreeing to the use of acupuncture by a Chinese patient as an adjunct to pain management using conventional medicines such as opioid analgesics (Huber, 2009).
Cultural accommodation entails a situation where the nurse supports the use of cultural practices that have been shown as not harmful (Stanhope & Lancaster, 2014, p. 78). For example, placing a table knife under the bed of a laboring woman to symbolically cut the pain (Smith, 2013). For African Americans in the Delta, alcohol or Vaseline rubs to the chest are utilized for comfort measures (Gunn & Davis, 2011). Within cultural accommodation, these acts would be supported if not contraindicated in the patient’s care.
Cultural repatterning entails a nurse working in collaboration with a patient towards helping them change cultural practices that are considered harmful (Stanhope & Lancaster, 2014, p. 78).
In case, when a pregnant Muslim patient intends to fast during the month of Ramadan, but is unaware of the negative impact that it would have upon her and her pregnancy (Wintz & Cooper, 2009, p. 28).

Cultural brokering utilizes negotiating between the patient’s culture and biomedical healthcare to ensure that the care is used together as culturally competent (Stanhope & Lancaster, 2014, p. 79).
Community health nurses need to utilize various cultural competence strategies in ensuring that they effectively deliver health care services that are able to meet the individual needs of their patients. Such strategies help community nursing in improving the health outcomes and quality of care provided by the nurse (Betancourt, et.al, 2016). Theses methods also help in the elimination of racial and ethnic health disparities and boundaries that may hinder effective delivery of care. Consequently, the nurse is able to develop and cultivate patient trust, understanding and respect that help significantly in ensuring the realization of the best health outcomes. In achieving the above, community nurses can use a number of approaches such as cultural preservation, cultural accommodation, cultural repatterning, and cultural brokering. Possible barriers in the utilization of the above strategies would be attributed to conflicts arising from different cultures, languages, and beliefs. For example, in the instance of persuading a patient to stop taking a herb that has been used for many years by their native community would be seen as insensitive and rude by the patient.

Andrews, M. M., & Boyle, J. S. (2008). Transcultural concepts in nursing care (5th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins Health.