Dicussion: APNs role in health literacy

DNP 825 Topic 3 DQ 1 Dicussion: APNs role in health literacy

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Provide examples of measures that APNs can collaborate with direct care nurses in implementing evidence-based changes to improve health literacy in practice.

DNP 825 Epidemiology Paper-Part Two: Analysis and Application Solution Approach

Epidemiology is the study behind public health, and it is the science behind Evidence based study. Epidemiology is divided in to descriptive and analytical. Descriptive epidemiology answers question about diseases, injuries, and hazards that occur in the environment by using data collected by epidemiologist from vital statistics, field investigations, surveillance systems and other sources. Descriptive epidemiology is used to describe the distribution of disease and other health-related states and events in terms of personal characteristics, geographical distribution, and time (Curley, 2019).

Analytical epidemiology is complex and larger, and it focuses on the why and how diseases occurs. Analytical epidemiology test hypothesis that was built from descriptive epidemiology. Therefore, the main objective of analytical epidemiology is to assess the determinants of diseases, risk factors and causes, as well as, to analyze the distribution of diseases and their exposures (Lakna, 2019).  The main goal of this paper is to identify a population at risk and provide data to validate why the population is at risk, health risk, potential barriers relating to implementation of disease prevention and health promotion measures and collaborations between health professionals for risk reduction strategies.

At risk population

A population at risk   is defined as people who are poor, frail, have economic disadvantages, racial or ethnic minorities, low literacy rate, disabled, homeless, and who have isolated from the general population. Population at risk suffers from several disparities which could become a burden to society. At risk population remains a challenge for the Healthy People 2020 making it one of their overarching goals.  The goal of Healthy People 2020 is to eliminate health disparities in the United States (U. S).  Access to health services is important to because it targets at risk population who are lack health insurance, availability to health services, and financial needs to afford health services. The barriers listed can lead to financial burden for the individuals and the nation, lack of preventable care, increase hospitalizations, delay in the appropriate care delivery, and health needs not met. Access to health care can impact an individual’s physical social, and mental health wellbeing and   quality of life. Access to care often varies based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity, and residential location (HealthyPeople.gov, 2020).

A population that is consider at risk in the U.S is the Veterans because they suffered from several disparities such as: economic, social, educational, health, gender, race, cultural, and many others. This population also has the highest rate of suicide and homelessness. In January 2017, the U.S. Department of Housing and Urban Development Point-in-Time Count estimated that 40,000 Veterans were homeless and just over 15,300 were living on the street or unsheltered on any given night (U.S. Department of Veterans Affairs, 2019). Homelessness plays a role in elevated rate of suicide. Veterans also have a difficult time adjusting to civilian life, making it difficult to secure employment, creating economic disparities. This population feels a sense of hopelessness, and lack of belonging, leaving them to feel isolated from the general population.

Most of them have low literacy rate, low income, or lack of income, making them susceptible to homelessness. They suffered from poor health outcomes due to lack of access to care. They also suffered from severe mental illnesses due to Post Traumatic Stress Disorder (PTSD). In addition to demographics, factors such as insomnia, depression, anxiety, sexual victimization, gun ownership and substance use disorders also appear to contribute to suicide risk among service members and veterans (Novotney, 2020).

According to the Veterans Health Administration (VHA) suicide record, about 17 Veterans died daily from suicide compare to the general population.  6,000 Veterans lose their lives yearly due to suicide, making Veterans 1.5 times more than the general population.  Male Veterans are 70.7% more than female Veterans at 43.2% to commit suicide (U.S. Department of Veterans Affairs, 2019).

Health risk

Mental illness is a health risk plaguing the Veteran population in the U.S. It remains one of the health risks because it leads to high suicide mortality. Mental health issues can range from anxiety, depression, bipolar disorder, and PTSD. Mental illnesses remain the most common causes of disability and the disease burden remains the highest among other diseases.  In any given year, an estimated 18.1% (43.6 million) of U.S. adults ages 18 years or older suffered from any mental illness and 4.2% (9.8 million) suffered from a seriously debilitating mental illness. Neuropsychiatric disorders are the leading cause of disability in the United States, accounting for 18.7% of all years of life lost to disability and premature mortality (HealthyPeople.gov, 2020).

Successful and productive mental health allows individuals to perform successfully, form fulfilling relationships with others, contribute to change within their society and communities, and adapt to change without complications. Suffering from mental illness limit an individual from all these abilities, making that individual more vulnerable and susceptible to other risk factors. For example, if a person is suffering from depression, it affects his or her mental, emotional, and behavioral state. This makes the individual at risk for other chronic conditions such as obesity, high blood pressure, heart disease, and suicide risk.

Veterans who suffers from mental illness feel a sense of failure and feel stigmatized preventing them from seeking help. Due to the stereotypes Veterans experience from society, they tend to internalize these stigmas which can create negative effects on their health. Internalized stigma has profound negative effects, contributing to depression, hopelessness, social isolation, poor self-esteem, as well as reduced quality of life, recovery, and treatment engagement (Wastler et al., 2020).

Implementing preventive health measures to combat mental illness for Veterans has led to federal funding to help combat mental illness and homelessness. Access to mental health services were implemented into VHA for Veteran to be able to seek care at any VA facilities on a walk-in basis. Having walk-in access clinics make it easier for Veterans to seek help when in crisis. Veteran also have access to a 24-hour suicide hotline that they can call not only for suicide ideation, but for any situation that might create stress and be directed to the appropriate professional for assistance. Since its launch in 2007, the Veterans Crisis Line has answered nearly 4.9 million calls and initiated the dispatch of emergency services to callers in crisis more than 159,000 times (U.S Department of Veterans Affairs [VHA], n.d.).

Veterans still have difficulty accessing care due to potential barriers like difficulty making their appointments due to employment or family lives. Some report lack of means to appointments such as no transportation or living too far from nearest facility. These barriers remain a constant hinder to Veterans accessing care for mental health services. Another barrier is the lack of mental health providers due to decreased staffing. Veterans become lost to services (LOS) due to no-shows of the Veterans or the providers. When providers fall ill or must take time off for emergency, there is no one to cover leaving appointment a missed appt and rescheduling may take 2-3 months. It makes Veterans feel they are not a priority, and they start to experience internalized stigma.

Collaboration is especially important in combating mental illness. The VHA decided to implement the Primary Mental Health Care Integration (PCMHI) to mange Veterans with less severe mental illnesses such as PTSD, mild depression, and anxiety. PCMHI consist of the primary care team working limited mental health providers who are available to give advice to the primary care team and assess Veteran seeing their primary care providers (PCP) who may screened positive for depression, anxiety, or PTSD. Working with other health care team members such as Registered Nurses, Licensed Social Workers, Psychologist, and Peer Support staff has been successful in reducing the burden of no-show and managing care for the Veterans. This open doors for opportunity for the Veteran to be seen by someone who is part of the mental team that can collaborate with the Psychiatrist for psychopharmacology treatment or the Psychologist for Psychotherapy. Working with mentally ill patients required a collaborative team effort because it give the patient access to care and demonstrate a sense of empathy for the Veterans.

References

Curley, A. (Ed.). (2019). Population-based nursing. Springer Publishing Company. https://doi.org/10.1891/9780826136749

HealthyPeople.gov. (2020, July 26). Access to health services. Retrieved July 26, 2020, Dicussion: APNs role in health literacy from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

Lakna. (2019, July 5). What is the Difference Between Descriptive and Analytic Epidemiology. PEDIAA. Retrieved July 26, 2020, from https://pediaa.com/what-is-the-difference-between-descriptive-and-analytic-epidemiology/

Novotney, A. (2020, January 1). Stopping military and veteran suicides. American Psychological Association. Retrieved July 26, 2020, Dicussion: APNs role in health literacy from https://www.apa.org/monitor/2020/01/ce-corner-suicide

U.S Department of Veterans Affairs. (n.d.). What is vcl? – veterans crisis line. Retrieved July 26, 2020, from https://www.veteranscrisisline.net/about/what-is-vcl

U.S. Department of Veterans Affairs. (2019). 2019 national veteran suicide prevention annual report [PDF]. Retrieved July 26, 2020, Dicussion: APNs role in health literacy from https://www.mentalhealth.va.gov/docs/data-sheets/2019/2019_National_Veteran_Suicide_Prevention_Annual_Report_508.pdf

Wastler, H., Lucksted, A., Phalen, P., & Drapalski, A. (2020). Internalized stigma, sense of belonging, and suicidal ideation among veterans with serious mental illness.. Psychiatric Rehabilitation Journal, 43(2), 91–96. Retrieved July 26, 2020, Dicussion: APNs role in health literacy from https://doi.org/10.1037/prj0000386