1. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 23
Homelessness, Poverty, Mental
Illness, and Teen Pregnancy

2. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 2
Introduction
 Four groups of vulnerable populations—the poor, the
homeless, pregnant teens, and those who are
mentally ill—present complex nursing needs
 Nurses must recognize their own beliefs about these
groups and understand the issues surrounding these
clients’ illness and/or personal situations
 To interact effectively with these groups, the nurse
must identify health care needs, barriers to care, and
essential health care services for each client and, in
some instances, for the client’s family as well

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Cultural Attitudes and Media
Communication as Factors
 Cultural attitudes are the beliefs and perspectives
that a society values; perspectives about individual
responsibility for health and well-being are influenced
by prevailing cultural attitudes
 The media communicate thoughts and attitudes
through newspapers, films, TV, art, and literature
 To understand poverty, homelessness, mental
illness, and teen pregnancy, nurses must consider
their own personal beliefs and attitudes, clients’
perceptions of their condition, and the social, political,
cultural, and environmental factors that influence the
client’s situation

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Defining and Understanding Poverty
 Poverty and homelessness have significant
effects on health status
 Definition of poverty varies depending on the
source
 The federal government defines poverty on the
basis of income, family size, age of the head of
household, and number of children younger than
18 years
 Those who are poor insist that poverty has less to
do with income and more to do with a lack of
family, friends, love, and support

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Defining and Understanding Poverty
(cont’d)
 Many complex, interrelated factors contribute to the
growing number of poor persons in the United States:
 Decreased earnings
 Increased unemployment rates
 Changes in the labor force
 Increase in female-headed households
 Inadequate education and job skills
 Inadequate antipoverty programs
 Inadequate welfare benefits
 Weak enforcement of child support statutes
 Dwindling Social Security payments to children
 Increased numbers of children born to single women

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Poverty and Health:
Affects Across the Life Span
 Higher rates of chronic illness
 Higher infant morbidity and mortality
 Shorter life expectancy
 More complex health problems
 More significant complications and physical
limitations resulting from chronic disease
 Hospitalization rates three times that for
persons with higher incomes

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Poverty and Health
 Poor health outcomes are often secondary to
barriers that impede access to health care,
such as inability to pay for health care, lack of
insurance, geographical location, language,
inability to find a health care provider,
transportation difficulties, inconvenient clinic
hours, and negative attitudes of health care
providers toward poor clients

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Effects of Poverty
 Poverty has an especially negative effect on:
 Women of childbearing age
 Adolescent women
 Children
 Older adults
 Both urban and rural communities

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Concept of Homelessness
 Difficult to know exactly how many people
are homeless; two common ways to
determine the number of homeless people:
1. Point-in-time-counts: counts the number of
people who are homeless on a given day or
during a given week
2. Period prevalence counts: counts the number of
people who are homeless over a given period of
time
 Crisis poverty
 Persistent poverty

10. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 10
Concept of Homelessness (cont’d)
 Causes of homelessness
 More people living in poverty
 Fewer affordable housing units; gentrification of
neighborhoods and consequent increased costs
for housing
 Loss of single-room occupancy buildings where
people can rent a room on a long-term basis
 Emergency demands on income
 Alcohol and drug addiction
 Limited number of transitional treatment facilities
for deinstitutionalized mentally ill individuals;
important since a sizable number of homeless
people suffer from a significant mental illness

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Concept of Homelessness (cont’d)
 Effects of homelessness on health
 Hypothermia and heat-related illnesses
 Infestations and poor skin integrity
 Peripheral vascular disease and hypertension
 Diabetes and nutritional deficits
 Respiratory infection and chronic obstructive
pulmonary diseases
 Tuberculosis (TB)
 HIV/AIDS
 Trauma
 Mental illness
 Use and abuse of tobacco, alcohol, and illicit
drugs

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Concept of Homelessness (cont’d)
 Homelessness and at-risk populations
 Pregnant women
 Children
 Adolescents
 Older adults

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Trends in Adolescent Sexual
Behavior and Pregnancy
 The provision of reproductive health care services to
teens requires sensitivity to the special needs of this
age-group, including awareness of state laws about
confidentiality and services for birth control,
pregnancy, abortion, and adoption
 Factors such as a history of sexual victimization,
family dysfunction, substance use, and failure to use
birth control can influence whether a young girl
becomes pregnant
 The pregnant teen will need support during and after
pregnancy from her family and friends and from the
father of the baby

14. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 14
Trends in Adolescent Sexual
Behavior and Pregnancy (cont’d)
 Background factors
 Sexual activity, use of birth control, and peer
and partner pressure
 Other factors
 Young men and paternity
 Early identification of the pregnant teen
 Special issues in caring for the pregnant teen

15. Copyright © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 15
Scope of Mental Illness in the U.S.
 Prevalence rates for mental health problems are very
high, and people are at risk for threats to mental
health at all ages across the life span
 Deinstitutionalization: moved many people from state
psychiatric hospitals to communities with the goal of
improving the quality of life for those persons;
however, community-based services were often not
in place and continuity of care became a problem
 At-risk populations for mental illness
 Low income and minority groups are often at increased risk
for mental illness because they may lack access to services

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Levels of Prevention
 Primary prevention
 Affordable housing, housing subsidies, effective job-training
programs, employer incentives, preventive health care
services, multisystem case management, birth control
services, safe-sex education, needle-exchange programs,
parent education, and counseling programs
 Secondary prevention
 Reducing the prevalence of pathological nature of a
condition (supportive and emergency housing, soup
kitchens, screening for depression)
 Tertiary prevention
 Restore and enhance functioning (support of affordable
housing, promotion of psychosocial rehabilitation programs)

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Role of the Nurse
 Create a trusting environment
 Show respect, compassion, and concern
 Do not make assumptions
 Coordinate a network of services and providers
 Advocate for accessible health care services
 Focus on prevention
 Know when to walk beside the client and when to
encourage the client to walk ahead
 Develop a network of support for yourself