The Health Resources & Services Administration (HRSA) defines the term underserved within the context of healthcare delivery as, "areas or populations designated by HRSA as having too few primary care providers, high infant mortality, high poverty, or a high elderly population. Health professional shortage areas (HPSAs) are designated by HRSA as having shortages of primary medical care, dental, or mental health providers and may be geographic (a county or service area), population (low income or Medicaid eligible) or facilities (federally qualified health center or other state or federal prisons)."1 The populations and communities noted are also commonly described as vulnerable and by no means are all-inclusive. Individuals do not achieve optimal health outcomes because of health disparities, which can be partially attributed to the impact of one or more identified social determinants of health that prevail in their environments. The COVID-19 pandemic highlighted the health disparities experienced across the nation in marginalized (another related term) communities.
Nurses as safety net providers
Nurses have traditionally provided healthcare services to underserved, vulnerable, and marginalized groups in the US, acting as safety net providers to increase access to high quality healthcare for many. From Lillian Wald and the Henry Street Settlement (HSS) visiting nurse service to Mary Breckinridge and Frontier Nursing Service, and then on to Loretta Ford and the NP role, nursing has been there.2 I was privileged to work in several service areas at the HSS during my career through an HRSA-funded grant to provide primary care services in nontraditional settings-child care center, adolescent after-school program, older adult daycare, and older adult home services. The HSS is a real testament to the power of nursing innovation and intervention. Now, in the preferment of my professional career, I am practicing per diem in an established traditional federally qualified health center (FQHC) with additional exposure in a family shelter. Patients present with common complaints seen in primary care but complicated by the impact of multiple challenges stemming from the social determinants of health over which patients may have little control; they are earnestly struggling to survive. Working within multidisciplinary teams facilitates more effective and efficient care, and FQHCs typically have professional staff who are educated, trained, and skilled in addressing the social issues in patients' lives. The NP must acknowledge the aforementioned issues and incorporate ways to address them in the medical plan.
Special issue articles
The Nurse Practitioner journal editorial team is pleased to present a special issue on underserved communities this month. Topics of four articles address different populations and health issues related to care for the underserved. Rebecca Carron, PhD, RN, FNP describes an intervention using community-based participatory research to improve care for American Indians/Alaska Natives with type 2 diabetes mellitus. Leslie Miles, DNP, PMHNP-BC and co-authors discuss the importance of addressing the physical healthcare needs of patients with mental illness. Donna M. Zucker, PhD, RN, FAAN and co-authors present different examples from NPs who provide care to incarcerated persons in different settings and models. And finally, Kathleen A. Bykowski, BA, BScN, RN provides insight into the management of hypertension in rural populations in Canada. Many NPs have experience working with the underserved, and sharing what these populations and communities need is important in our understanding of how we as a profession can move the system toward greater health equity and improved outcomes, or simply, health for all.
Pray for Ukraine.
Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP, FAAN
EDITOR-IN-CHIEF [email protected]
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