Minority groups 少數族群 Uninsured 無保險者 Poor or homeless 貧困或無家可歸者 Chronic illness or disabilities 慢性病或殘障者 Immigrants & refugees 移民與難民 Limited English proficiency 英語能力有限者 Incarcerated 監禁者 LGBTQIA community 多元性別族群

Start with introduction, explain role, ask permission.\

General Background Questions

Nurses must approach with nonjudgmental, nonthreatening manner.護士必須以 不批判、不威脅 的態度進行。 Focus first on reported symptoms → ↑ adherence.先處理病人自述症狀 → 提升依從性。 Subsequent care: health maintenance, common problems, emergency contacts.後續照護：健康維持、常見問題、緊急聯絡人。 Nurse self-awareness (culture, values, bias) = better outcomes.護士自我覺察（文化、價值、偏見） → 提升照護品質。 Avoid stereotyping; treat each client as individual.避免刻板印象；每位病人都是獨特的。

COVID-19 is caused by SARS-CoV-2 and affects multiple systems.COVID-19 是由 SARS-CoV-2 引起的，會影響多個系統。 High-risk groups: elderly, chronic diseases, immunocompromised, minority groups, crowded living, essential workers.高風險族群：老人、慢性病、免疫低下、少數族群、擁擠居住環境、必要工作者。 Common symptoms: cough, shortness of breath, fever, sore throat, myalgia, anosmia, GI symptoms.常見症狀：咳嗽、呼吸急促、發燒、喉嚨痛、肌肉痛、失去嗅覺/味覺、腸胃症狀。 Emergency signs: dyspnea, chest pain, confusion, cyanosis, inability to wake.緊急警訊：呼吸困難、胸痛、意識混亂、發紺、無法喚醒。 Prevention: hand hygiene, mask + eye protection, distancing, avoid crowds, cover cough/sneeze, avoid touching face, quarantine if exposed.預防：手部衛生、口罩+眼部防護、保持距離、避免人群、遮掩咳嗽打噴嚏、避免觸摸臉部、接觸後隔離。

Minority groups often lack insurance and preventive care.少數族群常缺乏保險與預防醫療。 Hispanic/Latinx: Obesity, DM, ESRD, cervical cancer.西語/拉美裔：肥胖、糖尿病、腎衰竭、子宮頸癌。 Native Hawaiian/Pacific Islander: Smoking, obesity, DM, Hepatitis B, HIV/AIDS, TB, infant mortality, SIDS.夏威夷/太平洋島民：抽菸、肥胖、糖尿病、B 型肝炎、愛滋、結核病、嬰兒死亡率、嬰兒猝死。 Native American/Alaska Native: Alcohol, smoking, DM, cancer, stroke, suicide, SIDS, teen pregnancy, hepatitis.美洲原住民/阿拉斯加原住民：酗酒、抽菸、糖尿病、癌症、中風、自殺、嬰兒猝死、青少年懷孕、肝炎。 African American: Obesity, HTN, DM, heart disease, cancer, stroke.非裔美國人：肥胖、高血壓、糖尿病、心臟病、癌症、中風。 Asian American: Cancer, TB, Hepatitis; deaths from cancer, heart disease, stroke.亞裔美國人：癌症、結核病、肝炎；主要死因：癌症、心臟病、中風。 Nursing consideration: Use professional interpreters, not family.護理要點：使用專業翻譯，不可用家人。

Barriers: Stigma, discrimination, lack of provider knowledge.障礙：污名、歧視、醫療人員缺乏知識。 Risks: Less cancer screenings, more STIs, cancer, depression, suicide.風險：癌症篩檢率低、性病高、癌症、憂鬱、自殺。 Youth: Bullying, absenteeism, abuse, victimization.青少年：霸凌、缺課、虐待、受害。 Nursing: Respect pronouns, inclusive policies, cancer/STI/depression screening, safe-sex education.護理：尊重代稱、包容政策、癌症/性病/憂鬱篩檢、安全性教育。

Risks: Limited access to care, malnutrition, infections, mental illness, substance abuse.風險：就醫困難、營養不良、感染、精神疾病、藥酒濫用。 Children: Higher asthma, anemia, GI problems, behavioral issues.兒童：哮喘、缺鐵、腸胃病、行為問題較多。 Nursing: Nonjudgmental, treat symptoms first, connect to resources, avoid addictive meds, arrange follow-up.護理：不批判、先治急症、連結資源、避免成癮藥物、安排追蹤。

Risks: Unsafe housing, poor diet, risky behaviors, low education.風險：住房不安全、飲食差、冒險行為、教育不足。 Nursing: Assess risk behaviors, education needs, refer social services.護理：評估風險行為與教育需求，轉介社工。

Risks: No preventive care, unmanaged chronic illness.風險：缺乏預防醫療、慢性病失控。 Nursing: Help access Medicaid/social services.護理：協助申請醫療補助/社會資源。

Risks: Epilepsy, GERD, constipation, aspiration, poor oral health.風險：癲癇、胃食道逆流、便秘、嗆咳、口腔問題。 Behavior may signal illness.行為改變可能代表生病。 Nursing: Safe environment, assess behaviors, treat medical first, supervise eating.護理：安全環境、行為評估、先治醫療問題、進食監督。

Victims: Elderly, women, children.受害者：老人、女性、兒童。 Effects: Bruises, fractures, PTSD, depression, substance abuse, low self-esteem.影響：瘀傷、骨折、創傷後壓力、憂鬱、藥酒濫用、自尊低落。 Nursing: Safety first, mandated reporting, documentation, wound care, support.護理：安全優先、強制通報、完整紀錄、傷口處理、支援服務。

Risks: Stress, limited resources.風險：壓力大、資源有限。 Nursing: Rapport, connect to childcare/food/healthcare, sexual development counseling for child.護理：建立信任、連結托育/食物/醫療資源、協助兒童性發展教育。

Risks: Poor physical, mental, dental care, chronic illness.風險：缺乏身心牙醫照護、慢性病。 Nursing: Frequent visits, social work, community resources, medical foster homes.護理：定期檢查、社工轉介、社區資源、醫療寄養家庭。

Risks: Poor lifestyle, med side effects (weight gain, DM, metabolic syndrome, dry mouth), ↑STIs, risky behaviors.風險：生活品質差、藥物副作用（體重增加、糖尿病、代謝症候群、口乾）、性病與危險行為增加。 Nursing: Regular screening, support services, access care, monitor meds.護理：定期篩檢、連結支援、改善就醫、監測藥物。

Risks: Elder abuse (most often neglect).風險：老人虐待（多為忽視）。 Nursing: Must report, manage multiple chronic illnesses.護理：必須通報、處理多重慢性病。

Risks: Injury, PTSD, moral injury, TBI, suicide, substance abuse.風險：受傷、創傷後壓力、道德傷害、腦外傷、自殺、藥酒濫用。

Prison environment predisposes to tuberculosis, STDs, and infectious diseases.監獄環境容易導致結核病、性病和其他傳染病。 Social determinants of poor health are often present.囚犯常見影響健康的社會因素。 Health concerns include asthma, diabetes, hypertension, heart disease, and mental health problems.健康問題包括氣喘、糖尿病、高血壓、心臟病與心理疾病。 Health care considerations 照護考量 Prison facilities are usually the sole provider of health care.監獄設施通常是唯一的醫療來源。 Screening protocols must be thorough, consistent, and regular.篩檢程序需完整、一致且定期執行。 Educational and vocational programs may help mitigate health problems.教育與職業訓練有助於減少健康問題。 History of incarceration increases risk of poor health after release.服刑史會增加出獄後的健康風險。 Failure to address mental health may lead to repeated crimes.若忽視心理健康，可能導致再犯。

Challenges include language, cultural barriers, citizenship, employment, housing, health care, transportation.挑戰包括語言、文化、入籍、就業、住房、醫療、交通。 Acculturation increases risk for poor health due to diet, risk-taking behaviors, and loss of family support.文化適應過程會因飲食不佳、冒險行為、失去家庭支持而增加健康風險。 Health concerns: infectious diseases (TB, hepatitis, influenza, COVID-19, STDs, measles, mumps, rubella, polio).健康問題：傳染病 (結核、肝炎、流感、新冠、性病、麻疹、腮腺炎、風疹、小兒麻痺)。 Refugees often face mental health issues from war, violence, rape.難民常有因戰爭、暴力、性侵引起的心理健康問題。 Health care considerations 照護考量 Services must be available regardless of insurance status.醫療服務需不論保險狀態都能提供。 Refugees may lack long-term health care coverage.難民可能缺乏長期醫療保險。 Nurses need to explore possible health care resources.護理人員需尋找可用醫療資源。 Vaccinations must be provided to prevent communicable diseases.必須提供疫苗以預防傳染病。

Chronic illness is leading cause of death and disability in U.S.慢性病是美國主要死因與致殘原因。 Includes cardiovascular disease, cancer, respiratory disease, diabetes, mental health problems, sensory impairment, oral, bone/joint disorders, genetic diseases.包括心血管疾病、癌症、呼吸病、糖尿病、心理疾病、視聽障礙、口腔、骨關節病、遺傳病。 Poor health outcomes and high costs are associated.與不良健康結果與高醫療成本相關。 Many professionals feel unprepared to manage multiple chronic illnesses.許多醫療人員覺得準備不足以應對多重慢性病。 One chronic illness increases risk for multiple illnesses.一種慢性病會增加多重慢性病風險。 Modifiable factors: diet, inactivity, tobacco.可改變因素：飲食不佳、缺乏運動、菸草使用。 Nonmodifiable factors: age, genetics.不可改變因素：年齡、遺傳。 Health care considerations 照護考量 Follow-up care is important.追蹤照護很重要。 Managing multiple illnesses requires big-picture approach.處理多重疾病需有整體觀。 Interprofessional collaboration is key.跨專業合作是關鍵。 Nurses facilitate communication among providers.護理師需協調醫療溝通。 Include client and family in decision-making.將病人與家屬納入醫療決策。