For the purposes of this course guide, only a few vulnerable aggregates have been selected for discussion. You are encouraged to extend your thinking beyond this preliminary list to include the kinds of clients you meet or expect to meet in your own practice. As you read the scholarly papers posted in the forum, further issues related to vulnerable aggregates will emerge.
New mothers, perhaps more than any other aggregate, look to Registered Nurses for support and guidance throughout their pre- and post-natal experiences. Opportunities to promote mental health exist in childbirth education classes, inpatient care throughout the birthing process, and pre-school vaccination clinics. One notable example is the primary prevention strategy mentioned previously where television advertisements promoting entirely substance free pregnancies are hoped to deter the onset of Fetal Alcohol Syndrome (FAS).
According to the Pacific Post Partum Support Society (http://www.postpartum.org/), both in Canada and internationally, an estimated one out of every six women experiences troubling depression or anxiety after the birth or adoption of a child. This is referred to as postpartum depression and can be a tremendously stressful time for the family. Many factors contribute to a difficult postpartum adjustment or depression including sleep deprivation, financial stress, grief over an unexpectedly difficult birth, a traumatic family history, and the high expectations of the mother and the society in which she lives. Instruments such as the Edinburgh Postnatal Depression Scale can help nurses identify potential problems and facilitate help through prompt referral and follow up.
Children and Adolescents
Knowing the differences between normal developmental milestones and psychopathology are essential when helping children and their parents. For example, repeated incidents of behaviours such as intentionally setting fires or maliciously hurting animals or other children are NOT normal. Research suggests that children who experience major losses, such as death or divorce, are at risk for the development of psychopathology (Boyd, 2008). Similarly, children whose parents engage in unhealthy lifestyles are also at risk. Issues of attachment with parents or significant others often emerge with younger children. Issues of seeking identity and independence through high risk behaviours such as drug use, unprotected sex, and delinquent behaviours often emerge with adolescents. Adolescents are considered an at risk population for suicide. Telephone hot lines are valuable resources for children and adolescents.
Recent advances in the psychiatric field, many of which are controversial, have created diagnostic “labels” for behaviours previously often considered simply a “phase” or “just part of growing up.” Standardized data collection instruments that involve parents, teachers, health professionals and the children themselves can assist with diagnosis and differentiating patterns of aberrant behaviour from isolated incidents of mischief.
DSM IV classification distinguishes among childhood disorders through categories such as developmental, externalizing, internalizing, and “other” behaviour. Developmental categories include Mental Retardation (below-average intellectual functioning as evidenced by an IQ score under 70) and Pervasive Developmental Disorders (PDD) including communication and learning disabilities. Autism, one common PDD, is a long-term disability where individuals seem detached and experience profound difficulty engaging and interacting with others. Children with autism often engage in repetitive behaviours such as incessant head banging.