Leininger’s Theory of Culture Care states that “Care is the essence of nursing and the central, dominant and unifying focus of nursing (2002). ” Leininger observes that culture is linked to every individual and that the purpose of “care, is to provide culturally congruent care to people of different or similar cultures to maintain or regain well-being and health or face death in a culturally appropriately way (2002). ” Even if that culture is the homeless. According to de Chesnay (2008), “Vulnerable populations are those at risk for poor physical, psychological, or social health.
Anyone can be vulnerable at any given point in time as a result of life circumstances or response to illness or events” (2008 pg. 3). In this paper I will focus on the homeless population their assessment, Healthy People 2020 recomendations and intervention strategies for this group. The homeless have the highest level of exposure to social and environmental risk factors. This population is at risk for severe deprivations such as hunger and lack of adequate hygiene and victimization such as physical assault, robbery, and rape.
Approximately one-third to two-thirds of homeless people are subjected to crime. Sexual assault rate also is higher in homeless population than in the general population. Lack of a protective and safe home, living in unfamiliar environments, and increased vulnerability from mental illness or drug-related problems are the reasons for their traumatic life events. Homeless children growing up in shelters and without a stable home often have unmet educational, social, and emotional needs (Levinson, 2004).
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Heath risk factors facing the homeless include and are not limited to lack of insurance, permnent shelter, lack of transportation, Where are the homeless living ? NHCHC (2010) ? Homeless youth rely on themselves or peers for survival and for this reason they engage in illegal activities and risky behaviors such as theft, panhandling, drug dealing, and exchanging sex for food, money, and shelter. Lack of safe environment during adolescence and experiences of trauma contribute to mental illness, substance use, and risky behaviors. Approximately 20% of homeless children do not attend school.
Disruption of learning, teacher, and peer supports results from frequent moving associated with homelessness and lead to poor academic achievement in homeless children. Overcrowded living arrangements in shelters result in high infection rates in homeless people. Poor nutrition may result from limited access to cooking facilities and food. Homeless people living in the street have high exposure to cold and hot weather (Levinson, 2004). Healthy People 2020 Objectives ?The goals of Healthy People 2020 homeless population include achieving health equity, eliminating disparities, and improving the health of all groups.
Homeless people have high risk for negative health consequences. They have more chronic diseases, mental illness, and substance abuse problems. Poverty and lack medical insurance prevent them from obtaining needed health services (Kidder, Wolitski, Campsmith & Nakamura, 2007). Financial and nonfinancial barriers prevent them from accessing the needed services. Nonfinancial barriers include mistrust of health care providers, lack of access to primary care provider, and assault victims’ fear of reporting of assault when seeking treatment.
The strategies to eliminate these barriers include education of health care workers about the importance of non-stigmatizing attitudes toward homeless people, primary prevention of physical assault, and establishment of special programs to provide primary care for homeless patients (Hwang, Ueng, Chiu, Kiss, Tolomiczenko, Cowan, Levinson, & Redelmeier, 2010). Treating homeless patients equally with respect will help health care workers to create a trusting relationship with them, which in turn eliminate their hesitancy to seek help and improve their health outcomes.
Plan of Care and Interventions ? A plan of care for homeless clients will need to be performed and communicated to team members that can support care. Assessing patient by collecting the data is the first step and will help to determine thy type and depth of nursing that is needed. The nursing diagnosis and plans with rationale of the sign and symptoms presented y will help to formulate a plan that is effective to meet the patient’s therapeutic self care demands and overcome the self care deficits pertaining to knowledge deficit.
Nurses can help educate homeless patients, shelter staff and others directly involved with them about prevention, care and management of chronic illnesses, as well as how to access the healthcare services they need (Cotton & Roden, 2006). Community nurses work in homes and places of employment. They have skills and expertise that they can use to implement health promotion strategies that will be sustainable and have enduring outcomes for individuals (Cotton and Roden, 2006). Homeless people use emergency rooms and psychiatric hospitals as there doctors so when they are admitted, Nurses need to identify the homeless during the admit process.
Nurses can work collaboratively with the social work department to help them with necessary resources to control disease, maintain treatment or preventative measure to prevent further deterioration of health on discharge. Educating the homeless families and hospital staff about preventing chronic illnesses is crutial for supporting this population. Community Nurses can teach health promotion strategies. Identify the at risk when Emergency room or Psychiatric department visits are made. Be aware of the patients emotional, physical and psychiatric health to help in holistic care.
Advocate for longer hospital stay if necessary for holistic care to be achieved. Homeless families and children have many health risks and nursing care needs that can be addressed once contact and an assessment is complete. For example, for the nurse admitting homeless family members to hospital, such knowledge pertaining to their emotional, physical and psychological needs and strengths is an important aspect that assessment techniques can bring out so they are addressed. (Cotton & Roden, 2006). References Johnson, D. J. (2001). Understanding culture, learning cultural competence.
American Public Health Association. Retrieved from http://apha. confex. com National Health Care for the Homeless Council. (2010). Addressing cultural and linguistic competence in the homeless setting. Retrieved from http://www. nhch. org Cotton, A. H. , & Roden, J. (2006, December). Using patterns of knowing in nursing as a possible framework for nursing care of the homeless families with children.. Contemporary Nurse: A Journal for the Australian Nursing Profession, 23(2), 331-341. Hwang, S. W. , Ueng, J. , Chiu, S. , Kiss, A. , Tolomiczenko, G. , Cowan, L. , Levinson, W. , & Redelmeier, D. 2010). Universal Health Insurance and Health Care Access for Homeless Persons. American Journal of Public Health, 100(8), 1454-1461. doi:10. 2105/AJPH. 2009. 182022. Kidder, D. P. , Wolitski, R. J. , Campsmith, M. L. , & Nakamura, G. V.. (2007). Health Status, Health Care Use, Medication Use, and Medication Adherence Among Homeless and Housed People Living With HIV/AIDS. American Journal of Public Health, 97(12), 2238-45. Retrieved December 4, 2010, from ABI/INFORM Complete. (Document ID: 1392878511). Levinson, D. (2004). Encyclopedia of Homelessness. Thousand Oaks, CA: Sage Publications. 8
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