Download Public Health Nursing

Mellanie Hopkins
March 9, 2010
 Lack a regular and adequate nighttime residence or…
 Have a primary nighttime residence that is
 A supervised shelter
 An institution that provides a temporary residence to
people that are intended to be institutionalized
 A public or private place not designed for regular
sleeping accommodations (Martins, 2008).
 More people living in poverty
 Decrease in affordable housing
 Loss of single room occupancy buildings
 Emergency demands on income
 Alcohol and drug addiction
 Limited transitional treatment facilities for
deinstitutionalized mentally ill people (Stanhope &
Lancaster, 2006).
 http://www.youtube.com/watch?v=EDQA2yCQkC4&f
eature=related
 (Health This Week, 2009)
 3.5 million people are homeless over the course of a
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year.
Half are families with children.
20% maintain full or part-time jobs.
23% of homeless are veterans
50% of homeless women and children become
homeless as a result of domestic violence.
 3% report having HIV/AIDS
 26% report acute health problems such as TB,
pneumonia, or sexually transmitted diseases
 16% of single adult homeless population have serious
mental illness (Stanhope & Lancaster, 2006).
 Homeless adults have a mortality rate 4 times that of
the general population.
 Average life span of a homeless person=45 years (CDC,
2010).
 Infestations and skin ailments
 PVD and hypertension
 Diabetes and malnutrition
 Respiratory infections and COPD
 Trauma
 Mental illness
 Substance abuse
 Communicable diseases
 TB, HIV/AIDS, STDs (Stanhope & Lancaster, 2006).
 Increase proportion of people with health insurance.
 Increase proportion of people who have a specific source of
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ongoing care.
Reduce the number of families that experience difficulties
or delays in obtaining health care.
Reduce the number of homeless adults who have serious
mental illness to 19% from 25%.
Increase employment of people with serious mental illness
from 43% to 51%.
Increase the number of states from 24 to 50 that have
screening, crisis intervention, and treatment services for
older adults (Stanhope & Lancaster, 2006).
 Homeless use tremendous energy on obtaining food,
shelter, and a place to rest (Nickasch & Marnocha,
2009).
 Implement neighborhood education and interventions
that promote health among people most at risk of
becoming homeless (Schanzer, Cominguez, Shrout &
Caton, 2007).
 Homelessness is associated with numerous risks that
expose people to communicable infections which may
spread among the homeless and lead to serious public
health concerns (Badiaga, Raoult & Brouqui, 2008).
 For the homeless, health care is crisis oriented and
usually found in emergency departments (Stanhope &
Lancaster, 2006).
 Vaccination against hepatitis B virus, hepatitis A virus,
influenza, Streptococcus pneumoniae, and diptheria
 Distribution of free condoms.
 Improvement of clothing and bedding hygiene.
 Provide disease prevention education in areas heavily
populated with homeless (Badiaga, Raoult & Brouqui,
2008).
 Screening for TB in shelters.
 Mental health screening in shelters and homeless
areas.
 Use of ivermectin for scabies and body lice.
 Scabies and body lice infestations lead to pruritus which
may result in bacterial superinfections (Badiaga, Raoult
& Brouqui, 2008).
 Providing services and treatment directly to the
homeless individual’s location (Drury, 2008).
 Provide access to medication in homeless
neighborhoods for patients requiring consistent
pharmacological treatments.
 Social triaging
 Instead of being triaged by health care needs, homeless
may be triaged according to the ability to pay.
 No system in place for health care of the homeless
 Being labeled and stigmatized
 Being treated with disrespect
 Homeless feel invisible to health care providers
(Martins, 2008).
 Patients who have no place to rest, bathe, cook, or
store medicine require creative care planning.
 Tailor education to targeted populations focused in
areas where homeless reside.
 Draw on a person’s strengths and inner resources.
 Emphasize full participation by the individual (Billings
& Kowalski, 2008).
 Homeless individuals feel they are not in control of
their health needs.
 Healthcare providers must be aware that basic physical
needs must be met before trying to address health
related concerns (Nickasch & Marnocha, 2009).
 Homeless people deserve respect while seeking health
care.
 Nurses need to build on the strengths and inner
resources of the homeless rather than try to overcome
their problems (Martins, 2008).
 Badiaga, S., Raoult, D., & Brouqui, P. (2008). Preventing
and Controlling Emerging and Reemerging
Transmissible Diseases in the Homeless. Emerging
Infectious Diseases, 14(9), 1353-1359.
doi:10.3201/eid1409.080204.
 CDC/National Center for Health Statistics. The Homeless.
Center for Disease Control. Retrieved February 27,
2010, from http://www.cdcnpin.org/scripts/
population /homeless.asp.
 Drury, L. (2008). From homeless to housed: caring for
people in transition. Journal Of Community Health
Nursing, 25(2), 91-105. Retrieved from MEDLINE
database.
 Health This Week (2009, May 20). Health care for the
homeless. (Video file). Video posted to
http://www.youtube.com/watch?v=EDQA2yCQkC4&f
eature=related.
 Martins, D. (2008). Experiences of Homeless People in the
Health Care Delivery System: A Descriptive
Phenomenological Study. Public Health Nursing,
25(5), 420-430. doi:10.1111/j.1525-1446.2008.00726.x.
 Nickasch, B., & Marnocha, S. (2009). Healthcare
experiences of the homeless. Journal of the
American Academy of Nurse Practitioners, 21(1), 3946. doi:10.1111/j.1745-7599.2008.00371.x.
 Office of Disease Prevention and Health Promotion. Community
Setting and Select Populations. Healthy People 2010. Retrieved
February 22, 2010, from http://www.healthypeople.gov
/Document/HTML/Volume1 /07Ed.htm#_Toc490550859.
 Schanzer, B., Dominguez, B., Shrout, P., & Caton, C. (2007).
Homelessness, Health Status, and Health Care Use. American
Journal of Public Health, 97(3), 464-469.
doi:10.2105/AJPH.2005.076190.
 Stanhope, M. & Lancaster, J. (2006). Foundations of nursing in the
community: Community-oriented practice (2nd ed.) St. Louis:
Mosby.
 Zrinyi, M., & Balogh, Z. (2004). Student Nurse Attitudes Towards
Homeless Clients: A Challenge for Education and Practice.
Nursing Ethics, 11(4), 334-348. doi:10.1191/0969733004ne707oa.