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Week 3 Nursing Practicum Assignment

For this practicum assignment, you will identify a vulnerable, at-risk population in your community. You will examine the challenges currently facing members of this group and the resources available to assist them. You will gather information from a variety of sources. A vulnerable or at-risk population can be defined as a population with a commonly identified risk factor or risk exposure presenting a threat to health. Examples of at-risk populations include, but are not limited to the following:

For this practicum assignment, you will identify a vulnerable, at-risk population in your community. You will examine the challenges currently facing members of this group and the resources available to assist them. You will gather information from a variety of sources. A vulnerable or at-risk population can be defined as a population with a commonly identified risk factor or risk exposure presenting a threat to health. Examples of at-risk populations include, but are not limited to the following:

  • Urban or rural individuals and families living at or below the poverty line
  • Immigrants and non-English-speaking individuals
  • Stigmatized or marginalized groups
  • Undocumented workers
  • Incarcerated individuals
  • The homeless
  • The mentally ill
Practicum Step #1: In this assignment, you will
  1. Identify your vulnerable, at-risk population of interest.
  2. Complete a needs assessment using the attached worksheet.
  3. Use this document. Do not change the formatting. This is not a formal, APA style research paper, although you are expected to cite sources using APA 7th edition as needed.
Practicum Step 2: In this assignment, you will
  1. Use your assessment data worksheet from step 1 to identify significant health disparities in your at-risk group.
  2. Research and propose recommendations to decrease one of these disparities.
  3. Write a minimum 2-page (500 word) paper in the form of a proposal to area leaders to address the disparity in your community. Your proposal should include:
  • A description of the disparity.
  • The influence the disparity has on healthcare systems and resources.
  • Recommendations to address the problem.
  • Any graphs or charts in your document that are needed to support your proposal.

Requirements: .doc file.

Week 3: Needs Assessment

Provide an overview of the at-risk group you are investigating and its presence in your community. Provide any available demographic data. Why are you interested in studying this group? Complete the following chart. Be as specific to your community (city or county) as possible. Common sources of data include US Census data, Chamber of Commerce, community libraries, social service agencies, the US Department of Labor, the Department of Public Health, and the Department of Education. Needs Assessment Assessment Data for the At-risk Group Environment/Living ArrangementsAccess to TransportationFinancial considerations cultural/language barriersPublic perception of the group common health risk access to health and social services based on the information you gathered and what you find in the literature, address the following questions: What are the primary health concerns for this group? How does the care provided to this population differ from the care provided to other populations? Explain how health inequalities impact healthcare access and delivery for this group. What impact does this under-served population have on the healthcare delivery systems in your area? How might this affect nursing practice?

Health Disparities among the Homeless

Student Name

Institutional Affiliation

Needs AssessmentAssessment Data for the At-risk Group
Environment/Living ArrangementsHomelessness levels in America have hit the highest levels since the great depression due to the high housing cost. According to the housing and urban development department, an average of 0.17% of Americans are homeless (“Housing and shelter,” 2020). 35% of the homeless people in America are unsheltered and sleep in open spaces, while 65% of the homeless live under various shelter programs. However, the homeless shelters’ living conditions are not conducive, with several homeless people describing them as cold warehouses filled with beds. Therefore, most homeless people face poor living conditions and are prone to various physical and mental health conditions regardless of whether they live in a shelter or the streets.
Access to TransportationMost homeless people are unable to access transport services in America due to the high cost of transportation. According to Murphy, the high cost of transport is one of the primary factors preventing individuals’ upward mobility from homelessness (Murphy, 2019). Homeless people experience a transport disadvantage, limiting their access to education, healthcare, social services, and employment opportunities. Although it is under-researched, transport is a critical variable to homeless people and should thus be given more attention as a basic necessity.
Financial considerationsHomeless people are mainly unable to participate in most day to day activities due to financial constraints. With no programs to assist homeless people in accessing financial assistance, it is tough for them to improve their economic situation. Thus, they struggle with accessing basic amenities. Most homeless shelters also accommodate people for a maximum of 24 months. The shelter then forces them to leave regardless of whether they have gotten employment, and their financial status has improved. Most homeless people being unable to afford a home, end up taking on more debt, thus worsening their financial situation.
Cultural/language barriersHomeless people from culturally diverse backgrounds are likely to remain homeless because of language and cultural barriers (“Cultural diversity & homelessness,” n.d.). Homelessness has also led to the erosion of specific cultures as it is not easy to follow some of the cultural requirements while living in shelters and the streets. In Muslim culture, young women should not stay in the same room as men. Therefore, a homeless young Muslim woman is culturally not allowed to stay in a shelter because it goes against her Muslim culture.
Public perception of the groupThe general public often views homeless people as drug addicts and mentally challenged people (Agans & Liu, 2015). The image significantly reduces homeless people’s participation in ordinary people’s activities as they are ostracized and discriminated against by other society members. However, research has shown that the highest percentage of homeless people are drug and alcohol abusers, followed by people suffering from mental health issues.
Common health risksHomeless people are at more risk of contracting diseases like diabetes, heart diseases, and HIV/AIDs. The poor living conditions and the environment in which homeless children grow up also affect their health, thus increasing the risk of contracting common health issues. According to the state department of housing and development, 16% of homeless people are likely to contract mental health issues (“National survey of substance abuse treatment services (N-SSATS),” 2015). In contrast, a considerable percentage of homeless people are likely to contract hypothermia due to a lack of a blanket to keep themselves warm in the cold season. Other common health risks to homeless people include infectious diseases like hepatitis and tuberculosis, limiting the accessibility of homeless people to healthcare.
Access to health and social servicesAccording to Bagget, 2.3 million to 3.5 Americans experience homelessness and thus have poor access to social and healthcare services (Baggett et al., 2010). The low access to health care and social services is the primary contributor to the high mortality rate. The rates of acute, chronic illness among homeless people are also very high, with homeless people having six times as many chronic disease cases as the general population.  Two-thirds of homeless individuals have dental problems, while 40% of the homeless have issues with their visions. Access to social services like education, food, and water, as most homeless, depends on charitable organizations to help them access social services.  

Primary health concerns of the Homeless

The primary health concern for homeless people is access to chronic disease treatment since many homeless people are affected by chronic illnesses such as HIV/AIDs, lung diseases, and malnutrition. According to the National Library of medicine, access to healthcare will help homeless people rebuild their lives and homes if they get treatment (“Homeless health concerns: MedlinePlus,” n.d.). Although mental health is also a significant factor affecting homeless people, by giving them access to general healthcare, the government will lower the homeless people’s burden, thus reducing their mental stress. Giving free treatment to homeless people or making it more affordable will lessen the burden homeless people have. Therefore, the government will enable them to save more income, which they can use to stabilize their lives in the streets and homeless shelters and eventually get back to their everyday lives.

Difference between care provided to homeless people and the general population.

            Healthcare services offered to homeless people differ significantly from those provided to the general population due to the additional barriers homeless people face while accessing healthcare. According to William, homeless people have various characteristics that make it challenging to provide them with the treatment or medication they require (Williams, 2017). Some of these characteristics include an inconsistent daily schedule, making it challenging to offer a specific treatment plan. Prescription of some drugs to homeless people is not recommendable since they have different daily challenges requiring maximum alertness. Most homeless people also need specialized healthcare services due to the diversity of their needs. A homeless person can be suffering from a chronic illness, a mental illness, and be a drug addict; hence they have various requirements that need to be treated all at once. Many homeless people also lack social support structures; thus, they find it difficult to cooperate with healthcare providers.

How health inequalities impact healthcare access and delivery for homeless people

            Health inequalities are unfair and avoidable health differences between the population and different groups in society. Homelessness is a significant source of health inequality in various populations as people with homes are healthier than homeless people (Jego et al., 2019). Health inequalities make homeless people access health facilities or services when their health is at a critical point. The poor living conditions that most homeless people use to give them the tenacity to live with various forms of pain; thus, they live while sick for quite some time before accessing healthcare services.  Health inequalities have made the government give special treatment to homeless people in terms of healthcare delivery.

Impact of homeless people on the healthcare delivery systems

            The country’s homeless population has encouraged multiple private organizations to join the healthcare industry and provide affordable healthcare services. Some organizations that provide free or cheap healthcare services to the homeless include religious rescue missions, nonsectarian organizations, private-public partnership programs, and free clinics (Klop et al., 2018). Homeless people face more challenges in accessing healthcare; thus, various organizations have decided to help the government make healthcare services more affordable and bring health clinics closer to the people. Therefore, homeless people have improved the efficiency of healthcare delivery systems in the country. By making healthcare accessible to homeless people, the organizations also made healthcare accessible to everyone else.

How changes in healthcare delivery systems affect nurses’ practice.

            Well-trained and highly skilled nurses play an essential part in improving healthcare delivery systems (Mcenroe-Petitte, 2020). To have a well-functioning healthcare delivery system, nurses will have to improve their skills to handle various mental health issues to addiction. Therefore, the improvement of the healthcare delivery systems will allow nurses to grow their practice and increase their nursing experience. Nurses will also have more job opportunities as the system will require more nurses to handle homeless patients in hospitals.

Part 2

Proposal to end mental health disparity among homeless people

            Homeless people are at higher risk of developing mental illnesses as compared to the general American population. Homeless people face many challenges from inadequate finances, inability to access social amenities such as schools and hospitals, inadequate transport facilities, and low public image that makes integration into society difficult. Due to the several challenges they face living in the streets and shelters, most homeless people end up as drug addicts or with some form of mental illness. According to Peter Tarr’s research, 45% of homeless Americans were suffering from mental illnesses (Ph.D., Tarr, 2018). However, there is no direct causal relationship between homelessness and mental illness. Researchers have also proposed that having a mental illness may be why homeless individuals cannot make a stable enough income to afford permanent housing.

The graph above shows the distribution of where people with severe mental illnesses live (Nelson, n.d.).

            From the graph above, one can quickly notice that while the number of severe mental illness patients reduced in mental facilities, they increased drastically in the homeless category. More and more homeless people became mentally ill. Most homeless people do not have any family or friends on whom they can depend for social support, and thus as their mental illness worsens, they still have to survive on the streets because no one can take them to a mental facility.

            According to data from the department of health and human services, 81% of mental health facilities are privately owned, with 63% being nonprofit organizations and only 18% being for-profit organizations (“National survey of substance abuse treatment services (N-SSATS),” 2015). The disparity in mental health among the homeless in America has led to the development of and improvement of the country’s health systems by the private sector. They try to fill the gap left by the public health systems. The data depicts that the mental health sector is run mainly by private organizations.  However, the disparity has led to the scramble for resources among the organizations operating in the mental health sector as each organization tries to provide the best care for its patients.

            To address the disparity in mental health among homeless people in the country, the government should step in and provide stable homes for a minimum period of 1 year (“Health,” 2019). According to Tarr, providing mentally ill homeless people with a stable home is the first step towards stabilizing society (Ph.D., Tarr, 2018). By providing them with homes, the government will enable them to rebuild friendships and reconnect with the community. The individual efforts, coupled with training on building a connection with other people, will help reduce homeless people and people suffering from mental illnesses. After they become stable in their new environments, the governments can then offer them training that will help them develop skills to monetize and become fully functional members of society.

References

Agans P., & Liu, G. (2015). Public Attitudes toward the Homeless. Global Journal of Science Frontier Research: E Interdisciplinary15(3), 9.

Baggett, T. P., O’Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The unmet health care needs of homeless adults: A national study. American Journal of Public Health100(7), 1326-1333. https://doi.org/10.2105/ajph.2009.180109

Cultural diversity & homelessness. (n.d.). Homepagelessness NSW Inc. https://www.homelessnessnsw.org.au/resources/cultural-diversity-homelessness

Health. (2019, March 5). National Alliance to End Homelessness. https://endhomelessness.org/homelessness-in-america/what-causes-homelessness/health/#

Healthcare transformation and changing roles for nursing. (, 2017). Orthopaedic Nursing36(1), 26-27. https://doi.org/10.1097/nor.0000000000000320

Hensel, F. J. (2017). Towards better health: Improving access to health care for homeless people. Deutsches Aerzteblatt Onlinehttps://doi.org/10.3238/arztebl.2017.0663

Homeless health concerns: MedlinePlus. (n.d.). MedlinePlus – Health Information from the National Library of Medicine. https://medlineplus.gov/homelesshealthconcerns.html

Housing and shelter. (2020, April 15). SAMHSA – Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/housing-shelter

Jego, M., Abcaya, J., Calvet-montredon, C., & Gentile, S. (2019). Improving health care management in primary care for homeless people: A literature review. European Journal of Public Health29(Supplement_4). https://doi.org/10.1093/eurpub/ckz186.005

Klop, H. T., Evenblij, K., Gootjes, J. R., De Veer, A. J., & Onwuteaka-Philipsen, B. D. (2018). Care avoidance among homeless people and access to care: An interview study among spiritual caregivers, street pastors, homeless outreach workers, and formerly homeless people. BMC Public Health18(1). https://doi.org/10.1186/s12889-018-5989-1

Lamanna, D., Stergiopoulos, V., Durbin, J., O’Campo, P., Poremski, D., & Tepper, J. (2017). Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions. Health & Social Care in the Community26(1), 56-64. https://doi.org/10.1111/hsc.12461

Mcenroe-Petitte, D. M. (2020). Caring for patients who are homeless. Nursing50(3), 24-30. https://doi.org/10.1097/01.nurse.0000654600.98061.61

Murphy, E. R. (2019). Transportation and homelessness: A systematic review. Journal of Social Distress and the Homeless28(2), 96-105. https://doi.org/10.1080/10530789.2019.1582202

National survey of substance abuse treatment services (N-SSATS). (2015). ICPSR Data Holdings. https://doi.org/10.3886/icpsr34539

Nelson, A. (n.d.). Graphics: Mental illness and homelessness. Development Roast. https://inesad.edu.bo/developmentroast/2013/01/graphics-mental-illness-and-homelessness/

Ph.D., Tarr, P. (2018, November 19). Homelessness and mental illness: A challenge to our society. Brain & Behavior Research Foundation. https://www.bbrfoundation.org/blog/homelessness-and-mental-illness-challenge-our-society

Williams, J. C. (2017). The politics of homelessness in the United States. Oxford Handbooks Onlinehttps://doi.org/10.1093/oxfordhb/9780199935307.013.153

(“Healthcare transformation and changing roles for nursing,” 2017)

(Hensel, 2017)

 (Lamanna et al., 2017)

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