Public Health Nursing Models
Introduction
Homelessness has become an issue of public health significance in the US and across the globe. Providing effective and accessible healthcare services to this population in today’s economic environment is a significant problem facing public health nurses. It places an enormous financial burden on taxpayers. Homeless people lack access to care and the nature of their lifestyle makes them a likely reservoir to propagate and spread infectious diseases. Public health nurses must address this issue by developing strategies to improve the care for homeless people. Orem’s self-care model provides a step by step approach to solving problems as well as a perspective to assess patient’s issues and develop strategies for nursing care. From Dorothy Orem’s perspective, homeless care increases the utilization of healthcare services by improving self-esteem, fostering dignity, and promoting efficient utilization of services.Public Health Nursing Models
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Homelessness as A Public Health Issue in the US
Although the number of homeless individuals has been decreasing gradually since the year 2010, in the year 2017, more than 550,000 were living in shelters and places not intended for habitation by humans. Homeless populations have health inequalities (Stafford & Wood, 2017). Homelessness is linked to a short life expectancy, frequent use of acute healthcare services, and high morbidity. Homeless people are less likely to access preventive and primary healthcare services, which increases the risk of diagnosis in the advanced stages of a condition, poor prognosis of chronic illnesses such as type 2 DM and hypertension. According to the findings of a survey conducted in 2016 by Perth, it was established that 71% of 307 people had visited the ED within six months on several occasions (Stafford & Wood, 2017). Similarly, data from Canada, the UK, and the US indicate a high prevalence of unplanned admissions to hospitals and ED visits by homeless individuals.Public Health Nursing Models
Dorothy Orem’s Self-care Theory
Dorothy Orem’s Self-care theory describes when and how nursing care is required to help patients who cannot meet their self-care needs. Orem acknowledges the environment and humans as one unit and strongly believes that humans and the environment as well as humans themselves have a reciprocal relationship (Kapetanovic, 2016). Other factors that influence self-care behaviors are personal characteristics, the relationship between patients and healthcare providers, beliefs, cultural and social backgrounds. Other factors include employment status, lack of knowledge, sociopolitical variables and ethnicity, and environmental factors such as pollution.
Orem’s self-care theory is associated with human needs to maintain health and recovery, inadequate/lack of access to care, and increased healthcare spending. Self-care activities help to alleviate the complications and symptoms of the disease, they decrease the duration of recovery, rates of rehospitalization, and hospital stay (Kapetanovic, 2016). Lack of self-care knowledge among homeless people is the primary reason for frequent ED visits and the utilization of acute healthcare services.
Addressing Homelessness from The Lens of Orem’s Self-Care Theory
Self-care deficit sets in when a person’s capacity and power to meet individual self-care needs are not suitable due to an illness or other health-related issues. Homeless people have a self-care deficit which hinders their ability to meet the demands of self-care and therapeutically sustain life, coping or injury. Therefore, they need nursing care. The self-care theory provides a foundational framework for public health nurses to deliver interventions that can empower health-seeking behavior among homeless people, and promote their ability to make healthy choices through collaboration and education (Kapetanovic, 2016). Basing on the self-care theoretical framework, the following are the most effective and recommended interventions that public health nurses can implement to improve care among homeless individuals.Public Health Nursing Models
Fostering self-esteem and dignity among the homeless-public health nurses can foster dignity and self-esteem among homeless individuals through developing a nonjudgmental and trusting relationship that conveys value, and respect, non-stereotyping, and treating each person as an individual. When communicating, Kapetanovic (2016) suggests that the public health nurse should follow the patient’s lead, and communicate in the individual’s primary language. If required, it is recommended to use a medical interpreter. The PHN should also practice active listening to find common themes and identify clues to their anxieties and concerns. This helps to make more definitive diagnoses that promote efficient use of services.
Collaboration- since most homeless individuals cannot access care, nurse-managed clinics, particularly those serving homeless populations can provide cost-effective solutions. The primary care providers in these centers can be NPs with prescriptive authority collaborating with other healthcare providers(Kapetanovic, 2016). Public health nurses working in case management and outreach can also liaise with the homeless and other NMHC staff. This collaboration helps to promote the participation of homeless people in programs for health promotion and health screening.
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Education-public health nurses can act as referral sources, case finders, and resources for homeless people in need of shelter. PHNs can as well as provide educational programs based on population needs. Since inadequate/lack of knowledge the ability of homeless individuals to make informed decisions or seek assistance to improve individual care, PHNs should counsel homeless people to apply for federal and state programs such as welfare, Medicaid, Medicare, food stamps, and the Supplemental Security Income (SSI) program.
References
Kapetanovic, T. (2016). Re-discovery of health self-care among homeless men and women after an incarceration experience. Journal for Evidence-based Practice in Correctional Health, 1(1), 6.
Stafford, A., & Wood, L. (2017). Tackling health disparities for people who are homeless? Start with social determinants. International journal of environmental research and public health, 14(12), 1535. Public Health Nursing Models