Homeless in New York Discussion Paper

Introduction

Homeless is a major public health concern. As a multidimensional problem, homeless harms the health of both the persons who are homeless and the general public. The many communicable diseases that homeless persons can contract could result in outbreaks that later turn into serious hazards for the public health. This is a sobering fact for the health care personnel with evidence suggesting that appropriate interventions could help in preventing and controlling the spread of diseases (Luchenski, 2018). A review of demographic data for New York City reveals that in April of 2020, there were about 60,422 homeless persons in the city who include 20,494 children and 13,861 families (Coalition for the Homeless, 2020). The prevalence of physical ailments to include infectious diseases among this population is approximately 44%. The average life expectancy in the USA is 78 years while the average life expectancy of homeless persons is 44 years. All homeless persons are spiritually, psychologically, socially and physically vulnerable, and they experience higher rates of suicide, homicide and violence than persons who are housed. Older adults, women and children are the most vulnerable in this populations (Lee & Donaldson, 2018). The homeless population presents a nursing care concern with regards to poor adherence to discharge instructions. This contributes to burnout among nurses as well as increased levels of frustration and powerlessness. Some nurses understand that this population has unique needs and they leverage their position to improve their health care. However, their efforts are limited by the fact that these nurses do not understand the personal beliefs and values of the homeless persons so that they (nurses) end up prescribing medication and offering professional advice without comprehending their (homeless persons) lifestyle (Rae & Rees, 2015). The present paper proposes a project that makes use of street outreach strategy among nurses serving homeless persons in the Bronx borough of New York City as the strategy for improving health care outcomes among the population. The objective of the project is to leverage nursing resources to ensure the efficient delivery of health care among the population of homeless persons in New York City.

Goal statement

The project will leverage nursing resources to target homeless persons in the Bronx borough of New York City. The nurses engaged in the project will make use of street outreach strategy. This will help in building rapport with the patients as they are met where they are most comfortable. The homeless and nurses can be considered as cultural strangers who avoid each other on normal occasions because of mutual fears. This has resulted in nurses offering treatment and professional advice without the medical facilities (clinics and hospitals) without understanding the lifestyle of the homes or knowing where they live. This makes it difficult for the homeless to adhere to the discharge instructions. Street outreach strategy is anticipated to reverse this trend through enabling nurses to offer a personalized care plan that each patient can easily adhere to for the best care outcomes (Lee & Donaldson, 2018).

Project objectives

The project will assign nurses to patients identified as homeless persons. The nurses will then use street outreach strategy to understand the conditions particular to each patient. This strategy will enable the nurses to take enough time and exercise patience in developing a nonjudgmental and trusting relationship that conveys value, dignity and respect with the patients.  Homeless in New York Discussion Paper

Two objectives have been identified for the project. Firstly, the selected nurse personnel will pilot and evaluate the use of the strategy (street outreach strategy) targeted at homeless persons within the defined geographical area resulting in a 50% increase in adherence to discharge instructions. Secondly, improve health care outcomes among the targeted homeless persons resulting in 70% reduction in the need to visit medical facilities.

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Homeless persons are identified as living in places not designed for habitation, such as train and bus stations, car parks, stairwells, tents, parks and doorways. They have the poorest health outcomes in the society and their numbers are increasing. They are socially excluded and their circumstances makes it difficult for them to adhere to discharge instructions (Kearns et al., 2015). In fact, they are 10 times more likely to be re-hospitalized than the general population. They typically rely on emergency rooms and facilities that serve the poor to obtain the needed health care services. They are more susceptible to certain medical conditions, have greater difficulty in accessing health care when needed, and are harder to treat than other populations, all because they do not have a home (Health Quality Ontario, 2016). There are significant barriers that hinder their access to health care, to include inflexible appointment and registration rules, competing priorities even as they struggle to survive on the streets, and negative attitudes of medical personnel. This results in about 33% of treatable conditions among the population worsening to result in either disability or death (Dorney-Smith et al., 2018). Street outreach strategy by nurses can help to address this concern though bringing nursing services directly to homeless patients thereby providing an approach face of health care and ensuring that this underserved population receives medical care (Lamb & Joels, 2014). The street outreach approach is an assertive strategy that locates the patients discharged from hospital, builds a relationship in their ‘home’ environment, and supports them to engage with nursing services (Szeintuch, 2015). The strategy is based on the principle of making patients comfortable by meeting them in the environment where they exist existentially and physically, and respecting their experiences, preferences and needs. This is expected to personalize nursing care delivery so that patients are more receptive to health care and observe the discharge instructions (Ungparkon & Rae, 2019).

Methodology

The project intends to apply a philosophy of mixed methodology in which quantitative and qualitative elements will be includes. The methodology will participatory action principles within a community health nurse model as identified by Goeman, Howard and Ogrin (2019). The participatory action principles focus on involving the community to understand their world and ensure that the nursing services are appropriate for their needs. In this instance, the community health model will be co-located with a facility providing medical services in the Bronx borough area of New York City. The program will recruit three nurses who will provide nursing services to homeless patients through the street outreach framework. The recruited nurses will serve homeless patients who reside within a five-block radius of the medical facility. The program expects that homeless persons residing within the area covered by the program will be high users of the nursing services. The recruited nurses will focus on meeting the specific health care needs of the homeless persons who do not access mainstream nursing services. In this project, the community health model will fill a gap by offering a flexible nursing care response to homeless persons. The specific nursing services provided by the program will included emotional support and primary care such as patient education and wound care (Goeman, Howard & Ogrin, 2019).

Resources

The program will require access to the (EHR) electronic health records to identify the homeless persons who live within the area covered by the program. In addition, the EHR will identify some of the common health care problems affecting this population, the challenges they face, as well as monitoring the changes in their health status. Besides that, the program will make use of a standard patient needs assessment tool to understand the specific nursing care needs of this population. Also, the program will recruit three nurses who will apply the street outreach strategy in offering personalized nursing care services to the recruited homeless patients.

Formative evaluation

Formative evaluation will be conducted to during the project’s implementation with a focus on improving the performance and design of the project. Two formative evaluation approaches will be applied. Firstly, interactive evaluation will be conducted during the project implementation to improve its design even as it is rolled out. This is a continuous improvement approach that makes use of a project diary, focus group and semi-structured interviews with participants to identify the project aspects that can be improved. Secondly, monitoring evaluation will be conducted during the project implementation to ensure that the activities conducted in the project are effectively and efficiently delivered. This evaluation makes use of observation, dartboard, questionnaire, and time tracking (Moran, Burson & Conrad, 2014).

Summative evaluation

Summative evaluation will be conducted to determine the impact of the project on homeless persons who are the target group. This will determine what the project has achieved in terms of its objectives. It will be undertaken at the end of the project to assess whether the project met its goals and objectives, if there were unintended consequences and benefits, what was learnt, and how to improve in future projects. The summative evaluation will collect two data types. The first data type is qualitative data that is collected through health care outcomes and focus group discussions. The second data type is quantitative data that is collected through questionnaires and counts (Moran, Burson & Conrad, 2014).

Timeline

Eight activities have been identified as critical for the successful implementation and conclusion of the project. The first activity is to finalize the project implementation details. This will be completed in the first week. The second activity is to determine the geographical boundaries of the project in terms of the area in which the homeless patients will be recruited. This will be conducted in the first week. The third activity is to recruit the nurses and patients who will participate in the project. This will be conducted in the second week. The fourth activity is to acquire the resources for the project to include access to the EHR and a standard patient needs assessment tool. The fifth activity is to rollout the project. This will be conducted over seven weeks, beginning in the third week and ending in the ninth week. The sixth activity is to conducted formative evaluations and make adjustments to the project design. This will be conducted weekly over five weeks, beginning in the fourth week and ending in the eighth week. The seventh activity is summative evaluation. This will be conducted over two weeks, beginning in the tenth week and ending in the eleventh week. The final activity is submission of findings and recommendations that will be conducted in the eleventh week (see Table 1).

References

Coalition for the Homeless (2020). Basic Facts About Homelessness: New York City. https://www.coalitionforthehomeless.org/basic-facts-about-homelessness-new-york-city/

Dorney-Smith, S., Schneller, K., Aboim, S., Radcliffe, M., Tanner, N., Ungparkon, R., O’Brien, R., & Hall, A. (2018). Meeting the healthcare needs of people experiencing homelessness. Nursing Standard, 34(1), 27-34. https://doi.org/10.7748/ns.2018.e11155

Goeman, D., Howard, J., & Ogrin, R. (2019). Implementation and refinement of a community health nurse model of support for people experiencing homelessness in Australia: a collaborative approach. BMJ Open, 9(11), e030982. https://doi.org/10.1136/bmjopen-2019-030982

Health Quality Ontario (2016). Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review. Ontario Health Technology Assessment Series, 16(9), 1-50.

Kearns, A., Whitley, E., Tannahill, C., & Ellaway, A. (2015). Loneliness, social relations and health and well‐being in deprived communities. Psychology, Health and Medicine, 20(3), 322–344. https://doi.org/10.1080/13548506.2014.940354

Lamb, V., & Joels, C. (2014). Improving access to health care for homeless people. Nursing Standard, 29(6), 45-51. https://doi.org/10.7748/ns.29.6.45.e9140

Lee, W., & Donaldson, L. (2018). Street Outreach Workers’ Understanding and Experience of Working with Chronically Homeless Populations. Journal of Poverty, 22, 5, 421-436. https://doi.org/10.1080/10875549.2018.1460737

Luchenski, S., Maguire, N., Aldridge, R., Hayward, A., Story, A., Perri, P., … & Hewett, N. (2018). What works in inclusion health: overview of effective interventions for marginalised and excluded populations. The Lancet, 391(10117), 266–280.

Moran, K., Burson, R., & Conrad, D. (Eds.) (2014). The Doctor of Nursing Practice Scholarly Project: A Framework for Success. Jones & Bartlett Learning, LLC.

Rae, B., & Rees, S. (2015). The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care. Journal of Advanced Nursing, 71(9), 2096–2107. https://doi.org/10.1111/jan.12675

Szeintuch, S. (2015). Street work and outreach: A social work method? British Journal of Social Work, 45, 1923–1934. https://doi.org/10.1093/bjsw/bcu103

Ungparkon, R., & Rae, B. (2019). Health‐related street outreach: Exploring the perceptions of homeless people with experience of sleeping rough. Journal of Advanced Nursing, 76(1). https://doi.org/10.1111/jan.14225

Project-Pick an evidence base issue of Homelessness in New York.
(must be able to be accomplish by a student)
Thank you so much for your help

1. Title: The title should include the name of your project and should follow the Uniform Guidelines format.

2. Introduction: The introduction includes the purpose of the paper, the goal of the project, and the name of the project. It also outlines the structure of the paper.

3. Goal statement: A goal statement identifies what you expect to accomplish, the focus area, and the population. It introduces the project and conveys, in broad terms, how you plan to solve a particular problem (must be able to do in an 11 week span)

4. Project objectives: Project objectives delineate your strategy for reaching the goal and the steps you will follow to complete the project.

a. You must include two or three measurable objectives that use application-level or higher verbs from Bloom’s Taxonomy. (CAN NOT be hands on (meaning unable to speak directly with the homeless) and NO DATA collection allowed
b. Evidence-based review of the literature for project justification: This review provides evidence-based support for your identified problem, project methods, and evaluation. The literature should be directed toward justifying the project, not focus on potential solutions. You must include a review of your specialization’s professional-practice standards and guidelines related to your project and a minimum of five (5) scholarly references for this section of the paper.

5. Methodology: This section addresses in detail how you will accomplish the project objectives.
a. Include, as relevant, the who, when, where, and how of each objective.

6. Resources: Identify and justify the human, physical, and/or technical resources you will need to complete this project.
a. Note that for this assignment, you do not have to address the financial aspects of your plan.

7. Formative evaluation: Describe how and when you will conduct formative evaluation of your project.
a. Explain how you will use the evaluation results and how you will determine if the project is proceeding as planned.

8. Summative evaluation: Describe how and when you will conduct summative evaluation of your project. Explain how you will use the evaluation results.

9. Timeline: Create a graphic timeline representing significant stages of your project. Provide a narrative to help your Instructor understand the timeline. *** a small table will be fine

a. Include the timeline in an Appendix to your Practicum Project
Plan.
****If you are using any types of posters, pamphlets etc just let me know and I will design them.
This project eventually ends up as a power point.  Homeless in New York Discussion Paper