Introduction
Homeless people live under environmental stresses in groups, crowds and poor situations resulting in upper respiratory tract and lungs infections (Homelessness, 1988). The most common form of homelessness is related to dermatologic conditions. 30% of the people suffer from mental illness, in which 50-60% homeless women suffer from mental issues. Due to the external exposure, limited access to water, inability to follow homely routine and social isolation combined with financial downfall leads them to numerous diseases of all form (Donohoe, 2004). In U.S. and Canada, an observed pattern of health with different diseases is observed due to overcrowding. A high rate of morbidity and mortality is observed from the respiratory illness rising from the homeless people. Tuberculosis is on top of the list in the respiratory infections. The paper discusses several respiratory illnesses rising from homelessness (Wrezel, 2009).
Chronic obstructive pulmonary disease (COPD)
In US, COPD is the fourth common disease occurring at a six times higher in homeless people compare to the homed people. The diseases come from cigarette smoking resulting in respiratory disturbances such as asthma. Among homeless people, it is a challenging disease due to environmental surroundings of homeless. Programs with pulmonology consults, disease education, discussions are very important. Philip Corsello, gave his expert advice to clinicians working for the homeless person includes strong favor to use antibiotics as they shorten intensity and duration of illness. Similarly, he suggests avoid steroids; usefulness of bronchodilators though they are expensive but effective; avoid Small volume nebulizers, carrying oxygen tanks and getting vaccinations of COPD annually. Diseases like emphysema, bronchitis and all others related to short of breath and cough etc. (Healing Hands, 2000).
Tuberculosis (TB)
TB occurs to people have a weak immune system, infected with HIV or in contact with people infected with TB. It is most common disease and is observed as 2 per 100,000 people in U.S. and Canada. Its prevalence is 1.6% to 6.8% and 18% to 51% for latent disease. Most of the diseases such as malnutrition, poverty etc. are risk factors of tuberculosis. It arises from respiratory infections growing with crowds of people sharing same breath. It is an example of latent disease reaching to active disease. It comes from alcoholism and leads to HIV(Wrezel, 2009).
Pneumonia
It is 6th cause of death and has 14% mortality rate. A study based on Edmonton 2000-2002 reports showed pneumococcal infection rate to be 266.7 per 100000 contrasted with 9.7 per 100,000 among general population. These outbreaks are 60% more in crowded homeless shelters. The rate of smokers in homeless individuals is 78% and abuse alcohol is 60%. In order to cure from the disease, pneumococcal pneumonia is an invasive disease among homeless people. It is present in hard to reach populations, so such crowds should be spotted and vaccine. Vaccination is the best way to curative measures of pneumonia. The disease rises from the use of drugs and alcohol among homeless (Wrezel, 2009).
Influenza
Influenza has an after effect of 100,000 hospitalizations with 36,000 deaths. It is the initial step before leading towards secondary pneumonia and exacerbations of asthma or COPD. Although a vast number of morbidities and mortalities are related to the virus, there are very few relevant studies related to it. The curative measures towards influenza include vaccination for homeless residents or ones with COPD. The vaccinations stay underutilized and take a day or week to vaccinate all shelter residents (Wrezel, 2009).
Population groups at risk
Recent descriptive studies show an alarming report about the age group affected by respiratory illness; it is heterogeneous as compare to skid row populations. Women and minority group members including blacks and Hispanics; families with children and people with mental illnesses or drug abuse are included in the population groups at higher risk from respiratory issues. Previously, these populations were limited to people above 50 but now the homeless shelters of each age group are suffering from all of these diseases greatly (Homelessness, 1988).
Community Challenges
The basic community challenge among all of these diseases includes the absence of awareness programs among the homeless people. An important drawback in such situation is the absence of proper meal, sleep and resting place. Homelessness is the root cause to more than half of the problems. Firstly, ending homelessness is very important. Later, adherence to drawbacks towards smoking and other hygienic issues in relation with its outcome can be helpful in giving them psychological and medical assistance. Similarly, it is not about the services only but also about the service with housing facilities which will help in improving overall acute and chronic diseases (Homelessness, 1988).
Role of Community Health Nurse/ Nursing Society
Role of nursing community: A community nursing society helps in promotion respiratory nursing development program for its members. The programs are designed to include health promotion and disease preventions according to society’s culture and spans.
Role of the nurse: Respiratory community nurses help in the improvements related to therapeutic and diagnostic procedures. As a nurse, I will participate in health research diseases plan for patients involved in lungs diseases. We are trained for all pulmonary hypertension, COPD, transplantation etc. Nurses are involved in educating, self-management and therapeutic programs (Respiratory nurses).
They work to monitor new method of diagnosis and therapies and also the patients being treated under them.
They educate patients towards self-management and care of the disease.
Research towards the clinical application and improvement of new procedures.
A large number of homeless populations include old people as the respiratory illness is profoundly found in people above 50. Nursing interventions can be designed and implemented in such a way that they may improve quality of life by early intervention, identification and management of specially COPD (Respiratory nurses).
Program Offered: Keeping in mind the majority number of older people with respiratory disease, as a community nurse, a comprehensive program identifying care plans can be designed with some important pointers. Long-term oxygen use, correct diagnosis, proper medication, monitoring treatment functionality, cessation of smoking and such addictions; early intervention of any respiratory disease and continuous assessment of the illness is a must.
The Costs of the nursing programs will only be needed to set up teams, provide them project needs and living costs of their living. Apart from that, the curative programs will require training sessions which are cost-effective and will not require high end budgeting (Respiratory nurses).
Conclusion
Respiratory infections such as TB, influenza, pneumonia and etc. are most hazardous for homeless individuals. Exposure to increased pathogen, overcrowding and COPD factors such as alcoholism, abuse, drug, smoking, HIV co-infection and lung diseases are the risk factors; with mortality, morbidity as the complications which vary in different populations and outbreaks. The most challenging factors are diagnosis and treatment non-compliances in Marion homeless shelters. Social factors affect respiratory infections the most. Initiatives towards establishment of comprehensive programs are the key solution. Those programs should include screening, immunization, stopping smoking, education programs to increase compliance, low threshold for hospitalization, education programs to increase awareness towards preventions and treatments to solve respiratory infections for the homeless (Wrezel, 2009).
References Page
Homelessness, health, and human needs. (1988). Washington, D.C.: National Academy Press.
Wrezel, O. (n.d.). Respiratory infections in the homeless. Retrieved February 21, 2016, from http://www.uwomj.com/wp-content/uploads/2013/06/v78n2.61-65.pdf
Donohoe, M. (2004, July 07). Homelessness in the United States: History, Epidemiology, Health Issues, Women, and Public Policy. Retrieved February 21, 2016, from http://www.medscape.com/viewarticle/481800_3
Short of Breath: A Winter’s Tale of Asthma, COPD & Homelessness. (2000, December). Retrieved February 21, 2016, from https://www.nhchc.org/wp content/uploads/2012/03/Dec2000HealingHands.pdf
What interventions are used to treat COPD? (n.d.). Retrieved February 20, 2016, from http://www.aihw.gov.au/copd/treatment/
Respiratory nurses. (n.d.). Retrieved February 22, 2016, from http://www.erswhitebook.org/chapters/allied-respiratory-professionals/respiratory-nurses/
