Worldview and Nursing Process Personal Statement.

Introduction

Homelessness is a significant public health concern. There are many facets of homelessness that not only can harm the homeless but also the public. Worldview and Nursing Process Personal Statement.Due to the lack of medical treatment and environmental exposure, homeless people can develop an infectious disease that can ultimately cause an outbreak andcreate a public health threat.

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This is a sobering fact for the health care personnel, with evidence suggesting that appropriate interventions could help prevent and control 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 contain infectious diseases among this population is approximately 44%.Worldview and Nursing Process Personal Statement. The USA’s average life expectancy 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 population (Lee & Donaldson, 2018). The homeless population presents a concern with poor adherence to discharge instructions. This contributes to burnout among nurses as well as increased levels of frustration and powerlessness. Worldview and Nursing Process Personal Statement.Some nurses understand that this population has unique needs, and they leverage their position to improve their health care. However, their efforts are limited due to lack of knowledge by individual nurses who do not understand the personal beliefs and values of the homeless persons, so they end up prescribing medication and offering professional advice without comprehending their lifestyle (Rae & Rees, 2015). The present paper proposes a project that makes use of street outreach strategy among nurses serving homeless persons in the Staten Island borough of New York City to improve health care outcomes among the population. The project’s objective is to leverage nursing resources to ensure the efficient delivery of health care among homeless persons in New York City.

Goal statement

The project will leverage nursing resources to target homeless persons in the Staten Island borough of New York City. The nurses engaged in the project will be educated onthe communicable disease tuberculosis prevention and treatment towards a specific community. This will facilitate knowledge and compliance towards this infectious disease.The homeless and nurses can be considered cultural strangers who avoid each other on regular occasions because of mutual fears. Creating the program will allow a personalized care plan that each patient can easily subscribe to for the best care outcomes (Lee & Donaldson, 2018).Worldview and Nursing Process Personal Statement.

Project objectives

The project will educate nurses to identify homeless individuals. The nurses will then use their educational tools and assessments to understand the conditions particular to each patient. This strategy will enable the nurses to take time and exercise understanding oftheir needs, culture, and situation without prejudice and communicates with dignity, and respect to the patients.Worldview and Nursing Process Personal Statement.

1. The selected nurse personnel will pilot and evaluate the educational tool kit targeted at homeless persons within the defined geographical area resulting in a 50% increase in adherence to knowledge and compliance.
2. Improve health care outcomes among the targeted homeless persons resulting in a 70% increase visit to medical clinics.

Homeless persons are classified as residing in places not intended for habitation and usually unsafe areas. They have the most mediocre health outcomes in society, and their numbers are increasing. They are socially excluded, and their circumstances make it difficult for them to adhere and comply (Kearns et al., 2015). They are 10 times more likely to be re-hospitalized than the general population.Worldview and Nursing Process Personal Statement. They typically rely on emergency rooms and facilities that serve the poor to obtain the needed healthcare services. They are more susceptible to certain medical conditions, have greater difficulty 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). Nurses’ can help address this concern by bringing educational in aneasy, simple, and appropriate leveldirectly to homeless patients, thereby ensuring that this underserved population receives medical care (Lamb & Joels, 2014). This is expected to personalize nursing care delivery so that patients are more receptive to health care and attend regular visits (Ungparkon & Rae, 2019).Worldview and Nursing Process Personal Statement.

Methodology

The project intends to apply a mixed methodology philosophy in which quantitative and qualitative elements will be included. The methodology will consist of participatory action principles within a community health nurse model 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 Staten Island borough area of New York City. The program will recruit three nurses who will provide nursing services to homeless patients through the tuberculosis educational tool kit. The hired nurses will serve homeless patients who reside within the local community of the outreach center.Worldview and Nursing Process Personal Statement. The program expects homeless people living within the area covered by the program as high users of the nursing services. The recruited nurses will focus on meeting the specific healthcare needs of 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 program’s specific nursing services will include emotional support and primary care, such as patient education and treatment (Goeman, Howard & Ogrin, 2019).Worldview and Nursing Process Personal Statement.

Resources

The program will require evidence-based peer-review articles, government, and educational websites in creating the education program. Program director to approve education program, provide workspace including computers, office supplies, and printing. Volunteer nurses will be educated on the tuberculosis tool kit offering personalized nursing care services to homeless patients. In addition to identifying some of the universal health care problems affecting this population, the challenges they face, and monitoring the changes in their health status. Besides that, the program will use a standard patient needs assessment tool to understand the specific nursing care needs of this population.Worldview and Nursing Process Personal Statement.

Formative evaluation

Formative evaluation will be conducted during the project’s implementation to improve the performance and design of the project. Two formative evaluation approaches will be applied. Firstly, the 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 uses 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 undertaken in the project are effectively and efficiently delivered. This evaluation uses observation, dartboard, questionnaire, and time tracking (Moran, Burson & Conrad, 2014).Worldview and Nursing Process Personal Statement.

Summative evaluation

A 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. At the end of the project, it will be undertaken to assess whether the project met its goals and objectives if there were unintended consequences and benefits, what was learned, 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 collected through questionnaires and counts (Moran, Burson & Conrad, 2014).Worldview and Nursing Process Personal Statement.

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 project’s geographical boundaries in terms of the area in which the homeless patients can be located. This will be conducted in the first week. The third activity is to recruit nurses who will participate in the project. This will be held in the second week. The fourth activity is to acquire the resources for the project to include evidence base materials, and the standard patient needs assessment tool. The fifth activity is to roll out 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 conduct formative evaluations and make adjustments to the project design. This will be done 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, starting in the tenth week and ending in the eleventh week. The last action is to submit findings and recommendations that will be held in the eleventh week (see Table 1).Worldview and Nursing Process Personal Statement.

Project 2: Fight against Tuberculosis in the Homeless

This paper aims at discussing the fight againsttuberculosis in the homeless. Specifically, this project aims to lower the cases of tuberculosis among homeless individuals, which is a significant public health issue(Holland et al., 2019). Its name is “The Management of Tuberculosis among HomelessIndividuals in the Staten Island borough of New York City.”This paper will include a goal statement, objectives of the project, methodology, resources,formative evaluation, summative evaluation, and timeline.Worldview and Nursing Process Personal Statement.

Goal Statement and Objectives

This project focuses on reducing cases of tuberculosis among homeless individuals. According to Gupta et al. (2015), the high rate of tuberculosis is among the significant public health issues facing homeless individuals. Theproject will utilize nursing resources to solve tuberculosis among homeless persons in the Staten Island borough of New York City. Individuals diagnosed with tuberculosis will be treated in the community clinic.Worldview and Nursing Process Personal Statement. The nurses who will be involved in the project will be equipped with knowledge about tuberculosis. Particularly, they will be educated about the strategies that can be implemented to reduce tuberculosis among homeless persons in the Staten Island borough of New York City. The trainer will emphasize on the significance of maintaining a healthy environment to control this contagious disease. According to Riccardo et al. (2018), environmental health, including consuming clean water, having adequate sanitation, and safe shelter plays a crucial role in regulating infectious diseases, including tuberculosis. Additionally, healthcare workers will be trained on how to diagnose the disease at an early stage and treat it. Early diagnosis and effective treatment prevent the disease from spreading further (Jo, 2017).Worldview and Nursing Process Personal Statement.

The adopted strategy will enhance the achievement of critical objectives. First, it will enable healthcare providers to apply the acquired knowledge to lower tuberculosis cases among the targeted population. This objective will be measured by comparing cases of tuberculosis before and after the project. Secondly, the strategy will enable providers to understand tuberculosis, including its spread, diagnosis, and treatment. This objective will be measured by comparing the number of tuberculosis patients treated at the community clinic before and after the implementation of this project.Worldview and Nursing Process Personal Statement.

Methodology

The project will utilize a mixed methodology in which quantitative and qualitative elements will be utilized to gather the required data. Consequently, both qualitative (open-ended) and quantitative (closed-ended) data will be collected. Fifty homeless individuals from the Staten Island borough of New York City will participate in the study. This methodology will support the achievement of the set objectives. First, it will enable healthcare providers to apply the acquired knowledge to lower tuberculosis cases among the targeted population. The knowledge will be applied among homeless persons in the Staten Island borough of New York Citywho has been diagnosed with tuberculosis. The method will be applied after the completion of the project. It will be applied by adopting measures that prevent further spread of pathogens, causing this disease. Secondly, this methodology will enable providers to understand tuberculosis. The care providers will give questionnaires with both closed and open-ended questions to the sample population. The participants will fill these questionnaires providing details about the tuberculosis tool kit and return them. The provided responses will, in turn, help the nurses to prevent and treat tuberculosis amongst the homeless population.Worldview and Nursing Process Personal Statement.

Resources

The completion of this project will require various resources, including human, physical, and technical resources. First, trainers will be required to equip the nurses with knowledge about preventing, diagnosing, and treating tuberculosis among homeless persons in the Staten Island borough of New York City. Additionally, participants (homeless individuals residing in the Staten Island borough of New York City) will be involved to provide details about the spread and impact of tuberculosis in the city. Physical resources, including treatment-monitoring tools, will be required to facilitate the diagnosis of tuberculosis among homeless individuals in the targeted region(Lee et al., 2020). Finally, technical resources, including a network of TB facilities, will be required to facilitate this condition’s diagnosis. According to Getahunet al. (2012), technical resources prevent the spread of tuberculosis.

Formative Evaluation

A formative evaluation of this project will be conducted to assess whether it is proceeding as planned. This evaluation is conducted before the implementation and at various stages of the project(Frunza,2014). First, the members of the project team will conduct a formative evaluation before the actual implementation. This action will enable them to assess whether they have met the requirements for implementing the proposed project. Any required adjustment will be made before the implementation, thus increasing the project’s likelihood of success.Worldview and Nursing Process Personal Statement.

Additionally, this evaluation will be done during the implementation process, starting at the initiation stage. This phase will involve understanding the goals, objectives, requirements, priorities, and deadlines of the proposed project. The implementation team will assess whether the results of this step meet the expectations.Worldview and Nursing Process Personal Statement. The second evaluation will be conducted at the end of the planning phase. This stage of the implementation process outlines all the activities, the required resources such as treatment-monitoring tools, and the specific time that each one of them will be conducted. Evaluating this stage will enable the implementation team to correct any error before proceeding to the execution phase. Formative evaluation is conducted throughout the execution phase since it is the most critical stage of project implementation. It is conducted to ensure that everything is executed as planned. Continuous evaluation of this stage increases the possibility of achieving the desired results. Therefore, formative evaluation is recommendable for this project. Evaluating the project at every step will enable the implementation team to make the required correction before proceeding to the next stage. In other words, the team will be able to improve the project’s design and overall performance.Worldview and Nursing Process Personal Statement.

The results of this evaluation will be used to determine if the project is proceeding as planned. The project will be on the right track if these results meet the expectations. On the contrary, the project will not be proceeding as planned if the results differ with the expectations significantly. A slight difference between the two will be addressed by making some adjustments at various implementation stages. Nonetheless, the project will be abandoned if a substantial difference is reported between the actual results and expectations.Worldview and Nursing Process Personal Statement.

Summative Evaluation

This evaluation will be conducted at the end of this project to assess the overall outcomes. The evaluation will be conducted by comparing the final results with the targets set at the beginning of the project. The project will be considered successful in the cases of homeless individuals with tuberculosis reducing following this project’s implementation. However, a slight difference in the cases of tuberculosis might be reported. Under such circumstances, the project is considered as successful. On the contrary, the project will be considered to have failed if no difference in tuberculosis cases will be reported. Therefore, the results of the summative evaluation will be used to determine the success of the project.Worldview and Nursing Process Personal Statement.

Timeline

The proposed project will be conducted in various stages, including initiation, planning, execution, and closure. All four stages will be complemented in 8 weeks. The implementation team will spend the first week to initiate the project. The team members will understand the goals, objectives, requirements, priorities, and deadlines of the proposed projectthis week.Worldview and Nursing Process Personal Statement. Planning for the proposed project will be done in weeks two and three. The team members will gather all the resources and set the deadline required to fight tuberculosis among the targeted population. The execution of the project will be conducted from week four to week seven. The nurse will be educated about reducing the spread of tuberculosis among homeless persons in the Staten Island borough of New York City. Finally, the project will be closed in week 8. During this period, the implementation team will summarize the project results and determine the next action to be taken. Worldview and Nursing Process Personal Statement.

The above discussion indicates that tuberculosis management among homeless persons in the Staten Island borough of New York City will be done in for significant stages. The first stage initiation will involve understanding the goals, objectives, requirements, priorities, and deadlines of the proposed project. The second stage planning will involve gathering the required materials and setting the timeframe for completing the project. The third stage, which is execution, will involve utilizing the acquired knowledge to reduce tuberculosis cases among the targeted population. The final stage of the project, closure, will focus on comparing the results to assess whether the actual outcomes match the expectations.Worldview and Nursing Process Personal Statement.

´The Fight against Mycobacterium Tuberculosis
in Homelessness

´August 13, 2020

´Walden University

´

´Introduction

´Homelessness is a significant public health concern. There are many facets of homelessness that not only can harm the homeless but also the public. Due to the lack of medical treatment and environmental exposure, homeless people can develop an infectious disease that can ultimately cause an outbreak and create a public health threat. This is a sobering fact for the health care personnel, with evidence suggesting that appropriate interventions could help prevent and control the spread of diseases (Luchenski, 2018).Worldview and Nursing Process Personal Statement.

´ In April of 2020, New York City reports roughly 60,422 are homeless on any given night (Coalition for the homeless, 2020).

´Mycobacterium Tuberculosis (TB) tends to be 10% higher in the homeless population than the general public. In 2017 NYC, 3.6% of the high-risk community contracted TB (CDC, 2018).Worldview and Nursing Process Personal Statement.

´Project Goal & Objectives

´Rationale

´Mortality rates among persons experiencing homelessness are significantly higher than the general population. Contributing factor to these premature deaths can include a lack of access to healthcare, which can increase the probability of exposure and or suffering from tuberculosis disease (CDC, 2015).Worldview and Nursing Process Personal Statement.

´Addressing stigma is essential for improving TB control efforts. The stigma that arises in part of a correlation between TB and poverty can substantially impact a person’s willingness to access care and adhere to treatment plans (CDC, 2015).

´The relationship between the homeless and nurses can be considered cultural strangers, who avoid each other on regular occasions because of mutual fears. (Lee & Donaldson, 2018). Creating the program will allow a personalized care plan that each patient can easily subscribe to for the best care outcomes.Worldview and Nursing Process Personal Statement.

´

´Methodology

´The project intends to apply a mixed methodology philosophy in which quantitative and qualitative elements will be included

´Nurses will be educated on tuberculosis (TB) using a Tuberculosis tool kit that will be utilized to educate on prevention and treatments amongst the homeless population. The project will be conducted in the community health clinic through the Northwell system in New York.Worldview and Nursing Process Personal Statement.

´The program’s specific nursing services would include patient education, prevention, testing and treatment of Tuberculosis (Goeman, Howard & Ogrin, 2019).

´Developing an environment/relationship that would allow homeless individuals to comply with testing and treatment and develop the education of prevention.Worldview and Nursing Process Personal Statement.

´

´Methodology

Tuberculosis Education tool kit

´

´

´

´ CDC’s power point “TB 101for Healthcare workers”

´ “Among persons experiencing homelessness” power point

´Enhancing supportive social services for TB patients (video). https://youtu.be/Xmh5Ym-2TO8

´TB among the Homeless: Dealing with unique challenges (video)   https://youtu.be/_yUrFyWbBW4

´Tb clearance form

´TB screening form

´TB signs and handouts

´

´

´

´

´Findings

´Screening and testing has been effective in reducing TB incidence and mortality in homeless people (Paquette et al. 2014).

´Lack of policies and procedures can cause reoccurrence and TB outbreaks (Gupta et al. 2015).

´Average of 30% tested for TB do not return for their results (Holland et al 2019).

´New York reports higher rates of TB than the national average, representing one of four states that is above benchmark (Schwartz et al. 2020)Worldview and Nursing Process Personal Statement.

´

´ Conclusion
& Recommendations
´Implementing a TB tool kit that is used to identify, evaluate, and treat persons who are at high risk for developing Tuberculosis is a crucial part of controlling and eliminating TB disease in the United States

´Educating patients on the personal and public health implications of TB disease and influence them to accept prevention and therapeutic services (Schwartz et al. 2020) could streamline the path to extinction.

´Continue using the tool kit for new hires and annual orientation.

´Update program with current data and statistics

´Increase the program to train other staff, like volunteers, shelter workers and other medical staff.Worldview and Nursing Process Personal Statement.

´Summary

´

´Incomplete adherence to treatment has identified as the most severe problem in TB control and a significant obstacle to the eradication of the disease

´TB control programs should provide education and training in the clinical setting and should demonstrate proficiency of prevention and control (Schwartz et al. 2020)Worldview and Nursing Process Personal Statement.

´Increasing access to care is essential in eliminating TB in the US homeless population.

´

Tuberculosis

Screening

Form

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Tuberculosis Clearance

Form

´Resource

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Education Material

´Logic Model

´                  References

´Block, J., Courtney, M., & Clark, M. (2016). Practice-Based Clinical Inquiry in Nursing: Looking Beyond Traditional Methods. Springer Publishing Company.

´Center for Disease Control and Prevention (CDC). (2018). TB in the homeless population. https://www.cdc.gov/tb/topic/populations/homelessness/default.htm

´Center for Disease Control and Prevention (CDC). (2016). TB 101 for Healthcare workers. https://www.cdc.gov/tb/education/ce/tb101.htm

´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

´Gupta, V., Sugg, N., Butners, M., Allen-White, G. & Molnar, A. (2015, April 16). Tuberculosis among the homeless — Preventing another outbreak through community action. N Engl J Med, 372, 1483-1485. DOI: 10.1056/NEJMp1501316

´Holland, D. P., Alexander, S., Onwubiko, U., Goswami, N. D., Yamin, A., Mohamed, O., Sales, R.-M., Grant, G., Talboy, P., Ray, S., & Toomey, K. E. (2019). Response to Isoniazid-Resistant Tuberculosis in Homeless Shelters, Georgia, USA, 2015-2017. Emerging Infectious Diseases, 25(3), 593–595.

´ 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

Worldview and Nursing Process Personal Statement.