The Advanced Emergency Nursing Journal is pleased to participate in the Council of Science Editors' Global Theme Issue on Poverty and Human Development. On or af- ter October 22, 2007, more than 200 science journals from around the globe published ar- ticles about the impact of poverty on human development. The goal of this global theme issue is “to raise awareness, stimulate inter- est, and stimulate research into poverty and human development” (Council of Science Editors, 2007). Participation ranges from an entire issue devoted to the topic of poverty and human development to editorials and individual manuscripts. In this issue we have two articles dealing specifically with a subset of the impoverished population: the homeless.
The first article describes the case of a homeless patient with tuberculosis and presents a model for the assessment of homeless patients in the emergency department (ED) (Faragher & Hayes, 2007). Homeless individuals with unique situations, and frequently with tuberculosis, present to the ED. The advanced practice nurse (APN) faces a myriad of challenges that require a variety of assessment skills. APNs need to pay special attention to the assessment of mental health, substance use/abuse, residential history, victimization, and perceived health status in this patient population. The behavioral model in this article provides vulnerable populations with a framework for access to health services and a method for determining health outcomes of the homeless. This behavioral model also outlines a format for factors used in assessing this population. Continued use of this model offers a template for healthcare for the homeless and use of the ED.
The second article explores the perceptions of healthcare access among the homeless in San Diego (Haley & Woodward, 2007). The overall aim of this study was to explore healthcare needs, healthcare access and delivery issues, and the process of seeking and experiencing healthcare in one county in California, San Diego. In addition, the study provided participants with a voice in the development and delivery of their own healthcare. The objectives of the study were (a) to accumulate data on homeless individuals regarding their access and utilization of healthcare, including when, where, why, how, and their satisfaction level; and (b) to articulate these data so that future nursing services would be available in San Diego to better serve the homeless population's healthcare needs.
The impact of poverty on ED patients is undeniable. Frequently called “the safety net,” in healthcare delivery, ED personnel often see patients who have no other options for healthcare. Many of these patients have ignored symptoms for lengthy periods of time, hoping they would resolve spontaneously. Often, this means the preventable progression of a disease state that now requires more resources to manage than would have been required with more timely intervention. Specifically, there are data to show that children from poorer socioeconomic areas visit the ED with more severe asthma symptoms and are more likely to be admitted to the hospital than their counterparts in wealthier neighborhoods (Babin et al., 2007).
In 2005, 12.6% of the U.S. population met the U.S. Government's definition of poverty; this equals 37 million individuals and 7.7 million families (DeNavas-Walt, Proctor, Lee, & U.S. Census Bureau, 2006). The likelihood of having health insurance increases with income. The likelihood of visiting the ED is inversely proportional to income; thus, ED patients are more likely to be impoverished and disadvantaged.
The role of APNs is to provide care to “allcomers”—regardless of race, creed, socioeconomic, insurance, or healthcare status. In many instances, ED APNs are crucial in assessing and identifying the health needs of the ED patients. APNs in many communities across the country have established comprehensive, cost-effective approaches to care by being the actual providers of ED care (e.g., ED fast tracks, retail clinics); APNs are on the front lines to serve these populations. APNs also provide follow-up in clinics and offices on the back end. APNs are a valuable resource in the overall health and healthcare of these disenfranchised, disadvantaged, and marginalized groups.
K. Sue Hoyt, RN, PhD, FNP, APRN, BC, CEN, FAEN
Emergency Nurse Practitioner St. Mary Medical Center, Long Beach, CA
Jean A. Proehl, RN, MN, CEN, CCRN, FAEN
Emergency Clinical Nurse Specialist Dartmouth-Hitchcock Medical Center, Lebanon, NH
Babin, S. M., Burkom, H. S., Holtry, R. S., Tabernero, N. R., Stokes, L. D., Davies-Cole, J. O., et al. (2007). Pediatric patient asthma-related emergency department visits and admissions in Washington, DC, from 2001–2004, and associations with air quality, socio-economic status and age group. Environmental Health, 6
(9). Retrieved August 19, 2007, from http://www.ehjournal.net/content/6/1/9
Council of Science Editors. (2007). Global theme issue: Call for participation.
Retrieved August 20, 2007, from http://www.councilscienceeditors.org/globalthemeissue.cfm
DeNavas-Walt, C., Proctor, B. D., Lee, C. H., & U.S. Census Bureau. (2006). Current population reports, P60–231, income, poverty, and health insurance coverage in the United States: 2005
. Washington, DC: U.S. Government Printing Office. Retrieved August 19, 2007, from http://www.census.gov/hhes/www/poverty/poverty05.html
Faragher, M. E., & Hayes, K. (2007). Homeless tuberculosis patient in the ED. Advanced Emergency Nursing Journal, 29