Term Paper: Family Health Promotion

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Family Health Promotion

Homelessness has been a foundationally recognized aspect of need in our culture from the period of the progressive era, and especially beginning during the great depression. Yet, the focus has traditionally been on homeless single men, as historically they have been the demographic that has been the most vulnerable to Homelessness. Additionally, a period of deinstitutionalization occurred in the 1970s that left many only marginally functional people with mental illnesses with few options, and many ended up homeless. Yet, in recent years, with economic and social changes that have occurred, including increased monetary pressures and reduced flexibility of home providers, as well as increased awareness of the detrimental environments that are created by relationships in conflict have shifted homelessness to a new social strata, that of families. In the last 20 years that shift has demographically focused upon female headed households becoming homeless. In 1994, Burg writes that "Female-headed families are the fastest growing subgroup of the homeless population...The increasing diversity of the homeless population is matched by the increasing range of health problems found among them." p. 125)

As a result of this shift, and the pressures that have influenced in homelessness has required a new set of indicators, and social support networks, than has been available in the past. Families with young children, either supported by a single woman or a partnership that somehow manages to navigate the frequently gender specific shelter system must achieve new focus with regard to support networks that emphasis the needs of not a single adult male but a family with nutritional, medical and long-term needs for sustainability and recovery. In the past the homeless health focuses have been on mental illness, alcoholism, and drug abuse, as the highest risk factors and therefore risk factors in need of support systems. Yet, with this changing demographic the expansion of health needs is evident. The additional focus must be on access to health care in general, immunization obtainment, nutritional support, educational support and care for associated domestic violence issues.

Healthy people 2010 in fact lists several of the most common health indicators that specifically plague the homeless family; Access to Health Care, Injury and Violence, Environmental Quality and lastly Immunization. These factors, according to the healthy people initiative, when present (or absent, depending on their nature) indicate the overall health of an individual or group. (Healthy People, ND) if these four circumstances of risk are avoided or obtained then the group can generally be thought of as more healthy. Though there are other health indicators, these are the four that are especially important for homeless families. These four indicators are particularly challenging for the homeless family as access to health care is an issue for the homeless.

Health care services and transportation to such services are challenged by the condition of homelessness because health coverage often ends when an individual loses his or her address, as well as awareness of available services declines due to the new environment and other pressing issues, such as how to obtain employment to change the situation often overshadow these needs and many others. " to compound this enhanced risk, homeless people face more barriers to medical care than other population groups. Problems with access increase the likelihood of health problems becoming acute and resulting in tragic consequences." (Burg, 1994, p. 125)the sustaining of injury or violence, or the threat of it as a result of the environment they have left or the condition of homelessness currently is also troublesome. The quality of the environment in which they live, which can include exposure to the elements and unsanitary living conditions outside shelters or inside shelters exposure to confined limited spaces with many other people in close proximity, all of whom share the same risk for communicable and non-communicable diseases is a reality of family homelessness. Lastly access to childhood immunizations is challenged as a result of interruption of services as well as education, as education is frequently the number one reason for compliance among families with regard to immunization obtaining, and this is especially true among poverty stricken families. It is surprising that level of nutrition is not one of the leading health indicators according to Healthy People, though it is secondary under the level of physical activity as well as obesity and overweight conditions, in the homeless group the issue is more one of access to adequate nutritional support, and this is highly dependent upon environment. Shelters tend to offer at least some nutritional support, while those who live outside this system, in cars or on the streets struggle daily with this issue. "Homeless families face the economic and personal challenges of sparse employment opportunities and child care and nutrition needs, compounded by the loss of adequate housing." (Fischer, 2000, p. 402)

In a sense pressing needs alter exponentially when a family is homeless, often depending on available services and the environment the family ends up in. Finding adequate conditions for sanitary needs, finding food and shelter as well as long-term pressures of finding avenues for long-term change, such as adequate child care and employment to alter the situation become the most pressing daily concerns of the homeless family. Other concerns of the family frequently become secondary, unless acute.

In one fascinating and comprehensive article homeless families where interviewed utilizing the theory of ethnography, where language and ideas expressed are analyzed to seek understanding of the problem, as it has grown exponentially over the years. (Thrasher & Mowbray, 1995, p. 93) One interesting fact discovered by the researchers in the ethnographic interviews was the degree of transition being experienced by the homeless families interviewed.

Many of the women in this study lived intermittently with relatives and friends for weeks and months before arriving at a shelter. Moving from relatives' to friends' homes and back again to relatives' homes was a repeated pattern for these women. As a result, by the time a family arrived at the shelter they had experienced multiple residences of varying lengths with a number of friends and relatives (Thrasher & Mowbray, 1995, p. 93)

The exponential implications of these constant transitions as well as the conflict and level of rejection that was possibly felt by children and their caregivers is essential to the theories surrounding homeless families. In other words by the time they reach specific community-based resources they all must feel as if they are no longer wanted by anyone and that sense of self is not a healthy one for transition or need development, let alone long-term growth and sustainability. Children are also likely to feel this acutely, as even though their care provider likely made many sacrifices to keep the family together each lost family member in the chain was a source of a relationship for the child that they no longer have access to. This was then exacerbated by a real potential breakdown in the communication and strength of the mother-child relationship:

Many of the women expressed difficulties and frustration in child caretaking and in the parent-child relationship because of the stress of homelessness and shelter rules that exacerbated already diminished parental authority. Mother-child interactions among homeless women with children living in shelters have been referred to as "public mothering," which results in an unraveling of the mother role (Boxill & Beaty, 1990). It has been suggested that the absence of a home and residence in a shelter distorts the role of the mother, and thus she loses the opportunity to be primary nurturer, teacher, and negotiator. (Thrasher & Mowbray, 1995, p. 93)

There is not a single issue that does not become more difficult, with regard to Health Care Access, Environmental Quality, Immunization seeking and lastly protection from of healing from Injury and Violence, when communication between children and their primary care provider breaks down. It is therefore important to understand the whole theory behind the cumulative problems associated with homeless families. It is an utterly degrading experience in both the figurative as well as the practical sense.

Nursing interventions that can be associated with these interventions have a great deal to do with the above theoretical and anecdotal concerns, as well as information dissemination on the part of the nurse. Nurses must approach the head of family with the understanding that a feeling of being unwanted and cast off as well as communication breakdown in the family may be two of the biggest barrier to achieving greater health, in the family. A nurse must give special credence to this reality as while giving information about health care access as well as other issues. Advanced practice nurses in many communities have frequently been at the core of interventions, such as developing roving clinics and/or helping coordinate immunization drives and treatment access transportation to shelters.

Healthy People 2010 identifies three health objectives that can be focused upon with regard to this risk group; 1-6. Reduce the proportion of families that experience difficulties or delays in obtaining health care or do not receive needed care for one or more… [END OF PREVIEW]

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