Community health nursing in Kenosha, Wisconsin is a challenging yet paramount issue. Located on the southwestern shore of Lake Michigan, Kenosha is the fourth largest city both on the lake and in Wisconsin County. The city has an area of 27.03 square miles with a population of 100, 164 as of 1 st July 2018 ("U.S. Census Bureau Quick Facts: Kenosha city, Wisconsin", 2019). The population density of Kenosha city stands at 3611.53 people per square milestone. From a racial standpoint, most of the Kenosha city population is made of whites ("U.S. Census Bureau Quick Facts: Kenosha city, Wisconsin", 2019). Pacific Islanders are the smallest occupants who make 0.02% of the population. Using the most recent data from the American Community Survey, education level varies between males and females in different races across Kenosha City. The highest rate of high school graduation is among the white males while that of bachelors degrees is among people of Asian ethnicity with a 52.82% rate. It is also worth noting that the rate of unemployment stands at 36.99% for males and 50.64% for females. The high population density, low education levels and high rates of unemployment, make Kenosha in Wisconsin a vulnerable population. The purpose of this paper is to focus on health problems in the vulnerable population which is the homeless, identify resources available and gaps in these resources from a community health nurse standpoint.
Aggregate of Interest
Homelessness in Kenosha city is a statewide concern. Mostly it affects both individuals and families, many of whom have substance abuse issues or mental health disorders. A recent study taken by advocates of homelessness in Kenosha revealed the magnitude of the crisis of facing the area. On the basis of figures by the American Community Survey done in July 2018 on a single day, approximately 276 people were homeless in Kenosha city (American Community Survey, 2018). Of that number 100 people were classified chronically homeless and were involved in substance and alcohol abuse. This confirms a windshield survey conducted earlier which revealed that the homeless are a vulnerable population when it comes to health community problems such as substance abuse, inequality to access health care, and environmental health disparities. According to an interview done with one of the residents, the figures may actually be low. He estimated that there were more than 1500 homeless people in Kenosha.
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Based on an annual report of 2018, figures from HMIS reveal that 516 people were served in emergency shelters for being homeless in Kenosha City. From the standpoint of household types, 58% of single adults in the city are homeless while 40% are members of particular households or family. It is also worth noting that the youth and unaccompanied children form a large part of the homeless population. As of 2018, 88 youths most of whom are transgender are homeless for identifying with LGBT (Jones, DeFillipis & Yarbrough, 2018). Based on the interview with the Chief Medical Examiner for Kenosha, Patricia Hall, the majority of homeless populations are either living at or below the federal poverty level. This is due to the high rates of unemployment in the city as well as low literacy levels. The rate of unemployment stands at 36.99% for males and 50.64% for females most of whom are from the vulnerable homeless population. On the other hand, education levels are quite low among the homeless. In 2013, HMIS figures revealed that 544 students were homeless (Ingram, Bridgeland, Reed & Atwell, 2017). Studies indicate that homeless people have difficulties in completing education. Most of them never go beyond high school level. In Kenosha very few percentages of the homeless population have completed college. Sequentially they become low or average in health literacy.
Aggregate Resources
During my assessment at Kenosha city, findings indicate that there seem to be limited resources for this vulnerable population. There are a few resources to assist individuals with shelter and food, rehabilitation for mental disorder issues and substance and alcohol abuse. Among the few resources in the city include Homeless Assistance Leadership Organization Shelter and Services (HALO), Mary’s Mission, VETS Place, and Southern Center, Walkin’ In my Shoes, The Shalom Center, and the Habitat for Humanity at Kenosha ("Kenosha Wisconsin Homeless Shelter List", 2019). The organizations are in various parts of Kenosha city and render different services to the homeless population. Based on Shelter Listings database for Kenosha city the resources offer services that include transitional housing, shared housing and day shelters that also offer residential drug and alcohol rehabilitation programs.
Among the few listed resources, The Shalom Center and Walkin In my Shoes are the most preferred. The former provides a food pantry, soup kitchen and after school-tutoring for homeless children. They also offer a nightly homeless shelter. On the other hand, the former latter takes the initiative of going out into the community to look for homeless youth, men, women, and children to help them leave the streets and secure permanent housing.
In addition to resources for the homeless, Kenosha city also has substance abuse centers such as Hope Council on Alcohol and other Drug Abuse, Kenosha Human Development Services, Recovery matters, and Crisis intervention. These resources have programs that have made it their duty to educate the vulnerable population regarding improper dispose of used needles which is a key health problem in Kenosha.
Gaps in Resources
According to the windshield survey, there are numerous gaps in resources for the homeless population in Kenosha. To begin with, there is no consistent structure for guiding work for the homeless. Meetings held across various relevant departments are done with irregularities. The inadequacy of consistent structures yields unreliable results on how to address the issue and health concerns like substance and drug abuse associated with homelessness. Another gap was low data sharing and data facilitation among the relevant parties. Findings from the windshield survey, individual interviews, and from the American Community Survey have a huge gap in terms of figures due to inadequate sharing of data and facilitation (Brown, Batko. Leopold & Shroyer, 2018). Notably most of the above previously mentioned resources focus on the single adults and people that are chronically homeless while in a real sense there are others like students who are from homeless families. According to a recent study, in 2013 there were approximately 544 students who attended school from homeless families. Data sharing will reveal the actual figures to enable focus on the entire homeless population other than merely single adults.
Community Health Problem
The three health problems of the homeless population of Kenosha are in alignment with Healthy People 2020 Leading Health Indicators. These include environmental quality, access to health services, and substance abuse. The health indicators go hand in hand when discussing the homeless population in Kenosha County. People’s ability to access health care services has a profound effect on every aspect of their health. Yet most of the homeless population in Kenosha County have no access to a health center where they can receive regular medical services. It is also worth noting that having medical insurance is important for access to health care. The homeless people, however, have no medical insurance due to low literacy levels and high levels of unemployment. As a result they skip routine medical care increasing their risks for health conditions. Furthermore, a recently done research indicates that Americans with high incomes have better access to medical services compared to those that are not (Pickett, 2015).
The quality of the environment has direct impact on the quality of life. As highlighted from the windshield survey, Kenosha has a poor environmental quality resulting from the improperly disposed used needles by illicit drug users most of whom are from the vulnerable population. Disposed needles in places like parks and beaches pose a risk to the health of Kenosha. For instance, if a person got stuck with a needle that has been disposed, they risk contracting diseases such as Hepatitis B and Hepatitis C and in worst cases HIV/AIDS.
Substance abuse involving drugs, alcohol or even both has destructive social conditions such as decreased performance in school, or even total drop out, financial problems, lost productivity, and crime among others. In the United States, health and crime-related problems arising from substance use and alcohol abuse cost the country an average of $600 billion on an annual basis (Horn, Li, Mamun, McCrady & French, 2018). Although progress has been made in lowering the number of substance abuse, it continues to take a toll on the health of the vulnerable population.
Theoretical Framework
To address the community health problems that the homeless population of Kenosha County is facing, the application of a nursing theory rather theoretical framework is needed. Recent research was done by (Nyamathi, Salem, Zhang, Farabee, Hall, Khalilifard & Lake, 2015) propose the use of comprehensive health-seeking and coping paradigm for the homeless population in Kenosha. The paradigm is theorized to be suitable because it is a function of 12 factors which include clients' situational and personal factors, resources, sociodemographic characteristics, cognitive appraisal, health goals, health-seeking and coping behaviors, nursing goals and strategies, clients' perceived compliance, clients' perceived coping effectiveness, and immediate and long-term health outcome (Nyamathi, Salem, Zhang, Farabee, Hall, Khalilifard & Lake, 2015). These factors describe the homeless population in Kenosha. As a nursing multidimensional framework the comprehensive health-seeking and coping paradigm will provide community nurses with an opportunity to enhance, and promote the health conditions of the homeless population in Kenosha. Nurses will provide an intellectual focus for both the initial and ongoing variables such as homelessness, poverty, unemployment, and illiteracy among others which influence health-seeking and coping.
In addition, specific and appropriate strategies will be developed and enhanced based on the variables. Among them are having more resources for the homeless population and creating awareness on substance and alcohol abuse and the dangers of the careless disposal of used needles. Notably, the strategies should be done in a collaborative manner by all stakeholders. Community nurses, however, should take a proactive role to spearhead the creation of more resources and awareness for the vulnerable population.
Conclusion
Located in Wisconsin, Kenosha is an attractive residential place. There are numerous schools, health centers, and financial structures that enable the economic and social well-being of its members. However, the issue of homelessness in the county is an issue of concern not just in the state but across the United States. In addition, there are scarce resources to aid the vulnerable population. As highlighted there are many gaps that need to be filled to cater to the housing needs. Besides being a habitable place, Kenosha’s environment, particularly the parks and beaches, are scattered with used needles that have been carelessly disposed. This poses a health threat to Kenosha community. Community nurses, however can come up with a coping mechanism to help illicit drugs and alcohol abusers and educate the public on the importance of having an environment of good quality. As a vulnerable population, the homeless can be helped by community nurses having more interventions in collaboration with stakeholders such as the county government to put up more resources and plan for affordable housing.
References
American Community Survey. (2019). Retrieved 2 November 2019, from https://www. americancommunitysurvey.com/city/wi-kenosha
Brown, S., Batko, S., Leopold, J., & Shroyer, A. (2018). Final Report and Recommendations on Homelessness in Kenosha County, Wisconsin
Horn, B. P., Li, X., Mamun, S., McCrady, B., & French, M. T. (2018). The economic costs of jail-based methadone maintenance treatment. The American journal of drug and alcohol abuse , 44 (6), 611-618.
Ingram, E. S., Bridgeland, J. M., Reed, B., & Atwell, M. (2017). Hidden in Plain Sight: Homeless Students in America's Public Schools. Civic Enterprises .
Jones, A., DeFilippis, J. N., & Yarbrough, M. W. (2018). LGBTQ youth and education: rethinking children’s rights in schools. In The Unfinished Queer Agenda After Marriage Equality (pp. 118-132). Routledge. Kenosha Wisconsin Homeless Shelter List. (2019). Retrieved 2 November 2019, from https://www.shelterlist.com/city/wi-kenosha
Nyamathi, A., Salem, B. E., Zhang, S., Farabee, D., Hall, B., Khalilifard, F., & Leake, B. (2015). Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: a randomized clinical trial. Nursing Research , 64 (3), 177.
Pickett, K. E., & Wilkinson, R. G. (2015). Income inequality and health: a causal review. Social science & medicine, 128, 316-326.
U.S. Census Bureau QuickFacts: Kenosha city, Wisconsin. (2019). Retrieved 2 November 2019, from https://www.census.gov/quickfacts/kenoshacitywisconsin
