Scholarly – hypertension in homeless

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PLease follow the “SCHOLARLY INSTRUCTIONS” for the instructions about it and build on all the other attachments for it

Write a scholarly paper for the capstone project:

Hypertension in Homeless Population


Build on the previous completed work that is attached

Requirements:

·
16 pages

· APA 7th ed.; size 12 font

· Minimum of six scholarly references within the
last five years

·
Follow and include the outline and sections

The capstone project OUTLINE AND SECTION:

1. Title page

2. Abstract

3. Background & Significance

4. Literature Review

5. Supporting Evidence

6. Purpose or Aims of the Study

7. Theoretical Model or Framework

8. Methods/Design/Sampling

9.
Proposed Interventions

10. Expected Results/Outcomes

11. Anticipated Conclusion

12. Possible Limitations

13. Potential Implications to Practice

14. References

15. Poster

16. Appendices 

Include:

· Clear, problem statement 

· Establish synthesis of literature and evidence-based practice in all content sections.

· Apply concepts of cultural competency and cultural literacy within the background section and Purpose or Aims of the Study section.

· effective collaboration of the advanced nursing role through leadership, collaboration and improving outcomes in the proposed interventions section


Hypertension in the Homeless Population Abstract

Hypertension is a prevalent health challenge that significantly affects the homeless population. This capstone project aims to clarify the relationship between homelessness and elevated blood pressure, steering the conversation beyond individual health behaviors to include broader social influences. The objective is to dissect the intersection of social determinants of health (SDOH) and hypertension among the homeless to inform effective intervention strategies. The project adopts a mixed-methods approach, employing both quantitative and qualitative research tools to paint a comprehensive picture of the hypertensive landscape within this vulnerable group. The rationale for selecting hypertension within the homeless population is rooted in the evident health disparities accentuated by the lack of stable housing. Factors such as inadequate access to healthcare, nutritional deficiencies, and the psychological toll of homelessness exacerbate the risk and severity of hypertension (Hatef et al., 2021). The design incorporates cross-sectional surveys to quantify the prevalence of hypertension and in-depth interviews to unravel the personal and systemic barriers faced by this demographic. Anticipated results point towards a high incidence of hypertension, influenced by a complex array of SDOH, including economic instability, educational gaps, and suboptimal healthcare access (Foster et al., 2021). The project expects to conclude that multifaceted, tailored healthcare interventions are necessary to address the unique challenges faced by homeless individuals. The findings advocate for policy reforms and the implementation of targeted healthcare services, such as mobile clinics and shelter-based health programs. This capstone project has the potential to significantly impact clinical practice settings, highlighting the necessity for healthcare systems to adapt to the needs of the homeless. By integrating the insights garnered from this study, healthcare professionals can develop more empathetic and effective care models, thereby contributing to the reduction of health inequities and promoting better health outcomes for the homeless.

References

Foster A. A. Daly C. J. Logan T. Logan R. Jarvis H. Croce J. Jalal Z. Trygstad T. Bowers D. Clark B. Moore S. & Jacobs D. M. (2021). Addressing social determinants of health in community pharmacy: innovative opportunities and practice models. 
Journal of the American Pharmacists Association: Japha e48–e54.


https://doi.org/10.1016/j.japh.2021.04.022

Hatef E. Ma X. Rouhizadeh M. Singh G. Weiner J. P. & Kharrazi H. (2021). Assessing the impact of social needs and social determinants of health on health care utilization: using patient- and community-level data. 
Population Health Management 222–230.
https://doi.org/10.1089/pop.2020.0043

6

Evaluating Hypertension in the Homeless Population: A Methodological Approach:

Methods/Design/Sampling


Introduction

This capstone endeavor sets out to explore hypertension’s prevalence and risk elements among the homeless, steering its course with the Social Determinants of Health (SDOH) model. In doing so, it attempts to elucidate the interactions between various socio-economic aspects and their direct and indirect effects on the health of homeless people. The objective is to maximize understanding of the broader systemic and contextual factors that contribute to the prevalence of hypertension in this vulnerable population, thereby paving the way for the development of more targeted and effective intervention strategies in the future. This exploration is critical to inform public health approaches and policies aimed at reducing health disparities and improving well-being in homeless communities.

Methods/Design

1.
Evaluative Criteria (Indicators or Variables)

· Prevalence of hypertension among the homeless population.

· Socio-demographic factors such as age, gender, and ethnicity.

· Behavioral factors including alcohol and tobacco use.

· Access to healthcare services and public assistance.

· Environmental and economic factors, such as sleeping conditions and employment status (Naser et al., 2020).

2.
Research Approaches

A mixed-methods approach, integrating both quantitative and qualitative research, will be pivotal in exploring hypertension among the homeless comprehensively. Quantitative methods will explain the prevalence and demographic correlations of hypertension, providing tangible data (Asenahabi, 2019). In contrast, qualitative research will enrich our understanding by revealing the lived experiences, personal narratives, and systemic barriers that this vulnerable population encounters when accessing healthcare (Asenahabi, 2019). Together, these methods will provide a multifaceted perspective, grounding statistical findings in real-world contexts and individual experiences, thereby enhancing the depth and applicability of the research outcomes (Asenahabi, 2019).

·
Quantitative: Surveys and health assessments will be used to gather data on the prevalence of hypertension and associated risk factors.

·
Qualitative: Interviews and focus groups will explore personal experiences, barriers to accessing healthcare, and the effectiveness of public assistance programs (White et al., 2020).

Data Collection

·
Quantitative Data: Standardized health assessments will be conducted by healthcare professionals to measure blood pressure and other health indicators. Surveys will be conducted by trained researchers to collect socio-demographic and behavioral data.

·
Qualitative Data: the research team will conducted semi-structured interviews and focus groups, to delve into personal experiences and challenges faced by the homeless population in managing hypertension.

According to Asenahabi (2019), data collection is the linchpin in the operational framework of this study, necessitating a thorough and meticulous design of evaluative instruments such as surveys and interview guides. A critical step in enhancing the reliability of these instruments is to initiate a pilot phase, to ensure that each item is finely tuned to accurately and reliably measure the intended variables. Based on established research protocols, a stringent assessment of validity will be conducted to affirm that the instruments precisely encapsulate and measure the critical concepts under exploration, such as the prevalence and associated risk factors of hypertension (Naser et al., 2020). To fortify the methodological rigor and enhance the study’s integrity, continuous assessments and recalibrations of these tools will be meticulously carried out, ensuring their enduring relevance, accuracy, and effectiveness in navigating the study’s evaluative criteria and overarching research objectives (Asenahabi, 2019).

Statistical Analysis

Statistical analyis, a cornerstone of this research, will be carefully conducted using specialized software, such as SPSS or R. According to Asenahabi (2019), utilizing descriptive statistics, such as means, standard deviations, and frequencies, is imperative for synthesizing and providing a clear overview of the collected data. Based on these foundational statistical insights, inferential methods, including chi-square tests and logistic regression, will be deployed to uncover and analyze the multifaceted associations between hypertension and various social determinants within the homeless population (Naser et al., 2020). This nuanced, methodological approach is fundamental for bolstering the reliability, validity, and overall rigor of the research findings and their subsequent contributions to evidence-based knowledge and practice.

·
Quantitative Analysis:

· Prevalence rates will be calculated, and associations between hypertension and various factors will be analyzed using chi-square tests and logistic regression (Naser et al., 2020).

·
Qualitative Analysis:

· Thematic analysis will be conducted to identify common themes and patterns in the qualitative data. This analytic strategy according to Asenahabi (2019), is crucial for distilling rich, nuanced insights from the qualitative data, allowing for a deeper understanding of the lived experiences and systemic challenges faced by the homeless population in relation to hypertension.

Conclusion

This capstone project is based on the SDOH model and aims to provide a holistic exploration of hypertension in the homeless population. It aims to unravel the intricate web of social determinants that can influence of health outcomes. Employing a versatile blend of research methods, supported by meticulous data gathering and rigorous statistical analysis, the objective is to uncover profound insights, serving as a compass to steer targeted interventions and tailored public assistance programs, adjusted to the unique tales and journeys of the homeless community.

References

Asenahabi, B. M. (2019). Basics of research design: A guide to selecting appropriate research design. 
International Journal of Contemporary Applied Researches
6(5), 76-89.
https://www.researchgate.net/publication/342354309_Basics_of_Research_Design_A_Guide_to_selecting_appropriate_research_design

Naser, E., Aboujaoude, A., Lenkiu, L., Carvel, J., Avais, M., Hassouneh, S. A. D., & Cobty, M. (2020). Risk Factors and Public Assistance Role in Hypertension among Homeless Population: A Cohort Study. 
Biomedical Journal of Scientific & Technical Research
24(4), 18510-18514.

https://www.researchgate.net/publication/344058748_Risk_Factors_and_Public_Assistance_Role_in_Hypertension_among_Homeless_Population_A_Cohort_Study

6

Theoretical Model Framework


Social Determinants of Health (SDOH) Model

The Social Determinants of Health (SDOH) model is a comprehensive framework that explains how various factors in the social environment influence health outcomes. This is particularly important when studying hypertension in homeless population.

Alignment with Capstone Project

Hypertension, a significant public health concern, disproportionately affects vulnerable populations, including the homeless. Hatef et al. (2021) emphasizes that the SDOH model goes beyond genetics and personal decisions to acknowledge that health is closely related to the environment in which people are born, live, work, and grow. Homelessness, as a stark representation of adverse social determinants, has the potential to worsen hypertension due to factors such as lack of access to healthcare, poor nutrition, stress, and exposure to environmental hazards.

Key Features of the SDOH Model

The Social Determinants of Health (SDOH) model intricately weaves several crucial components that, when combined, signficanly influence health outcomes. Economic stability, one of its core determinants, underscores the influence of financial security and job stability on health, highlighting how financial strain can negatively impact mental and physical well-being (Foster et al., 2021). Education access and quality emphasize the long-term health implications of literacy and educational attainment, showcasing how knowledge equips individuals to make healthier life choices and access better job opportunities (Nagorcka-Smith et al., 2022). Healthcare access and quality focus on the availability and standard of medical services, illuminating how barriers to quality healthcare can exacerbate health disparities (Foster et al., 2021). The neighborhood and built environment component illustrates how safe housing, clean environments, and access to nutritious food can directly influence health outcomes (Hatef et al., 2021). Lastly, the social and community context sheds light on the importance of supportive social networks and community structures in promoting mental health and resilience (Berkman & Krishna, 2014). Each of these determinants intricately intertwines to shape an individual’s overall health course, emphasizing the need for holistic interventions.

Research Approaches and Alignment

The SDOH model emphasizes the intricate interation among various health determinants. Research methods consistent with this holistic perspective, such as ethnographic studies and cross-sectional surveys, can shed light on the numerous challenges experienced by people experiencing homelessness and reveal underlying causes and exacerbators of hypertension (Shuck et al., 2023). The SDOH model, as articulated by Shuck et al. (2023), argue that health outcomes are not only determined by personal decisions or biological factors but are also profoundly affected by the surrounding social, economic, and environmental context. By exploring these broader contexts through appropriate research methodologies, we can devise more effective interventions tailored to the unique needs of vulnerable populations such as the homeless, ensuring a comprehensive approach to addressing health disparities.

Quantitative or Qualitative Methods

The SDOH model is adaptable to both quantitative and qualitative approaches. Quantitative methods can measure hypertension prevalence and its relationship to specific determinants, while qualitative methods can provide a deeper understanding of individual experiences and systemic challenges.

Appropriate Methods

Quantitative tools, specifically pre/post-tests, can be used as reliable indicators to assess the prevalence of hypertension before and after specific interventions, ensuring a data-driven understanding of the effectiveness of intervention (Shuck et al., 2023). Alternatively, qualitative techniques, including immersive focus groups and in-depth interviews, provide insight into the immersive experiences of homelessness. These methods not only illuminate the barriers they encounter but also capture the intricate nuances of their daily struggles, allowing for a deeper undrestanding of their healthcare needs (Nagorcka-Smith et al., 2022). Such valuable insights can serve as a compass to help pinpoint barriers to health care access and develop solutions tailored to the unique challenges faced by this population.

Evaluation and Critique

The SDOH model serves as a comprehensive lens for evaluating the effectiveness of interventions deisgnated to combat hypertension within the homeless population (Garg et al., 2019). By sharpening the focus on the underlying social determinants, these interventions can bring about transformative shifts in health outcomes, transcending the ordinary treatment of symptoms to tackle root causes (Nagorcka-Smith et al., 2022). This model highlights the complex interaction among different health determinants, suggesting that the most effective interventions are likely to be those that embrace a holistic approach. Nevertheless, the model’s wide-ranging perspective may present challenges when it comes to isolating the effects of individual interventions, highlighting the necessity for flexible initiatives that address a range of determinants to achieve profound and long-lasting impacts.

Assessment of Model Advantages and Limitations

At its core, the SDOH model excels in its holistic approach, acknowledging that health outcomes are not solely determinated by personal choices or biologic factors. Instead, they are profoundly shaped by an intricate web of social, economic, and environmental influences, as emphasized by Garg et al. (2019). By capturing this complex interaction, the model allows for a more complex understanding of health disparities, and the underlying systemic barriers they present (Nagorcka-Smith et al., 2022). However, its expansive scope can also have both positive and negative consequences. While it provides a panoramic view of the determinants of health, precise interventions targeting specific determinants may require deeper research and more targeted studies to effectively capture subtle insights.

Though it offers a comprehensive perspective on health determinants, achieving nuanced insights through precise interventions targeting specific determinants may necessitate more extensive research and focused studies.

Conclusion

Understanding health through the lens of the SDOH model emphasizes the importance of addressing systemic issues to improve individual health outcomes. While the model provides a holistic view, specific projects may need to focus on specific determinants to have a tangible impact.

References

Foster, A. A., Daly, C. J., Logan, T., Logan Jr, R., Jarvis, H., Croce, J., & Jacobs, D. M. (2021). Addressing social determinants of health in community pharmacy: innovative opportunities and practice models. 
Journal of the American Pharmacists Association
61(5), e48-e54.

Garg, A., Homer, C. J., & Dworkin, P. H. (2019). Addressing social determinants of health: challenges and opportunities in a value-based model. 
Pediatrics
143(4).

Hatef, E., Ma, X., Rouhizadeh, M., Singh, G., Weiner, J. P., & Kharrazi, H. (2021). Assessing the impact of social needs and social determinants of health on health care utilization: using patient-and community-level data. 
Population health management
24(2), 222-230.

Nagorcka-Smith, P., Bolton, K. A., Dam, J., Nichols, M., Alston, L., Johnstone, M., & Allender, S. (2022). The impact of coalition characteristics on outcomes in community-based initiatives targeting the social determinants of health: a systematic review. 
BMC Public Health
22(1), 1-26.

Shuck, B., Hart, J., Walker, K., & Keith, R. (2023). Work determinants of health: New directions for research and practice in human resource development. 
Human Resource Development Quarterly
34(2), 227-244.

6

Proposed Interventions for Managing Hypertension in the Homeless Population


Extent of Evidence-Based Data for Proposed Interventions

According to research conducted by Caires (2019), the proposed interventions are strongly supported by an extensive body of literature. Mobile health clinics have been shown, through empirical evidence, to serve as responsive healthcare delivery systems, providing essential services like blood pressure monitoring, medication distribution, and frequent check-ups (Rickles et al., 2023). Likewise, community outreach programs, as substantiated by the literature, are effective in raising awareness, providing evidence-based health education, and engaging communities in evidence-supported preventive care.

Medication adherence programs, as evidenced by Rickles et al. (2023) and other studies, use strategies like personalized counseling and reminders, all rooted in the existing literature, to enhance compliance with antihypertensive medications. This focus on evidence-based medication adherence is crucial, given the complexities of managing hypertension, which requires consistent treatment. The large body of literature supporting these interventions underscores their effectiveness in achieving better blood pressure control, reducing cardiovascular risks, and enhancing the overall well-being of vulnerable populations (Hopkins & Narasimhan, 2022). The synergy of mobile clinics, community outreach, and medication adherence programs forms a thoroughly validated, holistic approach, consistently supported by the existing literature, for improving hypertension outcomes.

Factors Influencing the Use of Proposed Interventions

Community acceptance of mobile health clinics is a key factor, requiring prior engagement and educational initiatives to build trust and encourage the use of services. Accessibility, encompassing geographical reach and operational hours, directly impacts the effectiveness of these mobile units. The availability of culturally competent, qualified healthcare providers is essential for delivering impactful interventions. Furthermore, the Social Determinants of Health (SDOH) framework sheds light on systemic factors like economic stability and societal conditions that significantly influence individual interaction with healthcare services, especially among the homeless population (Nutbeam & Lloyd, 2021). These interrelated factors necessitate a comprehensive, nuanced approach for successful implementation.

Barriers Related to Proposed Interventions

Stigmas and misinformation present challenges such as creating mistrust and constructing barriers among the homeless which limits access to essential healthcare services. Furthermore, the limited funding restricts the program’s scope and quality of care that can be provided. The dispersion of homeless communities complicates consistent healthcare delivery, requiring innovative solutions (Hopkins & Narasimhan, 2022). These solutions need to be adptable to the unique needs and circumstances of each community. Addressing each of these barriers requires the development of specific and tailored strategies aimed at fostering trust, dismantling stigma, optimizing resource allocation, and devising creative approaches for reaching and supporting this vulnerable population.

Detailed List of Resources

Mobile Health Units are important and necessary for delivering healthcare to the homeless. Not only are they equipped with crucial medical supplies and diagnostic tools, but they are also designed to meet healthcare regulations and need regular maintenance for sustained operational efficiency. The mobile units need be staffed with qualified healthcare professionals like doctors, nurses, and healthcare workers is essential. In addition to their base credentials, these professionals should have specialized training in hypertension management and cultural competency, supported by ongoing education in current best practices and new research. A well-managed stockpile of antihypertensive medications is essential for ensuring that patients receive consistent and uninterrupted treatment. This includes a secure storage system to maintain the medications at required temperature and conditions. Proper inventory tracking mechanisms must be in place to prevent shortages and ensure timely replenishment. By working together with community non-profits, medical facilities, and governmental groups can help to give more resources and assistance. These collaborations may benefit the project in a number of ways, including community outreach, educational initiatives, and obtaining funding.

Implementation Steps

Secure Funding: Obtaining sufficient financial backing is the first crucial step, enabling the procurement of mobile health units, medications, and salaries for qualified healthcare providers.

Partner with Community Organizations: Forming alliances with local non-profits, healthcare groups, and governmental agencies can lend credibility to the initiative, promote community outreach, and provide additional resources.

Deploy Mobile Units: The rollout of mobile health units involves logistical planning to ensure they reach areas with the highest concentration of homeless people and operate at times most accessible to this population.

Conduct Initial Screenings: Before embarking on any long-term treatment plan, initial screenings are imperative to assess the prevalence and severity of hypertension within the targeted homeless communities.

Establish Medication Distribution Protocols: Standardized protocols for dispensing antihypertensive medications are essential to ensure consistency in treatment and to monitor medication adherence effectively.

Monitoring, Tracking, and Ongoing Review

Monitoring key performance indicators such as medication adherence, changes in blood pressure, and participant engagement in educational programs is essential for evaluating the program’s effectiveness. Utilizing technologies such as electronic health records and mobile health applications can significantly simplify this tracking process. For example, these digital platforms can alert healthcare providers if medication adherence rates drop, or if self-reported blood pressure readings exceed safe limits. By automating the collection and analysis of these crucial metrics, the program not only enhances its efficiency but also allows for real-time adjustments to intervention strategies. Furthermore, the cost-effectiveness achieved through technological streamlining enables the program to allocate resources more judiciously, thereby facilitating its long-term sustainability and potential for scalability.

Staff Responsible and Qualifications

The core team for this healthcare initiative includes nurse practitioners, community outreach workers, and pharmacists, all holding the necessary healthcare certifications for their roles to ensure high-quality care. What’s more, they undergo training in compassionate care (Liu & Hwang, 2021) to enhance their ability to engage empathetically with the homeless population. This combination of medical expertise and empathy enables a holistic, patient-centered approach to managing hypertension in homeless individuals, resulting in a compassionate and effective healthcare experience.

Strategies for Implementation

Implementing an effective healthcare intervention plan involves several key strategies. First, partnerships with established healthcare facilities can enhance service accessibility and provide a solid foundation. What’s more, developing comprehensive training modules for the staff ensures that the healthcare workforce is equipped with the necessary skills and knowledge to deliver high-quality care to the homeless community. Furthermore, public health awareness campaigns can play a vital role in educating the community and promoting preventive healthcare measures, by instilling the proper knowledge and safety to all. These three core strategies, partnerships, staff training, and public awareness campaigns, collectively contribute to the successful implementation of a strong healthcare initiative.

Timeline

I would estimate the timeline to follow a duration of one year to ensure its success. The first three months will mainly be allocated to fundraising activities and the establishment of essential partnerships. This in ensures the financial resources and cooperation requiered for implementation. Months 4 to 6 will be dedicated to the initial pilot phase, the real world test that is instrumental in assessing its initial impact on the homeless population. Lastly, months 7 to 12 will involve concentrated efforts on data collection and making necessary modifications. This will assist with any identifying challenges, refining the operational process, participant feedback. It is the longest since it gathers valuable information on the outcome of the program. This in turns allows for informed decisions and improvements to be made to ensure the program evolves and adapts to the needs of the homeless population and community it serves.

Expected Outcomes

Expected outcomes for this healthcare initiative incorporate a broad spectrum of positive changes. These include a significant decrease in hypertension rates, reflecting a healthier community. Improved medication adherence is expected, contributing to better management of the chronic disease. Enhanced accessibility to healthcare services will empower people to seek timely medical attention. Furthermore, participants are anticipated to engage more actively in educational programs, fostering a culture of health awareness and prevention. These changes, over time, will translate into long-term health improvements for the community. Additionally, the program’s scalability and adaptability will allow it to be tailored to different settings and populations, ensuring its impact in diverse healthcare contexts.

References

Caires, A. L. (2019). Mobile health care for people who are homeless. 
Creative nursing
23(3), 152-157.

Hopkins, J., & Narasimhan, M. (2022). Access to self-care interventions can improve health outcomes for people experiencing homelessness. 
bmj
376.

Liu, M., & Hwang, S. W. (2021). Health care for homeless people. 
Nature Reviews Disease Primers
7(1), 5.

Rickles, N. M., Mulrooney, M., Sobieraj, D., Hernandez, A. V., Manzey, L. L., Gouveia-Pisano, J. A., … & Possidente, C. J. (2023). A systematic review of primary care-focused, self-reported medication adherence tools. 
Journal of the American Pharmacists Association
63(2), 477-490.

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Hypertension in Homeless Population

Background/Significance

Hypertension is a critical public health issue that disproportionately affects the homeless population. Environmental stressors, lack of consistent healthcare, and poor nutrition contribute to the prevalence of hypertension within this demographic. Understanding these factors is crucial for developing targeted interventions (Hatef et al., 2021).

Methods/Design for Better Work-Life Balance

Potential Implications to

The findings could inform the development of public health policies and healthcare practices tailored to the needs of the homeless, potentially leading to more effective management of hypertension and overall improvement in health equity (Gordon et al., 2019).

Purpose or Aims of the Study

The study aims to investigate the prevalence of hypertension among the homeless population and to identify the social determinants that most significantly impact their health outcomes, as outlined by the SDOH model (Foster et al., 2021).

Anticipated Conclusions

The conclusion is expected to underscore the complex interplay between social determinants and health, highlighting the need for holistic health interventions that address these broader social factors to effectively manage and prevent hypertension in the homeless population (Nagorcka-Smith et al., 2022).

The study will utilize a mixed-methods approach, combining quantitative data from health screenings and qualitative data from interviews and focus groups to gain a comprehensive understanding of the health status and social determinants affecting the homeless population (Shuck et al., 2023).

It is anticipated that the study will reveal a high prevalence of hypertension among the homeless, with social determinants such as lack of access to healthcare, poor diet, and environmental stressors playing significant roles in these health outcomes (Garg et al., 2019).

Expected Results/Outcomes

References

Foster A. A. Daly C. J. Logan T. Logan R. Jarvis H. Croce J. Jalal Z. Trygstad T. Bowers D. Clark B. Moore S. & Jacobs D. M. (2021). Addressing social determinants of health in community pharmacy: innovative opportunities and practice models. Journal of the American Pharmacists Association: Japha e48–e54.
https://doi.org/10.1016/j.japh.2021.04.022

Hatef E. Ma X. Rouhizadeh M. Singh G. Weiner J. P. & Kharrazi H. (2021). Assessing the impact of social needs and social determinants of health on health care utilization: using patient- and community-level data. Population Health Management 222–230. https://doi.org/10.1089/pop.2020.0043

Potential Implications to Practice.

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