More than 200 homeless men and women were provided vaccinations against pneumococcal disease in an initiative spearheaded by nurse practitioners (NPs), according to a report published in the Journal of the American Association of Nurse Practitioners.

Because infectious diseases like influenza, varicella, measles, mumps, rubella, hepatitis, and the new coronavirus disease 2019 (COVID-19) can easily spread in settings like group shelters, researchers sought to employ a vaccination program to reduce the prevalence of communicable diseases among homeless individuals. NPs implemented a 5-step immunization program to vaccinate men and women in southern Florida over a 3-month period.

The majority of the 209 adult participants were Black (n=117), 50 were White, 35 were Hispanic, and 7 identified as Haitian. There were more men (n=177) than women (n=32) enrolled in the program, but this figure aligns with the population of the shelter where the project took place.

All participants were all given the pneumococcus (PPSV23) vaccine. Participants aged 65 years and older were also given the Prevnar 13 vaccine. Prior to administering vaccinations, NPs conducted face-to-face interviews with sheltered and unsheltered homeless adults in southern Florida to assess adherence to recommended adult vaccine schedules. Less than 40% of interviewees were aware of their immunization history or were up to date with their vaccinations.


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The first step in the vaccination program involved establishing structured classes conducted over a 6-month period. NPs collaborated with volunteer staff at the shelter to provide weekly, 1-hour educational sessions about health and safety topics of particular relevance to homeless individuals, including communicable diseases, opioid and substance abuse, hand washing, sexually transmitted infections (STIs), and stress reduction.

The second step involved nursing study engagement. The study authors stated that programs similar to this vaccine initiative pair well with the core values of nursing practice. Nursing students helped to break out groups of men and women into smaller learning groups.

“Nursing practice is enhanced by applying evidence based health care practices for the numerous conditions seen among the homeless. The NP is in a good position to identify patient safety issues that, if addressed, can improve quality and client safety,” researchers said.

The third step was to validate the vaccine status of each person receiving a vaccine; the program lead enrolled participants into the state’s online health tracking system, Florida SHOTS. The system provided individual vaccine status data and follow-up vaccine dates if the individual had previously received a vaccine in Florida. For participants whose vaccine records were out of state, NPs relied on clinic records and the individual’s vaccine history.

In step four, every nursing volunteer was trained to monitor vaccine recipients for adverse effects and to document results. Volunteers were instructed on best practices for receiving, storing, and administering vaccinations. Two weeks following receipt of the vaccine, participants answered a 9-question post-vaccination survey conducted by an NP.

NPs provided 209 vaccinations to homeless men and women in southern Florida over a 3-month period; following the initial vaccination program, the project was continued and expanded in scope. The program now offers vaccines for influenza, tetanus, diphtheria, pertussis, and hepatitis A — all of which are provided by the Miami-Dade County health department.

The fifth step was to conduct post-vaccination follow-up. NPs are continuously collecting and analyzing data as part of this initiative and conducting weekly follow-ups with residents who remain in the shelter to record any delayed adverse responses.

“Since working with the homeless population, the challenges to illness prevention and health promotion have become clear and that strategies and models of care must be developed to address the unique, medically complex needs of underserved homeless populations,” the authors concluded. “By providing preventive health care services to the homeless, health interventions may help to reduce inappropriate use of emergency care centers and decrease the need for inpatient or critical care services.”

Reference

Washington-Brown L, Cirilo RW. Advancing the health of homeless populations through vaccinations. J Am Assoc Nurse Pract. Published online October 7, 2020. doi:10.1097/JXX.0000000000000509