College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
Professor of Community Nursing and Public Health Centre for Health Services Studies, University of Kent, Canterbury, UK.
Prim Health Care Res Dev. 2022 Mar 21;23:e16. doi: 10.1017/S1463423621000384.
This article documents the impact of a Nurse Practitioner-led primary health service for disadvantaged children living in housing instability or homelessness. It identifies that First Nations children miss out on essential primary care, particularly immunisation, but have less severe health conditions than non-First Nations children living in housing insecurity.
Health services for homeless populations focus on the 11% of rough sleepers, little is done for the 22% of children in Australia living in housing instability; many of whom are from First Nations families. Little is known of the health status of these children or their connections to appropriate primary health care.
This research implemented an innovative model of extended health care delivery, embedding a Nurse Practitioner in a homeless service to work with families providing health assessments and referrals, using clinically validated assessment tools. This article reports on proof of concept findings on the service that measured immunisation rates, developmental, medical, dental and mental health needs of children, particularly First Nations children, using a three-point severity level scale with Level 3 being the most severe and in need of immediate referral to a specialist medical service.
Forty-three children were referred by the service to the Nurse Practitioner over a 6-month period, with nine identifying as First Nations children. Differences in severity levels between First Nations/non-First Nations children were Level 1, First Nations/non-First Nations 0/15%; Level 2, 10/17%; and Level 3, 45/29%. Forty-five percent of First Nations children had no health problems, as compared to 29% on non-First Nations children. Immunisation rates were low for both cohorts. No First Nations child was immunised and only 9% of the non-First Nations children. While numbers for both cohorts are too low for valid statistical analysis, the lower levels of severity for First Nations children suggest stronger extended family support and the positive impact of cultural norms of reciprocity.
本文记录了以执业护师为主导的基层医疗服务对居住不稳定或无家可归的弱势儿童的影响。研究表明，第一民族的儿童错过了基本的初级保健，特别是免疫接种，但他们的健康状况不如居住在住房不稳定环境中的非第一民族儿童严重。
针对无家可归人群的卫生服务主要集中在 11%的流浪街头者身上，而对于澳大利亚 22%居住在住房不稳定环境中的儿童，几乎没有采取任何措施；其中许多人来自第一民族家庭。这些儿童的健康状况及其与适当基层医疗保健的联系鲜为人知。
本研究实施了一种创新的扩展医疗服务模式，将执业护师嵌入到无家可归服务中，与家庭合作进行健康评估和转介，使用经过临床验证的评估工具。本文报告了该服务的概念验证研究结果，该服务使用三点严重程度级别量表（级别 3 表示最严重，需要立即转介至专科医疗服务），衡量了儿童（特别是第一民族儿童）的免疫接种率、发育、医疗、牙科和心理健康需求。
在 6 个月的时间里，该服务共向执业护师转介了 43 名儿童，其中 9 名被认定为第一民族儿童。第一民族/非第一民族儿童的严重程度级别差异为：级别 1，第一民族/非第一民族 0/15%；级别 2，10/17%；级别 3，45/29%。45%的第一民族儿童没有健康问题，而非第一民族儿童则有 29%。两个群体的免疫接种率都很低。没有第一民族儿童接种疫苗，只有 9%的非第一民族儿童接种了疫苗。尽管两个群体的数字都太低，无法进行有效的统计分析，但第一民族儿童的严重程度级别较低表明，他们得到了更强大的大家庭支持，并且互惠的文化规范产生了积极影响。
