Vaccines, Herd Immunity, and COVID-19.

Vaccines in America have led to the eradication of transmissible infections and the reduction of vaccine preventable diseases among all age groups. Vaccines are important to the safety and welfare of our nation because vaccines produce immunity from infectious diseases. When most of the American population is vaccinated against COVID-19 and other transmittable diseases, herd or community immunity can slow disease transmission, including protection against the disease among persons who have not received the vaccines, and reduce the risk at-large of severe infections and adverse consequences of those diseases.

Coronavirus Disease - 2019-nCoV (COVID-19).

According to the World Health Organization (WHO) (2020b), coronaviruses refer to a large family of viruses known to be zoonotic (transmitted from animals to humans) and cause a variety of illnesses from the common cold to more concerning diseases such as severe lower respiratory tract infections (LRTIs). These viruses are called coronaviruses because their surfaces have crown-like spikes and "corona" is the Latin word for crown (WHO, 2020b). The potential community health risk caused by the current coronavirus (2019-nCoV) is high for young children, older adults, persons with comorbid cardiac or respiratory diseases, and immunocompromised individuals because their immune systems may be weak, making them more susceptible to contracting the coronavirus. Other members of the community that are at risk include healthcare and essential community workers at the forefront of this global epidemic, anyone with close person to person contact, and recent travelers to Wuhan and its surrounding provinces in China (Chinazzi et al., 2020). Healthcare and other frontline workers must be knowledgeable and prepared for the global outbreak of the coronavirus.

The fundamentals of integrating service in a post-licensure RN to BSN program.

Integrating service in a post-licensure registered nurse to bachelor of science in nursing (RN to BSN) program provides licensed registered nurse (RN) students the opportunity to learn, develop, and experience different cultures while serving the community and populations in need (McKinnon & Fitzpatrick, 2012). Service to the community, integrated with academic learning can be applied in a wide variety of settings, including schools, universities, and community faith-based organizations. Academic service-learning (ASL) can involve a group of students, a classroom, or an entire school. In the RN to BSN program, the authors use a student-directed service learning approach that integrates service-learning throughout the curriculum. RN students are introduced to service-learning at program orientation prior to the start of classes and receive reinforcement and active engagement throughout the curriculum. The students and volunteer agencies receive and give benefits from the services provided and the life lessons gained through mentorship, education, and hands-on experiences.

Transitioning RN to BSN students from acute care to hospice care nursing.

Today, most medical professionals focus on a cure. However, hospice care provides a quality of life for those persons nearing the end of life or persons experiencing a life-limiting illness. The distressing reality is that most nurses are not taught the full scope of end of life care (EOL) in schools of nursing. Because of this educational deficit, a variance in care is created that may adversely affect the dying patient and family's wishes. In our RN to BSN program, we established a partnership with a national hospice organization to provide (1) leadership in end-of-life course development, (2) lecturers experienced in hospice and palliative care, (3) field placement for students with hospice nurses, and (4) nursing scholarships to complete the bachelor's degree. The end result of this partnership is to educate registered nurses about hospice and palliative care, as well as to increase the nursing workforce in this area.

Psoriasis Vulgaris Masked by Tinea Pedis in Two Unhoused Patients.

Psoriasis is a chronic inflammatory disease characterized by clearly marginated silvery plaques that affect men and women equally. Symptoms can vary among individuals; typically, it presents on the scalp, elbows, and knees. We present two cases of patients initially diagnosed with tinea pedis who showed no improvement with medical treatment. The first patient is an African American male in his 50s who arrived at a free clinic for unhoused persons with lesions to both feet initially diagnosed as tinea pedis. Although the patient was compliant with applying topical formulations of tolnaftate and clotrimazole, there was no discernible improvement in his symptoms and the skin lesions. After a thorough examination of the skin throughout the entire body, the diagnosis of psoriasis was considered. The patient started treatment with steroidal cream with improvement of the symptoms and lesions. The second patient is a Caucasian male in his 20s who also presented initially with complaints of a dry, intensely pruritic, and scaly rash on the dorsum of both his feet, as well as in between the digits of his feet for which an initial diagnosis of tinea pedis was also made. The patient remained non-compliant with treatment and, after reevaluation of his lesions along with an extensive survey of his body, was deemed to have psoriasis and prescribed topical hydrocortisone. The patient continued to remain non-compliant with his therapeutic regimen and subsequently developed cellulitis which is yet to resolve with treatment.

Advancing the health of homeless populations through vaccinations.

BACKGROUND: Homeless individuals and families are at an increased risk for contracting and transmitting communicable infections and diseases. Due to poor living conditions and limited access to health care resources, homeless people of all ages are vulnerable to acquiring communicable infections, such as pneumococcal pneumonia. LOCAL PROBLEM: Less than 40% of sheltered and unsheltered homeless people in South Florida, who were interviewed for this project, knew their immunization status and/or were up-to-date with their recommended vaccine histories. METHODS: The immunization project implemented a five-step process to provide pneumococcus (pneumococcal polysaccharide vaccine 23) and Prevnar 13 vaccinations to a convenience sample of adult homeless men and women (N = 209) participants, who completed the financial eligibility form (J11) during their intake process to admission, for sheltered services from two local clinics. INTERVENTIONS: To promote herd immunity, the five-step process was followed. As per the Centers for Disease Control and Prevention guidelines, initial training was provided to homeless shelter health care providers on vaccine storage, handling, and vaccination. A subsequent 1-week follow-up was completed with participants to determine if any delayed vaccination adverse reactions occurred. RESULTS: Descriptive statistics was used to examine data from the initial project implementation. Findings indicated that more African Americans (n = 117) participated in the project than Whites (n = 50), Hispanics (n = 35), or Haitians (n = 7). CONCLUSIONS: Homeless individuals experience illnesses that are preventable through involvement with a structured immunization program. Collectively, nurse practitioners can reduce barriers to immunization by increasing vaccine coverage and introducing incremental policy changes that enhance the health status among homeless populations.