Homelessness as culture: How transcultural nursing theory can assist caring for the homeless

Experiences of Adult Men Who Are Homeless Accessing Care: A Qualitative Study

INTRODUCTION

Homeless individuals experience increased rates of chronic physical and mental health conditions. They also experience difficulty accessing care and poor health outcomes compounded by social and economic factors, such as housing insecurity, unemployment, and limited social support. The purpose of this study was to describe the perceptions of homeless individuals related to their health and experiences accessing care.

METHOD

Qualitative descriptive methods and content analysis were used to gather, analyze, and interpret the data and identify themes.

RESULTS

Three themes were identified: men who are homeless experience bias throughout their health care and interpersonal relationships, the best care is person-centered and considers patients' priorities, and care coordination resources are inadequate.

DISCUSSION

The housing needs of homeless individuals are best contextualized by their health and social needs. In addition, their priorities must be taken into consideration to develop culturally congruent services that are appropriate and effective care for this population.

Assessing needs of student volunteers related to providing care to a homeless population

PROBLEM STATEMENT

Microsystem analysis of the free clinic run by students from Rush University at a Chicago homeless shelter revealed many unfilled volunteer shifts, and a lack of training.

METHODS

As a quality improvement project to assess educational gaps and concerns, an online survey was distributed to actual and potential student volunteers.

RESULTS

Among the 54 participants, the majority were nursing students (70.4%), had volunteered at the clinic at least once (59.3%), reported not feeling confident in their ability to care for homeless patients (64.8%), and did not believe their academic program adequately addressed care of homeless patients (70.4%). Analysis did not identify a statistically significant relationship between academic program and confidence or perceived program adequacy, likely due to the small sample size of medical and physician assistant students. Content analysis of the qualitative responses identified four categories of educational gaps and concerns-knowledge deficits, skill deficits, volunteer support, and site-specific concerns.

CONCLUSION

Numerous educational gaps and concerns were identified from subjective data, though no negative attitudes toward the patients were noted. These data will help design a training session for potential clinic volunteers, and suggest that further exploration of educational gaps in caring for homeless patients is warranted.

Lessons from the Homeless: Civil and Uncivil Interactions with Nurses, Self-Care Behaviors, and Barriers to Care

BACKGROUND

Civility, rooted in social justice, is a fundamental value of nursing. Homeless people are particularly at risk for experiencing uncivil behavior from nurses.

PURPOSE

The purpose of this study was to explore homeless people's perceptions of their interactions with nurses.

METHOD

In this descriptive, qualitative study, we interviewed 15 homeless adults who described their experiences with nurses. The interview guide, developed by the researchers, consisted of open-ended questions and probes. Transcriptions and field notes were analyzed through thematic analysis.

RESULTS

Three major themes emerged: nurses should be civil, self-care behaviors, and barriers to good care. Subthemes included listening, compassion, attentiveness, and judgment as components of civility; where they go for care and who cares for them as self-care behaviors; and lack of money and homeless status as barriers to care.

CONCLUSIONS AND IMPLICATIONS

Our findings indicate people who are homeless often perceive nurses to be uncivil and uncaring toward them; furthermore, our participants provide a unique description of healthcare interactions from the perspective of the homeless. These findings can be used as a basis for the development of education interventions for students and practicing nurses to assist them in learning to provide civil and compassionate care for the homeless.

Going Domestic: Importing the Study Abroad Experience. The Development of a Multicultural New York City Study Away Program

PROBLEM

Significant off-campus domestic study away experiences have been shown to be a transformative active learning environment for students and achieve similar learning outcomes as study abroad programs.

METHODS

This manuscript describes the conception, development, and pedagogical approach of a faculty-led domestic study away experience in New York City for pre-licensure and post-licensure nursing students as an active learning strategy for developing cultural competence. Students participated in service-learning activities that illuminated the realities and challenges persons from other cultures face as they interact with health care in a culture that is not their own.

FINDINGS

In partnership with New York Cares©, students were immersed in well-established ongoing sustainable community-based projects. These experiences fostered reflective conversations between community members, student participants, and faculty regarding social factors, cultural issues and needs, and global issues and trends.

CONCLUSIONS

Through the New York study away program, students were able to broaden their perspectives about social factors and culture beyond geographic or ethnic boundaries and apply these service experiences to their nursing practice. Study away programs are an excellent strategy for nursing educators to prepare students for care of multicultural populations and for proficiency in cultural competency within the globalization of the United States.

Worlds apart in the same town? A qualitative comparison of pre- and post-clinical themes assessing student nurse perceptions of homeless, mentally ill clients

Student nurses' negative attitudes towards men who are homeless and mentally ill disrupt development of therapeutic relationships. Without therapeutic relationships these men may feel stigmatized. Assessing student attitudes allows for insights to improve students' abilities to develop therapeutic relationships. The purpose of this research was to assess student nurses' pre- and post-perceptions towards homeless mentally ill clients during a mental health clinical through analysis of pictorial data. Data was analyzed through a qualitative, phenomenological method. On the first and last days of clinical experience, students were asked to draw a picture in response to the question: "How far apart are you from these men?" We analyzed pre- and post-drawings separately and changes were compared. Four pre-attitude themes and two post-attitude themes were identified. Pre-attitude themes demonstrated student drawings as geographically distanced from the clients and living in two different worlds. Post-drawings reflected themes where clients and students were under the same roof and often physically touching. We suggest using this easily reproducible, inexpensive method to gain insights into student attitudes. The difference in the drawings objectively demonstrates the effectiveness of clinical experiences in changing student nurse attitudes towards men who are homeless and mentally ill.