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Johansson JA, Turcotte PL, Holmes D. Assembling packs: Outreach nurses, disaffiliated persons, and sorcerers. Nurs Philos 2024; 25:e12486. [PMID: 38853432 DOI: 10.1111/nup.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
Nurses working in outreach capacities frequently encounter disaffiliated or 'hard to reach' populations, such as those experiencing homelessness, those who use substances, and those with mental health concerns. Despite best efforts, nurses regularly fail to find meaningful engagement with these populations. Mobilizing the work of Deleuze and Guattari, this paper will critically examine conventional outreach nursing practices as rooted in the royal science of psychiatry, which many 'survivors' of psychiatric interventions reject. The field of Mad Studies offers an understanding of patient resistance to outreach nursing interventions. Delueze and Guattari's concepts of packs and sorcerers provide a framework to envision alternative nursing practices as a form of resistance and creativity, where new alliances may be formed outside the coercive confines of traditional practices. In response to patient resistance, outreach nurses themselves must assemble packs and engage in acts of sorcery.
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Affiliation(s)
- Jim A Johansson
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Pier-Luc Turcotte
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Dave Holmes
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Tu Y, Sarkar K, Svirydzenka N, Palfreyman Z, Parry YK, Ankers M, Parikh P, Raghavan R, Lakhanpaul M. Interventions to promote the health and well-being of children under 5s experiencing homelessness in high-income countries: a scoping review. BMJ Open 2024; 14:e076492. [PMID: 38216205 PMCID: PMC10806763 DOI: 10.1136/bmjopen-2023-076492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Homelessness among families with children under 5 residing in temporary accommodation is a growing global concern, especially in high-income countries (HICs). Despite significant impacts on health and development, these 'invisible' children often fall through the gaps in policy and services. The study's primary objective is to map the content and delivery methods of culturally sensitive interventions for children under 5 experiencing homelessness in HICs. DESIGN A scoping review guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SOURCES Databases include PubMed, Medline, SCOPUS, The Cochrane Library and Google Scholar were searched up to 24 March 2022. ELIGIBILITY CRITERIA This scoping review includes studies that describe, measure or evaluate intervention strategies aimed at improving child health programmes, specifically those yielding positive outcomes in key areas like feeding, nutrition, care practices and parenting. DATA EXTRACTION AND SYNTHESIS Articles were selected and evaluated by two independent reviewers, with a dispute resolution system involving a third reviewer for contested selections. The methodological quality of the studies was assessed using various tools including the Risk of Bias (RoB) tool, Cochrane RoB V.2.0, the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), each selected according to the type of article. RESULTS The database search yielded 951 results. After deduplication, abstract screening and full review, 13 articles met the inclusion criteria. Two predominant categories of intervention delivery methods were identified in this research: group-based interventions (educational sessions) and individual-based interventions (home visits). CONCLUSION This review highlights effective interventions for promoting the health and well-being of children under 5 experiencing homelessness, including educational sessions and home visits. Research has supported the importance of home visiting to be instrumental in breaking down language, cultural and health literacy barriers.
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Affiliation(s)
- Yanxin Tu
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Nadia Svirydzenka
- School of Applied Social Sciences, De Montfort University Faculty of Health and Life Sciences, Leicester, UK
| | - Zoe Palfreyman
- School of Applied Social Sciences, De Montfort University Faculty of Health and Life Sciences, Leicester, UK
| | - Yvonne Karen Parry
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Matthew Ankers
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Priti Parikh
- The Bartlett School of Sustainable Construction, University College London, London, UK
| | - Raghu Raghavan
- School of Nursing and Midwifery, De Montfort University Faculty of Health and Life Sciences, Leicester, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
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Korab M, Kilpatrick K, Sarasua I. Exploring Frontline Shelter Staff Perspectives on the Healthcare Needs of Clients Experiencing Homelessness. J Community Health Nurs 2024; 41:30-43. [PMID: 37732740 DOI: 10.1080/07370016.2023.2256307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE To examine healthcare service development needs for persons experiencing homelessness from the perspective of frontline staff at a homeless shelter in Montreal, Quebec. DESIGN Qualitative descriptive design. METHODS Purposive sampling, semi-structured interviews with frontline shelter staff (n = 8), and thematic analysis. FINDINGS Themes included: 1) Challenges meeting healthcare service needs in a shelter environment. 2) Visions for improving healthcare services while accounting for health issues and barriers to care. 3) Participants' own knowledge gaps around health and healthcare services. CONCLUSIONS Future research should emphasize this group's crucial role in homelessness healthcare services development.
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Affiliation(s)
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Irene Sarasua
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
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Le H, Rew L. Youth-centered Recommendations to Address Social Stigma and Discrimination Against Unhoused Youth: An Integrative Literature Review. J Sch Nurs 2023:10598405231214061. [PMID: 37994006 DOI: 10.1177/10598405231214061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
Youth between ages 13 and 25 who experience homelessness face numerous barriers to excellent health, including social stigma and discrimination. Applying socio-ecological model and intersectionality theory, an integrative literature review was conducted. Peer-reviewed studies (N = 29) representing 808,296 participants extracted from four databases (CINAHL, MEDLINE, PsychINFO, SocINDEX) were analyzed. The studies included sources of discrimination and stigma from interpersonal interactions with support services staff upwards to policy and systemic levels with housing and justice systems. Health outcomes include poorer physical and behavioral health status from increased likeliness of denied access to support services, prolonged time spent being homeless, and higher incidences of experiencing violence. School nursing has power to push for recommended changes and support unhoused youth towards excellent health. Proposed changes include adapting Housing First framework, engaging with unhoused youth in program planning, policy writing, and public education that address the causes of poverty.
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Affiliation(s)
- Huy Le
- The University of Texas at Austin School of Nursing, Honors Program, TX, USA
| | - Lynn Rew
- Denton & Louise Cooley and Family Centennial Professor in Nursing, The University of Texas at Austin, TX, USA
- The University of Texas at Austin School of Nursing, Austin, TX, USA
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Repka B, Bejda G, Kułak-Bejda A, Czarnecki D, Ziółkowski M, Mosiołek A, Szulc A, Waszkiewicz N, Ślifirczyk A, Kułak W, Krajewska-Kułak E. Health behaviors and problems in Polish homeless men. Front Public Health 2023; 11:1208877. [PMID: 37915825 PMCID: PMC10616840 DOI: 10.3389/fpubh.2023.1208877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Homelessness is considered to be a global problem, independent of the material situation of a given country and occurring in most societies around the world. Aim of the study Assessment of the preferred health behaviors of homeless people. Materials and methods The study covered 153 men who are homeless and 312 men who are not homeless. The original questionnaire of homeless, and validated the Satisfaction with Life Scale (SWLS), the Health Behavior Inventory (HBI), the General Self-Efficacy Scale (GSES) and the Multidimensional Health Locus of Control (MHLC) Scale were used. The research covered fully completed questionnaires from 153 homeless men staying in Białystok and Gdańsk homelss centers. Results On average, the homeless men assessed their health at 6.0 ± 2.7 points, and the non-homeless at 7.8 ± 2.2 points (p < 0.001). Significant differences were found between people experiencing a homelessness crisis and the control group in selected aspects concerning the everyday life hygiene of the respondents, health self-assessment, declarations of visits to a specialist and carrying out check-ups, level of satisfaction with life, coping with difficult situations, preferred pro-health behaviors and dimensions of health control. In the used scales, SWLS, HBI, GES, and MHCL, the majority of homeless men obtained average scores. They were rather dissatisfied with their lives, with a low level of effectiveness in coping with difficult situations and obstacles, a low level of health behaviors, and in the scope of health, control increasing the impact of chance. Conclusion The level of the presented health behaviors showed statistically significant diversification with all dimensions of the health locus of control, and its internal dimension with age, homelessness phase, the respondents' criminal history, being under constant medical care, and self-assessment of health.
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Affiliation(s)
- Bernadetta Repka
- Medical College of the Universal Education Society, Łomża, Poland
- MindHealth Mental Health Center, Białystok, Poland
| | - Grzegorz Bejda
- The School of Medical Science in Białystok, Białystok, Poland
| | | | - Damian Czarnecki
- Department of Preventive Nursing, Nicolaus Copernicus University, Toruń, Poland
| | - Marcin Ziółkowski
- Department of Preventive Nursing, Nicolaus Copernicus University, Toruń, Poland
| | - Anna Mosiołek
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Warszawa, Poland
| | - Agata Szulc
- Department of Psychiatry, Faculty of Health Sciences, Medical University of Warsaw, Warszawa, Poland
| | | | - Anna Ślifirczyk
- Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
| | - Wojciech Kułak
- Department of Pediatric Rehabilitation and Center of Early Support for Handicapped Children “Give a Chance”, Medical University of Białystok, Białystok, Poland
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Paradis-Gagné E, Kaszap M, Ben Ahmed HE, Pariseau-Legault P, Jacques MC, Potcoava S. Perceptions of mobile and acute healthcare services among people experiencing homelessness. Public Health Nurs 2023; 40:36-43. [PMID: 36372948 DOI: 10.1111/phn.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/15/2022] [Accepted: 10/25/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This paper presents findings from our collaborative research on the perceptions and preferences of people experiencing homelessness regarding outreach nursing services. METHOD We conducted qualitative research using a critical ethnography approach. SAMPLE A total of 15 participants were interviewed individually (n = 12 people experiencing homelessness) and in focus groups (n = 3 care providers). We also conducted direct observation. RESULTS This paper focuses on one of the core categories that emerged from the data analysis "Perception of Health Care." This category emerged from the following three subcategories, which we will present in this paper: (1) Conflicting Relationships with Institutional Health Services; (2) Perception of Outreach Services; (3) Recommendations from Mobile Clinic Users. CONCLUSION There are a range of perceptions of health services among people experiencing homelessness. Some are satisfied with the care received in the public health system, while many have experienced dehumanizing practices. Overall, outreach services are a promising strategy to reach people who are not served by the traditional modes of care delivery. Based on our findings, we suggest several key practices to personalize and adapt healthcare services and foster inclusive environments to better serve people experiencing homelessness.
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Affiliation(s)
| | - Myriam Kaszap
- Faculty of Nursing, Université de Montréal, Québec, Canada
| | | | | | - Marie-Claude Jacques
- Faculty of Medicine and Health Sciences, School of Nursing, Université de Sherbrooke, Québec, Canada
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McWilliams L, Paisi M, Middleton S, Shawe J, Thornton A, Larkin M, Taylor J, Currie J. Scoping review: Scope of practice of nurse-led services and access to care for people experiencing homelessness. J Adv Nurs 2022; 78:3587-3606. [PMID: 35894221 PMCID: PMC9795912 DOI: 10.1111/jan.15387] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/02/2022] [Accepted: 06/20/2022] [Indexed: 12/30/2022]
Abstract
AIMS To investigate the scope of practice of nurse-led services for people experiencing homelessness, and the influence on access to healthcare. DESIGN A scoping review. DATA SOURCES On 20 November 2020, the following databases were searched: CINAHL, Embase, MEDLINE, PubMed and Scopus. REVIEW METHODS Included studies focused on people experiencing homelessness aged 18 years and over, nurse-led services in any setting and described the nursing scope of practice. Studies were peer-reviewed primary research, published in English from the year 2000. Three authors performed quality appraisals using the mixed methods assessment tool. Results were synthesized and discussed narratively and reported according to the PRISMA-ScR 2020 Statement. RESULTS Nineteen studies were included from the United States (n = 9), Australia (n = 4), United Kingdom (n = 4) and Canada (n = 2). The total participant sample size was n = 6303. Studies focused on registered nurses (n = 10), nurse practitioners (n = 5) or both (n = 4), in outpatient or community settings. The nursing scope of practice was broad and covered a range of skills, knowledge and attributes. Key skills identified include assessment and procedural skills, client support and health education. Key attributes were a trauma-informed approach and building trust through communication. Important knowledge included understanding the impact of homelessness, knowledge of available services and the capacity to undertake holistic assessments. Findings suggest that nurse-led care facilitated access to healthcare through building trust and supporting clients to access services. CONCLUSION Optimized nursing scope of practice can facilitate access to healthcare for people experiencing homelessness. Key factors in enabling this include autonomy in nursing practice, organizational support and education. IMPACT The broad range of skills, knowledge and attributes reported provide a foundation from which to design an educational framework to optimize the nursing scope of practice, thereby increasing access to healthcare for people experiencing homelessness.
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Affiliation(s)
- Lucy McWilliams
- St Vincent's Hospital SydneyDarlinghurstNew South WalesAustralia,Nursing Research Institute, St Vincent's Hospital Network SydneySt Vincent's Hospital Melbourne & Australian Catholic UniversityDarlinghurstNew South WalesAustralia
| | - Martha Paisi
- School of Nursing and Midwifery, University of PlymouthPlymouthUK,Peninsula Dental Social Enterprise, Knowledge SpaRoyal Cornwall HospitalCornwallUK
| | - Sandy Middleton
- St Vincent's Hospital SydneyDarlinghurstNew South WalesAustralia,Nursing Research Institute, St Vincent's Hospital Network SydneySt Vincent's Hospital Melbourne & Australian Catholic UniversityDarlinghurstNew South WalesAustralia
| | - Jill Shawe
- School of Nursing and Midwifery, University of PlymouthPlymouthUK
| | - Anna Thornton
- St Vincent's Hospital SydneyDarlinghurstNew South WalesAustralia,Australian Catholic UniversityNorth SydneyNew South WalesAustralia
| | - Matthew Larkin
- St Vincent's Hospital SydneyDarlinghurstNew South WalesAustralia
| | - Joanne Taylor
- St Vincent's Hospital SydneyDarlinghurstNew South WalesAustralia
| | - Jane Currie
- St Vincent's Hospital SydneyDarlinghurstNew South WalesAustralia,School of Nursing, Queensland University of TechnologyBrisbaneQueenslandAustralia
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Jagasia E, Lee JJ, Wilson PR. Promoting community institutional partnerships to improve the health of intimate partner violence survivors experiencing homelessness. J Adv Nurs 2022; 79:1303-1313. [PMID: 35841325 DOI: 10.1111/jan.15357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/21/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Disparities faced by individuals experiencing homelessness pose significant threats to the health and wellbeing of communities. Survivors of intimate partner violence are at heightened risk, with over 80% experiencing homelessness at some point in time. The intersection of homelessness and survivorship creates numerous barriers to care including safety concerns, stable housing, employment and childcare needs. The establishment of community institutional partnerships offers an opportunity to provide healthcare in transitional housing settings. AIMS The aim of this paper is to discuss the need for community institutional partnerships in addressing the health needs of intimate partner violence survivors and provide a working example of an existing partnership. METHODS A critical literature review of the literature was conducted. Multiple databases were searched to identify articles relating to health services, community institutional partnerships, intimate partner violence and sheltered housing. Articles were reviewed using The Johns Hopkins Nursing Evidence-Based Practice Quality Guide. FINDINGS Three types of partnerships that can be leveraged to address the needs of individuals experiencing homelessness were identified: academic-community, hospital-community, and large-scale partnerships. Only one article was identified that focused on the health needs of survivors experiencing homelessness, pointing to the need for implementation of more community institutional partnerships to address the unique needs of homeless intimate partner violence survivors. We highlighted a current successful community institutional partnership that addresses the health needs of survivors living in an emergency shelter. IMPLICATIONS Addressing the complex needs of this population is imperative to dismantle health inequities and structural barriers to healthcare. Holistic, nurse-led approaches to care are essential to address the health of intimate partner violence survivors experiencing homelessness. The example of a successful community institutional partnership provides a framework for delivering a wide range of healthcare services. Future nursing research is needed to evaluate programmes and provide foundational support for increased funding.
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Affiliation(s)
- Emma Jagasia
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Jennifer J Lee
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Patty R Wilson
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Fornaro M, Dragioti E, De Prisco M, Billeci M, Mondin AM, Calati R, Smith L, Hatcher S, Kaluzienski M, Fiedorowicz JG, Solmi M, de Bartolomeis A, Carvalho AF. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 2022; 20:224. [PMID: 35818057 PMCID: PMC9273695 DOI: 10.1186/s12916-022-02423-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. METHODS Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. RESULTS Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. CONCLUSION While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
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Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Anna Maria Mondin
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nimes, France
| | - Lee Smith
- Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
| | - Jess G. Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
- UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy
| | - André F. Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
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Aragão CP, Ximenes MAM, Brandão MGSA, Galindo Neto NM, Caetano JÁ, Barros LM. Validação de álbum seriado sobre redução de danos para pessoas em situação de rua. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022200939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo buscou construir e validar um álbum seriado sobre redução de danos para pessoas em situação de rua. Foi desenvolvida pesquisa metodológica para a construção e validação do álbum seriado por 22 juízes especialistas. Foi considerado índice de concordância de, no mínimo, 80% para se garantir a validação do material. Houve nível de concordância de 100% quanto aos objetivos do material, assim como sua relevância para prática clínica. A estrutura e apresentação obteve concordância de 95,5%. Assim, o índice de validade de conteúdo global na validação com juízes foi igual a 0,99, o que confirma a validação de conteúdo e aparência junto aos especialistas da área. A tecnologia foi considerada válida quanto ao conteúdo, podendo ser utilizada como ferramenta educativa sobre redução de danos, e como meio de aproximação e construção de vínculo do profissional com pessoas em situação de rua nos serviços de saúde e assistência social.
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Development and Initial Evaluation of a Nurse-Led Healthcare Clinic for Homeless and At-Risk Populations in Tasmania, Australia: A Collaborative Initiative. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312770. [PMID: 34886510 PMCID: PMC8657728 DOI: 10.3390/ijerph182312770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
People who are homeless experience significantly poorer health than the general population and often face multifaceted challenges engaging with public healthcare services. Mission Health Nurse-led Clinic (MHNC) was established in 2019 to meet the healthcare needs of this marginalised population in Launceston, Tasmania. This study examines barriers to healthcare access amongst individuals who experience homelessness, client and staff perceptions of the MHNC services and explored opportunities for service expansion. Descriptive statistics were drawn from administrative data, and all interviews were thematically analysed. A total of 426 presentations were reported for 174 individuals experiencing homelessness over 26 months. The median client age was 42 years and 60.9% were male; A total of 38.5% were homeless or lived in a supported accommodation. The predominant reasons for clinic visits included prescription requests (25.3%) and immunisations (20.1%). A total of 10 clients and 5 City Mission staff were interviewed with three themes emerging from the findings: personal vulnerability, disconnectedness and acceptability of the MHNC. The MHNC services were reported to be highly appreciated by all clients. Mental health and allied health, extra operating hours and maintaining the flexibility of walk-in appointments were suggested as expansion areas for the service and were highlighted as ways to increase engagement for improved health outcomes. Continued partnerships with interprofessional primary healthcare providers would contribute to addressing unmet healthcare needs in this vulnerable population.
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Schneiderman JU, Nedjat-Haiem F, Rivera D, Pérez Jolles M. Nurse and case manager views on improving access and use of healthcare for adults living in permanent supportive housing. Res Nurs Health 2021; 45:218-229. [PMID: 34713455 DOI: 10.1002/nur.22193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/19/2021] [Accepted: 10/09/2021] [Indexed: 01/08/2023]
Abstract
Housing is one of the social determinants of health, and homelessness is associated with health inequalities including increased morbidity and decreased life expectancy. Services to improve access to and use of primary healthcare are provided to formerly homeless individuals (hereafter residents) who live in permanent supportive housing (PSH). Residents do not always utilize services, nor receive adequate healthcare, and often have poor health outcomes. The study aims were to explore nurse and case manager (hereafter participants) views on the challenges of providing healthcare to residents, and strategies to address challenges. This descriptive, qualitative study used thematic analysis. Five nurses and eight case managers working with residents of PSH agencies were interviewed using semistructured interviews. Five main themes emerged. The first theme of context of healthcare use included how the residents' history of homelessness, trauma, and survival affected using services. The second theme was how aspects of relationships (communication issues and mistrust) were barriers to care. The third theme was how residents' health issues (physical chronic diseases, mental health, and substance dependency) affected care. Community level barriers (insurance, financial hardship, and transportation) was the fourth theme. The final theme highlighted recommendations to improve access and use of healthcare by building rapport, addressing mistrust, and using effective communication techniques. Participants noted that barriers to healthcare use were often influenced by residents' previous homeless experience. Nurses noted that chronic physical health issues were problematic for residents. Participants expressed the need to take time to form an authentic relationship to increase trust with residents.
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Affiliation(s)
- Janet U Schneiderman
- Department of Nursing, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | | | - Dean Rivera
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Mónica Pérez Jolles
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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13
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Doran K, Barrett BA, Buchanan M. A Nurse-Run Public Health Clinic for Individuals Utilizing a Community Outreach Center. J Community Health Nurs 2021; 38:173-178. [PMID: 34148434 DOI: 10.1080/07370016.2021.1932951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article describes a nurse-run clinic for low-income individuals or individuals experiencing homelessness. We conducted a quality improvement project using data from 111 individuals over 194 visits. Thirty-seven percent of patients had difficulty managing their health and 22% reported being in an active health crisis. The visits resulted in patients leaving with their visit goal being met (86%), and 96% of nonemergent cases being diverted from the emergency room. The nurse-run clinic provided access to care and served as a safety net for a vulnerable population, providing support for this clinic model with this population.
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Affiliation(s)
- Kelly Doran
- Department of Family and Community Health, School of Nursing, University of Maryland, Baltimore, Maryland, United States
| | - Barbara A Barrett
- Department of Family and Community Health, School of Nursing, University of Maryland, Baltimore, Maryland, United States
| | - Marjorie Buchanan
- Senior Consultant Population Health Networks, Lewes, Delaware, United States
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14
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Paradis-Gagné E, Pariseau-Legault P, Villemure M, Chauvette S. A Critical Ethnography of Outreach Nursing for People Experiencing Homelessness. J Community Health Nurs 2021; 37:189-202. [PMID: 33150808 DOI: 10.1080/07370016.2020.1809858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
People experiencing homelessness have a high prevalence of substance abuse and mental and physical problems. Although they have very complex health needs, they face many barriers that reduce their access to health care and social services. Several research studies have shown the need to implement adapted nursing interventions to address these crucial access issues. In this article, we present the results of a critical ethnography of outreach nurses who work with homeless people (n = 12). Robert Castel's theoretical model, which focuses on the process of social disaffiliation, provided the conceptual underpinnings for this research. Our qualitative data analysis revealed four categories, namely 1) the professional role and identity of nurses; 2) the social function of outreach nursing; 3) clinical realities and 4) disaffiliation and stigmatization. Our findings highlight the need to raise awareness among health care providers about the ethical, clinical and organizational issues of homelessness, particularly the mechanisms of exclusion and stigmatization in health care settings that affect people experiencing homelessness.
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Affiliation(s)
| | | | - Midori Villemure
- Department of Nursing, Université du Québec à Trois-Rivières , Québec, Canada
| | - Simon Chauvette
- Department of Nursing, Université du Québec à Trois-Rivières , Québec, Canada
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15
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Paradis-Gagné E, Pariseau-Legault P. Critical ethnography of outreach nurses- perceptions of the clinical issues associated with social disaffiliation and stigma. J Adv Nurs 2020; 77:1357-1367. [PMID: 33222342 DOI: 10.1111/jan.14671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/05/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to gain a better understanding of how nurses experience their practice with homeless people. More specifically, we wanted to consider the role as it is practised and certain clinical characteristics associated with social disaffiliation and stigma. BACKGROUND Previous research has shown the need to implement adapted nursing interventions to address the problems homeless people encounter in obtaining health services. According to the literature, such interventions have positive health outcomes for homeless people, who exhibit complex health needs. DESIGN We chose critical ethnography as our research method. METHOD Semi-structured interviews were conducted with 12 nurses who work with people experiencing homelessness in Eastern Canada. They were selected using the convenience sampling method. Recruitment was conducted between June-October 2019. FINDINGS Four categories emerged from the qualitative analysis of the data: (1) the professional role and identity of nurses; (2) the social function of outreach nursing; (3) clinical realities; and (4) disaffiliation and stigmatization. In this article, we will present the findings associated with the fourth category. CONCLUSION Nursing practice with this population is conducted in non-traditional settings such as shelters, community groups, camps, and the street. Nurses must be able to gain acceptance in these environments in order to forge trusting relationships with disaffiliated and stigmatized patients. Our analysis of the data also indicates that nurses who care for homeless people may be subject to stigma by association or "courtesy stigma." IMPACT The results of this critical ethnography are useful in that they highlight the clinical interventions and health policies best suited to a highly marginalized clientele that is poorly served by traditional health services.
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16
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Sleet DA, Dellinger AM. Using behavioral science theory to enhance public health nursing. Public Health Nurs 2020; 37:895-899. [PMID: 32893391 DOI: 10.1111/phn.12795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022]
Abstract
The application of behavioral science theory is instrumental in advancing nursing research and practice. Nurses can benefit from a thorough understanding of theoretical perspectives related to health behavior change. Behavioral science theory can provide a conceptual context for understanding patient behavior, it can guide research on the determinants of health behavior and health service delivery, and it can offer alternative approaches to nursing practice that may improve the effectiveness of patient care. The aim of this paper is to provide some examples of behavioral theories that can be used in nursing research and practice, and provide an example of how one theory, Stages of Change (Transtheoretical Model), can be applied to older adult fall prevention. Given the critical role behavior plays in premature morbidity and mortality, public health nurses and researchers can benefit by broadening the use of theory in the design and implementation of interventions, using behavioral theory as their guide.
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Affiliation(s)
- David A Sleet
- The Bizzell Group/TJFACT/Veritas Management, LLC and the Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ann M Dellinger
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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17
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Hungaro AA, Gavioli A, Christóphoro R, Marangoni SR, Altrão RF, Rodrigues AL, Oliveira MLFD. Homeless population: characterization and contextualization by census research. Rev Bras Enferm 2020; 73:e20190236. [PMID: 32609214 DOI: 10.1590/0034-7167-2019-0236] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/06/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze characteristics of homeless people and factors associated with living on the streets. METHODS a census-type sectional survey carried out between 2015 and 2018, in the municipality of Maringá-Paraná. A total of 701 homeless answered a structured questionnaire with sociodemographic data, living conditions, and drug use. We used Pearson's correlation test for the association analysis of the variables at a 95% confidence level. RESULTS men (90.7%) the average age of 37.7 years had been homeless for an average of 5.39 years. Most had little education (54.2%), and homelessness was due to drug use (47.2%) and family disagreements (38.9%). CONCLUSIONS drug use and family disagreements were the main reasons for homelessness. Time on the street, gender, and drugs were associated with a negative correlation to be homeless; and age, mean daily income, the number of daily meals, having been in prison, and having an income source were associated with positive correlation.
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Affiliation(s)
| | - Aroldo Gavioli
- Universidade Estadual de Maringá. Maringá, Paraná, Brazil
| | | | | | | | - Ana Lúcia Rodrigues
- Universidade Estadual de Maringá, Observatório das Metrópoles. Maringá, Paraná, Brazil
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Frazer K, Paul G, Kroll T. Learning from Nightingale’s engagement with complex systems: 21st-century public health issues of homelessness and achieving Sustainable Development Goals. Perspect Public Health 2020; 140:139-140. [DOI: 10.1177/1757913920914653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- K Frazer
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - G Paul
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - T Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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