Health-seeking behaviours in the homeless population: A concept analysis

This concept analysis aims to define the concept of health-seeking behaviour in relation to the homeless population. The altered experiences of individuals who are homeless suggest that the concept of health-seeking behaviours has distinct attributes and therefore, a new definition of this concept is needed when compared with other populations. The framework outlined by Walker and Avant was used for this analysis with model, borderline and contrary cases. Databases searched were: CINAHL, Sociological Abstracts, PsycInfo, Google Scholar and PubMed. Because of the limited literature on the overall health-seeking behaviours of the homeless population, the most relevant 15 sources were selected from these databases for the literature review. Critical attributes derived from the literature were: (a) distrust in healthcare services, emerging from feelings of judgement or stigma from healthcare providers; (b) prioritising physiological needs such as food, shelter and clothing over the safety needs of health; (c) delaying seeking care until physical symptoms are severe; and (d) having decreased access to healthcare because of being uninsured or having no money, requiring transportation, experiencing long wait times for appointments, or lacking knowledge of available healthcare services. We define health-seeking behaviours in the homeless population as a complex process where a homeless individual seeks out healthcare for a problem or illness, but must first meet his or her physiological needs and then deem current symptoms severe enough to seek medical treatment despite his or her distrust in the healthcare system and barriers to accessing healthcare. Homeless individuals may face unique physiological hardships and emotional stressors compared to the general population, which results in distinct attributes surrounding health-seeking behaviours. Healthcare providers need to be aware of current barriers to care and perceived access to care in order to reduce the barriers to care that the homeless population faces.

Development of a foot care model to determine the risk of foot problems among homeless adults in Canada

Foot care is a common problem for homeless adults in cities, who often receive fragmented foot care services, resulting in increased foot problems, health complications, hospitalisation, limb removal and disabilities. Among the health factors that negatively affect the homeless, foot health is essential, but often neglected. This study employed a descriptive, cross-sectional research design to assess the foot care of homeless people and develop recommendations for clinical practice. Using Inlow's 60-s foot screening method, the foot conditions of a purposive sample of 65 homeless adults were examined in British Columbia, Canada, in 2019-2020. Descriptive and inferential statistics were used to analyse the data. Determinants, such as sex and years of homelessness significantly contributed to homeless individuals' risk of developing foot problems. Differences in perceived and observed foot problems were influenced by equitable access to social health and healthcare services. Foot assessment is not well-covered by homeless health services and should be implemented as part of the standard medical review of homeless patients. Furthermore, foot assessment should be conducted by healthcare professionals, rather than relying on the standard practice of service users' self-report. Finally, foot care should be based on tailoring assessments and interventions for the individualised needs of homeless service users. Future research must seek ways to integrate homeless individuals' voices in the development, implementation and evaluation of foot care services.

Transforming attitudes of nursing students: evaluating a service-learning experience

Homelessness is a compelling social and public health issue. Nurse educators are challenged to better prepare graduates to serve this growing segment of the population. Clinical experiences with those experiencing homelessness allow students a better understanding of this population and may foster more compassionate care. This pretest-posttest intervention study examined nursing students' attitudes toward homelessness before and after participation in a service-learning clinical rotation with families experiencing homelessness. Twenty-three students enrolled in a public health nursing course at a small midwestern university participated in the research. The Attitudes Toward Homelessness Inventory was used to measure students' attitudes at the beginning and end of the course. Data analysis using descriptive statistics revealed significant differences in both global and specific attitudes toward people experiencing homelessness. These results suggest the clinical experiences positively influenced students' attitudes and support the value of integrating service-learning clinical opportunities with homeless individuals into nursing curricula.

A SAFE DC: a conceptual framework for care of the homeless inpatient

Homeless patients suffer disproportionately from medical disease and from barriers to healthcare, affecting their likelihood of presentation, severity of disease, long-term outcomes, and mortality. In the hospital, homeless patients are frequently cared for by hospitalists. Homeless patients' unstable social situation may challenge usual systems of inpatient care and discharge. To provide more effective care for this group, it is important to recognize the demographics of the hospitalized homeless patient. We suggest a structured approach to the inpatient care of the unstably housed patient, represented by a simple mnemonic checklist "A SAFE DC," describing evidence-based adaptations of care, where available, and discussing systems-based approaches to discharge.