Nurses' perceptions of people who are homeless

Student Nurse Attitudes Towards Homeless Clients: a challenge for education and Practice

The purpose of this research was to describe attitudes of nursing students (and paramedic officers) towards marginalized clients. Convenience quota sampling in a major health faculty was employed. Students participated on a voluntary basis. A 58-item Likert scale, developed by the authors, assessed the student nurses’ attitudes. In general, attitudes towards homeless clients were neutral; detailed analyses, however, revealed that student nurses would decline to care for homeless clients in various situations. Personal experience with homeless patients and positive attitudes of nurses significantly contributed to increased quality of care and equality of treatment for homeless clients. Certain student nurse behaviors warrant immediate attention to prevent marginalized patients from being exposed to unfair, inaccessible and biased nursing care. Based on our results, we recommend that further research attention be paid to the role of ethics education and faculty behaviors, as faculty members serve as role models for professionalization.

Healthcare professionals' stigmatization of men with anabolic androgenic steroid use and eating disorders

Building upon previous research on the stigmatization of individuals with eating disorders (EDs), the present study sought to evaluate healthcare providers' attitudes toward male anabolic androgenic steroid (AAS) users. Healthcare providers (N=148) were first randomly assigned to read one of four vignettes describing a male AAS user, ED patient, cocaine user, or healthy control. Each provider then rated, on a scale of -3 to +3, how strongly either word in one of 22 word-pairs described his or her feelings toward the person described in the vignette. Results indicated that providers perceived the ED and AAS use patients less favorably than the cocaine user or healthy adult, suggesting that the two groups may be stigmatized by health providers. Given the psychiatric and medical risks associated with AAS use and EDs, reducing bias may help reduce the personal suffering and public health burden related to these behaviors.

"Rewarding and challenging at the same time": emergency medicine residents' experiences caring for patients who are homeless

OBJECTIVES

The objectives were to examine how emergency medicine (EM) residents learn to care for patients in the emergency department (ED) who are homeless and how providing care for patients who are homeless influences residents' education and professional development as emergency physicians.

METHODS

We conducted in-depth, one-on-one interviews with EM residents from two programs. A random sample of residents stratified by training year was selected from each site. Interviews were digitally recorded and professionally transcribed. A team of researchers with diverse content-relevant expertise reviewed transcripts independently and applied codes to text segments using a grounded theory approach. The team met regularly to reconcile differences in code interpretations. Data collection and analysis occurred iteratively, and interviews continued until theoretical saturation was achieved.

RESULTS

Three recurring themes emerged from 23 resident interviews. First, residents learn unique aspects of EM by caring for patients who are homeless. This learning encompasses both specific knowledge and skills (e.g., disease processes infrequently seen in other populations) and professional development as an emergency physician (e.g., the core value of service in EM). Second, residents learn how to care for patients who are homeless through experience and informal teaching rather than through a formal curriculum. Residents noted little formal curricular time dedicated to homelessness and instead learned during clinical shifts through personal experience and by observing more senior physicians. One unique method of learning was through stories of "misses," in which patients who were homeless had bad outcomes. Third, caring for patients who are homeless affects residents emotionally in complex, multifaceted ways. Emotions were dominated by feelings of frustration. This frustration was often related to feelings of futility in truly helping homeless patients, particularly for patients who were frequent visitors to the ED and who had concomitant alcohol dependence.

CONCLUSIONS

Caring for ED patients who are homeless is an important part of EM residency training. Our findings suggest the need for increased formal curricular time dedicated to the unique medical and social challenges inherent in treating patients who are homeless, as well as enhanced support and resources to improve the ability of residents to care for this vulnerable population. Future research is needed to determine if such interventions improve EM resident education and, ultimately, result in improved care for ED patients who are homeless.

Client-provider relationships in a community health clinic for people who are experiencing homelessness

Recognizing the importance of health-promoting relationships in engaging people who are experiencing homelessness in care, most research on health clinics for homeless persons has involved some recognition of client-provider relationships. However, what has been lacking is the inclusion of a critical analysis of the policy context in which relationships are enacted. In this paper, we question how client-provider relationships are enacted within the culture of community care with people who are experiencing homelessness and how clinic-level and broader social and health policies shape relationships in this context. We explore these questions within a critical theoretical perspective utilizing a critical ethnographic methodology. Data were collected using multiple methods of document review, participant observation, in-depth interviews and focus groups. The participants include both clients at a community health clinic, and all clinic service providers. We explore how clients and providers characterized each other as 'good' or 'bad'. For providers, this served as a means by which they policed behaviours and enforced social norms. The means by which both providers' and clients' negotiated relationships are explored, but this is couched within both local and system-level policies. This study highlights the importance of healthcare providers and clients being involved in broader policy and systemic change.

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.

Transformation in Family Nurse Practitioner Students' Attitudes Toward Homeless Individuals After Participation in a Homeless Outreach Clinic

PURPOSE

To use a retrospective pre/post self-assessment survey to determine the attitudes of family nurse practitioner (FNP) students toward homeless individuals before and after participating in a homeless outreach clinic (HOC) and to elicit, through focus groups, their perspectives on the homeless population after their HOC participation.

DATA SOURCES

A mixed-methods study using focus group tapes and transcripts of 15 FNP students who were divided into two separate focus groups as well as three completed survey measures: Demographic Data Form, Attitudes Toward Homelessness Inventory, and HOC Attendance Form.

CONCLUSIONS

Overall, the FNP students revealed no stigmatizing attitudes toward homeless people prior to their HOC participation, but a significant positive change in their attitudes occurred after the experience. There were significant mean differences in 6 out of the 11 scale items and in the overall total mean scores after the HOC experience (p = .013). The focus groups revealed the transformation of the students' attitudes toward homeless individuals after their HOC participation, supporting and illuminating the survey findings.

IMPLICATIONS FOR PRACTICE

The study findings underscore the importance of including the care of homeless patients in FNP educational programs. Such exposure provides FNP students with an opportunity to develop the social responsibility to care for all segments of society, especially homeless people, in keeping with nursing's social contract as a helping profession.

Marginalization and health geomatics

Marginalized groups have been defined as groups that have been peripheralized from the center of society. Increasing nursing knowledge of marginalized groups and the dynamics of population diversity will enable nurses to better recognize shifting health patterns, plan for utilization of health services, and determine ethnic and cultural differences that exist in marginalized populations. The authors of this article review theoretical models responsible for defining the concept marginalization, describe geographical information systems as a recommended tool to evaluate marginalized groups, and provide a case study utilizing tools and maps as a means of assessing marginal situations.

Nursing student-patient relationship: a review of the literature from 1984 to 1998

AIM AND BACKGROUND

The aim of this review is to examine the research of the nursing student-patient relationship for planning an empirical study in this area.

METHODS

A literature search was made focusing on relationship from student and patient perspectives. The sample included 104 articles from 1984 to 1998. The articles were analysed using an inductive analysis of the literature.

RESULTS

The review shows that there has been an increasing research interest in the issue since the 1980s, with the main focus on nursing students. Most of the studies were of a descriptive nature, using both qualitative and quantitative approaches. It seems that the relationship with a patient is an important part of a meaningful learning process, teaching nursing students about the patient's individualised care and promoting their personal and professional growth, confidence and self-esteem. Patients are willing to participate in students' learning process and they tend to benefit from therapeutic and social interaction with students. Instruction has the effect of changing students' attitudes and improving their interaction skills, but it does not affect their feelings of anxiety in novel situations.

CONCLUSIONS

In future empirical research should be based more firmly on theory-based illuminations of the student-patient relationship.