Effective Nursing for the Homeless

Kim E. Lesniak

School of Nursing, James Madison University

NSG 462: Issues in Contemporary Nursing Practice

Professor Bethany Andrews

November 15, 2020

 Abstract

The following paper explains different key elements that are needed for nurses to provide

effective health care for the homeless population. It begins by discussing the importance of the

nurse’s self-awareness and education that leads to using our communication skills to develop

relationships with the patient group to bridge the gap between them and the medical world.

Once relationships are formed, the nurse is able to teach the importance of understanding their

illness and advocate for these individuals by informing them of services available.

Keywords: homeless, homelessness, nursing, health care, advocate

People experiencing homelessness have unique health care needs. As a nurse, I feel compelled to

learn more about this issue and how to care for these vulnerable patients. While this is not an

easy topic to address, according to Bacon, et al. (2016), “There is an increasing need for nurses

who are prepared to transition from individualized nursing care to the care of populations” (p.

115). It is important for schools of nursing to offer courses and/or experiences for nursing

students to gain skills and competencies in community and public health. Nurses have the ability

to bridge the gap between the medical community and this patient group. In order to provide

effective care, we, as nurses, not only need proper education and training but also the ability to

adequately reach out, communicate, and connect with this population to advocate for and educate

them on medical and preventative care as well as available services.

A part of becoming educated to serve the homeless, we need to understand our own

beliefs and values in order to move past any prejudice or discriminatory barriers we may have as

individuals. Our lives as caregivers and those of the homeless are so different that we are

basically cultural strangers. Without being judgmental, nurses need to learn how these patients

became homeless and what their day to day lives are like (McEnroe-Petitte, 2020). Educating

ourselves includes learning more about the uniqueness of each of these patient’s circumstances.

For example, where exactly are they living; on the street, in a wooded area, in a parked car, in a

tent, or in a shelter? Understanding and knowing these details can explain why patients have

certain illnesses and how to adequately treat them.

As nurses, we may feel that we lack the power to make a difference with the homeless

population. In order to have effective outreach we first must develop a trusting, nonjudgmental

relationship that conveys respect, dignity, and value with these individuals. We also need to

keep in mind that it takes time to develop rapport with these individuals and results may not
come quickly. There are many small ways in which we can gain trust. Some of these include:

respecting personal space; being prepared to experience hostility; distributing small hygiene

items; accepting hospitality; being clear about expectations; and honoring our commitments to

them (Abiom, et al., 2018).

One of the most important strategies in developing a relationship is good communication

between a nurse and her patient. Effective communication, this includes listening, is also a very

effective way for a nurse to find out what is bothering this individual. “Nurses can better assess

and provide individual care for people who are homeless by using open-ended, easy-to-

understand questions, and an interpreter to address language barriers” (McEnroe-Petitte, 2020,

p.28). An example of this, according to McEnroe-Petitte (2020), would be to ask, “What would

make your day better right now?” (p.28). Once good communication is developed, we need to

help educate our patients. As a patient educator, “nurses provide information about illnesses and

teach about medications, treatments, and rehabilitation needs” (Black, 2020, p.326). A nurse can

help their patients understand acute and chronic illnesses and the importance of medication

compliance. Education equals prevention and, as prevention is the primary goal in healthcare,

nurses can offer interventions and services to guide their patients (McEnroe-Petittie, 2020).

In addition to providing education, the nurse is also a patient advocate. This may be the

most important role as a nurse especially to the homeless. This role includes everything from

knowing and explaining rules and regulations of complex health care systems to making sure the

privacy and dignity of the patient are protected. Most of the provisions in the Nursing Code of

Ethics apply to directly to the care or advocacy of patients. One of the most important of these is

Provision 1 that states, “The nurse practices with compassion and respect for the inherent

dignity, worth, and unique attributes of every person” (Lachman, et al., 2015, p.269).
As an advocate to the homeless, a nurse must be informed of the public services available for

their patients. While researching information for this paper, I learned about many programs and

services, both medical and nonmedical, for the homeless population in our country. One

important problem is that these folks are unaware of most of them. A majority of the homeless

don’t have access to computers and the internet and, even if they did, may not know where to

begin to look for these programs. This is when, as an advocate, we can direct our patients to the

assistance they need. Two medically related programs that I discovered include the McKinney-

Vinto Homeless Assistance Act, a federal program that provides outpatient health service funds,

and the nurse managed health clinics (NMHC), some of which only serve the homeless

population. Other programs that are better known include Medicare, Medicaid, Supplemental

Security Income (SSI), and the Affordable Care Act.

In 2010 the Affordable Care Act provided fifteen million low-income Americans with

health insurance. “In this diverse newly insured group, those experiencing homelessness may be

an unexpected population that has particularly benefited from changes in eligibility” (DePeitro,

2020, p.2). According to DiPeitro (2020), “Five key benefits that Medicaid expansion has made

possible for the vulnerable people that lack housing: better patient coverage, improved access to

services and quality of care, increased resources for health care providers, better addresses social

determinants of health, and increased dignity and inclusion” (p.2). In addition to and because of

these benefits, opioid overdose deaths have decreased, there have been earlier detection of cancer

and treatment, and increased access to prescription drugs for heart disease, diabetes, and mental

conditions (DiPeitro, 2020). One more intangible benefit of Medicaid expansion that shouldn’t

be overlooked is the increased sense of dignity and inclusion. Dipeitro (2020) went on to say,
“As a population that is regularly stigmatized, ostracized, or simply ignored by the health care

system, extending Medicaid coverage is literally a lifeline” (p. 8).

The homeless population is increasing in America and these folks have complex health

care needs and often encounter barriers to health care services. Providing health care for the

homeless is and will always be difficult. There are so many different factors to consider when

trying to mitigate this issue. As nurses, we have the ability to establish trust and bridge the gap

between the medical community and the self-contained world in which the homeless live.

Educating ourselves to the health needs and uniqueness of this population, using our

communication skills, and establishing relationships are key elements in providing effective

health care. Once we accomplish this then we are not only able to care for this population but

also educate and advocate for these individuals which ultimately enables them to care for

themselves and each other.

 References

Aboim, S., Dorney-Smith, S., Schnellar, K., et al. (2018). Meeting the healthcare needs of

people experiencing homelessness: Nursing Standard, 27-33.

doi: 10.7748/ns.2018.e11155

Bacon, C., Evans, C., Randolph, S. (March/April 2016). Preparing BSN students for population

focused nursing care: Nursing Education Perspectives, 115-117. ISSN: 1536-5026

Black, B. (2020). Health care in the United States (Ninth Edition), Professional Nursing:

Concepts & Challenges (p. 326). Elsevier Inc.

DiPietro, B. (February 2020). Five ways Medicaid expansion is helping homeless populations

ten years after the ACA became law: Health Affairs, 1-12.

https://www.healthaffairs.org/do/10.1377//hblog20200225.434660/full/

Lachman, V.D., Swanson, E.O., & Windland-Brown, J. (2015). The new ‘code of ethics for

nurses with interpretive statements’ (2015): Practical clinical application, part I.

MEDSURG Nursing, 24(4), 268-270.

McEnroe-Petitte, D. (2020). Caring for patients that are homeless: Nursing2020, 50/3, 24-30.

https://www.nursingcenter.com/ce