Medicine and Health Sciences Commons^™

Identifying Patients Suffering From Housing Instability In The Emergency Department, Jarvis D. Roberts

Doctor of Nursing Practice Projects

Homelessness is the most visible form of housing instability in the United States of America. Yet, millions of people across our nation live in unstable housing, which consists of temporary housing, shelters, outside encampments, and vehicles. Many citizens facing these types of insecurities live paycheck to paycheck and are one health crisis or emergency away from financial ruin. The COVID-19 pandemic, inflation, and slow hourly wage growth have exacerbated this situation. This project aimed to construct a screening tool to identify patients suffering from housing instability in the emergency department setting and provide them with community resources.

Point Of Care Testing: Best Practice Toolkit For Improving Access To Point Of Care Testing In Mobile Medicine, Michaela Gist

Student Scholarly Projects

Practice Problem: Healthcare for persons experiencing homelessness (PEH) is a complex issue. Chronic and communicable diseases are disproportionately represented within this population. Healthcare spending is 2.5 times more costly in comparison to those who have not experienced homelessness. Although mobile health clinics aim to reduce the concerns with access to care, they do not eliminate barriers if the appropriate tests are not immediately available.

PICO: In the homeless population treated in mobile medicine (P), what is the effect of point of care testing (I) on turnaround time (O) compared with outside laboratory testing (C)?

Evidence: Critical analysis of the literature …

Reducing 30-Day Psychiatric Inpatient Hospital Readmission Of Mentally Ill Homeless Men With Substance Use Disorder By Using A Discharge Checklist, Chibuogwu E. Ogbuka

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Psychiatric inpatient readmission of mentally ill homeless men with substance use disorder is greater than that of the non-use population. Substance use disorder co-occurs with high prevalence among patients diagnosed with mental illness. For mentally ill homeless individuals discharged after inpatient treatment, substance use disorder negatively impacts health, behavior, and medication non-compliance, resulting in hospital readmission.

Problem: In acute psychiatric facilities in Northern California, the greatest readmission after inpatient hospitalization occurs at 53% in a week and 74.8% within two weeks of discharge. For homeless individuals, substance use disorder exacerbates personal problems and decreases the likelihood of …

Mental Health And Parenting Among Young Adults Experiencing Homelessness With And Without Their Children, Rebecca Bergh

Dissertations & Theses (Open Access)

Background: Parent-child separation and custody loss are common among parenting young adults experiencing homelessness (YAEH). These experiences may be traumatic for YAEH, a population already vulnerable to mental health disorders and high levels of trauma. Little is known about how YAEH who have their children with them compare to YAEH separated from their children in terms of mental health and risk and resilience factors. Further evidence is needed to better understand the parenting and mental health support needs among YAEH, particularly surrounding parent-child separation.

Aims: This study aimed to examine the characteristics of (1) parenting YAEH living with their children …

Reducing 30-Day Hospital Readmission Among Mentally Ill Homeless Men With Substance Use Disorder, Chibuogwu Ugbana

DNP Qualifying Manuscripts

Abstract

Background: Psychiatric inpatient readmission of mentally ill homeless men is greater than that of the overall population. Substance use disorders co-occur with high prevalence in patients diagnosed with mental illness. For mentally ill homeless individuals discharged after inpatient treatment, substance use disorder negatively impacts health behavior, and medication non-compliant, resulting in hospital readmission.

Problem: In an acute care psychiatric facility in Northern California, the greatest readmission after inpatient hospitalization occurs at 53.9% in a week and 74.8% in two weeks of discharge. For homeless individuals, substance use disorder complicates personal problems and decreases the likelihood of a long-term …

The Clinical Healthcare Provided To Homeless Communities Across The United States: A Literature Review, Saylor Sisemore

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Homelessness has become a global public health concern as it results in poorer physical and mental health than age-matched people living in permanent housing (Ortiz & Roser, 2017). The area that comprises Northwest Arkansas (NWA), like other areas of the United States experiencing rapid growth, has seen a marked increase in the number of people experiencing homelessness in recent years. The homeless population is one of the most vulnerable and underserved groups of individuals in NWA and beyond. Public health nursing as a discipline is dedicated to providing compassionate care and exceptional service for all members of communities, with special …

Self-Healing With Reiki For Homeless Individuals Suffering From Past Traumatic Events, Kathryn Piha

Theses and Graduate Projects

Living with symptoms that resemble PTSD from past trauma can be detrimental to health, healing, and quality of life. Symptoms that resemble PTSD are intrusive and disruptive to daily life and can cause anxiety, vivid flashbacks and nightmares, and intense memories. Homeless individuals navigate challenges and are at increased risk for developing symptoms that resemble PTSD. This project explored Reiki as a healing modality to improve health, healing, and quality of life from the negative implications of past traumatic experiences. Guided by Martha Roher's SUHB Theory, this project connects Reiki with energy as healing. Understanding energy and energy fields can …

Integration Of Sexual Assault Nurse Examiners (Sane’S) Care Program, Erin B. Mehta

Theses and Graduate Projects

Sexual assault is a public health issue, especially for individuals experiencing homelessness, violence, and victimization. Barriers to post-sexual assault health care must be addressed to ensure individuals experiencing homelessness receive effective and adequate care. Traditionally found in Emergency Departments, Sexual Assault Nurse Examiners (SANEs) offer patient-centered, comprehensive health care to sexual assault survivors. To reduce barriers for individuals experiencing homelessness, SANEs must be accessible where health care services are utilized. Guided by Jean Watson’s Theory of Human Caring and trauma-informed principles, this project aims to embed a SANE program into a homeless-specific Midwest Health Care Center. The SANE program will …

Screening For Human Trafficking: Best Practice Guidelines And Recommendations For Health Care Providers, Bernadette Portillo

Student Scholarly Projects

Human trafficking (HT) is a federal and international crime and is regarded as one of the most pressing human rights issues. Adult and minor victims are trafficked by force (rape, beatings, confinement), fraud, and coercion resulting in profound physical and psychological injuries (Chisolm-Straker et al., 2019, p. 72; Department of Homeland Security, 2020; Vera Institute of Justice, 2014, p. 6). Most clinicians fail to recognize HT victims (Egyud et al., 2017; Leslie, 2018; Mason, 2018; McDow & Dols, 2020; Mostajabian et al., 2019; Patient Safety Monitor Journal, 2017; Stevens & Dinkle, 2020). This policy brief’s purpose is to provide health …

Improving Care Coordination For The Homeless Population Using Systematic Quality Improvement, Rutendo Nyasvisvo

Doctoral Projects

Background and Objectives: Care coordination for the homeless population is challenging due to the complexity of healthcare and the uncertain life circumstances of the homeless individual. Objectives were developed to guide care coordination for the homeless by utilization of the free clinic to create PCP referrals, appointments and tracking follow-up care to increase appointment attendance and improve health outcomes for the homeless individual.

Design: A quality improvement project.

Setting: A faith-based non-profit homeless shelter organization in the Midwestern United States.

Participants: Participants include 25 homeless guests, 5 staff members including a clinic coordinator, 3 registered nurses and 1 licensed practical …

Evaluating The Impact Of Federal Mental Health Policy: An Analysis Of How Federal Deinstitutionalization Impacted Persons With Severe Mental Illness, Jillian K. Douglas

Doctor of Nursing Practice Projects

This policy evaluation project evaluated how federal mental health policy changes impact individuals diagnosed with severe mental illness through analyzing how institutionalization and deinstitutionalization policies impact persons with severe mental illness (SMI). In order to determine how federal policy changes impact outcomes for people diagnosed with SMI, psychiatric hospitalization rates per 100,000 from 1850 to 2015 are compared to the life expectancy, incarceration rates per 100,000, and percentage of unhoused population with SMIs in the United States (U.S.) during the same years. Research compiled for this paper found that decreasing the numbers of psychiatric beds correlates within creased rates of …

Long-Acting Reversible Contraception Education For Street-Involved Youth: Impact On Knowledge, Attitudes, And Behaviors, Lizzie Simon

Doctor of Nursing Practice Projects

Despite evidence that long-acting reversible contraception (LARC) is safe, appropriate, and highly efficacious for people under age 25, this younger population is under-represented among LARC users in the US. At the Orion Clinic in Seattle, Kaiser Permanente offers primary care to street-involved young people between the ages of 12 and 24. Since opening in 2016, young patients at the Orion Clinichave initiated LARC at low rates, which reflects national trends. The aims of this project are to understand the reasons for this population’s underuse of highly effective contraceptive methods; to increase participants’ knowledge and positive attitudes toward LARC; and to …

A Proposal To Implement Assertive Community Treatment Into A Primary Care Shelter Clinic, Julie Churcher-Fields

Theses and Graduate Projects

Individuals who are experiencing homelessness and severe mental illness have a difficult time accessing healthcare systems. Without mental health treatment and stable housing, individuals develop multiple needs that must be addressed during an individual visit. Without treatment for mental health symptoms, individuals may experience a negative impact on their quality of life and the ability to get basic needs met. Community organizations have an obligation to provide integrated care with a goal to improve overall health for this population. As nurse leaders there is an opportunity to be advocates and implement innovative ideas to improve care. In a large adult …

Hepatitis C Education, Testing, And Treatment In Homeless Shelters: Models For Linkage To Care In High-Risk Populations, Erin H. Higley

All Electronic Theses and Dissertations

Background: With the increase of IV drug use, Hepatitis C viral (HCV) infections have increased considerably among the homeless population. The introduction of direct-acting antiviral (DAA) medications has made treating marginalized populations much easier. However, getting homeless patients and people who inject drugs (PWID) linked to care remains a challenge worldwide. More research is needed to ensure that all persons with HCV are able to access treatment regardless of social or economic status. Purpose: The purpose of this critical review of research is to identify models of care for treating HCV among the homeless. This review was done to support …

Improving The Rate Of Hand Hygiene Immediately Before And After Wound Care In The Street Nurse Microsystem, Amanda Ramos Sandoval

Master's Projects and Capstones

The street nurse team of Sacramento, CA provides many services to patients who are experiencing homelessness, including a substantial amount of wound care. While the street nurses were performing hand hygiene (HH) prior to and after wound care, they would often not be performing it immediately prior and post-wound care. Because the nurses hike to their patients (who are living on the streets or in out of the way camps) the street nurses would often perform hand hygiene while at their cars prior to going to the patient and again when they returned to their cars after performing wound care. …

Improving Diabetic Foot Screening In A Primary Care Clinic For Homeless Adults: A Quality Improvement Project, Theresa Causa

Doctor of Nursing Practice

The purpose of this project was to increase the adherence of clinic providers at the homeless primary care clinic by implementing the American Diabetes Association Clinical Guidelines for the evaluation and management of Type 2 diabetes with foot care. Type 2 diabetes is a chronic condition that affects 13% of the Texas adult population (Centers for Disease Control and Prevention, 2014). The homeless person's main method of transportation is walking. The complications of undiagnosed foot problems include reduced mobility, pain, lower limb amputations, and difficulty controlling chronic diseases including diabetes and depression. Provider responsibilities include screening for diabetes in all …

Pathways To Homelessness: Exploring The Mental Health Experiences Of Refugees Experiencing Homelessness In Canada, Bridget Annor

Electronic Thesis and Dissertation Repository

BACKGROUND: Homelessness among refugees continues to be a growing issue in Canada. Recent reports indicate the rapidly growing population of refugees, most especially refugee claimants, accessing emergency shelters in Canada. Research to date has been limited on how the diversity of factors, such as refugee’s mental health experiences, could potentially play a role as pathways to shelter. The purpose of this study therefore is to explore the mental health experiences of refugees through their pathways to homelessness in Canada.

METHODS: This study, a secondary analysis, is framed within the critical theoretical perspective and an intersectional lens. The study sample …

Exploring The Homeless Persons Perception Of Living In A Long-Term Care Facility, Janice Woods

Dissertations

Objective:The purpose of this study was to explore the lived experiences of homeless persons admitted to a nursing home facility. Originally, the study was to explore their understanding of and their experience with advance health care planning; coincidently, the participants were more open to their experience of living in a long-term care facility.

Method:A convenience sample of 13 participants (12 male, 1 female) at four long-term care facilities in Southern California were interviewed about their perception of advanced health care planning, including the physician’s orders for life sustaining treatment (POLST); a consent form required in all nursing homes. …

Social Inclusion For Women Experiencing Homelessness, Jenna Richards

Electronic Thesis and Dissertation Repository

Background: People experiencing homelessness have been described as one of the most socially excluded groups in society due to their inequitable access to basic necessities (Everett 2009; Labonte, 2004). Particular consideration regarding social inclusion should be given to the unique vulnerabilities of sub-populations of those experiencing homelessness, such as women (Wesely & Wright, 2005) due to their increased rates of ‘hidden homelessness’ (Walsh et al., 2009) and experiences of violence and discrimination (Roschelle, 2017; Weiser et al., 2009). Community participation, particularly sports activities, have been cited as one method towards increasing social inclusion among people experiencing homelessness. However, differential access …

Gender And Experiences Of Family Homelessness, Fawziah Almalki

Electronic Thesis and Dissertation Repository

BACKGROUND: Family homelessness is a growing issue in Canada. Families have been reported as the most rapidly increasing population of emergency shelter users. The purpose of this study was to understand the experiences of family homelessness in A mid-sized Canadian city and, in particular, the role that gender plays in these experiences.

METHODS: This project was a secondary analysis situated within a critical theoretical perspective. The data for this study, consisting of 4 focus groups, 36 family member participants interviews, and 10 shelter staff members interviews, was extracted from a primary study that focused on diversion from family homelessness. Qualitative …

Exploring Harm Reduction Among Canadian Veterans Experiencing Homelessness, Olivia Marsella

Electronic Thesis and Dissertation Repository

BACKGROUND: The use of substances is substantially higher among people experiencing homelessness than the general population (Podymow, Turnbull, Coyle, Yetisir, & Wells, 2006). In Canada, veteran homelessness is an increasing concern and it is estimated that there are 2,950 veterans experiencing homelessness (Gaetz et al., 2016). Furthermore, veterans often use substances, particularly alcohol, to cope with the transition from the military to civilian life (Ray & Forchuk, 2011). A strategy that has been shown to reduce the negative harms of substance use and facilitate housing stability is harm reduction (MacNeil & Pauly, 2010). Exploring how veterans who have experienced homelessness …

Open Space, Thin Blankets, And Snores: An Examination Of Sleep In Young Adults Experiencing Homelessness, Claire Olivia Moore

Honors Projects

Sleep has been identified as a public health concern, especially among college students and young adults, which are defined here as adults ages 18-25 years old. Individuals who are homeless also face specific challenges to getting high quality, restful sleep. The purpose of this review is to investigate the potential health burden of impaired sleep quality in young adults experiencing homelessness. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ebscohost, Medline, Google Scholar, and PsychInfo databases were searched using the following terms independently and in combination: sleep, sleep quality, young adults, college students, emerging adults, sleep hygiene, homeless, …

A Journey Through Homelessness: A Photovoice Project With Youth Experiencing Homelessness In Minnesota, Bonnie D. Paulsen

Theses and Graduate Projects

The purpose of this project was to conduct a photovoice project with youth experiencing homelessness who frequent a drop-in center in the Midwest. Youth experiencing homelessness are a marginalized population whose numbers continue to grow. Photovoice is a method by which marginalized populations have an opportunity to express their lived experiences through photographs and what those photographs mean to them. Four youth from the drop-in center in the Midwest participated in the photovoice project. The youths were given cameras and instructions to take photographs of three broad areas: what homelessness means to them, their dreams for their futures and how …

Mammography Utilization In African American Women, April D. Kidd

Electronic Theses and Dissertations

Purpose: Breast cancer presents differently among women causing breast cancer health disparities with women of color disproportionally shouldering later-stage screening, incidence, and treatment, and greater mortality. This study assessed 10 predictors and rates of recent and long-term mammography utilization for women 43-79 years of age to better understand differences among age strata and races. This was the first study to use both the calculated Gail Risk scores (calculates absolute breast cancer risk over time intervals) from the 2010 National Health Interview Survey (NHIS) and a temporary homelessness variable in predicting mammography utilization using national-level data.

Theoretical Framework: A modified Behavioral …

Interventions To Increase Vaccination Rates In Homeless Adults Aged 50 Years And Older In A Shelter-Based Clinic, Rubeena Smith

Doctor of Nursing Practice

Pronounced disparities in adult immunizations exist across the country. In homeless adults over 50 years of age with chronic diseases, coverage rates for influenza and pneumococcal vaccinations falls at 30% as compared to the 60% coverage rate found in the general public. Hepatitis B immunization rates are also significantly lower in the elderly homeless population. Increased prevalence of chronic diseases in the elderly homeless shelter residents’ increase their risk for severe complications following influenza, hepatitis B and meningococcal infections. To prevent disease epidemics and further disability in the homeless population, the need for appropriate and timely vaccinations is critical. Attitudes …

The Relationship Between Elements Of Health And Social Systems And Substance Use Severity For Individuals Experiencing Homelessness, Sommer Froats

Electronic Thesis and Dissertation Repository

Canadians experiencing homelessness often live with severe substance use (Aubry et al., 2015; Khandor & Mason, 2007). Health challenges related to severe substance use contribute to the early mortality experienced by homeless Canadians (Hwang, Wilkins, Tjepkema, O’Campo & Dunn, 2009). This population also experience health and social system disadvantages. Using General Systems Theory, relationships between substance use severity and access to health care, housing stability, therapeutic relationship and quality of family and friends relationships were explored as elements of health and social systems. A correlational secondary analysis examined this in a sample of 65 individuals accessing housing first. Relationships were …

Mothers Experiencing Homelessness: Social Exclusion, Resistance, And Health, Sarah Benbow

Electronic Thesis and Dissertation Repository

Background and Purpose: Mothers experiencing homelessness in Canada are faced with unique challenges in achieving health. The purpose of this two-phase study was to critically examine the socio-political context, health needs, exclusionary and inclusionary forces, and strategies of resistance demonstrated by mothers experiencing homelessness.

Methodology: This study falls under the critical paradigm informed by the theoretical perspective of intersectionality. Methodologies employed included critical narrative and critical discourse analysis. Data were collected at various homeless shelters and programs that provide services for women and mothers who are homeless in Southern Ontario. A purposive sample of women experiencing homelessness, and service …

Comparison Of Housed And Homeless Patients With An Orthopedic Diagnosis, Susan M. Williams

Electronic Thesis and Dissertation Repository

Studies on homelessness have shown that people who are homeless are admitted to hospital more frequently, for longer periods of time, and at a younger age than people who are housed. Once admitted to hospital, discharge planning is difficult and resource intensive, often leading to discharge back to the streets or a shelter. This puts this population at risk for complications and readmission. Although people who are homeless are prone to orthopedic injuries, there is no research on the outcomes of patients who are homeless with orthopedic injuries. This retrospective, case control study, based on the social determinants of health, …

The Lived Experience Of Transitioning From The Foster Care System To Adulthood, Carla Renee Parker

Doctoral Dissertations

Approximately 408,000 children were in foster care in the United States at the end of fiscal year 2010 (U.S. Department of Health and Human Services, 2012). Some children return to their families of origin; however, some children remain in the foster care system until they reach age 18 or 21 and must leave, which is called “emancipation” or “aging out” (U.S. Department of Health and Human Services, 2012). Transitioning foster youth are at risk for many negative consequences including poverty and homelessness. These negative consequences are associated with significant health implications, such as mental health problems and risky sexual behaviors. …

Feeding The Homeless Through Collaboration: A Proposal For Consideration, Valetta M. Johnson Massaquoi

Theses and Graduate Projects

The homeless are faced with many challenges of adverse nutritional deficiencies that predispose them to several illnesses commonly associated with the lack of adequate nutrition and the frequent utilizations of health care resources. Provision of nutritious food for the homeless can help decrease the prevalence of these identifiable markers and can be accomplished by u collaborative effort. The purpose of this project is to describe a collaboration between Regions Hospital and the Dorothy Day Center to provide supplemental nutrition for the homeless. Leininger's culture care diversity and universality theory along with culture care accommodation/negotiation are used as a theoretical framework …