Self‐efficacy as a unifying construct in nursing‐social work collaboration with vulnerable populations

WASHINGTON OGM and MOXLEY DP. Nursing Inquiry 2013; 20 : 42–50
Self‐efficacy as a unifying construct in nursing‐social work collaboration with vulnerable populations The authors consider self‐efficacy practice as an organizing construct guiding nursing–social work action research in partnership with older homeless and formerly homeless African‐American women. The authors, both academics who together have worked with members of this vulnerable population for a decade and a half, report on their unifying action research perspective immersed in self‐efficacy theory. We examine how our adaptations of Bandura’s classic four sources of self‐efficacy form a distinctive intervention practice designed to help older African‐American women emerge from homelessness. We amplify the incorporation of the four sources (vicarious experience and exposure to powerful role models, emotional arousal and accompanying catharsis, verbal persuasion, and role performance) into a grand strategy useful in working collaboratively with members of vulnerable populations, so they can achieve outcomes that improve their functional health, well‐being and ultimately their quality of life.     

RECAPTURING THE ESSENCE OF SPIRITUALITY: A LETTER TO THE GUEST EDITOR

More older African American women are homeless, with this issue receiving little research attention. An exploratory study examined demographics and health characteristics of 100 women. Their mean age was 52.55 years (SD = 3.57) and ranged from 50 to 74 years. Most were unmarried, homeless more than three months, reported more than two diagnoses, and self-rated their health as fair or good. Length of time homeless did not significantly influence self-reported health. Medical diagnoses increased with time homeless, and rates of some chronic diseases were higher than domiciled African American elders 60 years of age and over. Nearly half (48.5%) of women who were homeless more than 12 months reported emotional/mental illness.     

‘I was broken in so many different ways’: The intersection of complex factors impacting homeless and at-risk African American women's mental health and well-being

African American women are at higher risk of poor mental ill health compared with other racial and ethnic groups in the United States. For low-income and homeless African American populations, the risk of poor mental ill health is even higher. The purpose of our study was to learn what programmes at a long-term transitional living centre helped at-risk and homeless African American mothers to succeed on their own, in accordance with self-identified goals. We conducted ten focus group interviews with 39 graduates of a long-term transitional living centre located in a Midwestern city, and an individual interview with the founder of that centre (N = 40). Our study was informed by Black Feminist Thought, Life Course Theory, and an instrumental case study design. Thematic analysis was used to identify patterns in the qualitative data collected. Findings pertaining to mental health included impacts of adverse childhood experiences, lack of social networks, child placement in foster care, and implications on self-esteem and self-worth. Our findings demonstrate the need for healthcare providers to take into account the intersecting factors facing African American women experiencing homelessness undergirded by systemic racism, which impacts their mental health and well-being.     

Health situation and perceived health status among women experiencing homelessness: A longitudinal study in Spain

The paper analyses the health situation and the perceived health status of a sample of women experiencing homelessness (n = 138) in Madrid, Spain. All participants were adults, and the night before the baseline interview, they had slept on the street, at a shelter or any facility provided to care for people living homeless. The information was collected using structured interviews, repeated twice a year for a 3-year follow-up period. The findings of this study show that women experiencing homelessness presented poor health, particularly in comparison with the general Spanish population. Over half of the women questioned claimed to have a diagnosed serious or chronic illness, with a correlation between these conditions and the age, time spent homeless or high levels of drug use. There was a positive correlation found between women's perceived health status and being younger and having access to independent accommodation, while having suffered a number of stressful life events and having spent long periods of time living homeless presented a negative correlation with a good perceived health status.     

A picture of the older homeless female veteran: A qualitative,case study analysis

BackgroundHomelessness among female veterans is increasing and expected to rise further as more women enter the military. Very few studies qualitatively describe female homeless veterans’ needs from their own perspective.PurposeHomeless female veterans’ perceptions of their homelessness and what they believe is needed for independence and self-sustenance was examined.MethodsOA qualitative interpretive interview design was used and findings are reported as a case study.ResultsA definitive picture emerged of a homeless female veteran, bounded by several factors they all had in common including age, family upheaval, mental health diagnoses, substance abuse, trauma, and need for information and networking.     

Health Beliefs of African American Women on Breast Self-Exam

PurposeInvestigate the relationship between African American women's health beliefs in regard to breast cancer screening behaviors.Data sourcesA sample of 131 African American women, age 20–65, from a family practice clinic and 3 rural churches in Southeast.ConclusionsOne-hundred and nine of the participants reported practicing breast self-exam (BSE) within the past 12 months. However, 21 women had never practiced BSE. Fear of not doing it correctly was a main barrier.Implication for practiceSteps should be taken to increase confidence and resolve barriers of African American women through the development of culturally sensitive educational training on BSE and cancer prevention.     

African American women and physical activity

Abstract

Background: The rates of overweight and obesity are the highest in African American women over 40 years of age. Excess weight is associated with significant health risks. Physical activity is an essential component of weight management and disease prevention. Participation in physical activity is lower among African American women than all other race–gender groups except Mexican American women.

Objectives: This article reviews the literature on the role of physical activity in weight management in African American women. There were limited studies to include in the review. Intervention studies with primarily African American women failed to demonstrate a significant increase in physical activity behaviours over the long term. Qualitative studies explored the role of physical activity in the lives of African American women through focus group and semistructured interviews.

Major findings: Common identified facilitators of physical activity included setting goals, convenient, safe places to exercise, and having social support. Common identified barriers to physical activity included physical activity interfering with caretaker roles, lack of child care, and unsafe neighbourhoods.

Conclusions: Few physical activity studies of African American women were identified. Future studies should focus on promoting family physical activity, as social support is a key component of successful adoption of physical activity in this population.     

Becoming Homeless,Being Homeless,and Resolving Homelessness Among Women

The purpose of this investigation was to more comprehensively articulate the experiences of homeless women and make evidence-based inferences regarding optimal social services. This study was conducted using qualitative meta-synthesis methods. As youth, homeless women experience challenging circumstances that leave them ill-prepared to prevent and resolve homelessness in adulthood. Resolution of homelessness occurs in iterative stages: crisis, assessment, and sustained action. To enhance forward progression through these stages, nurses are encouraged to promote empowerment in concordance with the Transtheoretical and Harm Reduction Models. Services that are highly valued include physical and mental health care and child care assistance.     

A qualitative exploration of nursing students’ perceptions of the homeless and their care experiences

The health care needs of the homeless are more complex than those of the population at large. The purpose of this qualitative study was to explore undergraduate nursing students’ perceptions of the homeless. Thematic content analysis of responses from 19 undergraduate nursing students yielded four themes describing student experiences with the homeless, their perceptions of homelessness and the health care of the homeless, and their suggestions for best teaching strategies. Students in this study had varying amounts of experience with and knowledge of the homeless. While our participants strongly believed that homeless people deserved compassionate, equitable nursing care, many of their statements suggested an implicit bias toward the homeless. This suggests that student nurses need more comprehensive education concerning the homeless and the health care needs of this vulnerable population. Few interventions aimed at educating student nurses about homelessness and changing their attitudes to mitigate bias are based on research, particularly research conducted from the perspective of the homeless, and few explore the impact of civil interactions on health outcomes. The findings of this study may assist nurse educators in developing education interventions to improve students’ knowledge of homelessness.     

An exercise trial to reduce cancer related fatigue in African American breast cancer patients undergoing radiation therapy: Design,rationale, and methods

BackgroundCancer related fatigue (CRF) is a common and debilitating side-effect of radiotherapy in breast cancer patients. Physical activity interventions can attenuate CRF but evidence in African–American women with breast cancer is lacking.Methods/designThe “Pedlar” Study is a prospective, 8-week structured moderate-intensity exercise intervention, delivered concurrently with radiotherapy, to reduce CRF and improve health-related quality of life among African American breast cancer patients. Forty African American women with breast cancer scheduled to receive radiation therapy at MedStar Washington Hospital Center will be randomized to one of the two trial arms: 1) a facility-based aerobic exercise utilizing a portable stationary pedal exerciser; and 2) a control group. Intervention arm participants will exercise at the hospital either before or after their radiation treatment. Assessments will be conducted at baseline, 4, and 8 weeks. The outcome variables are CRF, biomarkers of inflammation, and health-related quality of life.DiscussionThe Pedlar Study will provide preliminary evidence on whether a short-term moderate-intensity exercise intervention might be effective in reducing CRF in African American women undergoing radiotherapy for breast cancer, and whether this effect is mediated by inflammation.     

The truth about marijuana is all rolled up in a blunt: prevalence and predictors of blunt use among young African–American adults

Several studies suggest that African–American young adults are more likely than other racial groups to smoke marijuana in blunts (i.e., hollowed-out cigars filled with marijuana). Given that tobacco content is found in the wrapper leaf of cigars that are used to make blunts, more studies are needed to assess the co-occurring use of marijuana and tobacco among African–American young adults. The present study was designed to address this gap by examining the prevalence rates and predictors of blunt usage among young African–American men and women (ages 18–25) participating in the 2012 National Survey on Drug Use and Health. Among participants who reported using marijuana in the past month, 74.4% of African–American women (N?=?246) and 82.7% of men (N?=?312) smoked marijuana in a blunt in the past 30 days (current blunt smokers). Logistic regression analyses revealed that current blunt smokers, both men and women, were approximately five times more likely to drive under the influence of illegal drugs in the past year than former and non-blunt smokers. Future marijuana research should examine the dual use of marijuana and tobacco rather than focusing solely on marijuana use, especially among young African–American men and women.     

Efficacy-based Contraceptive Counseling for Women Experiencing Homelessness in Iowa City,Iowa

ABSTRACT

This study evaluated homeless women’s contraception knowledge and demonstrated improved knowledge following efficacy-based contraceptive counseling. Women were surveyed using a pre-test then post-test following standardized efficacy-based contraceptive counseling. 47 women participated. 13/19 (68.4%) of reproductive-aged women were not using contraception. After education there was significant increase in good-excellent self-rated knowledge (35, 75.5% vs 44, 93.6%; p < .001) and correct identification of most effective contraception OR 5.90 (95% CI = 2.31–15.02; p < .001). In conclusion, homeless women overestimated their understanding of contraception. Following education, there was significantly increased understanding of efficacy. While most did not desire pregnancy, few were using effective contraception and may benefit from education.

Abbreviations: SH: Shelter House; LARC: Long-Acting Reversible Contraception; IUD: Intra-Uterine Device; ACOG: American College of Obstetricians and Gynecologists     

Homelessness in the Medical Curriculum: An Analysis of Case-Based Learning Content From One Canadian Medical School

Phenomenon: Homelessness is a major public health concern. Given that homeless individuals have high rates of mortality and morbidity, are more likely to be users of the healthcare system, and often report unmet health needs, it is important to examine how homelessness is addressed in medical education. We wanted to examine content and framing of issues related to homelessness in the case-based learning (CBL) curriculum and provide insights about whether medical students are being adequately trained to meet the health needs of homeless individuals through CBL. Approach: CBL content at a Canadian medical school that featured content related to homelessness was analyzed. Data were extracted from cases for the following variables: curriculum unit (e.g., professionalism/ethics curriculum or biomedical/clinical curriculum), patient characteristics (e.g., age, sex), and medical and social conditions. A thematic analysis was performed on cases related to homelessness. Discrepancies in analysis were resolved by consensus. Findings: Homelessness was mentioned in five (2.6%) of 191 CBL cases in the medical curriculum. Homelessness was significantly more likely to be featured in professionalism/ethics cases than in biomedical/clinical cases (p = .03). Homeless patients were portrayed as socially disadvantaged individuals, and medical learners were prompted to discuss ethical issues related to homeless patients in cases. However, homeless individuals were largely voiceless in cases. Homelessness was associated with serious physical and mental health concerns, but students were rarely prompted to address these concerns. Insights: The health and social needs of homeless individuals are often overlooked in CBL cases in the medical curriculum. Moreover, stereotypes of homelessness may be reinforced through medical training. There are opportunities for growth in addressing the needs of homeless individuals through medical education.     

Top 10 presenting diagnoses of homeless veterans seeking care at emergency departments

BackgroundThe health concerns that spur care-seeking in emergency departments (EDs) among homeless populations are not well described. The Veterans Affairs (VA) comprehensive healthcare system does not require health insurance and thus offers a unique window into ED service use by homeless veterans.ObjectiveThis study examined the top 10 diagnostic categories for ED use among homeless and non-homeless veterans classified by age, gender, and race/ethnicity.DesignAn observational study was conducted using national VA administrative data from 2016 to 2019.ParticipantsData on 260,783 homeless veterans and 2,295,704 non-homeless veterans were analyzed.Main measuresHomelessness was defined as a documented diagnostic code or use of any VA homeless program. Presenting diagnoses to the ED were grouped based on Clinical Classifications Software Refined (CCSR) categories endorsed by the Agency for Healthcare Research and Quality (AHRQ).Key resultsThe most common diagnostic categories for ED use among homeless veterans were, in order, musculoskeletal pain, alcohol-related disorders, suicidal behaviors, low back pain, and non-specified conditions, which together accounted for 22–24% of all ED visits. Among non-homeless veterans, alcohol-related disorders, suicidal behaviors, and depressive disorders did not number in the top 10 diagnostic categories for ED use. Some differences between homeless and non-homeless veterans presenting for ED care, such as age, gender, and race/ethnicity largely mirrored known epidemiological differences between these groups in general. But respiratory infections and symptoms were only in the top 10 for black veterans and depressive disorder was only in the top 10 for Hispanic veterans. Conclusions: These data suggest that addressing psychosocial factors and optimizing healthcare for behavioral health and pain conditions among veterans experiencing homelessness has the potential to reduce emergency care-seeking.     

A Qualitative Study of a Maintenance Support Program for Women at Risk of Homelessness: Part 1: Personal Factors

In this article, a qualitative study of homeless women and their experiences attending a Maintenance Support Programme (MSP) is discussed. The overarching theme that emerged from the study of women in the MSP was ‘A life-changing event: I have the power to change’. The article focuses on the first of the sub-themes: personal factors including: (a) health status, (b) beliefs and attitudes, (c) knowledge, and (d) life and interpersonal skills. Findings demonstrate the influence that these factors have on the capacity of homeless women to change their lives. The MSP was instrumental in supporting these women to manage personal issues, by assisting with accessing health and social services, and developing life skills and achieving life goals. Understanding the homeless women's experiences may inform the development of future programmes and services in order to support and empower them to break the cycle of homelessness and help them to lead meaningful lives within society.     

Characteristics and Factors Associated With Pain in Older Homeless Individuals: Results From the Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE HOME) Study

Individuals experiencing homelessness in the United States are aging; little is known about chronic pain in this population. In a cross-sectional, population-based study, we interviewed 350 homeless individuals aged 50 years and older to describe pain experienced by older persons experiencing homelessness and to assess factors associated with chronic moderate to severe pain, defined as pain lasting ≥3 months, with a past week average severity score of 5 to 10 (scale 0–10). The median age of participants was 58 years. Participants were predominantly African American (79.6%) and male (77.3%). Overall, 46.8% reported chronic moderate to severe pain. Almost half of participants reported a diagnosis of arthritis (44.3%) and one-third reported symptoms consistent with post-traumatic stress disorder (PTSD; 32.8%). Three-quarters (75.3%) endorsed a personal history of abuse. In multivariate analyses, PTSD (adjusted odds ratio [AOR]: 2.2, 95% confidence interval [CI], 1.4–3.7), arthritis (AOR: 4.8, 95% CI, 3.0–7.8), and history of experiencing abuse (AOR: 2.4, 95% CI, 1.3–4.3) were associated with chronic moderate to severe pain. HIV status, diabetes, depressive symptoms, and substance use were not associated with pain. Clinicians should consider the management of associated mental health conditions and the sequelae of experiencing abuse in the treatment of chronic pain in older adults experiencing homelessness.

Results of a mindfulness intervention feasibility study among elder African American women: A qualitative analysis

Objectives. Older African Americans have a significantly higher risk than older white Americans for cognitive decline and other health problems. Much of this may be due to the unique stressors, both historically and in-the-moment, that African Americans face in contrast to whites, such as gentrification and health disparities. Gender further exacerbates this effect. This study aims to understand stressors unique to older African American women, as well as coping strengths that have emerged organically over time for use in tailoring stress-reduction mindfulness classes in this communityDesign and setting. A four-week mindfulness training class adapted from mindfulness-based stress reduction (MBSR) was implemented in a historically black, gentrifying neighborhood in Portland, Oregon with 10 older African American women aged 50–89.Main outcome measures. Focus groups discussed stressors, coping, responses to mindfulness classes, and preferences to better reflect older African American cultural values and norms.Results. Stressors reflected participants’ intersectionality as older black women, including neighborhood and workplace race-based microagressions, and gentrification-related cultural and generational incongruences. Coping strategies included self-care, remembering core-self amidst stress, and drawing strength from family and faith. Participants found mindfulness classes appropriate for addressing stress and felt that classes provided a forum for connecting on issues of race and community.Conclusion. Tailoring classes to older African American women should consider integrating biblical teachings, African American instructors who understand socio-historical contexts of older black women’s stressors and strengths, and time for group-reflection to support community building.