Mental Ill Health in Homeless Women: A Review

Research indicates that homeless women are reported to experience more mental health issues than women who are not homeless and are an increasing proportion of the overall homeless population. In addition, homeless women are more likely to have alcohol and/or other drug use disorders. We provide a comprehensive review of the contemporary literature that revealed homeless women experience a range of mental health problems including depression, anxiety, post-traumatic stress disorder and alcohol and other drug use disorders. Studies in this literature review indicate that some women have pre-existing mental health issues which precipitate homelessness while others develop mental illness because of their homelessness; domestic violence was also recognised as an antecedent to homelessness, although further research is needed in this area. The results of this study indicate that the homeless cohort is a complex one with distinct needs. We provide information that can help refine assessment processes and plan appropriate services to address the mental health needs of homeless women. Finally, recommendations for mental health nursing practice in regard to caring for homeless women are made.     

Homeless patients' experience of satisfaction with care

This article explores homeless individuals' experiences of satisfaction with health care, and explores the interrelationship among experiences of being homeless, health perceptions of participants, and experiences of satisfaction with health care. It presents the findings of a phenomenological study that was conducted using participants selected from five sites in one southeastern state. Participant interviews were conducted at a nurse-managed primary health care clinic for homeless, at a night time soup-kitchen, and at three private, not-for-profit, homeless shelters in two different towns. The study was part of a larger study designed to develop and validate a reliable measure of client satisfaction with primary health care among homeless individuals. Face-to-face in-depth interviews with 17 homeless individuals were conducted, with the semistructured interview constituting the primary data source. Common themes were identified and the interrelationship of theme clusters was explored. Analysis of the data yielded five distinct themes that represent the lived experiences of satisfaction with health care. These themes were mediated and directly informed by five themes of homelessness and three themes of health identified in the shared experiences of the participants. The themes identified suggest that satisfaction with health care for homeless persons differs from currently identified dimensions of satisfaction with care, and that some aspects of homelessness are seen by participants as positive and health promoting.     

The Risks,Invisibility, and Health Issues Facing Women Veterans Who Are Homeless

Women veterans may experience a variety of traumatizing events and conditions before, during, and after their military service, such as intimate partner violence, military sexual trauma, moral injury, and posttraumatic stress disorder. These experiences put them at greater risk for significant behavioral and physical health sequelae, which can be associated with difficulty with civilian reintegration and complexities around homelessness. Homeless women military veterans are often uncounted, undergo different environmental situations than their male counterparts, and are vulnerable to sexual violence and unintended pregnancies. Identifying homeless women military veterans is an important first step; otherwise, they remain “invisible.” Comprehensive, collaborative, interdisciplinary health care in which trust is established and care is holistic and individualized will produce the most optimal outcomes.     

Homeless Health Needs: Shelter and Health Service Provider Perspective

The effects of homelessness on health are well documented, although less is known about the challenges of health care delivery from the perspective of service providers. Using data from a larger health needs assessment, the purpose of this study was to describe homeless health care needs and barriers to access utilizing qualitative data collected from shelter staff (n = 10) and health service staff (n = 14). Shelter staff members described many unmet health needs and barriers to health care access, and discussed needs for other supportive services in the area. Health service providers also described multiple health and service needs, and the need for a recuperative care setting for this population. Although a variety of resources are currently available for homeless health service delivery, barriers to access and gaps in care still exist. Recommendations for program planning are discussed and examined in the context of contributing factors and health care reform.     

Nurses’ perceptions on the skills,knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia: A qualitative study

BackgroundPeople experiencing homelessness have unmet healthcare needs often related to chronic health conditions and injury. Nurses are often the first and only point of contact for people experiencing homelessness accessing healthcare. However, education that prepares them to meet the needs of this vulnerable population is limited.AimTo qualitatively explore nurses’ perceptions on the skills, knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia that could underpin an educational pathway.DesignSemi-structured interviews with registered nurses and nurse practitioners.MethodsParticipants of a national survey were invited to undertake an interview. Interview data were analysed thematically and reported here in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.FindingsThe registered nurses (n = 11) and nurse practitioners (n = 6) had varying levels of experience providing care for homeless Australians. Overarching themes that arose from the registered nurse and nurse practitioner participants included equitable access to care, knowledge around homelessness, contribution of nursing, and nurses’ role. However, nurse practitioners had a greater sense of agency and empowerment to enact care, while registered nurses perceived being underprepared and overwhelmed by the unmet needs of people experiencing homelessness.ConclusionsThe findings suggest that nursing practice holds opportunities to improve access and care provision for people experiencing homelessness. Capitalising on these opportunities requires that nurses are educationally prepared with the skills, knowledge, and attributes to meet the needs of this vulnerable population without necessarily becoming nurse practitioners. These findings will be used to underpin the development of an educational pathway for nurses to enhance their response to homeless populations.     

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.     

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.     

Nursing Practice Strategies for Prenatal Care of Homeless Pregnant Women

Women who are homeless are less likely to receive preconception care or prenatal care in the first trimester, and they tend to have fewer prenatal visits overall than their housed counterparts. Homelessness during pregnancy can increase the risk for many maternal, fetal, and neonatal complications. Barriers to proper prenatal care can be categorized as logistical, psychosocial, intellectual, and attitudinal. Although all women face potential barriers to optimal care, women who are homeless are particularly vulnerable and experience these barriers to a greater degree. Nursing strategies for prenatal care of homeless pregnant women include therapeutic communication, focused assessment, and upstream interdisciplinary approaches.     

Homeless chronicity and health-related quality of life trajectories among adults with addictions

BACKGROUND: New federal initiatives target funds toward chronically homeless as distinct from other homeless persons. Few data exist, however, to substantiate the implications of chronic homelessness for major health outcomes. OBJECTIVES: Using data from a 2-year cohort of addicted persons, we tested whether changes in mental and physical health-related quality of life (HRQOL) differed according to homeless chronicity. METHODS: Using self-reported homelessness, we classified subjects as chronically homeless (CH; n = 60), transitionally homeless (TRANS; n = 108), or as housed comparison subjects (HSD; n = 106). The Short Form-36 Health Survey, administered at baseline and 2 follow-ups over a period of 2 years, provided a Mental Component Summary (MCS) and a Physical Component Summary (PCS) for HRQOL. Mixed model linear regression was used to test the association between housing status, MCS, and PCS. Additional models assessed whether medical, psychiatric, addiction, and social support measures could account for HRQOL differences. RESULTS: All subjects had low MCS scores at study entry (mean, 31.2; SD, 12.6). However, there was a significant housing status-by-time interaction (P = 0.01). At final follow-up, CH and TRANS subjects had lower adjusted MCS scores than HSD subjects (33.4, 38.8, and 43.7 for the 3 groups, respectively; all P < or = 0.01). By contrast, housing status and PCS were not significantly associated (P = 0.19). Medical, psychiatric, addiction, and social support variables had significant associations with MCS, and their inclusion in the regression reduced the apparent effect of housing status on MCS. CONCLUSIONS: Chronic homelessness was associated with especially poor mental but not physical HRQOL over time. These findings reinforce a new typology of homelessness.     

Mothering in Public: A Meta-Synthesis of Homeless Women With Children Living in Shelters

ISSUES AND PURPOSE The purpose of this paper is to synthesize the current qualitative literature on homeless women with children living in shelters. METHODS Eighteen qualitative studies on homeless women with children living in shelters were included in the synthesis. The meta‐synthesis was conducted using the meta‐ethnographic approach of Noblit and Hare (1988). RESULTS Six reciprocal translations (themes) of homeless mothers caring for their children in shelters emerged: On becoming homeless, protective mothering, loss, stressed and depressed, survival strategies, and strategies for resolution. PRACTICE IMPLICATIONS The results may be used by healthcare workers as a framework for developing intervention strategies directed toward helping mothers find new solutions to dealing with shelter living and innovative ways to resolve their homelessness.     

Nurse‐Managed Free Clinic Fosters Care Connection for Homeless Population

The goal of this article is to demystify the process that healthcare providers must follow when working with homeless patients who sustain injuries or exhibit illnesses that necessitate rehabilitation care. Observations made over a period of more than 12 years at an inner‐city medical/psychiatric nurse‐managed free clinic that delivers cutting‐edge services and educates multidisciplinary students to care for disenfranchised populations led the author to several conclusions: homeless people frequently lose their identity as individuals when facing healthcare providers; previous negative perceptions of homelessness can turn positive when care providers meet these patients on a person‐to‐person level; the concept of health and rehabilitation must be clearly understood in the same way by both providers and patients for nursing goals to be realistic and achievable; and a collaborative relationship must be formed between nurses and patients.     

Homeless patients tend to have greater psychiatric needs when presenting to the emergency department,

IntroductionHomeless patients tend to visit Emergency Departments (EDs) more frequently than the non-homeless population. The goal of this study was to assess differences in chief complaint, medical conditions, and disposition between homeless patients compared to non-homeless patients presenting to an urban ED.MethodsThis was a retrospective cohort of homeless patients ages ≥18 years compared to non-homeless controls from January 1, 2017 to December 31, 2017. Exclusion criteria were as follows: direct admission to hospital floor, repeat visits, or leaving without being seen. The primary endpoint of this study was to assess differences in chief complaint of homeless versus non-homeless patients upon presentation to the ED. Our secondary endpoints included differences in ED utilization between the two groups, in terms of length of stay, ambulance use, diagnosis, and disposition.ResultsHomeless patients were more likely present to the ED for a psychiatric evaluation (homeless group 34% vs. non-homeless group 4%, p < 0.01) and have a history of a psychiatric diagnosis (56% vs. 10%, p < 0.01) compared to non-homeless controls. Homeless patients also tended to require more ambulance transport (46% vs. 16%, p < 0.01). More homeless patients were transferred to a psychiatric facility (40% vs. 1%, p < 0.01), while the majority of non-homeless patients were discharged home (50% vs. 93%, p < 0.01).ConclusionThis study found that homeless patients had a significantly higher association with psychiatric diagnoses and greater ED utilization than non-homeless. This suggests the importance of increased access to consistent psychiatric care and follow up within the homeless population.     

Perception of Access to Health Care by Homeless Individuals Seeking Services at a Day Shelter

Homeless individuals experience significant physical, mental health and substance abuse issues. This study describes the prevalence of health issues and perceptions of access to care among 300 homeless individuals who use a day shelter. Approximately 43% described a serious/chronic physical health problem, 53% a serious mental health problem, and 49% a substance use disorder. Those reporting a serious problem were more likely to have insurance and to report greater perceived access to care but perceived access to care was less than expected. Having insurance was also related to longer duration of homelessness. Targeting interventions to better match services to homeless individuals is the next challenge for advanced practice psychiatric and other nursing groups. Implications for doctoral level nurses in ways of evaluating models of care for this marginalized group are discussed.     

Homeless persons' decisions to accept or reject public health disease-detection services

The purpose of this study was to describe the factors that homeless persons report as influencing their decisions to utilize or reject a public health disease-detection program. Although there is copious literature on homelessness, few studies report the real-life perspectives of homeless persons toward health or health promotion. A convenience sample of 55 sheltered and street-dwelling homeless persons, who either resided in or were visiting seven shelters in a large northeastern U.S. city, were interviewed. The interview questions focused on the bases for decisions to accept or reject tuberculosis screening. The in-depth semistructured audio-taped interviews were transcribed, coded, and categorized using Ethnograph software. Interviews were analyzed using the constant comparative content analysis methods. The findings describe homeless persons' reasons for accepting or rejecting a tuberculosis-detection service, the prominent role of shelter personnel in recruitment for health-related interventions, and the confidentiality needs of women with children. This information can assist community health practitioners in designing and advertising health-promotion and disease-detection programming.     

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.