Managing Health Problems among Homeless Women with Children in a Transitional Shelter

Purpose: To describe health problems among homeless women with children living in a transitional shelter, analyze how they managed various ailments and when and how they sought care.
Design: Qualitative using grounded theory and dimensional analysis.
Sample: During 1992 and 1993, data were gathered from a convenience sample of 13 Latina, 11 White, and 6 African American women (n=30) who lived in a transitional shelter in California, USA.
Methods: In-depth, semi-structured interviews
Findings: Despite many supportive services in transitional shelter, respondents had difficulty managing health problems. Typically, a woman reported she managed a health problem by overcoming it alone.
Conclusions: The pattern of overcoming it alone existed years before transitional shelter life, and, in many instances, persisted during shelter years.
Clinical Implications: Clinical nursing interventions that address shame, fear, lack of information, and eligibility for services could improve health outcomes among women and children living in transitional shelters.     

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.     

Community Collaboration: Prevention and Control of Tuberculosis in a Homeless Shelter

Abstract An urban shelter in Charleston, South Carolina developed and began a tuberculosis (TB) prevention and control plan that addressed the priorities recommended by the Centers for Disease Control and Prevention. After an increase in TB in the shelter in 1992, the local health department, the homeless clinic nurse practitioners, and Medical University of South Carolina College of Nursing faculty and students collaborated with the shelter staff to provide initial mass screenings for contact investigation. They also developed and implemented new policies and procedures for an ongoing TB prevention and control program. The new policies required that guests obtain screening for TB within 7 days of arrival at the shelter and every 6 months thereafter. Also, a public health nurse began providing directly observed therapy twice weekly at the shelter. Of the initial 22 persons who started TB preventive therapy in 1993, 17 (77%) completed therapy. The clinic nurse practitioners, nursing students, and public health nurses had important and defined roles in the mass-screening process, case identification and treatment, policy development and implementation, health education, and establishing methods of communication between the shelter, clinic, and health department. An ongoing health care community collaborative effort may successfully reduce tuberculosis disease in a homeless shelter 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.     

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.     

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.     

Giving Up: Shelter Experiences of Battered Women

Abstract Within the last decade intrafamilial violence has been identified as a major health and social problem. Women in particular are at high risk for battering and often seek refuge in shelters. Empirical evidence is required regarding the experiences of battered women who use these shelters. Therefore, we collected qualitative data from interviews with seven battered women and by observation in ten group counseling sessions at a shelter in the Southeast. Using grounded theory methodology, the core concept that emerged was “giving up.” Supporting concepts were helplessness and fear of the unknown. The participants found it easier to give up and return to the abusive relationship than to seek alternatives.     

Mothering on the Margins: Homeless Women with an SUD and Complex Mental Health Co-Morbidities

The purpose of this study was to explicate students' perceptions of working with at-risk teens in a service-learning experience. In rural North Carolina, nursing students co-facilitated a wellness series for at-risk teens. A focus group explored students' perceptions. The focus group of ten students was recorded with participants' written consent and transcribed verbatim. Heideggerian hermeneutics guided thematic analysis. Five themes described students' perceptions: (a) Catching ourselves, (b) Learning how to drive home a concept, (c) Teaching is difficult, (d) Self as teacher/Self as learner, and (e) Seeing myself as a nurse. There was an overarching pattern of “Standing in their shoes.”     

Violence between Women in an Urban Emergency Department Patient Population

OBJECTIVE: To determine what percentage of women presenting to an urban emergency department (ED) for any reason had been the victims of violence committed by another woman in the previous year. METHODS: This was a prospective study of a consecutive sample of female patients of legal age presenting to the ED between 8 AM and 12 midnight over an 11-week period. Patients were asked a series of questions adapted from the George Washington University Universal Violence Prevention Screening Protocol. Non-English-speaking patients, those unable to give informed consent, and those meeting regional criteria for major trauma were excluded. RESULTS: One thousand six hundred seventy-six women participated; 426 (25%) refused. Of the 1,250 women interviewed, 118 (9.4%; 95% CI = 7.8% to 11.1%) reported being assaulted by another woman in the previous 12 months. Compared with the nonvictims, the victims were more frequently younger and single. The most common forms of assault were slapping, grabbing, and shoving (54.7% of victims). These were followed by being choked, kicked, bitten, or punched (46.2%). Eighteen percent of the assaults involved a weapon or an object. Five percent of the victims described being forced to have sex. Thirty-seven percent of the victims contacted the police, 13% required medical attention, 17% pursued legal action, and 10% sought follow-up counseling. CONCLUSIONS: Nine percent of the women in the study sample had been assaulted by another woman in the previous year. Further attention to the recognition and management of violence committed by women against other women may be warranted to ensure that patients receive appropriate treatment and referral.     

The Epidemiology of the Homeless Population and Its Impact on an Urban Emergency Department

OBJECTIVES: To characterize the homeless adult population of an urban emergency department (ED) and study the medical, psychiatric, and social factors that contribute to homelessness. METHODS: A prospective, case-control survey of all homeless adult patients presenting to an urban, tertiary care ED and a random set of non-homeless controls over an eight-week period during summer 1999. Research assistants administered a 50-item questionnaire and were trained in assessing dentition and triceps skin-fold thickness. Inclusion criteria: all homeless adults who consented to participate. Homelessness was defined as being present for any person not residing at a private address, group home, or drug treatment program. Randomly selected controls were concurrently enrolled with a 3:1 homeless:control rate. Exclusion criteria: critically ill, injured, or incapacitated patients, or patients <21 years of age. Univariate analysis with appropriate statistical tests was used. The Mantel-Haenszel test was used to adjust for population differences. RESULTS: Two hundred fifty-two homeless subjects and 88 controls were enrolled. Data are presented for homeless vs control patients, and all p-values were <0.01. Odds ratios (ORs) with 95% confidence intervals (95% CIs) are given where appropriate: mean age (+/-SD) = 42 +/- 10 vs 48 +/- 13; male gender 95% vs 54% (OR = 17; 95% CI = 8 to 37); history of (hx) tuberculosis 49% vs 15% (OR = 2.5; 95% CI = 1.2 to 3); hx HIV infection 35% vs 13% (OR = 3.8; 95% CI = 1.8 to 8); hx penetrating trauma 62% vs 16% (OR = 8.62; 95% CI = 4.4 to 17.1); hx depression 70% vs 15% (OR = 13.4; 95% CI = 6.7 to 27); hx schizophrenia 27% vs 7% (OR = 5.1; 95% CI = 2.0 to 14); hx alcoholism 81% vs 15% (OR = 24; 95% CI = 12 to 49); significant tooth loss (>3) 43% vs 18% (OR = 3.3; 95% CI = 1.8 to 6.4); percentage of body fat 16.5% vs 19.7%; hx social isolation (no weekly social contacts) 81% vs 11% (OR = 33.3; 95% CI = 14 to 100); mean number of ED visits/year 6.0 vs 1.6. CONCLUSIONS: In the study population homelessness was associated with a history of significantly higher rates of infectious disease, ethanol and substance use, psychiatric illness, social isolation, and rates of ED utilization.     

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.     

Correlations Between Spirituality and Health-Promoting Behaviors Among Sheltered Homeless Women

This study examined the relationship between spirituality and health-promoting behaviors in a convenience sample of 90 sheltered homeless women using the Health Promotion Lifestyle Profile II, the Spiritual Well-Being Scale, and a demographic questionnaire. A moderate positive correlation was found between spiritual well-being and overall health promoting lifestyle (r = .426). Moderate to strong positive correlations were found between the Spiritual Well-Being Scale and the Health Promotion Lifestyle Profile II dimension subscales (physical activity, nutrition, spiritual growth, interpersonal relations, and stress management). The results support the importance of spirituality in relation to health-promoting behaviors among sheltered homeless women.     

Characteristics Associated with the Risk of Unintended Pregnancy Among Urban Homeless Women: Use of the Shuler Nurse Practitioner Practice Model in Research

In this pilot study, family planning practices and risk for unintended pregnancy among 50 homeless women residing in the downtown area of Los Angeles were investigated through the retrospective analysis of data collected through a wholistic clinic intake questionnaire. Those women who were least likely to use a birth control method in this study were Black, used cocaine daily, had multiple sources of emotional support, were satisfied with their sex lives, and reported access problems to family planning services ( p ≤ .05). Furthermore, over half of the total sample was at risk for unintended pregnancy. These at risk women were more likely to be separated from their children ( p ≤ .05), report current ( p ≤ .05) and past ( p ≤ .01) drug problems, have multiple sex partners ( p ≤ .001), engage in prostitution ( p ≤ .01), have a past history of sexually transmitted diseases ( p ≤ .05), and were least likely to be satisfied with their sex lives ( p ≤ .05). The findings suggest that homeless women are in great need of family planning health services, and that such services should be combined with vocational, social service, and drug treatment programs.     

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.