Department of Nursing, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA.
School of Social Work, San Diego State University, San Diego, California, USA.
Res Nurs Health. 2022 Apr;45(2):218-229. doi: 10.1002/nur.22193. Epub 2021 Oct 28.
Housing is one of the social determinants of health, and homelessness is associated with health inequalities including increased morbidity and decreased life expectancy. Services to improve access to and use of primary healthcare are provided to formerly homeless individuals (hereafter residents) who live in permanent supportive housing (PSH). Residents do not always utilize services, nor receive adequate healthcare, and often have poor health outcomes. The study aims were to explore nurse and case manager (hereafter participants) views on the challenges of providing healthcare to residents, and strategies to address challenges. This descriptive, qualitative study used thematic analysis. Five nurses and eight case managers working with residents of PSH agencies were interviewed using semistructured interviews. Five main themes emerged. The first theme of context of healthcare use included how the residents' history of homelessness, trauma, and survival affected using services. The second theme was how aspects of relationships (communication issues and mistrust) were barriers to care. The third theme was how residents' health issues (physical chronic diseases, mental health, and substance dependency) affected care. Community level barriers (insurance, financial hardship, and transportation) was the fourth theme. The final theme highlighted recommendations to improve access and use of healthcare by building rapport, addressing mistrust, and using effective communication techniques. Participants noted that barriers to healthcare use were often influenced by residents' previous homeless experience. Nurses noted that chronic physical health issues were problematic for residents. Participants expressed the need to take time to form an authentic relationship to increase trust with residents.
住房是健康的社会决定因素之一，无家可归与健康不平等有关，包括发病率增加和预期寿命缩短。为改善获得和使用初级保健服务的机会，向居住在永久性支持性住房（PSH）中的以前无家可归者（以下简称居民）提供服务。居民并不总是利用这些服务，也没有得到足够的医疗保健，而且往往健康状况不佳。本研究旨在探讨护士和个案经理（以下简称参与者）对为居民提供医疗保健的挑战的看法，以及解决这些挑战的策略。本描述性、定性研究使用了主题分析。对五名护士和八名在 PSH 机构工作的个案经理进行了半结构化访谈，以了解他们的看法。出现了五个主要主题。第一个主题是医疗保健使用的背景，包括居民无家可归、创伤和生存的历史如何影响服务的使用。第二个主题是关系方面（沟通问题和不信任）如何成为护理的障碍。第三个主题是居民的健康问题（身体慢性疾病、心理健康和药物依赖）如何影响护理。社区层面的障碍（保险、经济困难和交通）是第四个主题。最后一个主题强调了通过建立融洽关系、解决不信任问题和使用有效的沟通技巧来改善医疗保健的获取和利用的建议。参与者指出，医疗保健使用的障碍往往受到居民以前无家可归经历的影响。护士注意到居民的慢性身体健康问题是个问题。参与者表示需要花时间建立真实的关系，以增加与居民的信任。
