For homeless persons, posthospitalization care is increasingly provided in formal medical respite programs, and their success is now reported in the literature. However, there is a dearth of literature on posthospitalization transitional care for homeless persons in the absence of a respite program. Through this formative study, we sought to understand the process of securing posthospitalization care in the absence of a formal homeless medical respite. Results demonstrated a de facto patchwork respite process that has emerged. We describe both human and monetary costs associated with patchwork respite and demonstrate opportunities for improvement in homeless health care transitions.
Objective
The purpose of this study was to evaluate a homeless medical respite pilot program to determine if program participants had health care utilization pattern changes and improved connection to income, housing, and health care resources post program.
Design
This is a quantitative descriptive pre‐/post‐program evaluation.
Sample
A total of 29 patients experiencing homelessness and discharged from an acute care hospital in the southeastern United States were provided with housing and nursing case management.
Measurements
Demographics including age, sex, race, and ethnicity were collected. Connection to primary care, mental health, substance abuse services, income, insurance, and housing were assessed at program entry and completion. Health care utilization and charge and payment data were collected 1 year prior and 1 year post‐respite stay.
Results
Participants demonstrated reduced hospital admissions (−36.7%) and when admitted, fewer inpatient days (−70.2%) and increased outpatient provider visits (+192.6%). Health care charges for the cohort decreased by 48.6% from the year prior to the program. Housing and income improved.
Conclusions
The medical respite pilot program was successful in guiding patients to community resources for more appropriate health care at a demonstrated cost savings. Participants also derived benefits in the form of improved housing and income.
Refugees often experience compromised health from both pre- and post-migration stressors. Coalition theory has helped guide the development of targeted programs to address the health care needs of vulnerable populations. Using the Community Coalition Action Theory as a framework, a coalition was formed to implement a community garden with apartment-dwelling refugees. Outcomes included successful coalition formation, a community garden, reported satisfaction from all gardeners with increased vegetable intake, access to culturally meaningful foods, and evidence of increased community engagement. The opportunity for community health nurses to convene a coalition to affect positive health for refugees is demonstrated.
More than 80 percent of African American women struggle with overweight and obesity. We implemented a 5‐week physical activity intervention using Facebook™ and pedometers with African American women. Twenty‐seven African American women participated in a single‐group pre/post design intervention to promote walking and physical activity. Participants were given access to a private Facebook™ group along with a free Omron Alvita pedometer. The five‐week intervention challenged participants to increase weekly daily steps and the number of days they were physically active. At the end of the intervention, participants had significantly increased their weekly steps by 190% as compared to baseline (p = .005). Nearly, 80% of participants reported being active two or more days per week as compared to baseline (35.7%). Technologies such as social media and pedometers can assist in educating individuals and improving physical activity. These findings are relevant to public health nurses when implementing programs to increase physical activity for African American women.
Service providers are gatekeepers to health-sustaining services and resources, although little is known about service encounters from the perspective of homeless women. We conducted in-depth semistructured interviews with 15 homeless women to better understand their experiences of service encounters. Using a phenomenological method, 160 significant statements were extracted from participant transcripts; more positive than negative interactions were reported. The 10 themes that emerged fall along a dehumanizing/humanizing continuum primarily separated by the power participants experienced in the interaction and the trust they felt in the service provider. Implications for nursing practice and research are offered.
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