Lessons from the Homeless: Impact of Civil and Uncivil Interactions With Nurses in the U.S.

Purpose:

The health of homeless people is poorer than that of the population in general (Bernstein, Meurer, Plumb, & Jackson, 2015; Lebrun-Harris et al., 2013; Seiler & Moss, 2012). This is true in the United States and across the world (Daiski, 2007; Irestig, Burstrom, Wessel, & Lynoe, 2010). Mortality rates for the chronically homeless are higher than expected (Hwang et al., 2010); on average, they live only 42 - 52 years (Bernstein et al., 2015). Factors leading to increased morbidity and mortality include lack of insurance, poor nutrition, violence, and inadequate living conditions (Bernstein et al., 2015; Lebrun-Harris et al., 2013; Su, Khoshnood, & Forster, 2015). Nurses’ attitudes and uncivil behavior may also negatively impact this vulnerable population (Chung-Park, Hatton, Robinson, & Kleffel, 2006). The purposeof this study was to explore homeless people’s perceptions of their interactions with nurses to ultimately help nurses understand the impact of civility and incivility on their care of the homeless. Leininger’s (1991) Culture Care Diversity and Universality Theory and Sunrise Model guided this study and data analysis.

Methods:

In this qualitative study, we interviewed ten homeless men and five homeless women ranging in age from 18 to 53 years. Interviews were conducted at a homeless ministry in a community of 120,000 in the Midwestern United States. The interview tool was developed by the researchers and was comprised of broad questions with open-ended prompts. We received approval from our university’s institutional review board. A researcher attended numerous ministry activities over six months and invited potential participants to join the study. Those who agreed were escorted to a quiet, private counseling room. Informed consent was obtained and audiotaped interviews commenced.

Results:

Three major themes emerged. In the first theme, participants emphasized that nurses should be civil in their interactions with the homeless. They wanted to be listened to and taken seriously, to be treated with compassion and empathy. They believed nurses should be attentive, treat them with respect and fairness, and not be judgmental toward them. An unexpected finding was that our participants thought nurses should enjoy what they do. The second theme revealed that homeless people relied heavily on self-care, but when they could not care for themselves, they sought treatment at emergency departments or clinics for the indigent. Most did not believe family or friends would provide assistance when they were ill or injured. In the third theme, our participants asserted that lack of finances and their homeless status prevented them from getting good health care.

Conclusion:

 In order to effectively care for this vulnerable population, nurses must understand the obstacles the homeless face when they need healthcare and realize that nurses’ uncivil behavior poses a significant barrier to compassionate care. Our study provides insight into the ways homeless people want to be treated by those who care for them. Our findings can guide development of education interventions for nurses and students that will promote better understanding of the healthcare needs of the homeless from their own perspective.