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Civility is a crucial element in therapeutic communication and healthy patient relationships; conversely, incivility can negatively influence healthcare environments and patient care (American Association of Colleges of Nursing, 2008; The Joint Commission, 2008). Vulnerable populations, especially homeless people, may be particularly at risk for experiencing uncivil behavior from nurses (Irestig, Burstrom, Wessel, & Lynoe, 2010). Several studies have demonstrated that homeless people believe they are treated with disrespect (Cocozza Martins, 2008) and lack of compassion by nurses (Irestig, 2010, Nickasch & Marnocha, 2009), which constitutes a barrier to their seeking care. Nursing students may be unfamiliar with the needs of the homeless and hold negative perceptions about them. Few studies have explored undergraduate nursing students’ perceptions of the homeless, and how these perceptions may affect their therapeutic interactions. Boylston and Rourke (2013) identified that second degree baccalaureate nursing students held negative stereotypes of the homeless. Patterson and Hulton (2011) determined that senior nursing students had negative attitudes toward people living in poverty. However, there is little literature exploring how these perceptions may impact nursing students' therapeutic interactions. Therefore, the purpose of this study is to explore the knowledge, beliefs, and attitudes of undergraduate student nurses toward homeless people in order to develop an intervention to change perceptions and improve therapeutic interactions.
Methods:
We will recruit 20 junior, undergraduate nursing students, aged 18 and over, from a baccalaureate nursing program in the Mid-west. Members of the research team will attend Health Assessment class, which has an average enrollment of 90 students who will have entered the program in fall semester, to describe the study and invite students to participate. Students will be given a copy of the recruitment script that includes research team members’ contact information. Students who are interested will be instructed to contact a team member to schedule the 60 minute interviews. The first twenty students who respond will be included in the study.
At the initiation of the interview, a research team member will explain the study and procedures, obtain informed consent, then complete the audiotaped interviews. During the interviews, participants will provide demographic information and take part in an open-ended interview using broad questions and prompts from an interview guide. This guide was developed based on the researchers’ expertise with civility and the homeless population and on the existent literature.
Each person who participates in an interview will receive a $15 Walmart gift card. All participants will be given the incentive whether they complete the entire interview or not. We anticipate interviews will take no more than one hour. Interviews will be audio-taped and later transcribed verbatim. Field notes will be recorded with each interview to allow for an audit trail.
Results: Study is in progress.
At the completion of interview sessions, tapes will be transcribed verbatim, and transcriptions and field notes will be analyzed for emerging themes. Qualitative data will be analyzed through concept analysis identification of themes. Coding categories will be generated from the data. Researchers will conduct coding individually and consensus will be achieved on final themes through an iterative process. This process will continue until data saturation is reached. Themes will be examined for fit with Leininger’s (1991) model; they will also be compared to themes found in the literature and examined for congruency. Trustworthiness of the findings will be strengthened through our use of an audit trail to track decision making and development of codes, and by triangulation through the iterative review. Descriptive statistics will be used to explore participants’ characteristics.
Two techniques will be used to determine trustworthiness of the study: audit trail and member checking. The interviewers will keep accurate records during data collection to maintain an audit trail. This will allow an external auditor to evaluate the dependability of the data and enhance dependability of the study. In order to establish validity, informal member checking will be performed at the end of each interview to ensure that researcher interpretations are consistent with those of participants. Additionally, after data analysis is completed, a member of the research team will meet with two or three of the participants to ascertain whether the themes identified by the researchers actually represent the experiences of the participants.
Conclusion: Social justice is a fundamental value of the nursing profession (AACN, 2008), and drives the mandate that nurses provide competent, compassionate care for the vulnerable people they serve, including the homeless. Moreover, nurses have a responsibility to advocate for social justice and promote health policies that ensure adequate care resources for the homeless (Daiski, 2006). Nurses who are successful in meeting the needs of the homeless value justice and believe that caring for underserved, marginalized populations is foundational to nursing. They are able to recognize their biases, communicate respect, establish trust, and engage the homeless in taking ownership of their healthcare (Seiler & Moss, 2012). However, not all professionals possess these skills; they may be unfamiliar with the unique challenges homeless people face and the multiplicity of health problems they experience (Drury, 2008; Nickasch & Marnocha, 2009; Seiler & Moss, 2012), making it more difficult to tailor care to meet their needs.