Leadership Development Program for Nurses at a Healthcare for the Homeless Program: A Educational Intervention.

PURPOSE: This quality improvement, educational intervention project aimed to develop nurse leaders at a large urban federally funded Health Care for the Homeless Program (HCH), using the Nursing Leadership Institute Competency Model. METHODS: A leadership seminar series which addressed six leadership topics for homeless health care nurses was developed, implemented, and evaluated using a one group pre/posttest design. The Leadership Practices Inventory (LPI) was also administered before and after the seminar series. RESULTS: There were statistically significant increases in new skills in the areas of interpersonal skills, personal mastery, systems thinking, and finance management. LPI scores improved after completion of the leadership seminar series. CONCLUSION: Participation in the leadership seminar series improved leadership skills and competencies of nurse leaders at the HCH. The acquired new knowledge may prepare homeless health nurses for sustained leadership roles which in turn will result in better meeting the needs of organizations providing care to homeless individuals.

"Walking in a maze": community providers' difficulties coordinating health care for homeless patients.

BACKGROUND: While dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population. METHODS: Three semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used. RESULTS: HCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received. CONCLUSIONS: Substantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons.

Dual use of Department of Veterans Affairs and community healthcare: Homeless veterans' experiences, perspectives, and perceptions.

BACKGROUND: Veteran homelessness is a pervasive problem and a high-priority, mission-oriented area of investigation in the United States (US). Most veterans enrolled in healthcare with the Department of Veterans Affairs (VA) carry additional health coverage, which may increase their access to care. For veterans, dual use of VA and non-VA healthcare has potentially positive and negative consequences. PURPOSE: To explore homeless veterans' experiences seeking and obtaining healthcare within and outside the VA. METHODOLOGY: US homeless veterans were recruited from a large, urban Northeast Healthcare for the Homeless program from two sites. This was a descriptive phenomenological study. Three semistructured focus group interviews were conducted (total n = 21 distinct participants). We used inductive content analysis procedures to identify main themes in the data. RESULTS: We found four main themes: dual use decision making, access to care, preferences and perceptions of care, and suggestions for improving VA care. Although veterans in our sample had mixed positive and negative experiences with both systems, positive responses were more common regarding community care than VA. Veterans provided more verbose responses when describing negative VA experiences and more succinct responses for positive experiences. CONCLUSIONS: We found mixed positive and negative experiences for both healthcare systems, although reports were more positive for non-VA care than VA. IMPLICATIONS: Veterans' healthcare concerns and needs appeared difficult to meet. Future research is warranted to improve veteran-centered care access and care experiences.