Homeless women and children's access to health care: a paradox.

Homeless women and children who reside in shelters experience many health-related problems. The aim of the qualitative study reported here was to (a) explore how shelter staffs manage health problems among their residents and assist them in accessing health services, and (b) identify clinical strategies for community health nurses working with this population. Findings demonstrate a paradox whereby homeless shelter staffs try to gain access to care for their residents through a system that is designed to keep them out. In addition, findings indicate a need for increased community health nursing services in homeless shelters. Strategies for resolving this paradox include providing assessment, policy development, and assurance of health care for homeless women and children.

Lives on hold: evaluation of a caregiver's support program.

Evaluation research of a caregiver community-based support program is described. Initially, caregiver-participants characterized their lives as being "on hold." They were overwhelmed, isolated, and lacking time for a personal life. Socialization activities and learning to care for themselves were the most powerful and helpful aspects of the program. Suggestions are made for developing a caregivers' support program within a home healthcare agency.

Environmental paradigms: moving toward an ecocentric perspective.

This article examines a taxonomy of three environmental paradigms. The egocentric paradigm is grounded in the person and is based on the assumption that what is good for the individual is good for society. The homocentric paradigm is grounded in society and reflects the utilitarian ethic of the greatest good for the greatest number of people. The ecocentric paradigm is grounded in the cosmos, and the environment is considered whole, living, and interconnected. Historically, nurses have adhered primarily to the egocentric paradigm and to a lesser extent to the homocentric paradigm. However, because the world has become a global community, contemporary nurse scholars are shifting to the ecocentric paradigm.

Rethinking the environment as a domain of nursing knowledge.

Nurses frequently care for individuals whose problems originate from the environment. Yet the environmental paradigm in nursing is client-oriented and psychosocial and does not adequately explain these conditions. Nursing theory and research in the environmental domain are explored in this article and found to be focused within this limited paradigm. Models and theories from other disciplines and upstream nursing approaches that address multidimensional environmental characteristics are discussed in terms of providing direction for making a paradigm shift leading to a revolution in nursing's environmental consciousness.

Home health patient classification system.

A patient classification system has been developed for use in a home health setting. It is easy to use and is readily adaptable for computerization. The reliability and validity of the system has been supported through use by nurses on approximately 1,000 home visits. After appropriate adaptations are made, it can be a useful tool in measuring nurse workload and in costing out nursing services.

An ecofeminist analysis of nursing knowledge.

The planet is facing ecological disaster, yet the environmental domain of nursing is currently understood as the immediate surroundings or circumstances of the individual or family. Such a definition keeps nurses from addressing the larger social, political, economic, and global issues that affect health. The author suggests that nursing, essentially a women's profession, and the environment share a long history of domination and oppression; and that an ecofeminist perspective offers a conceptual foundation for developing a new consciousness of the environment with the potential for liberating both.