Experiences of Care in the Emergency Department Among a Sample of Homeless Male Veterans: A Qualitative Study.

INTRODUCTION: Homeless populations are historically high users of the emergency department for low-acuity issues that could be treated in more appropriate settings such as primary care. Veterans make up 11% of the homeless adult population and are often seen in community and Veterans Affairs Medical Center (VAMC) emergency departments. The purpose of this study was to describe the experiences of a sample of homeless male veterans as they attempt to access health care in the emergency department. METHODS: Grounded theory methodology provided the overarching framework for this research project. Structured interviews were conducted with 34 male homeless veterans, with 25 discussing their ED care. Veterans were recruited and interviewed from one VAMC emergency department, an all-male emergency shelter, and 1 soup kitchen. Text units about ED use were extracted and compared from 25 recorded transcripts to identify categories. RESULTS: Three categories defined ED experiences: "no other option," "lack of voice," and "feeling valued." DISCUSSION: The sample of homeless veterans in this study provided first-person knowledge about their experiences receiving care in emergency departments. These results are consistent with previous research indicating that homeless populations are high users of ED care; however, they often feel undervalued and lack of empathy from health providers. Emergency nurses are an integral part of the ED health care delivery system for the homeless, providing advocacy and much needed education about health problems and alternatives to ED care. The insight obtained about the lives and experiences of veterans in the ED is valuable to the practice of emergency nurses.

A systematic review of nurse-led interventions with populations experiencing homelessness.

Homelessness is associated with poorer health status, and affects men, women, children, and veterans alike across the United States. With over half a million-people suffering from homelessness on any given night, it is imperative that the health care delivery system step in to help this vulnerable group. Registered nurses encounter people experiencing homelessness in hospitals, clinics, shelters, and across the public health sector. They have the necessary skills to help make positive health-related changes for homeless populations and improve their overall quality of life. Therefore, the purpose of this systematic review was to (a) assess existing nurse-led interventional studies with homeless populations, (b) highlight effective methods that nurses used to impact care, and (c) make recommendations about future research needed. PRISMA guidelines were used and multiple databases were searched for nurse-led interventional research with those experiencing homelessness. Recommendations include using a holistic nursing approach when working to improve outcomes for homeless populations to ensure optimal treatment for their complex physical, mental, and social health problems.