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Journal of Nursing

Women and Homelessness

Grace Augustine, ARNP, Barry University [email protected]


A retrospective review was conducted with several females at a local shelter, which revealed factors associated with homelessness. The main reasons given for using the shelters were housing problems, domestic violence, drug dependency, and past or current involvement in abusive relationships. Nurses can understand the issues of how women are affected due to homelessness in Palm Beach County, Florida. What emerges from a story of single white women who is homeless with her past abusive rape traumatic experiences? This led one to further explore the social construction of white American homeless women.

One of the women faced many challenges as she carried a sign “I need money to help my baby” and that was what had drawn me to converse with her. Her baby son was a result of being rape from a close by friend, and due to her spiritual upbringing she did not want to abort the child. She was planning to give the child up for an adoption. When the baby was born she began to bond with the baby and then changed her mind to keep her baby. During the interview her best friend accompanied her of whom she met while she was homeless. She lived at the Red Roof Inn hotel approximately 6 months ago, with her 1 year-old son as a temporary housing shelter. She does not have any immediate family support (Bonugli, Lesser, & Escandon, 2013).
A few years ago, she had a boyfriend that lives up north and now they are no longer a couple. The concept of quality of life and the opportunities to make choices and even change situation the public needs assistance from our local government. The local mayor of whom was interviewed regarding this and other cases stated; the local officials in Palm Beach County are looking at how to use the homeless women to generate income to the local cities. One of the suggestions he shared was to open a craft market and employ homeless women to make things so that the community can buy them and, the women would receive the profit and pay taxes on a portion of the cost.

Women and homelessness is a great concern that affects the global policy and health determinants to improve health. This case study is a glimpse of the cultural class as it revolves around the lives of mostly White homeless mothers, attending to both everyday lives and cultural norms while exploring and interpreting their interdependencies. These mothers so often get displace and lead to silence. The culture of homelessness is both complex and contested in various research reviews (Law & John, 2012). This paper reviews homelessness through the lens of transcultural nursing theory; increasing understanding of homelessness can be usefully conceptualized as a culture (Schindler, & Kientz, (2013).

Homelessness focuses on risk factors including poverty, low education, physical and or mental disability in minority status. According to the study by Kim, Ford, Howard, and Bradford (2010), most women that are homeless live in isolation and have been exposed to street violence such as sexual trauma. The literatures used in this paper refer to single homeless people. The single homeless refers to those with no partner or close family, living in hostels, temporary shelters, sleeping on the streets, or at serious risk of eviction (Law & John, 2012). The participants also had psychological abuse problems due to substance abuse and, physical health problems.

The psychological trauma most often leads to post traumatic stress disorders (PSTD). According to the Urban Institute, there may have been more than one million persons in the United States who were homeless at some time during 1987 (Healthy People 2010 & National Center for Health Statistics, 2001). There are several determinants of health in relations to homelessness and health issues, policy-making, individual behavior, social factors, and physical &health determinants (Healthy People 2010 & National Center for Health Statistics, 2001).

Policymaking


The access to medical care for low-income persons in the United States is considerably less on average than for the rest of the population. Numerous investigations have noted large inequities in access for low-income and minority populations. Currently, women who are victims of domestic abuse have unmet needs for both short and long-term housing. The National Network to End Domestic Violence reports that on a given day, 1,740 people could not receive emergency shelter and 1,422 could not be provided transitional shelter (Rayburn, 2013).

Homeless emergency shelters provide immediate safety to battered women and their children and assist women to gain control over their lives. The provision of safe emergency shelter is a necessary first step in meeting the needs of women fleeing domestic violence. In some states that have looked at domestic violence report that approximately 50-60% of current recipients say that they have experienced violence from a current or former male partner. In the absence of cash assistance, women who experience domestic violence may be at increased risk of homelessness or compelled to live with a former or current abuser in order to prevent homelessness (Rayburn, 2013).

A review of various articles it is noted that large inequities in access for low-income and minority populations regarding lack of health insurance coverage, lack of access to a regular source of care, gaps in preventive care, delays in obtaining needed care, and higher rates of morbidity, hospitalization, and mortality that could have been avoided with appropriate access to care. Community-level health care access may exist for a variety of reasons. When federal and state participation is required to support health insurance programs for vulnerable populations allocation of resources at the state and local levels can result. This uneven allocation of resources is likely to persist because care for uninsured persons is driven largely by state and local policy (Andersen et al., 2010).

Policies at the local state and federal level that affect individuals population health, due to implications from these results focus on the importance of choosing a good life partner, the reduction of alcohol and drug use among abusers, and emphasizing stable employment. The literatures used emphasizes a growing body of work from crime and examines some major policy issues. The majority of these homeless substance abusers had prior convictions in 1991 (77%) and probably a good number more do now (Healthy People 2010 & National Center for Health Statistics, 2001).

The United States (US) government should do more by enforcing distribution laws and providing drug treatment programs to those who need it, not just those than can afford it. Many centers are very high cost for these low- income people to afford; and as a result they do not get the help (Healthy People 2010 & National Center for Health Statistics, 2001).

Individual Behavior


The application of transcultural theory adds to the repertoire of skills the nurse needs to care for not only homeless clients, but for a diverse range of client groups. Many public health and healthcare interventions focus on changing individual behaviors such as substance abuse. Positive changes in individual behavior can reduce the rates of people that are affected by alcohol, cigarette, and other drug use activity. Fifty-three percent identified as multiple substance abusers; slightly less than 48% reported having problems with alcohol, and a very large percentage eighty-five percent reported abusing crack cocaine. For people with mental illness this includes job loss and declining income (Law & John, 2012).

Social Factors


People with chronic mental illness are at risk of social alienation; these populations that are homeless with mental illness are discriminated against by society in general. And therefore people do not socialize with this population so they remain in a concentration for poverty and live mostly on the streets and or in shelters Safety is a big factor as most of the homeless people are robbed and attacked from their immediate peers of who are homeless. Women living in poverty whether homeless or not have elevated rates of lifetime post traumatic stress disorders (Law & John, 2012).

Another problem inadequately addressed by homelessness that is readily apparent to anyone working in or passing through the mental illness, both a contributor to and consequence of homelessness. However most homeless people are on the streets not because they are mentally ill, but because they have lost a job or are unable to find a place to live. For them, the stress of homeless life leads to depression, alcoholism and suicide (Cousineau, 1987).
Most of the clients had some work history and some job skills at the time the program started, but as a whole were not prepared for employment. Homeless woman had limited educational backgrounds as well, but the majority had at least 12 years of education (Rayburn, 2013). Ending and preventing homelessness in America is a matter of basic social justice. One view homelessness as a lack of basic human rights issue, and it’s a basic human rights principle that rights are interdependent.

Physical & Health Determinants


Homeless people have to deal with the natural environment such as rain, sun, snow, and other environmental mishaps. Their housing is not permanent and they are mobile constantly, and this makes it difficult for them to attach to people. To get supportive help as there is no way to get in-touch with them via the phone or utilizing an address system. Millions of people that are homeless have unhealthy level of pollutants, and there is often a higher result seen with asthma when compared to the state and national averages (Rayburn, 2013). Because tuberculosis (TB) is a major problem among homeless persons, the Advisory Council for the Elimination of Tuberculosis has developed recommendations to assist health care providers, health departments, shelter operators and workers, social service agencies, and homeless persons in preventing and controlling TB in this population (Centers for Disease Control and Prevention {CDC}, 1992).

Such conditions put the homeless at risk for serious disease and injury. Our clinics for the homeless commonly treat people for hypothermia, traumatic injuries, infestations of lice and scabies, peripheral vascular disease, skin disorders and leg ulcers. Not surprisingly, upper respiratory infections such as colds, bronchitis and pneumonia are common among the homeless. Alcoholism, a common affliction of the homeless, leads to cirrhosis, hepatitis, anemia and ulcers. Homelessness is particularly harmful to the health of children, whose rate of chronic physical disorders is twice that observed among children in general (Centers for Disease Control {CDC}, 1992).

This population has a poor health outcome due to practitioners’ inability not able to do any preventative to treat this population (Healthy People 2010 & National Center for Health Statistics, 2001). Tuberculin skin test screening and isoniazid preventive therapy programs among homeless people have been generally unproductive because of poor patient adherence to follow-up visits and treatment regimens. Screening should be undertaken only if there is a reasonable possibility that most infected persons identified will complete preventive care. Priorities for preventive therapy among TB infected persons have been established.

Homelessness reduces the dominant stereotype and stigmatization thus increasing their invisibility and reducing their access to help and support. It is vital therefore that nurses treat homeless patients with respect and dignity in every interaction. Law and John (2012), stated 9 out of 10 homeless young people, could identify someone they felt close to and could turn to share their troubles many of whom were similarly homeless. Interestingly, they also draw attention to the fact that it is the strength of some of these friendships, which lessen against leaving street life; a strong indicator of the power of the collective support felt within this cultural group. For one to exercise the transcultural models as a lens for reviewing care for this group of clients; a deeper understanding of the health needs of the homeless and more appropriate care planning and interventions can be identified. Perhaps more importantly, nurses can see the utility of these theories for a wider client base.

In conclusion, homelessness culture focused on transcultural theories to provide congruent care for homeless White women. The extension of their focus from a concept of culture highlights their application for a wide range of social groups. This analysis leads to the conclusion that transcultural nursing should apply to all clients the nurse encounter on a daily basis, all clients have specific culture and needs to be assessed and considered, if appropriate care is to be provided.

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