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RESEARCH

Healthcare experiences of the homeless


Bonnie Nickasch, RN, MSN, FNP, APNP (Family Nurse Practitioner)1 & Suzanne K. Marnocha, PhD, RN, CCRN
(Associate Professor and Director of Traditional Undergraduate Program)2
1 Thedacare, Appleton, Wisconsin
2 University of Wisconsin, Oshkosh, Wisconsin

Keywords Abstract
Homelessness; healthcare experiences;
grounded theory; vulnerable populations. Purpose: To explore the healthcare experiences of homeless individuals and
inform providers of the barriers created by the situation of homelessness.
Correspondence Data sources: This was a qualitative research study using a grounded theory
Bonnie Nickasch, RN, MSN, FNP, APNP, approach. The sample included homeless individuals older than 18 years living
122 E. College Avenue, Appleton, WI 54912. in northeastern Wisconsin.
Tel: 206-222-2049; Fax: 206-222-2049;
Conclusions: This research provided rich insight into the healthcare experi-
E-mail: bonnie.nickasch@thedacare.org
ences of the homeless. Five key conclusions were made: (a) the great majority of
Received: August 2007;
homeless people have an external locus of control; (b) most homeless individ-
accepted: February 2008 uals lack the necessary resources to meet their physical needs of shelter, air,
water, and food; (c) most homeless individuals lack the financial resources to
doi:10.1111/j.1745-7599.2008.00371.x seek adequate health care; (d) access to resources is limited because of poor
transportation, telephones, and mail; and (e) all those interviewed felt that
healthcare providers lack compassion for the homeless.
Implications for practice: Healthcare providers can use the concepts discov-
ered in this study to help improve their skills and comfort level when working
with homeless individuals. A decrease in acute illnesses and an increase in the
effective management of chronic disease resulting in fewer long-term compli-
cations and medical costs because of these unnecessary complications could be
seen. Healthcare professionals may also volunteer to become more involved
with the care of the homeless if they are confident in their skills. Improving the
health of the homeless in the community will result in improvements in the
overall health of the community.

Homelessness is a social problem that has been on the rise beings are motivated by unsatisfied needs and that certain
since the early 1980s (Gelberg et al., 2002). There is little lower needs must be satisfied before higher needs can be
agreement among researchers on what is classified as satisfied. According to his theory, one must first satisfy the
homelessness; however, researchers do agree that home- necessities of air, water, food, and sex prior to satisfying
lessness is increasing, and with homelessness comes many other needs. Yet, despite these enormous obstacles, many
healthcare challenges and beliefs. Therefore, a focus on the homeless are classified as resilient (Rew, Taylor-Seehafer,
homeless as a population should not be overlooked by Thomas, & Yockey, 2001).
health professionals. Several studies have focused on the negative health
Homeless individuals expend tremendous energy on consequences of homelessness (Pfeil & Howe, 2004;
survival strategies such as obtaining food, shelter, and Rew, Taylor-Seehafer, & Fitzgerald, 2001; Rotheram-
a place to rest (Capponi, 1997; McCormack & Gooding, Borus, Mahler, Koopman, & Langabeer, 1996; Yoder,
1993). Only after these basic human needs have been Hoyt, & Whibeck, 1998). However, adapting clinical prac-
satisfied are they able to focus on their other health issues tice to the health needs and living situations of the home-
(Flynn, 1997). This struggle is also supported by Maslow’s less has remained challenging for clinicians. Strehlow,
(1970) hierarchy of needs, which postulates that human Kline, Zerger, Zlotnick, and Proffitt (2005) surveyed

Journal of the American Academy of Nurse Practitioners 21 (2009) 39–46 ª 2009 The Author(s) 39
Journal compilation ª 2009 American Academy of Nurse Practitioners
Healthcare experiences of the homeless B. Nickasch & S.K. Marnocha

diverse clinicians caring for the homeless and found that Problem statement
adapted clinical practice guidelines can be implemented
The current qualitative theory study was designed to
for the care of homeless individuals. This article clearly
expand on what is known about the experiences of home-
identifies the unique needs of this aggregate group and
less individuals who seek health care. An understanding
the clinical utility of evidence-based practice guidelines
of the healthcare experiences within this group may
adapted for care of the homeless patient. However, few
expose unknown beliefs and practices and as a result lead
studies have addressed the positive health practices of this
to changes in the working relationship between health-
vulnerable population. Little is known about homeless
care providers and homeless individuals. As a result, the
individuals’ experiences with the healthcare system, posi-
homeless individuals may have more positive experiences
tive or negative.
in healthcare settings and presumably more accurate diag-
nosis and improved treatment and outcomes.
Theoretical framework
This study used Glaser and Strauss’ (1967) grounded
Methodology
theory approach to qualitative research. Emerging from
the field of sociology, this inductive approach to research
Research design
allows investigators to compare units of interview tran-
scripts in order to identify and organize the common The purpose of this study was to gain a better under-
themes that exist within them. The grounded theory standing of the homeless individual’s healthcare experi-
approach is an iterative process of induction, deduction, ences. A grounded theory design was used because so little
and verification. is known about the topic. According to Speziale and
Carpenter (2003), the main purpose of selecting a groun-
Review of literature ded theory approach is to allow the researcher more
flexibility and freedom to explore a phenomenon in depth.
The literature reviewed revolved around the ongoing
In this type of research, the researcher begins by asking
acute and chronic medical problems of the homeless pop-
very broad questions but continually refines the questions
ulation, their delay in seeking care, and demographic
throughout his study. The goal of having broad, open-
characteristics. There were also studies of the contributing
ended questions is to allow study participants to define
factors to homelessness such as domestic violence, pov-
what is important to them, whereas other approaches
erty, and death of a spouse. Some studies have focused on
could begin with assumptions, hypothesized as important,
homelessness; however, their focus has been on the expe-
by the researcher. As topics emerge, the researcher refines
rience of homelessness and the meaning of health and
the questions and continues gathering data until the point
resiliency of some homeless individuals. There have even
of saturation is reached. According to Polit and Beck
been a few studies addressing the healthcare provider’s
(2004), ‘‘the point of saturation is the point in the study
experience with providing care to the homeless. After
where a sense of closure is attained because new data yield
extensive literature review, only one study was identified
redundant information’’ (p. 731).
that addressed the personal evaluation of a homeless indi-
Data were collected through individual interviews that
vidual’s healthcare experiences (Martins, 2003).
were audio recorded and transcribed verbatim. Field notes
Homelessness in the United States is considered to be a
were taken, and participant observations were recorded
leading social problem. A homeless individual needs a wide
throughout the study.
variety of social strategies just to survive. These individuals
find themselves in a range of difficult situations, such as
Population, sample, and setting
having inadequate shelter, lacking food, or lacking health
care. These situations correlate with an increase in mental The target population for this study was homeless indi-
and physical problems within the homeless population. viduals; the accessible population was homeless individuals
According to Power, French, Connelly, George, et al. in northeastern Wisconsin. Homelessness is a term upon
(1999), the health status of the homeless person is whose definition many cannot agree. For the purposes of
extremely poor when compared to the general population. this study, the definition of homeless individual is a person
Many believe homeless individuals avoid seeking care at who lacks a fixed, regular, and adequate nighttime resi-
all costs. However, in a recent study in Boston, it was dence and has a primary nighttime residency that is (a)
shown that 100% of recently deceased homeless individ- a supervised publicly or privately operated shelter, (b) an
uals (n = 13) had experienced multiple recent contacts institution that provides a temporary residence for
with the medical, psychiatric, and substance abuse systems individuals intended to be institutionalized, or (c) a pub-
(O’Connell, Mattison, Judge, Allen, & Koh, 2005). lic or private place not designed for regular sleeping

40
B. Nickasch & S.K. Marnocha Healthcare experiences of the homeless

accommodation for human beings (U.S. Department of 1. What are some of your healthcare experiences as
Housing and Urban Development, 1987). a homeless individual?
In this study, the researcher used a convenience sample 2. Do you have any suggestions for healthcare professio-
of homeless individuals by contacting a key informant nals related to providing care to the homeless individual?
from the local community clinic who introduced the 3. What is your definition of health?
researcher to two potential research participants. These 4. Do you believe in an internal or external locus of
individuals were identified based on their long-standing control? (The researcher used the analogy of who is driving
relationship with the community clinic and their length of your bus—are you in charge of what happens to you or is
homelessness. One of these individuals agreed to be inter- someone else in charge of what happens in your life?)
viewed. From this point on, snowball or network sampling Participants were also asked to complete a demographic
was used to gather the rest of the sample. In other words, questionnaire related to age, educational attainment,
study participants were gained through referrals from length of time homeless, and work history. Eight of the
earlier informants. Data saturation was obtained after interviews were tape-recorded after gaining written
interviewing nine homeless individuals. informed consent from the informants, and the other
Criteria for inclusion included (a) 18 years of age or interview was transcribed during the interview per
older, (b) ability to understand and speak English, and (c) request of the interviewee not to be audio-taped. Inform-
willingness to volunteer for an interview and have the ants were asked four open-ended questions and filled out
interview audio-taped. Criteria for exclusion included a short demographic questionnaire. The interview times
homeless children younger than 18 years. ranged from 20 to 60 min per informant. After completion
The demographic characteristics used to describe the of the interview, participants were thanked and given
sample included age, educational attainment, length of a $3 food coupon.
time homeless, and work history. Previous research had Prior to data collection, the researcher engaged in a for-
shown that these characteristics have contributed signifi- mal process of ‘‘bracketing’’ to explore and record initial
cantly to the understanding of the homeless in Canada personal preconceptions, values, and beliefs about the
(McCormack & Gooding, 1993). Therefore, it was hypoth- homeless population. These opinions were formed from
esized that these demographics would also contribute to life experiences as well as from the researcher’s current
the understanding of homelessness anywhere throughout work as an emergency room nurse and from recent expe-
the United States. riences as a nurse practitioner student at the local com-
Demographic characteristics were gathered by self- munity clinic and local emergency shelter.
report using a pencil-and-paper form. Interviews were Following procedures established by Glaser and Strauss
conducted in a quiet location at the local emergency (1967), the process of data collection, coding, and analysis
shelter or local community clinic. The exact location occurred simultaneously. The researcher continually re-
was determined based on the homeless individual’s pref- viewed the data obtained and revised the research ques-
erence related to transportation and comfort level. Both tions to better capture data from the participants. The data
locations were quiet, confidential, and nonintimidating. from the first interview were analyzed, and additional
probing questions were added to future interviews.
The questions were continually analyzed and adjusted
Procedures for data collection to better gain knowledge related to the homeless health-
care experience.
Protection of human participants

Approval from the University of Wisconsin Oshkosh Reliability and validity


institutional review board (IRB) for the protection of
A member check was performed to ensure creditability.
human participants was obtained prior to data collection.
Two of the participants met with the researcher after the
An informed consent was obtained from each participant
study was completed to discuss the common themes that
agreeing to be interviewed. Eight of the participants also
were identified by the researcher. They were asked to
agreed to be audio-taped. All audiotapes are stored in
assess whether they felt that the themes adequately
a locked boxed according to IRB protocols.
described their perceptions of their healthcare experien-
ces as a homeless individual. Both participants agreed
Procedures for collecting data
that it was an excellent portrayal of their perceptions.
Individualized open-ended questions via a one-to-one According to Lincoln and Guba (1985), member checks
interview were used for data collection. The following four are the most important technique in establishing credi-
questions were asked: bility of qualitative data.

41
Healthcare experiences of the homeless B. Nickasch & S.K. Marnocha

Data analysis The ages of the homeless individuals ranged from 18 to


66 years with a mean age of 40.5 years. Four of the
As the data were collected (i.e., interviews, participant
participants were male and five were female. One partici-
observation, field notes), they were coded. The interviews
pant was African American, one was Native American, and
were transcribed verbatim, data were coded, concepts
seven were Caucasian. Four of the participants did not
were defined, and emerging themes identified. After de-
complete high school. The number of years of education
termining the major overarching themes and concepts, an
ranged from 2 years of elementary education through 1.5
extensive literature review was executed to expound/
years of postsecondary education.
expand the developing theory. Last, the data were com-
All nine participants in the study had seen a healthcare
pared with data from past studies to determine if the
provider within the past 3 years, and five of them had seen
emerging themes were congruent. The steps of reduction,
a healthcare provider in the past month. Eight of the
selective sampling of the literature, and selective sampling
participants identified at least one medical condition from
of the data were followed to help guarantee that the
which they were suffering. The medical conditions were
sample was adequate and the data gathered were sufficient
amblyopia, degenerative joint disease, diabetes, hyperten-
(i.e., that data saturation had been reached).
sion, hypothyroidism, or migraines. Eight of the partici-
Limitations pants suffered from at least one type of mental illness,
including bipolar disease, depression, obsessive-compulsive
The possible limitations identified in this study related to disorder, or schizophrenia. Three were recovering alco-
the adequacy of the sample and included: holics and two were recovering drug addicts.
1. The sample may be biased because of the convenience
sample technique. The use of snowball sampling may have Interview findings
resulted in a sample of individuals from the same social
group with similar views. Many times people associate with Analysis of the participants’ views of their healthcare
those who have similar views and avoid those with differing experiences identified a large range of themes. An over-
views. If this is the case, the results are less generalizable. arching theme of the participants’ descriptions of their life
2. The methodological challenge of defining the concept of experiences, specifically in regard to health care, was their
homelessness might have resulted in inclusion of individuals identification of an external locus of control. Within this
who were not representative of the homeless population. theme were four underlying subthemes, including lack of
3. The interview format made it difficult for the partic- attainment of physical needs, lack of affordability, lack of
ipants to tell their whole story. The brief encounters may available resources, and lack of compassion of healthcare
not be truly representative of their entire life experiences. providers. Each of these subthemes contained additional
4. The sample is not generalizable to children younger subsets. Figure 1 shows a depiction of this model. The
than 18 years because they were not included in the participants identified an external locus of control as the
sample. main cause of their circumstances. External locus of con-
trol is exhibited in individuals who believe the events of
their lives are controlled by external circumstances, such
Results
as fate or luck. This theory of locus of control is based on
Rotter’s (1954) social learning theory.
Demographic data
For example, one participant said, ‘‘I am totally a victim of
Fifteen individuals who were purportedly homeless were my circumstances . right now I lack complete free will .
identified through snowball sampling. One of the identified life is dictating to me.’’ Another participant stated, ‘‘The
participants did not meet the eligibility criteria for the study circumstances of my life is why I am where I am.’’ Whereas
because he did not lack a fixed, regular, and adequate a middle-aged homeless man said, ‘‘I don’t have any fucking
nighttime residence most days of the month. Four other control over what happens . life is not fair. You and all your
potential participants met the criteria but chose not to tooty-fruity friends go home every night to your nice warm
participate in the study for various reasons, including fear homes and don’t give a damn about us. People should be
of their ideas being published, personal feeling that the more generous.’’ And a young high school dropout in
research would not benefit them, it would be a ‘‘waste of trouble with the police stated, ‘‘I don’t have any control
time,’’ and transportation concerns. Nine of the individuals over who my parents are, where I lived growing up,’’
agreed to participate and completed the interview process. implying he is not in control of what happens to him.
The average length of homelessness was 7 weeks, and the Although each participant described his or her individ-
range was 4 days to 6 months. Three of the participants had ual experiences in a different manner, they each demon-
been homeless prior to this current homeless experience. strated what is known as the concept of external locus of

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B. Nickasch & S.K. Marnocha Healthcare experiences of the homeless

External
Locus of Control

Lack of Lack of Lack of


Attainment of Lack of Available Compassion of
Physical Needs Affordability Resources Health care
Providers

Overcrowded
Inadequate Excessive
Community Stereotyping
Shelter co-pays
Clinics

Inadequate
Inadequate
Insufficient Food Health Presumptions
Transportation
Insurance

Inadequate Lack of
Hygiene Telephone
Facilities Access

Figure 1 Themes and subthemes from interviews.

control. They feel someone or something else is controlling questions asked but could not sleep at the shelter for
their life, and they lack many of the resources necessary to the night.
lead a healthy life. One homeless man with poorly controlled diabetes
stated, ‘‘It’s difficult you know. You can’t get three hot
Theme 1: Lack of attainment of physical needs
meals in this damn city, just a cold breakfast and a hot
For many homeless people, unmet physical needs can lunch. I try to eat right, I am diabetic, but I eat what I can
lead to a downward spiraling of their health. This is get.’’ Another gentleman said, ‘‘I am not getting good sleep,
supported by Maslow’s (1970) theory of the hierarchy I am not eating probably as I should and my health in
of needs, which postulates that human beings are moti- general living on the streets is stressed.’’
vated by unsatisfied needs and that certain lower needs These unmet physical needs place a great burden on an
need to be satisfied before higher needs can be fulfilled. individual’s health. If one does not sleep well, his or her
According to his theory, one must first satisfy the details of immune system is not as effective. One hundred percent
shelter and food prior to satisfying other needs. (n = 9) of the homeless individuals interviewed went to
Homeless individuals lack shelter, clothing, and healthy the local Salvation Army and homeless shelter for a cold
food. When asked why a homeless man decided to live on breakfast and a warm meal over the lunch hour each day.
the street without shelter rather than stay at the local However, they struggled with the fact that often they were
homeless shelter, he stated, ‘‘I tried that, I can’t take it, all not eating as well as recommended considering their
the people, it makes my mind go crazy.’’ Another reason chronic health concerns.
many homeless reported they were on the streets and not One man with diabetes expressed the frustrations of not
in a shelter was because they were in trouble with the law being able to find three warm meals each day and
or had a felony on their record, therefore disqualifying described how he would hoard extra food from the lunch
them from homeless shelter services. In this study, 33% program to save for dinner each evening. He emphasized
(n = 3) of the participants were unable to seek shelter the fear of developing hypoglycemia some nights because
services because of a history of felony or current con- he was unable to eat appropriately. He was able to obtain
flicts with the law. They could receive food with no free medications and diabetic testing supplies but seldom

43
Healthcare experiences of the homeless B. Nickasch & S.K. Marnocha

took the recommended amounts of insulin for fear of about the core of facilitating health care for homeless
hypoglycemia related to lack of access to meals. persons describes the problematic paperwork maze that
homeless people must struggle through to obtain adequate
care. He identified the struggle to complete all necessary
Theme 2: Lack of affordability
paperwork as a major obstacle to care.
The participants felt that the term ‘‘free clinic’’ was used All participants in the current study verbalized that they
too loosely. A homeless woman stated, ‘‘There is no such were aware of the local community clinic, but 67% (n = 6)
thing as a free clinic,’’ and a homeless man said, ‘‘Plus, it felt that the services were not available when they needed
isn’t free like they say it is. Where am I going to find the them. They perceived the community clinic as better than
$9.00 just to see the doctor . ?’’ ‘‘I feel like a beggar . it nothing but expressed frustration with the lack of timeli-
hurts your self esteem . it puts you in a depressive state.’’ ness. For instance, when asked why they did not use the
Eight of the participants alluded that it is difficult to get community clinic, one participant stated, ‘‘I think they are
insurance; ‘‘to get health insurance here in (city) you have too busy and I am not sure they’d have time for me. I know
to be disabled, blind, crippled or crazy . ’’ and even with a lot of people wait days to get in and that it is really
insurance, the cost of the office visits, medications, and crowded.’’ Another said, ‘‘If they are gonna provide assis-
treatments, it is more than most can afford. None of the tance to the homeless or the low income, make sure that
nine study participants had health insurance. they provide it in a timely and professional manner versus
A young lady with a seizure disorder stated, ‘‘Yes, um I making people wait to go through a lot of red tape to get
have about $80,000 in medical bills . it could be closer to what they need.’’
the $100,000 mark . it is absolutely terrible because Several participants elaborated on this theme by
everything is based on money . I have always been describing the difficulties they have encountered trying
a second class citizen when it comes to medical attention.’’ to set up services or appointments. The homeless indi-
She goes on to say that she wanted to attend the community vidual lacks a permanent address or a telephone number,
smoking cessation program, but she was not able to because which makes scheduling of doctor’s appointments and
she did not have the ‘‘$9.00 it costs to walk into the door.’’ utilization of community resources more difficult. One
Another woman portrays a picture of society through participant emotionally vented about her frustrations
her eyes by this statement, ‘‘Okay it just is hard to look out related to applying for county services, giving a detailed
at everyone when everyone you see look like they got. You explanation of the application process, phone tag, and
know what I am saying? Here in (city) . they hide all their difficulties receiving the appropriate paperwork because
homeless, they put them in the corner somewhere. Now she had to use someone else’s mailbox for a return
when you walk down, when you go down (city), Wiscon- address. What frustrated her most is she ‘‘didn’t have
sin you wouldn’t believe there are homeless here. (City) the damn stamp’’ to mail it back when she finally received
hides their stuff. They kick them over in the corner and all the appropriate paperwork.
cover it up. I’ve learned that since I been here. I didn’t Eight of the participants expressed concerns related to
know (city) had homeless people. I did not. . You don’t a lack of affordable transportation. For instance, one
see no bums on the street here.’’ homeless woman stated, ‘‘There were some times that
One hundred percent of the participants in the study they wanted me to get a blood test, and I didn’t get it until
also alluded to the difficulties they encountered trying to later cause I couldn’t get there . ’’ She went on to describe
obtain health insurance and also the financial burden that her struggle with being disabled and the lack of bus services
paying for the insurance placed on them. Jezewski’s in the county in which she lived. She stated that she did not
(1995) study on homeless found that lack of health insur- have enough money for cab services and the county lacks
ance was a major barrier to health care. resources to provide taxi vouchers, leaving her without
many options. She was compassionate about the fact that
‘‘transportation is a big issue,’’ and being disabled with
Theme 3: Lack of available resources
a medical diagnosis of seizure disorder makes getting
Another homeless adult with schizophrenia expressed a driver’s license impossible.
his need for assistance with the paperwork: ‘‘But I can’t fill
out that paperwork with my mind racing like it does . if
Theme 4: Lack of compassion
they would have taken the time to help me fill out the
paperwork that would have helped a lot . Just the way I Many homeless expressed feelings of disappointment
was feeling, my mind racing, . ’’ This statement expresses with how they were treated. They felt that they were
frustration with the system and has been shown in mul- judged by their appearance. As one homeless man stated,
tiple studies on homelessness. Jezewski’s (1995) study ‘‘It is hard to stay clean when you live on the street. If you

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B. Nickasch & S.K. Marnocha Healthcare experiences of the homeless

notice, you can’t really tell I am homeless by the way I am Analyzing the transcripts and scrutinizing the major
groomed, but my clothes are filthy. I shave everyday, and statements led to an overarching theme and four subsets.
clean up at restrooms and stuff, but it is hard to wash Through the use of constant comparison and level I, level
laundry cuz even when I scrape up enough money to do II, and level III coding (Glaser & Strauss, 1967), it is likely
laundry at the Laundromat I can’t wash the clothes I am fair to say that a commonly held theory of fatalism in the
wearing you know. It is difficult you know, living on the poor and homeless was validated with this research.
streets, I am a person too, have some fucking compassion, Healthcare providers will be able to use this insight to
I am not a piece of shit.’’ examine their own feelings and improve the care they give
‘‘Well, it seems like I was just another part of their job. to homeless people. It is essential to improve relationships
I didn’t feel like a . person, I just felt like I was part of their with homeless clients and the management of chronic
job and they shoved me through. Get me in and out as fast disease in these difficult circumstances.
as they can. A kind of process.’’ ‘‘I may be homeless . but I
am still a person. Regardless, I need some respect. I am not
Conclusions
just a number, or something, or an obstacle that someone
needs to overcome.’’ ‘‘And I don’t understand how people The following conclusions are based on the results of this
of a profession to save lives work for money. I don’t see study: The great majority of homeless people have an
that. Yes you have to live, and the money you get you can external locus of control. Therefore, most homeless indi-
live real good off of, but there are people that don’t have viduals feel they are not in control of what happens to
that money to pay to you and you took an oath to take care them; whatever happens is outside of their control.
of these people. How can you turn them down and let Healthcare providers need to be aware of this when assess-
them go out there and die?’’ She goes on to describe some ing and managing the health of a homeless individual.
of the lack of compassion she has seen in the healthcare Healthcare providers may need to readjust their interven-
industry. tions to better serve this population.
Another homeless person’s advice for the healthcare Most homeless individuals lack the necessary resources
provider providing services to the homeless was, ‘‘Be needed to meet their physical needs. Healthcare providers
compassionate. Don’t think I am a lazy no good son of must make sure the most basic physical needs of shelter,
a bitch just because I am homeless. Don’t think I have no air, water, and food are met before trying to address con-
feelings just because I don’t cry when I tell you about my cerns related to health. Assisting the patient to find shelter
abusive relationships. Ask me lots of questions, because I may be the most important step that can be taken by a
am more likely to tell the whole story if you give me more healthcare provider. It is essential to get back to the basics.
than one chance to answer the tough question. I am an Most homeless individuals lack the financial resources
abused woman I need help, from compassionate and to seek health care. If they are lucky enough to see a health-
caring health care providers.’’ ‘‘Don’t judge me strictly care provider, they may not have enough money to follow
on my past. Give me a chance to talk.’’ ‘‘Don’t cut me through on discharge advice. Healthcare providers must be
off. I made a few bad choices recently but that doesn’t diligent in asking the questions related to how patients will
mean I am a bad person.’’ afford a medication or treatment device. If patients are
unable to afford the medication, the prescription will be of
no use to them. Healthcare providers need to assess the
Discussion of results
situation and seek alternatives for obtaining necessary
The goal of nursing research is the discovery of a theory resources for patients. Another similar conclusion relates
from data generation and analysis to explain a particular to the availability of resources. Increasing the numbers of
phenomenon. Glaser and Strauss’ (1967) grounded theory community clinics will not be effective if the people in
approach to qualitative research is an excellent approach need cannot access their services. The availability of tele-
to use when interested in the social experience. It allows phones and transportation services is integral to the uti-
the researcher to uncover the inner meaning of a particular lization of services. Just having the services is not good
life event. enough; healthcare providers must be aggressive in their
The current research study is supportive of this theory. outreach efforts to get the services to those in need.
This is evident in the participants’ candid description of the Last, 100% (n = 9) of the participants felt that healthcare
challenges they meet as homeless people. Each participant providers lack compassion. Healthcare providers must
described his or her life as being controlled by external remember that all individuals deserve basic health care.
surroundings. They described a lifestyle with unfulfilled It is a human right to feel respected and have someone
physical needs, unaffordable and unavailable health care, listen to one’s needs and an important part of each indi-
and perceptions of uncompassionate care. vidual’s well-being. It is essential to keep one’s biases in

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Healthcare experiences of the homeless B. Nickasch & S.K. Marnocha

check when caring for diverse populations and to provide locus of control and the lack of attainment of physical
compassionate care to all those in need. Healthcare pro- needs, lack of affordability of care, lack of available resour-
viders must focus on helping the homeless overcome their ces, and the lack of compassion on the part of healthcare
problems by demonstrating unconditional positive regard. providers were very evident throughout all interviews.
Accepting individuals for who they are with openness and These insights can help improve the care provided to
genuineness (Rogers, 1951) is a core nursing value. homeless populations.

Implications
The role of the healthcare provider is one of collabora- References
tion with individuals regardless of their social, economic, Capponi, P. (1997). Dispatched from the poverty line. New York: Penguin.
or personal beliefs. Working with homeless individuals is Flynn, L. (1997). The health practices of homeless women: A causal model. Nursing
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