Nursing Ethics in Addressing Homeless Veterans' Healthcare and Living Needs

Jared Norman

School of Nursing, Azusa Pacific University

GNSR 504- Bioethics and Healthcare Policy

Dr. Brent A. Wood, PhD

November 22, 2023

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Nursing Ethics in Addressing Homeless Veterans' Healthcare and Living Needs

The Department of Veterans Affairs (VA) estimates that on any given night, over 67,000

veterans are homeless, and that veterans make up 10% of all homeless adults (Guina, 2023). To

ensure these individuals receive the comprehensive medical, social, and emotional care they are

entitled to, nurses must apply their clinical knowledge with a broader understanding of the social,

economic, and political factors impacting this vulnerable population. The effective application of

nursing ethics requires knowledge from various fields, such as healthcare literature, societal

dynamics, and politics. To address homeless veterans' healthcare and living needs, nursing

ethics play a pivotal role as nurses navigate the complex balance between delivering

specialized care within VA facilities and cultivating external partnerships with community

organizations to ensure equitable access and comprehensive support.

Specialized Care within VA Facilities

Specialized care at VA facilities is where nurses face clinical duties, ethical mandates,

and address moral dilemmas while providing healthcare to homeless veterans. Fowler (2015)

highlights ethical principles through provision 4 as nurses' moral beacon needed to traverse the

complex VA healthcare setting. However, maintaining nursing ethics is challenging due to the

volume of patients and limited resources often present in VA Facilities.

Fowler (2015) highlights provision 3 as the need for specialized care for homeless

veterans, which involves theoretical ideas and the utilitarian principle of being practical. Jonsen

et al. (2021) explains that there are practical approaches to handling ethical decision-making in

clinical medicine. Caring for homeless veterans demands practical solutions, and these methods

offer invaluable direction.

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VA nursing professionals must realize the importance of transcending a one-size-fits-all

methodology when attending to homeless veterans. Healthcare utilization among homeless

veterans was investigated by Raad et al. (2020). Their findings align with Cornell et al. (2020),

demonstrating that ethical care necessitates awareness of clinical requirements and

socioeconomic factors that impact how homeless veterans access healthcare resources.

Ultimately, this research highlights the ethical responsibility to tailor care for everyone by

considering each veteran's unique background and experiences that shape their journey through

the healthcare system.

VA facilities' specialized care continuously evolves, demanding that nurses balance their

clinical duties with ethical obligations. Blonigen et al. (2022) explore inventive strategies like

peer support and holistic health coaching, a departure from conventional medical models. By

adopting such techniques, nurses uphold their ethical pledges toward comprehensive care beyond

immediate medical concerns, and outside the norm of conventional nursing practices. This aligns

with ethical guidelines and cultivates a sense of belonging and mutual accountability among

homeless veterans, addressing their distinct psychological and social dimensions of well-being.

An additional area where ethical practices are essential is serving the frequently

overlooked necessities of homeless female veterans. As Conard et al. (2021) investigated, these

women encountered unique obstacles that necessitated an ethically conscious nursing approach

to addressing their gender-related issues. One example is that VA facilities do not offer prenatal

care. Additionally, as large numbers of female veterans are survivors of military sexual trauma, a

trauma-informed approach is essential. Taking care of homeless female veterans goes beyond

just providing medical help. It promises to recognize and fix the problems that create
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inequalities, using a comprehensive approach covering physical and mental health while

addressing social factors affecting their well-being.

Ethical responsibility also requires that the VA expands its services outside VA hospitals

to maximize the impact of their resources. Research by Jones et al. (2019) highlights the

influence of customized medical homes, endorsing a wide range of ethical care provisions. This

approach establishes an environment where immediate health care needs are addressed, while

fostering ongoing care and assistance. Ethical nursing conduct within VA settings identifies a

moral duty to deploy resources effectively, encouraging the formation of a healthcare system

sensitive to the special challenges confronting homeless veterans.

Providing specialized care inside VA institutions represents a testing ground for applying

nursing ethics. Nurses must apply pragmatic techniques in making ethical decisions to discern

the importance of customizing care for each homeless veteran. Ethical care involves more than

just tending to immediate medical concerns; it embraces an all-encompassing ideology tailored

towards acknowledging the necessities of homeless veterans and the gender specific needs of

female veterans.

Cultivating External Partnerships

Expanding healthcare marks a crucial change in contemporary healthcare, emphasizing

the need for partnerships with community providers to offer services that VA facilities do not

currently offer. This innovative strategy aligns with ethical values deeply rooted in nursing. As

nurses deal with the complex dynamics of partnering with community organizations, the

collaboration must include the implementation of the ethical practices of effective and moral

nursing care.
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The outreach of care transcending institutional limits highlights a deviation from

conventional medical care models. Crone et al. (2022) conduct research on the accessibility

hurdles that homeless African American veterans face which demonstrates the value of

collaborating with communities. This strategy recognizes that both clinical interventions and

social determinants affect health outcomes. By incorporating community care, nurses can tackle

a broader range of health-influencing factors, such as poverty and homelessness.

Ethical considerations arise when nurses collaborate with community organizations.

Blonigen et al. (2022) showcases that peer support and health coaching underscores the

transformative power of community partnerships. Considerations go beyond healthcare

delivery’s technical aspects and involve the creation of trust, cultural competence, cultural

humility, and joint decision-making (Mattocks et al., 2019; Klee et al., 2019). Acknowledging

and cherishing diverse community contexts is ethically essential when collaborating with

community organizations. Conard et al. (2021) conducted a study on the risks and health issues

facing homeless women veterans and emphasizes the importance of gender-specific approaches.

Within collaborative efforts, ethical nursing practice necessitates comprehending the distinct

needs of various populations with cultural sensitivity.

In community cooperation, ethical deliberations also encompass concerns related to the

distribution and allocation of resources. Nurses collaborating with community-based

organizations must consider fair and equitable resource distribution (Rosen et al., 2021). Raad et

al. (2020) investigate healthcare usage among homeless veterans and underscore the significance

of ethically sound choices when maximizing resources. This moral obligation becomes vital in

community partnerships where resources might be scarce, necessitating informed decision-

making to guarantee equal access to essential healthcare services for all.

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The establishment of external relationships constitutes a transformative change in

healthcare by expanding access to high-quality services to supplement gaps in VA care.

Collaborating with local organizations brings the highest levels of ethical care into the

community. Ethical collaboration requires embracing diversity, demonstrating cultural

competence and cultural humility, and pledging fair resource distribution. Thus, nurses who

embrace the ethical complexities of community collaborations have become moral caregivers.

Equitable Access and Comprehensive Support

When navigating the complexity of healthcare to serve veterans experiencing

homelessness it is crucial to maintain a strong sense of justice and fairness. Peer support

programs demonstrate the value of community support in healing, and demonstrates that

everyone has something to offer in making their community a better place. Nursing ethics are

clear in depicting that healthcare goes beyond immediate medical concerns and addresses the

obstacles contributing to health inequities among vulnerable groups.

Tsai et al. (2023) performs a study examining unsatisfied demands among homeless

American veterans which emphasizes the requirement of comprehending social factors that

impact health. Upholding justice in ethical terms requires that healthcare practitioners, including

nurses, endorse policies and initiatives that extend beyond clinical settings. This approach

includes tackling systemic issues like housing, education, employment, and incarceration that

greatly influence homeless individuals' well-being. Penn et al. (2019) agrees that the quest for

justice revolves around unbiased resource allocation and underscores the ethical duty of health

care policy makers, health care providers, and politicians to remediate social factors leading to

health inequalities.
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Jonsen et al. (2021) proposed that healthcare services should surpass conventional

medical models by including overall wellness's social, mental, and environmental components.

Franco et al. (2020), through their investigation into cooperative research strategies involving

veteran community participation, support this ethical mandate for all-encompassing care. The

dedication to providing extensive assistance acknowledges that various elements intertwine and

impact health, and calls for more holistic methods that go beyond standard clinical interventions.

This commitment to complete care aligns with the ethics and values of beneficence and patient-

focused nursing practices. As health guardians, nurses must go beyond catering to immediate

medical needs to create settings that enhance well-being and fortitude.

Haahr et al.'s (2020) research into nurses' experiences with ethical issues highlights the

challenges of healthcare decision-making. Practicing ethically in nursing requires

comprehending the broader social context and social determinants, and acknowledging that

comprehensive support is both a moral duty and a way to achieve improved health outcomes.

Inpatient care for homeless veterans is also essential in offering comprehensive care that exceeds

standard medical interventions, and encompasses the complexities of mental health concerns

which are frequently exacerbated by the challenges of homelessness. Kaya and Boz (2019)

emphasize the development of a professional values model in nursing to highlight the moral

obligation to recognize the link between mental and physical well-being.

Escobar (2020) emphasizes the need for patient engagement when dealing with

healthcare provisions for homeless veterans. By incorporating an ethically sound and

comprehensive support system, this approach encourages and respects the autonomy of homeless

individuals in making informed choices regarding their healthcare. It is essential to cultivate an

environment where those who are homeless feel competent and confident to take charge of their
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healthcare decisions. Jones et al. (2019) supports this strategy, emphasizing that this environment

promotes self-determination and fosters a sense of mutual respect between patients and

healthcare providers.

Acknowledging veterans' decision-making power strengthens their sense of control over

their lives. It reinforces the belief that they can improve their circumstances. These approaches

embody the ethical principle of autonomy. This allows for the establishment of meaningful

connections based on empathy and respect. Adhering to justice and equality principles in

healthcare, as shown by Blonigen et al. (2022), and offering all-encompassing assistance beyond

medical treatment, as underlined by Jonsen et al. (2021), helps nurses understand how to care for

others appropriately. Justice calls for disassembling barriers leading to health disparities and

actively advocating for policies tackling social health influences.

Issues and Dimensions

Veterans experiencing homelessness represent a vulnerable and at-risk demographic due

to the impact of their living situation on their mental and physical health issues, which is very

often caused by their military service. These individuals are prone to developing chronic health

conditions and psychological distress due to their traumatic encounters, substance abuse,

physical injuries, or moral injuries. Homeless veterans face significant barriers when it comes to

accessing medical treatment (Klee et al., 2019). They encounter challenges accessing medical

care due to their housing conditions, inadequate health insurance coverage, and unreliable

appointment transportation.

Assisting disadvantaged veterans poses ethical dilemmas for nursing professionals. While

upholding the principle of fair and equitable treatment, nurses occasionally encounter obstacles

in this pursuit due to resource constraints and competing responsibilities. To provide optimal
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care, maintain patient confidentiality, and uphold professional autonomy, nurses face numerous

obstacles (Klee et al., 2019). A high degree of cultural competence and cultural humility, which

recognizes the power inequity between patient and provider, is essential when engaging with

homeless veterans due to the profound influence that their service and trauma have exerted on

their worldview.

Argument from Ethical Norms

Nursing ethics govern nursing practice and are pivotal in addressing homeless veterans'

housing and healthcare needs. These ethical principles are essential in driving the provision of

adequate support and care for this susceptible population. Regarding the care of homeless

veterans, autonomy is an indispensable ethical principle that nurses must uphold. It is important

to involve them in decision-making processes regarding their care, despite the challenging

circumstances associated with homelessness (Crone et al., 2022). To attain this, open discussions

regarding the various treatment options at hand, adherence to the patient's preferences, and active

involvement of the patient in decision-making processes are essential.

Nurses must enhance the health of their patients through the provision of appropriate and

expeditious treatment, including efforts to enhance the healthcare accessibility of homeless

veterans as well as handling housing, food, and transportation insecurity issues that worsen their

already compromised health. The nonmaleficence principle requires that nurses strive to prevent

harm from being inflicted whenever possible (Fowler, 2015). This may prove particularly

challenging in cases where a homeless veteran is struggling with mental illness, substance abuse,

or physical injuries.

Social-Structural Dynamics
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The barriers that homeless veterans must overcome to obtain medical care are rooted in

more extensive social and structural mechanisms. A significant portion of the cycle of veteran

homelessness is sustained by the insufficiency of funds and resources allocated to assist people

experiencing homelessness. It is difficult enough for disadvantaged veterans to obtain medical

care; they also struggle with stigma (Conard et al., 2021). Due to their housing circumstances,

they encounter prejudice and stigma, which deters people from seeking treatment.

Defining the Role of Nursing Ethics

Within the healthcare domain, nursing ethics serve as a moral guide for professionals

navigating complex patient care pathways, such as those frequently encountered in treating

homeless veterans. Fowler (2015), in her text, "Guide to the Code of Ethics for Nurses" lays

down the foundational principles governing ethical behavior in nursing. These principles,

anchored in values like autonomy, nonmaleficence, beneficence, and justice, provide a structural

framework that directs the moral dimensions of nursing practice. Fowler (2015) illustrates

several core principles that form the basis for ethical conduct in nursing. Autonomy is

emphasized as a core value and fundamentally describes the nurse’s duty to respect patients’

rights to make their own informed choices about their healthcare. This essential principle puts

patients at the heart of making decisions by recognizing their right to engage actively in

decision-making processes regarding their health and well-being.

According to Haahr et al. (2020), autonomy is expressed in nursing ethics through

promoting transparent dialogue, sharing extensive information, and honoring patients' decisions

even when they disagree with and refuse to follow their healthcare provider's recommendations.

Nonmaleficence derives from the fundamental ethical principle of first do no harm in medicine.

Its importance is self-evident and calls to mind the no longer acceptable unethical practices of
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involving active-duty military service members and veterans in research studies without their

knowledge or consent.

Beneficence is the principle of doing good. Sometimes the principles of beneficence and

nonmaleficence can come into conflict such as in programs like harm reduction for substance

abuse. There are several questions that may arise, for example: do programs such as needle

exchanges, and providing safe places for IV drug injection cause more harm by enabling

addiction? Do they create improved health by reducing the spread of HIV and Hepatitis and by

preventing overdoses? Healthcare policy makers must weigh the pros and cons of each of these

principles in making their decisions.

Beneficence also encompasses the ethical responsibility of healthcare professionals to

advocate for their patient's welfare. This requires that in addition to delivering skilled and

empathetic clinical care, nurses must also identify resources that will improve the quality of life

for those under their supervision (Grace & Uveges, 2022). In practice, beneficence emerges from

efforts to avoid harm, ease distress, and secure optimal patient outcomes. This ethical directive

compels nurses to abide by their ethical standards and nurture an environment where their

patients’ well-being takes precedence.

Justice is the ethical obligation that requires all clinicians to treat everyone equally

regardless of background or socioeconomic classification. Nursing ethics founded on justice

require unbiased and equitable care delivery while ensuring all patients have equal access to

high-quality healthcare services. This vital principle plays a significant role in addressing health

disparities and advocating for fair healthcare policies. Justice within nursing ethics entails

dedication to correcting systemic issues that foster healthcare inequality.

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Learning practical techniques for ethical decision-making equips nurses with resources

needed to navigate complex scenarios encountered in clinical medicine, such as whether to offer

someone harm reduction, hospitalize someone involuntarily because he/she/they are a danger to

themselves, or reporting them to childrens’ or elders’ protective services when someone else is at

risk due to their behavior. Ethical strategies connect ethical principles and real-life cases,

yielding a blueprint for moral reasoning (Jonsen et al., 2021). The ‘principled’ approach is one

such strategy wherein ethical problems are examined through the core principles of autonomy,

nonmaleficence, beneficence, and justice. This method allows nurses to balance contrasting

ethical factors to reach morally defensible conclusions.

Jonsen et al. (2021) underscore the narrative ethics approach, which prompts healthcare

practitioners to regard patients' stories and experiences as paramount in ethical decision-making.

This approach acknowledges ethics' subjective quality and therefore requires that patients impart

their personal and distinct viewpoints to their healthcare providers. By integrating narrative into

their understanding of their patients, nurses can better grasp the intricacies of patients'

circumstances, engendering a more empathetic and patient-focused method to moral decision-

making. Trauma-informed care, particularly important in helping homeless veterans, as veterans

suffer a very high incidence of PTSD, relies heavily on narrative in understanding and helping

patients.

The causal approach contrasts current ethical dilemmas with historical analogous cases,

using precedents as decision-making guides (Jonsen et al., 2021). This approach appreciates the

differences in each case example and accepts that ethical choices heavily depend on the facts of

each unique situation. Nurses who use the causal method analyze previous experiences and

moral reasoning to find solutions that align with current nursing's ethical principles.
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Nursing ethics are highlighted by guiding principles that shape moral behavior and

decision-making within the nursing vocation. Fowler’s “Guide to the Code of Ethics for Nurses”

establishes autonomy, nonmaleficence, beneficence, and justice as cornerstones and underscores

patient-centered care's significance, promoting well-being, and treating everyone fairly and

equitably.

Jonsen et al.'s (2021) practical strategies for moral decision-making equip nurses with

methodical resources to make ethically based decisions in medical practice. Principles, narrative

ethics, and casuist approaches supply nurses with the frameworks that apply ethical tenets to

real-life circumstances, ensuring nurses arrive at ethically informed conclusions.

Nursing Profession and Policy Recommendations

Veterans experiencing homelessness have distinct accommodation and healthcare needs,

and nurses can assist in a variety of ways. An intensive education and training program is

required for nurses, emphasizing cultural competence, cultural humility and trauma-informed

care. By obtaining this education, they will be more adept at meeting the unique needs and

demands of destitute veterans. Additionally, interdisciplinary collaboration is essential to patient-

centered care (Blonigen et al., 2022). Nurses must collaborate with social workers, healthcare

professionals, mental health providers, and community organizations. Nurses are confronted

head-on by the multifaceted challenges that homeless veterans encounter, including substance

abuse, mental health disorders, food insecurities, incarceration, violence, and homelessness.

Blonigen et al. (2022) describes the extensive influence of peer support and integrative

health coaching, and highlights their value in promoting fairness and justice throughout the

medical system. The impact of peer support exceeds simply meeting healthcare necessities; it

actively dismantles social biases linked to homelessness, and advocates for an equitable
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healthcare environment. These approaches celebrate the inherent dignity and independence of

those without permanent shelter. Furthermore, the integration of health coaching into the

community aids in cultivating holistic wellness and promotes equality by valuing all individuals

within the system equally (Mattocks et al., 2019). In doing so, healthcare providers ensure a

more balanced and inclusive approach to meeting everyone's needs. Ultimately, this fosters a

harmonious social landscape where no one is left behind or disempowered due to their living

circumstances.

Advocating for policy is an additional and crucial duty for nurses. They might advocate

for policies that assist homeless veterans, such as affordable housing and improved access to

mental health care (Penn et al., 2019). Furthermore, nurses can contribute to outreach efforts by

establishing mobile healthcare units or clinics in areas where homeless veterans are densely

populated, and participate in telehealth approaches to remote veterans who cannot access VA

facilities. These efforts enhance healthcare provision for homeless veterans by streamlining their

access to essential services.

Conclusion

As nurses provide healthcare for homeless veterans, nurses are guided by nurses' ethical

values. The importance of nursing ethics is its capacity to coordinate a cooperative care strategy

that transcends clinical limitations and addresses the distinct needs of homeless veterans.

Upholding values in nursing ethics forms the foundation of a healthcare outlook that

acknowledges dignity, personal agency, and overall wellness for those who have served in the

military. The ethical principle of justice in nursing care becomes front and center by endorsing

equal opportunity to accessing healthcare resources for homeless veterans. This commitment

involves eliminating hurdles, rectifying systemic problems, and tackling social determinants that
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lead to health disparities among this susceptible group. Nursing ethics represents not merely a

series of guidelines, but a moral compass guiding nurses in overcoming the obstacles that get in

the way of administering ethically conscientious and comprehensive care.

Addressing the healthcare requirements of homeless veterans is a template for tackling

future challenges. This approach includes both clinical and social aspects of health and becomes

a prototype for nursing practice within a changing healthcare environment. Ethical reflections in

nursing practice reach beyond the immediate obstacles, impacting how healthcare is perceived

and provided. Holistic support and justice in healthcare serve as a guide for nurses in various

settings. As healthcare undergoes dynamic transformations, ethical foundations established while

meeting homeless veterans' needs set the stage for a patient-focused, inclusive, and empathetic

approach that can adapt to new challenges.

Nursing ethics is not a fixed set of rules, but an evolving force that molds the direction of

nursing practice. The lessons and ethical perspectives gained from catering to homeless veterans'

health needs reverberate far beyond the present moment, becoming essential roadmaps for

providing ethical nursing care in a continually evolving healthcare environment. As the field

progresses, nurses equipped with principles of justice, fairness, and all-inclusive support are

prepared to face upcoming challenges with ethical resolve, ensuring that everyone obtains

medically effective and ethically transformative care regardless of their situation.

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