Capella 4015 Assessment 4

Name

Capella university

NURS-FPX4015 Pathophysiology, Pharmacology, and Physical Assessment: A Holistic Approach to Patient-Centered Care

Prof. Name

Date

Introduction to the Special Population Group

Homelessness remains a persistent social and public health challenge impacting millions globally. In the United States alone, from 2018 to 2022, approximately 327,000 individuals experienced homelessness in shelters, representing around 0.1% of the national population (Glassman, 2024). The causes of homelessness are multifaceted, including poverty, lack of affordable housing, unemployment, mental illness, and substance use disorders. These factors contribute to unstable housing situations that lead to significant health consequences. Individuals may move between temporary shelters, streets, overcrowded housing with relatives, or abandoned buildings—circumstances that expose them to severe weather, poor sanitation, malnutrition, and healthcare inaccessibility (Fornaro et al., 2022).

A significant proportion of homeless individuals suffer from untreated chronic conditions, including diabetes, cardiovascular disease, mental health disorders, and substance dependence. These issues are often intensified due to irregular or non-existent access to healthcare. Consequently, healthcare professionals, particularly nurses, must be equipped to understand the lived realities of homelessness. Employing culturally competent, trauma-informed, and accessible healthcare strategies is crucial to closing the health disparity gap and improving the well-being of this vulnerable group (Fornaro et al., 2022).

Cultural Values, Beliefs, and Healthcare Disparities

Cultural Values and Beliefs in Healthcare Context

Despite cultural diversity among homeless individuals, their shared experiences with housing insecurity shape certain common values that influence their interactions with the healthcare system. Many prioritize self-reliance, having learned to survive independently with limited resources. This value, while adaptive, may result in resistance to seeking help, especially when combined with prior negative encounters in clinical environments (Gilmer & Buccieri, 2020).

Distrust of institutions is also common. Historical experiences of neglect, discrimination, or inadequate treatment have led many homeless individuals to be wary of hospitals, clinics, and social services. This distrust is compounded by the perception that one’s lack of insurance or formal documentation leads to subpar care. Additionally, for many homeless individuals, immediate needs such as food and shelter take precedence over preventive health measures or management of chronic illness. Mental health stigma further complicates access to care; individuals may internalize shame or fear related to conditions such as PTSD or depression, hindering timely intervention (Gilmer & Buccieri, 2020).

Healthcare providers must recognize and respond sensitively to these cultural beliefs. Culturally competent care involves developing rapport, offering nonjudgmental communication, and understanding how values such as autonomy and distrust influence healthcare behaviors.

Healthcare Disparities and Social Determinants of Health

Homeless individuals experience pronounced disparities in health due to interconnected social determinants. These disparities can be illustrated as follows:

Determinant	Impact on Health
Economic Instability	Inability to afford care, medications, or nutritious food worsens chronic diseases.
Lack of Access	Absence of health insurance, transportation, and ID prevents medical service usage.
Social Isolation	Reduced support systems lead to neglect of health and worsening mental illness.
Environmental Exposure	Living outdoors or in unsafe shelters increases risk of infections and injuries.
Stigma and Discrimination	Experiences of bias from clinicians discourage care-seeking behaviors.

Sources: Flaubert et al., 2021; D’Souza & Mirza, 2021; Gilmer & Buccieri, 2020

Addressing these disparities requires systemic changes, including increased integration of mobile care, collaboration with housing programs, and expansion of trauma-informed models that align care delivery with the lived experiences of the homeless population.

Culturally Competent Nursing Strategies and Case Applications

Strategies for Inclusive, Competent Care

Nurses must employ strategies that are respectful, inclusive, and trauma-informed. Key approaches include building trust through active listening and empathetic engagement. Given the trauma many homeless individuals have faced, communication should be clear, respectful, and supportive (D’Souza & Mirza, 2021). Accessibility is essential—flexible hours, walk-in appointments, and mobile clinics are critical to overcoming logistical barriers.

Partnerships with community organizations, shelters, and outreach programs can connect patients to both medical and social resources. Furthermore, a trauma-informed care model acknowledges the effects of previous abuse or neglect, fostering an environment where patients feel safe and respected. Practical health education, such as simple instructions for managing chronic illness, can empower individuals. Collaboration with interdisciplinary teams enhances the quality of care by addressing both medical and non-medical needs (Dobischok et al., 2024).

Strategy	Description
Trust Building	Demonstrating respect, empathy, and active listening.
Trauma-Informed Care	Recognizing the impact of trauma and fostering safety in care environments.
Accessibility	Flexible appointments, mobile clinics, and walk-ins.
Community Collaboration	Partnerships with shelters and food banks for comprehensive support.
Health Education Customization	Visual, low-literacy instructions for managing health.

Case Study Applications

Case Study 1: Street Nursing in Southern Oregon

In Southern Oregon, a street nursing initiative was launched to address the healthcare needs of homeless individuals in their environment. Nurses trained in trauma-informed care delivered services directly on the streets. By meeting patients in familiar settings and fostering respectful, non-coercive relationships, the program effectively managed tri-morbidities—chronic illness, mental illness, and substance use disorders—and significantly improved engagement and outcomes (OHSU School of Nursing, n.d.).

Case Study 2: Mobile Substance-Use Unit in Portland

Portland introduced a mobile unit offering substance-use treatment to individuals without housing. By bringing medications such as methadone and buprenorphine directly to those in need, the program overcame transportation and access barriers. Plans to expand to rural and tribal areas reflect a broader commitment to equitable, culturally sensitive care (Post, n.d.).

These case studies demonstrate the transformative impact of care models that prioritize accessibility, trust, and cultural understanding in serving homeless populations.

Resources for Further Learning

Healthcare professionals, particularly nurses, can enhance their capacity to care for homeless individuals by utilizing the following resources:

Resource	Description
National Healthcare for the Homeless Council (NHCHC)	Offers toolkits, research, and cultural humility training (NHCHC, 2021).
Centers for Disease Control and Prevention (CDC)	Provides guidelines on managing communicable diseases in homeless populations.
American Nurses Association (ANA)	Delivers continuing education on trauma-informed and equitable care (Nurse Journal, 2025).
Sigma Theta Tau International (STTI)	Offers professional development and access to global health education initiatives.
Local Clinics & Outreach Programs	Provide opportunities for hands-on experience and community engagement.

Engaging with these platforms can build expertise in advocacy, interdisciplinary care, and culturally competent practice—critical tools for nurses seeking to close healthcare gaps in homeless care.

Conclusion

Caring for individuals experiencing homelessness requires a multidisciplinary, culturally sensitive approach. Recognizing the cultural values, healthcare barriers, and social challenges unique to this population is essential for delivering effective care. Nurses, through trauma-informed communication, community collaboration, and the use of mobile and outreach-based services, can significantly impact homeless individuals’ health trajectories. As demonstrated through real-life case studies, integrating respect, accessibility, and cultural awareness fosters trust and improves outcomes. Continued professional development through resources and training is vital for nurses striving to create equitable health systems that truly serve marginalized populations.

References

Bedmar, M. A., Veny, M. B., Lelong, B. A., Mut, F. S., Pou, J., Moyano, L. C., Toro, M. G., & Yáñez, A. M. (2022). Health and access to healthcare in homeless people: Protocol for a mixed-methods study. Medicine, 101(7). https://doi.org/10.1097/MD.0000000000028816

Dobischok, S., Archambault, L., & Goyer, M.-È. (2024). Trauma-informed care (TIC) interventions for populations experiencing addiction and/or homelessness: A scoping review of outcomes. Journal of Drug Issues. https://doi.org/10.1177/00220426241263264

Capella 4015 Assessment 4

D’Souza, M. S., & Mirza, N. A. (2021). Towards equitable health care access: Community participatory research exploring unmet health care needs of homeless individuals. Canadian Journal of Nursing Research, 54(4), 084456212110321. https://doi.org/10.1177/08445621211032136

Flaubert, J. L., Menestrel, S. L., Williams, D. R., & Wakefield, M. K. (2021). Social determinants of health and health equity. In www.ncbi.nlm.nih.gov. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK573923/

Fornaro, M., Dragioti, E., De Prisco, M., Billeci, M., Mondin, A. M., Calati, R., Smith, L., Hatcher, S., Kaluzienski, M., Fiedorowicz, J. G., Solmi, M., de Bartolomeis, A., & Carvalho, A. F. (2022). Homelessness and health-related outcomes: An umbrella review of observational studies and randomized controlled trials. BMC Medicine, 20(1). https://doi.org/10.1186/s12916-022-02423-z

Gilmer, C., & Buccieri, K. (2020). Homeless patients associate clinician bias with suboptimal care for mental illness, addictions, and chronic pain. Journal of Primary Care & Community Health, 11(11), 215013272091028. https://doi.org/10.1177/2150132720910289

Glassman, B. (2024, February 27). New survey data provides demographic profile of population experiencing homelessness who lived in emergency and transitional shelters. Census.gov. https://www.census.gov/library/stories/2024/02/living-in-shelters.html

NHCHC. (2021, March 3). Medical respite care tool kit. National Health Care for the Homeless Council. https://nhchc.org/resource/medical-respite-recuperative-care-tool-kit/

Nurse Journal. (2025, February 24). Free online nursing courses & classes you can take right now. 2019 NurseJournal.org. https://nursejournal.org/articles/online-nursing-courses-you-can-take-for-free/

Capella 4015 Assessment 4

OHSU School of Nursing. (n.d.). Street nursing team. https://www.ohsu.edu/school-of-nursing/street-nursing-team

Post, P. (n.d.). Mobile health care for homeless people: Using vehicles to extend care. NHCHC. https://nhchc.org/wp-content/uploads/2019/08/mobilehealth-1.pdf