Nurses’ attitudes and perceptions towards homelessness

Abstract

Homelessness is a growing nationwide crisis with significant implications for healthcare. Nurses are frontline workers who play a large role in providing equitable and compassionate care to this vulnerable population. This research investigated the attitudes of registered nurses in Northern California toward patients experiencing homelessness. The study was conducted using a valid and reliable tool, “Attitudes Towards Homeless Inventory” (ATHI) and collecting demographic information. Participants sampled varied from several Northern California hospitals.Results found that a significant portion of respondents associated homelessness with substance abuse, resulting in homelessness as a personal versus societal causation. There seemed to be no differences in scores on the questionnaire based on age, work experience, and unit worked on when comparing attitudes towards personal vs societal causation. Total scores of the ATHI found that nurses with more experience had improved attitudes toward the homeless compared to those with less experience. Older nurses also had improved attitudes toward the homeless.The study highlights the need for interventions to address potential biases towards this population. Given the limited research on nursing attitudes toward homelessness, these findings expose a gap in investigating nursing attitudes regarding this patient population.

Keywords

Attitudes / Homelessness / Nurses / Perceptions

References

[1] Sleet DA, Francescutti LH. Homelessness and public health: a focus on strategies and solutions. Int. J. Environ. Res. Public Health. 2021; 18(21): 11660. PMid:34770173 https://doi.org/10.3390/ijerph182111660

[2] Daniel Soucy MJ, Hall A. State of Homelessness: 2024 Edition. 2024; Available from: https://endhomelessness.org/state-of-homelessness/

[3] Kendall M. Exclusive: California’s homeless population grew again this year, especially in these counties. 2024; Available from: https://calmatters.org/housing/homelessness/2024/09/pit-count-analysis-2024/

[4] CDC, About Homelessness and Health. 2024; Available from: https://www.cdc.gov/homelessness-and-health/about/index.html#:-:text=People%2

[5] Saldua M. Addressing Social Determinants of Health Among Individuals Experiencing Homelessness. 2024; Available from: https://behavioralhealthnews.org/addressing-social-determinants-of-health-among-individuals-experiencing-homelessness/

[6] Gutwinski S, et al. The prevalence of mental disorders among homeless people in high-income countries: an updated systematic review and meta-regression analysis. PLoS Medicine. 2021; 18(8): e1003750. PMid:34424908 https://doi.org/10.1371/journal.pmed.1003750

[7] Mundell E. Most Homeless Americans Are Battling Mental Illness. Health News 2024. 2024; Available from: https://www.usnews.com/news/health-news/articles/2024-04-17/most-homeless-americans-are-battling-mental-illness

[8] Narayan MC. CE: addressing implicit bias in nursing: a review. AJN The American Journal of Nursing. 2019; 119(7): 36-43. PMid:31180913 https://doi.org/10.1097/01.NAJ.0000569340.27659.5a

[9] Gaber SN, et al. The relationship between attitudes to homelessness and perceptions of caring behaviours: a cross-sectional study among women experiencing homelessness, nurses and nursing students. BMC Women’s Health. 2022; 22(1): 159. PMid:35546674 https://doi.org/10.1186/s12905-022-01744-8

[10] Irestig R, et al. How are homeless people treated in the healthcare system and other societal institutions? Study of their experiences and trust. Scandinavian Journal of Public Health. 2010; 38(3): 225-231. PMid:20056785 https://doi.org/10.1177/1403494809357102

[11] Woith WM, et al. Lessons from the homeless: civil and uncivil interactions with nurses, self-care behaviors, and barriers to care. in Nursing Forum. Wiley Online Library; 2017.

[12] Gilmer C, Buccieri K. Homeless patients associate clinician bias with suboptimal care for mental illness, addictions, and chronic pain. Journal of Primary Care & Community Health. 2020; 11: 2150132720910289. PMid:32133906 https://doi.org/10.1177/2150132720910289

[13] Rae BE, Rees S. The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care. Journal of Advanced Nursing. 2015; 71(9): 2096-2107. PMid:25916241 https://doi.org/10.1111/jan.12675

[14] Wen CK, Hudak PL, Hwang SW. Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters. Journal of General Internal Medicine. 2007; 22: 1011-1017. PMid:17415619 https://doi.org/10.1007/s11606-007-0183-7

[15] Parkinson R. Nurses’ attitudes towards people who are homeless: A literature review. Diversity in Health and Care. 2009; 6(4): 227-240.

[16] Pennington K, Coast MJ, Kroh M. Health care for the homeless: A partnership between a city and a school of nursing. Journal of Nursing Education. 2010; 49(12): 700-703. PMid:20954573 https://doi.org/10.3928/01484834-20100930-02

[17] Boylston MT, O’Rourke R. Second-degree bachelor of science in nursing students’ preconceived attitudes toward the homeless and poor: A pilot study. Journal of Professional Nursing. 2013; 29(5): 309-317. PMid:24075265 https://doi.org/10.1016/j.profnurs.2012.05.009

[18] Kee CC, Minick MP, Connor A. Nursing student and faculty attitudes toward people who are homeless. American Journal of Health Behavior. 1999; 23(1): 3-12. https://doi.org/10.5993/AJHB.23.1.1

[19] Stamps DC. Nursing leadership must confront implicit bias as a barrier to diversity in health care today. Nurse Leader. 2021; 19(6): 630-638. https://doi.org/10.1016/j.mnl.2021.02.004

[20] Job C, et al. Health professional’s implicit bias of adult patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review protocol. BMJ open. 2022; 12(12): e059837. PMid:36523234 https://doi.org/10.1136/bmjopen-2021-059837

[21] Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. American Journal of Public Health. 2013; 103(5): 813-821. PMid:23488505 https://doi.org/10.2105/AJPH.2012.301069

[22] Van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Social Science & Medicine. 2000; 50(6): 813-828. PMid:10695979 https://doi.org/10.1016/S0277-9536(99)00338-X

[23] Job C, et al. Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review. BMJ open. 2024; 14(7): e081723. PMid:38960454 https://doi.org/10.1136/bmjopen-2023-081723

[24] Kingree J, Daves WF. Preliminary validation of the attitudes toward homelessness inventory. Journal of Community Psychology. 1997; 25(3): 265-288. https://doi.org/10.1002/(SICI)1520-6629(199705)25:3＜265::AID-JCOP4＞3.0.CO;2-V

[25] Fasano HT, et al. Influence of socioeconomic bias on emergency medicine resident decision making and patient care. Simulation in Healthcare. 2021; 16(2): 85-91. PMid:32649585 https://doi.org/10.1097/SIH.0000000000000471

[26] John-Henderson NA. and Implicit cognition: implications for global health disparities. Child Adolescent Psychiatric Clinics. 2015; 24(4): 751-763. PMid:26346387 https://doi.org/10.1016/j.chc.2015.06.005

[27] Crowe L. Medical-surgical nurses’ attitudes toward patients who are homeless: How attitudes develop and transform. 2012.

[28] Stone J, Moskowitz GB. Non-conscious bias in medical decision making: what can be done to reduce it? Medical Education. 2011. 45(8): 768-776. PMid:21752073 https://doi.org/10.1111/j.1365-2923.2011.04026.x

[29] Gardner J, Emory J. Changing students’ perceptions of the homeless: A community service learning experience. Nurse Education in Practice. 2018; 29: 133-136. PMid:29324393 https://doi.org/10.1016/j.nepr.2018.01.001

[30] Everson N, Levett-Jones T, Pitt V. The impact of educational interventions on the empathic concern of health professional students: A literature review. Nurse education in practice. 2018; 31: 104-111. PMid:29852474 https://doi.org/10.1016/j.nepr.2018.05.015

[31] Walker JN, et al. The impact of an educational intervention on nursing staff attitudes toward patients experiencing homelessness and mental illness. Journal of the American Psychiatric Nurses Association. 2022; 28(6): 474-479. PMid:33949244 https://doi.org/10.1177/10783903211011669