Video Case Study - Homelessness

Nurse Margo works as a community health nurse in the health department and is assisting a local homeless shelter to address concerns among its residents.

Nurse Margo goes through the steps of the clinical judgment measurement model to make decisions by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse Margot recognizes cues. She distributes an anonymous questionnaire to residents at the shelter to gather demographic data, employment status, presence of medical conditions and any other concerns they have.

Nurse Margot then interviews willing residents to gather additional information on factors contributing to their need for the shelter and discusses with staff any concerns they have about residents.

She also obtains data from the shelter on the number of residents at houses and services that are offered. Next.

Nurse Margot analyzes these cues. She reviews data from the questionnaire and her notes from the interviews to identify common themes.

She notes many residents are unemployed and have indicated they're unable to maintain employment due to mental health conditions.

They cite lack of transportation and financial concerns as a barrier to accessing mental health care. And staff also report many residents have been struggling mentally due to lack of access to needed care.

Nurse Margo reviews services provided by the shelter which includes support groups wi fi and assistance with housing applications.

Nurse Margo knows homelessness is a complex socioeconomic issue that consists of a range of living situations. She knows there are many types of homelessness including rooflessness, sometimes called absolute homelessness where individuals lack any shelter, houselessness also called sheltered homelessness such as those who don't have a permanent residence, but stay in temporary housing like shelters in secure housing where individuals face threat of eviction or instability with their living arrangements and inadequate housing in which conditions are substandard, have structural hazards like leaking roofs or lacking basic utilities such as clean water.

Additionally, hidden homelessness is when individuals live temporarily in their vehicles or with friends or family and may not be included in the official homelessness statistics.

Margot understands there are a variety of factors that contribute to homelessness including unemployment or working for low wages, mental illness, domestic violence and inaccessible health care.

She also knows that homelessness contributes to poor health outcomes which can interfere with the ability to maintain employment, become financially independent and obtain long term housing stability.

Nurse Margo knows the residents need assistance in accessing mental health care and obtaining employment to assist them with housing stability.

Now, using the information she's gathered, nurse Margot identifies the priority hypothesis of housing instability. Then she generates solutions to address the resident's housing instability and establishes the expected outcome that in one year residents will report improved housing stability.

First, nurse Margot takes action. She presents her data to the health department together with her colleagues, she develops a free job readiness program to be run by local volunteers and offered at the shelter on a monthly basis.

The program will provide residents with assistance in resume writing, interview preparation and financial literacy all with the goal of helping residents obtain and maintain employment.

Next, Nurse Margot discusses her findings with stakeholders at the health department's free medical clinic. She reports how residents lack access to care due to financial constraints and lack of transportation and that many have untreated conditions preventing them from securing and maintaining a job.

After gaining support from stakeholders, nurse Margot develops proposes and implements an extension of the free clinic that provides telehealth services to the residents in the shelter.

One year later, Nurse Margo evaluates the outcomes of her actions. She distributes another anonymous questionnaire to the residents and has follow up discussions with those she initially interviewed.

She notes there's positive feedback and participation in the job readiness program and the telehealth services have helped with access to care.

Nurse Margo notes that a few of the interviewees have recently found stable housing outside of the shelter after obtaining employment and will be moving at the end of the month.

Nurse Margo also gathers feedback from shelter staff who report that many residents are taking advantage of the new services.

They also note that a higher percentage of residents with mental health issues are feeling more confident in their ability to maintain their own living arrangements and have recently submitted housing applications.

All right, it's a quick recap. Nurse Margo recognized and analyzed cues related to the residents housing instability and prioritized hypotheses and generated solutions to address the problem.

Nurse Margo then implemented interventions and evaluated the outcomes compared with the expected outcomes. Since the residents reported improved housing stability.

Nurse Margot determined the plan of care was successful.