Why every nursing student should learn about homelessness

Homelessness and poor housing have a huge effect on health, yet many nursing students have little opportunity to learn about these issues. The Queen’s Nursing Institute’s David Parker-Radford says more commitment is needed from universities

Homelessness and poor housing have a huge effect on health, yet many nursing students have little opportunity to learn about these issues. The Queen’s Nursing Institute’s David Parker-Radford says more commitment is needed from universities

  • A homeless person's life expectancy is 30 years below the UK average
  • Only two UK universities surveyed offer a homeless health undergraduate module
  • Queen's Nursing Institute wants universities to strive for greater consistency in homelessness education

The Nursing and Midwifery Council recently consulted on standards required of the ‘future nurse’. As trusted health professionals, nurses should have a wide body of knowledge on the determinants of health, in addition to caring and clinical knowledge.

Where you live is one of the biggest factors influencing how healthy you are. Someone living in a deprived area with substandard housing has a significantly reduced life expectancy. In the UK, a person who is homeless has a life expectancy around 30 years below the average.

One of the most effective strategies we have for improving population health is improving housing in areas of poverty and deprivation. We can prevent the numerous health conditions arising from or exacerbated by damp, poorly insulated, overcrowded homes in polluted areas.

A man living alone in a room in a London squat. Picture: Alamy

A 2016 report commissioned by the Queen’s Nursing Institute (QNI) for the Department of Health’s Inclusion Health Board highlighted that health professionals do not have enough access to specialist learning about homeless and inclusion health issues.

Learning events

The QNI believes every nursing student should have opportunities to learn about homelessness – the most stark housing and health inequality of all. The institute's Homeless Health Network, which began ten years ago, encourages nursing students to join. This free network enables people to share news and resources, and hosts learning events for nurses on issues related to homelessness and inclusion health – the health of people with poorer health outcomes, such as refugees, Gypsy and Roma people, travellers and sex workers.

Last summer, the QNI surveyed every programme lead for all 68 BSc nursing programmes in England, Wales and Northern Ireland to discover what nursing students learn about homelessness and health inequalities. We found a diversity in approaches to this issue.

Involving service users

Some pre-registration programmes have committed to involving service users in the education of their students and are offering a diverse range of placements, or have focused exploratory learning based on people who are homeless.

'The QNI believes all programmes of pre-registration nursing study should do more to offer nursing placements in homeless and inclusion health'

Just two universities had a specific module on homeless and inclusion health. The QNI learned that 23 of the universities offered between one and 25 hours of learning content about homelessness during the whole programme, while six universities offered no hours at all.

Six others offered more than 25 hours (about one week of learning) during the whole programme. Interesting approaches from these included: a health inequalities module focusing on marginalised sections of communities, a module on homelessness, refugee, traveller and prison health (including placements in offender institutions), a full-day meeting with homeless service users and asylum seekers, and a module on anti-oppressive practice, conflict management and empowerment using enquiry-based learning and a case study.

Homelessness in the curriculum

The inclusion of homelessness in the curriculum could be dependent on a variety of factors, including the location of institutions, the relationship between the institution and local homelessness organisations, the number of local trained nurse mentors working in homeless or inclusion healthcare with capacity to take on placements, and the expertise of course tutors and mentors.

Just under half the universities that responded to the survey offered placements in homeless and inclusion health, and a further 14% made it possible to get some experience of homeless healthcare through other means such as 'spoke visits'. The placements varied from a six-week placement with the homelessness charity St Mungo’s and placements with homeless health teams to working alongside GP specialists.

For the 37% that offered no homeless and inclusion health placement, the barriers to placements included: the current NMC requirement that nursing students have to be supervised by a nurse, not having a qualified mentor who can sign off their competencies in these settings, and not having access to the required local homelessness charities that could host a placement. The QNI believes all programmes of pre-registration nursing study should do more to overcome these barriers and offer nursing placements in homeless and inclusion health.

The more proactive universities identified a series of steps they had taken to improve their curriculum or approaches to the teaching of homeless and inclusion health, which had a demonstrable effect. One example is the Pathway charity’s Experts by Experience – a group of people who have experienced being homeless and who talk to providers and educators to promote awareness and improve care.

Promoting understanding

Another course includes a 'humanising nursing framework', which involves small groups of students talking to service users and people who have experienced homelessness. This was very well evaluated by students and service users. Another university adopts a similar approach called World Café, in which students can ask questions of service users and people who work in the field. Some have since arranged their own placements with World Café facilitators.

One university holds a session on homelessness and inequality between men and women, and the students have set up a local campaign based on the national initiative Helping Handbags, to provide women with sanitary products in times of crisis.

Another university asks students to develop public health resources and a commissioning project for service evaluation, and many of them elect to focus on homelessness and inclusion health, helping to develop different skills at different levels of the health system. One institution offers a variety of relevant placements, and allows students to develop projects. 

More commitment from universities

The QNI hopes this work will encourage institutions to share more knowledge, commit more to this area and aim for more consistency in approach in educating nursing students in homeless health. The QNI would like to see universities commit to supporting service users to share their experiences as part of the course.

A lack of suitable housing puts people at high risk of poor health, with no environment suitable for recovery from ill health. Wider understanding of homelessness and the risks is an essential quality for a nurse working in hospital or in the community.

The Homelessness Reduction Act, passed last year, requires health professionals to refer people to their local authority if there is a risk they will become homeless in the next eight weeks.

The QNI is working with partners to ask that housing status is consistently recorded in patient data and that services are proactive in identifying housing need. We believe housing is a critical health intervention and a key part of the modern nurse’s toolkit of knowledge.

QNI resources

The QNI has worked with homeless health nurse specialists to produce the eight-chapter learning resource Transition to Homeless Health Nursing, which is recommended reading for universities looking to develop their knowledge and practice. In 2015, the QNI worked with nurses to develop a specialist health assessment tool specifically for working with people who are homelessness.

David Parker-Radford is homeless health programme manager at the Queen’s Nursing Institute

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