Newly qualified nurses

Community nursing is a complex and varied, but often underestimated, career option

Caring for homeless people requires a complex set of skills that can enable nurses to reach out to those who are often excluded from the healthcare system, says Jane Morton.
Homeless-outreach_tile_iStock.jpg

Caring for homeless people requires a complex set of skills that can enable nurses to reach out to those who are often excluded from the healthcare system, says Jane Morton.

Most pre-registration training takes place in the hospital environment. This, combined with the misconception in some quarters that nurses who work in the community are not proper nurses, may result in students and newly qualified nurses underestimating the fields complexity.

Yet it is community nursing that has the potential to provide the most varied experience of nursing and the greatest opportunity to develop a wide range of skills.

Providing care to the homeless, for example. The stereotypical view of a homeless person is the bearded, older man drinking strong cider on a park bench, but there

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Caring for homeless people requires a complex set of skills that can enable nurses to reach out to those who are often excluded from the healthcare system, says Jane Morton.


Homeless people have a range of support needs that stretch beyond their
lack of accommodation. Picture: iStock  

Most pre-registration training takes place in the hospital environment. This, combined with the misconception in some quarters that nurses who work in the community are not ‘proper nurses’, may result in students and newly qualified nurses underestimating the field’s complexity. 

Yet it is community nursing that has the potential to provide the most varied experience of nursing and the greatest opportunity to develop a wide range of skills. 

Providing care to the homeless, for example. The stereotypical view of a homeless person is the bearded, older man drinking strong cider on a park bench, but there are as many different types of homelessness as there are causes. There are homeless families and single homeless people, as well as foreign nationals, ex-prisoners and ex-service personnel who are at high risk of becoming homeless. 

Causes of homelessness include being unable to afford suitable accommodation through unemployment, illness or high rental costs. Another common cause is the breakdown of relationships, which could mean marriage, civil partnership, or the relationship between parent and child. Other causes include leaving military service, prison or care. 

Diverse field 

The transient nature of homelessness creates many issues for nurses, and those who practise in the field work with people who do not easily fit into existing services. Homeless people have a range of support needs that stretch beyond their lack of accommodation. They will often have multiple and enduring complex needs, including those related to mental health issues, substance misuse, offending, difficulty in forming and sustaining relationships, physical disability, self-harm, learning difficulties, domestic abuse, sex working and neglect. 

Terms such as ‘multiple and/or complex needs’, ‘hard to reach’, ‘difficult to engage’, and ‘socially excluded’ are also often applied to people who are homeless, in an attempt to quantify the significant barriers they face when accessing services. 

Nurses who work with groups who are at risk of such exclusion from services need to develop an extensive toolkit. They need to be exceptional, not only capable of communicating with patients who can be unpredictable, but also of acting on behalf of those they serve, who often face significant barriers when accessing help. They also need to form good networks with people working in non-statutory organisations, such as hostel staff and volunteers at drop-in centres. 

Importantly, they need to be ‘real’, as patients often have a deep-seated mistrust of health and social care professionals based on a perception that they have been let down or have experienced poor treatment in the past. The fundamental requisite for an effective therapeutic relationship is trust, which can be one of the greatest challenges within this group. However, if this is allowed to develop, concordance and cooperation rapidly improve. 

Caring for people who are homeless is a field of practice that may be frustrating and distressing, but it can also provide diversity. It can be challenging and rewarding, and is certainly never boring. 


About the author 

 

 

 

Jane Morton is a senior lecturer in health at Staffordshire University, Stoke-On-Trent 

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