Development and Initial Evaluation of a Nurse-Led Healthcare Clinic for Homeless and At-Risk Populations in Tasmania, Australia: A Collaborative Initiative
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Qualitative Data Collection and Analysis
2.3. Quantitative Data Collection and Analysis
2.4. Ethical Considerations
3. Results
3.1. Qualitative Findings
3.1.1. Personal Vulnerability
Hardship and Adversity
“They haven’t walked a day in my shoes, or any of our shoes so there’s no way on God’s earth that they can tell us it’s gonna be alright … they don’t have a clue till they walk in our shoes”.(MHNC client, 1)
“I didn’t have a lot of money … I get a lot of stuff stolen off me so I usually end up with not much money and then because I couldn’t pay [for a doctor’s appointment] they have declined to meet my essential needs as a human being”.(MHNC client, 7)
“A couple of those are [domestic violence] clients and they get very anxious and upset if they’re sitting in a waiting room full of people. So, some of them just won’t go anywhere until they can come on a Thursday to Mission Health”.(MHNC staff, 13)
“Mental health is a big issue, alcohol and drugs are a big issue, the fact that they are homeless is a big issue on their health, the Mission Health’s focus is to provide some of those basics to those health needs to help overcome the challenges.”.(MHNC staff, 13)
Homelessness
“[Homeless people] don’t have any paperwork, they don’t have any ID, you don’t have any of that, they can’t get the help that they need but through this [Mission Health] they can”.(MHNC client, 7)
“… people that are either homeless or socially isolated or [unable to] manage their lives in a way that most people would regard as normal”.(MHNC staff, 13)
Lived Experiences and Wellbeing
“[I’ve] just been struggling so hard with mental health and self-harm since I was a boy, I’ve got the scars to prove it”.(MHNC client, 1)
“Oh, my mental health, I suffer from severe depression…. I end up being in bed for weeks at a time. So, sometimes I miss my appointments because I’m not in the right place to go there and as medical practitioners they should be aware of that”.(MHNC client, 7)
“In Tasmania in general…I’m hearing stories…people are not happy, not happy about [the lack of mental health services]. Personally, I’m one of ‘em. I’ve had to wait a month to see a mental health counsellor….a lot can happen within a month”.(MHNC client, 10)
“… need for primary health services delivered in a setting and a situation that is acceptable to [their clients]”.(MHNC staff, 2)
Lack of Empowerment
“You know, once you lose the loop of socialising you do find it hard to get help. … I did see a lady [GP], but she retired, she was really good and listened to what I had to say”.(MHNC client, 1)
“Because there’s a lot of people out and about on the streets that definitely need the medical attention and help but they won’t sit in a hospital, they can’t build a rapport with a normal doctor [GP]”.(MHNC client, 6)
“… if they’re in a sensitive state, you know, a mental health state, then they don’t necessarily have it in them to chasing multiple locations and multiple services”.(MHNC staff, 15)
3.1.2. Disconnectedness
Gaps in Services
“I was with [another medical service] for a long time and then my doctor passed away and my other doctor retired after a two-year rapport and then I was just going here, there and anywhere”.(MHNC client, 6)
“It seems that it’s difficult to access general health care apart from emergency or ambulatory care in this town, in this region even”.(MHNC client, 10)
“We often used to hear of them just presenting at emergency at the hospital when they [had] certain conditions because they know when they turn up there and they wait long enough they will see someone”.(MHNC staff, 12)
“We wouldn’t have a referral process. We’d just say [to clients], ‘… just try your luck there’ basically. We’d get reports back saying, ‘[GP’s are] not taking on new clients’”.(MHNC staff, 13)
Social Stigma and Societal Expectations
“Don’t’ be so silly, just tell ‘em [MHNC nurses] who you are, tell‘ em the story. They don’t care about your smelly feet”.(MHNC client, 1)
“The last time I went to the doctor I felt like cattle … I’m somewhat disillusioned”.(MHNC client, 10)
“[With general practice services] it’s difficult for them to just attend at a certain time and sit in a waiting room and not sort of rush from the place or not turn up”.(MHNC staff, 12)
Expense of Services
“Well, it costs money, cos my family doctor, she doesn’t bulk bill anymore”.(MHNC client, 2)
“I’ll make appointments with best intentions and then don’t rock up and get a $50 (AUD) charge for it and still don’t get to see the doctor”.(MHNC client, 6)
“Most of our clients [don’t] have the money to pay the gap … there wasn’t really places we could send because most of the clients who come to us have no money”.(MHNC staff, 11)
3.1.3. Acceptability of Mission Health Services
Rapport and Trust
“…here [at MHNC] they can see the same people every week. And, like I said build a rapport”.(MHNC client, 6)
“They actually listen to me. They don’t judge you, like there’s all walks of life that come here but most of us are drug addicts, alcoholics or victims of one sort or the other”.(MHNC client, 1)
“Well, they’ve [Mission Health staff] saved my life and that’s, and that’s very humbling”.(MHNC client, 7)
“We had a gentleman come in the other day with his three-year-old grandchild left in his care and he had no idea what to do. He didn’t have the money to take her to a doctor, and they’re just so grateful. You know, it’s people’s health, if you haven’t got your health what have you got?“(MHNC staff, 15)
Continuity of Care
“A lot of our clients have multiple complex needs. A five-to-seven-minute session with your [GP cannot] possibly identify what they actually do need”.(MHNC staff, 11)
“Since I’ve been in Launceston for the last six months, I’ve been coming here to see the [nurses] every Thursday when I can”.(MHNC client, 1)
“I’m very happy with the services that I’ve got because they can refer you for x-rays, higher specialists. So no, for me they’ve covered everything I’ve possibly needed. But they’ve referred me through and given me the help and support I’ve needed to try and look after myself”.(MHNC client, 7)
Drop-In/Fee-Free Service
“I’m not reliable or good with meeting appointment times, here I drop in and have a coffee and just wait and that works for me rather than being structured to a time that doesn’t necessarily work for me”.(MHNC client, 6)
“And if ya haven’t got much money you can just come here and get help”.(MHNC client, 4)
“Within the cohort that we service I think that they really appreciate the fact that it’s gonna be free … I think they like the fact that they can just turn up without a lot of organisation, they don’t have to pre-book and that sort of thing. You know that’s an opportunity just to turn up and see if you can be treated”.(MHNC staff, 12)
Client Advocacy
“I will actually come with them on the first appointment just to get them in that door”.(MHNC client, 7)
“There’s just that whole advocacy of their health management that [MHNC clients] need … the great thing I think with the nurse practitioner is that they do really advocate well [for clients]”.(MHNC staff, 14)
Health Promotion
“It certainly is identifying all the health issues and we are able to treat, we’re fortunate to have a nurse practitioner [here] so we are able to do more than we could achieve without a nurse practitioner”.(MHNC staff, 14)
3.1.4. Client and Staff Recommendations
“It all just [needs to] happen in the one place. I think for a lot of people, the continuity and stability and availability is really important”.(MHNC staff, 15)
3.2. Quantitative Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
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No. | Median | Range (95th %) | |||
---|---|---|---|---|---|
Total number of clients | 174 | ||||
Total number of presentations | 426 | 1 | 1–21 (1–9.7) | ||
Age | 42 years | 1–77 years (3.3–69.4) | |||
No. | % | ||||
Gender | |||||
Male | 106 | 60.9 | |||
Female | 68 | 39.1 | |||
Living situation | |||||
Home | 107 | 61.5 | |||
Supported | 19 | 10.9 | |||
Homeless | 48 | 27.6 | |||
Medical condition | History | Presentation | |||
n = 174 | % | n = 174 | % | ||
Medication prescription | n/a | n/a | 44 | 25.3 | |
Immunisation | n/a | n/a | 35 | 20.1 | |
Musculoskeletal (chronic or acute) | 15 | 8.6 | 20 | 11.5 | |
Mental Health | 43 | 24.8 | 17 | 9.8 | |
Skin | 5 | 2.9 | 17 | 9.8 | |
Respiratory conditions | 15 | 8.6 | 13 | 7.5 | |
Gastrointestinal/renal/urinary conditions | 17 | 9.8 | 11 | 6.3 | |
Other | 21 | 12.1 | 10 | 5.8 | |
Cardiovascular conditions | 13 | 7.5 | 7 | 4.0 | |
Eyes/ears/nose/throat | 2 | 1.2 | 6 | 3.5 | |
Substance and alcohol use | 24 | 13.8 | 4 | 2.3 | |
Reproductive/sexual health | n/a | n/a | 3 | 1.7 | |
Diabetes Mellitus | 13 | 7.5 | 2 | 1.2 | |
Missing/unknown | 60 | 34.5 | 1 | 0.6 | |
Neurological conditions | 7 | 4.0 | 0 | 0 |
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Bennett-Daly, G.; Unwin, M.; Dinh, H.; Dowlman, M.; Harkness, L.; Laidlaw, J.; Tori, K. Development and Initial Evaluation of a Nurse-Led Healthcare Clinic for Homeless and At-Risk Populations in Tasmania, Australia: A Collaborative Initiative. Int. J. Environ. Res. Public Health 2021, 18, 12770. https://doi.org/10.3390/ijerph182312770
Bennett-Daly G, Unwin M, Dinh H, Dowlman M, Harkness L, Laidlaw J, Tori K. Development and Initial Evaluation of a Nurse-Led Healthcare Clinic for Homeless and At-Risk Populations in Tasmania, Australia: A Collaborative Initiative. International Journal of Environmental Research and Public Health. 2021; 18(23):12770. https://doi.org/10.3390/ijerph182312770
Chicago/Turabian StyleBennett-Daly, Grace, Maria Unwin, Ha Dinh, Michele Dowlman, Leigh Harkness, Jane Laidlaw, and Kathleen Tori. 2021. "Development and Initial Evaluation of a Nurse-Led Healthcare Clinic for Homeless and At-Risk Populations in Tasmania, Australia: A Collaborative Initiative" International Journal of Environmental Research and Public Health 18, no. 23: 12770. https://doi.org/10.3390/ijerph182312770