Cheryl Forchuk

Homelessness and Health in Adolescents

Despite an abundance of resources, many of the worlds wealthiest nations have a large homeless population. People at all stages of development are affected by this problem, but adolescents who are homeless face a unique set of challenges. In this critical narrative study the authors examined the experiences of homeless adolescents with particular attention to the role of gender and public policy, health experiences and perceptions, and barriers to health care services. Six girls and 7 boys participated in semistructured dialogic interviews. Their stories revealed that living without a home had a substantial impact on their health and wellness. The findings from this study support the need for health care professionals to work in collaboration with homeless youth so that more effective care that is sensitive to their unique health needs can be provided.

Peplau's Theory: Concepts and their Relations

This article focuses on Peplaus major concepts, including nursing, person, health, and environment. The concepts are described and the relations among concepts are specified. The purpose of the specification is to facilitate the use of Peplaus theory in research and practice and to facilitate comparison with other nursing theories.

Uniqueness within the nurse-client relationship

The uniqueness of individual nurse-client relationships was explored by comparing therapeutic relationships of two different clients with the same nurse, and two different nurses with the same client. This secondary analysis included 38 nurses who had two different clients in the original study, and 13 clients who had two different nurses. Instruments included the Working Alliance Inventory, semantic differential scales related to the nurses view of the client and the clients view of the nurse, and the Relationship Form. The same nurse working with two different clients had different preconceptions, and a different relationship with respect to bond, task, and goals with each client. There was a relationship between the time required to establish a therapeutic relationship with the two different clients. Clients working with two different nurses had no significant relationship on any of the relationship measures. Findings suggest that the same individual, whether a nurse or a client, experiences very different therapeutic relationships with different people.

Developing and testing an intervention to prevent homelessness among individuals discharged from psychiatric wards to shelters and 'No Fixed Address'.

Shelter data in a recent study revealed discharges from psychiatric facilities to shelters or the street occurred at least 194 times in 2002 in London, Ontario, Canada. This problem must be addressed to reduce the disastrous effects of such discharge, including re-hospitalization and prolonged homelessness. An intervention was developed and tested to prevent homelessness associated with discharge directly to no fixed address. A total of 14 participants at-risk of being discharged without housing were enrolled, with half randomized into the intervention group. The intervention group was provided with immediate assistance in accessing housing and assistance in paying their first and last months rent. The control group received usual care. Data was collected from participants prior to discharge, at 31 and 6-months post-discharge. All the individuals in the intervention group maintained housing after 3 and 6 months. All but one individual in the control group remained homeless after 3 and 6 months. The exception joined the sex trade to avoid homelessness. The results of this pilot were so dramatic that randomizing to the control group was discontinued. Discussions are underway to routinely implement the intervention. Systemic improvements can prevent homelessness for individuals being discharged from psychiatric wards.

Perceptions of health and health service utilization among homeless and housed psychiatric consumer/survivors

Homelessness has a direct impact on health. Homeless individuals report several barriers to accessing health care. Although research exists regarding the utilization of health services for homeless and housed psychiatric consumer/survivors, few studies have compared the perceived health and service utilization of these two groups. The objective of this study was to determine whether or not differences exist between the utilization of health services and the perceptions of health of homeless and housed psychiatric consumer/survivors in London, Ontario, Canada. It was hypothesized that differences would exist between homeless and housed psychiatric consumer/survivors on all health-related variables examined. A secondary analysis of quantitative data was conducted in a Community-University Research Alliance on Mental Health and Housing project funded by the Social Sciences and Humanities Research Council of Canada. Key findings include significant differences in the characteristics of each population, the use of health services and their perceptions of health. Implications for practice and policy are discussed.

Interlocking oppressions: the effect of a comorbid physical disability on perceived stigma and discrimination among mental health consumers in Canada.

People living with mental health problems often face stigma and discrimination; however, there is a lack of research that examines how comorbid conditions affect this perceived stigma. This study sought to determine whether people who have a comorbid physical and psychiatric disability experience more stigma than those with only a psychiatric disability. It also looked at how perceived stigma and discrimination affect physical and mental health. A secondary analysis on data from interviews with 336 former and current clients of the mental health system in a mid-size Canadian city in 2005 was performed. Of these, 203 (60.4%) reported they had a psychiatric disability, 112 (33.0%) reported that they had a physical disability, with 74 reporting both a psychiatric and a physical disability. People with a self-reported psychiatric disability and a self-reported comorbid physical disability faced more overall perceived discrimination/stigma (P = 0.04), than those with a psychiatric disability alone. Perceived discrimination/stigma was positively correlated with psychiatric problem severity (P = 0.02), and negatively correlated with self-rated general health (P < 0.001), physical condition (P < 0.001), emotional well-being (P < 0.001) and life satisfaction (P < 0.001). These results bring to light the aggravating effect of a physical disability on the perceived stigma for those living with a mental illness, and also strengthen the knowledge that stigma and discrimination have a negative impact on health. Healthcare providers should recognise this negative impact and screen for these comorbid conditions. Policy-makers should take measures such as improving access to housing and employment services to help reduce stigma and discrimination against this particularly vulnerable group.

Prescriptive Authority for Nurses: The Canadian Perspective

PURPOSE This study aims to describe the role of prescriptive authority for nurses within Canada. CONCLUSIONS Prescriptive authority for Canadian nurses is linked to the development of advanced practice nursing generally and nurse practitioners specifically. Recent legislative changes allow nurse practitioners to function more independently regardless of the availability of medical practitioners. The smaller population results in less legislative variety for specific nurse practitioner specialty areas. Facilitators and barriers to implementing effective prescriptive authority remain as challenges and mirror findings from other literature. PRACTICE IMPLICATIONS Role clarity, strength in nursing focus, and support from administrators and legislation are required for prescriptive authority to be fully enacted.

Supported housing programs for persons with serious mental illness in rural northern communities: A mixed method evaluation

BackgroundDuring the past two decades, consumers, providers and policy makers have recognized the role of supported housing intervention for persons diagnosed with serious mental illness (SMI) to be able to live independently in the community. Much of supported housing research to date, however, has been conducted in large urban centers rather than northern and rural communities. Northern conditional and contextual issues such as rural poverty, lack of accessible mental health services, small or non-existing housing markets, lack of a continuum of support or housing services, and in some communities, a poor quality of housing challenge the viability of effective supported housing services. The current research proposal aims to describe and evaluate the processes and outcomes of supported housing programs for persons living with SMI in northern and rural communities from the perspective of clients, their families, and community providers.MethodsThis research will use a mixed method design guided by participatory action research. The study will be conducted over two years, in four stages. Stage I will involve setting up the research in each of the four northern sites. In Stage II a descriptive cross-sectional survey will be used to obtain information about the three client outcomes: housing history, quality of life and housing preference. In Stage III two participatory action strategies, focus groups and photo-voice, will be used to explore perceptions of supported housing services. In the last stage findings from the study will be re-presented to the participants, as well as other key community individuals in order to translate them into policy.ConclusionSupported housing intervention is a core feature of mental health care, and it requires evaluation. The lack of research in northern and rural SMI populations heightens the relevance of research findings for health service planning. The inclusion of multiple stakeholder groups, using a variety of data collection approaches, contributes to a comprehensive, systems-level examination of supported housing in smaller communities. It is anticipated that the studys findings will not only have utility across Ontario, but also Canada.

The value of the hospital-based nurse practitioner role: development of a team perspective framework

Abstract There is a need to understand nurse practitioner (NP) interprofessional practice within hospital teams to inform effective role integration and evolution. To begin this understanding a supplementary analysis of 30 hospital team member focus groups was carried out using constructivist grounded theory methodology. This conceptual rendering of the team members’ shared perspective of NP actions provides insight into the meaning and importance of the NP role. Participants emphasized three hospital-based (HB) NP practice foci as the meaning of role value; easing others’ workload, holding patient care together and evolving practice. Trust emerged as a pre-requisite condition for HB NP role efficacy. A team member perspective framework of HB NP practice is presented as the first stage in developing a model of HB NP interprofessional practice within hospitals. The framework provides multiple perspectives to the meaning and value of the HB NP role beyond basic role description. The framework may be used by healthcare professionals, operational leaders, academia and HB NPs to enhance role respect and understanding.

Resilience in Nursing Education: An Integrative Review.

BACKGROUND Resilience is a phenomenon known to buffer the negative effects of stress. Resilience is important in the lives of nursing students and nurse educators. METHOD An integrative literature review was conducted to explore the current state of knowledge of resilience in the context of nursing education. Implications from the review findings were deduced for nursing education practice and research. RESULTS Three theoretical papers and 16 empirical reports were included in the review. Three themes emerged from the analysis: (a) Resilience Is Important in Nursing Education, (b) Resilience Is Conceptualized as Either a Trait or a Process, and (c) Resilience Is Related to Protective Factors. CONCLUSION The findings provide data to support interventions to enhance the resilience of nursing students and nurse educators and offer a foundation for further research of resilience in nursing education.