Question 1

The nurse is working in a shelter for homeless men. When planning the care for these clients, the nurse integrates understanding that men who have been homeless for a long period of time often feel a sense of which assessment finding?

Accepted Answer

After being homeless for quite some time, individuals often feel a sense of depersonalization and fragmented identity; a loss of self-esteem and self-efficacy; and a stigma of being "nothing," "a bum," "lazy," and "stupid." However, most people who are homeless describe themselves as resourceful, independent, proud, and "survivors."

Question 2

A nurse is presenting a talk on homelessness and its effect on individuals. The nurse describes the resiliency and hope of homeless individuals based on which factor?

Accepted Answer

Persons who are (or have been) homeless and have mental illnesses can become resilient because they typically have endured and coped with constraints or problems, extreme stressors or catastrophes, and negative life events. Deprivation of needs, the sense of isolation and stigma, and the lack of accessible resources may be of short- or long-term duration. In turn, self-confidence and a sense of competence can be eroded. Yet many people who experience homelessness maintain hope and a positive attitude, which in turn helps them to reach out for help, take advantage of opportunities, and become part of the housed population.

Question 3

The nurse is caring for a homeless client who has been seen in the mobile clinic every week for the past month because of a foot infection. Which nursing diagnosis would the nurse most likely identify as the priority?

Accepted Answer

Although Social Isolation, Chronic Low Self-Esteem, and Imbalanced Nutrition may be applicable nursing diagnoses, the existence of the foot infection requiring treatment for the past month indicates Ineffective Health Maintenance.

Question 4

A new graduate nurse is considering taking a job that focuses on meeting the mental health needs of homeless populations. During the pre-employment interview, the graduate nurse asks the interviewer what characteristics are common in this population. Which response by the interviewer would be most likely?

Accepted Answer

The homeless population includes people of all ages, economic levels, racial and cultural backgrounds, and geographic areas. People who are homeless are often chronically ill, jobless, or have recently lost all financial resources. Long-term homeless people may have lived in poverty for years with no home site. Among homeless people, the educational level varies greatly, from less than an eighth-grade education to doctoral degrees.

Question 5

A nurse is assessing a 49-year-old homeless client. The nurse fashions the assessment process based on the understanding that the client would most likely demonstrate which behavior?

Accepted Answer

Because of negative past experiences with the health care system, health care providers, or because of mental illness or substance use, the client may not allow a thorough physical examination. The client may also refuse to answer questions about personal history at the first visit. The client will most likely be resistant and cautious with the nurse, resisting anything more than a superficial conversation and observation.

Question 6

A nurse has formulated several nursing diagnoses for a homeless client after a thorough nursing assessment. Which diagnoses would the nurse determine as the priority?

Accepted Answer

The priority for people who are homeless is meeting the basic needs-food, shelter, and so on. Care for the responses to the mental illness is secondary.

Question 7

The nurse is helping a homeless 56-year-old client develop a plan for care after discharge. Which action will be most appropriate to take to support a successful transition?

Accepted Answer

Nurses are in a key position to help clients re-establish family and other supportive relationships. Clients who are homeless are likely to engage their children as a main social support; parents and other family members are perceived as unlikely to help. People with mental illness who have been homeless need assistance in using available resources, such as medical, psychiatric, substance abuse, emergency department treatment, and other outpatient psychiatric services. However, providing the client with a binder full of resources or with telephone numbers of insurance companies would be overwhelming and impractical. Information should be as portable as possible; legible; concise; and be able to fit in a pocket, purse, shoe, or boot.

Question 8

A nursing instructor is preparing an education plan for a group of nursing students who will be working with homeless populations. As part of the class, the instructor will be including information about barriers to successful treatment of homeless clients who are mentally ill. Which reason would the instructor include as contributing to lack of compliance with psychotropic medications?

Accepted Answer

Compliance with medication and treatment regimens is difficult for homeless individuals because successful treatment requires collaboration, monitoring, time for medication and other measures to be effective, and a secure place to keep medication.

Question 9

A nurse is working for a mobile homeless treatment program. Which method would the nurse most likely use to provide follow-up care to clients?

Accepted Answer

Some agencies provide a street or mobile outreach program. As part of this program, a van travels the streets to areas where people who are homeless are found outdoors. Food, warm coffee, hygiene kits, and blankets are the first steps in building trust between staff and homeless persons. People who are homeless may accept an offer to be driven to a local shelter for the night. Follow-up the next day by van or bicycle provides a way to reconnect with the individual and invite him or her to the agency programs, or to other social or health care services.

Question 10

A nurse is providing an in-service education class on caring for homeless populations. When explaining the difference between the care provided by Safe Havens and Shelter Plus Care, which statement would the nurse include?

Accepted Answer

A Safe Haven, in addition to serving hard-to-reach people with severe mental illness who are on the streets and have been unwilling or unable to participate in traditional supportive services, meets the following criteria: it provides 24-hour residence for an unspecified duration; it provides private or semiprivate accommodations; and it limits overnight occupancy to 25 persons. Shelter Plus Care provides long-term housing and supportive services for people who are homeless with disabilities, primarily those with serious mental illness, chronic problems with alcohol or drug use, or AIDS or related diseases.

Question 11

After describing the various legislative efforts to address the issue of homelessness in the United States, a nursing instructor determines that the education was successful when the students identify which legislation as addressing the need for a continuum of care approach?

Accepted Answer

The McKinney-Vento Homeless Assistance Act (Public Law 100-77, first passed in 1987 as the McKinney Act), a landmark legislation, reflected concern in the United States about people who are homeless and provided the first comprehensive, federal funding program targeted specifically to address the health, education, and welfare needs of the homeless population. Subsequent revisions to the McKinney Act incorporated a continuum of care approach, including emergency shelter, transitional or rehabilitative services, and permanent housing or supportive living arrangements. Because of the gap in services for people who are homeless and mentally ill, amendments were made to the McKinney Act in 1992 that included a provision for the creation of Safe Havens, which are a form of supportive housing that serves hard-to-reach people with severe mental illnesses. The Bringing Home America Act (HR 4347) includes housing development, support for living income, rental assistance (no more than 30% of income to be spent on housing by low-income families or individuals), job training opportunities, civil rights (including the right to vote) protection for persons without housing, emergency funds to prevent homelessness, and increased access to health care for this population. The Affordable Care Act, passed in 2010, focuses on preventive care coverage. The American Recovery and Reinvestment Act of 2009 provided funds to the Human Resources and Services Administration, the primary federal agency responsible for improving access to health care for people who are uninsured, isolated, or medically vulnerable (all characteristics of the homeless population).

Question 12

A nurse working in an emergency homeless shelter is interviewing a woman who has just arrived with her two small children. When assessing this client, the nurse would expect the woman to report which reason for seeking shelter?

Accepted Answer

Fifty percent of all women and children who experience homelessness are fleeing from domestic violence. Studies show that men tend to report that their homelessness is caused by unemployment, alcohol and drug abuse, or imprisonment.

Question 13

A nurse is developing a plan of care for a client who is homeless. Which action would the nurse take first?

Accepted Answer

The priority with any homeless client is meeting the basic needs. Thus, the nurse would work on stabilizing the client's physical health status first. Referrals, suggestions for safe facilities, and education or counseling related to maintaining privacy would follow.

Question 14

A group of nurses is in a discussion about the homeless population in their community as well as means for developing appropriate programs for this group. Which statement by one of the members indicates a need for the group to address the nurse's stereotypical thinking?

Accepted Answer

It is a myth that street dwellers are unwilling to accept services. Most people who are homeless recognize the need for help, but survival needs take priority over the need for mental health treatment. People who are homeless come from all walks of life and must be creative to secure resources and constantly change life ways to survive. In addition, about 110,000 people are estimated to be chronically homeless; most are homeless for a relatively short period of time.

Question 15

Before caring for homeless clients, nurses need to examine their own myths and feelings about homelessness. What is this type of reflection called?

Accepted Answer

A self-aware nurse reflects on myths and feelings the nurse has about clients who are homeless and mentally ill. Relating to people who are homeless requires gentle and compassionate nursing care.

Question 16

A nurse completed a health history on a homeless client who was sexually assaulted in a shelter. What is the priority nursing diagnosis for the client?

Accepted Answer

The client has suffered from a sexual assault and will be anxious and upset. The nurse should be prepared to provide a very comforting and safe environment for the client with minimal interruptions to reduce the anxiety the client is eliciting. Imperative to this assessment is a psychosocial evaluation during the immediate interaction and later to assess for post-traumatic stress. The client is able to discuss the event; no impaired verbal communication is the nursing diagnosis. Fatigue can be occurring but anxiety is the priority nursing diagnosis.

Question 17

A psychiatric-mental health nurse is preparing a class for a group of staff nurses on individuals who are homeless and mentally ill. When describing the characteristics of this population, which finding would the nurse most likely include? Select all that apply.

Accepted Answer

Individuals who are homeless and mentally ill often experience poorer physical health than other individuals who are homeless, and they have more contacts with the legal system than other homeless or housed people. They have at least one psychiatric service encounter annually, usually in an emergency department rather than inpatient or outpatient units. Although most are eligible for benefits, they have difficulty obtaining them. Seriously mentally ill people are at greater risk for homelessness than the general population.

Question 18

The nurse is developing a plan of care for a client who has been admitted to the inpatient unit after being brought to the emergency department by law enforcement. Assessment in the emergency department reveals that the client is homeless and has been diagnosed with posttraumatic stress syndrome. The client also has a history of substance abuse. When reviewing the client's medical record, which factor would the nurse identify as contributing to the client's homelessness? Select all that apply.

Accepted Answer

Homelessness has no single cause. Many factors typically combine, with time, to cause the person or family to lose permanent housing. Risk factors for homelessness include mental illness, substance abuse, lack of needed services, lack of family support, low-paying job, unemployment, and changes or reductions in public assistance programs.

Question 19

A client who is homeless and mentally ill is being discharged to an Assertive Community Treatment (ACT) program. The nurse interprets discharge as including which services? Select all that apply.

Accepted Answer

Assertive Community Treatment (ACT) programs focus on service delivery to the homeless and mentally ill population by a transdisciplinary team of 10 to 12 specialists with a 1:10 staff-client ratio. A single, integrated, mobile staff team uses outreach, case management, practical assistance and support, and rehabilitation services to maximize the possibility that the most disabled consumers will live independently in the community and have a good quality of life. The team provides counseling and advocacy; monitors the person's management of housing, income, medication use, and leisure activities; and provides opportunities for employment, if appropriate. Substance abuse management and physical health care are provided as needed. Living skills classes are often provided in day treatment programs. Shelter for one night would be provided by emergency services programs.

Question 20

A nurse is completing an admission assessment of a client admitted for an infection. The client states that the client lives in a homeless shelter. What additional assessments should the nurse complete on the client? Select all that apply.

Accepted Answer

When a client identifies living in a shelter, additional assessments should be obtained. Shelters are run by federal or state agencies and received limited donations on food. Nutrition should be assessed during the interaction. There is also a high risk of mental illness and substance abuse with those who are homeless. The nurse should be aware of these potential problems and assist in assessment. Vision is not a priority at this time. The stem of the question does not address medication issue so assessment of adherence is not warranted at this time.

Quiz 41: Caring for Persons Who Are Experiencing Homelessness and Mental Illness