Nov 04, 2019
A nursing student health promotion strategy serving homeless people
Take away messages:
- Nursing students demonstrate commitment to learning about and serving a vulnerable and diverse population outside of their curriculum activities.
- Student-led health promotion activity gives students leadership experience with peers and faculty.
- Meaningful conversations with individuals from diverse and vulnerable backgrounds inspire student nurses to work with these populations after graduation.
Homeless people are both visible and invisible. In Canada, at least 235,000 Canadians experience homelessness in any given year (Gaetz, Dej, Richter, & Redman, 2016). In Alberta, 5,735 people experienced homelessness in 2018 and of those, 1,194 were in Edmonton ((Turner Strategies, 2018). In fall 2018, 2,300 individuals, including families who are homeless and at risk for being homeless, attended the biannual Homeless Connect event in Edmonton. Homeward Trust Edmonton is a non-profit organization whose mission is to end homelessness. Since 2009, Homeward Trust has organized these events. The Homeless Connect event offers essential and dignity-enhancing, free services from more than 70 community agencies (Indigenous and social services, legal, dental, hairdressing, foot care, family photos, and more). It is the largest event in Canada to assist and empower those who are homeless or at risk of homelessness.
In spring 2015, a 4th-year MacEwan University BScN student, Cat Wilde organized students and faculty to offer a health promotion booth at this event. A year later, the foot clinic, one of the Homeless Connect services, needed volunteers. Students volunteered to meet this need. Students continue to successfully organize and lead the health promotion booth and volunteer at foot clinics for the homeless at Homeless Connect events beyond course and curriculum requirements.
This student-initiated and -led volunteer activity provides opportunity for the students’ exposure to a diverse and vulnerable population. As well, the students and faculty learn about the various community agencies in Edmonton. Students’ enthusiasm drives their engagement with homeless people at the health promotion booth. The students utilize their relational practice skills to build a strong rapport with these people. Such engagement of students with homeless people enables them to listen to their life stories and daily concerns, and to experience the negative health outcomes of homelessness. Furthermore, students network with service providers from other community agencies to promote their services. For example, in the fall events, students walk through the crowds with signs to promote flu shots for another agency that provides this service.
During and between events, the students learn and improve upon their administrative, leadership, and team skills through such activities as recruitment of other nursing students, project management, and writing event reports to share with the Faculty of Nursing. Students are excited to work alongside faculty. Faculty members who volunteer are passionate about working with this vulnerable population. Another highlight is meeting our nursing school graduates at these events as registered nurses who work for community agencies. These graduate nurses are role models for our current students.
Implementation and lessons learned
Students create an executive team that varies from year to year, depending on the needs and capacity of the students. Various roles on this executive may include a team leader, volunteer coordinator, marketer, and treasurer. The functions of the executive team include preparing an application to Homeward Trust for a health care booth (tables, chairs, and space), recruiting students, developing schedules for students, ensuring that everyone completes Workers’ Compensation Board forms for MacEwan University (liability), developing a budget, requesting lab equipment from the Clinical Simulation Centre (e.g., BP cuffs, glucometers), providing an orientation for students prior to the event, and writing event reports. The event report documents the number of students and faculty involved, the budget, and the number of homeless people that visit the health promotion booth.
From the beginning, this project employed a trial-and-error approach and problem-solving between and during events. Our first event had 40 students and 8 faculty involved at the health promotion booth. The enthusiasm in participating in this first event was remarkable. Over the years, we have learned to manage the health promotion booth with 8 students for 3-hour shifts, plus the student executive team. There is high interest among the students to volunteer, and therefore many are not afforded the opportunity. The students are chosen from all years of the BScN program. We have found that about 28 students per event is manageable, as previous attempts to increase this number resulted in mayhem. We decreased the number of faculty to 2 or 3 for both 3-hour shifts. The dress code was also changed over time, as nursing students wearing full scrubs were mistaken for registered nurses. As a result, we now wear supplied Homeless Connect volunteer T-shirts, scrub pants, and student name tags.
Over the years, the health promotion activities that students choose have changed. Initially, students were taking children’s temperatures and teaching parents how to manage their child’s fever, and distributing diabetic nutritional and foot care pamphlets. To engage with families, students provided crayons, colouring books, and stickers to the children. The supplies and materials for each event were continuously adjusted based on ongoing feedback and demand. For example, one year we brought band-aids and sugar-free candy, but the next year we brought more stickers, as they were popular with both children and adults. As well, the necessary materials also changed owing to lessons learned.
Students are paired so that a senior nursing student is partnered with a 1st- or 2nd-year student to roam the huge conference centre and engage homeless people. They carry health promotion pamphlets and signs that read, “Blood Sugar Testing” and “Blood Pressure Testing” to promote awareness of and access to these services.
Eventually, students decided to stop printing the educational pamphlets because of the high cost and lack of effectiveness with homeless people. The executive team determined that a meaningful conversation with homeless people was more mutually beneficial than handing out excessive pamphlets. This change decreased the budget required for this project from about $150 per event to $50 per event. Cash donations from the MacEwan University local chapter of the Canadian Nursing Students’ Association (CNSA) and Faculty of Nursing were greatly appreciated, and the equipment was borrowed from MacEwan’s Clinical Simulation Centre.
In fall 2016, students started in the foot care clinic. During recruitment of student volunteers, students are given the choice of the foot care clinic or the health promotion booth. The foot clinic is managed by registered nurses who recruit licensed health care providers (physicians, occupational therapists, and nurses). It was necessary to determine the students’ roles and responsibility in the foot clinic. It was determined, from a liability perspective, that students were not allowed to provide basic foot care, as it could be offered only by licensed health care professionals. It was then decided that students could wash the feet of the homeless people who had been triaged to see podiatrists. Typically, 3 students work 3-hour shifts.
A faculty member supports, facilitates, and challenges executive student members in managing this volunteer project. This faculty member recruits other members to support students during the event. The faculty member also ensures a smooth transition between student executive groups.
Each event prepares students and faculty and offers insights for future practice. For example, a woman complained about service providers’ inappropriate judgmental comments about lice in her hair and was guided to an Indigenous community agency for support. These moments are critical for students and faculty to reflect on and to inform their future nursing practice.
In the last 9 Homeless Connect events, about 270 students have participated. Typically, 26 student volunteers and 4 to 5 faculty volunteers participate at each event. The student volunteers build networks with approximately 5 community agencies. We engage approximately 150 to 160 homeless people for blood glucose testing and 50 to 60 for blood pressure testing.
Nursing students volunteer in the foot clinic working with an interdisciplinary team; that team provides foot care to about 175 homeless people. The nursing students wash the feet of about 50 homeless people before these see advanced foot care practitioners. Organizers for the foot clinic are grateful for the students’ contribution.
The most significant result of this ongoing project is those students who choose careers with agencies that serve the homeless population. Students’ perceptions of the possibility of diverse nursing practice settings are enhanced. Other significant results include the students’ pride in leading and managing a community volunteer project, their willingness to participate with a vulnerable and diverse population, and their networking with other community agencies.
The administration of this project is formally transitioning to the local CNSA chapter to ensure greater stability and sustainability between student executive groups. An initial meeting has been held, and volunteers have been identified to take on the executive positions in fall 2019. Principles going forward are (a) to keep this project simple and easy to organize and manage for and by students; (b) to ensure that students are represented on the executive from all years; and (c) that faculty should provide direct supervision for activities on the event day.
Acknowledgments: Cat Wilde was the 4th-year student who, in spring 2015, started this project for students and faculty. We especially thank the local CNSA chapter for financial support, the Clinical Simulation Centre for the use of equipment, and the Faculty of Nursing for financial support.
Gaetz, S., Dej, E., Richter, T., & Redman, M. (2016). The state of homelessness in Canada 2016. Toronto: Canadian Observatory on Homelessness Press. ISBN: 978-1-77221-057-6.
Homeless Connect Edmonton. (2019). Home Page.
Homeward Trust Edmonton. (2019). Home Page.
Turner Strategies. (2018). 7 cities on housing and homelessness: 2018 Alberta Point-in-Time Homeless Count Technical Report.