Summary
The research question addressed in the given summary table is whether homeless shelters should provide nursing and other medical services to their residents. The search for articles was based primarily on the issues they addressed: they all concern the issue of health care for homeless people and try to single out the most optimal models of it. The research question we try to answer requires a multidimensional perspective, which is why the articles overview the issue from diverse points.
The levels of evidence are necessary to consider when making a research since they are an undebatable cornerstone of evidence-based approach. Biases and unscrupulousness in evidence can mislead other researchers’ findings whereas a high-quality piece of evidence can provide a solid ground for further interpretation. Which is why two of the sources on this list have deployed control groups and are Level IV (Lynch et al., 2015; Wang et al., 2015). It does not necessarily mean that the other two sources are lower-quality since they are descriptive and are Level VI (Chong et al., 2014; Greysen, Allen, Lucas, Wang, & Rosenthal, 2012). They were chosen mainly because the findings presented are relevant and reflect the goal of the research. As for the designs, the studies use descriptive, case-control, and cross-sectional ones; again, the design of these studies does not determine their value.
Overall, the findings suggest that homelessness and healthcare are intertwined and make up a complicated issue. On the one hand, there are possibilities to address the problems concerning homeless health care and nursing. For example, it is estimated that a significant part of homeless with health issues and comorbidities are non-adherent to hospitals for whatever reason (Chong et al., 2014). In their turn, Greysen et al. (2012) find out that the majority of such patients do not feel hospitals meet their housing needs, with a significant part of them not adhering because they are forced back into the shelters immediately post-discharge. These results show there is a significant conflict between the homeless patients’ needs and how hospitals address them. On the other hand, the majority of homeless patients adhering to ED use it inappropriately, meaning their cases are either avoidable or non-emergency (Wang et al., 2015). By stating this, the authors of the research do not wish to put the blame on any of the parties involved; rather, their study demonstrates that the patients in question are under-educated about their opportunities. Speaking of which, there is a proof that nurse-guarded homeless health care can be implemented in shelters (Lynch et al., 2015). The results can at first appear insignificant and humble considering that homeless patients tend to move from one shelter to another which brings into question the whole idea of institutionalized nursing care, locally. Still, the concept of health screening appears perfectly utilizable. Nevertheless, the initial research issue formulated above cannot be answered directly, as yet. It can be estimated that the shelters are capable of providing health care services but whether they should do it remains questionable and requires additional literature study.
The sampling in all four sources appears adequate; every research team relied on what they could find and afford and selected their groups in accordance with their topics. In the first two sources the scope seems smallish which is why the findings should be interpreted cautiously. The study of ED admissions by Wang et al. (2015) provides the sample of more than 5,000 records – including recurrences – which is by far the most extensive one on our list. Because a bigger sample facilitates a more exact result, this source might be regarded as the most reliable here.
As to the limitations, all of the enlisted sources have them, as the majority of studies do. Because their sample size is smaller than the others’, the first two articles can be limited in terms of findings exactitude. In turn, the studies by Greysen et al. (2012) and Wang et al. (2015) use members of a single community or institution as their samples. Among other limitations there is the undetermined duration of homelessness status, failure to access gender diversity as a critical factor, and the patients’ self-assessment as a source of information. However, these limitations can be overcome in further studies by expanding the samples and scope, including gender and marital status as variables, and retrieving the information about homelessness status and health conditions from record databases.
All in all, the evidence we have found in these studies is not quite enough to take moves towards any changes at once. The main question that we have formulated above cannot be fully answered y what was discovered. So far, as the findings imply, it can be stated that rendering medical services in homeless shelters can prove beneficial for the vulnerable class of people. The reason is that the homeless are either not educated about their opportunities, and misuse them as a result, or not addressed by hospitals in terms of their housing needs. Medical care provided locally could assist those who would otherwise remain unassisted, as the studies have shown. Whether and how exactly the issue should be addressed to benefit all parties involved requires subsequent and more detailed research.
References
Chong, M. T., Yamaki, J., Harwood, M., d’Assalenaux, R., Rosenberg, E., Aruoma, O., & Bishayee, A. (2014). Assessing health conditions and medication use among the homeless community in Long Beach, California. Journal of Research in Pharmacy Practice, 3(2), 56-61.
Greysen, S. R., Allen, R., Lucas, G. I., Wang, E. A., & Rosenthal, M. S. (2012). Understanding Transitions in Care from Hospital to Homeless Shelter: A Mixed-Methods, Community-Based Participatory Approach. Journal of General Internal Medicine, 27(11), 1484-1491.
Lynch, S., Wood, J., Livingood, W., Smotherman, C., Goldhagen, J., & Wood, D. (2015). Feasibility of Shelter-Based Mental Health Screening for Homeless Children. Public Health Reports, 130(1), 43-47.
Wang, H., Nejtek, V. A., Zieger, D., Robinson R. D., Schrader C., Phariss C.,…Zenarosa, N. R. (2015). The Role of Charity Care and Primary Care Physician Assignment on Emergency Department Utilization in Homeless Patients. American Journal of Emergency Medicine, 33(8), 1006-1011.