HOMELESS INDIVIDUALS' PERCEPTIONS OF EMERGENCY DEPARTMENT STAFF

Purpose: The goal of this study was to understand how the homeless perceive medical professionals in the Emergency Department (ED) based on their unique experiences, thoughts and emotions. Much research has been conducted on the perceptions nurses, doctors and other medical personnel have of the homeless; however, little research exists on the homeless population's perception of health care professionals. Furthermore, this study aims to determine an overall sense of welcomeness or unwelcomness from the participants by uncovering repeating themes, patterns and concepts.

Background: Homelessness is a misunderstood condition involving stereotypes, stigmas and assumptions. The combination of acute-care medical professionals with patients of chronic illness and chronic homelessness can lead to incongruity of attitudes. These mindsets have the potential to affect the care homeless individuals receive in the ED and impact their intentions to seek medical help (Ugarriza & Fallon, 1994). Homeless individuals account for 54.5% of all ED visits in the United States, and, they are three times more likely to visit an ED than a non-homeless individual at least once during the year (Kushel et al., 2002). Understanding the perspective of the patient has the potential to clarify existing barriers to care as well as identify areas of improvement for ED staff necessary for positive patient outcomes when working with homeless individuals.

Methods: A qualitative descriptive approach was utilized. After receiving Institutional Review Board (IRB) approval, 10 participants from a Day Resource Center which neighbors a homeless shelter in a southwest urban city were recruited into the study and participated in an interview. A script consisting of open–ended questions formatted around the apriori categories of welcomeness and unwelcomeness was used; prompting questions were used to clarify or redirect. Responses were transcribed by the researcher during the interview.  Utilizing content and thematic analysis, interview transcripts were coded and reoccurring patterns were isolated, resulting in generalizations regarding the perceptions of welcomeness and unwelcomeness. Interviews were conducted until no new themes were emerging from the data.

Results: There were three themes that supported the concept of welcomeness; trust, genuine care and feeling like a priority. Additionally, there were four themes that supported the concept of unwelcomeness; dehumanization, feeling dismissed, unresolved care and stereotypes. Findings support significantly unwelcome experiences in the ED and negative perceptions of ED staff, reinforced by similar findings of current research studies.

Implications: Given the supporting literature, negative ED experiences have the potential to steer homeless individuals away from seeking medical attention. This antagonizes health promotion and illness prevention and slows efforts to decrease overcrowding in emergency departments and improve patient outcomes. Findings from this study can inform ED nurses of the perceptions of their homeless patients and promote positive interactions and experiences of welcomeness. Further research is needed to create interventions for improving perceptions of ED staff, promoting health and preventing illness in the homeless population, and reducing ED visits by homeless individuals.