Disucuss about the history of substance use and there stuck in psychiatric hospitals due the fact they are homeless the ethic issue there whats need to be done if its right or wrong.
In the field of nursing, homelessness among psychiatric and substance abuse patients is a critical issue to consider. The state of being homeless among addicts might be characterized by the illness or other co-occurring disorders such as antisocial personality disorders. Homelessness can be defined as the state of living in unsuitable accommodation which might be overcrowded, living in friend places, in temporary structures or the streets. In most cases, the substance abuse patients that are affected by homelessness are probably single with few or no close friends and family members. Thus, most of them reside in temporary and unsafe accommodations that may expose them to health hazards and irrational behaviors in the society. Thus, this paper will discuss and provide a personal reflection and individual views on whether it is ethically right for the recovered and homeless patients to be accommodated in the hospitals and with people who used to be addicts.
Other than homelessness, most of the patients with substance abuse disorders are unemployed. Therefore, they are at a higher probability of facing health disparities in health facilities. Due to such circumstances, nursing ethics are important in ensuring that the homeless patients receive maximum health care and accommodation before they are released from healthcare facilities. There is a still a question of whether the treated homeless and recovered patients should be released from the hospital or sustained with members who used to be addicts until their residential issues are solved ((Rae, 2015).
Homelessness as an issue in the field of nursing has its major cause. Research reveals that there is a significant connection between addiction and homelessness. Also, the connection is reinforced by despair and withdrawal emotions. Unlike other co-related factors, homelessness is primarily influenced by drug and substance abuse. Before the patients diagnosed with substance abuse disorders and mental breakdowns are declared homeless, most of them have a family, friends or other people to relate to until drug abuse become their daily practice (Johnson, 2008). On the other hand, some journals written by different researchers are conducted reveal that there are some probabilities of homelessness leading to substance abuse which later cause addiction. In any case, substance abuse is more common in the homeless population than to the normal population. Research conducted in Europe reveal that about thirty-eight percent of the homeless population consume alcohol more frequently than the general population (Tsemberis, 2010).
Additionally, the abuse of alcohol is more prevalent among the older individuals in the homeless population. Correspondingly, it has been established that about twenty-six present of individuals in the homeless population abuse a variety of other drugs other than alcohol in the European countries. In general, statistics reveal that the younger homeless individuals are more associated with drug and substance abuse that lead to addiction and mental breakdown (Pleace, 2011). Additionally, results of a research conducted to determine the major cause of homelessness revealed that sixty-eight percent of the homeless individuals characterized by substance abuse were single adults. Two-thirds of the interviewed persons under the same category testified that substance abuse, especially alcohol, was a major reason for their homelessness. Additionally, the number of military veterans associated with homelessness suffered from substance abuse disorder as well as mental breakdowns.
Apart from substance abuse, stressful situations in life which include domestic violence, traumatic harm, and loss, devastating medical condition, disastrous financial loss among others. Such issues lead to substance and drug abuse as well as homelessness to stay away from the stressful conditions. Abuse of drugs among the homeless population in Europe is highly characterized by critical mental illness (Toro, 2007). Such issues make it much hard for individuals to access and maintain appropriate, affordable and stable housing for individuals together with their families.
Diagnosis conducted by nurses and other healthcare providers in Europe reveal that most homeless addicts became absorbed into alcoholism at their young stages of life. The major cause of such dependency could be traced from child abuse subjected to them by their parents and guardians (Philippot, 2007). Research also implied that alcoholic parents parented two-thirds of the recovering patients. Also, most of them suffered from mood disorders, anxiety, and psychosis. The condition of homelessness among the patients resulted from substance abuse. Also, prioritizing for alcoholic needs led to the incapability of meeting the basic needs thus leading to chronic homelessness which they refer to it as free. Depressions and frustrations among patients with mountains of problems to solve propel them to more alcohol abuse as well as mental breakdowns.
Moreover, research conducted in Europe reveals that less than twenty-five percent of the homeless addicts of drugs and substances are likes to benefit from high-quality health services from the European health facilities. Therefore, it is fundamental for health facilitators to address the condition of the mentally ill and addict homeless individuals in a more critical manner. According to research conducted on treatment of homeless addicts, it is realized that a stable and a proper living setting is a fundamental aspect of the recovery process of the patients (Dolan, 2016).
As the nursing ethics imply, experienced, compassionate and flexible care form nursing staff is vital to a recovery program for recovering homeless individuals from mental breakdown and addiction to alcohol and other drugs. Also, provision of healthcare by multidisciplinary professionals would ensure that thorough and effective care was subjected to the needy homeless patients (Roche, 2017). Moreover, the environment or accommodation provided by the health facilities would be important in providing other complex necessities of a homeless person such as social need and survival.
The research conducted on treatment mechanisms subjected towards the mentally ill and homeless addicts imply that there is a need for a good and conducive environment as well as high-quality care from nurses and other healthcare providers. There is a higher probability of addicts to recover better and more effectively under proper household than those dispatched immediately after treatment and without an appropriate condition of housing. Therefore, there is a need for nurses to consider admitting homeless patients are recovering from substance abuse and mental breakdown other than releasing them to walk away (Woith, 2017). Such patients may experience a relapse at a very high rate since similar incidences that led to the occurrence of such disorders revolve around them in their daily lives.
However, there are various attitudes exhibited by nurses towards patients from the homeless populations. The attitude may have some negative effects towards quality healthcare. Although the nursing staff is bound by some codes of conduct that ensure care is provided equally among all needy patients, it is still difficult to identify how they are achieved while treating the homeless population. It is also not known how attitudes portrayed by nurses affect the access to care by the homeless patients (Boyd, 2016).
Research conducted by Scottish executive (2009) implies that homelessness is one of the major causes of health disparities and inequalities. Hence various policies imply that there is a need to improve the conditions of homeless individuals. The research implied that it requires collaboration between housing and care providers, homelessness prevention, and objection to inappropriate discharge of homeless people from the hospital. For example, in Scotland, round forty-one thousand individuals were declared homeless by 2008 compared with forty thousand individuals reported by the year 2003 (Van, 2015). The statistics prove that there is still a high probability of homelessness among many individuals who are propelled to drug and substance abuse as well as mental breakdowns. Thus, the latter makes the homeless population a relevant subject of consideration to nurses. Although it is difficult for nurses to verify the population of the homeless patient at any time due to people movements, it is their mandate to ensure that patients are not discharged inappropriately from healthcare facilities.
The international council of nurses established a code of ethics that implies that nursing should be respectful and unrestricted in matters pertaining age, creed, color, culture, illness, disability, sexual orientation, age, race, nationality, social status, and politics. Similar requirements are observed by the nursing and midwifery council standards of conducts (O’Donnel, 2017). The organ implies that nurses should show a professional and personal commitment to diversity, equality, and lack of discrimination despite the fact that some patients might be poor.
In studies conducted by Wen et al. (2007), he implies that there is a probability of homeless patients in psychiatric facilities to misinterpret attitudes revealed by nurses as negative. Of any ten interviews conducted, six homeless were positive that nurses have some negativity towards homeless patients because they were poor. However, Wen et al. (2007) imply that a higher prevalence of mental breakdown among the patients predicted the received outcomes of the interview. However, research conducted by Price et al. (1989) revealed that fifty-eight percent of nurses believed that homeless ladies became expectant with the aim of claiming welfare payments (Gabrielian, 2015). Also forty-three percent most homeless patients were taking advantage of care provided in healthcare facilities while all nurses concurred that most homeless patients targeted benefits with at most dishonesty (Beaton, 2015).
Moreover, all nurses imply that they are of service of to every needy individual irrespective of their social, physical or economic status. Further research also implied that homeless people feel disempowered and ignored by healthcare providers. Buber (2004) also suggest that most homeless patients aiming at recovering from a mental breakdown and substance abuse were identified with object prepositions such as `it’ and `that.’ It made them feel neglected and treated as objects (Kukreti, 2016). Furthermore, such treatments were exhibited by nurses were different in the case of the general population. It is also noted that negative nurses’ attitudes act as a barrier to many homeless and addicted patients who avoid medical procedures to avoid such humiliations. Also, some become victims of relapse after the negative attitudes are subjected to them.
In my perspective, honest homeless patients recovering from mental breakdowns and substance abuse disorder should be granted the proper accommodation. As the international council of nurses suggest, every patient regardless of their tribe, financial status, race, and other factors have the right to high-quality care. It should include accommodation and other necessities to facilitate an active recovery process. However, discharging homeless patients to the streets is an inhuman and against the code of conduct of nurses. Providing accommodation to the homeless in the same environment with patients who have recovered from drug and substance abuse would encourage them to progress positively with the provide healthcare services. However, sending them away would slower their healing process, and some patients would turn from bad to worse conditions.
As discussed in the context, nurses have a major role to play in the health of the mentally disordered addicts and homeless individuals. The attitude they exhibit should aim at attracting or encouraging more homeless patients towards proper and effective treatment. The negative attitude towards homeless patients acts as barriers toward healthcare provisions. The probability of patients experiencing a relapse due to negativity exposed by nurses is still high. Research conducted on nursing students reveal that most nurses might have had some negativity when providing services to patients. After providing care to a few homeless patients, their attitudes towards them have changed, and the urge to provide care to more patients have also increased. Hence, the personal attitude of nurses towards providing quality healthcare to homeless patients is important as far as code of conducts and ethics are concerned.
On the other hand, homeless patients have a role to play as matters pertaining health is concerned. Submission to correction and recovery program would be fundamental for homeless and recovering patients. They provide ease to nurses in providing maximum care. Cooperative patients are the key to proper therapeutic relationships established between them and nurses. Correspondingly, honesty is a primary aspect of any nursing. Strategies for identifying honesty and needy homeless patients who are not targeting resources and benefits from health facilities should be established. Since statistics show an increase in the number of homeless individuals with substance abuse disorders, relevant health facilities and organs that regulate its prevalence should reflect on the critical or chronic situations faced by homeless individuals. They should ensure that nursing ethics and other policies are followed and efficiently implemented to control the spread of the problem.
In conclusion, it is clear that Europe has faced an increase in the number of homeless individuals associated with substance abuse and mental breakdown. Stress conditions caused by domestic violence, unemployment, and engagement in military activities has led to drug and substance abuse which results to SUD. Prolonged drug abuse is a major factor that has led to homelessness and mental disorders as correlating factors. Also, nursing ethics are also significant in determining the quality of care provided to the homeless patients. A negative attitude is a major barrier towards the provision of high-quality healthcare services. Ethics also ensure that every patient has a right to good health care without being discriminated by any means. Thus, it sheds light on homeless individuals that adequate services that include accommodation should be offered in the whole process of recovering from substance use disorders as well as mental breakdowns.
References
Beaton, L., Coles, E., Rodriguez, A., & Freeman, R. (2015). Homeless People in SCOTland: a process evaluation of a Community–based oral Health intervention-the findings of a pilot study from 4 NHS Boards.
Boyd, J. E., Bassett, E. D., & Hoff, R. (2016). Internalized stigma of mental illness and depressive and psychotic symptoms in homeless veterans over 6 months. Psychiatry research, 240, 253-259.
Dolan, A. (2016). Examining the increase of families becoming homeless in Ireland and the effect on child wellbeing.
Gabrielian, S., Bromley, E., Hellemann, G. S., Kern, R. S., Goldenson, N. I., Danley, M. E., & Young, A. S. (2015). Factors affecting exits from homelessness among persons with serious mental illness and substance use disorders. The Journal of clinical psychiatry, 76(4), e469.
Johnson, G., & Chamberlain, C. (2008). Homelessness and substance abuse: Which comes first?. Australian Social Work, 61(4), 342-356.
Kukreti, P., Khanna, P., & Khanna, A. (2016). Chronic Mental Illnesses and Homelessness. Chronic Mental Illness and the Changing Scope of Intervention Strategies, Diagnosis, and Treatment, 1.
O’Donnell, P. (2017). Engaging with homeless patients. InnovAiT, 10(11), 693-696.
Philippot, P., Lecocq, C., Sempoux, F., Nachtergael, H., & Galand, B. (2007). Psychological research on homelessness in Western Europe: A review from 1970 to 2001. Journal of Social Issues, 63(3), 483-503.
Pleace, N. (2011). The ambiguities, limits and risks of Housing First from a European perspective. European Journal of Homelessness, 5(2).
Rae, B. E., & Rees, S. (2015). The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care. Journal of advanced nursing, 71(9), 2096-2107.
Roche, M. A., Duffield, C., Smith, J., Kelly, D., Cook, R., Bichel?Findlay, J., … & Carter, D. J. (2017). Nurse?led primary health care for homeless men: a multimethods descriptive study. International nursing review.
Toro, P. A., Tompsett, C. J., Lombardo, S., Philippot, P., Nachtergael, H., Galand, B., … & MacKay, L. (2007). Homelessness in Europe and the United States: A comparison of prevalence and public opinion. Journal of Social Issues, 63(3), 505-524.
Tsemberis, S. (2010). Housing first: The pathways model to end homelessness for people with mental illness and addiction manual. Hazelden.
Van Straaten, B., Rodenburg, G., Van der Laan, J., Boersma, S. N., Wolf, J. R., & Van de Mheen, D. (2015). Substance use among Dutch homeless people, a follow-up study: prevalence, pattern and housing status. The European Journal of Public Health, 26(1), 111-116.
Woith, W. M., Kerber, C., Astroth, K. S., & Jenkins, S. H. (2017, July). Lessons from the Homeless: Civil and Uncivil Interactions with Nurses, Self?Care Behaviors, and Barriers to Care. In Nursing forum (Vol. 52, No. 3, pp. 211-220).
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