A Qualitative Study Exploring Nursing Scope of Practice for the Care of People Experiencing Homelessness

To explore the key knowledge, skills, attributes and organisational support that nurses require to optimise their scope of practice when providing care to people experiencing homelessness.

A qualitative descriptive study exploring nurses' scope of practice for addressing health needs of people experiencing homelessness.

Interviews and focus groups were conducted from 2022 to 2024 with 42 people with lived experience of homelessness across two Australian cities. Thematic analysis identified essential skills, attributes and approaches to improve access to care and eliminate stigma. Findings were then presented in focus groups with 11 registered nurses in specialist homeless health services to elicit views on optimising scope of practice. The study follows COREQ reporting guidelines for qualitative research.

Lived-experience participants-ranging from 18 to 84 years, a third living in cars or tents-identified key nursing attributes and practices, including approachability, compassion, non-judgement, flexibility, community embeddedness, trauma-informed and culturally safe practice, plus skills in physical and mental health assessment, medication management and service navigation. Nurse participants agreed with lived-experience participants, and highlighted organisational support needs, including information sharing, clinical supervision, assertive outreach, nurse prescribing and long-term funding for nurse-led programs.

With rising housing instability, preparing nurses to optimise access to care for people experiencing homelessness is critical. Optimal scope of practice includes personal attributes to build rapport and reduce stigma alongside clinical skills. Co-developing educational programs in partnership with people with lived experience of homelessness and homeless health nurses offers a promising approach.

This research informs the scope of practice definitions and the future development of a co-developed nursing education pathway and organisational framework to improve access to care for people experiencing homelessness in Australia.

Limited patient and public involvement was incorporated and focused on providing feedback on interview guides.