Staying connected: the core of facilitating health care for homeless persons

A grounded theory study explored the ways nurses and others in nurse-managed shelter clinics facilitate health care for homeless persons. Analysis of in-depth interview and participant observation data yielded a core category, "staying connected," that represents the essence of what the staff do to facilitate care for homeless persons. The three most important aspects of "staying connected" are the links that nurses establish with the homeless patient, the connections nurses establish in the form of networks with other providers, and facilitation of the homeless person's connections with the health care system. The nurses' descriptions of "staying connected" demonstrate the barriers to facilitating health care and the breakdowns that occur while trying to facilitate care for homeless persons. The barriers include lack of health insurance, insensitivity of health care providers towards homeless persons, stigmatization, cultural barriers, and communication breakdowns. Homeless persons are socially, economically, and politically vulnerable in the American health care system. Nurses have a powerful influence, both macro- and micro-socially, in facilitation of care for this population.