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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.
To explore the published literature on nurse/midwife and peer worker collaborations in healthcare services.
Scoping review and narrative synthesis.
The framework proposed by Levac et al. was used. PubMed, CINAHL, MEDLINE, Scopus, and Embase databases were systematically searched, and results uploaded to Covidence for screening against inclusion criteria. A critical narrative synthesis of included studies was conducted, guided by Popay et al.
Sixteen studies from five countries met the inclusion criteria. They examined peer worker and nurse/midwife collaboration across diverse settings including cancer, HIV, mental health, and community services. Findings indicated that nurse/midwives and peer workers valued the distinct forms of expertise they contributed, which enhanced care. Tensions in collaboration related to clinical dominance and control in hierarchical structures, challenges navigating scope and role boundaries, and mistaken notions of what constitutes ‘successful’ peer work. Peer workers and nurses/midwives could be ‘close strangers’ with little opportunity to build genuine rapport.
Successful collaboration requires attention to power dynamics within healthcare cultures and opportunities to connect and understand each other's disciplinary expertise. Identifying strategies to optimise partnership and mobilise collective strengths has the potential to further enhance care.
Peer worker or ‘lived experience’ roles within healthcare services have rapidly expanded. Our study highlights the benefits of peer worker and nurse/midwife collaborations and areas that require attention, including recognition of peer worker and nurse/midwife roles and responsibilities in the healthcare setting and effective integration of peer workers into existing healthcare teams. Importantly, strategies should be developed to address disparate power dynamics between nursing/midwifery staff and peer workers as these impact workforce relations and capability. Addressing these key areas will strengthen collaboration between nurses/midwives and peer workers, improve healthcare provision, and ultimately benefit service users.
This study highlights the tensions arising when nurses/midwives and peer workers carry out duties alongside each other, as well as factors that can promote effective collaboration. Successful collaboration in healthcare necessitates addressing power differentials, fostering mutual understanding, and providing the tools, training, and inclusive environments needed for nurses/midwives and peer workers to work together effectively.
This scoping review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) extension for scoping reviews.
Our authorship team includes experts with experience in peer work and supervision of peer workers, and designing and implementing peer-led interventions within health and community service settings.
To explore the perceived impact of a nurse-led domestic and family violence service on access to care.
Delivered from a metropolitan community based not for profit organisation, this nurse-led service provided a multidisciplinary response to meeting the needs of women, and or women and children experiencing the consequences of domestic and family violence and homelessness. This involved integration of specialist community services to support women's safety planning, housing, and mental health.
A mixed methods single-site study was conducted.
Routine patient attendance data were analysed to identify service use. Semi-structured interviews with service providers and key stakeholders explored perceived service impact on access to care.
Data were collected over 2.5 years from n = 233 women experiencing domestic and family violence, of whom 28% (n = 64) identified as First Nations, and 26% (n = 61) had at least one dependent child. The nurse facilitated access through referrals, and care navigation, often driving and accompanying women to their appointments. Person-centered and trauma sensitive approaches were highly effective in gaining trust. Qualitative data themes were, care environment, macro context, care outcomes and person centeredness.
Stakeholders' perspectives highlight the need to improve health professionals' capability to respond effectively when women disclose domestic and family violence. The success of this nurse-led service was its capacity for flexibility, which meant it could address women's unmet health needs in most environments and directly facilitate their access to mainstream healthcare and social supports.
Accessing healthcare is extremely challenging for women experiencing domestic violence in Australia. The nurse-led specialist service provided much needed support to women experiencing domestic and family violence and to health professionals within the broader organisation, to improve access to care. Optimising the nurse's scope of practice in terms of authority to refer for investigations and prescribe medications, would further increase access to care.
This study has been reported using the Consensus Reporting Items for Studies in Primary Care (CRISP) checklist.
No Patient or Public Contribution.
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