Scoping review: Scope of practice of nurse-led services and access to care for people experiencing homelessness.
Lucy McWilliams, Martha Paisi, Sandy Middleton and 5 others
PMID 35894221WHAT IT FOUND
Nurse-led services for adults experiencing homelessness were broad, from wound care and vaccination to case management and advocacy.
Trauma-informed, consistent, non-judgemental care and practical help with appointments were reported to improve access.
Key findings
01Nurse-led services for people experiencing homelessness covered physical and mental health assessment, pathology collection, wound care, vaccination, case management, care coordination, referrals, accompaniment and health education.
02Access to care was described as facilitated by trauma-informed and consistent nursing, adapting presentation to the setting, autonomous and flexible practice, help navigating services, accompaniment and advocacy.
03Access was hindered by fragmented services, rigid appointment rules, administrative requirements, stigma, distrust, competing priorities and limited resources.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only English-language peer-reviewed studies, so relevant non-English studies and grey literature were missed. Participants were restricted to adults aged 18 years or more, so it does not address children, youth or family homelessness. The included studies used very different designs, settings and outcomes, and several had incomplete data or unclear allocation, so the evidence is not strong enough to show that nurse-led services improve access. No comparison or control was included, and the review states no firm conclusions can be drawn about the association between scope of practice and access to care. It is a scoping review, so it maps the range of practice rather than testing effectiveness.
Declared interests
This work was supported by a research grant from the St Vincent's Health Australia Inclusive Health Fund. The funder did not play a role in any part of the review process or the decision to submit. The authors declared no conflict of interest.
The easy way to misread this
Do not read this as proof that nurse-led services improve access or health outcomes. It is a scoping review of heterogeneous descriptive studies, and the authors state no firm conclusions can be drawn about the association between scope of practice and access to care.