What opportunities do nursing students have to learn about health and homelessness?

Where you live is one of the biggest influencing factors on how healthy you are. In the UK, a person experiencing homelessness has a life expectancy around 30 years below the average.

The QNI believes that every student nurse should have opportunities to learn about health and homelessness. Our Homeless Health Network enables people to share news, resources, and attend free learning events on this and related subjects.

What do nursing students currently learn?

Given the importance of housing to health, the QNI was curious to discover what student nurses currently learn on their programmes of study in relation to the impact of homelessness on health. Over the summer, the QNI invited every programme lead at all 68 NMC approved BSc Nursing programmes in England, Wales and Northern Ireland to complete a survey. The results are available to read in this paper: National Scoping of Homeless and Inclusion Health Nursing Education

Different approaches

The results show a real diversity in approaches to covering this issue. Just two universities had a specific module on homeless and inclusion health, and some involved service users, to hear their experiences of healthcare.

The QNI learnt that while six universities offered no hours at all of dedicated learning time to homeless health issues, six offered more than one week of learning during their programmes. Interesting approaches from these included:

• a health inequalities module focused on marginalised sections of communities,
• a module on homelessness, refugee, Traveller, and Prison health (including placements in offender institutions),
• a full day meeting with homeless service users and asylum seekers,
• a module on anti-oppressive practice, conflict management and empowerment using enquiry-based learning and
• a case study of a man who is homeless, and recovering from an episode in hospital and needing to be discharged which informs workshops, case studies, scenarios and reflection.

Placements in homeless health settings

Just under half the universities who responded to the survey offered placements in homeless and inclusion health. The placements varied from a six week placement with homelessness charity St Mungo’s, placements with local homeless health teams, to working alongside GP specialists. For the universities offering no homeless and inclusion health placement, barriers to placement availability included; the current NMC requirement that student nurses have to be supervised by a registered nurse, not having a qualified mentor who can sign off their competencies in these settings and not having access at the moment to the required local homeless charities who could facilitate a placement.

Being proactive

The more proactive universities identified a series of steps they had taken to improve their curriculum or approaches to the teaching of homeless and inclusion health, which had a demonstrable impact.

One university holds a session on homelessness and inequality between men and women, and the new nursing students set up a local campaign based on the national campaign Helping Handbags to support women with sanitary products in times of crisis.

Another course includes a Humanising Nursing Framework which involved small groups of students talking with service users and people who had experienced homelessness, which was very well evaluated by students and service users. A separate university adopts a similar approach called World Café where students could share experiences, ask questions of service users and people who work in the field and develop knowledge. Some have since arranged their own placements with world café facilitators.

One university asks students to develop public health resources and a commissioning project for service evaluation and many elect to focus on homelessness and inclusion health, helping to develop different skillsets at different levels of the health system, and another offers a wide variety of relevant placements, and allows students to develop innovation projects.

Why the variety?

The amount and type of homeless health information on nursing programmes varies substantially between different universities. This could be due to where the universities are located, the relationship between the university and local homelessness organisations, the number of local trained nurse mentors working in homeless/inclusion healthcare with capacity for placements, and the expertise of course tutors and mentors.

Having done this work, the QNI hopes more universities will be encouraged to share knowledge, commit more to this area and aim for more consistency when educating nursing students around homeless health. The QNI would like to see courses commit to supporting service users to share their experiences as part of the course.

A lack of suitable housing puts people at high risk of poor health, with no environment suitable for recovery from ill health. Therefore, a wider understanding of homelessness and the risks is an essential quality for a nurse in hospital or the community.