Microsoft Word - Garner_377-2039-1-ED.docx Online Journal of Rural Nursing and Health Care, 2015(1) http://dx.doi.org/ 10.14574/ojrnhc.v15i1.376 4 Reducing Barriers to Healthcare for Rural Homeless Individuals and Families: Experiences of Community Health Nursing Students Presented at the 2014 International Rural Health & Rural Nursing Research Conference Co- Sponsored by the Montana State University College of Nursing and the Rural Nurse Organization (RN0). Linda Garner, PhD, RN, APHN-BC, CHES 1 1 Assistant Professor, Department of Nursing Southeast Missouri State University lgarner@semo.edu Reducing Barriers to Healthcare for Rural Homeless Individuals and Families: Experiences of Community Health Nursing Students Purpose The purpose of the project was to organize a wide variety of services in a central location for homeless individuals and families in a rural setting. The project was designed to reduce barriers and offer services in one day that would ordinarily take months. Numerous partners from the rural community were involved in the planning and implementation of the project, including the Department of Nursing from a local university. Twenty-eight community health nursing students were integrated into the project as a pilot study to explore the effectiveness of this type of hands-on service learning experience. Background Experiential learning opportunities enhance student understanding of complex health issues in a variety of populations. Service learning affords the opportunity to match student and community needs. Through an organized service activity with a defined target population, students come to Online Journal of Rural Nursing and Health Care, 2015(1) http://dx.doi.org/ 10.14574/ojrnhc.v15i1.376 5 understand the unique needs of the population within the context of a specific community’s resources. Description Student preparation involved focused reading assignments and group discussions regarding the unique health issues found in homeless populations. Emphasis was placed on how the face of homelessness often looks different in a rural versus urban setting. Based on the findings from a recent community assessment, students developed a variety of prevention and health promotion activities designed to address the specific needs of the homeless population. A modified version of the Attitude Towards Homeless People Scale developed by Zrinyi and Balogh (2004) was administered to the students as a pre- and post-event measure. Students also completed a post- event written reflection activity. Throughout the event, students conducted an initial health history for each incoming client, assisted clients in identifying their priority needs, and guided individuals and families from one station to the next. In collaboration with other healthcare providers, students assisted with activities such as HIV and Hepatitis B/C screening, administration of flu, tetanus, and pertussis immunizations, diabetes education, and blood pressure screenings. Students also provided oral hygiene education, application of dental varnish, and assisted with teeth extractions through use of the University’s mobile health clinic on wheels. Students rotated through the various stations throughout the day to gain different perspectives about the health services being provided and the population they were serving. Outcomes Students were less afraid of homeless people after their participation in the event (p< .01). Even though data analysis did not demonstrate a statistically significant difference in the student Online Journal of Rural Nursing and Health Care, 2015(1) http://dx.doi.org/ 10.14574/ojrnhc.v15i1.376 6 attitudes regarding homelessness as a social versus health issue, the post-event means were higher on both measures. The majority of students (79%) felt their understanding of vulnerable populations increased as a direct result of participation in the event. Additionally, 86% of the students felt the experience met the stated learning objectives. With the exception of dental services, students also felt the event met the needs of the 200+ homeless individuals who participated in the event. Qualitative themes from the reflection activity indicated that students were mostly unaware of the homeless population within their community. Students also reported that, prior to the event, they had not interacted face-to-face with an individual who was homeless. Factors that contribute to and sustain health disparities in the rural region were also described, including lack of accessible resources, low paying and limited jobs, lack of public transportation, low health literacy, language barriers, lack of healthcare insurance, and geographic challenges in the more remote parts of the region. Students also described their perceptions of the relationships between health outcomes, prevention education, health screenings, and referrals. Conclusion This pilot study demonstrated that an organized service learning experience for community health nursing students increased their understanding of vulnerable populations in a rural setting and decreased their fear of working with homeless individuals and families. Future studies with a larger sample size are needed. No external funding was received for completion of this study.