Self-identified health concerns of two homeless groups.

A number of conclusions can be drawn from the themes derived from the interview data. First, even though the most basic physical needs, such as food, clothing, and shelter were being met, a recurring theme from the responses of the homeless was the need for interaction with a caring person. The feeling that no one cares, a lack of self-worth, and a sense of limited control over their lives may lead to depression, hopelessness, and finally illness. The extent and effectiveness of health-seeking behaviors among this group are limited because of decreased trust, decreased motivation for self-care, and isolation from social and health care systems. Second, if health needs are to be met, services must be provided in sites where they can be accessed by the homeless. For transients, health care services may be provided most effectively through the shelters. For the SRO residents, these services could be provided through a combination of clinics in hotel lobbies and visits to rooms. Third, developing trust with the homeless includes meeting their self-perceived basic needs. What may seem like nonnursing activities, such as fixing a meal, may be important in establishing rapport with SRO residents. If a nurse assists a homeless person to meet survival needs, that person may be more willing to deal with health issues. Fourth, the population is highly heterogeneous. Each subgroup has its own identity. Most SRO residents do not want to be identified with street people, even through a portion of them move between street life and SRO life. Health care professionals need to recognize these differences, accept the life-style of each subgroup, and respect each homeless person as a unique individual. Finally, caring is the primary element necessary in providing nursing services to the homeless. Awareness and understanding of the homeless way of life will increase nurses' effectiveness in working with this ever growing population.