Research and practice development projects
An analysis of nurse-led COVID-19 interventions among homeless populations
COVID-19 presents health and healthcare challenges worldwide, including the need to protect vulnerable individuals/communities and to limit infection to and from these populations. Those who are homeless are particularly at risk from COVID-19. This research, which is funded by RCQPS, aims to examine the characteristics of a selection of nurse-led COVID-19 interventions among homeless populations in Ireland. Through analysing the strengths and limitations of these initiatives, the most effective practice in preventing, identifying and treating COVID-19 among homeless populations will be identified and communicated to guide practice and policy development.
Additionally, the research aims to capture inclusion health nurses’ experiences, perceptions and support needs in the context of COVID-19 to inform appropriate/useful clinical /psychological assistance. The research methodology involves a case study approach using mixed method data collection and analysis of five nurse-led COVID-19 intervention services among homeless populations. A questionnaire will be designed and administered to determine inclusion health nurses’ experiences, perceptions and support needs in the context of COVID-19.
Lead Researcher: Dr Briege Casey, School of Nursing, Psychotherapy and Community Health (SNPCH) Dublin City University (DCU)
Lead Knowledge user: Dr Fiona O’Reilly, Safetynet Primary Care
Postdoctoral Researcher: Dr Claire Cullen, DCU
Research Assistant: Eric Whelan, DCU
Co-investigators (Research): Dr Mary Rose Sweeney, SNPCH, DCU; Dr Denise Proudfoot, SNPCH, DCU;
Co-investigators (Knowledge users): Niamh Murphy, Dublin Simon; Emma Coughlan, Safetynet Primary Care; Maxine Radcliffe, Homeless Healthlink CHO7, HSE; Noelle Woods, Peter Mc Verry Trust; Chris O Donnell, peer researcher; Sarah Jayne Miggin, Inclusion Health, Mater Hospital; Anne Marie Lawlee, Inclusion Health St James’ Hospital.
Collaborators: Steve Pitman, INMO; Raul Menendez, Homeless Healthlink CHO7, HSE; Lydia Barry, Safetynet Primary Care, Sinead Grogan, Safetynet Primary Care; Caroline Mulqueen, Safetynet Primary Care; Lauren Fitzsimmons, Safetynet Primary Care; Michelle Connolly, Dublin Simon, Joao Amaral, Dublin Simon, Elizabeth Pena, Peter Mc Verry Trust.
Funding body: The Research Collaborative in Quality and Patient Safety (RCQPS) - a collaborative initiative between the Health Research Board, the Health Service Executive, National Quality Improvement Team and the Royal College of Physicians of Ireland
Inclusion Health Nursing at Dublin Simon Community
Nurses play a pivotal role in Dublin Simon Community’s Medical Residential Treatment services. In 2004 the charity, with the support of the HSE, opened an eight-bed Alcohol Detoxification Unit for clients experiencing homelessness.
Today these medical services have grown to encompass an 11-bed Alcohol and Benzodiazepine detoxification unit, a twelve Bed Step Up Step Down (Intermediate Care) unit, an eight bed BBV Stabilisation/Respite Unit and a Primary Care Nursing Service. These services are staffed by 44 nurses and focus on providing vital nursing interventions that are a vital step in rebuilding lives and supporting people to exit homelessness.
Dublin Simon Community’s nursing staff come from a variety of geographic locations (The Azores to Zimbabwe) and clinical backgrounds, including general, mental health, forensics, development studies, gerontology intellectual disability and a range of other specialisations. This team is supported by placements of high-calibre student nurses from Dublin City University and University College Dublin.
Head of Treatment and Enterprise at Dublin Simon Community, Majella Darcy, said: “2020 is Year of the Nurse and what better way to mark this than to showcase the incredible work that nurses do across the broad range of services Dublin Simon Community provides. We have been marking various world Health Days with a range of materials including profiles, articles, projects and pieces of research undertaken by our nursing staff.”
The Lived Experience of Adherence to HIV medication in the context of addiction and homelessness; a qualitative study of a Blood Borne Virus Unit in Dublin City
In 2017 The Global Health Observatory estimated that there are 36.9 million people worldwide living with HIV/AIDS (WHO 2017). The rates in Ireland are increasing and people who Inject drugs account for 5% of the total diagnoses in Ireland. Research studies and health strategies emphasize the importance of adherence to HAART (HIV Medication) to avoid viral replication and personal/public health consequences. However, it is evident that addiction and homelessness can contribute to non-adherence to medical and pharmacological treatment for a range of diseases (Hinkin 2007). Explanations have been put forward in the research including, lack of structure/routine, cognitive impairment caused by drug use, lack of motivation/worth, lack of facilities to store and take medication. While research studies have been carried out regarding clinical manifestations and prevalence of co-morbidity as well as rates of HIV medication adherence, there are few qualitative studies containing more in depth explorations which capture the voices and perspectives of those encountering complexities and challenges. There is little exploration concerning the effects of homelessness/addiction on adherence to ART’ in the literature.
Currently there are calls for public and patient involvement/engagement in research in this area in order to fully understand lived experience and develop innovative person centred approaches to support HIV treatment adherence in this challenging context. The proposed research, using IPA methodology with 12 participants receiving services at Dublin Simon Community Blood Borne Virus Unit, aims to fill this gap in the literature and to contribute the voices, knowledge and expertise of persons directly affected to service planning and support initiatives. Research on adherence to Blood Borne Virus medication and treatment is essential for gaining knowledge and insight which in turn can be used to improve treatments aimed at suppressing viral loads. This knowledge also has benefits for healthcare professionals as they engage with clients in the context of homelessness and addiction to support them to achieve adherence. It is anticipated that the findings, discussion and recommendations from the study will contribute to Improved understanding of the needs of this population and more sensitive client centred approaches
Dates: September 2019 - September 2021 (2 year Research MSc)
Researcher: Eavanna Maloney
Funding: Irish Research Council /Dublin Simon Community Employment Based Programme.
Nursing Now campaign
Nursing Now, a three-year global campaign, aims to improve health by raising the profile and status of nursing worldwide. Run in collaboration with the World Health Organization and the International Council of Nurses, Nursing Now seeks to empower nurses to take their place at the heart of tackling 21st Century health challenges and maximize their contribution to achieving Universal Health Coverage
The campaign will focus on five core areas:
Ensuring that nurses and midwives have a more prominent voice in health policy-making
Encouraging greater investment in the nursing workforce
Recruiting more nurses into leadership positions
Conducting research that helps determine where nurses can have the greatest impact
Sharing of best nursing practices.
Nursing Now Ireland was launched in 2019 at an event hosted by the Irish Nurses and Midwives Organisation (INMO) at the Richmond Education and Event Centre in Dublin. Nursing leaders and other high-level stakeholders from the world of public health gathered to present Nursing Now Ireland and discuss the importance of nursing.
Dates: 2018 - 2020
Organisers: WHO and International Council of Nurses
Local engagement: Dr Daniela Lewaldt, SNHS DCU
Premature ageing in long-term homeless adults (PAth Study)
In partnership with Dr. Cliona Ni Cheallaigh and St. James’s Hospital Inclusion Health services, preliminary data demonstrating premature onset of chronic age-associated conditions such as multimorbidity, frailty, COPD and dementia in homeless people in Depaul services.
We are now undertaking an extension of the internationally renowned Irish Longitudinal Study on Ageing (TILDA) to homeless people in partnership with Dr. Ni Cheallaigh.
The proposed study will characterise physical and cognitive frailty in homeless people, measure the prevalence and incidence of functional impairment and care needs, and inform the development of integrated health and social care to meet the needs of homeless people in Dublin .Finally, homelessness provides a clear human model of health inequities and premature ageing associated with psychological and socioeconomic stress throughout the life course. Understanding the premature ageing seen in homelessness will give us insight into the pathways, processes and mechanisms via which social exclusion gets “under the skin” to precipitate earlier ageing and will inform policies to deliver improved health equity
Organisers: DEPAUL & St. James’s Hospital Inclusion Health services
Local engagement: Jess Sears, Depaul
Depaul HHPA programme
Depaul’s Homeless Health Peer Advocacy (HHPA) works to reduce unplanned use of health services and missed appointments by people experiencing homelessness. This programme empowers people experiencing homelessness to overcome the barriers to accessing care through the provision of intensively trained HHPAs, all of whom have experience of homelessness. The complex nature of homelessness presents multiple inter-related, physical, personal and systemic barriers to accessing healthcare. This service takes a targeted approach to addressing the systemic and personal barriers faced by this group in accessing health care and facilitating safe discharge, improve attendance rates and health outcomes by supporting clients to better understand their health needs.
As part of the HSE Homeless Hospital Discharge protocol, this programme take a participatory and co-production approach to involve peers in:
Informing the design and ongoing improvement of the Inclusion Health services
Identifying research priorities and carrying out peer-led research
Organisers: Depaul’s Homeless Health Peer Advocacy (HHPA)
Local engagement: Jess Sears, Depaul
Adult autism in homelessness: prevalence, experiences and support needs in an Irish context – a mixed methods study
Dr Briege Casey and Dr Mary Rose Sweeney have been awarded funding from the National Disability Authority.
The relationships between mental health problems, intellectual disability and homelessness are well recognised, yet there is little empirical research concerning the prevalence, experiences and needs of people with autism who are homeless. This study, the first of its kind in Ireland, will research these areas and will also examine the self-perceived knowledge and skills levels of staff working with people who have autistic traits and are homeless.
We are delighted to be collaborating with the following agencies/ individuals regarding this project: Dublin Simon Community, ASIAM, Alasdair Churchard, Psychologist, University College London, DCU PPI Ignite, Dublin Region Homeless Executive.
Dates: 2019 - 2020
Funding: National Disability Authority.