Date of Award
Spring 5-24-2022
Document Type
Doctor of Nursing Practice Final Manuscript
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Joseph Burkard, DNSc, CRNA, EBP-C
Second Advisor
Briony DuBose, PhD, MHI, RN
Abstract
Background: At present, nearly half (48%) of homeless individuals in California are 50 to 89 years old (Espinosa et al., 2024). Among the cities most affected is San Francisco where this has been growing public health concern. At an advanced age, this group faces a wide range of problems including chronic illnesses, mental health disorders, and trauma from past experiences added to the current situation of being homeless. Long-term care facilities are where they are usually sent after acute conditions and for permanent housing when they can’t be independent. However, the lack of trauma-informed care practices may lead to re-traumatization and poor health outcomes.
Purpose: The purpose of this evidence-based health policy is to discuss the integration of Trauma-Informed Care within long-term care facilities based on systematic evidence and formulate strategies specific to the San Francisco region. Furthermore, the primary objective of this health policy proposal is to create a safe and supportive environment that reduces re-traumatization and to improve overall health outcomes.
Methods: To guide TIC implementation in skilled nursing facilities in San Francisco, the project utilizes the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance. The first strategy is comprehensive staff training on TIC principles. Second, the incorporation of trauma assessment tools into resident intake processes. Finally, resident and family engagement in care planning, and sustainable practices through ongoing evaluation and feedback mechanisms.
Evaluation of Outcomes/Results: Short-term goals include training ninety percent (90%) of the staff on TIC practices within six months and using trauma assessment tools. The long-term goal is to reduce the number of trauma incidents and hospital readmissions by twenty percent (20%) in two years and attain high levels of resident satisfaction. The success metrics identify staff training rates, resident health outcomes, and stakeholder's feedback as the qualitative measures for success.
Conclusion: The project demonstrates that incorporating TIC in nursing homes for elderly adults who were homeless significantly improves their health outcomes. The project sets a foundation for a more compassionate approach towards an underserved population which suffers the most, through the focus on the trauma-informed care framework.
Recommendations and Action Plan: To advance TIC in LTC facilities, collaboration with American Nurses Association California (ANA\C) is essential to publish an advocacy article on the need for TIC integration in LTC services, especially for elderly adults who have experienced homelessness. Additionally, working with the San Francisco Department of Public Health (DPH) to lobby for mandatory TIC adoption in LTC will aid in the creation of standard policies, and ancillary TIC education and training. Direct contact with LTC administrators is also of equal importance to encourage them to adopt policies enabling LTC facilities to apply TIC principles into daily care practices. With these strategies, the goal is to make TIC an integral part of the services offered in LTC, thereby decreasing re-traumatization and negative health outcomes for this population. By promoting awareness, advocating policy, and cultivating leadership support, this initiative promises to enhance the way care is provided and improve the health of the elderly adults in LTC facilities.
Digital USD Citation
Reyes, Brian Paul, "Trauma-Informed Care for Homeless Older Adults in Long-Term Care Facilities in San Francisco" (2022). Doctor of Nursing Practice Final Manuscripts. 301.
https://digital.sandiego.edu/dnp/301
Copyright
Copyright held by the author
