HOMELESSNESS is a growing problem nationwide. A 2009 survey conducted by the Department of Housing and Urban Development (HUD) estimated that every night, 110,917 American adults experienced chronic homelessness; about 75% of the population were men with an average age of 50.1 Nearly 242,000 persons in families experienced homelessness and almost 1 million children were identified as homeless in the 2009-2010 school year.2
The University of Tennessee at Chattanooga (UTC) is located near downtown Chattanooga, where many homeless people live. The College of Nursing's senior class participates in a community-based project every semester as a component of the community health class. The focus of the project for the class graduating in December 2010 was helping the homeless in Chattanooga. This article describes my experiences during this eye-opening project.
In Chattanooga, the HUD point-in-time survey (conducted January 25, 2009) showed that more than 4,094 people experience homelessness annually, and one-third of these are children with an average age of 5 years.3
Here in Chattanooga, ending homelessness has been a personal crusade of the mayor as well as the professor who teaches community health at UTC. The latter has been involved with homeless people for many years and arranges for her students to participate at the Chattanooga Community Kitchen, where they provide foot care for the homeless, away from the actual kitchen. A few years ago, our professor met the podiatrist who volunteers at the foot clinic once a week. The podiatrist mentioned that he needed volunteers and our professor thought that bringing in nursing students was a natural match.
One day our professor announced that we'd be divided into five groups, four of which would be sent out onto the streets of Chattanooga as simulated homeless people in various situations. This project was created to raise awareness among students about the plight of underserved populations—populations that we as future nurses would be serving. Simulating homelessness created a more lasting impression than another lecture on the subject. The assignment was an experiential learning activity to promote engagement and advocacy through introspection. Four groups of three to four students were assigned to one of two scenarios:
Scenario one: A teenage girl is abandoned by her boyfriend on a road trip while passing through Chattanooga. She's pregnant and distraught by the tension of the relationship. Her boyfriend stops the car, tells her to get out, and drives away. In an unfamiliar city with $5 to her name, she has to figure out how to find food, shelter, and clothing while staying safe.
Scenario two: A man leaves Chicago on a bus with his destination determined by the small amount of money he's carrying. He's trying to escape his chaotic life of addiction and substance abuse and can travel only as far as Chattanooga. When he gets off the bus, he has only $5 in his pocket.
Students assigned to these groups had to find food and shelter, both for the short- and long-term. They also had to plan for their healthcare needs. The students did role play as the pregnant teenager and the older man. Although it wasn't part of the assignment, students also spoke with homeless people to learn what they do to survive. The students made sure to inform everyone they spoke with that they were nursing students.
I was part of the fifth group, which had a special assignment. We had 3 hours to complete background research and then meet with the mayor to discuss the problem of homelessness in Chattanooga. Students in the other four groups also conducted brief research before proceeding to the streets.
Meeting the mayor
Group five convened at the mayor's office, where he immediately put us at ease. The mayor was quite animated as he discussed the need for short- and long-term shelter space for the city. He was visibly upset when we discussed the topic of homeless families, particularly the plight of groups of homeless children fending for themselves.3 The mayor lauded the efforts of groups such as the Chattanooga Homeless Coalition, the Chattanooga Community Kitchen, and UTC nursing students.
As we left his office, the pictures that the mayor had painted replayed in my mind. He knew exactly how many beds were available in Chattanooga, how many homeless people were estimated to be in the area, how the homeless population changed seasonally, and so on. Meeting with the mayor transformed my perception of homeless people. I wondered what my classmates were thinking and how they felt about this experience.
All five groups met back at the classroom, which was buzzing with energy as students shared their experiences with each other and our professor. The room was filled with emotion as students from each group relived their day in detail to convey the depth of their experiences. Most of the preliminary chatter focused on how the students were treated and how quickly they were able to connect with the homeless. Despite the differences in their lives, the students felt connected to the homeless by their common human experiences. By the end of the interviews, the students felt that they had a better understanding of these peoples' struggles and, because of the honesty and candor of the homeless people they'd interviewed, were able to gain remarkable insight.
Students reflected on how most of the homeless did nothing to put themselves into their current situation. Many times it was just a string of bad luck, such as being laid off from a job or receiving an expensive medical bill that started a cascade of events that spun out of control. Students also came to realize how powerless this population had become mostly due to negative stereotyping by the media. The truth is, among the homeless we interviewed, most would have relished being gainfully employed again. And many of them were well-educated coming from successful backgrounds and families.
At no time did any of the students feel threatened or even uncomfortable once the ice had been broken. The homeless were people just like us who'd experienced unfortunate circumstances leading to homelessness.
Capturing the experience on film
At the next class meeting, our professor announced that she was so pleased with the emotional, transformative response from the class that after the debriefing, she'd contacted the head of the UTC film department. She hoped to capture this entire experience on film. As she talked about what she wanted from this project, I could imagine how the film would appear and volunteered to help produce it.
The next week I met with her and our director and explained my vision for the film: vignettes and interviews filmed on the locations that the simulated homeless groups had visited, coupled with the emotional voice-overs of the students' experiences. We made arrangements to recreate the experience for the camera, including bits of the interview with the mayor. Once the location shots were completed, each student was asked about the experience and what moved him or her the most. These sound bites were then used over the location portrayals to give the viewer a taste of the powerful, experiential learning that had taken place and how it changed the way these students would view and treat this vulnerable population when they became nurses.
Educating nurses for the future
Throughout the semester, our professor endeavored not only to educate us on the problems of underserved populations, but also to change the way we thought and felt about homeless people because we may see them as patients in the future.
By stepping outside the classroom and placing students in these roles, our professor took us out of our comfort zones and put us into situations that we may have never experienced otherwise, which helped dissolve many negative perceptions we had. The assumption that the homeless were to blame for their circumstances was lifted. Also, the perception of the homeless as uneducated, lazy people was eradicated and the idea that this could “never happen to us” was gone. This project not only transformed how these future nurses viewed the problem of underserved patient populations, but more important, how the students felt about and would treat these potential patients throughout their nursing careers.