Enhancing Patient Safety and Quality of Care for Homeless Populations in a Community Health Clinic
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Patient safety and quality improvement are core roles for all baccalaureate-prepared nurses in any health care environment. Homeless people face particularly high levels of barriers to care and poor access to health care services and support, including disease prevention and treatment adherence. Being homeless is linked to higher rates of chronic diseases, mental health issues, drug and alcohol abuse, poor nutrition, infectious diseases, and avoidable hospitalizations (Richards & Kuhn, 2022). Healthcare providers face significant barriers in providing safe, effective care to this population due to unstable housing, limited access to good hygiene practices, poor nutrition, low health literacy, and limited transportation. This paper examines patient safety risks within the homeless population in a community health clinic, the evidence-based approach to improving patient safety and reducing organizational cost, the role of the nurse in coordinating care, and the stakeholders that can be involved in improving the quality and safety of care for homeless patients.
Factors Leading to Patient Safety Risks Among Homeless Individuals
Numerous social determinants of health can increase patient safety risks for homeless individuals in health care settings. A major factor is the lack of stable housing, impacting almost all aspects of health management. Patients who are homeless are less likely to store medications correctly, maintain proper hygiene, get proper nutrition, or make timely follow-up visits. These barriers can result in poor compliance with medications, poorer health outcomes from chronic conditions, infections, and more frequent ED visits. Other factors that contribute to homeless patients’ risks for poor patient safety include poor communication and limited health literacy. Many homeless patients may not be able to comprehend medical instructions, prescription schedules, or discharge plans (Begum et al., 2024). Others may also have an untreated or unaddressed mental health or cognitive disability that affects their ability to communicate and make decisions effectively.
There is also an additional risk to patient safety if mental health disorders and substance use disorders are present. Depression, anxiety, post-traumatic stress disorder, or addiction are frequent issues for many homeless people that can affect their ability to follow treatment or engage in self-care. There can also be risks of overdose, drug interactions, and risky behaviors associated with substance abuse. The lack of adequate care coordination is another important factor. Many people experiencing homelessness suffer from disorganized health care when they switch between clinics, emergency departments, shelters, and temporary housing. Community health clinics can also have staffing issues and be overworked, which can affect patient safety. According to Lucas et al. (2023), poor nursing practice environments have a negative impact on patient safety and quality outcomes. Stigma, discrimination, or negligence by health care systems may also make homeless people less likely to trust health care. Consequently, patients tend to postpone care until their health deteriorates, making treatment more complicated and expensive.
Evidence-Based and Best-Practice Solutions to Improve Patient Safety and Reduce Costs
Several evidence-based interventions can enhance the safety and quality of care provided to homeless people and lower organizational costs in community health clinic settings. An important strategy is to embrace trauma-informed and patient-centered care. Trauma-informed care acknowledges the physical and emotional trauma often faced by homeless people and prioritizes respect, empathy, and nonjudgmental communication (Goldstein et al., 2024). A key intervention is enhancing communication through health literacy approaches and patient education. A teach-back method, along with plain language and visual aids, can be used to ensure the patient’s understanding of medications, appointments, and discharge instructions. Simple and written instructions can decrease medication errors and increase adherence. Syyrilä et al. (2021) emphasize that effective communication practices are critical for reducing preventable adverse events and improving patient safety outcomes.
Community outreach and mobile healthcare are also effective tools for enhancing healthcare access and cost-effectiveness within a homeless population. Early intervention can be used to stop the disease from getting worse and minimize the need for costly visits to the emergency department and hospital admissions. A root cause analysis (RCA) can also be used to determine the root causes of patient safety incidents involving homeless people. The Joint Commission recommends RCA to examine system failures and develop corrective actions that prevent future harm (Singh et al., 2024). Frequent hospital visits for homeless people with diabetes, for instance, can expose challenges including food insecurity, limited refrigeration options for insulin, and other transportation issues. Solving these underlying issues through community organization and care coordination can not only enhance care results but also lower health care costs as well. Nurses’ education and training are also crucial in order to enhance patient safety.
The Role of Nurses in Coordinating Care to Improve Safety and Reduce Costs
Nurses are first-line health care workers who are accountable for the assessment of patients’ needs, identification of safety risks, facilitating communication, and making sure patients have access to necessary resources. Comprehensive assessment is an important responsibility for the nurse, and includes medical and social determinants of health. Nurses who care for the homeless should conduct a social history, evaluate food, transportation, mental health issues, substance abuse, and social support needs, and make referrals to community resources or develop plans for patients to obtain these services (Ravaghi et al., 2023). Another critical role for a nurse is managing patients’ medications. Patients experiencing homelessness may have difficulty accessing and paying for medications, comprehending medication directions, or safely storing medications. The nurses can check the patient’s medication for reconciliation and teach patients how to take their medicines as prescribed, and coordinate with pharmacists to make treatment regimens easier. Nurses also enhance patient safety by following up with patient discharge planning and follow-up care coordination. For instance, a nurse can make arrangements for transportation to appointments, refer patients to homeless shelters, or to mental health and substance abuse services.
Stakeholders Involved in Driving Safety Enhancements
Collaboration among stakeholders both within and outside the healthcare organization is necessary to improve patient safety among homeless populations. Nurses should work with practitioners, doctors, pharmacists, social workers, case managers, mental health providers, and outreach personnel in the community to provide integrated and patient-centered care. Healthcare administrators and clinic leaders play an important role as stakeholders because they allocate budgets, develop policies, and facilitate quality improvement efforts. Patient safety culture has a significant influence on communication, teamwork, staffing, and organizational performance, all of which are greatly influenced by leadership commitment. Community organizations also have a voice in improving outcomes for homeless persons. Because social determinants of health impact patient safety and treatment adherence, a variety of resources are available to address these issues, including shelters, food banks, housing agencies, transportation programs, substance abuse treatment programs, and public health departments. Patients are also important actors in efforts to improve safety. Involving homeless patients in care plans and decision-making builds trust, facilitates communication, and promotes treatment plan adherence.
Conclusion
Unstable housing, inadequate access to care among the homeless, problems with communication, mental illness, drug or alcohol use, and social issues are major sources of patient safety issues for the homeless in community health clinics. These challenges lead to medication errors, avoidable hospitalizations, chronic disease complications, and sub-optimal health care outcomes. Trauma-informed care, interdisciplinary collaboration, patient-centred communication, outreach services, and quality improvement programs are evidence-based practices that can have a profound impact on patient safety, lower healthcare costs, and enhance the overall experience. Nurses are key players in the care coordination process, promoting the health of homeless individuals, teaching them, and promoting the implementation of evidence-based approaches to improve safety and quality of care. Effective patient safety enhancements need to involve healthcare professionals, organizational leaders, community agencies, and patients.
References
Begum, T., Murrell, K., & Robinson‐Barella, A. (2024). Tackling inequalities in access to medicines for people experiencing homelessness: A meta‐ethnography and qualitative systematic review. Health Expectations , 27 (5). https://doi.org/10.1111/hex.70076
Goldstein, E., Chokshi, B., Melendez-Torres, G., Rios, A., Jelley, M., & Lewis-O’Connor, A. (2024). Effectiveness of trauma-informed care implementation in health care settings: Systematic review of reviews and realist synthesis. The Permanente Journal , 28 (1), 135–150. https://doi.org/10.7812/tpp/23.127
Lucas, P., Elvio, J., Almeida, S., & Araújo, B. (2023). Relationship of the nursing practice environment with the quality of care and patients’ safety in primary health care. BMC Nursing , 22 (1). https://doi.org/10.1186/s12912-023-01571-8
Ravaghi, H., Guisset, A.-L., Elfeky, S., Nasir, N., Khani, S., Ahmadnezhad, E., & Abdi, Z. (2023). A scoping review of community health needs and assets assessment: Concepts, rationale, tools and uses. BMC Health Services Research , 23 (1), 1–20. https://doi.org/10.1186/s12913-022-08983-3
Richards, J., & Kuhn, R. (2022). Unsheltered homelessness and health: A literature review. AJPM Focus , 2 (1), 100043. https://doi.org/10.1016/j.focus.2022.100043
Singh, G., Patel, R. H., & Boster, J. (2024). Root cause analysis and medical error prevention . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK570638/
Syyrilä, T., Vehviläinen‐Julkunen, K., Manias, E., Bucknall, T., & Härkänen, M. (2021). Communication related to medication incidents—A concept analysis and literature review. Scandinavian Journal of Caring Sciences , 36 (2). https://doi.org/10.1111/scs.13044
Assessment 1 Instructions: NURS FPX 4035 Enhancing Quality and Safety Assessment 1 – Enhancing Patient Safety and Quality of Care for Homeless Populations in a Community Health Clinic
For this assessment, you will develop a 3–5 page paper that examines a safety quality issue in a healthcare setting. You will analyze the issue and examine potential evidence-based and best-practice solutions from the literature as well as the role of nurses and other stakeholders in addressing the issue.
Introduction
The role of the baccalaureate nurse includes identifying and explaining specific patient risk factors, incorporating evidence-based solutions to improving patient safety and coordinating care. A solid foundation of knowledge and understanding of safety organizations such as Quality and Safety Education for Nurses (QSEN), the Institute of Medicine (IOM), and The Joint Commission and its National Patient Safety Goals (NPSGs) program is vital to practicing nurses with regard to providing and promoting safe and effective patient care.
You are encouraged to complete the Identifying Safety Risks and Solutions activity. This activity offers an opportunity to review a case study and practice identifying safety risks and possible solutions. We have found that learners who complete course activities and review resources are more successful with first submissions. Completing course activities is also a way to demonstrate course engagement.
References
Kohn, L. T., Corrigan, J., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system . National Academy Press.
Overview
As a baccalaureate-prepared nurse, you will be responsible for implementing quality improvement (QI) and patient safety measures in healthcare settings. Effective quality improvement measures result in systemic and organizational change, ultimately leading to the development of a patient safety culture.
Consider the hospital-acquired conditions that are not reimbursed under Medicare/Medicaid, some of which are specific safety issues such as infections, falls, medication errors, and other concerns that could have been prevented or alleviated with the use of evidence-based guidelines.
The purpose of this assessment is to better understand the role of the baccalaureate-prepared nurse in enhancing quality improvement (QI) measures to address patient safety risk at a healthcare setting of your choice. You will do this by exploring the professional guidelines and best practices for improving and maintaining patient safety in healthcare settings from organizations such as QSEN (Quality and Safety Education for Nurses) and the IOM (Institute of Medicine). Looking through the lens of these professional best practices to examine the current policies and procedures in place at your chosen organization and the impact on safety measures for patients, you will consider the role of the nurse in driving quality and safety improvements. You will identify stakeholders in QI improvement and safety measures as well as consider evidence-based strategies to enhance quality of care and promote safety in your chosen healthcare setting.
See Nursing Competencies for more information.
Instructions
Select one of the safety quality issues presented in the Assessment 01 Supplement: Enhancing Quality and Safety [PDF] Download Assessment 01 Supplement: Enhancing Quality and Safety [PDF] resource and incorporate evidence-based strategies to support communication and ensure safe and effective care.
For this assessment, be sure to focus on an organizational setting. This could be a primary care office, urgent care, mobile clinic, hospital ED, rural clinic, etc. Then use the literature to support the problem and solution in the organization. Reflect on costs to that organization/setting and what nurses can do to coordinate the care within the setting. Reflect on stakeholders who may be involved.
Be sure that your plan addresses the following, which corresponds to the grading criteria in the rubric. Please study the rubric carefully so you understand what is needed for a distinguished score.
Explain factors leading to a specific patient safety risk.
Explain evidence-based and best-practice solutions to improve patient safety related to a specific patient-safety risk and reduce costs.
Explain how nurses can help coordinate care to increase patient safety and reduce costs.
Identify stakeholders with whom nurses would need to coordinate to drive safety enhancements.
Communicate using writing that is clear, logical, and professional, with correct grammar and spelling, using current APA style.
Additional Requirements
Length of submission: 3–5 pages of content plus title and reference pages.
Number of references: Cite a minimum of 4 sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old. Use the Capella University Library and BSN Nursing Program Library Guide as needed.
APA formatting: References and citations are formatted according to current APA style. See the APA Module .
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
Competency 1: Analyze the elements of a successful quality improvement initiative.
Explain evidence-based and best-practice solutions to improve patient safety related to a specific patient safety risk and reduce costs.
Competency 2: Analyze factors that lead to patient safety risks.
Explain factors leading to a specific patient-safety risk in a healthcare setting.
Competency 4: Explain the nurse’s role in coordinating care to enhance quality and reduce costs.
Explain how nurses can help coordinate care to increase patient safety and reduce costs.
Identify stakeholders with whom nurses would coordinate to drive safety enhancements with a specific safety quality issue.
Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.
Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.
Scoring Guide – NURS FPX 4035 Enhancing Quality and Safety Assessment 1 – Enhancing Patient Safety and Quality of Care for Homeless Populations in a Community Health Clinic
Use the scoring guide to understand how your assessment will be evaluated.
Criterion 1
Explain factors leading to a specific patient-safety risk in a healthcare setting.
Distinguished
Explains factors leading to a specific patient-safety risk in a healthcare setting. Refers to specific data, evidence, or standards to illustrate the safety risk.
Criterion 2
Explain evidence-based and best-practice solutions to improve patient safety related to a specific patient safety risk and reduce costs.
Distinguished
Explains evidence-based and best-practice solutions to improve patient safety related to a specific patient safety risk and reduce costs. Makes explicit reference to scholarly or professional resources to support explanation.
Criterion 3
Explain how nurses can help coordinate care to increase patient safety and reduce costs.
Distinguished
Explains how nurses can help coordinate care to increase patient safety and reduce costs. Provides specific examples related to a patient safety risk.
Criterion 4
Identify stakeholders with whom nurses would coordinate to drive safety enhancements with a specific safety quality issue.
Distinguished
Identifies stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements with a specific safety quality issue, noting the relevance and potential importance of the stakeholders.
Criterion 5
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.
Distinguished
Organizes content with a clear purpose. Content flows logically with smooth transitions using coherent paragraphs, correct grammar or punctuation, and word choice, and is free of spelling errors.
Criterion 6
Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.
Distinguished
Exhibits strict and flawless adherence to APA formatting of headings, in-text citations, and references. Quotes and paraphrases correctly.
FPX-4035
Course Introduction
Welcome to your Capella University online course, NURS-FPX4035 – Enhancing Patient Safety and Quality of Care.
Course Overview
Baccalaureate-prepared nurses contribute significantly to the quality improvement of healthcare and patient safety. This course focuses on the development of generalist nursing practice competencies to facilitate quality improvement processes to achieve desired patient, systems, and population outcomes.
Please click on the link below for an introduction to what you can expect in this course.
About This Course .
BSN Program Journey
View the BSN Program Journey for a useful map that will guide you as you continue your program. This map gives you an overview of all the steps required to prepare for completing your degree. It also outlines the support that will be available to you along the way.
BSN Program Journey.
NURS-FPX4020 Reading List – NURS FPX 4035 Enhancing Quality and Safety Assessment 1 – Enhancing Patient Safety and Quality of Care for Homeless Populations in a Community Health Clinic
This course uses reading lists created in the Capella library. Reading lists allow you to access multiple library and Internet resources from a single location.
NURS-FPX4035 Reading List is the entire reading list for the course. Activities in the course will link to specific sections of the reading list appropriate to each assessment. There may be one or more reading lists per assessment. View the Reading Lists Onboarding video for a brief walkthrough of how to access and navigate your lists. The Reading List Guide can also help you navigate your reading lists.
Note: Although you can export citations from the readings in your reading lists to use in your assessments, citations in the reading lists may not be in proper APA format. Use Academic Writer for guidance in citing sources and formatting your paper in proper APA style. See the Writing Center for more APA resources specific to your degree level.
Course Competencies
To successfully complete this course, you will be expected to:
Analyze the elements of a successful quality improvement initiative.
Analyze factors that lead to patient safety risks.
Identify organizational interventions to promote patient safety.
Explain the nurse’s role in coordinating care to enhance quality and reduce costs.
Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.
For Assessment 1
NURS-FPX4035 Reading List
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/lists/5705572820006731?auth=SAML
Agency for Healthcare Research and Quality, . (n.d.). What is patient safety culture? Retrieved https://www.ahrq.gov/sops/about/patient-safety-culture.html
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705572880006731?auth=SAML
Athanasakis, E. (2021). Medication safety practices in clinical nursing: Nurses’ characteristics, skills, competencies, clinical processes, and environment [PDF]. International Journal of Caring Sciences , 14 (3), 2019–2028. http://library.capella.edu/login?url=https://search.proquest.com/docview/2630948614?pq-origsite=
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705572940006731?auth=SAML
Diehl, M., & Shever-Doletzky, L. (2022). The electronic health record, activity-based approach for measuring nursing care value and costs: A quality improvement project [PDF]. Nursing Economics , 40 (5), 238–246. http://library.capella.edu/login?url=https://search.proquest.com/docview/2737499445?pq-origsite=
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705572920006731?auth=SAML
Ji, Y., & Park, S. (2021). Developing an integrated curriculum for patient safety in an undergraduate nursing program: A case study. BMC Nursing , 20 (1), 172. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8447691/
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705572930006731?auth=SAML
Lucas, P., & Araújo, B. (2023). Relationship of the nursing practice environment with the quality of care and patients’ safety in primary health care. BMC Nursing , 22 (1), 413. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621276/
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705572910006731?auth=SAML
Mull, H. J., & Rivard, P. E. (2017). Identifying risks and opportunities in outpatient surgical patient safety: A qualitative analysis of veterans health administration staff perceptions. Journal of Patient Safety , 17 (3), e177–e185.
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705572890006731?auth=SAML
Patient Safety Network, . (2019, July). Detection of safety hazards . https://psnet.ahrq.gov/primer/detection-safety-hazards
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705572870006731?auth=SAML
Syyrilä, T., & Härkänen, M. (2021). Healthcare professionals’ perceptions on medication communication challenges and solutions –text mining and manual content analysis cross-sectional study. BMC Health Services Research , 21 (1), 1–19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590289/
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705572900006731?auth=SAML
Assessment 1
NURS-FPX4035 Reading List
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/lists/5705572820006731?auth=SAML
Cole, M., & Milner, K. A. (2022). Implementation of just culture policy in nursing programs to support quality safety competency. The Journal of Nursing Education , 61 (12), 706–710. http://library.capella.edu/login?url=https://search.proquest.com/docview/2747560556?pq-origsite=
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705573100006731?auth=SAML
Draganovic, S., & Offermanns, G. (2022). Patient safety culture in Austria and recommendations of evidence-based instruments for improving patient safety. PloS One , 17 (10), e0274805–e0274805. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9576070/
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705573090006731?auth=SAML
Manno, M. S. (n.d.). The role transition characteristics of new registered nurses: A study of work environment influences and individual traits [PDF]. Retrieved https://pdfs.semanticscholar.org/5c12/2bcf00956ad3a3e71e61d62da6df81fb9c12.pdf
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705573110006731?auth=SAML
Vikan, M., & Danielsen, S. O. (2023). The association between patient safety culture and adverse events – A scoping review. BMC Health Services Research , 23 (1), 300–326. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053753/
https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/5705573080006731?auth=SAML
