Summary: The Homeless Population

The homeless population is vulnerable and are subject to discrimination. Sometimes, what becomes normal practice can violate compassionate, evidence-based care for clients in the homeless shelters. When a shelter client violates one of the behavioral rules, they will be exited for serious infractions without any notice. In the client case below, she was smoking marijuana in the bathroom and was in possession of the illegal substance. In these type of cases, there is moral ambiguity, where there is a vagueness or uncertainty of meaning as to what is the right and good thing (Lachman, 2016a).
As a nurse working with this population we can advocate to have their expulsion rescinded. We are often met with adversity because the shelter staff have

to retain order in the shelter. Nurses could inflict moral injury by perpetrating, failing to prevent or observe a situation where a client’s moral and belief expectations are not met. (Lachman, 2016b). Clients expect the shelter to provide food, shelter and a plan for housing upon exit.
In this case, an elderly client with major health concerns, CHF, COPD, on oxygen and had been hospitalized several times in the few months was exited from the shelter. This was particularly frigid day with the temperatures expected to be in the 20’s overnight. The client did not have an alternative living arrangement and the other shelters she contacted were full. She would have been forced to sleep outside that night in the freezing weather. She did break shelter policy, so the shelter management would not want to allow her to stay, even though it was a code blue night.
I discovered the client outside the shelter with all her belongings including her oxygen tanks. She was cold and trying to reach out to family, friends and shelter for a place to stay. I needed to advocate for this vulnerable person, so I requested help from my supervisors in the health department. We advocated for to receive a temporary readmission into the shelter, so she could get her affairs in order. Unfortunately, she continued to not comply with the rules and was permanently exited. As a nurse, it is important to treat each client with respect, advocate on their behalf and assure they have autonomy.
Tronto (2010) identifies the four elements of caring: attentiveness, responsibility, competence and the responsiveness of the care receiver. Attentiveness means that the nurse becomes aware of the client’s needs. There is a responsibility to take action on the clients’ behalf and in return the client is responsible for their decisions. Competence is demonstrated when an individualized plan is developed allowing the person to be as independent as possible, yet remain safe. As a part of ethical practice, nurses should accept the responses of the client (care receiver), even though the decisions are not in the best of their health and emotional wellbeing.