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This ethnographic study was conducted to determine what homeless people experience during the transition from street life into community housing. Data were gathered through participant observation at a program designed to secure housing and support services for homeless people upon discharge from a psychiatric hospital. Sixty homeless, mentally ill adults were followed from hospital discharge through their first 2 years in community housing. Homeless people interact with health care providers across a cultural divide produced by vast differences in their lived experiences. This cultural distance limits access to the services that these individuals require to achieve residential stability.

Background: In the evolving landscape of health care, the need for highly skilled nursing professionals has never been greater. Central to meeting this demand is the collaboration between academic institutions and health care settings, particularly through faculty practice partnerships. Method: An academic-practice partnership in a safety-net hospital partnered with doctorally prepared faculty from a private university and a public community college to create an academic-practice partnership triad. This triad addresses every level of need, including the clinical placements of licensed practical nurses; associate, baccalaureate, and master's students; and doctoral candidates completing their research in the facility. Results: These collaborations between academic institutions and health care organizations aimed to enhance new graduate nurse readiness, improve health care quality, and strengthen workforce development. Conclusion: Through shared resources, interdisciplinary learning, and real-world application, this partnership not only benefits students and professionals but also strengthens the health care system as a whole.

Hospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of relational ECA, provided by Care Coach (care.coach, inc): an animated animal avatar on a tablet device, monitored and controlled by live health advocates. The ECA implemented algorithm-based clinical protocols for hospitalized older adults, such as reorienting patients to mitigate delirium risk, eliciting toileting needs to prevent falls, and engaging patients in social interaction to facilitate social engagement. Previous pilot studies of the Care Coach avatar have demonstrated the ECA's usability and efficacy in home-dwelling older adults. Further study among hospitalized older adults in a larger experimental trial is needed to demonstrate its effectiveness. The aim of the study was to examine the effect of a human-in-the-loop, protocol-driven relational ECA on loneliness, depression, delirium, and falls among diverse hospitalized older adults. This was a clinical trial of 95 adults over the age of 65 years, hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on a control unit received a daily 15-min visit from a nursing student. Measures of loneliness (3-item University of California, Los Angeles Loneliness Scale), depression (15-item Geriatric Depression Scale), and delirium (confusion assessment method) were administered upon study enrollment and before discharge. Participants who received the avatar during hospitalization had lower frequency of delirium at discharge (P<.001), reported fewer symptoms of loneliness (P=.01), and experienced fewer falls than control participants. There were no significant differences in self-reported depressive symptoms. The study findings validate the use of human-in-the-loop, relational ECAs among diverse hospitalized older adults.

The current randomized controlled trial investigated the effect of a robotic pet on social and physical frailty in community-dwelling older adults. The intervention group (n = 107) received a robotic pet and the control group (n = 113) received usual care following hospital discharge. Social and physical frailty were measured using the Questionnaire to Define Social Frailty Status and the FRAIL questionnaire. Cognitive function and depression were assessed using the Short Portable Mental Status Questionnaire and Geriatric Depression Scale, respectively. Continuous outcomes were compared between groups using t tests or Wilcoxon rank sum tests, as appropriate. Categorical outcomes were compared between groups using chi-square tests or Fisher's exact tests, as appropriate. Main findings showed the robotic pet positively impacted cognitive status in participants who reported they enjoyed engaging with their pet. This finding supported the theoretical premise of the current study that greater engagement with the robotic pet would yield greater improvement in study outcomes. [Research in Gerontological Nursing, 15(5), 229–237.]

Hospital-based nurses who have not practiced in home health care may find it difficult to anticipate patients' needs during the transition from hospital to home. This column focuses on increasing competency in preparing patients for home health services. J Contin Educ Nurs 2008;39(5):198–199.

Nurses play a critical role in helping homeless patients make the transition from revolving door hospitalizations or emergency department visits to ongoing care through an outpatient clinic. This column focuses on increasing competency in the care of homeless patients. The next column will focus on a different type of transition—preparing hospitalized patients for discharge and referral to home health care. J Contin Educ Nurs 2008;39(4):153–154.

Purpose Loneliness screening is recommended as best practice in primary care for older adults, yet it is not widely implemented. The purpose of the current study was to assess feasibility of a loneliness screening and referral program (SOCIAL Rx) in a primary care practice. Method Loneliness was assessed using the 3-item UCLA Loneliness Scale and curated referrals were provided for those who screened positive. Outcome measures were organized using the RE-AIM framework domains of reach, effectiveness, and adoption. Qualitative interviews were conducted to explore feasibility/acceptability and patient preferences regarding referrals. Results Eighty-one percent of patients were screened for loneliness; 33.3% were somewhat lonely and 17.7% were very lonely. Fifty-two percent of those who were lonely were provided a referral, and 40% of providers referred ≥50% of eligible patients. Conclusion Loneliness was prevalent in this population of older adults, highlighting the imperative for screening and intervention. [Research in Gerontological Nursing, 18(2), 69–80.]

This qualitative longitudinal study documents the experiences of 60 people who are homeless and mentally ill from their state mental hospital discharge through their first two years in community housing. The study explores the personal, cultural, and environmental contexts of life for adults who are homeless and mentally ill and examines the interaction between an individual's needs and community resources. The research identifies forces that perpetuate homelessness and traces the struggles that people who are homeless and mentally ill encounter during the transition from the streets to stable housing. The findings describe a culturally based pattern of mutual avoidance between homeless mentally ill clients and caregivers, which limits delivery of services to the population. Recommendations include development of alternative systems of care delivery, expansion of educational experiences with underserved populations, and increased funding for service or research with people who are homeless and mentally ill.

This qualitative longitudinal study documents the experiences of 60 people who are homeless and mentally ill from their state mental hospital discharge through their first two years in community housing. The study explores the personal, cultural, and environmental contexts of life for adults who are homeless and mentally ill and examines the interaction between an individual's needs and community resources. The research identifies forces that perpetuate homelessness and traces the struggles that people who are homeless and mentally ill encounter during the transition from the streets to stable housing. The findings describe a culturally based pattern of mutual avoidance between homeless mentally ill clients and caregivers, which limits delivery of services to the population. Recommendations include development of alternative systems of care delivery, expansion of educational experiences with underserved populations, and increased funding for service or research with people who are homeless and mentally ill.

This study uses a modified ethnonursing approach (Leininger, 1985, 1991) to analyze qualitative data collected during two years of field work with a group of Homeless Chronically Mentally Ill Individuals (HCMI). Leininger's ethnonursing theory was used to promote a holistic view of the lifeways of HCMI individuals who were attempting to leave the streets. The data document the experiences of HCMI individuals who were placed in temporary community housing after discharge from a state mental hospital. Data analysis focuses upon explicating the specific needs of HCMI individuals within the sociocultural environment where those needs exist. This qualitative study explores the personal, cultural, and environmental contexts of life for HCMI individuals and describes the interaction between individuals' needs and community resources. Individuals in the study group suffered from chronic mental illness, substance abuse, and physical illness. Their needs were expressed through efforts to function in the community. Direct requests for care were infrequent. Physical manifestations and circumstantial evidence symbolized unspoken needs. Unmet needs for care were demonstrated by critical incidents which disrupted community life such as household moves, legal disputes, and bureaucratic problems. Findings revealed a culturally based pattern of mutual avoidance between HCMI individuals and caregivers which limited delivery of services to the population. Social policy issues underlying caregiver behavior were discussed. Recommendations include development of nurse-managed systems of care delivery, expansion of nurses' educational experiences with underserved populations, and additional qualitative longitudinal research on HCMI populations.