4B Research File Title Synthesis
4B Research File Title Synthesis
4B Research File Title Synthesis
19 Pandemic
A Thesis Presented to
The Faculty of the College of Nursing
University of St. La Salle
Bacolod City
In Partial Fulfilment
Of the Requirements for
NCM 111 - Nursing Research
April 2022
TABLE OF CONTENTS
TITLE PAGE i
ii
APPROVAL SHEET iii
ACKNOWLEDGMENT iv
v
TABLE OF CONTENTS vi
LIST OF TABLES vii
1
LIST OF FIGURES 1
ABSTRACT
INTRODUCTION
Background of the Study
Statement of the Problem
Theoretical and/or Conceptual Framework
Scope and Limitations
Significance of the Study
Definition of Terms
Review of Related Literature
INTRODUCTION
The COVID-19 pandemic has wreaked havoc on all aspects of life, including the
economy, society, and, most significantly, people's health. As of September 2022, the
World Health Organization (2022) reports that there are 612 million confirmed COVID-19
cases and 6.5 million deaths globally. About 3.94 million cases and 68,882 deaths have
been confirmed in the Philippines (World Health Organization, 2022). From March 2021 to
September 2022, 73,051,416 Filipinos have completed their COVID-19 vaccine doses
vaccination for "individuals at risk," which included homeless people, in which 650 people
were vaccinated (Jadloc, 2021). The vulnerable, particularly the homeless, are the
unrecognized victims of this pandemic. Homeless people are more vulnerable to the virus
because they lack one basic human need: shelter. They lack access to clean water, food,
clothing, and other basic necessities because they live on the streets without permanent
housing.
According to the study by Tan, L.F., & Chia, J. W., (2020), homeless people are at
higher risk of different infectious diseases. Staff members should be mindful of this and
offer communication services, and assistance in a courteous way that recognizes and
accommodates this diversity. Furthermore, that the admonition to stay at home is unusable
to someone who does not have place, the same with COVID-19 prevention strategies such
as handwashing and social distancing is difficult since many "public" facilities are only for
customers' use which can be difficult to keep on the streets or in homeless people (Tan,
2021). Moreover, poor access is a big challenge despite the fact that persons experiencing
recent changes to the delivery of primary care in response to the COVID-19 pandemic
inequalities. This could have implications for how primary healthcare is delivered to those
experiencing homelessness not only for the duration of the pandemic but in the future
(Howells, 2021). The lack of shelter, potable water, proper nutrition, and essentially the
basic needs of an individual greatly affect the chances of one being affected no just by the
pandemic but any other disease that is present today. These are factors that contribute to
raising the risk of infection to the homeless. Coupled with the inability to seek medical help
because of financial incapacity, the current health status of the majority of homeless people
is at an all-time low.
In contrast to other nations, where research has been done on ways to protect and
assist those without stable housing as well, the Philippines has not yet completed any
studies on the health experiences and healthcare service utilization of those without such
housing. Furthermore, there are only a few studies in the pool of literature that include
homeless persons as participants. They are a vulnerable group that has received little
attention especially in the Philippines. No further research has been conducted to explore
their experiences during a time of a global health crisis. There is no information available in
the nation or even at the local level about the COVID-19 vaccine roll-out update and
healthcare services for the vulnerable population, specifically the homeless people.
In Bacolod City, there are no existing programs that cater to the basic healthcare
needs of homeless people. Only community-led activities assist them in acquiring basic
healthcare needs, which are also limited. Despite the rise and fall of COVID-19 cases,
homeless people remain on the streets, with many lacking basic necessities such as masks
This study aims to investigate the health experiences and healthcare service
utilization of homeless people in Bacolod City in order to shed light on their conditions in
the midst of the pandemic and the availability of healthcare services and resources. Another
goal of this research is to promote inclusive health care. The data gathered can be utilized to
prompt an action plan and develop a strategy to address the needs of homeless persons. It
can be a basis for healthcare organizations in the planning of interventions for the
pandemic. This study may be beneficial to the local government units, non-governmental
and healthcare organizations, medical professionals, nurses, barangay health workers, the
This study aims to explore lived experiences of homeless persons in healthcare utilization
Specific objectives
1. What are the health experiences of homeless persons during COVID-19 pandemic?
pandemic?
Theoretical Framework
People who have been unwell for a while may occasionally be asked to perform to
the best of their ability. This is crucial in rehabilitation settings because after receiving care
from doctors and nurses, patients have a right to greater independence. By definition, self-
care is "the practice of acts that individuals start and undertake on their own behalf in
preserving life, health, and well-being," as articulated by Dorothea Orem. This theory
concentrates on each person's ability to practice self-care. This hypothesis emphasizes that
persons who maintain a measure of responsibility over their own self-care are more likely to
recover (Iran, 2016). Those who are unable to care for themselves are said to have self-care
deficiencies. By connecting this theory to the research, it will be possible to find out how
homeless people maintain their health in the face of the spreading COVID19 worldwide
despite the lack of resources, including the need for money, healthcare, and a permanent
home. Given the fact that homeless people do not have enough knowledge in taking care of
Sister Callista Roy, a nursing theorist, suggests that humans are able to adapt
through identifying the internal and external stimuli which can affect their adaptation (Roy,
1999). The stimuli could be something that the person is immediately faced with, something
that is helping to cause the main stimuli, or an unclear outcome of a situation. Health is a
reflection of how well a person's adaptive systems have adjusted to their ever-changing
changes in their environment thus their adaptive abilities are affected by the stimulus they
encounter daily. Roy's adaptation model is supported by this study because it will show how
homeless people adjust to changes in their environment, particularly in the midst of a global
health crisis. This will also depend on whether they respond well or poorly to stimuli.
"The state of the environment that people lived in is associated with people's health
System Model, Human beings tend to respond to internal and external environment
( Gonzalo, 2021). Person's environment is one of the many factors that affects its overall
health and well-being. Living in an environment where you are exposed to poor nutrition
changes in temperature and many more can lead to serious health problems. Unfortunately,
this is the kind of life that homeless persons live. Anchored in this theory, this study will
shed light on how homeless persons experience these environmental stressors, if they were
able to manifest different kinds of health problems, how they were able to address it with
limited healthcare resources and if they were able to utilize the different healthcare services
that was given by the government and their experiences to the services given.
Conceptual Framework
Figure 1 is the schematic diagram of the study. It demonstrates the relation between
the independent and dependent variables. The independent variables considered in this
study is when the participants are grouped according to their age, sex, number of people in
their family, location, and vaccination status are taken into consideration in the analysis.
Their coping mechanism, health status, health seeking behaviors, and the availability and
utilization of healthcare services are the variables that could affect their experiences during
the COVID-19 pandemic. This is where the different variables leads to the title of the study
in which the independent variables first are arranged and categorized and precedes to the
intervening variables where this will acts as a guide and the outcome of this variables can
be used as data for determining the lived experiences of homeless people during the spike of
demographic profiles play a significant role in determining the outcome of the lifestyle and
characteristics of each homeless person, for this creates a different level of living
perspective and coping mechanism (Fargo, 2013). Furthermore, intervening variables aids
in making the type of connection between both the independent and dependent variables
more concise that will further result in a clear research (Crossman, 2019).
In line with this, the study is anchored on the Self-Care Deficit Theory by Dorothea
Orem, Theory of System Model by Betty Neuman and Sister Callista Roy’s Adaptation
Model whereas these models will help demonstrate the connections between the concepts to
the study and would act as a basis in correlating the literatures in the said study. The Self-
Care Deficit Theory by Dorothea Orem highlights each person's capacity to practice self-
care whereas this will determine how a homeless person deals with their coping
management and health status. Roy suggests that adaptation affects how a person identifies
their external and internal stimuli, in relation to this the coping mechanisms and health-
seeking behaviors of the homeless people must be determined further to understand their
experiences and their healthcare service utilization to determine what factors affect their
stimuli. Lastly, Betty Neuman highlighted in the Neuman systems model that the state of
the environment that people live in is associated with people's health and well-being. This
will determine how a homeless person’s health status is affected in the kind of environment
These theories contribute to the key variables that influence the said phenomenon of interest
Figure 1 presents a diagram demonstrating the connection between the theories and
the study's variables. The first box on the left is the starting profile of the participants
categorized based on age, sex, number of people in the family, location, and vaccination
status. Factors that affect the lived experiences of homeless people in healthcare service
utilization amidst COVID-19 pandemic include: coping mechanisms, health status, health
The primary focus of this study is to identify the lived experiences of homeless persons in
This study is qualitative research. It will explore the health experiences in the
utilization of healthcare services of homeless persons in Bacolod City. This study will
involve six (6) family heads, preferably mothers, all of whom will be interviewed. Each
participant will be given a consent form to prove that they are not being forced to
participate in this study. A month will be set aside for data collection. Data collection will
and area where the researchers will conduct the interview. This will encourage the
researchers to utilize safe areas to conduct the study. Next, the limited resources, whereas
the researchers have limited amounts of resources such as the materials needed for
conducting the study, and the transportation going back and forth to the designated place.
Lastly, the ethical consideration, whereas a private room is needed to conduct the study.
This is one of the limitations where the researchers do not have a private room to conduct
the interview and if needed to rent a space, it would be a heavy financial load.
Local Government Units. Local government units are in charge of enacting laws
and implementing programs that benefit society. There are no programs that provide health
care services to homeless persons. Thus, this study may increase the local government
units’ knowledge of health care and health habits of homeless people, prompting them to
led actions that helped in providing assistance to homeless persons. These activities and
Federation of the Philippines. This study may serve as their additional basis in making
programs and creating medical missions related to providing health services to different
Medical Professionals. People who work in the healthcare industry offer medical
treatment and assistance based on professional training and practical experience to sustain
human health via the use of evidence-based medicine and humanistic approaches. In line
with this, this study can be used by medical professionals in enhancing their care to a wider
scope of people.
Nurses. Nurses are medical professionals who deliver and ensure quality care to all
kinds of clients. They play a big role in health maintenance and promotion. Nurses use a
nursing process that serves as a guide in giving care for clients. This study may serve as a
Barangay Health Workers. The first line of medical workers that provides the
medical available needs and resources to the people in the community. This may serve as a
basis to formulate different ways to address the basic health care needs for vulnerable
Academe. This study may be beneficial to the college and to the institution as this
can act as a guide, and basis for students to read and to further harness and widen their
study may be beneficial because it will serve as a reference for student nurses to identify
the underlying themes in this phenomenon to help them comprehend why this is happening.
Future Researchers. This may serve as a useful guide and reference for the future
Definition of Terms
that supports what is known because it can be seen or felt (Crosby, 2013). In this study this
term is used to perceive the real-life events that were undergone by a group of people.
Health Experiences. A person's interaction with the healthcare industry, patients,
and the medical personnel who care for them (Goodwin, 2021). In this study, this term
refers to the information gathered about a group of people's overall well-being during a
pandemic.
by individuals. Derives from the phenomenological tradition and is rooted in the enactive
approach of cognition. As such, lived experience appears to be active and passive, holistic,
adequate housing. (Keenan & MccGreevy, 2019) In this study, this term refers to people
who are part of the vulnerable group, specifically those who live on the streets.
virus that arose in 2019, having killed over five million people worldwide (Burgan, 2019).
In this study this term is used to refer to the pandemic that has aroused since 2019 until and
thematic approach.
likely to contract severe acute respiratory syndrome coronavirus 2 due to a lack of secure
housing, and therefore also have a greater likelihood to contract COVID19 because of the
high incidence of risk factors in homeless communities (Mellisa Pherri, 2020). Due to
restricted access to health care and social services, the spread of SARS-CoV-2 is often fast,
and disease treatments are being delayed. People who are homeless are more prone to have
their daily lives stigmatized. Until today, the homeless people have stayed on the city's
streets, safeguarding their families in the midst of the protocols (Wang, 2020). Though there
are measures implemented in the US and Canada to increase capacity to allow safe physical
distancing for homeless people, the unique needs of categories of persons experiencing
homelessness must be acknowledged (Wang, 2020). In relation to the previous study, the
statistics show that homeless persons seem to be more likely to have previous health
difficulties, poor mental health, high rates of drug use, and low health literacy, all of which
contribute to inadequate adherence to COVID-19 safety measures like mask wearing and
social distance. (Cromer, 2022). People opt to handle their own health needs instead of
going to the hospital because of the stigma and even experiences that made them feel harsh,
because they have never been welcomed in the hospital, which has resulted in Pandemic-
On the contrary, the homeless people also felt loneliness especially during the first
wave of COVID19. This study conducted in Harmburg, Germany showed during the initial
wave of the COVID-19 epidemic, the general populace saw an upsurge in loneliness
(Bertam, 2021). Increased loneliness was connected with male gender, being single, being
originally from Germany, a high frequency of sharing a sleeping area with more than three
analysis. Furthermore, this affected the emotional health of the homeless persons living in
the streets during the first stage of COVID19 pandemic with decreased hope and feeling of
depression and sadness, and many stated that consuming drugs was a common coping
mechanism they used to deal with their emotions. Their street experience during COVID-19
increases drug usage because it serves as a coping strategy in which individuals tend to
forget that COVID is present and that they have easy access to street drug dealers. (Salem,
2022). The belief that alcohol could be more safely secured during COVID-19 than
narcotics, or that alcohol killed the COVID-19 virus also governed the perspective of adult
persons living on the streets. This led to actions that resulted in too much alcohol intake as a
coping mechanism (Nyamathi, 2022). There are also homeless people who have an eye
view and caution when it comes to protecting themselves during COVID19. Some made
use of social distance by not being too close with their fellow homeless folks and limited
their trash-digging for the look of food. Though their resources when it comes to disease
prevention such as public bathrooms and water fountains are restricted, they still made use
In addition to that, from 2018 to 2019, the number of people suffering homelessness in
Denver, Colorado, grew by approximately 15%, this tendency, paired with the 2020 SARS-
CoV-2 (COVID-19) pandemic, has created a significant issue for unhoused populations
(Briggs, 2022). Unhoused people tend to gather together as a group to help each other and
this led to the big groups domination. The unavailability of public restrooms and shelter
spaces dominated Denver Colorado from the start of the pandemic. This also led to people
sleeping in piles of sweeps because of the displacement of outdoor tent encampments where
the coping method of homeless people is to survive despite being left out and the scarcity of
some of the poorest cities of France indicated that the experience of being homeless put risk
among numerous others. (Mosnier, 2021). Different forms of protection were discovered
depending on the type of living environment, such as emergency shelters but this put them
into high-risk of infection because the number of homeless people were huge. Despite the
negative impact on the homeless people, they still have hope to live and survive the
pandemic through thriving their best to support their daily needs such as food (Allaria,
2021).
Due to their particular difficulties, it has been hypothesized that COVID-19 will
disproportionately affect vulnerable groups including the homeless. People who are
homeless frequently have no access to healthcare and may reside in unclean or congested
conditions. These obstacles make it challenging for homeless people to follow suggestions
for frequent hygiene, social isolation, and self-quarantining (Matthew, et al. 2022).
Additionally, homelessness refers to the state where people live under the minimum
standard or lack of secure tenure. Humans under this social category inhabit the streets,
moving between temporary shelters, living in private boarding houses without a private
bathroom, and/or marginal caravan park residents who are renting (Pacaol, 2021). In
comparison to younger homeless people, older homeless adults appear to use more hospital-
based medical care and less non-acute, preventative healthcare. Shelter-based or community
beneficial for this vulnerable population (Dongen, et al. 2019). Since the start of the
pandemic, homeless people have had somewhat higher infection prevalence rates than those
with housing, which may be explained by the different homeless sample, which also
included people without shelter. While cleanliness practices, appropriate sleeping and
separation arrangements, daily symptom monitoring, they could not be assured for people
Each and every one specifically urges rigorous community-based homelessness care
providers to share their personal, observant, and attitude-based knowledge to help us gain a
deeper grasp of how the pandemic is affecting homeless populations across the nation. The
voices of vulnerable populations and the frontline professionals who are best equipped to
Homeless persons are most likely to experience health problems. Based on the
survey that was conducted, at least 75% of homeless people are suffering from mental
illness and the rest having cardiovascular disease, injury, and intoxication which requires
treatment. This concludes that more health care services and resources should be available
to homeless people other than basic health care services (Kaduszkiewicz, 2017). In line with
the previous study , this study discussed that having primary health care programs that are
specified with homeless people might be much more effective in standard primary health,
government and medical professionals should make sure to know and address risk factors
that result in homeless (Hwang & Burns, 2014). Homeless people frequently lack access to
vaccine information, may view vaccination as a low priority, People who are homeless have
lower immunization rates than the overall population. Hence there is no data to guide
practice in this area. Given that COVID-19 is the subject of the greatest vaccine campaign
in history, this is problematic (Cosker, et al.2022). When social workers and medical
streets, they can offer them treatments including wound care, medications for infections,
and management of chronic illnesses. Homelessness is associated with increased rates of
mental and physical health issues, such as HIV infection, alcohol and drug misuse, and TB,
according to the Centers for Disease Control and Prevention (Ginger. 2022).
In contrast, health problems and health care services are recognized by homeless
people, and one of the main reasons why some of them don't avail such services is because
of their experiences and encounters with these healthcare services. Homeless people feel
that they were insulted because of the prejudice that was given and some substandard care.
This goes to show that healthcare encounters can greatly affect the client's perspective in
healthcare especially homeless persons (Rae and Rees, 2015). In relation to that, this study
suggests that homeless people have different barriers that keep them from obtaining
knowledge, financial instability, mental illness, and psychological stress. With good
healthcare policies, programs, and interventions can help in overcoming these barriers
(White and Newman, 2014). Whereas, in this study, it suggests that The Affordable Care
Act provides a guide in forming and improving the healthcare system for homeless or
vulnerable people. However, with the programs and services that were given, improving
healthcare coverage can't alone be the solution in improving it. Healthcare improvements
must be implemented and integrated with different resources circulating the target
population to address the different challenges and barriers caused by inadequate shelter,
Also, another study offers a detailed account of homeless people experiences and
attitudes. Healthcare for the homeless, indicating generally positive opinions toward this
demographic while having mixed attitudes toward healthcare for these people. It will be
beneficial to understand the viewpoint of those whose occupations involve helping this
group as many sectors, including healthcare, evaluate and address the needs of people who
are experiencing homelessness (Qian & Hauser 2022). The relationship between helping in
homelessness prevention. Utilizing health services, being in good or fair health, insurance
reduced the likelihood of home instability. regardless of citizenship, have access to health
insurance Housing insecurity may be thwarted by status and the application of preventative
healthcare to keep one's health (Chinchilla et al.2021). The key to aiding the homeless
population is educating the medical community. Medical contact, which most frequently
occurs through emergency rooms, offers the chance to direct patients toward crucial
(2022).
The COVID-19 pandemic has presented many challenges to most people, especially
health care professionals. A healthcare team in Brazil, along with other organizations,
arranged an activity to promote health measures to prevent the spread of the virus. This was
done with the intention of investigating the experiences of homeless people during the
pandemic through the experience reports of professionals working with them. This study
revealed that when dealing with COVID-19 and working with homeless people, it is critical
to share difficulties and use empathetic methods to mitigate effects (Schettino et al., 2021).
Another study shows that homeless people have poorer health compared to others which
can be addressed through creating programs and services. These programs can be done
through collaborative, multidisciplinary, and integrated systems where physical and mental
health care are addressed (Jego, Abcaya, Stefan, et al., 2018). In light of the COVID-19
pandemic, vaccination completion for homeless people have been studied about. According
to a study done in Minnesota, USA, homeless people have lower completion rates of
COVID-19 vaccination compared to the general population at the end of 2021 (Shearer et
al., 2022). There is a significant difference in completed vaccination rates between the
general population and the homeless population. In a similar study, homeless people in
Ontario, Canada have lower vaccination rates than the general population (Stead et al.,
2022). The rate is influenced negatively by homeless people's negative attitudes toward
vaccination and their lack of trust. Stead et al. (2022) proposed methods for increasing the
vaccination status of homeless people. On the other hand, there are a significant number of
homeless people, both past and present, who are willing to receive vaccination and return to
people are not able to utilize healthcare services in Africa (Osei Asibey et al., 2020). The
hospital and clinic services, complementary services, and modern contraceptives are
can provide stigma-free health care and social assistance for these people. In contrast to
this, a study conducted in Rome, Italy revealed that healthcare service utilization was well
facilities. The study determined that compared to the Italian-born homeless population,
migrants utilize the ambulatory clinic more, hence the implementation of a series of
migrant-oriented practices may effectively increase the utilization of health care services by
these people (Silverstrini, 2017). Similarly, homeless children in Dublin, Ireland utilized
healthcare services especially the pediatric emergency department more than non-homeless
children but are less likely to receive primary health care (O’brien et al., 2022). It has been
indicated that they are less likely to be fully vaccinated and are more likely to be partially or
completely unvaccinated.
Synthesis
In the first wave of the pandemic, the emotions filled the hearts of the homeless
people were loneliness and sadness, where they felt as a left-out. Studies showed that the
coping mechanisms of homeless people vary depending on the place and environment they
are living in. This includes alcohol intake, substance and nicotine use for these mechanisms
to help them forget that COVID is present. Factors that contribute to this is the lockdown of
public services where homeless people thrive to survive this pandemic despite having very
limited resources. In line with this, homeless people are prone to catch COVID19 and that
their health are in risk especially having no resources and unavailability of grasping health
healthcare services for homeless people due to multiple factors. The stigma against them
that hinders them from seeking health care. Understanding them on a personal level and
approaching them with compassion are essential to help them seek health care more often.
Their perception of the COVID-19 vaccine also influences their use of healthcare services
underutilization of healthcare services. Among this pool of literature, there are no studies
that have been conducted in the Philippines, nor are there any available healthcare services
by governmental organizations that could start one. There are also suggestions for
additional research because there is a lack of knowledge about the relationship between
healthcare services and the homeless population. In addition to that, the need of attention
and emphasis to homeless people here in the Philippines is a must, also to make more
activities where the goal is to render services for those kind of people. Those people who
are considered to be homeless are ones who are more vulnerable to the pandemic we are
facing today. Being aware of the fact, our medical professionals are being urged to pay heed
to the needs of the people who are in need of healthcare the most. Being able to effectively
provide care to the homeless will educate them to seek the help from the professionals
rather than brace the diseases themselves. Having accessible healthcare facilities not only
promote inclusiveness but also health education to the homeless and reliability towards the
References
on-covid-19---28-september-2022
https://doh.gov.ph/covid19-vaccination-dashboard
Jadloc, M. (2021). UPD, WHO Philippines vaccinate at-risk population. University of the
Dieumegard, G., Nogry, S., Ollagnier-Beldame, M., & Perrin, N. (2021, December). Lived
experience as a unit of analysis for the study of learning. Learning, Culture and Social
guide). Nurseslabs.
https://nurseslabs.com/betty-neuman-systems-model-nursing-theory/#what_is_the_neuman
_systems_model
Thomas Münzel et al. (2018). Environmental stressors and their impact on health and
https://pubmed.ncbi.nlm.nih.gov/29278923/
Schettino, R., Simim, D., Soares, S., Almeida, S., & Castro, V. (2021, October 1). Primary
care health actions to homeless people during covid-19:an experience report. European
Tiedeman, M. E. (2006). Roy Adaptation Model (2nd. ed. ed.). Springer Publishing
Company.
Osei Asibey, B., Conroy, E., & Marjadi, B. (2020). Health problems and healthcare service
utilisation amongst homeless adults in Africa- a scoping review. BMC Public Health, 20(1),
1–12. https://doi.org/10.1186/s12889-020-08648-y
Silvestrini, G., Federico, B., Damiani, G., Geraci, S., Bruno, S., Maisano, B., Ricciardi, W.,
& Kunst, A. E. (2016, August 7). Healthcare utilization among urban homeless followed by
an outpatient clinic: more intensive use by migrant groups. The European Journal of Public
May 28). "locked down outside": Perception of hazard and health resources in COVID-19
epidemic context among homeless people. SSM - Population Health. Retrieved October 1,
Shearer, R. D., Vickery, K. D., Bodurtha, P., Drawz, P. E., Johnson, S., Jeruzal, J., Waring,
S., Chamberlain, A. M., Kharbanda, A. B., Leopold, J., Harrison, B., Hiler, H., Khazanchi,
R., Rossom, R., Margolis, K. L., Rai, N. K., Muscoplat, M. H., Yu, Y., Dudley, R. A., .
https://doi.org/10.1377/hlthaff.2021.02030
O’ Brien, N., Quinn, N., Joyce, B., Bedford, H., & Crushell, E. (2022, March). Emergency
Briggs, L. (2022). Left Behind in Lockdown: COVID-19 and the Denver Unhoused
journals/left-behind-lockdown-covid-19-denver-unhoused/docview/2668433196/se-
Stead, K., Self, J., Fleming, K., & Stead, T. (2022, June). Improving vaccination rates
https://doi.org/10.46747/cfp.6806408
Jego, M., Abcaya, J., Ștefan, D. E., Calvet-Montredon, C., & Gentile, S. (2018, February
10). Improving Health Care Management in Primary Care for Homeless People: A
Literature Review. International Journal of Environmental Research and Public Health,
Perri, M., Dosani, N., & Hwang, S. W. (2020, June 29). Covid-19 and people experiencing
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828890/
Rodriguez, Natalia M,PhD., et. al, 2022, June). Impact of COVID-19 on People
covid-19-on-people-experiencing/docview/2672393515/se-2
Bertram, F., Heinrich, F., Fröb, D., Wulff, B., Ondruschka, B., Püschel, K., König, H.-H., &
Hajek, A. (2021, March 16). Loneliness among homeless individuals during the first wave
https://www.mdpi.com/1660-4601/18/6/3035/htm
Nyamathi AM, Gelberg L, Lee D, et al. Perceptions of Homeless Adults and Their
Providers on Coping With the Impact of COVID-19 Pandemic on Mental Health, Substance
Use, and Harm Reduction Services. Global Qualitative Nursing Research. 2022;9.
doi:10.1177/23333936221108712
Gonzalo, A. B. (2021, March 5). Dorothea Orem: Self-Care Deficit Theory. Nurseslabs.
care_deficit_theory
Regis College Online. (2021, October 29). The Pivotal Role of Orem’s Self-Care Deficit
role-of-orems-self-care-deficit-theory/#:%7E:text=Orem’s%20self%2Dcare%20deficit
%20theory%20suggests%20patients%20are%20better%20able,Nursing%20Practice
%20(DNP)%20programs.