Advanced nurse practitioner and Arch Director, Hannah Bishop, obtained her Masters Degree in Specialist Community Practice last year. She shares insights from her dissertation below; a powerful piece of original research illustrating the potentially huge impact of positive experiences on the lives of women accessing primary care whilst homeless.
Whilst previous research has explored negative experiences for women accessing healthcare whilst homeless, my research also looked at the impact of positive interactions with doctors and other healthcare professionals. The main three themes emerging were around knowing, hearing and trusting: true engagement with a healthcare professional, who takes the time to acknowledge, trust, and really listen, had a profound effect on the women I interviewed. It often provided a turning point in their lives, leading to improved mental and physical health, and more stability. The women who had been able to establish such a relationship with someone in their GP service, gave moving accounts of what this meant to them. One stayed with her doctor despite having to move to a new area and needing to take a 40-minute bus journey to continue to see him. Another described the impact of feeling heard, and how this impacted her subsequent accessing of health services:
‘…I feel I can actually go there by myself cause I got listened to the first time… if I hadn’t have got listened to I mostly wouldn’t be accessing the services… I’d mostly be letting my health slip…’
This tied into the concept of a “therapeutic alliance”, i.e. healthcare professionals being true allies to patients through the establishment of a collaborative, trusting relationship. Taking the time to listen and understand their deeper needs, being aware of the trauma involved in homelessness, all that might have led up to it, and all the trauma that may stem from it. It is up to the healthcare provider to create space, be receptive, to listen and to respond appropriately, effectively creating a safe, home-like space, for a patient who does not have a home and may not often feel safe enough to address their own health needs.
It may seem counter to the time and resource pressures many of us in primary care services face, to take this time and create this space for a patient. However, the power that the doctor-patient relationship held for the women I interviewed, meant that some small investment early on could really be the start for these women regaining a sense of agency and control over their own lives, and making vital steps towards a healthy and stable life.
More widely, the research illustrates the importance of getting the views of people with lived experience of homelessness, in order to see what works and what doesn’t, when they access healthcare. Thus we can ensure that we focus resources on making changes that will actually work for those who need it. This is the philosophy behind the Brighton & Hove Common Ambition (BHCA) project, which uses co-production in order to drive healthcare improvements for people facing homelessness in Brighton. I am eager to see how this insight translates over into the work of the BHCA and leads to larger scale improvements to our city’s healthcare system, for those who need it most.