Effects of a nursing intervention with homeless veterans

The purpose of this quasi-experimental study was to determine if a specific nursing intervention to instill hope would positively influence levels of hope, self- efficacy, self-esteem and depression in homeless veterans. Miller's (1983, 1992) Model of Patient Power Resources served as the conceptual framework from which a middle-range theory of Homelessness-Hopelessness was derived to guide the study.

The sample consisted of 40 homeless veterans from the Homeless Evaluation Unit (HEU) Department of Veterans Affairs Medical Center at Mountain Home, Tennessee. The subjects completed pretests on admission, were randomly assigned to the treatment or waiting control group and completed posttests at the end of four weeks of either specialized nursing intervention or the usual and customary treatment in the HEU. Data were collected with the Miller Hope Scale (Miller & Powers, 1988), the General Self-Efficacy Subscale (Sherer, Maddox, Mercandante, Prentice, Dunn, Jacobs, & Rogers, 1982), the Rosenberg Self-Esteem Scale (Rosenberg, 1965) and the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979). Test-retest reliability was high for each instrument.

Qualitative data were recorded in field notes. Quantitative statistical analyses were performed on the data using correlations, analysis of covariance (ANCOVA) and t-tests. The qualitative data were analyzed for patterns and themes. Length of homelessness was inversely related to hope and positively related to depression on admission to the study. There was support for the vii Homelessness-Hopelessness theory as evidenced by a high level of depression and low levels of hope, self-efficacy and self-esteem among these homeless veterans. Further support for the theory was seen in the increased levels of hope and self-esteem and decreased depression in veterans who received the nursing intervention. Treatment and control groups differed significantly with regard to hope at posttest. Implications for the nursing profession, public policy and future research were discussed.