Publication Date

Winter 3-9-2022

Item Type

Text

Executive Summary

Introduction

In 1894, Angeline’s Day Center for Women was established through the Young Women’s Christian Association (YWCA) to serve the evolving needs of homeless women in Seattle by addressing existing racial and socioeconomic health disparities (Schafranek, 2021). Angeline’s provides overnight and day services to address the COVID-19 related heightened community need, including healthcare, meals, and hygiene services to 40 women (Schafranek, 2021). In 2022, the Seattle Pacific University (SPU) Lydia Green Nursing Program partnered with Angeline's to analyze and address the needs of the population they serve. The undergraduate nursing students performed a windshield survey and developed a community diagnosis of ineffective coping related to social circumstances and homelessness as evidenced by self-reports of health-harming behaviors. To address this diagnosis, mindfulness-based movement (MBM) sessions were implemented with the goal of reducing stress and promoting positive coping skills.

Background

Homelessness in King County continues to rise: the 2020 Point-in-Time Count for Seattle/King County found a total of 11,751 people experiencing homelessness countywide (Constantine, 2020). King County’s steady increase in homelessness is compounded by the ongoing pandemic. YWCA program participants experienced job loss, food insecurity, loss of health insurance, and loss of housing related to COVID-19 (Schafranek, 2021). Furthermore, homeless adult women demonstrate elevated rates of physical health concerns such as inadequate nutrition, under-utilization of preventative care, and heightened prevalence of mental health concerns secondary to trauma-exposure (Dickins et al., 2021). Research indicates that homeless women are more likely than other women to adopt health-harming coping strategies, including refusal to accept circumstances, avoidance, and increased smoking (Dickens et al., 2021). Fortunately, studies have demonstrated that physical activity and mindfulness-based stress reduction (MBSR) interventions have the potential to reduce stress, promote positive coping strategies, and improve health outcomes, in trauma-exposed, low-income women (Dutton et al., 2013; Vogel, et al., 2022). Considering the need for improved coping strategies and stress-reduction in homeless women, along with emerging health benefits of exercise and MBSR, the nursing students have partnered with Angeline’s to offer guided MBM.

Activities with Rationale

Studies have demonstrated the efficacy of relaxation-based movements such as guided breathing, yoga, dancing, and focused muscle training in reducing depression and anxiety in adults (Klainin-Yobas et al., 2015). Utilizing this research, the nursing students developed four sessions of MBM that focused on reducing stress and promoting positive coping. Each session opened with informal conversations with the women, followed by introductions, and implementation of 15-20 minutes of MBM. The nursing students provided verbal instructions and physically demonstrated full-body, yoga-like movements that promoted blood flow, relaxation, and intentional deep breathing.

Outcomes/Results

The total number of participants versus the total number of women present in the room for each implementation were as follows: 4 out of 10 (40%), 7 out of 9 (77.8%), 8 out of 10 (80%), and 5 out of 8 (62.5%). Following the first session, one participant reported that she felt more relaxed following the MBM. However, overall participation rates in the first week were low. To address this, the students reflected on potential barriers to engagement, including lack of trust and the presence of non-familiar people within the shelter. They decided to incorporate background music and a period of causal communication before the session to make the students’ presence more inviting. These changes contributed to a marked improvement in active participation in the second session. In the third and fourth weeks, the students donned scrub tops to model familiar nursing attire and gain trust among the residents. Additionally, stress balls were incorporated into the activity to serve as a tactile aid for deep breathing. The energy levels were considerabl y higher, and teaching from the students garnered surprise from the residents, indicating active listening. The nursing students recognized that the introduction of music before and after the sessions allowed for self-expressive dancing, increased participation, and was met by participant verbalization of increased collective energy. The combination of music and movement proved to be a positive coping strategy for the women of Angeline’s.

Conclusion

The program's goal was to decrease stress and introduce healthy coping mechanisms. This goal was met through the implementation of four MBM sessions. The women at Angeline’s vocalized enjoyment, decreased stress levels, and increased knowledge of physical movement. To leave a lasting impact, the nursing student provided the Angeline’s activity coordinators with exercise guides to be posted throughout the shelter to serve as a visual reminder for the women to apply exercises when seen. Additionally, a playlist was created to allow for continued unstructured movement time (Appendix C). Limitations encountered included COVID-19 restrictions at Angeline’s that limited the time of the sessions and prohibited the entire group of nursing students from attending at once. The most significant obstacle that the nursing students encountered was the lack of participation from the women secondary to lack of trust. However, the student’s repetitive presence and the incorporation of music significantly increased participation. The nursing students are hopeful that having increased time with the participants to develop therapeutic relationships would bolster active participation in future MBM sessions.

References

Dickens, K. A., Philpotts, J. F., Flanagan, J., Bartels, S. J., Baggett, T. P., & Looby, S. E. (2021). Physical and behavioral health characteristics of aging homeless women in the United States: An integrative review. Journal of Women's Health, 30(10), 1493-1507. https://doi.org/10.1089/jwh.2020.8557

Dutton, M., Bermudez, D., Matas, A., Majid, H., & Myers, N. (2013). Mindfulness-based stress reduction for low-income, predominantly African American women with PTSD and a history of intimate partner violence. Cognitive Behavioral Practice, 20(1), 23-32. https://doi.org/10.1016/j.cbpra.2011.08.003

Constantine, D. (2020). Point-in-time count estimates a 5 percent increase in people experiencing homelessness, newly updated data dashboards reveal more people receiving shelter and services. https://kingcounty.gov/elected/executive/constantine/news/release/2020/July/01-homeless-count.aspx

Klainin-Yobas, P., Oo, W. N., Suzanne Yew, P. Y., & Lau, Y. (2015). Effects of relaxation interventions on depression and anxiety among older adults: A systematic review. Aging & Mental Health, 19(12), 1043–1055. https://doi.org/10.1080/13607863.2014.997191

Schafranek, A. (2021). COVID-19: What women need now and in the future. https://www.ywcaworks.org/blogs/ywca/tue-02162021-1010/covid-19-what-women-need-now-future

Vogel, E. A., Zhang, J. S., Peng, K., Heaney, C. A., Lu, Y., Lounsbury, D., Hsing, A. W., & Prochaska, J. J. (2022). Physical activity and stress management during COVID-19: A longitudinal survey study. Psychology & Health, 37(1), 51–61. https://doi.org/10.1080/08870446.2020.1869740

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