In 2020, there were around 580,000 people experiencing homelessness in the US with about 39% of them in unsheltered locations (Montgomery et al., 2021). Many homeless women experience safety issues and have severely impacted physical and mental health, so finding shelter is crucial in efforts to improve their well being (Sarla, 2020). Women’s Shelter is a shelter for single homeless women in downtown Seattle that provides daily meals, laundry services, and overnight shelter. After assessing the women by visiting Angeline’s, the group found that hand hygiene was an issue among the women. Then, the group decided to focus on hand hygiene, COVID-19/infection education.
Women’s Shelter is located in Seattle, Washington and currently housing 50 women at their shelter. The mission is to provide a thriving community that empowers women towards affordable housing. Women’s shelter has overnight shelter for single adult women in addition to the day center. The shelter provides and connects the women with different resources including employment, housing and stability resources. The shelter’s services include breakfast, lunch, showers, laundry, personal storage lockers, group activities and referrals to community services. Accessing shelter is an important step in infection prevention because those experiencing homelessness are at risk for COVID-19 and may experience barriers to hand hygiene (Montgomery et al., 2021). Research has stated that during the pandemic among people experiencing homelessness in Atlanta; it was found that the primary barrier to hand hygiene was limited access to facilities and supplies and the lack of access has been exacerbated during the COVID-19 as the result of public services and business. The group discussed that hand hygiene could be an issue for the women at Angeline as well and planned to focus their project on hand hygiene education. Assessment data was gathered through surveying the women, asking the manager, and receiving recommendations from the instructor (see Figure E). All the data was evaluated and identified that hand hygiene was one of major health-related issues that the woman was experiencing. Hand hygiene is one of the most effective methods to prevent infections and lower risk of COVID infection. The group determined that the women would benefit from hand hygiene education. The group discussed how to successfully carry out the implementation and decided to add hand spa to the hand hygiene education as well as perform it with a one-to-one interaction with each of the residents. The main purpose of the project was to prevent COVID-19 among the women by providing them with hand hygiene education (see Figure D). Other goals of this project was to provide the women with the social interaction that they are lacking as a result of the pandemic and provide them therapeutic touch by providing them hand spa/hand hygiene.
Activities with Rationale
The most important factor in helping prevent the spread of COVID-19 is to “empower the people with the right information” (Reddy & Gupta, 2020). Therefore, vulnerable populations should not be ignored, instead have effective communication to decrease gaps between populations (Wen et al., 2007). All of CDC’s work has been aimed to combat COVID infection and therefore to assist with doing so, establishing effective communication through education is a direct way to do so. The group came to the decision that they will be doing education and hand hygiene through one-to-one interaction which includes touch because making an individual trust and feel cared for is crucial in connection with them. It has been seen that “feelings of dehumanization were frequently evoked by unwelcoming health care encounters, suggesting that participants felt treated as an object and in a manner not recognizing their worth and personhood (Wen et al., 2007). This was seen with the women at the shelter, as they expressed their feelings that they do not get a lot of interaction because so many individuals see them as a threat, crazy, or less than human. The group focused on making sure that these ladies did not feel dehumanized, instead getting treated like anyone else would at a spa. Throughout research it was seen that with welcoming health care encounters, it was associated with feelings of humanization and the individual's feeling cared for. (Wen et al., 2007).
Once the group successfully implemented the intervention, the next step was to evaluate the effectiveness of the intervention (see Figure E for evaluation). After the group demonstrated the proper hand hygiene to the women, the group used the teach back method to evaluate how well the individuals learned. Each individual got the chance to show how they would wash their hands and what they learned from the demonstration. The group gave the ladies feedback by watching them do proper hand hygiene. Once the demonstration of hand hygiene was done, the group moved on to doing the hand massage and spa. As the group was massaging their hands, they talked to them about useful tips for preventing COVID and infection. After talking and discussing different ways to prevent COVID and staying safe throughout this time, a teach back method was used to evaluate their understanding. The ladies were encouraged to explain back what they learned about specific ways we discussed about COVID/infection prevention.
It was surprising to see how well the ladies processed the presented information and how knowledgeable they were prior to our intervention. After our implementation (see Figure D for protocol of implementation) and COVID education (see Figure F) the women verbalized positive emotions (see Figure A). This indicates that the women had a positive experience. One of the goals of the group was to build trust and this was met as indicated that the women demonstrated experience of feeling welcomed arises through interpersonal interaction and that contributes to the creation of trust. They acknowledged how helpful it was to have this reminder to keep doing what they currently are doing. The ladies verbalized that although those around them know the right safe infection prevention techniques, they do not always implement it in daily tasks. With the group being at the facility demonstrating and verbalizing information was a motivating factor for them to keep up on safe practices and protecting each other.
Several limitations arose due to the COVID outbreak at the shelter that caused a one week shutdown. This had shifted the group’s plan and hand education for a week later. Since this COVID outbreak had happened, it was difficult for the group to communicate with the clients. When doing the hand spa, it felt as if the ladies had some fear regarding being so close to some of them and being hands on. Some ladies chose not to participate due to the fact that they did not feel comfortable with someone being so close to them. For more accurate evaluation, there needs to be more thorough verbalization or a longer post survey to see the depth of how much they learned and the difference between their knowledge before and after the hand spa education. Being able to come back another week and implement at least two more weeks would have been an amazing opportunity to be able to see how much the women would have opened up and felt more comfortable interacting and participating. A more organized setup of the hand spa layout, would have made it easier to replicate in the future for other groups. Also, more time would have been very beneficial to both the group and the ladies at the shelter to feel more comfortable and for the group to feel more confident in the planning. It would be very encouraging to see future SPU students to consider the recommendations (see Figure E) and come back to the shelter and replicate this project and work on carrying it out even further.
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Yerina, Anastasiya; Garibay, Cristal; Tewolde, Henok; Priya, Muskan; and Lee, Jeannie, "Hand Hygiene and COVID Education at Women’s Shelter" (2021). Nursing Leadership in Community Engagement Projects. 6.
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