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Jiramanee Apiwansri ’22, Jana Graham ’22, Veronica Wagner ’22, and other senior nursing students at ����ɫ��ҹ University of California are listening to and learning about community needs during a clinical rotation providing services as part of a new homeless outreach program.

In partnership with County of Marin ����ɫ��ҹ and Human Services (MHHS) Aging and Adult Services and the San Rafael Police Department, ����ɫ��ҹ senior level nursing students are participating as team members providing services at a homeless encampment in San Rafael. Each Tuesday this semester the students are offering individuals medical services and federal government vouchers to help residents without housing to find permanent home. It is part of the initiative Aging and Disability Resource Connection (ADRC) Telehealth/In Person ����ɫ��ҹ Profession Intern Program through the county.

There are 10 ����ɫ��ҹ nursing students from the School of ����ɫ��ҹ and Natural Sciences working with Stefanie Buot, BSN, RN, Community ����ɫ��ҹ Clinical Instructor. Half are doing provisory home health visits (such as hotels) and the other half are involved in the homeless outreach program.

“Oftentimes, when you would think about where nurses work, most likely, the first place that would pop up is at large-scale hospitals working at the bedside, but nursing extends beyond hospitals,” says Jiramanee, whose career goal is aimed at critical care in an intensive care unit.

“Some examples of nurses working outside of the hospital setting include hospice, public health, occupational, case manager, and nurse educator. With engaging ourselves with the residents at the homeless encampment, this would be a prime example of the work a public health nurse may be a part of in their daily work.”

The students are providing basic health assessments, such as blood pressure readings and blood glucose levels. They also assist people in applying for CalFresh and Medi-Cal and paperwork toward finding home placement or a health clinic.

“The goal for this program is to get people in this community to be a long-term client for case management. MHHS wants to help people navigate the system long term and get them to qualify with permanent solutions like Medi-Cal, CalFresh, food stamps, receiving care from a primary care physician, dental care, transportation services, etc.,” Buot says. “MHHS wants to consistently follow their case on multiple levels of their life and not just housing. The goal of the student interns is to help MHHS get every resident at the encampment site to be their client for case management, a free service, so we can guide people through these life transitions.”

The process is challenging.

 “We have to keep coming back to earn trust. People who lost their homes and lived on the streets are very cautious and one of the key factors for us to do our job is to gain their trust,” says Jana, who came to ����ɫ��ҹ from the Czech Republic to begin a career in nursing. “Our responsibilities are to improve the wellbeing of the clients on a physical and/or psychological level.”
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In the future, ����ɫ��ҹ nurses are hoping to extend their services to helping administer COVID-19 swabs and vaccines, as well as flu shots.

“Although at times services are provided to these individuals, they may not know where or how to get to them,” says Veronica, a graduate of St. Francis High School in Sacramento who is pursuing a career in psych nursing and home health nursing. “Our job is to help direct those at the homeless encampment to these resources. Active listening is an important part of being in this community as people just want to be heard.”

For Jiramanee, a graduate of Lowell High School, the struggles of the homeless in San Francisco are prevalent. She said that exposure could not have prepared her for what she and her fellow nursing students have encountered in the encampment which is supervised by the San Rafael Police Department.

“As nursing students, we have experienced a mix of positive and negative reactions from the residents as we are essentially strangers entering their home,” Jiramanee says. “This first-hand experience has really allowed me to truly understand their hardships and be a part of a greater community that cares about the overall well-being and health of those in their homeless community, which are at this point not only battling the pandemic as we are, but nights of interrupted sleep as cars are driving on the freeway above them, lack of accessible healthcare and even transportation to get to the medical clinic or hospital, as well as having to ration their drinking water and food to ensure they have adequate food for each meal to keep them full for the rest of their day.”

Jiramanee says there are many factors that contribute to the health of the homeless who do not have the benefit of being treated in a hospital setting. When ����ɫ��ҹ nursing students arrived for the first time, they brought two cases of water bottles, fresh pears, cloth face masks, health bags, and some pastries. They have recommended also bringing hygiene packs and hot soup.

“When we actually help the client with some issue and we see the joy in their eyes, that moment is always the highlight of my day,” Jana says.

“The highlight of this experience for me has been being able to talk openly with the clients,” Veronica says. “Remembering their names and following up with them about services they needed or solutions to problems.”

Jiramanee, who is secretary of the ����ɫ��ҹ Nursing Student Association (DNSA), is grateful for the “endless leadership opportunities ����ɫ��ҹ has to offer” and for the opportunity to apply a nursing students’ basic core value of helping and healing in a different environment.

“I believe our main responsibility as nursing students at the homeless encampment is to encourage, educate, and implement nursing interventions pertaining to improving community health in a holistic manner,” she says. “As senior 1 nursing students, we are able to carry our experiences and knowledge gained from our theory classes and clinical rotations - primarily in hospitals - to working with those in our San Rafael community.”

Jana understands the importance of trying to help and support people living in isolation.

“Everyone has their own story, and we cannot conclude based on assumptions about a certain population. Never. Sometimes people without homes need to be just heard, so listen. Be patient and compassionate.”

Photo above features (from far left, clockwise) Jessica Calderon, Jiramanee Apiwansri, Kristen Yang, Conner Vilter, and Alexa Sullivan.