Working with the UCLA Health Homeless Healthcare Collaborative during graduate school changed Zoe McFall’s life.
As part of UCLA’s nurse practitioner master’s program, McFall, FNP-BC, was assigned to a 10-week rotation in 2022 with the mobile unit that provides critical health services to people experiencing homelessness in Los Angeles County.
McFall was already a nurse with UCLA Health, 但她在无家可归者医疗保健合作组织的经历开阔了她的视野，也打开了她的心扉，让她看到了皇冠hga020电脑版医疗保健的广阔前景.
“It’s one of the best things that ever happened to me,” says McFall, 她现在是洛杉矶县卫生服务皇冠hga025的一名持证家庭护士. “我在流浪者医疗合作组织的轮转确实改变了我对医疗保健的看法. It laid a foundation for the care I will provide as a medical provider.”
Eye-opening experience
Students studying to become family nurse practitioners at the UCLA Health School of Nursing typically participate in seven field rotations during the two-year program. These applied-practice experiences might be in pediatrics, the emergency department, a neighborhood clinic or other medical setting.
并不是每个护理专业的研究生都能得到无家可归者医疗合作组织的培训, 这家公司经营五辆面包车，每个季度只能容纳两名护理学生. (医科学生、住院医师和精神病学研究员也在该单位进行轮岗.) But that hasn’t stopped current nurse practitioner student Kate Gieschen, 注册护士——她最近完成了移动医疗团队的轮岗——鼓励她的同学寻求经验.
“我想也许每个学生都能从轮转中受益，看看它会是什么样子,” says Gieschen. “这让我们大开眼界，了解了我们的许多患者面临的障碍，以及如何用对他们有效的计划最好地支持他们.”
在访问洛杉矶市中心的一个男性无家可归者收容所时，Gieschen和他一起工作 Phillip Brown, MD, an assistant clinical professor in family medicine at the David Geffen School of Medicine at UCLA. 在面包车停在医院的两个小时里，他们一起看了至少六个病人.
The men were dealing with a range of issues: some needed refills on their medications; one had muscle aches; another sought psychiatric support. Gieschen and Dr. Brown treated each like their most important patient of the day.
One patient complained of a sore throat. Gieschen轻轻地把手放在他的背上，用笔灯看着他的喉咙. An observer wondered when that man had last been touched so kindly. Such physical contact can be healing on its own, Dr. Brown says: “Being empathetic can go a long way.”
Gieschen and Dr. 布朗与每位患者讨论了可能阻碍他们拿起处方药并按照指示服用的挑战. Did they need a ride to the drugstore? (If so, the mobile health van can summon a car service.) Did they have a safe place to keep their meds?
Non-compliance with medications is a common issue in health care, Gieschen says, 但是，无家可归者面临的挑战为她增加了一个新的考虑维度.
“If your backpack’s getting stolen, how are you supposed to take your meds?” she says. “或者，如果我们不知道我们以后能不能检查你的血液水平，我们能给你开什么药呢??”
这种批判性思维和对个人及其生活环境的同情，不仅适用于照顾无家可归的人, 她说:“这真的是把一个人作为一个完整的人来看待——他们面临的障碍和他们拥有的优势——并为他们制定计划。.”
Training the next generation of providers
自2022年1月成立以来，无家可归者医疗合作中心一直是护理研究生的轮转网站.
“It’s a very nontraditional type of care that we’re providing,” says Brian P. Zunner-Keating, MS, RN, director of the Homeless Healthcare Collaborative. “We’re very happy to be able to train the next generation of health leaders, really ground them in health equity, 并且能够让他们在职业生涯的早期接触到传统医院或诊所环境之外的不同类型的护理.”
除了在非传统环境中与经常被边缘化的人一起工作, 在无家可归者医疗保健合作组织接受培训的护理专业学生将接触到各种各样的病人和健康状况, Dr. Brown says.
“They get the opportunity to practice a broad scope of medicine,” he says, including pediatrics, women’s health, mental health and acute care. “With the experience they gain here, 它使他们的选择更广泛，他们的前景和视野更加广阔.”
这也是一次强大的学习经历，因为学生们有机会接触到训练他们的医生, Gieschen says. Not only do they work together closely while tending to patients, but they’re literally sitting side by side in a van to and from each site.
Common humanity
Dr. 布朗选择与无家可归者医疗合作组织合作，因为他想为那些在社会上被低估的人提供优质的护理. 与流动卫生单位一起工作的执业护士学生也报告说，他们对可能被忽视的人的理解和同情有所扩大.
“I feel like my empathy grew by leaps and bounds,” McFall says.
与无家可归者医疗合作组织的合作改变了她的职业方向. 麦克福尔现在致力于为受健康社会决定因素影响的人提供护理, such as lower income and education; exposure to violence, racism and unsafe neighborhoods; and reduced access to clean water, air and healthy foods.
“These are people who are caught by a safety-net health care system, and I realized that actually that’s where I want to be,” McFall says. “我希望能够为这样的病人提供护理，因为我不仅有教育和经验，我可以在这些情况下提供, but even as a provider, it reminds me of the humanity in all of us.”
