Students learn compassionate care through street nursing

A single event in 2010 changed the country of Haiti. The same event — a magnitude 7.0 earthquake — also changed the way a UT Health San Antonio nurse views homelessness.

Like many health care professionals, Diana Cavazos, PhD, MSN, MHSA, RN, then a school nurse in Puerto Rico, felt compelled to join a nonprofit organization to provide care for the millions of people affected by the earthquake.

“Nothing prepared me for what I witnessed when I arrived,” said Cavazos now an assistant professor in the School of Nursing.

“All of my senses were immediately triggered. The screams of those in physical and emotional pain were very loud and real and were heard non-stop. The smell of death permeated the double face masks we were wearing. My eyes could not believe the sight of flattened buildings with people still inside them as their loved ones mourned them on top of the rubble. I could touch those in need, but my healing touch seemed diminutive compared to a catastrophe of this magnitude,” she said.

“My nursing practice evolved dramatically at that moment and my nursing perspective changed for the best. Seeing first-hand the unmet, basic human needs changed me personally and professionally,” Cavazos described in an article she wrote for the January Texas Board of Nursing Bulletin.

When Cavazos joined the School of Nursing in 2019, she brought with her the desire to help those who have the biggest unmet health care needs. In San Antonio, these are citizens with no home.

Since then, she has helped nursing students learn compassionate care with clinical skills education through the School of Nursing’s partnership with two nonprofits. These organizations are Corazón San Antonio, which provides services for individuals who are homeless, some of whom have substance use disorder, and Street Medicine San Antonio, which provides medical care to the unsheltered population. Just as in the school’s other clinical education options, students learn to assess patients, treat wounds, take medical histories, document care and refer patients for follow up.

In their orientation, students learn what to expect. “We approach (homeless individuals) with a lot of respect and we announce ourselves, because we need to build that trust,” Cavazos said. “We tell them we are from the School of Nursing and we’re providing medical care. We also tell them we are from the harm reduction program,” which provides care for individuals with substance use disorder, because often they think visitors are law enforcement coming to move them from their space.

“To me it is just like with any other patient. You don’t just walk into a patient’s room and say I’m going to do something without even introducing yourself and your intention,” she explained. “We just provide the service, and the patient has the right to refuse it. If they don’t want our help, then we just move along.”

One student in particular stands out as being uncomfortable with providing care in this setting. Street nursing was the only clinical education option that would fit into the student’s schedule, Cavazos said. “She was just terrified…. But as she became more comfortable, she began to enjoy it.”

One patient encounter was the turning point for that student. “A man told her he had been discharged from the hospital with an abscess on his leg and you could just see all the pus draining out of it. She was in shock when he told her that the nurse at the hospital knew he was homeless and just told him to change the dressing and keep it clean. She was furious that he was dismissed like that…. She said that she learned she needs to make sure that her patients have everything they need to comply with the discharge instructions when they leave the hospital. The student ended up continuing to volunteer after the clinical training ended,” Cavazos said.

Turning points like these — when students learn critical lessons or when patients are finally ready to enter recovery — keep Cavazos coming back. “Serving the community is what keeps me going. It gives me almost a spiritual connection to humanity in just doing what’s right. And when they thank you, it is proof that I’m in the right place doing what is needed.”

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