1. Bonaduce, Judith PhD, RN
  2. Hogan, Audrey BSN, RN

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"A hungry man is not a free man." Adlai E. Stevenson (, 2020a)


Recently I took a group of senior nursing students in a population health course to a Salvation Army site. The residents, mostly women, some men, and a couple, were all there for the same reason-they had lost their homes. One woman was folded in half with her head on the table. Her hat covered her face. I saw that she wore a hospital identification band. I gently whispered near her ear. "Is there anything I can get for you?""I am just so hungry," she responded. It was not yet time for lunch. As I took one kitchen worker's blood pressure, I gently asked if he could give this woman a sandwich. I was amazed that she did not open it right away when he kindly gave it to her-she could not open it with her arthritic fingers.


"That man is the richest whose pleasures are the cheapest." Henry David Thoreau (, 2020b)


"How would you feel?" I asked the students, "If she were your grandmother?" The students were not sure how to operate in this setting without using familiar hands-on nursing skills. I had given them an overview of the ARTT Model, which I had authored some years ago (Bonaduce, 2014). Their NCLEX nursing licensure exam is based on Maslow's Hierarchy of Needs, so I reviewed that with them as well.


The ARTT Model

The ARTT Model is best used in an environment where no hands-on nursing care is provided. The nurse Assesses the client, makes Referrals, Teaches the client, and applies Therapeutic use of the nursing self. One student was speaking loudly with a client who was hard-of-hearing. I taught her how to speak through the diaphragm of her stethoscope and put the earplugs in the client's ears. This works well unless the client is profoundly deaf.


Assessing and Referring the Client

I spoke with a client whose wife had died and who recently broke his back. Now the Salvation Army was his home. I assessed that he did not have a primary care provider. I taught the students to call the referral service of the nearest hospital. They called the nearest hospital and obtained a practitioner within walking distance for this Salvation Army resident. We referred the client. He walks every day and agreed with the doctor and the location. He never took any medications for the constant pain in his back. He said, "I just sit and be quiet and then it mostly goes away." "I'm outta here real soon," he said. "They're working on it."


Teaching the Client

The students taught him how to deep-breathe and meditate. They taught him to access Celestial White Noise, a meditation site, on his phone.


Therapeutic Use of the Nursing Self

I find it curious as an educator that students do not feel comfortable enacting the therapeutic side of their nursing. Listening is the greatest communication skill when dealing with others. I impressed this upon them. It is not necessary to touch the client, unless you think they would accept it and it would do the client well. A mere light hand on the shoulder says let me help you if I can, you are somebody. I encouraged them to talk to the kitchen personnel. Everyone has a story, as Oprah used to say.


"A decent provision for the poor is the true test of civilization." Samuel Johnson (, 2020c)


The Salvation Army's mission is provision for the poor. Homelessness displays predominantly in urban areas; areas similar to this one where the students were placed. Women can be at greater risk and more vulnerable in a shelter; especially women of childbearing years. Families are a quickly growing segment of the homeless population that cannot always be accommodated in a shelter. One woman and children's shelter reports not being able to accept over 300 requests for help in a single week.


Personal Experience

During a recent visit to a friend in Oregon, I noted many homeless. My friend wondered what could she do? She works full-time; her mother is not well; her husband is elderly. Together, we emptied her second freezer full of food in her garage and put all the contents in heavy dark-green trash bags. Then, we carted the bags around to a shelter that takes donations from the public. Will this cure homelessness in Oregon? Certainly not. In our way, we provided for the poor in some way on that day.


We went online and found a list of items that are beneficial to donate to shelters ( Think! Maybe you have these lying around the house and are not using them: bras, nail polish, art supplies, diapers, books, feminine hygiene products, cell phones, transportation passes, purses, and beauty products. We went through all her dresser and kitchen drawers (even her junk drawer) and found lots of goodies to bring to the shelter.


The Red Bell

Some of the students were not aware that the Salvation Army is a Christian organization. "Oh, now I get it, this is the organization that has the big red bucket outside of stores, the one with a lady ringing a red bell during the holidays." I assured my students that it certainly was, although the Salvation Army's care of the poor is all year and everywhere.


A month after this experience with my students, I was riding in my car near the Salvation Army. I saw the man who had broken his back and lost his wife. He was sitting on a bench by himself. I am sure they are still working on placement for him as I am also sure that the whole process is taking too long for a formerly independent man who has lost his independence.


Rural Youth Often Lack Access to Suicide Prevention Services

NIH: The rate of suicide among teens and young adults in the United States has increased over the last decade. Suicide is now the second leading cause of death in these groups. Studies have revealed geographic differences in youth suicide rates. Youth living in rural areas are at greater risk of suicide than those living in urban areas. Suicide rates are also growing at a faster pace among rural youth. Studies have found that youth in rural counties have access to fewer mental health services than those in urban and suburban counties.


A study led by Janessa Graves of Washington State University examined the nationwide distribution of mental health facilities that serve youth and offer suicide prevention services. The study was funded in part by the National Institute on Minority Health and Health Disparities. Results were published in JAMA Network Open.


The researchers identified about 9,500 mental health facilities and determined whether they offered suicide prevention services. These included suicide screenings, treatment for suicidal thoughts, and referrals for follow-up care. The team then used each facility's zip code to classify its location as metropolitan, micropolitan (a smaller urban community), small town, or rural. Location was also rated on a scale of 1 (most urban) to 9 (most rural), based on county. Using these data, the team analyzed where youth had access to mental health facilities, particularly those that offer suicide prevention services.


They found that highly rural areas had fewer mental health facilities serving youths-and fewer suicide prevention services-than more urban areas. Only 3% of rural areas had a mental health facility that offered suicide prevention services for youths. This is compared to 8% of metropolitan areas, 9% of micropolitan areas, and 12% of small towns.




Bonaduce J. (2014). The ARTT Model: Painting a better picture for the vulnerable among us. Home Healthcare Nurse, 32(5), 295-302. [Context Link] (2020a). Adlai Stevenson quotes.[Context Link] (2020b). Henry David Thoreau quotes.[Context Link] (2020c). Samuel Johnson quotes.[Context Link]