Graduate Student Spotlight, Alexandra Sain

Alexandra Sain will graduate this month with her Doctor of Nursing Practice Degree from the Psychiatric Mental Health Nurse Practitioner concentration. Sain received her BSN from Austin Peay State University, and has worked as an ER, critical care, and behavioral health nurse for eight years.

Sain, a Tennessee native, has spent the last several years focusing on how she can support the homeless community by providing equitable health care. She hopes that her passion for the homeless with mental health struggles, will provide an opportunity to apply evidence-based interventions to improve their care.

Read more about Sain and her time at UT below.

Tell us about your graduate project:

The project title is “Advancing the Care Continuum for the Homeless: A shelter-based care coordination project focused on mental health.” My project was implemented within a local homeless shelter, where the guests suffering from serious mental illness, such as schizophrenia, were the focus of the intervention. Local statistics validate that there is a prevalence of serious mental illness (SMI) within the homeless community. Serious mental illness is also very difficult to overcome and requires a lot of support and the appropriate treatment for positive outcomes. However, homeless individuals experience many barriers to their care. They experience health care disparities in the form of financial, communication, transportation barriers. It was determined that the population of homeless with SMI were the leaders of rehospitalizations in the area, and the local homeless shelters were recorded as the greatest source of 911 calls with countless surrounding ED visits. This frequent healthcare usage heavily contributes to our healthcare expenditures and creates a financial burden on the community. However, it is also reflective of inadequate treatment and care. So, I worked with the local homeless shelter to develop a reactive process to increase shelter-based care coordination services for this population.

The goals of the project were to increase the identification of the shelter’s high-risk guests, improve information sharing between the shelter and surrounding behavioral health hospitals, and to decrease the number of hospital readmissions/emergency service usage by this population. The reactive process was making sure that each guest that was hospitalized or called for ED services that fit this population was followed up with as soon as possible after returning to the shelter to ensure that all their needs are met. The coordinators asked about medication, appointments, rehabilitation services, and any other need they may have. Then, the individual was connected with the resource they needed all while being supported by the staff during their stay. There were participants that were selected to monitor over time and the data reflects that the follow-ups for these individuals proved beneficial. This is reflected by an inverse relationship between hospitalizations/911 calls and the shelter-based contacts of the participants. Furthermore, facility data shows that there was a significant decrease in overall 911 calls from the shelter facility between the pre and post-implementation timeline. The new process also required outlying behavioral health facilities to notify the shelter of patients that would be discharging to the shelter, so that the shelter could arrange for their coordination contact upon arrival. These contacts proved invaluable to many guests. It was determined that of all the guests seen for post-discharge, 35% of those were connected to resources that otherwise would not have been offered.

This includes again, medication resources, drug abuse programs, shelter-based programs, and additional resources for healthcare appointments. All contacts (with guest consent) were also documented in the shelter’s database for facility information-sharing to better serve and support the guest. The implications of the project were immense. Shelter- based follow-ups for the homeless with SMI prevent excessive healthcare service usage and contribute to community savings. More importantly, the increased support of having contact with a resource at the place they reside or receive meals from improves access to care promoting better mental health outcomes and possibly leading to an improvement in their quality of life.

The shelter now has a sustained process for these individuals and has taken even greater strides to create a mental health coalition with the surrounding facilities for this population. The project got the ball rolling, and the facility has really taken off in advancing the care continuum for these individuals. I’m happy to report that they also have a partnership with our DNP program faculty and will be utilizing further DNP students for future advancements. For myself, I have been disseminating my project through networking, presenting at the national APNA conference, and working towards publication. I have talked with a surrounding county commissioner about starting programs for their homeless, and I look forward to seeing the advances in care that emerge. Enhancing public awareness and knowledge about the subject has increased the endless opportunities to help these vulnerable individuals.

Why did you decide to focus on this area?

My experience as a surrounding ER, critical care, and behavioral health nurse combined with my years of volunteer work within the shelter allowed for the recognition of a problem and need in our community. I have a passion for the homeless with mental health struggles, and I wanted to use this opportunity to apply evidence-based interventions to improve their care.

I’ve also had the personal experience of watching someone very close to me struggle with serious mental illness which led to them being homeless for a period of time. This person had a great family and a lot of support and yet it took so much time and effort and multiple tries to get them off the street and stabilized. My thoughts are now, who is looking out for the ones who have no support? I wanted to find a way to help those individuals. There is also so much stigma behind homelessness; they are labeled “lazy” or described as reaping the consequences of their own addictions and choices. Until you have a personal experience like mine or spend time within the community talking with these individuals, it’s difficult to understand their struggles. I want to bring public awareness to this subject and help diminish the stigma.

What has been one of your favorite memories during your time at UT?

Probably the moment that I successfully defended my DNP project. That was the moment I finally felt validated to step into the doctoral role.

Why has your time as a Volunteer been memorable?

The relationships that I’ve formed while here are invaluable, both with peers and faculty. It truly is amazing to be surrounded by such an inspiring group that is highly motivated to improve lives by educational empowerment.

Do you think your story would resonate with prospective students? Why?

Yes, I do. I decided to pursue the mental health specialty due to witnessing the disparities of others and seeing areas in my community that were in need of change. I was given this platform by pursing my DNP project and have reaped the benefits of seeing how applying evidence- based practice benefits all care settings. My project has had lasting effects greater than I had imagined. By empowering me with the education to influence policy and practice change, I have been given the tools that I need to pursue my passion for mental health and helping vulnerable populations. I hope that prospective students looking to pursue a passion or create change will relate to myself and find this story encouraging.

In your own words, can you explain how you embody our vision statement of “Leading Creating Partnerships. Improving Health.”?

I saw this come together with the project process. I saw a need in the community and utilized my knowledge of evidence-based care to assess the situation and provide an intervention. The project site agreed upon the need, and we worked together to implement changes that augmented their goals and values. We all aligned on our objectives and while I provided the education and guidance that was needed, each project member had their own invaluable role to influencing positive health outcomes.

What are your career goals?

I plan to work in a community mental health setting and continue partnering with the local homeless shelters to advance the care for this population. My goal is to bring resources to where they are needed for these individuals, diminishing their healthcare disparities, and hopefully creating positive individual outcomes.

Please complete the following statement: The most influential element of my UT nursing education has been…being taught how to create change. We are talked to about our projects and leadership from day one of the Then, we are given the tools to make it happen. Over time, I looked back and was in awe of the progress I had made in creating the change I had envisioned. The faculty were there to support me along the way and guide me with their expertise.

CONTACT: Kara Clark Cardwell (, 865-974-9498)