Faculty of Nursing, Université de Montréal , Québec, Canada.
Department of Nursing, Université du Québec en Outaouais, Saint-Jérome , Québec, Canada.
J Community Health Nurs. 2020 Oct-Dec;37(4):189-202. doi: 10.1080/07370016.2020.1809858.
People experiencing homelessness have a high prevalence of substance abuse and mental and physical problems. Although they have very complex health needs, they face many barriers that reduce their access to health care and social services. Several research studies have shown the need to implement adapted nursing interventions to address these crucial access issues. In this article, we present the results of a critical ethnography of outreach nurses who work with homeless people (n = 12). Robert Castel's theoretical model, which focuses on the process of social disaffiliation, provided the conceptual underpinnings for this research. Our qualitative data analysis revealed four categories, namely 1) the professional role and identity of nurses; 2) the social function of outreach nursing; 3) clinical realities and 4) disaffiliation and stigmatization. Our findings highlight the need to raise awareness among health care providers about the ethical, clinical and organizational issues of homelessness, particularly the mechanisms of exclusion and stigmatization in health care settings that affect people experiencing homelessness.
无家可归者滥用药物和存在心理及生理问题的现象较为普遍。尽管他们有着非常复杂的健康需求，但他们面临着许多障碍，这些障碍降低了他们获得医疗保健和社会服务的机会。多项研究表明，需要实施适应护理干预措施来解决这些关键的准入问题。在本文中，我们介绍了对与无家可归者合作的出诊护士（n=12）进行批判性民族志研究的结果。罗伯特·卡斯特尔（Robert Castel）的理论模型，重点关注社会脱离的过程，为本研究提供了概念基础。我们的定性数据分析揭示了四个类别，即 1）护士的专业角色和身份；2）出诊护理的社会功能；3）临床现实；4）脱离和污名化。我们的研究结果强调了有必要提高医疗保健提供者对无家可归问题的伦理、临床和组织问题的认识，特别是在影响无家可归者的医疗保健环境中排斥和污名化的机制。
