A critical ethnography of outreach nursing for people experiencing homelessness

Abstract

People experiencing homelessness have a high prevalence of substanceabuse and mental and physical problems. Although they have very complexhealth needs, they face many barriers that reduce their access to health careand social services. Several research studies have shown the need to imple-ment adapted nursing interventions to address these crucial access issues. Inthis article, we present the results of a critical ethnography of outreachnurses who work with homeless people (n = 12). Robert Castel’s theoreticalmodel, which focuses on the process of social disaffiliation, provided theconceptual underpinnings for this research. Our qualitative data analysisrevealed four categories, namely 1) the professional role and identity ofnurses; 2) the social function of outreach nursing; 3) clinical realities and 4)disaffiliation and stigmatization. Our findings highlight the need to raiseawareness among health care providers about the ethical, clinical and orga-nizational issues of homelessness, particularly the mechanisms of exclusionand stigmatization in health care settings that affect people experiencinghomelessness.