Critical ethnography of outreach nurses– perceptions of the clinical issues associated with social disaffiliation and stigma. (22nd November 2020)

• Record Type: Journal Article
• Authors: Paradis‐Gagné, Etienne; Pariseau‐Legault, Pierre
• Is Part Of: Journal of advanced nursing. Volume 77:Number 3(2021)
• Page Start: 1357
• Page End: 1367
• Publication Date: 2020-11-22
• Subjects: critical ethnography -- homelessness -- nursing practice -- outreach nursing -- stigma; Nursing -- Periodicals; 610.7305
• DOI: 10.1111/jan.14671
• Languages: English
• ISSNs: 0309-2402

Abstract

Abstract: Aims: The aim of this study was to gain a better understanding of how nurses experience their practice with homeless people. More specifically, we wanted to consider the role as it is practised and certain clinical characteristics associated with social disaffiliation and stigma. Background: Previous research has shown the need to implement adapted nursing interventions to address the problems homeless people encounter in obtaining health services. According to the literature, such interventions have positive health outcomes for homeless people, who exhibit complex health needs. Design: We chose critical ethnography as our research method. Method: Semi‐structured interviews were conducted with 12 nurses who work with people experiencing homelessness in Eastern Canada. They were selected using the convenience sampling method. Recruitment was conducted between June–October 2019. Findings: Four categories emerged from the qualitative analysis of the data: (1) the professional role and identity of nurses; (2) the social function of outreach nursing; (3) clinical realities; and (4) disaffiliation and stigmatization. In this article, we will present the findings associated with the fourth category. Conclusion: Nursing practice with this population is conducted in non‐traditional settings such as shelters, community groups, camps, and the street. Nurses must be able to gain acceptance in these environments in order to forge trusting relationships with disaffiliated and stigmatized patients. Our analysis of the data also indicates that nurses who care for homeless people may be subject to stigma by association or "courtesy stigma." Impact: The results of this critical ethnography are useful in that they highlight the clinical interventions and health policies best suited to a highly marginalized clientele that is poorly served by traditional health services. 摘要: 目的: 本研究的目的是更好地了解护士如何对待无家可归者。更具体地说, 需要考虑这种做法的作用以及与社会脱离和排斥相关的某些临床特征。 背景: 先前研究表明, 需要实施适应的护理干预措施, 以解决无家可归者在获得保健服务方面遇到的问题。根据文献资料, 这种干预措施对拥有多重健康需求的无家可归者具有积极的健康效果。 设计: 选择批判人种志作为研究方法。 方法: 对加拿大东部无家可归者进行照料的12名护士进行了半结构式访谈。访谈护士采用方便抽样法挑选。抽样工作于2019年6月至10月间进行。 研究发现: 通过对数据的定性分析, 得出以下四个类别: (1) 护士的职业角色和身份; (2)外延护理的社会功能; (3) 临床实际情况; 以及 (4)脱离和排斥。本文将介绍与第四类相关的发现。 结论: 针对此类人群的护理实践是在非传统环境中进行的, 如收容所、社区团体、营地和街道。护士必须能够在这些环境中获得认可, 以便和与社会脱离和被社会排斥的患者建立信任关系。经数据分析发现, 护理无家可归者的护士可能会因与无家可归者有关联或"有连带关系"而受到排斥。 影响: 利用批判性人种志进行研究的结果很有帮助, 因为凸显了对高度边缘化的受保护者进行临床干预和适用卫生政策的重要性, 这些人群接受服务质量差的传统卫生服务, 而这一干预和政策对此类人群最为适用。