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“We live in a stone cage where everyone wants to be a lion”: A critical discourse-ethical study for homelessness nurse-led street outreach in Portugal

Year: 2025

Type: article

Abstract: BACKGROUND: Unsheltered homelessness in Portugal has grown, yet nurse-led street outreach remains under-studied. PURPOSE: To analyze how homeless men construct health and dependency, interrogate their institutional encounters, and generate nurse-led street outreach recommendations aligned with The Future of Nursing 2020-2030 and the National Plan for Health Equity. METHODS: A critical discourse study, comprising five semi-structured interviews with men who experienced homelessness in Coimbra, was conducted in July 2024 and analyzed incorporating Tronto's ethic of care and Rogers' bioethics of vulnerability. DISCUSSION: Four interlocking discourse terrains emerged: (a) corporeal safety-health begins with protected space; (b) procedural violence-bureaucratic hurdles re-inscribe exclusion; (c) relational discipline-earned trust and disclosure; and (d) micropolitics of respect-eye contact, conversational stance, and permissions signaled equality, unlocking unmet needs. CONCLUSION: Tailoring street-outreach policy, expanding nurse prescribing, and crediting trust labor can transform outreach from charity to a strategic lever for advancing coverage and equity.

Source: Nursing Outlook

DOI: 10.1016/j.outlook.2025.102604

Authors: Pablo Martínez-Angulo, Isabel Gil

Institutions: Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, University of Córdoba, Escola Superior de Enfermagem de Coimbra

Language: English

Topic: Homelessness and Social Issues

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities, Sustainable cities and communities, Peace, justice, and strong institutions

Open Access status: hybrid

Estimated APC paid: $4,260