"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.

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.