“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

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.