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In January 1998, a pilot project was set up using specially trained community health nurses� (CHN�s) through the BC Center of Disease Control (BCCDC). The nurses� wanted an evaluation that described the nature of their work and its challenges, as well as elucidating their impact on clients. The street nurse we described in the case study was a member of this project. The goals of the program were HIV and STD prevention within the broader context of harm reduction and health promotion. The nature of the nurses� work reflected five main themes:
One of the reflected aspects of the nurses� work was to build and maintain trust, respect and acceptance. To do so the nurses� were careful to remain open, nonthreatening, and completely nonjudgmental, so that clients could rely on being treated in a holistic and nonprejudicial manner; that they could rely on being respected regardless of their identities and lifestyles. This type of approach was also shown by street nurses� in an article entitled � Nurses� take back the streets,� written by Deborah Jaschik (2002), and published by Good Nursing Magazine. The article describes one street nurses� encounters throughout a shift in Pittsburgh, USA. Much of the same challenges exist for those nurses� across the border that serves the homeless population. Nell Davidson, the nurse whom the article is based upon, talks at length about maintaining the caring relational aspects of nursing within her practice. Like many other nursing specialties, street nursing is not just about treating the physical problems, its about seeing the person behind the problem, and giving that person the respect, dignity and attention they need to heal (Priest, 2002). In Hartrick�s (2002) article, health is seen as encompassing far more than the absence of disease. Some of the theorists she refers to include Ronald Labonte (1997) who includes interactive relationships as contributing to the meaning of health for the client. The World Health Organization also notes that health must entail choice, and the ability of the individual to control one�s life.In this way, we see CHN's contributing to the idea of personal views of helth. What is healthy for an addicted street worker may include using a condom, clean syringe or washing her hands and injection site before using. Health for an street nurse may include being free from the use of addictive substances, maintenance of a negative HIV status or eating a balnced diet. Those these defintions of health are different, they allow us to recognize the need to accept people where they are, without imposing our views of health on them. The street nurse becomes a pivotal relationship that can help individuals regain control over her life, and receive positive guidance on thier paths. Hartrick�s (2002) model denotes a need for the street nurse to have a �relational way-of-being�. This philosophy is in harmony with the programs mandate of health promotion through participation in prevention practices such as condom use, clean needle use and disease screening. However, Hartrick (2002) does go on to say that using relationships as a means to an end, for example, a prostitute becoming clean and removed from the DTES, may cause a dangerous shift in the power balance within the relationship. Rather, Labonte (1997) proposes that building a relationship should be the goal alone. The value should not be placed on gaining behavioral changes but having the client participate in a connected healthy relationship. |
