Abstract:

This study uses a modified ethnonursing approach (Leininger, 1985, 1991) to analyze qualitative data collected during two years of field work with a group of Homeless Chronically Mentally Ill Individuals (HCMI). Leininger's ethnonursing theory was used to promote a holistic view of the lifeways of HCMI individuals who were attempting to leave the streets. The data document the experiences of HCMI individuals who were placed in temporary community housing after discharge from a state mental hospital. Data analysis focuses upon explicating the specific needs of HCMI individuals within the sociocultural environment where those needs exist. This qualitative study explores the personal, cultural, and environmental contexts of life for HCMI individuals and describes the interaction between individuals' needs and community resources. Individuals in the study group suffered from chronic mental illness, substance abuse, and physical illness. Their needs were expressed through efforts to function in the community. Direct requests for care were infrequent. Physical manifestations and circumstantial evidence symbolized unspoken needs. Unmet needs for care were demonstrated by critical incidents which disrupted community life such as household moves, legal disputes, and bureaucratic problems. Findings revealed a culturally based pattern of mutual avoidance between HCMI individuals and caregivers which limited delivery of services to the population. Social policy issues underlying caregiver behavior were discussed. Recommendations include development of nurse-managed systems of care delivery, expansion of nurses' educational experiences with underserved populations, and additional qualitative longitudinal research on HCMI populations.