Engaging Nurses Across Disciplinary, Organizational and Sectoral Boundaries for the Health of Vulnerable Populations: A Systemic Model of an Unfolding Interface Nursing Practice in Quebec (Canada)

Purpose: It is internationally renowned that primary care nurses are key actors in public health programs that are dedicated to vulnerable populations. In Québec (Canada), such programs provide opportunities to develop a nursing practice at the interface of Health and Social Service Centres (HSSC) and community resources in order to reduce social vulnerability and health inequalities. Some nurses are now crossing their disciplinary, organizational and sectoral boundaries to engage in what we refer to here as interface nursing practice. Yet, to our knowledge, no study has documented this unfolding practice. The objective of this study was to produce a systemic model of interface nursing practice in the context of social vulnerability.

Methods: A qualitative exploratory study was undertaken in three urban HSSCs. Fifteen primary care nurses participated in semi-structured interviews, followed by one year of direct and participant observation of the interface practice of two nurses. During this time, informal interviews with administrators, interprofessional teams and community actors, as well as an analysis of program and governmental documents, were conducted to further our understanding of the context of interface nursing practice. Thematic analysis was initiated during data collection, whereas Le Moigne’s systemic modelling methodology was instrumental throughout the interpretive process of qualitative analysis and for the representation of our study results and further theoretical elaboration.

Results: Four inter-related themes qualify interface nursing practice. First, this practice is guided by a goal that is articulated as a social obligation for vulnerable populations, that of becoming autonomous. Second, relational processes are central as nurses interconnect vulnerable individuals with various actors and resources in the community. The third theme depicts interface nursing practice as strategic action. Finally, the fourth theme highlights opposing or contradictory processes that are experienced by nurses engaged in interface practice and that appear to change their sense of professional identity.

Conclusion: This study demonstrates the relevancy of creating coherent linkages with knowledge from various disciplines to strengthen our capacity to theorize nursing practice as well as intervention in the context of social vulnerability in order to reduce health inequalities. Further examination of our results, at the intersection of nursing knowledge and social science theories, underscores fundamental dimensions of the concept of practice that are essential to consider in nursing theory development: the central concepts of care and environment, in addition to those of knowledge and projects.