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Abstract：
At the end of life, the need for care increases. Yet, for structurally vulnerable populations (i.e., people experiencing homelessness and poverty, racism, criminalization of illicit drug use, stigma associated with mental health), access to care remains highly inaccessible. Emerging research suggests that enhancing access to palliative care for these populations requires moving care from traditional settings, such as the hospital, into community settings, like shelters and onto the street. Thus, inner-city workers (ICWs) (e.g., housing support and community outreach) have the potential to play pivotal roles in improving access to care by integrating a \"palliative approach to care\" in their work.
Drawing upon observational field notes and interview data collected for a larger critical ethnographic study, this secondary thematic analysis examines ICWs\' (n = 31) experiences providing care for dying clients and garners their perspectives regarding the constraints and facilitators that exist in successfully integrating a palliative approach to care in their work.
Findings reveal three themes: (1) Approaches, awareness, and training; (2) Workplace policies and filling in the gaps; and (3) Grief, bereavement, and access to supports. In brief, ICWs who draw upon harm reduction strategies strongly parallel palliative approaches to care, although more knowledge/training on palliative approaches was desired. In their continuous work with structurally vulnerable clients, ICWs have the opportunity to build trusting relationships, and over time, are able to identify those in need and assist in providing palliative support. However, despite death and dying is an everyday reality of ICWs, many described a lack of formal acknowledgement by employers and workplace support as limitations.
Findings contribute promising practices for enhancing equitable access to palliative care for society\'s most vulnerable populations by prioritizing front-line workers\' perspectives on how best to integrate a palliative approach to care where structurally vulnerable populations live and die.
Drawing upon observational field notes and interview data collected for a larger critical ethnographic study, this secondary thematic analysis examines ICWs\' (n = 31) experiences providing care for dying clients and garners their perspectives regarding the constraints and facilitators that exist in successfully integrating a palliative approach to care in their work.
Findings reveal three themes: (1) Approaches, awareness, and training; (2) Workplace policies and filling in the gaps; and (3) Grief, bereavement, and access to supports. In brief, ICWs who draw upon harm reduction strategies strongly parallel palliative approaches to care, although more knowledge/training on palliative approaches was desired. In their continuous work with structurally vulnerable clients, ICWs have the opportunity to build trusting relationships, and over time, are able to identify those in need and assist in providing palliative support. However, despite death and dying is an everyday reality of ICWs, many described a lack of formal acknowledgement by employers and workplace support as limitations.
Findings contribute promising practices for enhancing equitable access to palliative care for society\'s most vulnerable populations by prioritizing front-line workers\' perspectives on how best to integrate a palliative approach to care where structurally vulnerable populations live and die.
摘要：
在生命的尽头，对护理的需求增加。然而，对于结构脆弱的人群(即，经历无家可归和贫困的人，种族主义,将非法药物使用定为刑事犯罪，与心理健康相关的污名)，获得护理的机会仍然非常难以获得。新兴研究表明，为这些人群提供姑息治疗需要从传统环境中转移护理，比如医院，进入社区环境，比如避难所和街上。因此，市内工人(ICW)(例如，住房支持和社区外展）通过在工作中整合“姑息治疗方法”，有可能在改善获得护理的机会方面发挥关键作用。
利用为更大的关键人种学研究收集的观测现场笔记和访谈数据，此次要主题分析研究了ICW（n=31）的经验，为垂死的客户提供护理，并就成功地将姑息治疗方法纳入其工作中存在的制约因素和促进因素收集了他们的观点。
研究结果揭示了三个主题：(1)方法，意识,和培训；(2)工作场所政策和填补空白；(3)悲伤，丧亲,并获得支持。简而言之,采用减少伤害战略的ICW与姑息治疗方法密切相关，尽管需要更多关于姑息治疗方法的知识/培训。在与结构脆弱的客户的持续合作中，ICW有机会建立信任关系，随着时间的推移,能够识别有需要的人，并协助提供姑息支持。然而,尽管死亡和死亡是ICW的日常现实，许多人将缺乏雇主的正式认可和工作场所支持描述为局限性。
研究结果通过优先考虑一线工人对如何最好地将姑息治疗方法纳入结构脆弱人群生活和死亡的护理的观点，为提高社会最脆弱人群获得姑息治疗的公平机会提供了有希望的做法。
利用为更大的关键人种学研究收集的观测现场笔记和访谈数据，此次要主题分析研究了ICW（n=31）的经验，为垂死的客户提供护理，并就成功地将姑息治疗方法纳入其工作中存在的制约因素和促进因素收集了他们的观点。
研究结果揭示了三个主题：(1)方法，意识,和培训；(2)工作场所政策和填补空白；(3)悲伤，丧亲,并获得支持。简而言之,采用减少伤害战略的ICW与姑息治疗方法密切相关，尽管需要更多关于姑息治疗方法的知识/培训。在与结构脆弱的客户的持续合作中，ICW有机会建立信任关系，随着时间的推移,能够识别有需要的人，并协助提供姑息支持。然而,尽管死亡和死亡是ICW的日常现实，许多人将缺乏雇主的正式认可和工作场所支持描述为局限性。
研究结果通过优先考虑一线工人对如何最好地将姑息治疗方法纳入结构脆弱人群生活和死亡的护理的观点，为提高社会最脆弱人群获得姑息治疗的公平机会提供了有希望的做法。
