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N301 Theoretical Perspectives in Nursing: Harm Reduction

Harm Reduction Services, BCCDC

Nurse Educator

October, 2019

This presentation was created on the ancestral, traditional and unceded territories of the Coast Salish Peoples, and more specifically of the Musqueam, Squamish, and Tsleil-waututh Nations

To add, and share gratitude for, the host Musqueam Nation for their ongoing resistance as land protectors where UBC occupies; and for their inclusion of the Squamish and Tsleil-waututh Nations as people with ancestral ties to UBC's campus

Introduction

Who am I?

  • I believe everyone has unique gifts
  • I believe that teaching and learning can happen at the same time
  • I believe we, as nurses, have a responsibility to uphold with the amount of trust people put into our profession

Overview

Overview

Objectives

• Understand the many ways harm reduction care is nursing care

• Know what BCCDC’s Harm Reduction Services Program is, and does

• Articulate the impacts of the institutionalization of the term ‘harm reduction’

• Acknowledge that Harm Reduction can mean different things to different individuals and communities, and the importance of remaining creative and flexible in our nursing practice

• See more of the ways we can, and already do, approach our lives with a harm reduction lens

Outline

  • How to take care of each other in these types of conversations
  • Discuss primary health care as it pertains to harm reduction
  • Background on HR in BC & on the vast and ever-changing world of harm reduction
  • Legislation and regulation
  • Ethics
  • Applying it all to our practice through the 6 principles of primary health care

PHC Nursing Practice

Primary Health Care: Nursing Practice

N301 Course Goal: exploration of community as the place of nursing care and the three (3) levels of community-based primary health care nursing practice

1. Systems

2. Populations

3. Individual & Family

Taking Care of Each Other

Taking Care

Agreements

Group Agreements

  • Agree to Disagree
  • Respect: Open heart open mind
  • Confidentiality: Share the teaching, not the story
  • Honour what you need
  • Trust in Best Intentions
  • Step up, step back
  • Take risks: it's okay to feel uncomfortable
  • Have fun

Any others?

Background

Background

Harm Reduction in BC Now

Distribution Site Client Survey Results 2018

Activity

1. What have we heard, What do we know?

2. What is one thing we want to get out of today?

Harm Reduction Services (aka Toward the Heart)

BCCDC Harm Reduction Services

  • Collaboration
  • Education & Practice Leadership
  • Compassion, Inclusion, & Engagement (CIE)
  • Peer Programs
  • Overdose Surveillance

Harm Reduction Program

Harm Reduction Program

HRS in BC

HRS in BC

HRS in BC

Naloxone Program

2018 HR Client Survey

Preferred Drug Use Method

2018 HR Client Survey

HR Survey

Difficulty Picking up Supplies

HR Survey

When they could not find a new or unused pipe to smoke drugs, respondents:

HR Survey

What People in our Survey are using

HR Survey

HRNA Position Statement:

HR Education in BN Programs

HRNA

Current State:

  • knowledge-to-practice deficits
  • overemphasis of abstinence-based approaches

What it is not/does not:

  • Linear or absolute
  • Have a universal definition
  • Only pertain to substances and substance use

Harm Reduction

Specific to substances and substance use:

  • Require abstinence or discontinuation of substance use
  • Only benefit people using substances

Examples

  • Reducing transmission of nosocomial infections with regular hang washing
  • Providing safer sex education to high school students
  • reducing the possibility of falls in hospital settings through prevention strategies
  • contributing to public health campaigns to promote wearing a bicycle helmet

Examples

Harm Reduction

  • A newer Western term & a concept with a long history
  • Aligns with Indigenous ways of being and knowing
  • Meaningful engagement

What it is:

MORE OPTIONS

=

MORE CHANCES

creates more flexible options

It is complimentary to prevention and treatment approaches

HR & Substance Use

Legislation & Regulation

Legislation & Regulation

  • What/how did we learn about substance use and how does that influence the way we talk about it?

  • How do these approaches influence our work?

  • What makes drug use so dangerous?

Think-Pair-Share

Activity

  • What/how did we learn about substance use and how does that influence the way we talk about it? How are we taught to conceptualize drug use? In society? In healthcare? In the media?

  • How does the way we talk about substances and substance use influence our work?

  • What makes drug use so dangerous?

HPA & Regulation

  • Enacted by the Legislative Assembly of British Columbia in 1990
  • Minister of Health -> further regulations

  • Goal: to establish a common regulatory system for the province's health professions (i.e. BCCNP)

Health Professions Act

BCCNP

  • Establish standards of practice and professional ethics that govern the conduct of registrants –

  • Our code of conduct is based on Canadian Nursing Association’s code of ethics

Regulatory Body

CNA

“In spite of growing evidence of the effectiveness of public health approaches such as harm reduction, drug policy continues to be underpinned by a prohibitionist and moral stance.”

Canadian Nurses Association

CNA identified competing discourses

Health vs. Enforcement:

  • Health Professions Act (HPA) vs.

Controlled Drugs and Substances Act (CDSA)

Conflicting policy creates moral dilemmas.

Challenges

Four Core Principles of Biomedical Ethics

Ethics

  • Autonomy
  • Beneficence
  • Non-maleficence
  • Justice

1. Nursing Values and Ethical Responsibilities:

CNA Code of Ethics

  • Providing safe, compassionate, competent and ethical care
  • Promoting health and well-being
  • Promoting and respecting informed decision-making
  • Honouring dignity
  • Maintaining privacy and confidentiality
  • Promoting justice
  • Being accountable

ethical nursing practice addresses broad aspects of social justice that are associated with health and well-being.

2. Social justice Ethical Endeavours Related to Broad Societal Issues

Nursing Praxis

What does a Harm Reduction approach ask of us, as nurses?

HRNA

Evidence

>

Ideology

“We recognize that harm reduction also emphasizes the importance of providing safe and competent care that is based on evidence instead of personal beliefs, ideologies, or misconceptions”

Let's get creative!

  • De-stigmatize and decolonize our interventions (actions)
  • recognize opportunities for changing the narrative
  • Safer drug use education

Get Creative

REFLECTION

  • Witnessing one’s own experience in order to examine it more closely, give meaning to it, and learn from it.
  • Paying attention to experience, thoughts, feeling, and emotions
  • Thinking back on an event or situation

Reflexivity

>

Reflection

REFLEXIVITY

  • Conscious participation and knowing the self
  • Understanding of larger patterns, dynamics, and systems at play
  • Examining issues from different perspectives and see beyond established ways of thinking
  • Challenging assumptions of the self and others
  • Identify root causes of issues
  • In real time

Reflexivity

Advocacy

  • Safer Supply
  • Decriminalization
  • Meaningful Engagement
  • Overdose Prevention Services
  • Harm Reduction approach as an additional option to prevention and treatment (including ETOH)
  • Challenge policies, programs, and practices that maximize harm
  • Improving care retention and continuity at discharge (in acute care settings)

Advocacy

Intentional Practice

Align practice to evidence and theory

What are some of the challenges you face in considering/using harm reduction principles with clients? What makes it easier?

Principles of Primary Health Care

Six Principles of PHC

What are some of the ways we can implement HR approaches to our work in regards to the 6 different principles of primary care?

Principles of PHC + HR

1. Determinants of Health

2. Accessibility

3. Health Promotion/Illness

4. Intersectoral Collaboration

5. Appropriate Technology

6. Public Participation

Summary of Session

Wrapping

Up

Questions & Evaluation

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