Harm Reduction: A Concept Analysis

BackgroundOver the last 25 years, harm reduction has shifted to focus on public health and addressing the opioid crisis. Nurses working in addictions treatment utilize the principles of harm reduction to improve the health of clients. AimsConcept clarity assists healthcare providers to understand the applications and attributes of a concept. MethodA concept analysis of harm reduction using the Rodgers (1989) method of evolutionary analysis was un-dertaken. A comprehensive review of the literature was conducted using CINAHL Plus and Social Work Abstracts. FindingsThe key attributes of harm reduction include safety, supplies, education, partnerships, and policy. Applications of harm reduction include needle exchange programs, supervised consumption sites, medication-assisted treatment, and increased access to take-home naloxone kits. The main antecedent to harm reduction is the presence of harm. Consequences explored include safer injection practices, decreased transmission of blood-borne illnesses, improved client relationships, and decreased overdose-related deaths. Stigma, health promotion, and pragmatism are the related concepts discussed. A model case is provided. ConclusionThe principles of harm reduction are becoming increasingly popular as an inclusive and evidence-based nursing approach to addictions treatment and management. As using substances continues to shift and in-crease, harm reduction strategies must remain malleable and available in both the community and hospital settings to address the issue and decrease the associated healthcare costs. Future implications for nursing practice and research are provided.

Emerging Psychedelic-Assisted Therapies: Implications for Nursing Practice

BackgroundPsychedelic-assisted therapy research is demonstrating unprecedented rates of success in treating mentalillness, addictions, and end-of-life distress. This psychedelic renaissance is a turning point in how com-plex human conditions can be treated and has implications for nursing knowledge, advocacy, and practice internationally. ObjectiveThis article aims to explore the current state of knowledge in the field of psychedelic-assisted therapy and the practice implications for nurses. MethodsA scoping review of the literature was undertaken with a focus on mental health, addictions, and palliative care indications. Commentaries, syntheses, and reviews from the last 20 years were included, as well as all relevant primary study results. We then explored what is known about the nurse’s past and present role in this field. ResultsThe nurse’s role in psychedelic-assisted therapy and research has been hitherto mostly invisible and thus remains under-explored and undefined. The profession is ideally positioned, however, to contribute to the future of this promising field. ConclusionAs advocates for safe, ethical, and interdisciplinary practice, nurses can lead the development of psychedelic-assisted therapy practice, ethics, research, advocacy, policy, and education. This article provides guidance and support for prescient nursing leadership in these areas.

Turning East

This article concerns the observations of an advanced practice nurse's experience in working with the chemically dependent population. "Turning East" refers to a phenomenon observed with a few clients, which was unexpected and out of the control of both client and clinician. This author has prior contributions to the professional literature on the subject of treatment requirements for this population. In this writing, urgent spiritual needs, as reported by clients, are analyzed and discussed. In holistic treatment clinicians must also recognize the spiritual as well as physical. In the experience of this writer, spiritual disorder in clients can be the source or etiology of much discomfort, and this needs to be recognized and addressed. Discussions of clinical observations and research data also includes treatment recommendations

Harm Reduction, Stigma and the Problem of Low Compassion Satisfaction:

Background & Objective: Canada is in the midst of an opioid crisis. Given the sheer magnitude of the crisis and escalating death toll, the mobilization of harm reduction interventions is an important priority. Currently, little is known about the role played by stigmatization, particularly in terms of how this may impact the endorsement and uptake of harm reduction strategies and initiatives among front-line providers. Materials & Methods: Opening Minds, the anti-stigma initiative of the Mental Health Commission of Canada, undertook a one-and-a-half-year research project to understand the qualities, characteristics, sources, consequences, and solutions to the problem of stigmatization on the front-lines of the opioid crisis. A qualitative key informant design was selected. Participants included various first responder and health provider groups, people with lived experience of opioid or other drug use, and people in key policy or programming roles. Eight focus groups were held across Canada, and 15 one-on-one key informant interviews were completed. Results: Analysis of focus group and key informant interviews revealed three main ways in which stigma shows up on the front lines of the opioid crisis among providers. These themes coalesced around a central main problem, that of low compassion satisfaction. Suggestions for how these concerns can be addressed were also identified. Conclusion: The findings from this research revealed several key ways that stigma ‘shows up’ in the experiences and perceptions of front-line providers and provide several promising avenues for combatting stigmatization related to opioid use and harm reduction. An important avenue for future research is to develop and elaborate on the theoretical connections between the concepts of stigmatization and compassion satisfaction as a way to better understanding the problem of stigmatization in helping environments.

Sowing a Seed of Safety: Providing Culturally Safe Care in Acute Care Settings for People who use Drugs

This paper reviews the concept of cultural safety from the perspective of people who use illicit drugs and nurses in a hospital setting. Background Illicit drug use is often highly stigmatized and people who use illicit drugs often report negative healthcare experiences contributing to inequities in health and access to healthcare. Registered nurses play a key role in the delivery of healthcare when people who use drugs are hospitalized but often face difficulties in the provision of care. We explored understandings and meanings of cultural safety in healthcare as an approach to mitigate stigma and to promote health equity. Design and Methods Within an overall participatory approach to the research, we employed a qualitative ethnographic approach undertaking 275 hours of participant observation and conducting 34 open-ended interviews with 15 patients and 19 nurses on two acute care hospital units in 2012 and 2013. Result/Findings: Culturally safe care requires recognizing stereotypes and power imbalances; prioritizing trust and building relationships as important outcomes; giving patients space and time; and addressing conflicting organizational values and policies. Conclusions Providing culturally safe care requires organizational culture shifts that recognize the importance of historical, societal, and political forces that influence the way in which illicit drug use and people who use illicit drugs are constructed in society.

Recovery-Oriented Practice

Recovery-Oriented Practice

Suicide Prevention and Postvention Innitiatives

Suicide Prevention and Postvention Innitiatives

Emphasizing Mental Health in Nursing Education

Emphasizing Mental Health in Nursing Education

When Mental Health and the Justice System Intersect

When Mental Health and the Justice System Intersect

Reducing Stigma in Health-Care Settings

Reducing Stigma in Health-Care Settings