Thread by @tmc_RN, Nurses of twitter, I know we're busy :) but what do you [...]

Nurses of twitter, I know we& #39;re busy :) but what do you think about providing #harmreduction in the hospital? ( #nursetwitter #tweetorial)

For an intro to harm reduction, read this excellent concept analysis by Dominique Denis-Lalonde: https://www.ncbi.nlm.nih.gov/pubmed/31666391 ">https://www.ncbi.nlm.nih.gov/pubmed/31...

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As per @rs_mcneil et al. (and many other studies) the hospital is a ‘risk environment’ for people who use drugs (PWUD):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951660/
They">https://www.ncbi.nlm.nih.gov/pmc/artic... are dopesick, in pain, feel judged and imprisoned. The abstinence often imposed on them is deadly.

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Hospitals as a `risk environment: An ethno-epidemiological study of voluntary and involuntary...

People who inject drugs (PWID) experience high levels of HIV/AIDS and hepatitis C (HCV) infection that, together with injection-related complications such as non-fatal overdose and injection-related...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951660/

I tweeted this paper out earlier this month – clear documentation of the kind of policies (nevermind “unofficial” practices) which make inpatient stays untenable ( https://insights.ovid.com/medsurg-nursing/mednu/2019/03/000/care-heroin-addicted-inpatient/4/00008484):">https://insights.ovid.com/medsurg-n... security sweeps, mandatory gowns, no visitors

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Nurses in particular do not know how to treat PWUD when they are admitted to hospital ( https://www.ncbi.nlm.nih.gov/pubmed/31648259 ).">https://www.ncbi.nlm.nih.gov/pubmed/31... The ‘rituals and routine’ of both nursing AND substance use are often at odds with one another ( https://pubmed.ncbi.nlm.nih.gov/20846223/ ).

4/10">https://pubmed.ncbi.nlm.nih.gov/20846223/...

Routines and Rituals: A Grounded Theory of the Pain Management of Drug Users in Acute Care Settings...

The key aspects likely to contribute to problematic interactions with this patient cohort are outlined so that they can be prevented and, or addressed.

https://www.ncbi.nlm.nih.gov/pubmed/31648259

But if you think about the principles behind harm reduction ( https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0196-4)">https://harmreductionjournal.biomedcentral.com/articles/... they look like some modern NSG theories (e.g. Gottlieb’s strength-based care). A big difference? The involvement of PWUD in planning/implementation/delivery of harm reduction programs.

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Harm reduction principles for healthcare settings

Harm reduction refers to interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely. The vast majority of...

https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0196-4

So what should harm reduction in the hospital look like? We should ask PWUD what harm reduction means to them, and how they want health services to be provided (hint: it’s not just needles)… https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0145-2

6/10">https://harmreductionjournal.biomedcentral.com/articles/...

Expanding conceptualizations of harm reduction: results from a qualitative community-based partic...

The perspectives of people who use drugs are critical in understanding why people choose to reduce harm in relation to drug use, what practices are considered or preferred in conceptualizations of...

https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0145-2

This guide from Alberta, Canada was written with input from both PWUD and staff! Including a FAQ section and philosophy of service: https://crismprairies.ca/management-of-substance-use-in-acute-care-settings-in-alberta-guidance-document/">https://crismprairies.ca/managemen... (Thanks @DrKLMeador)

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. @BerniePauly
has written at length about what providing ‘culturally safe care’ for PWUD means. This is a great guide every nurse should read: https://www.uvic.ca/research/centres/cisur/assets/docs/bulletin11-creating-culturally-safe-care.pdf">https://www.uvic.ca/research/...

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Check out this thread started by @kelseycpriest
where she is starting to compile a list of what hospitals are doing with HR: https://twitter.com/kelseycpriest/status/1236429345356312577?s=20

What">https://twitter.com/kelseycpr... is your hospital doing? What are some of the barriers you would face in providing ‘culturally safe care’ for PWUD?

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https://twitter.com/kelseycpriest/status/1236429345356312577?s=20

Let me know if you need help finding any of these articles! This thread is in lieu of a few talks I was going to give this spring. Now more than ever I& #39;m hoping that people see the value in providing quality patient-centred care to ALL populations.

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