It’s a busy day on the general surgery unit and it's Katherine’s first day back after her days off. Katherine is a novice nurse who has been working on the unit for three months. One of her clients is Alex, a 35-year-old gentleman, post-operative day three. During report, the night shift nurse reviews Alex’s post-op care, history, pain management and medical history including diabetes, asthma and substance use. “He has a history of using drugs and is probably drug seeking. He keeps asking for PRN pain medications,” the night shift nurse tells Katherine.
Upon receiving report, Katherine is unsure how she should approach Alex’s care. While she is uncomfortable with the night shift nurse’s comments, she also hasn’t cared for many clients with a history of substance use. Katherine understands that she is responsible and accountable for providing safe, competent, and ethical care, but given her limited experience, she wonders whether providing PRN pain medications will further encourage Alex’s drug use.
As Katherine prepares for her morning rounds, she remembers a recent article that she read on Twitter about ways to address stigma among health professionals towards people who use substances. She takes a moment to reflect.
Katherine leaves the nursing station to start her morning rounds and sees Lisa, a nurse who works casual shifts on the unit. As she begins speaking to Lisa, she remembers that Lisa also works part-time in the community with inner-city clients living with substance use. Given Katherine’s limited knowledge about caring for individuals who use substances, she pulls Lisa aside to ask her for some help. “One of my clients has a history of substance use and I’m not sure how to approach his care.
The night shift nurse said he was drug seeking and that he kept asking for PRN pain meds. I know you have experience caring for clients who have a history of substance use. Do you have any suggestions?” says Katherine.
“I think you’ve done the right thing in seeking more information,” says Lisa. “I work with inner city clients who use substances and many face discrimination and stigma in acute care settings. First, it is important to use the right language when we talk about substance use. Terms like “drug seeking” or “drug user” further stigmatize this population. You’re already doing a good job modeling the right way of talking by putting the client first and it is appropriate to correct others when you hear language that is stigmatizing.”
“When caring for any client who has a history of substance use or is currently using substances, I always apply a harm reduction approach to care. This means, my care is focused on reducing the harms of substance use without expecting substance use to stop or decrease. Right now, as an inpatient, substance use likely isn’t his primary concern. He’s recovering from surgery and we should be managing his pain and treating him with the same level of respect as we do with all clients. It is also important to know that some individuals develop a physical tolerance to substances like narcotics and he might need higher doses to manage post-op pain effectively.” Katherine listens intently.
Lisa goes on to say “As nurses, we have the responsibility to accept and provide care for all clients, regardless of gender, age, health status, lifestyle, sexual orientation, beliefs and health practices. A harm reduction approach to care doesn’t mean nurses are encouraging substance use. It just acknowledges that people use substances for different reasons, and we need to meet them where they’re at. It is not our goal to decide whether clients need to change their substance use. Instead, it is about providing relational and ethical care. It is important to use your fundamental nursing skills such as listening and empathy to build trust and promote dignity, compassion and non-judgemental acceptance.”
“It’s a learning process, and as nurses, one of the competencies that we should all have is the ability to take action to minimize the potential influence of our own personal values, beliefs, and positional power on client assessment and care. I’ve come across many nurses who believe that harm reduction conflicts with our role as nurses. However, this approach is consistent with our Entry-to Practice Competencies, CARNA Practice Standards for Regulated Members and our Code of Ethics, which support us in providing safe, competent and ethical nursing care. In fact, CARNA has a Practice Advice document that you may find helpful and the Alberta Nurses Coalition for Harm Reduction (ANCHR) has a website with information as well,” says Lisa.
Katherine appreciates and thanks Lisa for the conversation. She mentions to Lisa that she wishes there was more education on the unit to support nurses in caring for individuals who use substances. Lisa suggests that they connect with the clinical nurse educator to explore ways in which they could be better supported by the organization and Katherine agrees. As Katherine makes her morning rounds, she takes extra time to build rapport with Alex and reflects further on her conversation with Lisa.