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

Main Article Content

Jane McCall
Bernie Pauly

Keywords

HIV, drug use, safety, health inequity

Abstract

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.


 


 

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References

1. McCoy C, Metsch L, Chitwood D, and Miles C. Drug use and barriers to use of health care services. Subst Use Misuse 2001;36(6&7):780–806.
2. McNeil R, Small W, Wood E, and Kerr T. Hospitals as a “risk environment”: An ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs. Soc Sci Med 2014;105:59–66.doi: 10.1016/j.socscimed.2014.01.010.
3. Merrill J, Rhodes L, Deyo R, et al. Mutual distrust in the medical care of drug users. J Gen Int Med 2002;17(5):327–33.
4. Lloyd C. Sinning and Sinned Against: The Stigmatization of Problem Drug Users. London, UK: Drug Policy Commission; 2010.
5. Room R. Stigma, social inequality and alcohol and drug use. Drug Alc Rev 2005;24(2):143–55.doi: 10.1080/09595230500102434.
6. Neuman M, Obermyer CM, Cherutich P, et al. Experiences of stigma, discrimination, care and support among people living with HIV: A four country study. AIDS Behav 2013;17(5):1–21. doi: 10.1007/s10461-013-0432-1.
7. Goffman E. Stigma: Notes on the Management of a Spoiled Identity. Englewood Cliffs: Prentice Hall; 1963.
8. Link B and Phelan J. Conceptualizing stigma. Ann Rev Sociol 2001;27:363–85.
9. Link B and Phelan J. Stigma and its public health implications. The Lancet 2005;367(9509):528–29.doi: 10.1016/50140-6736(06)68184-1.
10. Link BG and Phelan J. Stigma power. Soc Sci Med 2014;103:24–32. doi: 10.1016/j.socscimed.2013.07.035.
11. Browne AJ, Smye VL, Rodney P, et al. Access to primary care from the perspective of Aboriginal patients in an urban emergency department. Qualitative Health Research 2011;21(3):33–348. doi:10.1177/1049732310385824.
12. van Boekel LC, Brouers EP, van Weeghel J, and Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for health care delivery: A systematic review. Drug Alc Depend 2013;31(1):23–35.
13. Natan MB, Beyil V, and Neta O. Nurses’ perception of the quality of care they provide to hospitalized drug addicts: Testing the Theory of Reasoned Action. Int J Nursing Pract 2009;15(6):566–73. doi: 10.1111/j.1440-172X.2009.01799.x.
14. Aggarwal M, Ghai S, and Basu D. Attitude of nursing students towards psychoactive substance use: Does training matter? Int J Nurs Educ 2012;4(2):146–50.
15. Strike GJ, Myers T, and Millson M. Finding a place for needle exchange programs. Crit Pub Health 2004;14(3):261–75. doi: 10.1080/09581590400004386.
16. Krokmyrdal KA and Andenaes R. Nurses’ competence in pain management in patients with opioid addiction: A cross-sectional survey study. Nurse Ed Today 2015;35(6):789–94.doi: 10.1016/j.nedt.2015.02.022.
17. Campbell-Heider N, Finnell DS, Feigenbaum JC, et al. Survey on addictions: Towards curricular change for family nurse practitioners. Int J Nurs Educ Scholarship 2009;6(1):1–17.doi: 10.2202/1548-923x.1645.
18. Sohler NL, Wong MD, Cunningham WE, et al. Type and pattern of illicit drug use and access to health care services for HIV infected people. AIDS Patient Care STDs 2007;21(S1):S68–S76. doi: 10.1089/apc.2007.9985.
19. Papps E and Ramsden I. Cultural safety in nursing: The New Zealand experience. Int J Qual Health Care 1996;8(5):491–97.
20. Ramsden J. The Treaty of Waitangi and Cultural Safety: The Role of the Treat in Nursing and Midwifery Education in Aortearoo. Wellington: Nursing Midwifery Council; 1996.
21. Anderson J, Perry J, Blue C, et al. “Rewriting” cultural safety within the postcolonial and postnational feminist project: Toward new epistemologies of healing. Advances in Nursing Science 2003;26(3):196–214.
22. Browne AJ, Varcoe C, Smye V, et al. Cultural safety and the challenges of translating critically oriented knowledge in practice. Nursing Philosophy 2009;10(3):167–79.doi: 10.1111/j.1466-769X.2009.00405.x.
23. McCall J and Pauly B. Providing a safe place: Adopting a cultural safety perspective in the care of Aboriginal women living with HIV/AIDS. Can J Nurs Res 2012;44(2):130–45.
24. Thorne S. Interpretive Description. Walnut Creek, CA: Left Coast Press; 2008.
25. Thorne S, Reimer Kirkham S, and O’Flynn-Magee. The analytic challenge in interpretive description. Int J Qualitatat Meth 2004;3(1):1–21.
26. Pauly B, McCall J, Browne AJ, et al. Toward cultural safety: Nurse and patient perceptions of illicit substance use in a hospitalized setting. Adv Nurs Sci 2015;38(2):121–35. doi: 10.1097/ANS.0000000000000070.
27. Pauly B, McCall J, Parker J, et al. Creating Culturally Safe Care in Hospital Settings for People Who Use(D) Illicit Drugs, Bulletin #11. Victoria, BC: University of Victoria, Centre for Addictions Research of BC; 2013.