Fostering Cultural Safety in Nursing Practice With People Who Use Drugs  Dr. Bernie Pauly, RN, PhD1; Jane McCall, MSN, RN2; Dr. Annette Browne, RN, PHD3; Joanne Parker, MA3; Catherine McLaren3; Ashley Mollison1 1[University of Victoria], 2[St. Paul’s Hospital], 3[University of British Columbia] BACKGROUND HEALTH CARE AND DRUG USE People who use illicit drugs, especially those living in poverty, face challenges getting good health care. Bad experiences in hospitals can lead people to delay or avoid seeking care, or to stop their treatment and leave the hospital early. Nurses in acute care settings are a key point of access to care and play a critical role in the delivery of care. However, few models exist to guide ethical, safe and appropriate care for this population. CULTURAL SAFETY Cultural safety is a nursing concept that has been used to address problems of stigma, discrimination, and access to care for other groups, particularly Aboriginal peoples. Cultural safety requires nurses to reflect on their own position and on the differences in power between nurses and patients. RESEARCH QUESTIONS 1) What is culturally safe care in acute care settings for people who use illicit drugs and face multiple social disadvantages? 2) How can we enhance delivery of safe, competent and ethical nursing care? FINDINGS People who use drugs worry about – and experience – poor care, discrimination, and discomfort, including: Being judged and labelled a ‘drug addict’ Seen as less deserving of care Feeling under surveillance Not receiving adequate pain relief What does culturally safe care look like to patients? Nurses Trust me and give me space Listen to and believe me Do Little things that matter Take time and don’t hurry Explain things What does culturally safe care look like to nurses? View behaviours and decisions in the contexts of people’s lives ‘Think differently’ about drug use Recognize mistrust, marginalization and lack of control Emphasize building a positive relationship WHAT IS CULTURALLY SAFE CARE FOR PEOPLE WHO USE DRUGS? Care that fosters engagement and participation of people who have experience with substance use and marginalization in shaping the care they and their peers receive. Care that is grounded in an understanding how people’s health, health care, priorities and experiences are shaped by drug policy and the criminalization of drug use Care that considers how past histories of trauma and violence, layers of disadvantage and stigma may affect patients’ ability to engage with providers and care plans Care that emphasizes building relationships and trust as important outcomes are a priority Care that is provided in a culture of respect and safety within your unit or workplace. The whole thing that motivates me is to maybe plant a seed of safety…our patients have a really hard time trusting people METHODS Qualitative, ethnographic design including observation on hospital wards, document and policy review, and in-depth interviews with nurses and patients. Collaborative Approach: Practice and academic co-leads Project is guided by: -Nurse advisory at St. Paul’s -Peer advisory (SOLID) in Victoria Participants from two hospital medical units: 15 patients (8 men, 6 women, 1 transgendered) – 8 HIV+ and 10 HCV+ 12 Front line Nurses 7 Nurse managers or educators For additional information please contact: Jane McCall St. Paul’s Hospital jmccall@providencehealth.bc.ca