1. 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