https://www.infirmiere-canadienne.com/blogs/ic-contenu/2024/07/11/repondre-questions-etudiants-reduction-mefaits
What to do when asked, “Why don’t people just stop using drugs?” and more
By Trish Hanson
July 11, 2024
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It’s useful for lecturers to remember that the opioid crisis and drug poisonings are potentially a controversial topic, about which nursing students may have strong opinions that are not necessarily informed by evidence.
This article is part of the Canadian Nurse series, Harm Reduction Saves Lives.
With recruitment to nursing programs on the rise in Canada, more practising or retired nurses are finding themselves recruited as sessional lecturers to undergraduate nursing programs.
Courtesy of Trish Hanson
“Nurses can have a huge impact on reducing harmful stigma in all care settings through their own words and actions,” says Trish Hanson.
New sessional lecturers are often assigned to teach theory courses that cover the history of nursing, ethical and legal issues, inter- and intraprofessional collaborative practice, patient-centred care, cultural competence, and critical thinking. These foundational topics present opportunities for the nurse educator to introduce students to harm reduction practices in a way that can spark interest and depth of understanding in the field for new graduates.
In teaching the nursing fundamentals of bioethical principles, the topics of justice and beneficence are featured. These can prompt exploration of stigma and its effects on equity for the people served by harm reduction practices, one example being those who access supervised consumption sites.
Nurses can have a huge impact on reducing harmful stigma in all care settings through their own words and actions. It’s useful for lecturers to remember that the opioid crisis and drug poisonings are potentially a controversial topic, about which nursing students may have strong opinions that are not necessarily informed by evidence. Introduction to critical thinking for nursing students should emphasize the potential impact of bias on equity in health-care provision, and especially how to monitor ourselves for bias through the regular practice of reflection.
Engaging with students as they prepare to do their first written reflections can create ideal conditions for learning through discussion. Some questions students may voice include the following.
Why don’t people just stop using drugs?
As nursing students in the 1980s, my peers and I were told that charting “attention-seeking behaviour” about a patient would bring strong disapproval for its implied judgment. Once the need to self-monitor for bias through reflection is understood, teaching the fundamental attribution error, where one assumes that another person is operating on motivations that we would never attribute to ourselves, can be a powerful way of helping nursing students with self-management and interprofessional practice when caring for people with addictions or other conditions that health-care providers may struggle to comprehend.
In a standard example of the fundamental attribution error, we rage at the motorist who cut us off “on purpose,” but when we commit a traffic violation, we rarely do so with the intention of enraging other motorists. By the same token, we can attribute reasons for using substances to others that we would never attribute to ourselves.
To forge a successful therapeutic relationship, nursing requires that we aim to understand others beyond the constraints of our own experiences. From there, the skills of priority nursing, critical thinking, and clinical decision-making help nurses to create a plan for care that reduces the harms associated with addiction. But if the fundamental attribution error impairs understanding of our patients, the care we provide will be ill-informed and may even cause harm.
When teaching patient-centred care, we can instil the principle that the best way to understand behaviour can often be to simply ask your patient about it; assumptions are almost certain to fall short owing to our own internal biases. The continued use of potentially toxic substances cannot be assumed to mean that your patient wants to die or has stopped caring about life. This approach can lead to discussions about how accessing a supervised consumption service is also a behaviour that has meaning, which might be I don’t want to die from this today.
In sum, we don’t know why people do things, including persisting with substance use and other types of risk to self, by guessing or by looking at the question through the lens of our own experience. There are ways nurses can ask their patients and clients this question that show respect: “How are you feeling about how things are going for you lately?” is one that opens the door to disclosure. Regardless of the answer, you are starting a conversation based on your patient’s own experience and not your assessment of it, which is the first step to finding out why anyone does anything.
Why do we give people free needles and drug consumption supplies? Doesn’t this encourage drug use?
This question presents an opportunity to explain how upstream prevention practices, like making new supplies available, targets and reduces the spread of blood-borne infections by reducing activities known to present considerable risk, such as sharing or reusing injection supplies. Offering new supplies can also build trust with people who use drugs and create a point of contact with the health-care system.
Ultimately, having new, hygienic supplies doesn’t change the fact that the person receiving them is living with an addiction, and nurses act to reduce the harms associated with that addiction by taking actions within their scope of practice. These encounters can start a therapeutic relationship, which may help people think about other options in future.
Doesn’t keeping people from dying just encourage them to keep taking drugs?
In the scenario of repeated drug poisonings, we can teach that the priority nursing action lies in keeping patients alive until they are able to find a recovery method that suits their needs. Finding that method can take time, and nurses who have built trust with their patients can be a point of connection for other health-care resources.
These harm reduction principles are applicable to other conditions that tend to have a relapsing and remitting course with risk of mortality over time, such as eating disorders, obesity, or diabetes. It may be helpful to reflect on why we would question this approach more intensely in the context of opioid use than we would in hyperglycaemia.
What about clinical programs that actually give people opioids? Isn’t that enabling the addiction?
Students may learn through news items and in their pharmacology classes that pharmaceutical care can help patients recover from opioid dependence, and often wonder about the clinical as well as the ethical aspects of these practices.
To enhance understanding of this very complex topic, students can view Kímmapiiyipitssini: The Meaning of Empathy, a TVO documentary on YouTube. Following this, a discussion of Dr. Esther Tailfeathers’ years of contributions to this field, many of which are currently in the news, provides the multi-faceted examination indicated in critical thinking exercises.
Clients with addictions often require health care, and there is risk of harm if nurses are not educated about harm reduction. To ensure nurses continue to represent the leading edge of compassionate care provision, undergraduate nursing education can and should incorporate explicit harm reduction principles to foster nurse–patient interactions of the highest possible quality in any setting encountered.
Trish Hanson, RPN, MHS, is a recently retired provincial initiatives consultant with the provincial addiction and mental health portfolio at Alberta Health Services.
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#addictions
#harm-reduction
#nurse-patient-relationship
#nursing-education
#stigma
#substance-use