Addressing drug-related harms: the roles of community health nurses

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DeCosse, Brigitte
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Background. In Manitoba, drug-related harms such as drug poisonings, fatalities and emergency presentations have increased significantly, especially over the course of the COVID-19 pandemic. Other harms include blood-borne infections, stigma and discrimination, and legal harms. Community health nurses are well positioned, in theory, to address these harms in their practice. However, little is known about their perspectives and specific roles and practices in addressing drug-related harms. Purpose. The purpose of this study was to explore community health nurses’ perspectives and their roles in addressing drug-related harms. Their views and experiences with drugs were explored along with their thoughts of the “drug problem” and the current responses to the problem, including government and healthcare responses. Design. Sally Thorne’s qualitative research method of interpretive description was the methodology chosen for this study. Sample and setting. Participants included licensed nurses (i.e., RNs, RPNs, and LPNs) working in the community, including public health nurses, primary care nurses and nurses working in addictions services recruited from various community organizations in Winnipeg. Methods. Data was collected using semi-structured interviews and field notes. Interviews were conducted virtually using Zoom videoconferencing technology. Thematic analysis guided by the Framework Method was used to analyze data. Findings. The findings showed that community health nurses predominantly view the “drug problem” as a social issue rather than an individual one. They stress the importance of addressing root causes of drug-related harms within the context of social determinants of health. Despite this perspective, community health nurses continue to provide mainly individual level care with minimal community or systems level interventions. This misalignment is associated with moral distress. A number of systemic and organizational barriers that limit their ability to perform system level roles were identified. Conclusions. Community health nurses are well-positioned to address drug-related harms in their practice. However, the majority of their work is comprised of individual level care which fails to address underlying inequities experienced by their clients. Efforts are needed to support community health nurses to perform upstream or system-level roles.
community health nurses, drug-related harms, public health nurses, public health approach, system level care, drug use, substance use