Jennifer Jackson

The aim of this study was to identify how Peer Support Workers (PSWs) understand their scope of practice, to provide greater clarity for PSWs working in addiction care with interprofessional teams. We conducted semi-structured interviews with PSWs and analysed the results using qualitative description. We interviewed 17 PSWs from a variety of backgrounds. We identified five descriptive themes that illustrate how PSWs delineated their scope of practice: building relationships with clients, therapeutic engagement with clients, system navigation, providing supplies to clients, and professional development. PSWs had a clear sense of their scope of practice and how they could be most effective, despite a lack of recognition of this scope in their workplaces. By creating a preliminary description for a PSW scope of practice, we hope that PSWs and nurses can work together to support the PSW professional role, enhancing patient outcomes.

Objective: Harm reduction strategies can enhance patient care and reduce hospital departures against medical advice; however, implementing these strategies can be challenging if health care professionals are opposed to harm reduction. The aim of this scoping review was to synthesize evidence about the perspectives of acute care health care professionals on harm reduction strategies. Methods: We followed the Joanna Briggs Institute guidelines for our scoping review and searched the databases MEDLINE(R) (Ovid), APA PsycInfo (Ovid), EMBASE (Ovid), and CINAHL Plus with Full Text (EBSCO). Results: After screening, we included 29 studies in this review. The studies were mostly set in emergency departments and urgent care settings. Health care professionals were generally willing to engage with harm reduction interventions, but this willingness did not always translate to action. Authors highlighted tailored staff education as an important part of interventions. Stigma towards people who use drugs remained prevalent, and interventions were more effective when peers and people with lived experience were involved. Conclusion: Health care professionals often see the value in harm reduction interventions, but need support to implement these interventions in acute care settings. Increased staff education and involvement of people with lived experience will strengthen harm reduction interventions. Contexte et objectif: Les stratégies de réduction des risques peuvent améliorer la prise en charge des patients et réduire les sorties contre avis médical; cependant, la mise en œuvre de ces stratégies peut s’avérer difficile si les professionnels de santé y sont opposés. L’objectif de cette revue exploratoire était de synthétiser les données disponibles concernant le point de vue des professionnels de santé des soins de courtes durées sur les stratégies de réduction des risques. Méthodes: Nous avons suivi les lignes directrices du Joanna Briggs Institute (JBI) pour notre revue exploratoire et avons effectué des recherches dans les bases de données MEDLINE® (Ovid), APA PsycInfo (Ovid), EMBASE (Ovid) et CINAHL Plus with Full Text (EBSCO). Résultats: Après sélection, nous avons retenu 29 études pour cette revue. Ces études ont été menées principalement dans des services d’urgence et des centres de soins d’urgence. Les professionnels de santé se sont généralement montrés disposés à s’engager dans des interventions de réduction des risques, mais cette volonté ne s’est pas toujours traduite par des actions concrètes. Les auteurs ont souligné que la formation sur mesure du personnel constituait un élément important de ces interventions. La stigmatisation à l’égard des personnes qui consomment des drogues restait répandue et les interventions se sont avérées plus efficaces lorsque des pairs et des personnes ayant une expérience concrète étaient impliqués. Conclusion: Les professionnels de santé reconnaissent souvent l’intérêt des interventions de réduction des risques, mais ont besoin d’un soutien pour les mettre en œuvre dans les services de soins de courtes durées. Une formation accrue du personnel et l’implication de personnes ayant une expérience concrète renforceront les interventions de réduction des risques.

Objective: Needle debris refers to discarded drug paraphernalia that is associated with substance use and is a challenging issue for many municipalities. The presence of needle debris can decrease public support for harm reduction services, because of fears around public safety. We examined perceptions from people in both the public and private sectors in an urban municipality regarding needle debris prevention and management. Methods: We conducted semistructured interviews with 16 participants who manage needle debris cleanup for the local municipality, agencies, and businesses. The method for our analysis was reflexive thematic analysis using inductive coding. Results: Stigma was the main contextual factor in managing needle debris. Participants identified practical reasons why needle debris occurred, describing it as a social issue, and not a waste issue. Participants had varied preferences for centralized versus whole-of-society approaches to addressing needle debris. Proposed solutions included using less stigmatizing bin designs and creating a culture change around needle debris to create better services for people who use substances. Conclusions: Needle debris is complex and social considerations need to be part of any needle debris policy interventions. Contexte: Les débris d’aiguilles désignent les accessoires de consommation de drogue mis au rebut qui sont associés à la consommation de substances psychoactives et constituent un problème difficile pour de nombreuses municipalités. La présence de débris d’aiguilles peut diminuer le soutien du public aux services de réduction des risques, en raison des craintes liées à la sécurité publique. Nous avons examiné les perceptions des personnes des secteurs public et privé d’une municipalité urbaine concernant la prévention et la gestion des débris d’aiguilles. Méthodes: Nous avons mené des entretiens semi-structurés avec 16 participants, qui gèrent le nettoyage des débris de seringues pour la municipalité locale, les agences et les entreprises. Nous avons procédé à une analyse thématique réflexive à l’aide d’un codage inductif. Résultats: La stigmatisation est le principal facteur contextuel de la gestion des débris d’aiguilles. Les participants ont identifié des raisons pratiques pour lesquelles les débris d’aiguilles se produisaient, les décrivant comme un problème social et non comme un problème de déchets. Les participants avaient des préférences variées pour des approches centralisées ou pour des approches globales de la société pour traiter les débris d’aiguilles. Les solutions proposées comprennent l’utilisation de poubelles moins stigmatisantes et la création d’un changement culturel autour des débris d’aiguilles afin de créer de meilleurs services pour les personnes qui consomment des substances. Conclusions: La gestion des débris d’aiguilles est complexe et les considérations sociales doivent faire partie de toute intervention politique sur les débris d’aiguilles.

Background: Nursing students may struggle with community placements, preferring hospital placements because of the emphasis on acute care. There are limited numbers of community health nurses available for students, so settings outside of health services can be used as venues for community health placements. Purpose: We aimed to evaluate a pilot placement outside of health services setting in the context of a research study focused on harm reduction for people who use substances, to assess whether the placement was effective in engaging students with the full scope of community health nursing (CHN). Methods: We evaluated students’ experiences in this clinical placement using a thematic analysis approach to semi-structured qualitative interviews. We recruited students after their placements were completed and their final grades were submitted. Results: Three students participated in this evaluation and reported an increased understanding of CHN principles, such as social justice and equity, to address how social determinants of health affect clients. They also gained insight into the value of evidence-based practice and the full scope of CHN, particularly how it intersects with harm reduction. The nursing instructor role was critical to the success of the placement. Students wanted to have a higher level of interaction with people facing structural barriers to health during the placement. Conclusion: Our placement outside of health services settings was effective in expanding nursing students’ understanding of the full scope of CHN practice, including social determinants of health. Future studies can expand on this pilot to assess the value of diverse community placements for students. Résumé Contexte : Les étudiantes et étudiants en sciences infirmières peuvent avoir une préférence pour les stages en milieu hospitalier plutôt que ceux en milieu communautaire, et ce compte tenu de l’accent mis sur les soins aigus. Le nombre d’infirmières et infirmiers en santé communautaire disponibles pour accueillir des étudiantes et étudiants étant limité, des milieux autres que des services de santé pourraient servir à des stages en santé communautaire. Objectif : Notre objectif était d’évaluer un projet pilote de stages à l’extérieur du milieu des services de santé, dans le cadre d’une étude axée sur la réduction des méfaits pour les personnes souffrant de toxicomanie, afin de déterminer si un stage est un moyen efficace d’engager les étudiantes et étudiants dans la pleine étendue des soins infirmiers de santé communautaire. Méthode: Nous avons évalué l’expérience d’étudiantes et étudiants lors de ces stages en milieu clinique par l’entremise

Background: Many people with kidney failure start and remain on in‐centre haemodialysis treatment despite evidence of improved outcomes with home dialysis. To make an informed modality decision patients must receive frequent, high‐quality modality education. This education is inconsistent in the in‐centre haemodialysis setting, where patients spend the most time with nurses while receiving haemodialysis treatments.Objectives: The aim of this study was to examine in‐centre haemodialysis nurses' perceptions around modality education for patients receiving in‐centre haemodialysis using the COM‐B model of behaviour change.Design: We used framework analysis as a research method, applying the COM‐B model as a theoretical framework to understand nurses' perceptions of modality education.Participants: We interviewed 13 in‐centre haemodialysis nurses in a single province in Canada.Approach: We completed semi‐structured interviews via Zoom, which ranged from 30 to 60 min.Findings: Participants reported knowledge deficits, lack of experience or exposure to other dialysis modalities, and lack of resources to support modality education practices. In‐centre haemodialysis nurses reported some factors that enhanced modality education, including strong nurse–patient therapeutic relationships and previous experience in other dialysis modalities.Conclusions: Nurses could have a role in modality education but had different views on what this role should be. Nurses faced barriers in modality education such as knowledge deficits, a lack of experience with home modalities, and limited patient teaching resources. Factors that favoured modality education were strong nurse–patient relationships and previous experience with other modalities.