Evidence guiding culturally safe nursing practice

The current ANS featured article titled “Toward Cultural Safety Nurse and Patient Perceptions of Illicit Substance Use in a Hospitalized Setting”  is based on a collaborative project that focuses on cultural safety in health care.  The authors, Bernadette (Bernie) Pauly, PhD, RN; Jane McCall, MSN, RN; Annette J. Browne, PhD, RN; J. Parker, MA and Ashley Mollison, MA shared this background about their work:

Our article describes an ethnographic research project examining the experiences of people who use illicit drugs and nurses who provide care for them in acute care settings. The idea for this research emerged from a recognition that people who are identified as using illicit drugs and facing socio-economic disadvantages often experience stigma when accessing health care services. Nurses working at Insite, Vancouver’s supervised injection site, found that cultural safety helps to mitigate stigma when working with people who use illicit drugs, so this project set out to explore what cultural safety might look like with this population in other settings. Cultural safety was developed in New Zealand to address persistent health inequities experienced by Maori people and has been a strategy to enhance care for people experiencing the negative effects of stigma, racism and other forms of discrimination, and ongoing marginalization.

In exploring the meaning of cultural safety, from the perspectives of people who use illicit drugs and nurses, participants described 3 main conceptualizations of illicit drug use, as 1) individual failings; 2) criminal activity, and 3) a disease of ‘addiction’. They discussed how these intersect to negatively impact access to care, management of pain, and access to of harm reduction supplies.

In relation to illicit drug use, cultural safety can prompt nurses and other healthcare providers about the importance of situating drug use in the history of the criminalization of drug use, and how continued legacies of that criminalization impact the care that people receive, preventing people from accessing health services now and in the future. Creating culturally safe(r) environments involves health care professionals
examining their own values and conceptualizations of drug use, and about people who use drugs, and how that might affect practices and policies in acute care settings.

This project would not have been possible without the leadership and input from a peer advisory committee comprised of members of the Society of Living Illicit Drug Users (SOLID), an organization run by and for people who use(d) illicit drugs. The peer advisory met regularly throughout the project to provide direction on the interview questions, strategies for data collection, and input on research findings. A nurse advisory committee provided parallel leadership and direction to the research process. The advisory groups ensured that the research questions were relevant, that the process of data collection was attentive to needs of participants, and that the research findings were interpreted within an appropriate context of lived experience and practice. Together with the research team, the nurses and peers developed a practical set of recommendations for practice.

The results of the research were presented at two hospital forums where advisory committee members, nurses and managers discussed how research recommendations could be implemented through changes to hospital policy and practice. As a result of the research there have been changes to hospital harm reduction policies and practices. Today, the cultural safety bulletin is being mobilized by SOLID to offer peer-run trainings to front line health and social service providers.

This article is available for download without cost while it is featured on the ANS web site!  Download and read it now!  Then come back here and share your comments – we would be delighted to hear from you!