Community nurses’ experiences and perceptions of working in substance use harm reduction: a phenomenological study

Abstract

Canada is experiencing an ongoing and rapidly unfolding drug poisoning crisis that is especially prevalent in northwestern Ontario. Substance use is complex with significant physical and social impacts, including patient experiences of stigma, discrimination and resultant health inequities. Harm reduction is an important component to providing holistic care for individuals impacted by substance use. Given nurses’ proximity to patients, along with their training in relational practice and compassion, they are in a position to implement harm reduction interventions and principles in their care. Harm reduction initiatives have been implemented in northwestern Ontario, but research on nurses’ experiences and perceptions working in this area has been limited. The purpose of this dissertation was to explore the lived experience of nurses working in substance use harm reduction in a northern setting. van Manen’s phenomenology was used as the methodology to guide the research. The study includes the voices of eighteen nurses who work in substance use harm reduction. Participants were interviewed and data was analyzed using van Manen’s phenomenology to uncover the lived experience of their work. The data was analyzed and categorized in van Manen’s lived world existentials, including lived relationality, space, body and time. Within the nurses’ harm reduction practice, care was perceived and experienced as relationally contingent, with trust playing an important role in relationship development. Facilitators of trust and relationship development are explored. In addition to lived relationality, the nurses described the essence of their experiences related to lived space. The nurses’ conceptualizations of the space of harm reduction and factors underpinning the conceptualizations are described. Related to lived body, harm reduction work as an embodied experience is explored, including several psychological and some physical experiences. Additionally, how nurses protected the body from these impacts are described. Finally, in lived time, motivations to work in harm reduction, reasons to stay, shifted perceptions, and the future direction of harm reduction are detailed. This work offers implications for practice in northern settings, practice recommendations and potential areas for future research.