Harm reduction as an approach to ethical nursing care of people who use illicit substances: an integrative literature review of micro and meso influences

• Published in: Drugs : education, prevention & policy Vol. 28; no. 6; pp. 533 - 546
• Main Authors: Iammarino, Cassandra (Sammy), Pauly, Bernadette (Bernie)
• Format: Journal Article
• Language: English
• Published: Taylor & Francis 02.11.2021
• Subjects: access to health care; Harm reduction; health inequities; nursing ethics; substance use
• ISSN: 0968-7637; 1465-3370
• DOI: 10.1080/09687637.2020.1840515

People who use illicit substances and experience socioeconomic disadvantage experience poor health as a result of structural vulnerabilities made worse by barriers to health care. In particular, stigma and discrimination often act as a barrier to health care for people who use illicit substances. Lack of respect for persons and judgements based on discrimination are in violation of core ethical principles of nursing practice. Harm reduction, as a guiding philosophy, is proposed as a way to promote respectful and non-judgmental care and minimize the harms associated with illicit substance use in alignment with principles of ethical nursing practice. Utilizing McLeroy's Ecological Model of Health Promotion as the guiding framework, we conducted an integrated review of relevant literature to identify recommendations for implementing harm reduction in nursing practice at the intrapersonal, interpersonal, and institutional levels. The search yielded 20 primary research articles published from 2008 until 2020 to identify the actions necessary to implement harm reduction in nursing practice. This integrative review summarizes evidence-based actions necessary from the micro- to meso-level to support the implementation of harm reduction as a guiding philosophy to enhance ethical practice in nursing.