Harm Reduction in Nursing Practice: Compassionate Care for Persons With Addiction

Substance abuse and overdose deaths are increasing at profound rates in the United States. Nurses and clinicians must evaluate their response to this growing epidemic. Harm Reduction is an alternative therapy for rehabilitation and was traditionally used in tobacco cessation, and to control the spread of HIV and HCV. The concept of harm reduction can be described as accepting the possibility that individuals will abuse harmful substances, and the goal of treatment is to reduce the harm associated with the addictive behavior; ultimately, this treatment nurtures a non-judgmental environment that facilitates a therapeutic nurse-patient relationship. Much of the literature regarding harm reduction in nursing is isolated to Canada and parts of Europe. However, the 6-fold increase in heroin overdose deaths in the United States from 2001-2013, has prompted lawmakers, parents, and clinicians to explore alternatives to standard rehabilitation practices (National Institute on Drug Abuse, 2015).

This integrative literature review sought to explore current uses of harm reduction, evaluate their efficacy, and examine harm reduction for inclusion into nursing practice in the United States. The following nursing databases were utilized for provision of literature: CINAHL complete and PubMed. Databases were searched using the following terms and Boolean phrases: “harm reduction & nurs*,” and “harm reduction & addiction,”. Articles were chosen if the language was in English, published within the last 10 years (2006-2016), published in an academic peer-reviewed journal, and were primary sources. Of the 99 articles retrieved, 10 will be analyzed in the integrative literature review. The remaining 89 articles were excluded due to the following parameters: duplicate article, application of harm reduction to alternate health disparities (fall prevention, smoking cessation, or cardiovascular disease), no clear relationship to nursing practice, or a position piece.

Results of the literature review yielded 6 studies identifying current uses of harm reduction, and 4 studies focusing on clinician perspectives about providing harm reduction therapy. Selected literature was rated using the Melnyk Fineout-Overholt Hierarchy of Evidence (2011) (Appendix A). Analysis of the literature regarding clinician perspectives revealed common themes such as: harm reduction as a bridge to abstinence; harm reduction’s ability to address the patient as a holistic being; and harm reduction as honoring a patient’s autonomy. A research matrix was created to holistically analyze and categorize the body of selected literature. Studies regarding current use of harm reduction found positive results in patients’ self-reported advocacy, self-esteem, and ability to navigate social services. Patients also experienced a decrease in problems associated with drug and alcohol use, as well as a decrease in money spent on drugs or alcohol. In addition to the evidence-based successes, the ethical components of harm reduction align with much of the nursing code of ethics. Patient autonomy, and trust in a patient’s ability to make health related decisions, is one of the key tenants of Pender’s Health Promotion Model; both perceived self-efficacy and perceived barriers to action greatly influence a patient’s commitment to action, and ultimately the adoption of a health promoting behavior (Alligood, 2013). While it is unlikely that stand-alone facilities modeled under harm reduction will be created in the United States, there are elements of harm reduction that can be readily integrated, and may be unknowingly permeating, current nursing practice.

Appendix A.

Melnyk Fineout-Overholt Heirarchy of Evidence Rating	Frequency	Cumulative Percentage
Level 1: Systematic review & meta-analysis of randomized control trials (RCT) or evidence-based clinical practice guidelines	1	10%
Level 4: Case control & cohort studies	3	40%
Level 6: Single descriptive or qualitative study	4	80%
Level 7: Expert opinion	2	100%
Totals	10	100%