Harm reduction as an approach to ethical nursing care of street-involved people who use drugs: an integrative literature review




Mullally, Cassandra

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People who are street-involved and use drugs suffer from a host of physical, mental, and social harms related to homelessness and illegal drug use. Despite the great need for appropriate healthcare services, these health inequities are exacerbated by a lack of access to care that result from numerous financial, geographic, social, political, and relational barriers. The barriers posed by the stigmatizing attitudes and discriminatory behaviour of nurses is of particular concern as it violates professional ethical standards of practice and is rooted in a negative ethical climate. Harm reduction, as a guiding philosophy in nursing practice, is proposed to address these health inequities, increase access to health care, and improve the ethical climate of nursing practice. Utilizing Cooper’s (1998) framework, an integrative literature review was conducted to discuss actions at the intrapersonal, interpersonal, institutional, community, and public policy level necessary to implement harm reduction in nursing practice. A Socio-Ecological framework proposed by McLeroy, Bibeau, Steckler, and Glanz (1988) served as the theoretical underpinning guiding the exploration of contextual factors that influence the adoption of harm reduction as a guiding philosophy in nursing practice. Recommendations for action that highlight the importance of a comprehensive approach, including action on the social determinants of health, to improve the health of street-involved people who use drugs are discussed.



harm reduction, street people, drug use