School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
School of Nursing, University of Victoria, 3800 Finnerty Road, HSD Building A402a, Victoria, BC, V8P 5C2, Canada.
Harm Reduct J. 2024 Sep 18;21(1):171. doi: 10.1186/s12954-024-01088-6.
Emergency Departments (ED) staff, including nurses and physicians, are most directly involved in the care of people who use unregulated substances, and are ideally positioned to provide harm reduction interventions. Conceptualizing the ED as a complex adaptive system, this paper examines how ED staff experience opioid-specific harm reduction provision and engage in harm reduction practice, including potential facilitators and barriers to engagement.
Using a mixed methods approach, ED nurses and physicians completed a self-administered staff survey (n = 99) and one-on-one semi-structured interviews (n = 15). Five additional interviews were completed with clinical leaders. Survey data were analyzed to generate descriptive statistics and to compute scale scores. De-identified interview data were analyzed using a reflexive thematic analysis approach, which was informed by the theory of complex adaptive systems, as well as understandings of harm reduction as both a technical solution and a contextualized social practice. The final analysis involved mixed analysis through integrating both quantitative and qualitative data to generate overarching analytical themes.
Study findings illustrated that, within the context of the ED as a complex adaptive system, three interrelated contextual factors shape the capacity of staff to engage in harm reduction practice, and to implement the full range of opioid-specific harm reduction interventions available. These factors include opportunities to leverage benefits afforded by working collaboratively with colleagues, adequate preparation through receiving the necessary education and training, and support in helping patients establish connections for ongoing care.
There is a need for harm reduction provision across all health and social care settings where people who use unregulated opioids access public sector services. In the context of the ED, attention to contextual factors including teamwork, preparedness, and connections is warranted to support that ED staff engage in harm reduction practice.
急诊部（ED）的工作人员，包括护士和医生，是最直接参与照顾使用未经管制物质的人的人，他们是提供减少伤害干预的理想人选。将 ED 视为复杂自适应系统，本文研究了 ED 工作人员如何体验特定于阿片类药物的减少伤害供应，并参与减少伤害实践，包括参与的潜在促进因素和障碍。
使用混合方法，ED 护士和医生完成了自我管理的员工调查（n=99）和一对一的半结构化访谈（n=15）。还与 5 名临床领导进行了额外的 5 次访谈。对调查数据进行了分析，以生成描述性统计数据和计算量表得分。对匿名访谈数据进行了分析，使用了一种反映性主题分析方法，该方法受到复杂自适应系统理论以及对减少伤害作为一种技术解决方案和一种背景化社会实践的理解的启发。最终的分析涉及通过整合定量和定性数据来生成总体分析主题的混合分析。
研究结果表明，在 ED 作为复杂自适应系统的背景下，三个相互关联的背景因素塑造了员工参与减少伤害实践的能力，并实施了可用的全套特定于阿片类药物的减少伤害干预措施。这些因素包括通过与同事协作利用协作带来的好处的机会，通过接受必要的教育和培训获得足够的准备，以及在帮助患者建立持续护理联系方面的支持。
在人们使用未经管制的阿片类药物获取公共部门服务的所有卫生和社会保健环境中都需要提供减少伤害服务。在 ED 背景下，需要关注包括团队合作、准备和联系在内的背景因素，以支持 ED 工作人员参与减少伤害实践。
