Nurses advocate for the rights, health and safety of patients, but this can be challenging when those patients engage in risky behavior. Public health nursing utilizes harm reduction techniques to continue to care for and educate these patients — who are often noncompliant or suffering from addiction — while also minimizing consequences for the community. RNs typically learn about this branch of nursing and current harm reduction strategies as part of an online Registered Nurse to Bachelor of Science in Nursing (RN to BSN) program.
What Is Harm Reduction?
According to the Harm Reduction Coalition, harm reduction "is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use." Although originally developed in response to infectious diseases like HIV and then largely used with substance abuse patients, harm reduction strategies are helpful in many different circumstances and are a substantial component of most public health initiatives.
The primary goal in harm reduction is to decrease or eliminate the undesirable health effects of patients' choices, usually without completely stopping or modifying their behavior. The techniques acknowledge that even if the behaviors continue, the next best solution is to protect the patient and public from at least some of the resulting consequences.
What Are Some Harm Reduction Programs?
There are several successful harm reduction programs in place, all of which operate under the assumption that even when patients continue to participate in unsafe and risky behaviors, there are ways to offset the extent of personal and public injury or illness.
Needle exchange programs: To combat the spread of blood-borne diseases like HIV and hepatitis, needle exchange programs distribute sterile needles to drug users and dispose of dirty ones. Disease testing and overdose awareness and prevention, as well as referrals to treatment programs and counseling are frequently offered services.
Smoking cessation during pregnancy: Smoking during pregnancy can cause serious and irreparable harm to a fetus. Public health initiatives encouraging pregnant women to stop smoking for the duration of their pregnancy reduce these risks, even if they resume smoking following birth.
Supervised injection facilities: In response to the opioid crisis, many countries are utilizing supervised injection facilities. These are clean, secure locations where people bring illicit substances for self-administration and consumption. The facilities are staffed with nurses and other healthcare providers who distribute sterile needles, respond rapidly to overdoses or adverse reactions, and refer patients to social services, counseling and treatment programs. While shown to be effective at reducing overdose deaths and spread of disease, there are currently no facilities in the United States, though there are several proposed sites throughout the nation.
How Do Nurses Reduce Harm?
Nurses' greatest harm reduction technique is likely patient acceptance and education. When nurses acknowledge patients' autonomy and are nonjudgmental about patient choices and lifestyles — whether it is illicit drug use or failure to comply with a treatment plan for diabetes or hypertension — they can focus more acutely on informing patients of potential health and safety risks, and finding resources or programs to reduce harm instead of attempting to eliminate the behavior completely.
Participation in this process does not mean that nurses support or agree with patients' choices. According to the American Nurses Association (ANA) Code of Ethics, RNs have an ethical obligation to respect patients' decisions and offer resources to mitigate harm.
Do No Harm
Harm reduction techniques and programs represent a significant portion of public health and patient education initiatives. Not all patients will be compliant and make healthy choices. Nurses must be willing to accept patients as they are, so that risky behaviors are identified and effective methods to alleviate the resulting patient and community consequences can be implemented.
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