Margaret Dykeman

Access to harm reduction services in Atlantic Canada: Implications for non-urban residents who inject drugs

Awareness of drug use in rural communities and small towns has been growing, but we know relatively little about the challenges injection drug users (IDUs) living in such places face in accessing harm reduction services. Semi-structured interviews were conducted with 115 IDUs in urban and non-urban areas of Atlantic Canada. In many instances, geographic distance to a needle exchange program (NEP) meant that individuals living outside of urban areas and who were not provided services through an NEPs outreach program were at a disadvantage in terms of an array of supports offered through many NEPs. These include access to free clean injecting equipment, and such ancillary services as clothing, food, referrals, information and social support. The integration of the services and approaches provided by NEPs into mainstream health services in non-urban places is one possible model for improving such access.

The power of relationships: implications for safer and unsafe practices among injection drug users.

Aims: To explore the influence of social relationships, at the interpersonal and community level, on safer and unsafe drug use practices among injection drug users (IDUs) in Nova Scotia, Canada. Method: Thirty-eight current injection drug users were recruited through two needle exchange programs. Fifteen women and 23 men participated in semi-structured interviews about their daily lives, relationships and safer/unsafe drug use and sexual practices. Findings: Most participants were well aware of the risks associated with injecting drugs and reported purposely engaging in numerous strategies to minimize those risks for themselves and others. However, several IDUs revealed that the dynamics of their relationships with other IDUs and with non-IDUs could and did lead to unsafe practices including needle sharing. Stigmatizing encounters with non-users and social exclusion from mainstream resources and structures appear to underlie and reproduce these unsafe practices. Conclusions: Within the current Canadian political context, there is a move to shift drug policies away from harm reduction toward a more enforcement-based approach. This shift will likely only exacerbate the current discourse of blame and stigma directed at injection drug users. In addition, it may serve to increase the interdependency among IDUs, and social and economic exclusion from non-IDUs.

Development of a program logic model to measure the processes and outcomes of a nurse-managed community health clinic

Evaluation is an essential process that permits assessing the effectiveness and efficiency of planned programs. In implementing a new nurse-managed Community Health Clinic targeting services for the homeless and underserved, the stakeholders considered an evaluation process integral to the planning stage of the clinic as a whole as well as of all the different programs being offered. The program logic model was chosen and modified to guide evaluation. Work to develop the evaluation model and its components began before the clinic opened. This article describes the development of the modified program logic model, how it was modified, and the rationale for its modifications. We highlight the process of developing the evaluation model because we found limited descriptions of the process in the literature. The evaluation process itself will be evaluated on an ongoing basis to determine if it is capturing the evaluation needs of the clinic project accurately.

Drug interactions: how they affect people living with HIV/AIDS.

Given the diversity and increasing life span of HIV-positive people, medical management of the associated complications is becoming more complex. This complexity is compounded by the growing number of drugs available to treat people with HIV/AIDS. Information regarding the adverse reactions and/or interactions of these drugs in combination is limited. The purpose of this paper is to review what is currently known about synergistic, antagonistic, and potentially toxic interactions. Included is a table containing side effects and interactions among drugs commonly used to treat clients with HIV/AIDS.

Implementation Process of a Canadian Community-based Nurse Mentorship Intervention in HIV Care

&NA; We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12‐month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group‐based and one‐on‐one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long‐term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations.

Key challenges in providing services to people who use drugs: The perspectives of people working in emergency departments and shelters in Atlantic Canada

Aims: Many people who use drugs (PWUD) have multiple health and social needs, and research suggests that this population is increasingly accessing emergency departments (EDs) and shelters for health care and housing. This qualitative study explored the practices of those working in EDs and shelters when providing services to PWUD, with a particular focus on key challenges in service provision. Methods: EDs and shelters were conceptualized as ‘micro environments’ with various components (i.e. social, physical and resource). One-on-one interviews were conducted with 57 individuals working in EDs and shelters in Atlantic Canada. Findings: The social, physical and resource environments within some EDs and shelters are key forces in shaping the challenges facing those providing services. For example, the social environments within these settings are focused on acute health care in the case of EDs, and housing in the case of shelters. These mandates do not encompass the complex needs of many PWUD. Resource issues within the wider community (e.g. limited drug treatment spaces) further contribute to the challenges. Conclusions: Structural issues, internal and external to EDs and shelters need to be addressed to reduce the challenges facing many who work in these settings when providing services to PWUD.

The Unexpected Challenges of Clinical Research, or What They Do Not Tell You in School

Nurse clinicians are being asked more and more frequently to be involved in nursing research. After all, who better to conduct clinical research than those people who spend much of their working day dealing with direct patient care issues. Although more nurses are beginning to understand the value of research in their clinical practice and more articles discussing clinically based research are becoming available, little information is available concerning the process of doing research in a clinical setting. Educational institutions teach research methodology but do little to prepare nurses for the reality of conducting research as part of the daily work load. The following is a discussion of a number of realities encountered by a nursing research team conducting a qualitative study dealing with an outpatient population. Included are a number of suggestions that the research team believes will help other clinical researchers better prepare for conducting research in their clinical setting.

Keeping the focus on safer practices: A Safer Practices Lens

Atlantic Health Promotion Research Centre, Dalhousie University, 6230 South Street, Halifax, Nova Scotia, Canada B3J 3T1 Atlantic Health Promotion Research Centre & School of Health and Human Performance, Dalhousie University, 6230 South Street, Halifax, Nova Scotia, anada B3H 3J5 Faculty of Nursing, University of New Brunswick, P.O. Box 4400, Fredericton, NB, Canada E3B 5A3 School of Health and Human Performance, Dalhousie University, 6230 South Street, Halifax, Nova Scotia, Canada B3H 3J5 anad School of Social Work, Dalhousie University, 6414 Coburg Road, Halifax, Nova Scotia, C