Harm Reduction Teaching activities and resources
This section supports educators with knowledge and skills to integrate harm reduction philosophy in mental health and addiction curricula.
At the end of this section, the educator will:
- Define and understand the philosophy and key principles of harm reduction.
- Identify key areas of harm reduction in policies and practice.
- Identify harm reduction approaches in other areas of health and safety.
Harm reduction is a pragmatic public health approach to practices, programs, and policies that aim to reduce the adverse health, social, and economic consequences of substance use without requiring individuals to abstain from substance use (CNA, 2011; Rassool, 2010).
The aim of a harm reduction approach is to reduce the negative consequences of risky behaviours, including the harmful effects of substance use (CNA, 2011; Rassool, 2010). As such, a harm reduction response recognizes that substance use is a complex phenomenon that encompasses a continuum of behaviours, ensures a non-judgmental provision of care, and advocates for equal access to resources and services for care, regardless of drug use or engagement in other at-risk practices (CNA, 2011). It also focuses on promoting harm reduction within the communities that clients live in and in the areas and conditions where substances are used, rather than in contexts that are removed from these settings (Rassool, 2010).
The dangers associated with substance use are not minimized in a harm reduction approach, which also recognizes the realities of poverty, racism, social isolation, past trauma, and other social inequalities that affect a person’s vulnerability and capacity to deal effectively with substance-related harm (Rassool, 2010). According to RNAO’s (2015) Engaging Clients Who Use Substances, harm reduction:
- Is an alternative to the disease causation model of substance use.
- Accepts that at any given time some people are not ready to choose abstinence.
- Accepts that substance use occurs in society and works to minimize its harmful effects
- Accepts that people who are substance-dependent should have a voice in the creation of programs and policies designed to serve them
- Values patient autonomy.
- Does not exclude abstinence as an option (Beirness, Jesseman, Notarandrea, & Perron, 2008; CNA, 2011).
Nurses should integrate principles of harm reduction when working with clients who use substances and when treating those at risk for or experiencing a substance use disorder, according to RNAO’s Engaging Clients Who Use Substances (2015). Harm reduction principles and approaches can also be used to support individuals physical and mental health (e.g., from engaging in unprotected sex to refraining from driving after drinking).
Applying a harm reduction framework allows nurses to tailor their approach in order to meet clients “where they are,” establish goals collaboratively with the client, and develop a client-centred plan of care, while building trust and autonomy in the nurse–client relationship (RNAO, 2009). However, before integrating the principles of harm reduction, nurses must be aware of and address their own attitudes and biases (RNAO, 2015d).
For more information, see Resources.
Teaching and Learning Activities
The following are teaching and learning activities that can be employed in the classroom to further support nurses in the integration of theory, principles and best practices related to harm reduction principles and approaches.
- Design a learning activity that includes a variety of program/policy options. Have students in small groups determine which option has a harm reduction approach and present to a group how and why they have come to that conclusion. Debrief using examples.
- Bring together a panel of people who can speak to harm reduction approaches from a personal/community/professional perspective (e.g., AIDS coalitions, condoms programs, methadone maintenance programs, needle exchanges, peer administered Naloxone, Housing First, etc.)
- Group Activity that asks students to identify different types of harm reduction practices.
- Case studies across lifespan, life transitions, and with different populations/contexts—or use the template in Section 9.3
- Videos—see Resources
- Lived client experiences/family experience—Appendix H
- Arts-based approaches
Learner Engagement Questions
The following are thought-provoking and engaging learner questions that can be used to further discussions with nursing students regarding harm reduction theory and approaches. These questions can be used either to stimulate discussion, engage students in critical thinking or be tied to class assignments and/or reflection exercises.
- What are the benefits and barriers of a harm reduction approach?
- What are the ethical implications for nursing practice of not providing care to those in need?
- Supervised injection site in my backyard – thoughts?
- What is the difference, similarity, and relationship between harm reduction and abstinence?
- What is the relationship between housing first strategies and harm reduction strategies?
- What is an example of harm reduction safe sexual practices?
- Does handing out condoms promote sexual activity?
- Do needle exchange programs promote drug use?
Evaluation and Self-reflection
The following tool can be used to evaluate students in their understanding and application of harm reduction theory and approaches:
- Assignment on policy review
Reflection questions: Do you choose your illness? What are your values and beliefs regarding harm reduction approaches? Does harm reduction save lives?
RNAO E-LEARNING MODULES
- Engaging Clients with Substance Use Disorders E-learning module
- Engaging Youth Who Use Substances E-learning module
- Addictions E-Learning Series
- RNAO’s Screening & Brief Intervention
- RNAO’s Using Motivational Interviewing Approaches
- Opioids: Best Advice For People On, Or About To Start Taking Opioid Medications, Related To Chronic Non-Cancer Pain is an educational video by Dr. Mike Evans.
- University of Utah’s Mouse Party: Take a look inside the brains of mice on drugs
- Bevel up - Drugs, Users and Outreach Nursing - Nettie Wild (2007)
RNAO BEST PRACTICE GUIDELINES
- RNAO 2015, Engaging Clients Who Use Substances . Toronto, ON. Registered Nurses’ Association of Ontario.
- RNAO 2009, Supporting Clients on Methadone Maintenance Treatment . Toronto, ON. Registered Nurses’ Association of Ontario.
- O’Grady, C. P., & Skinner, W. J. W. (2007). A family guide to concurrent disorders. Toronto, ON: Centre for Addiction and Mental Health.