A case study exploration of harm reduction implementation and related barriers and facilitators in an emergency department in British Columbia, Canada
department or school: Applied Science, Faculty of
department or school: Nursing, School of
data provider: DSpace
degree campus: UBCV
creator: Jiao, Ziqian (Sunny)
issued: 2024-08-30T21:07:35Z
issued: 2024
related degree: Doctor of Philosophy - PhD
degree grantor: University of British Columbia
description: Background: Harm reduction in health care settings has demonstrated tremendous benefit for people who use unregulated substances. Currently, what is known prioritizes community settings. As acute care settings, particularly emergency departments, grapple with implementing harm reduction, research is urgently needed to examine harm reduction inclusive of barriers and facilitators in these settings. Methods: A case study design was used to explore harm reduction implementation in an ED in British Columbia, Canada. Data collection included: staff surveys (n=99), interviews with staff and clinical leaders (n=20), and organizational policies. The resulting dissertation consists of three manuscripts. The first examined how the ED is organized as a complex adaptive system to implement harm reduction. The next examined how staff practice harm reduction. Finally, as positioning people who use unregulated substances as perpetuators of violence can impact care provision, including harm reduction, the third manuscript explored staff perspectives of patient violence. Findings: Findings demonstrated that an array of system agents (i.e., people, policies) interact to enable harm reduction implementation. Limited access to specialist services, specialist control, non-specialist reliance, and safety concerns, created systemic tensions that hinder harm reduction. Additionally, numerous contextual factors influenced staff capacity to engage in harm reduction including educational preparation, opportunities to leverage collaborative inter-colleague relationships, and support to help patients establish other care connections for ongoing care. The third manuscript findings illustrated how disconnections between what patients need and what staff can offer create conditions that contribute to staff-patient conflict and potential violence. These disconnections are situated within operational constraints of the care system. Other influential factors included staff fear and hypervigilance, ex…
aggregated CHO: https://circle.library.ubc.ca/rest/handle/2429/89123
note: A CASE STUDY EXPLORATION OF HARM REDUCTION IMPLEMENTATION AND RELATED BARRIERS AND FACILITATORS IN AN EMERGENCY DEPARTMENT IN BRITISH COLUMBIA, CANADA by Ziqian (Sunny) Jiao B.Sc.N., The University of Northern British Columbia, 2012 M.H.A., The University of British Columbia, 2016 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Nursing) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) August 2024 © Ziqian (Sunny) Jiao, 2024 ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, the dissertation entitled: A case study exploration of harm reduction implementation and related barriers and facilitators in an emergency department in British Columbia, Canada submitted by Ziqian (Sunny) Jiao in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing Examining Committee: Dr. Vicky Bungay, Professor, Nursing, University of British Columbia Supervisor Dr. Emily Jenkins, Associate Professor, Nursing, University of British Columbia ______ Supervisory Committee Member Dr. Marilou Gagnon, Professor, Nursing, University of Victoria ______ Supervisory Committee Member Dr. Sandra Lauck, Associate Professor, Nursing, University British Columbia University Examiner Dr. Craig Mitton, Professor, School of Population and Public Health, University of British Columbia University Examiner Dr. Amanda Vandyk, Associate Professor, School of Nursing, University of Ottawa External Examiner iii Abstract Background: Harm reduction in health care settings has demonstrated tremendous benefit for people who use unregulated substances. Currently, what is known prioritizes community settings. As acute care settings, particularly emergency departments, grapple with implementing harm reduction, research is urgently needed to examine harm reduction inclusive of barriers and facilitators…
has type: Thesis/Dissertation
date issued: 2024-11
is shown at: 10.14288/1.0445265
language: eng
degree discipline: Nursing
provider: Vancouver : University of British Columbia Library
publisher: University of British Columbia
rights: Attribution-NonCommercial-NoDerivatives 4.0 International
rights URI: http://creativecommons.org/licenses/by-nc-nd/4.0/
scholar level: Graduate
contributor: Bungay, Vicky
type: Text
identifier URI: http://hdl.handle.net/2429/89123