B/C of the settings nurses work in. They are in a unique pos’n to prevent many of the harms associated with drug use. Using HR strategies in nursing practice creates future opportunities to promote the health and well being of those experiencing substance use. Underlying principles of HR reflect the CNA’s code of ethics (2002)
Working with FNIH Health Canada allowed me to explore other ways of looking at what Harm Reduction is and how the work could continue http://www.righttoplay.com/International/Pages/Home.aspx Right to Play for me would help kids get involved in sports, thus increasing self esteem, etc, and generally keeping them busy with healthy choices decreasing the opportunities for risky behaviors.
In April or 2008 I started to speak in public about Harm Reduction, good for the overall cause, not the greatest career move, I started to get letters from the Minister of Health’s office to stop speaking against the governments position on HR.
Share knowledge - Be a mentor - Support learning Seemed like a good idea to have a nursing student develop a presentation on Harm Reduction, good to support learning, but the presentation never got past the cubicle, let alone the front door.
I spoke at the International AIDS Conference, specifically the International Nurses’ Forum, which was a great opportunity, if you want my speech email me. email@example.com
I started to change my language around Harm Reduction, but was conflicted for sure.
MLK Martin Luther King I think this is a very important quote. Once Harm Reduction has been eliminated from our language, what will be next. HIV? I saw the elimination of HR as a slippery slope, and wanted to take a stand.
I got feedback, and if I kept up what I thought was the good fight, well, then what? What if Health Canada comes out with an official policy against anything related to Harm Reduction? Well, I would have pushed to much. Better, I thought, to plan an exit strategy and start to push from the outside.
http://www.joyofconflict.com/editor_articles/ConflictDrama-VictimVillainHero.htm Often we can be seen as different people within the triangle. And our peers, colleagues, bosses, and clients can see us as different player in this situation.
I thought that my clients were the public, I was a public servant afterall. Better to be a service to the public, than a servant of my bosses.
http://www.slapupsidethehead.com/tag/tony-clement/ It is easy to blame the person, but as with any philosophy that will not help in the long run, and the effort is momentous.
October 3rd, 2007 CANAC Response to Announcement by Minister Clement, Oct. 2nd, 2007 As you are no doubt aware Minister Clement announced, October 2nd, a 6 month extension for North America's only supervised injection site – Insite, located in the Downtown East side of Vancouver. Health Minister Tony Clement has advised the Vancouver Coastal Health Authority which operates Insite, a supervised injection site that their exemption under Section 56 of the Controlled Drugs and Substances Act has been extended until June 30, 2008. This extension will allow research on how supervised injection sites affect prevention, treatment and crime to be continued for another six months. (http://hc-sc.gc.ca/ahc-asc/media/nr-cp/2007/2007_137_e.html) It appears that health and human rights have become political issues and are especially hot topics with an election looming in the near future. The Canadian Association of Nurses in AIDS Care (CANAC) believes that this exemption is only a short reprieve and that a long-term decision is required to support the work that is currently occurring at Insite. In addition, later this week Minister Clement will announce Canada's new Anti-drug Strategy built on 3 pillars: prevention, treatment and enforcement. Harm reduction has been dropped and strategies to address HIV/AIDS are becoming more and more difficult to locate on Health Canada’s web sites. Harm reduction has been an official policy of Health Canada's since 1996 and was a major focus in the document Leading Together: Canada Takes Action on HIV/AIDS (2005 - 2010) blueprint for Canada-wide action on HIV/AIDS until 2010. CANAC supports a four-pillar approach, which includes harm reduction as a policy, strategy, and approach; we see this reactionary decision to drop harm reduction as immensely shortsighted. CANAC has known, or heard rumours, of this impending anti-initiative for some time. The roll out of the government’s three-pillar approach is a wobbly stool at best and is being met with disappointment. The successes of those working to implement harm reduction practices in the areas of substance use have lead the way for others to use similar approaches to reduce harm associated with other behaviours and circumstances. A four pillar approach, that includes Harm Reduction, has improved care for patients everywhere. It has taught us to measure success in small steps, to not be disappointed with relapse, to see the value in trying, and recognize that the sense of self worth that is so compromised in the most vulnerable of our patients and clients can be re-built with every moment that they experience understanding and acceptance. CANAC is in support of focusing on the need to maintain services (indeed expand services) to our most marginalized citizens. CANAC supports programs of harm reduction as an integral component of supervised consumption sites and these positive human rights initiatives need to be standard health care services for homeless drug using people. “ Understanding harm reduction has made me a better nurse and I use these practices in all areas of my work. We need to protect this.” (DRW RN from Toronto) Greg Riehl President Canadian Association of Nurses in AIDS Care The Federal Initiative ( http://www.phac-aspc.gc.ca/aids-sida/fi-if/fa-if/pdf/fed_init_e.pdf0 ) Leading Together ( http://www.leadingtogether.ca/ )
To be credible you have to know what you are talking about and you have to be able to get feedback and actively seek out feedback.
Buchanan, B., Shaw, S. Ford, A. and Singer, M. (2003). Empirical science meets moral panic: an analysis of the politics of needle exchange. Journal of Public Health Policy 24(3–4):427–444. One of the best articles I have read in a long time.
As a Registered Nurse I am supported in my professional activities.
I worked with the Ministy of Health in Saskatchewan on the Provincial HIV Strategy which was a good opportunity to work with a good team of committed individuals.
If and when I have some spare time I think it is important to share information, I like to send people links and articles whenever I find something interesting.
Working with the Saskatchewan Public Health Association allows me to have another hat and a different voice. It is important to stay current and stay involved. http://www.thestarphoenix.com/health/Needle+exchange+good+health+policy/4653521/story.html
I am still involved and am still passionate about advocacy and harm reduction.
This presentation was for the Alberta Harm Reduction Conference, and U2 was in the city, it was a great conference.
Transcript of "Harm Reduction Keep Doing the Work"
Alberta Harm Reduction Conference Keep Doing the Work: Just don’t call it Harm Reduction Greg Riehl RN June 1 st , 2011
Key Messages Hopefully my journey and story will give you an idea or two on how to work with organizations who do not support Harm Reduction
Know what not to do <ul><li>Conflict of Interest </li></ul><ul><li>Gregory Andrew? </li></ul><ul><li>Policy what policy? </li></ul><ul><li>Exit Interviews – don’t go to high!!! </li></ul><ul><li>Those who oppose harm reduction are unlikely to change their views until they feel their fears have been taken seriously </li></ul><ul><li>False Evidence Appearing Real = FEAR </li></ul><ul><li>Know which audience you are talking to </li></ul>
Nursing Career - <ul><li>1991 – Student Nurse Infectious Diseases </li></ul><ul><li>1994-2000 – First Nations on-reserve </li></ul><ul><li>2004 Public Health Sexual Health Street Health </li></ul><ul><li>ID Clinic </li></ul><ul><ul><li>THE RELATIONSHIP BETWEEN HEPATITIS C VIRUS AND INJECTION DRUG USE IN SASKATOON STREET YOUTH </li></ul></ul><ul><ul><li>Egadz youth Centre </li></ul></ul><ul><ul><li>The van </li></ul></ul><ul><li>HIV Nurse </li></ul><ul><li>HIV BBP STI TB Coordinator </li></ul>
Working for the Federal Government Public Health Agency of Canada www.publichealth.gc.ca Summary of NACHA meeting October 2 and 3, 2005 Regina, Saskatchewan “ Tanya reported that the Populations Section of the HIV/AIDS Division was looking for members of NACHA to provide comments on their draft Policy Framework on Harm Reduction and Drug Use. NACHA identified members to participate in the process.”
Nurses at the Forefront of HIV/AIDS: Prevention, Care and Treatment <ul><li>2006 International AIDS Conference </li></ul><ul><li>Share your vision </li></ul><ul><li>Work with people with similar philosophies </li></ul><ul><li>Don’t assume people have the same values. </li></ul>
Community Health Nursing <ul><li>Nurses are often the first point of contact in caring for those who use illicit drugs and are at risk for contracting HIV/AIDS </li></ul><ul><li>Nurses have a duty to provide safe, competent, ethical care </li></ul><ul><li>Protect dignity and choice </li></ul><ul><li>Enact social justice </li></ul>CNA, 2007
SRNA Position Statement <ul><li>Promoting Equity through Harm Reduction In Nursing Practice </li></ul><ul><li>February 2008 </li></ul><ul><li>Keep doing the work </li></ul>
Right to Play <ul><li>Need to be innovative </li></ul><ul><li>Meet the needs of the population that you work with </li></ul><ul><li>Give and take </li></ul><ul><li>Find solutions </li></ul><ul><li>Need to find projects and action to keep moving forward </li></ul>
CANAC <ul><li>16th Annual CANAC Conference </li></ul><ul><li>The Power if HIV Nursing: Context and Connections </li></ul><ul><li>April 19 – 22, 2008, Ottawa, ON at the Lord Elgin Hotel </li></ul>April 22, 2008 10:30 ET Canadian AIDS Care Nurses Voice Support for Harm Reduction
Harm reduction is part of professional and ethical nursing standards <ul><li>OTTAWA, ONTARIO--(Marketwire - April 22, 2008) - Nurses caring for people with HIV/AIDS have a professional obligation to promote the health and well-being of their patients, which includes supporting strategies that reduce harm to patients dealing with addictions, says the Canadian Association for Nurses in AIDS Care (CANAC). At the close of CANAC's eighth annual conference, held April 21 - 22 in Ottawa, the association is calling on municipal, provincial and federal governments to immediately implement evidence-based harm reduction programs throughout the country and to continue supporting those already operating. "Nurses are concerned about the lack of support for essential harm reduction programs in Canada," says CANAC President Greg Riehl. "Harm reduction has been dropped from the current government's new 'Anti-drug Strategy', and many vital programs are being threatened, including needle exchanges, the safer crack kit program in Ottawa, and the supervised injection site (Insite) in Vancouver, despite research showing that these programs work." The City of Ottawa recently withdrew support for the city's safer crack kit program and is now considering imposing a restrictive one-for-one needle exchange policy. "These actions represent a major step backwards," Riehl continues. "We need maximum - not restricted - access to programs that prevent disease and suffering." </li></ul>
Put focus on addicts: Nurses <ul><li>“ (Critics) should be taking two steps back and focusing on the homeless people trying to deal with their pain so they’re using injection drugs,” said Greg Riehl, president of the Canadian Association for Nurses in AIDS Care (CANAC) </li></ul><ul><li>“ The needles are a symptom of what’s happening in society.” </li></ul><ul><li>The association, closing its annual conference here, held a press conference yesterday in which it called on all levels of government — and for every day Canadians — to support “harm reduction programs” that have come under fire recently for dispensing free drug paraphernalia to addicts. </li></ul>
Harper urged to extend drug injection site agreement <ul><li>“ People who use drugs need to be given options and those options include harm reduction, and they also include treatment,” said Greg Riehl, CANAC president. </li></ul><ul><li>“ If we don’t have harm reduction, if we don’t have Insite, those people will be dead. Dead people cannot enter into treatment.” </li></ul>
HARM REDUCTION: A FIRST NATIONS APPROACH Désirée 4 th year NEPS Student First Nations and Inuit Health Health Canada – July 2008 Share knowledge, be a mentor, support learning
2008 International AIDS Conference Represent whenever and wherever you can
International Nurses' Forum <ul><li>Dedication and Action at the Forefront of HIV/AIDS; </li></ul><ul><li>Advances and Improved Practices in HIV/AIDS Care: CANAC‘s experience. </li></ul><ul><li>August 2 nd , 2008 </li></ul>Mentoring, partnership and Collaboration: Respect for Human Rights: Diversity: Participation and Empowerment: Integration: Accountability: Advocacy and leadership: “ There is nothing either good or bad but thinking makes it so”. (William Shakespeare)
SRNA - The SRNA Podcast Feed OOPS!!!!! <ul><li>The Saskatchewan Registered Nurses' Association delivers timely information about the nursing industry through regular video podcasts. </li></ul><ul><li>Harm Reduction Greg Riehl is the President Canadian Association of Nurses involved in AIDS Care. </li></ul><ul><li>He is currently working with Health Canada as the HIV/AIDS/Bloodborne Pathogens/Sexually Transmitted Infections Regional Coordinator for Health Canada First Nations and Inuit Health Programs Saskatchewan. Media files 2008_mar_19.mp4 (Movie Clip) </li></ul>
Back to Nursing for support <ul><li>Harm Reduction asks us to look at ourselves and how we offer services. As nurses, are we really open and accessible to those we want to reach? The intention of Harm Reduction is to help people make informed decisions and empower our clients to reduce the risk of HIV infection. </li></ul><ul><li>The Code supports visionary nurses and the art of nursing is enhanced through ethical practice. We need to focus on advocacy for our clients and staff and be able to use Harm Reduction models to guide our nursing practice. Holistic approaches are required to address issues and factors that affect HIV/AIDS programming, targeting not just the disease, but also the social determinants of health and economic circumstances. Good Harm Reduction programs strongly support the participation of those living with HIV/AIDS in the process. </li></ul><ul><li>The Canadian Nurses Association’s Code of Ethics for Registered Nurses is a statement of the ethical values of nurses and of nurses’ commitments to persons with health-care needs and persons receiving care. It is intended for nurses in all contexts and domains of nursing practice and at all levels of decision-making. It is for nurses by nurses. The Code assists nurses in practicing ethically and working through ethical challenges that arise in their practice with individuals, families, communities and public health systems. Harm Reduction and the Code meet people where they are at, improving the quality of people’s lives, especially the disadvantaged or vulnerable. </li></ul><ul><li>Advocating for our clients is ethical nursing. </li></ul><ul><li>http://www.cna-aiic.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf </li></ul>
Restoring Balance through Harm Reduction Sex, Health, Wellness and HIV Monday November 24 th , 2008 The Norwood Hotel Greg Riehl Canadian Association of Nurses in AIDS Care
<ul><li>“ Our lives begin to end </li></ul><ul><li>the day we become silent about the things </li></ul><ul><li>that matter” </li></ul><ul><li>MLK </li></ul>
Get feedback from those in you Inner Circle <ul><li>Conflict of Interest - it does not help to speak publicly against your employer </li></ul><ul><li>Policy? What Policy? </li></ul>
Who are you accountable to? <ul><li>And who do you work for? </li></ul>
It isn’t about the person.. . . “ Harm Addition”
Working from the inside <ul><li>Sometimes you are more effective working on the outside </li></ul><ul><li>And by working on the outside keep your connections on the inside </li></ul><ul><li>Keep current </li></ul><ul><li>Be an expert (or at least play an expert on…) </li></ul><ul><li>Use the media </li></ul>
Educate yourself <ul><li>Harm Reduction can take many faces </li></ul><ul><li>I researched a lot </li></ul><ul><li>From HR philosophy, to religion, to policy, to science </li></ul><ul><li>Get feedback from your people - Do you really want an ‘official policy’? Maybe not . . . </li></ul>
Morals can help Morale? <ul><li>Empirical Science Meets Moral Panic: </li></ul><ul><ul><li>An Analysis of the Politics of Needle Exchange </li></ul></ul><ul><li>DAVID BUCHANAN, SUSAN SHAW, AMY FORD, and MERRILL SINGER </li></ul><ul><li>We need to speak with one voice, but this is difficult because we don’t speak with one voice </li></ul>
You need to be heard, or at least listened to. <ul><li>We need to speak with one voice, but this is difficult because we don’t speak with one voice </li></ul><ul><li>Social media can be your friend, and it can be the friend of people opposed to Harm Reduction </li></ul><ul><ul><li>Don’t stop </li></ul></ul><ul><li>Focusing strictly on empirical evidence has not worked so far. </li></ul><ul><li>Don’t get caught in the trap of trying to prove your point (over, & over & over, & over & over…) </li></ul>
The Duty to Provide Care <ul><li>Perspectives of: </li></ul><ul><ul><li>The individual nurse </li></ul></ul><ul><ul><li>The employer </li></ul></ul><ul><ul><li>The nursing regulatory body </li></ul></ul><ul><ul><li>And the state </li></ul></ul>
I you can’t beat them – join them? <ul><li>Saskatchewan Ministry of Health 2009 </li></ul><ul><ul><li>One more lesson to learn . . . </li></ul></ul><ul><li>Harm Reduction Working Group – Building Capacity, Enhancing Capability, Engaging Community </li></ul><ul><li>HIV work strengthens health systems </li></ul><ul><li>A 6 month term </li></ul>
Every 48 Hours: Addressing Prairie Syndemics <ul><li>Why is everyone talking about Saskatchewan and what is so unique about the epidemiology of this province? </li></ul><ul><li>Hear from an RN in Saskatchewan how these numbers can help or hinder communities, agencies and, most importantly, people in the Prairies living with HIV. </li></ul>
Keep your friends informed <ul><li>http://news.nationalpost.com/2011/05/14/the-expert-patient-who-knows-best-the-doctor-or-the-patient/ </li></ul><ul><li>http://www.xtra.ca/public/Vancouver/Activists_aim_to_rekindle_vigil_in_2012-10144.aspx </li></ul>
Keep doing the work <ul><li>PHAC National Advisory Committee </li></ul><ul><li>U of T Male Call Canada </li></ul><ul><li>CPHA NPT Balkans </li></ul><ul><li>SPHA </li></ul><ul><li>AB HR Conference </li></ul><ul><li>Find your passion </li></ul>
Summary <ul><li>As a Registered Nurse, I care about my profession </li></ul><ul><li>As a citizen I care about people </li></ul><ul><li>We must support culturally competent care to all people. </li></ul><ul><li>Western culture tends to blame the victim. </li></ul><ul><li>Harm reduction can improve the quality of people’s lives. </li></ul><ul><li>We are all faced with several risk factors, at one time or another, that puts us at risk for ... </li></ul>