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Toward Cultural Safety: Nurse and Patient Perceptions of Illicit Substance Use in a Hospitalized Setting

Pauly, Bernadette (Bernie) PhD, RN; McCall, Jane MSN, RN; Browne, Annette J. PhD, RN; Parker, J. MA; Mollison, Ashley MA

doi: 10.1097/ANS.0000000000000070
Original Articles

As a group, people who use illicit drugs and are affected by social disadvantages often experience health inequities and encounter barriers such as stigma and discrimination when accessing health care services. Cultural safety has been proposed as one approach to address health inequities and mitigate stigma in health care. Drawing on a qualitative ethnographic approach within an overarching collaborative framework, we sought to gain an understanding of what constitutes culturally safe care for people who use(d) illicit drugs. The findings illustrate that illicit substance use in hospitals is often negatively constructed as (1) an individual failing, (2) a criminal activity, and (3) a disease of “addiction” with negative impacts on access to care, management of pain, and provision of harm-reduction supplies and services. These constructions of illicit substance use impact patients' feelings of safety in hospital and nurses' capacity to provide culturally safe care. On the basis of these findings, we provide recommendations and guidance for the development of culturally safe nursing practice.

School of Nursing and Centre for Addictions Research of BC (Dr Pauly) and Society of Living Illicit Drug Users (Ms Mollison), Victoria, British Columbia, Canada; and HIV Program, St. Paul's Hospital, Providence Health Care (Ms McCall), School of Nursing, University of British Columbia (Dr Browne), and Critical Research in Health and Healthcare Inequities, University of British Columbia School of Nursing (Ms Parker), Vancouver, British Columbia V8W 2Y2, Canada.

Correspondence: Bernadette (Bernie) Pauly, PhD, RN, School of Nursing, Centre for Addictions Research of BC, Box 1700 STN CSC, University of Victoria, Victoria, British Columbia V8W 2Y2, Canada (

We thank Michael Smith Foundation for Health Research For Funding to support the conduct of this research. We also gratefully acknowledge our appreciation for the patients, nurses and members of SOLID (Society of Living Intravenous Drug Users) who contributed to this work.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.