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Teacher's Guide TEACHER’S GUIDE FOR AN INTERACTIVE TEACHING DVD COPYRIGHT Dedicated to the nurses of the future Production Manager, Post Supervisor: Betsy Carson BEVEL UP: Drugs, Users & Bevel Up: Drugs, Users & Outreach Nursing is Outreach Nursing is available under Design, Animation, DVD Mastering: designed as an educational interactive DVD and limited copyright protection. You Ian Kirby, Caleb Bouchard may download, distribute, photo- teaching guide for student nurses and practicing Location Sound: Jeff Henschel, Jon Ritchie, copy, cite or excerpt this document, nurses wishing to learn more about providing Kirk Tougas provided it is properly and fully health care to people who use drugs. BEVEL UP credited and not used for commer- was produced by the British Columbia Centre for French Subtitles: Sette Inc., Laval Dumont cial purposes. The permission of the Disease Control, Street Nurse Program and the BC Centre for Disease Control TEACHING GUIDE (BCCDC) Street Nurse Program is National Film Board of Canada in collaboration required for all other uses. For more with Canada Wild Productions, in Vancouver, Writers: Neil Andersen, Alicia Priest, Laurie information, please contact the British Columbia. Seymour and Street Nurse Program Project Team BCCDC Street Nurse Program as Editor: Philip Moscovitch listed below. This project has been financially supported by Graphic Design/Layout: Fiona Gamiet Health Canada, the National Film Board of Street Nurse Program French Translation: Maryvon Delanoë British Columbia Centre for Canada and the British Columbia Nurses Union. Disease Control Printing: Hemlock Printers BEVEL UP was made possible through the gener- Telephone: 604 660 9695 Photo Credits: Fax: 604 660 1818 ous sharing and support of many community Front and Back Cover: Nettie Wild Email: [email protected] members and individuals working in the fields of Selected Images from BEVEL UP: Nettie Wild Website: www.nfb.ca/bevelup addiction, drug policy and nursing. For a full list National Library of Canada – of contributors please see page 100 for acknowl- TO ORDER ISBN 978-0-9782660-0-4 edgements and page 91 for biographies. BEVEL UP: Drugs Users & Outreach Nursing BEVEL UP: DRUGS, USERS & Title Code: 153C9907229 OUTREACH NURSING National Film Board of Canada Project Coordinator: Fiona Gold In Canada, call toll-free: 1 800 267 7710 Street Nurse Program Project Team: Caroline In USA, call toll-free: 1 800 542 2164 Brunt, Liz James, Elaine Jones, Janine Stevenson International: 514 283 2703 Original Concept: Caroline Brunt Email: [email protected] Visit www.nfb.ca DVD Website: www.nfb.ca/bevelup Director: Nettie Wild Editor: Michael Brockington Director of Photography: Kirk Tougas Producers for Street Nurse Program: Fiona Gold, Juanita Maginley Producers for Canada Wild Productions: Betsy Carson, Nettie Wild Producer for the National Film Board: Svend-Erik Eriksen Executive Producer for the National Film Board: Rina Fraticelli BEVEL UP TABLE OF CONTENTS INTRODUCTION 2 CHAPTER 3: LINDA 37 Reflections on Practice STRUCTURE OF THE DVD 4 Therapeutic Communication (1:17) 39 +Topics DVD SCREEN OUTLINE 5 Drugs & the Brain (15:51) 40 Mental Health & Drugs (7:49) 42 THE TEACHING GUIDE 6 Street Drugs 101 (34:58) 21 CHAPTER 4: BECKY & LIZ 43 CHAPTER 1: OPENING 7 Reflections on Practice Reflections on Practice Access to Health Care (3:33) 47 Insights (3:07) 11 Ethics & Practice (4:11) 49 Why Outreach? (1:45) 13 Pregnant Users (1:54) 51 CHAPTER 8: CONCLUSION 82 Dueling Agendas (2:04) 52 +Topics Reflections on Practice Beyond the City (10:21) 15 +Topics From Novice to Expert (5:16) 84 Prohibition (7:11) 17 Hospitals & Acute Care (9:25) 53 +Topics Street Drugs 101 (34:58) 21 Pregnancy & Drugs (7:21) 55 Nurses Who Use Drugs (4:10) 86 Street Drugs 101 (34:58) 21 Street Nurses For Change (6:19) 87 CHAPTER 2: WHEELS & BARRY 25 Street Drugs 101 (34:58) 21 Reflections on Practice CHAPTER 5: STREET YOUTH 57 People in Context (1:19) 28 Reflections on Practice Outreach Nursing Strategies – 29 Entrenchment (1:15) 62 ADDITIONAL +TOPICS Safety (2:12) Harm Reduction (3:14) 64 Sex, Drugs & Gender (9:46) 88 Outreach Nursing Strategies – 30 Peers & Natural Helpers (9:24) 89 +Topics Relationship Building (1:52) Street Drugs 101 (34:58) 21 Boundaries (2:19) 32 APPENDICES +Topics A. Glossary of Street Terms 90 CHAPTER 6: LEE 66 Aboriginals & Drugs (6:23) 34 B. Biographies 91 Fetal Alcohol Spectrum Disorder (7:38) 35 Reflections on Practice C. References & Resources 95 Street Drugs 101 (34:58) 21 Sex Work & Health (3:17) 69 +Topics ACKNOWLEDGEMENTS 100 Sex Work & Drugs (10:08) 71 Street Drugs 101 (34:58) 21 CHAPTER 7: LONG TRAN 75 Reflections on Practice Therapeutic Communication (1:35) 78 Access to Health Care (1:02) 78 Supervised Injection (1:58) 80 +Topics Street Drugs 101 (34:58) 21 BEVEL UP TEACHER’S GUIDE • 1 BEVEL UP INTRODUCTION HARM REDUCTION Welcome to BEVEL UP: Drugs, Users & Outreach Nursing. BEVEL UP In the early 20th Century both Britain and America were experiencing a has been created in response to the realization that a critical public wave of heroin addiction. In 1914 health need is not being met. It has been designed for nursing students America passed the Harrison Law, which forbade the dealing in, or and practicing nurses who wish to learn about working with people consuming of, opiates. (It is interest- who use drugs, or to improve their skills when nursing people who use ing to note that “addicts” were not considered “patients” in America drugs. This educational package was produced by the British Columbia and so the American enforcement of the Harrison Law forbade physicians Centre for Disease Control (BCCDC) Street Nurse Program, together to treat people who used drugs with with Canada Wild Productions and the National Film Board of Canada, opiate maintenance regimes.) In 1920 Britain followed suit and in Vancouver, British Columbia. passed a law called the Dangerous Drugs Act also designed to control the rampant use of opiates. In 1926, the British Ministry of Health For many years, nurses have provided remarkable stress on already overburdened health care servic- appointed the Rolleston Commission, health-care services across Canada, from the es. (Wood, Kerr, Spittal et al. 2003) More and chaired by Sir Humphrey Rolleston, expanses of the remote Arctic to urban hospital more health professionals are expressing concern to decide whether physicians in emergency departments. Working in a variety of that traditional models of care fail to meet the Britain should have the right to settings, nurses have always directly or indirectly needs of populations who use drugs. (Broadhead, prescribe maintenance doses of cared for people who use drugs and alcohol. heroin to people using opiates. The Heckathorn, Weakliem et al. 1998) commission sent Dr. Harry Campbell The Street Nurse Program has a provincial man- All Canadians are at risk if health-care services do to the United States to see how date to create an environment where individuals not meet the health care needs of people who use the Harrison Law was working. The British physician reported back and communities can make and sustain healthier drugs. The transmission of blood-borne pathogens that the US laws and stringent choices that reduce vulnerability to sexually trans- resulting from unsafe needle sharing and sexual prosecution of users and dealers mitted infections and HIV. The program provides practices has significant individual, community, had driven the drug deep into the STI/HIV prevention services to people who do not fiscal and public health consequences. (Kerr, black market. People using opiates, access mainstream health care. The nursing serv- O’Briain, 2002) Improved community health care having to pay exorbitant prices for heroin, were struggling with ices offered encompass clinical care, education for populations who use drugs can potentially poverty and ill health. As a result and training, project development and implemen- improve a wide range of problems: emergency the commission recommended that tation, research and advocacy. room overuse (Kerr, Wood, Grafstein et al. 2004), Britain provide maintenance doses incarceration rates (Wood, Li, Small et al 2005), People who use drugs report that they experience of heroin to chronic users. Having hospitalization rates (Palepu, Tyndall, Leon et al. seen the consequences of the severe discrimination in institutional care settings. 2001), public nuisance costs and enforcement American approach to addiction, (Wood, Kerr, Spittal et al. 2003) Consequently, costs. (Wood, Small, Li et al. 2004) Britain provided the first clear they tend to avoid institutional primary care, example of a pragmatic harm accessing emergency and acute hospital services reduction program. only when extremely ill. This, in turn, places (Riley, 1993) BEVEL UP TEACHER’S GUIDE Introduction • 2 HARM REDUCTION IN NURSING world to implement a range of harm reduction practices. (Stimson, 2007). Working on the The art of nursing involves providing opportuni- frontlines–in hospitals, clinics, prisons and street ties for clients and communities to make healthier outreach programs, nurses are the health care choices. Nurses do this by offering a continuum professionals uniquely situated to decrease the of respectful, client-centered and holistic health potentially high risks associated with drug use. care services to all clients and in all contexts. The principles of harm reduction fit naturally within Nurses are contributing significantly to an nursing practice for nurses working with clients ever-growing scientific evidence-base with respect who use drugs. to harm reduction interventions. In practicing nursing through the lens of a harm reduction As a public health approach, harm reduction philosophy, Canadian nurses are doing what accepts the reality that some people, despite the they have always done: providing opportunities risks, will use drugs. Alongside prevention, addic- for their clients, including those who use drugs, tion treatment and enforcement, harm reduction to live safer and healthier lives.
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