Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Nursing

Supervisor

Abe Oudshoorn

Abstract

Harm reduction as a philosophy has been widely recognized by healthcare professionals in Canada, yet the topic remains controversial in both political and public discourses. Understanding these discourses will allow health care providers to better respond to political and public concerns, as well as ensuring that services are aligned well with public health needs. This study explored the discursive use of the term “harm reduction” in Canadian health care and nursing policy documents’ contexts by using a Foucauldian framework and Bacchi’s ‘what’s the problem represented to be?’ approach. I propose three discursive themes: self-responsible citizen, evidenced-based practice, and what nurses must do. The findings indicate possibilities for designing favorable and humanistic policies and strategies for people who use substances. This study reveals the problem of how language is an enactment of power over people who use substances and recommends more humanistic policies and empowering language.

Summary for Lay Audience

This study focuses on the language used in the healthcare system to characterize people who use substances. The presupposition is that language is not unbiased or impartial, but rather is social and cultural. As such, oral and written language conveys the marks of human interactions, influential perspectives, and conversations in specific contexts. Using language with entirely overt or covert meanings creates discourses. Discourse analysis allows researchers to find out how language produces, shapes, and reorganizes social practices. With this knowledge, healthcare providers are better able to provide care and reduce unintentional harm to those people they interact who use substances. Harm reduction as a philosophy has been widely recognized by healthcare professionals in Canada. Various harm reduction facilities are provided throughout the healthcare system, but the topic is still contentious in both political and public discourses. For example, newspaper editorials, as well as Canadian politicians, have continued to assert that harm reduction interventions are not helpful and detract from rehabilitation. Currently, the news of how the opioid crisis has been aggravated by Covid-19 now comes from every corner of Canada. As a solution, Canada needs to integrate broader harm reduction services that include legitimized and safe drug supplies within drug policies. Nurses are on the forefront of these efforts to integrate harm reduction principles because they function as a bridge between the government and the public. Understanding the discourses related to harm reduction will allow healthcare providers to better respond to political and public concerns. This study explores how the Canadian healthcare and nursing policy document’ contexts approach harm reduction and what is hidden or left unsaid. Findings from this study indicate several discourses in policies, such as people who use substances being represented as self-responsible citizens, the emphasis on evidence in practice and policy actions, and the duties of nurses. The findings indicate possibilities for designing supportive, favorable, and humanistic policies and strategies for people who use substances. The discursive practices in these policies construct ‘addicts’ or ‘drug users’ and currently contribute to the stigmatization of people who use substances. This study therefore recommends more humanistic policies and empowering language.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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