Hep C - 2002.qxd - Canadian Public Health Association

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Special considerationsSubstance UseSharing of substance use equipment or injection drug use is currently the main modeof transmission of hepatitis C virus in Canada. After five years of injecting drugs, asmany as 90 per cent of users are infected with the hepatitis C virus (CLF NationalHepatitis C Education Program, 2000). Injection drug users living with hepatitis C,like those living with HIV/AIDS, often have had a poor relationship with health careproviders as a result of• their unique life circumstances;• discrimination related to injection drug use and hepatitis C; and• lack of information available to caregivers about them and their lives (CPCA &BCHPCA, 1999).In the last few years, more resources have been developed to help nurses learn to workwith people who inject drugs (See Readings and Other Resources). Nurses may findthe following statements from caregivers and users helpful as a basic set of principlesto guide their practice.• The goal is improvement in the person’s health and quality of life – any improvement,no matter how small.• Relate to the person as one human standing before another human.• The person is the expert on their life. They know what they need. Listen to them.It’s not about what the caregiver needs.• Be flexible and creative. A solution is there if you can be open to it. Let the personguide and teach you.• Appropriate, respectful care must never be denied just because a person uses drugs.• Communicate, communicate, communicate – with the client and among caregivers.(Source: McAmmond, 1998)Two specific guides for nurses are included as appendices. The first suggests strategies toguide the nurse in establishing a relationship of trust with the user and in fostering his orher autonomy (Appendix 2). The second tool is a guide for assessing substance use(Appendix 3). Many nurses are not comfortable discussing substance use with theirclients. This assessment provides examples of questions that can be used as a basis for discussion.How the questions are used will vary with the person and his or her situation.Prevention strategiesNurses should provide injection drug users with information on how to reduce theirrisk of acquiring hepatitis C and transmitting the infection to others (see Informationon Hepatitis C). The primary risk comes from injection with previously used needles28 HEPATITIS C A Nursing Guide
and syringes contaminated with the blood of another user. People who inject drugs areat an increased risk when they share other contaminated injecting equipment, such asspoons, or other drug paraphernalia, such as straws for snorting drugs.HCV infection is acquired very rapidly after initiation into injection drug use. Nursesshould include new injection drug users and those who are thinking about injecting intheir prevention strategies (Health Canada, 1999).Harm reductionSome drug users decide to abstain from drugs, and nurses must support their self-careefforts. However, for others, total abstinence is not a realistic goal. Nursing interventionsshould then focus on encouraging behaviours and substance use practices thatreduce the risk of hepatitis C and other infections such as HIV and hepatitis B. Forexample, the drug user could stop sharing equipment or change from injecting drugsto smoking, snorting or swallowing drugs. Most strategies to limit transmission ofthese viruses are based on a harm reduction model.Harm reduction is a philosophy and an approach to care that minimizes harm fromsubstance use and increases the health and quality of life of the person (McAmmond,1998). A consistent caring relationship between the person who uses drugs and thenurse is needed to facilitate harm reduction. The following principles underlie the successfulimplementation of a harm reduction approach.Harm reduction:• recognizes the intrinsic value and dignity of all human beings;• seeks to maximize social and health assistance, disease prevention and educationwhile minimizing repressive and punitive measures;• recognizes the right for comprehensive, non-judgmental medical and social servicesfor the fulfillment of basic needs of all individuals and communities, includingusers, their loved ones and the communities affected by drug use;• emphasizes the necessity for a comprehensive approach to drug use that addressesthe isolation, survival needs and drug use of the user;• does not judge licit and illicit drug use as good or bad, rather it looks at people’srelationship to drugs and emphasizes the reduction of drug-related harm whileencouraging safer drug use;• recognizes the competency of users to make choices and changes in their lives;• provides options in a non-judgmental, non-coercive way;• demands that the individuals and communities affected by drug use be involved inthe creation and implementation of harm reduction interventions;• recognizes the diversity of users and drug use and the necessity for outreach andservices reflecting every user’s needs;The Nurse and Hepatitis C 29
Page 1: Hepatitis CA NURSING GUIDE
Page 4 and 5: All rights reserved. No part of thi
Page 6 and 7: Debi RipleyConsumer representativeM
Page 9 and 10: TABLE OF CONTENTSI. Introduction .
Page 11: IINTRODUCTIONThe Canadian Nurses As
Page 15 and 16: III INFORMATION ON HEPATITIS CEpide
Page 17 and 18: Mother-to-child: The risk of vertic
Page 19 and 20: Essentially, there are two types of
Page 21 and 22: The definition of successful treatm
Page 23: Screening for HCVAnyone who is conc
Page 26 and 27: A friend of mine knew of a place I
Page 28 and 29: Through the years my illness remain
Page 31 and 32: VTHE NURSE AND HEPATITIS CNursing c
Page 33 and 34: with hepatitis C are aware of and u
Page 35 and 36: Chronic hepatitis CBy definition, h
Page 37 and 38: Symptom Characteristics ManagementP
Page 39: Symptom Characteristics ManagementH
Page 43 and 44: Many injection drug users with hepa
Page 45 and 46: Heath care workersNurses and other
Page 47 and 48: the person’s life. Monotherapy wi
Page 49 and 50: for treatment at a later time. Trea
Page 51 and 52: VIGLOSSARY OF TERMSAcute hepatitisA
Page 53 and 54: VIIREADINGS AND OTHER RESOURCESHepa
Page 55 and 56: Management of Symptoms of Hepatitis
Page 57 and 58: PerinatalBoucher, M. & Gruslin, A.
Page 59 and 60: VIIIREFERENCESAboriginal Nurses Ass
Page 61 and 62: Health Canada. (1999a). Hepatitis C
Page 63 and 64: IXAPPENDICESAppendix 1: Antiviral T
Page 65 and 66: • Be sensitive to cultural differ
Page 67 and 68: Appendix 4: Hemophilia and Hepatiti
Page 69 and 70: The following information on safety
Page 71 and 72: • Have the medical declaration se
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