A nurse is a nurse is a ?

A showcase of nursing skill and accomplishment
by Hema Zbogar

Susan Giles and Evanna Brennan are community health nurses who have met the challenge of an increasingly aggressive urban drug scene by developing an innovative intervention and service delivery process to support HIV-positive clients with substance use problems or mental illness. They work in Vancouver's Downtown East Side, Canada's poorest neighbourhood, where an estimated 25 per cent of the population is HIV positive.

Medication regimens for HIV are difficult for anyone to follow. But such regimens are particularly challenging for clients with an addiction who spend most of the day hustling for money to buy drugs, and may not trust health care workers and others in authority. "We found our agency's protocols did not address the needs of these people," says Giles. But while many people think that HIV therapy is out of the question for this population, Giles and Brennan have found some success with a supportive, client-directed approach.

This has meant adapting the nurse role to the local culture, in this case, a heavy street drug culture. "The practical realities of the situation have changed our practice," says Giles. "We have had to learn to relinquish the control that nurses may have in a hospital setting and allow clients to have that power. This is a difficult lesson for health professionals. And we never imagined what changes we would have to make to our mindset about drug use, mental illness and HIV."

(Reprinted from Crosscurrents : The Journal of Addiction and Mental Health, Winter 2002, Vol. 6 no.2, p.15)

Published by the Centre for Addiction and Mental Health, Toronto