Exploring the process of care for people who inject drugs in hospital settings

Abstract In recent years, hospitals have experienced alarming increases in admissions of people who inject drugs (PWID), which present unique challenges to the care process. Untangling the complexity of care can be difficult due to interactions that occur between human and non-human elements including hospital systems, policy, technology, time, and space. The purpose of this study was to explore relations between social and material elements within the acute care environment, to better understand how care is enacted and to identify novel approaches for improvement. Data collection and analysis utilized a practice-based approach informed by constructivist grounded theory and sociomaterial perspectives, which emphasized relationships between human and non-human elements. Data included observational field notes, interviews, and artifacts from 154 hours spent on acute medicine units of two hospitals in an urban setting in Ontario, Canada. Findings revealed that differing expectations, strained conversations, and various policies assembled to produce misalignments in care. Such misalignments included mistrust, suboptimal pain and withdrawal management, and frequent patient absences and/or discharge against medical advice. Care misaligned in ways that reflected both social and material elements, demonstrating a need for hospital staff and systems to challenge existing care models built around individual control and abstinence-informed practices.