Reframing Harm Reduction in Clinical Practice: The Relational Harm Reduction Framework

To advance the Relational Harm Reduction Framework as a conceptual model clarifying how harm reduction is operationalized within everyday clinical practice.

Perspectives paper.

The framework was developed through iterative synthesis across an integrated program of scholarship, including evidence review, community-engaged qualitative inquiry, and interprofessional educational innovation. Recurring themes related to trust, stigma, and ethical tension under institutional and structural constraints were conceptually integrated to articulate core relational mechanisms necessary for harm reduction in routine care.

The Relational Harm Reduction Framework identifies three interdependent domains: presence, language, and ethical clinical decision-making. Presence establishes psychological safety. Language protects dignity, interrupts stigma, and shapes clinical behavior. Ethical clinical decision-making translates relational trust into action while respecting autonomy and navigating institutional constraints. Together, these domains operationalize harm reduction beyond technical intervention and embed it within relational and professional practice.

The Relational Harm Reduction Framework offers a structured, relational guide for integrating harm reduction consistently and ethically within healthcare settings. Grounded in addiction nursing scholarship with applicability across health professions, the framework supports professional identity formation and clinical engagement when substance use persists.