Bridging ethics and practice: Nurses’ attitudes, norms, and self-efficacy delivering wound care for people who use drugs

Background There is a high demand for wound care among people who use drugs. Purpose The purpose of our study was to identify difference-making factors that consistently distinguish wound care nurses who practice harm reduction from nurses who do not. Methods Data came from a national, cross-sectional survey of 173 wound care nurses conducted from September 2024 to June 2025. The Theory of Planned Behavior and coincidence analysis were applied to pinpoint difference makers for three different outcomes: 1) intention to carry out harm reduction practices; 2) interest in volunteering in-person at a harm reduction organization; and 3) interest in volunteering remotely. Discussion Factors related to attitudes or norms were each sufficient by themselves for intention to practice harm reduction. Factors related to attitudes or self-efficacy were likewise sufficient on their own for volunteering in-person. Low stigma by itself was both necessary and sufficient for volunteering remotely. Conclusions Addressing stigma, attitudes, norms, and self-efficacy can strengthen nurses' ability to deliver ethically grounded, evidence-based care to stigmatized populations.