Interpersonal Challenges as a Constraint on Care: The Experience of Nurses' Care of Patients Who Use Illicit Drugs

Article excerpt

ABSTRACT

Men and women who use illicit drugs have a heavy reliance on health care in emergency departments and acute care wards. Nurses' care however, is known to be constrained by inadequate drug education and policy and practice standards. This paper describes an additional constraint on care, namely, patients' behaviour. The findings are part of a broader mixed-methods study of nurses' therapeutic attitude to this patient group. The themes of violence, manipulation and irresponsibility emerged from the data analysis of written reports provided by a sub-sample (N = 311) of the main study sample. Recommendations are made for assisting nurses to reconceptualise their role with this patient group, and importantly, for an increase in violence management education and organisational role support, safety and security measures. Finally, further research in the field is recommended so that a comprehensive analysis of the difficulties faced by nurses and patients can be made.

KEYWORDS: nursing; violence; illicit drugs; therapeutic attitude

INTRODUCTION

Despite their high visibility in general hospital wards and emergency departments, patients who use illicit drugs face well-recognised barriers to health care. Nurses' drug and alcohol education is known to be inadequate (Happell & Taylor, 1999; King, 2004; Peterson, 2002; Rassool, 2000) and they have limited support for their role in terms of policy and practice standards (Allsop et al., 1998; deCrespigny, 2002; Marcellus, 2002; Rassool, 2000). Additional to poor preparation and resourcing are interpersonal tensions inherent in the nursing role - the clinical interface with the patient is known to present a range of clinical challenges and personal risks (Allman et al., 2006; Peckover & Chidlaw, 2007). It is a nursing role that is considered crucial in facilitating better health outcomes for these patients (Nkowane & Saxena, 2004). An important step towards improving the circumstances of nurses and their patients is to establish pragmatic knowledge about the interpersonal challenges that arise at the clinical interface.

BACKGROUND

While the provision of nursing care to patients who use illicit drugs is known to be complex and demanding, it is also known to be an important link to better health outcomes. A body of nursing literature attests to the value of nurses' work with various patient groups, for example, peri-natal women and babies (Baldwin, Rawlings, Marshall, Conger, & Abbott, 1999; French, Pituch, Brandt, & Pohorecki, 1998; Marcellus, 2002; Selleck & Redding, 1998), and men and women in forensic settings (Carroll, 1995; Eliason & Arndt, 2004; McKeown & Liebling, 1995), mental health settings (Kendall, 2004; Phillips, 2000; Rassool, 2002) and community and outreach settings (Hilton, Thompson, & Moore-Dempsey, 2000; Mistral & Hollingworth, 2001).

Almost 20 years ago, Satterthwaite (1990) acknowledged the important role of nurses in general medical and surgical practice areas, more recently other authors have highlighted general nurses' need for improved knowledge of illicit drugs (Culver & Walker, 1999; Jones & Owens, 1996; McLaughlin, McKenna, & Leslie, 2000), including harm-reduction strategies (Hilton et al., 2001) and pain assessment and management (Cook, Sefcik, & Stetina, 2004). Increasingly evident in emergency departments and acute care wards (Dent, Phillips, Chenhall, & McGregor, 2003; Krenske, Mazerolle, Fowler, Fanning, & Najman, 2004; Patterson, Holman, English, Hulse, & Unwin, 1999; Tait, Hulse, Robertson, & Sprivulis, 2002), this patient group requires nursing care for a diverse range of conditions, for example, the infectious complications of drug use (Grau, Arevalo, Catchpool, & Heimer, 2002; Pieper & Hooper, 2005; Stein & Anderson, 2003), injury and trauma (Blondell et al., 2005; Zavala & Frency, 2003) psychopathologies (Henquet et al. …