Interpersonal Challenges as a Constraint on Care: The Experience of Nurses' Care of Patients Who Use Illicit Drugs
Ford, Rosemary, Contemporary Nurse : a Journal for the Australian Nursing Profession
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.
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., 2005; Kaye & Darke, 2004) and peri-natal care and obstetric care for women (Andrulis & Hopkins, 2001; Ludlow, Evans, & Hulse, 2004).
Recently, Allman et al. (2006) described the caring role of specialist drug and alcohol workers as complex and exhausting, while Peckover and Chidlaw (2007) described community nurses as at risk and vulnerable in their role. Little is known, especially in Australia, about the issues that generalist nurses face in their work with this patient group, and without this knowledge it is difficult to know how to support them in their role.
The findings reported here are the second part of a broader mixed-methods study of nurses' therapeutic attitude to patients who use illicit drugs, undertaken in the Australian Capital Territory (see Ford, Bammer, & Becker, 2008, 2009). The aim of the second part of the study was to explore impediments to the nursing role as reported by study participants. A key theme to emerge from the qualitative data was 'interpersonal challenges' as an impediment to the nursing role. …