The dissonant care management of illicit drug users in medical wards, the views of nurses and patients: a grounded theory study

Abstract

Aims The aim of this study was to explore how registered nurses manage and deliver care to patients admitted to medical wards and Medical Assessment Units with complications of drug use and to elicit the experiences and views of those receiving that care. Background Illicit drug use is a major public health problem worldwide. The physical complications of problem drug use often result in admission to medical wards. Registered nurses working in these settings have been reported as possessing negative attitudes towards patients who use illicit drugs and lacking preparation to provide problem drug use–related care needs. Design Grounded theory. Methods A grounded theory approach was used to collect and analyse 41 semi‐structured interviews. Data collection and analysis were undertaken in nine medical wards in the Northwest of England in 2008. A combination of purposive and theoretical sampling was adopted to recruit registered nurses (n = 29) and medical ward patients (n = 12) admitted for physical complications of problem drug use. Data were subjected to constant comparative analysis. Findings Two sub‐categories emerged: ‘Lack of knowledge to care’ and ‘Distrust and detachment’ and these formed the core category ‘Dissonant care’. The combination of lack of educational preparation, negative attitudes and experience of conflict, aggression, and untrustworthiness appeared to affect negatively the nurse–patient relationship. Conclusions This study illuminated interplay of factors that complicated the delivery of care. The complexity of caring for patients who are pre‐judged negatively by nurses appears to engender dissonance and disparities in care delivery. Better education and training, coupled with role support about problem drug use may reduce conflict, disruption, and violence and facilitate competent care for these patients.

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“…In dealing with patients who have an addiction, there's often an underlying false assumption of con trollability. 32,34,35 According to Monks and colleagues, this personal experience may help nurses "see the person behind the patient." 32 Similarly, Kelly and Westerhoff draw parallels between per ceived controllability and blame.…”

“…A systematic review by van Boekel and colleagues found that "high perceived controllability over a disease cause[s] more intolerant judgments and attitudes towards [that] disease." 35 Working in a psychiatric setting is also associated with more positive and nuanced atti tudes toward patients with OUD. 33 Personal exposure to substance use disorders among friends or fam ily members appears in many cases to be associated with a higher regard for patients with OUD.…”

The experiences of registered nurses caring for people with substance use disorders in emergency department settings

“…While higher regard for this client groups was reported in those with more frequent contact (Chu & Galang, 2013;Kelleher & Cotter, 2008;Howard & Holmshaw, 2010;van Boekel, Brouwers, van Weeghel & Garretsen, 2014) and formal training (Adams, 2008;Ford, 2010;Happell et al, 2002;Harling & Turner, 2012;Kelleher & Cotter, 2008;Lovi & Barr, 2009;Morgan, 2006), a lack of knowledge, related to limited education and training, was still seen as a major barrier to providing adequate care to PWSUD, even for specialty providers (Adams, 2008;Ford, 2010;Ford, Bammer & Becker, 2009;Kelleher & Cotter, 2008;Happell et al, 2002;Lovi & Barr, 2009;Monks, Topping & Newell, 2012). Some have related this deficit to a lack of related content in pre-registration education curricula (Harling & Turner, 2012;Howard and Holmshaw, 2010;Lovi & Barr, 2009;Kelleher & Cotter, 2008;Monks et al, 2012).…”

“…This is important background information for the investigation of nurses' experiences caring for PWSUD for comparison with the results of my study. Five qualitative studies were captured that related to this theme: a grounded theory study by Monks et al (2012); a cross sectional study by Ford (2011); a grounded study by Morgan (2006); a phenomenological study by Lovi and Barr (2009); and a qualitative study by Spence et al (2008). These will now be discussed.…”

“…In a Grounded Theory study of nurses and clients by Monks et al (2012), the issue of dissonance in the care of PWSUD in acute care settings was evaluated. A purposive sample of 29 RNs was recruited from a single British Hospital.…”