The mobilization of nurse-client therapeutic relationships in injectable opioid agonist treatment: Autonomy, advocacy and action

Blawatt, Sarin; Harrison, Scott; Byres, David; Foreman, Julie; Amara, Sherif; Burdge, Wistaria; MacDonald, Scott; Schechter, Martin T.; Oviedo-Joekes, Eugenia

doi:10.1016/j.josat.2023.209154

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…Most clients must attend the treatment site in-person up to three times a day for their injections, while a small percentage of clients have prescriptions for take-home doses [ 38 , 39 ]. The daily clinic visits provide opportunities for therapeutic relationship building between iOAT clients and service providers, and engagement in other addiction care services [ 4 , 41 ]. At the same time, the rigid protocols and supervision render iOAT a demanding and highly medicalized option that does not align with core principles in person-centered addiction care such as autonomy, individualized treatment, and holistic care [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

“It feels like I’m coming to a friend’s house”: an interpretive descriptive study of an integrated care site offering iOAT (Dr. Peter Centre)

Dobischok,

Carvajal,

Turner

et al. 2023

Addict Sci Clin Pract

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Background Injectable opioid agonist treatment (iOAT) has proven to be a safe and effective treatment option for severe opioid use disorder (OUD). Yet, iOAT is often isolated from other health and social services. To align with a person-centered care approach, iOAT can be embedded in sites that combine systems and services that have been historically fragmented and that address multiple comorbidities (integrated care sites). The present study investigates the addition of iOAT at an integrated care in Vancouver, British Columbia. We aimed to capture what it means for service users and service providers to incorporate iOAT in an integrated care site and describe the processes by which the site keeps people engaged. Methods We conducted 22 interviews with 15 service users and 14 interviews with 13 service providers across two rounds of individual semi-structured interviews (Fall 2021, Summer 2022). The second interview round was precipitated by a service interruption in medication dispensation. Interview audio was recorded, transcribed, and then analysed in NVivo 1.6 following an interpretive description approach. Results The emergent themes from the analysis are represented in two categories: (1) a holistic approach (client autonomy, de-medicalized care, supportive staff relationships, multiple opportunities for engagement, barriers to iOAT integration) and (2) a sense of place (physical location, social connection and community belonging, food). Conclusion Incorporating iOAT at an integrated care site revealed how iOAT delivery can be strengthened through its direct connection to a diverse, comprehensive network of health and social services that are provided in a community atmosphere with high quality therapeutic relationships.

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Section: Introductionmentioning

confidence: 99%

“It feels like I’m coming to a friend’s house”: an interpretive descriptive study of an integrated care site offering iOAT (Dr. Peter Centre)

Dobischok,

Carvajal,

Turner

et al. 2023

Addict Sci Clin Pract

Self Cite

View full text Add to dashboard Cite

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“It’s a delicate balance”: clinicians’ experiences of providing heroin-assisted treatment

Ellefsen,

De Pirro,

Haukland

et al. 2024

Harm Reduct J

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Background Little attention has been paid to the experiences of clinicians and health personnel who provide heroin-assisted treatment (HAT). This study provides the first empirical findings about the clinicians’ experiences of providing HAT in the Norwegian context. Methods 23 qualitative interviews were conducted with 31 clinicians shortly after HAT clinics opened in Norway’s two largest cities: Oslo and Bergen. By inductive thematic analysis of interview transcripts, we identified what research participants experienced and viewed as the chief rewards and challenges of providing HAT. The study aimed to offer an overview of these key rewards and challenges, with insights potentially transferable to HAT programs internationally. Results Participants experienced three aspects of providing HAT as particularly rewarding, and three as most challenging. The rewarding aspects were observing harm reduction outcomes; providing holistic care; and having a positive clinic milieu and patient–clinician relationships. The challenging aspects were dosing and overdose risk; rule enforcement and aggression management; and the difficulty of initiating treatments beyond medication and harm reduction. The rewarding and challenging aspects of providing HAT overlapped and were at times contradictory, thus reflecting the duality and tensions in clinicians’ work to provide HAT. The challenges were reported to vary between patient subgroups, according to their degree of instability. The most unstable patients were seen as involving more difficulties as regards the challenging aspects of HAT. Participants expressed uncertainty about HAT’s utility for a small group of the most unstable patients. Conclusion While studies about clinical experiences of HAT have usually examined individual or limited aspects of treatment provision, this study provided an overview of the main aspects of the rewards and challenges of providing HAT. Importantly, it also showed the tensions between these overlapping and sometimes contradictory aspects of HAT provision. Because a positive patient–clinician relationship is crucial to patient satisfaction and treatment outcomes in HAT, the provision of training for clinicians on navigating the inherent tensions of HAT provision, nurturing therapeutic alliances with patients, and managing their role as gatekeepers to medical heroin and valuable services, seem particularly important for ensuring that care is patient-centered and staff are adequately supported.

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The mobilization of nurse-client therapeutic relationships in injectable opioid agonist treatment: Autonomy, advocacy and action

Cited by 2 publications

References 27 publications

“It feels like I’m coming to a friend’s house”: an interpretive descriptive study of an integrated care site offering iOAT (Dr. Peter Centre)

“It feels like I’m coming to a friend’s house”: an interpretive descriptive study of an integrated care site offering iOAT (Dr. Peter Centre)

“It’s a delicate balance”: clinicians’ experiences of providing heroin-assisted treatment

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