Satisfaction with nursing care in drug users: the evolution of a scale. / Satisfação com os cuidados de enfermagem em usuários de drogas: evolução de uma escala.

OBJECTIVES: To identify the degree of satisfaction with nursing care, the significant variables and contribute to the evolution of the scale. METHODS: Descriptive, correlational, cross study, with 180 drug users. Data collected using the scale called "Satisfaction of users with the Nursing Health Center26", between February and December 2012 in three treatment units in the region of Lisbon and Vale do Tejo, Portugal. RESULTS: Users indicated 83.3% satisfaction. The dimension "Information individualization" was the most marked (98.5%). The more stability in the programs, abstinence from stimulants and benzodiazepines and more nursing interventions, the greater the satisfaction. Better working conditions, specializing in mental health, younger ages and less experience of nurses also contributed to satisfaction. Four items of the scale were extracted, assuming new SUCECS22 designation. CONCLUSIONS: Satisfaction was high, influenced by structural variables of users, nurses and working conditions. The scale has proved suitable for assessment in this population.

Satisfação com os cuidados de enfermagem em usuários de drogas: evolução de uma escala / Satisfacción con la atención de enfermería en los consumidores de drogas: evolución de una escala / Satisfaction with nursing care in drug users: the evolution of a scale

RESUMO Objetivos Identificar o grau de satisfação com os cuidados de enfermagem, as variáveis significativas e contribuir para a evolução da escala. Métodos Pesquisa descritiva, correlacional, transversal com 180 usuários de drogas. Dados coletados com a escala "Satisfação dos Utentes com os Cuidados de Enfermagem no Centro de Saúde26", entre fevereiro e dezembro de 2012, em três unidades de tratamento na região de Lisboa e Vale do Tejo, em Portugal. Resultados Os usuários assinalaram 83,3% de satisfação. A dimensão "Individualização da informação" foi a mais assinalada (98,5%). Quanto mais estabilidade nos programas, abstinência de estimulantes e benzodiazepinas e mais intervenções de enfermagem, maior a satisfação. Contribuíram ainda para a satisfação, melhores condições de trabalho, especialização em saúde mental, menor idade e menor experiência profissional dos enfermeiros. Extraíram-se 4 itens da escala assumindo nova designação SUCECS22. Conclusões A satisfação foi elevada, influenciada por variáveis estruturais dos usuários, dos enfermeiros e das condições de trabalho. A escala revelou-se adequada à avaliação nesta população.

RESUMEN Objetivo Identificar el grado de satisfacción con la atención de enfermería, las variables significativas y contribuir a la evolución de la escala. Método Estudio descriptivo, correlacional, transversal, con 180 usuarios de drogas. Datos recogidos con la escala "Satisfacción del paciente con el cuidado comunitario de enfermería26", entre febrero y diciembre de 2012, en tres unidades de tratamiento, en la región de Lisboa y el Vale do Tejo, Portugal. Resultados Los usuarios indicaron 83.3% de satisfacción. La dimensión "Individualización de la formación" fue la más marcada (98,5%). La mayor estabilidad en los programas, la abstinencia de estimulantes y benzodiacepinas y más intervenciones de enfermería, mayor es la satisfacción. Contribuyeron a la satisfacción, mejores condiciones de trabajo, especialidad en salud mental, más joven y menos experiencia de las enfermeras. Se extrajeron cuatro ítems de la escala asumiendo nueva designación SUCECS22. Conclusiones La satisfacción es alta, influenciada por las variables estructurales de los usuarios, de las enfermeras, y las condiciones de trabajo. La escala se reveló adecuada a la evaluación en esta población.

ABSTRACT Objectives To identify the degree of satisfaction with nursing care, the significant variables and contribute to the evolution of the scale. Methods Descriptive, correlational, cross study, with 180 drug users. Data collected using the scale called "Satisfaction of users with the Nursing Health Center26", between February and December 2012 in three treatment units in the region of Lisbon and Vale do Tejo, Portugal. Results Users indicated 83.3% satisfaction. The dimension "Information individualization" was the most marked (98.5%). The more stability in the programs, abstinence from stimulants and benzodiazepines and more nursing interventions, the greater the satisfaction. Better working conditions, specializing in mental health, younger ages and less experience of nurses also contributed to satisfaction. Four items of the scale were extracted, assuming new SUCECS22 designation. Conclusions Satisfaction was high, influenced by structural variables of users, nurses and working conditions. The scale has proved suitable for assessment in this population.

Adolescents at risk: pain pills to heroin: part II.

Casually exposing adolescents to prescription opioid agents may escalate to daily use. A trend exists for adolescents using prescription opioid agents to substitute heroin because it is significantly cheaper than pills (approximately half of the cost) and is often more readily available. Additionally, it is more potent than most prescription opioid agents and carries increased risks of overdose and death. Although treatment for substance use disorders has traditionally centered on total abstinence, opioid replacement therapy (ORT) is an option that saves lives and prevents overdose deaths. In the United States, ORT is based on two medicines: methadone and buprenorphine. These drugs can be substituted for other opiate agents and have much lower overdose risks. Nursing implications and web-based resources for teaching are presented.

Stresses, strengths, and experiences of mothers engaged in methadone maintenance treatment.

Although methadone maintenance treatment (MMT) is the intervention of choice for addiction, unfortunately, mothers are less likely to engage in care. Greater understanding of how mothers experience the addiction and the recovery process is needed to develop strategies to effectively engage mothers in MMT. This mixed method study applied quantitative and qualitative approaches with a sample of 12 mothers who were engaged in MMT for 3 or more months. Although the results showed stresses of high depression and difficult life circumstance scores, the mothers had strengths that included positive social support and family functioning. Inductive analysis of transcribed interviews identified three themes that explained how mothers experienced addiction and recovery: diminished maternal identity, choice for mothering, and redefined maternal identity. During addiction, mothers described a sense of diminished maternal identity with two subthemes of diminished performed mothering and interrupted mothering. With the second theme, choice for mothering, mothers described making the choice to attend MMT for their children. The third theme, redefined maternal identity, consisted of two subthemes that reflected potential outcomes of MMT and addiction recovery. Whereas most mothers described positive, restored maternal identity, two mothers of older children noted continued diminished maternal identity with persistence of negative mother-child relationships despite maternal addiction recovery. Recommendations are made to assist service providers to consider maternal identity within the recovery process.

Guided by priority: how clinicians manage access to opioid replacement therapy.

Access to opioid replacement therapy is a problem in some parts of Australia and it is not known how clinicians respond to this situation. The aim of this study is to develop a conceptual understanding of how clinicians apply clinical judgements in managing access to treatment. Grounded theory methodology was used to guide this study. Thirty-five clinicians were interviewed. The substantive theory presented to explain the process is Guided by Priority. By presenting this understanding of practice, clinicians can reflect on their actions related to the task and determine if they are beneficial or detrimental to consumers, which may influence their future practice.

Staff concerns in heroin-assisted treatment centres.

Heroin-assisted treatment (HAT) is a solution for improving the condition of treatment-resistant heroin addicts. Since 1994, six randomized controlled trials have concluded that HAT is more efficacious than oral methadone for severe heroin addicts. We visited seven HAT treatment centres in four countries in order to observe diacetylmorphine (DAM) administration and to study the main concerns of the staff. Nurses were concerned by the risk taken if a previously intoxicated patient received his dose of DAM. Another concern was the smuggling of DAM doses. The HAT centres face a dilemma: treating patients while at the same time allowing their risky street habits in the centre.

Enhancing the quality of nursing care in methadone substitute clinics using action research: a process evaluation.

AIM: This paper is a report of a study to answer the research question: can participative action research help to halt the deterioration in methadone substitution treatment and develop new care strategies which are better geared toward the patients' needs? BACKGROUND: In the Netherlands, methadone substitute treatment has been the main medical treatment for heroin addiction since the early 1980s. Although effective at first, this methadone provision has deteriorated during the last 15 years. Over time, nursing staff have had to restrict their activities to simply dispensing methadone and have not been able to develop any other interventions, such as outreach care. METHOD: A participative action research process was used in two outpatient methadone substitute treatment clinics. Using the four stages of the cooperative inquiry design of Heron and the knowledge development model of Johns, a diagnosis of all the bottlenecks was made and innovative care strategies were implemented. Reflection meetings were held to offer nursing staff maximum benefit in improving the quality of nursing care. FINDINGS: Action research partially succeeded in enhancing care strategies. Of the two clinics involved in the study, one improved both its care organization and patient-centred outcome. The other managed to improve the organization of the care. CONCLUSION: Participative strategies can be, but are not always, a helpful method for enhancing professional care in addictions nursing. By setting out attainable goals in daily practice, some nurses were able to become active change agents. The development of knowledge is inextricably connected with the growth of new care strategies. Chronic opiate users can benefit from the expansion of professional nursing knowledge.