Abstract
In opioid substitution treatment, nursing builds and provides the primary and main therapeutic relationship and care with patients. Despite its essential contribution to the treatment of drug-dependent patients, nursing in substitution treatment tends to be overlooked. Also, little is known about their work in heroin substitution in particular. The aim of this article is to describe the nursing actions provided in the care of patients in the PEPSA (experimental drug prescription program in Andalusia, Spain) trial, mainly concerned with patients receiving intravenous diacetylmorphine. The study was conducted in the Centre for diacetylmorphine prescription within the context of a heroin clinical trial, Virgen de las Nieves University Hospital, Granada, Spain.
The nursing team was responsible for overall care for the patient, focusing on his/her needs. Care provided to each patient was individualized, with verbal communication being the main tool to facilitate a two-way exchange of information between the patient and the nurse providing care. The protocol for nursing performance comprised the administration and supervision of the treatment and other actions aimed at reducing harm, encouraging healthy habits, monitoring the patient and counseling. The general process included: admission of the patient; assessment of his/her general health status; delivery of the treatment; and assessment of the patient's response receiving injected diacetylmorphine. The care of patients who are addicted to drugs provided calls for a relationship that ensure seamless care. This relationship should be aimed at fostering and maintaining therapeutic communication. This relationship involves nurses providing empathy, active listening, assertiveness, acceptance, respect, offering consistent information and avoiding a judgmental approach. In this trial, the nurses attempted to motivate change, detecting and providing positive reinforcement of any changes made, while always respecting the patient's choices. The fundamental aim was harm reduction, which involves reducing any adverse consequences arising from the use of drugs, without necessarily reducing the use of drugs.