Inpatient substance user's care and treatment: innovative guiding principles for nurses

Abstract

Substances use is an increasing national concern. Various forms of harmful disorders have also been noted as posing a national health crisis. Against this background, the aim of the study was to explore, identify, describe and analyse inpatient substance addiction and its disorders, and to propose a relevant framework of principles to guide and improve nursing care in this regard. The study adopted a combined mixed-methods research approach involving qualitative, quantitative, using convergent research design in order to maximise both the efficacy of the methods and sources of data collection and their concurrent analysis, as well as the eventual findings of the study, which was conducted at three substance addiction treatment centres in Gauteng Province. The quantitative aspect of the study was facilitated by means of a comprehensive review and analysis of admission records belonging to 244 substance addicted inpatients at one of the selected three treatment centres. The quantitative variables reflected in the admission records represented the entire range of sociodemographic, help seeking, substance abuse history, family support, and medical and psychological characteristics of substance abusers. On the other hand, the study’s qualitative aspect was facilitated by means of three (3) unstructured in-depth focus groups with selected nurses providing care to inpatient people addicted to substances. An investigation of 5 (five) inpatient treatment programmes at the self-same three treatment centres complemented the qualitative aspect of the study. For the majority cases of occurrence/ frequency at the treatment centre from which 244 admission records were obtained, the quantitative findings revealed, among others, that the majority of inpatients (n=224, 91.8%) were Blacks; single (n=223, 90%); at secondary school (n=207, 84.8%); unemployed (n=232, 95.1%); with the heroin as the most abused substance by 88.9% (n=217) inpatients followed by cannabis (n=205, 83.6%). The most critical of these variables was that the majority of the inpatients (n=74, 30.5%) were those who had been substance abusing for 7-10 years. The implication is most young people were the most at-risk group as they started substance abuse during the adolescent stages of their live, which increased the chances of progressing to substance abuse disorders and poor mental health. Meanwhile, the qualitative findings derived from the focus group discussions with the nurses and the five treatment programmes yielded five focal themes and associated multiple sub-categories. These principal/global themes are: psychological and emotional impediments to inpatient care; attitudes of patients’ relatives; quality of care by nurses to support inpatients; nurses’ attitudes; and challenges experienced by nurses. Collectively, both the quantitative and qualitative findings indicate that substance abuse disorder is a complex and multifaceted physiological and psychosocial challenge for both the sufferers and society as a whole. For its management and treatment, nurses should be adequately trained, and multi-professional teams should be part of a concerted and dedicated effort to provide care and eradicate the problem convincingly. The study envisages that its recommendations will contribute towards effective policy development and implementation based on a viable framework of inmate substance abuse guidelines to innovatively guide nursing care and management of substance abuse treatment centres. Such innovation should incorporate continuing professional development guidelines for different categories of nurses to enhance their skills and also improve knowledge on mental health implications as well.