Nursing Interventions for Drug Users: Qualitative Meta-Synthesis
1Neuropsychiatry of Universidade Federal de Pernambuco-UFPE, Psychosocial care center for alcohol and other drugs
2Social Service, Universidade Federal de Pernambuco
3Nursing, Universidade Federal de Pernambuco
4Psychiatry, Universidade Federal de Pernambuco
5Neuropsychiatry, Universidade Federal de Pernambuco
Objective: To identify the Brazilians nurses’ interventions in the drug users care. Methods: Research on the databases LILACS, PubMed, Scopus, CINHAL, and Cochrane, indexed from 2003 to 2012, using the keywords ‘health education’ and ‘substance-related disorders’. Obtained 8 articles as sample that resulted in a thematic and two sub themes. Results: Demonstrated that Brazilian nurses’ interventions in the drug users care are grounded in health education. Conclusion: Health education actions are relevant to the process of rehabilitation and social reintegration of drug user, can promote improvement in self-care and in the quality of life of this clientele, in addition to strengthening the nursing professional identity in this setting of care.
Keywords: nursing, health education, substance-related disorders, drug users, mental health
American Journal of Nursing Research, 2013 1 (1),
Received July 31, 2013; Revised November 06, 2013; Accepted November 08, 2013Copyright © 2014 Science and Education Publishing. All Rights Reserved.
Cite this article:
- Vasconcelos, Selene Cordeiro, et al. "Nursing Interventions for Drug Users: Qualitative Meta-Synthesis." American Journal of Nursing Research 1.1 (2013): 24-27.
- Vasconcelos, S. C. , Frazão, I. D. S. , Monteiro, E. M. L. M. , Lima, M. D. D. C. , Albuquerque, J. F. D. , & Ramos, V. P. (2013). Nursing Interventions for Drug Users: Qualitative Meta-Synthesis. American Journal of Nursing Research, 1(1), 24-27.
- Vasconcelos, Selene Cordeiro, Iracema da Silva Frazão, Estela Maria Leite Meirelles Monteiro, Murilo Duarte da Costa Lima, José Francisco de Albuquerque, and Vânia Pinheiro Ramos. "Nursing Interventions for Drug Users: Qualitative Meta-Synthesis." American Journal of Nursing Research 1, no. 1 (2013): 24-27.
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The performance of nursing experiences influences of social context, historical and cultural diversity of its clientele, constituting new demands on the health care that need to be inserted and adapted to different scenarios of care.
Particularly in the field of mental health, in recent decades, there has been a progressive restructuring in care, resulting from the redefinition of mental illness and its sufferers. Drug users, inserted in this context, also undergo a process of deconstruction and reconstruction of their representation in society, initially discriminated against and marginalized until the current understanding of patients.
These patients have peculiarities related to changes in behavior, changes in critical thinking and judgment, which results in functional disorders individual, family and social . Therefore the patient becomes vulnerable to health problems, puts himself in risk situations and has a commitment to self-care.
Thus, the logic of the expanded clinical care, offers a support for drug users grounded in the knowledge of professionals with different backgrounds , encouraging co-responsibility, autonomy and citizenship of this clientele. It is noted that each professional exerts its interventions according to their area of expertise.
In this context, the nurse needs to seek the knowledge necessary to effective practice, evidence-based, that provides the security needed to work within an interdisciplinary team without losing their specificity.
From these considerations, emerged the following research question: "What are the interventions of Brazilian nurses in the drug users’ care?" Therefore, this research aims to identify interventions used by Brazilian nurses in the care of drug users.
It was decided to conduct a meta-synthesis of the literature [3, 4]. This methodology aims to strengthen the role of qualitative research in the health sciences, improving the applicability of the results in clinical practice, support the theory, practice, research and health policies .
To contemplate the methodological rigor, followed the steps: 1. identify the purpose of the research and intellectual interests; 2. establish criteria for inclusion and exclusion of studies, conduct data collection and evaluation of individual research; 3. analyze the research; 4. relate studies by the juxtaposition of results; 5. prepare new statements; 6. develop a new explanation .
To find the articles were performed the choice of Descriptors in Health Sciences (MeSH): 'Health Education' and 'Substance-related Disorders'. The search was conducted by online access, in January 2013.
To select the articles we used the following databases: LILACS (Latin American and Caribbean Health Sciences), PubMed (Public/Publish Medline), CINHAL (Cumulative Index to Nursing and Allied Health Literature), Scopus and Cochrane. Adjustments were made in the strategies used to find the articles, but was preserved as guiding the question and the inclusion criteria previously established, to maintain consistency in the search for articles and avoid possible biases. The databases PubMed, Scopus, and CINAHL allowed perform an advanced search, justifying a lower number of items rescued.
The inclusion criteria adopted to guide the search and selection of articles were: research in Portuguese language, English and Spanish, full articles published in national and international journals in the period 2003-2012, indexed in the databases used, qualitative studies, portraying the nursing interventions care to drug users with, at least, one Brazilian nurse in the board of authors.
Exclusion criteria were: publications relating to conference abstracts, annals, editorials, reviews and opinions, review articles without systematic literature review, theses, dissertations and research projects.
After obtaining the sample, articles selected were submitted to the reading for the collection of relevant information  and assessment of methodological rigor  through the application of instruments [6, 7]. Both the analysis and synthesis of data extracted from the articles were made descriptively to observe, describe and classify the data in order to gather the knowledge produced on the theme explored in the meta-synthesis. Therefore, the meta-synthesis is capable of producing a new concept through synthesis of the content of the studies surveyed in order to transform several qualitative studies in a new study and contribute to the socialization of scientific knowledge .
From the digital search, 189 articles were found in the databases consulted, 181 were excluded for not meeting the inclusion criteria. Among the articles excluded, it was observed that the majority addressed the prevention of drug misuse and the epidemiological profile and/or characteristics of drug users. Other approached the conceptions of families about the use of drugs and treatment, the pattern of drug use, factors associated with drug use; characterization of chemically-dependent; medical comorbidities and drug use by students and nursing professionals.
The search was performed by online access, in January 2013, being the final sample of this integrative review constituted by 8 articles (Table 1).
Table 1. Selection of research articles in the databases LILACS, PubMed, CINAHL, Scopus e Cochrane, according to the inclusion criteria
All selected articles were published in Brazilians journals. Eight articles were identified in LILACS. In relation the type of journal in which they were published, two belonged to the Journal Interface - Comunicação, Saúde, Educação, the others were published in the Anna Nery School Journal of Nursing.
The 8 articles selected and analyzed showed a level of evidence VI, because they are evidence derived from a single descriptive or qualitative study . These articles were identified by letters of the alphabet as follows:
A. Youth and drug use: workshops instrumentalization of workers in social institutions, in view of health/2009.
B. The nurses’ role in primary health care approach drug addict in João Pessoa, PB, Brazil/2010.
C. Alcoholic beverage in adolescence: the care-education as action strategy of nursing/2010.
D. Alcoholism in women: support for the professional practice of nursing/2008.
E. Nurse's role in caring for the user of alcohol and other drugs in outpatient services/2007.
F. Reflections on drug abuse and violence in youth/2010.
G. Health education in nursing work with drug users/2003.
H. The harm reduction approach in non-formal educational spaces: a qualitative study in the state of Rio de Janeiro, Brazil/2011.
The theme "Learning to care" was built as a new assertion of this meta-synthesis because the eight articles discussed the importance of the nurse know the reality of the person who needs their care, whether it be the user, their family or the own healthcare team. Therefore, the intervention of nurses has been: individual care, therapeutic workshops, therapeutic groups, individual semi-structured interviews, and semi-structured interviews with collective application.
By knowing your clientele, nurses take subsidies to plan your tour. From this perspective, the analysis of items B, C, E, F and G originated the themed - 1 "The nurse performs actions of health education for drug users”. The articles described interventions of Brazilian nurses in the drug users’ care. These actions were executed through advices, referral and therapeutic listening and aimed to promote integrated care, disease prevention, health promotion, furthermore, consider the user context in which he lives.
As a result of these nursing interventions, users demystified their ideas about alcohol consumption and developed critical reflection on protective strategies, drug dependence, consequences of consumption and harm reduction.
Analysis of articles A and D originated the themed - 2 "The nurse plays educational actions for professionals who care for drug users" where the clientele was composed by health professionals. These interventions were developed through therapeutic workshops and semi-structured interviews with collective application.
Thus, professionals appropriated concepts and develop critical analysis of reality; learned about the origin of harmful drug consumption; undid myths, prejudices and stereotypes about the user, the power and effects of drugs; understood the female alcoholism; were made reflections in relation to public policy and the reality of nursing practice through health education.
As result of the interpretation of the research found in the selected studies and demonstrated in this meta-synthesis, knowledge for improved care, implies the understanding of the socio-historical context  and the knowledge of the other as an assumption of therapeutic care, which must be built from a supportive relationship, looking for alternatives and possibilities facing the problems, noting the complexity of the subject and the world in which he lives . Knowledge about the family history provides care for it in an integral way, with opportunity to interact with people, strengthening the bond and favoring communication, being able to share the care to be performed .
Moreover, the family has an important role to perform a control on the use of psychoactive substances among its members, with socialize according to idealized community values .
To know about the users and their families contributes to the elaboration of strategies most appropriate to this clientele reality with the aim to employ a harm reduction approach based on the social determinants of health that supports evidence-informed choice among programme participants .
Beyond this, a program’s health educators provide a space for conversation between the members. In these calls, the parents reported full involvement with the treatments and benefitted from each. They also understand the importance of communicating with their members and the relationship between participating parents and the health educators appears to have contributed to the program’s successful implementation .
However, just knowing this reality is not enough to perform nursing interventions appropriate to the logic of the expanded clinical care. As an example, some nurses reported that even working on Psychosocial Care Center for Alcohol and other Drugs (CAPSad) feel unprepared to care for drug users, hindering their integration into health treatment .
An academic deficit about drug use, generates a lack of knowledge about the complexity of this phenomenon and the nurse's role in the scenery . Faced with the limited experience with this theme, nurses tend to seek other sources of knowledge, such as discussion with the team, internet, reading books and articles .
Due to the work process, the nurses remain more time with your clientele and build a broad experience in interpersonal relationships, which contributes to their interventions with drug users, developing educational and therapeutic health promotion, prevention, monitoring of comorbidities, rehabilitation and social reintegration within health institutions and in the community .
This situation reinforces the importance of nurses conduct health education with other health professionals team in the workplace itself, about the use of drugs . At this moment, it is necessary linkage between the service management and public policy for this educational support. The theoretical knowledge acquired during the graduate is appointed as a facilitator to overcome difficulties during labor insertion of newly graduated nurses . To improve this formal education, courses are offered on the drug phenomenon, which has been a successful experience in the political, academic and social .
This insight is important in providing a foundation for the development of educational approaches aimed at challenging what appear to be negative attitudes to illicit drug users within nursing. Student nurses enter training with a wide range of personal experiences relating to illicit drug use. The influences of society's, negative views and the image of drug use presented in the press appeared to be significant factors in developing their attitudes on the subject. In the absence of effective approaches to education, and given that many professionals in the practice environment appear to view illicit substance users in a negative way, it is likely that interventions with identified drug users will be influenced by negative attitudes .
Strategies to increase knowledge involving this phenomenon may extend the work of professionals in relation to the process of working with the chemically dependent and exercise care emancipatory able to help in the construction of the autonomy of the subject and put them in touch with reality contributing to an understanding about themselves . Health education contributes to the user's awareness about his problem with drug use and the difficulties to achieve their rehabilitation . From this understanding, professionals may also expand its interventions for family members, building more space to care during treatment in CAPSad .
Therefore, health education becomes a strategy for nurses to contribute to the maintenance of individual and collective health . It also enables one nurse's role in the different scenarios of care, such as: individual consultation, group waiting room, therapeutic groups and home visits .
This study demonstrated that the speeches of Brazilian nurses in the care of drug users have been guided in health education as a strategy that values the knowledge of drug user, being an effective therapeutic approach that stimulates and co-responsibility in their treatment, contributing to the improvement of the general health of these clients.
In addition, the Brazilian Nurse also intervenes through educational actions to professionals who care for drug users. Therefore, strategies were used to work in groups, enabling the exchange of experiences and sharing of challenges and overcoming searches. The studies showed an increase in the capabilities of professionals involved in educational activities, resulting in improved service to these clients, through a more appropriate management and safe this problem.
This meta-synthesis also led to reflection on the gap in the scientific reality of professional nurses, considering the overhead of duties and requirements regarding scientific rigor. Highlights the need to expand the links between the university and nursing care, aiming at the strengthening of the category and the construction of a theoretical knowledge with practical visibility as to the impact on care; well as in public policy. Thus emerges the meaning of foster better links between education, research, outreach and assistance for the socialization of scientific knowledge, thus strengthening the professional identity of the nurse in different settings of care.
|||Laranjeira R, Bordin S, Figlie NB. Counseling in chemical dependency. São Paulo: Roca; 2010.674p.|
|||Campos GWS, Amaral MA. The clinic expanded and shared, democratic management and care networks as theoretical-operational for hospital reform. Ciênc Saúde Coletiva 2007;12(4):849-59.|
|||Sandelowski M, Barroso J, Corrine IV. Using Qualitative Metasummary to Synthesize Qualitative and Quantitative Descriptive Findings. Research in Nursing & Health 2007;30:99-111.|
|In article||CrossRef PubMed|
|||Lopes ALM, Fracolli LA. Systematic Literature Review and Qualitative meta-synthesis: Considerations on its use in nursing research. Texto Contexto Enferm. 2008;17(4):771-8.|
|||Francis-Baldesari C. Systematic reviews of qualitative literature[Internet]. Available on: http://www.dcu.ie/cochrane/presentations/FrancisBaldesari_06.pdf.|
|||Ursi ES. Prevention of skin lesions in the perioperative period: a literature review [dissertation]. São Paulo: Nursing School of Ribeirão Preto, University of São Paulo; 2005.|
|||Critical Appraisal Skills Programme = CASP. Milton Keynes Primary Care Trust. 2002. Disponível em: http://www.sph.nhs.uk/sph-files/casp-appraisal-tools/Qualitative%20Appraisal%20Tool.pdf.|
|||Matheus MCC. Qualitative meta-synthesis: development and contributions to evidence-based practice. Acta Paul Enferm. 2009;22(Especial-Nefrologia):543-5.|
|||Pires MRGM. Politics of care and work process in health: knowing to take better care to confront, care to emancipate. Ciênc Saúde Coletiva 2005;10(4):1025-35.|
|||Schoeller SD, Leopardi MT, Ramos FS. Cuidado: eixo da vida, desafio da enfermagem. Rev Enferm. 2011;1(1):88-96.|
|||Borges R, D’Oliveira AFPL. The medical home visit as a space for interaction and communication in Florianópolis - Santa Catarina. Interface - Comunic, Saúde, Educ. 2011;15(37):461-72.|
|||Roche AM, Steenson T, Adrew R. Alcohol and young people: What the legislation says about access and secondary supply. Drug and Alcohol Review (March 2013), 32, 124-132.|
|In article||CrossRef PubMed|
|||Greenspana NR, Aguinaldob JP, Husbandsa W, Murrayc J, Ho P, Sutdhibhasilpe N, Cedanof J, Laug C, Grayh T, Maharajj R. “It’s not rocket science, what I do”: Self-directed harm reduction strategies among drug using ethno-racially diverse gay and bisexual men. International Journal of Drug Policy 22 (2011) 56–62.|
|In article||CrossRef PubMed|
|||Vanderhoff, Aphichat Chamratrithirong, Orratai Rhucharoenpornpanich and Katharine A. Atwood Michael J. Rosati, Pamela K. Cupp, Warunee Chookhare, Brenda A. Miller, Hilary F. Byrnes, Warunee Fongkaew, Jude. Successful Implementation of Thai Family Matters : Strategies and Implications Health Promot Pract 2012 13: 355.|
|||Vargas D, Duarte FAB. Nurses of psychosocial care centers for alcohol and drugs (CAPSad): training and search for specific knowledge area. Texto Contexto Enferm. 2011;20(1):119-26.|
|||Carraro TE, Rassool GH, Luis MAV. Nursing education and the drugs phenomenon in southern Brazil: attitudes and beliefs of nursing students about care. Rev. Latinoam Enferm. 2005;13(n. esp):863-71.|
|||Vargas D. Attitudes of nursing students facing issues related to alcohol, alcoholism and alcoholics. Acta Paul Enferm. 2011;24(5):638-44.|
|||Spricigo JS, Carraro TE, Cartana MHF, Reibnitz KS. Attention to drug users - a space for nurses.Texto Contexto Enferm. 2004;13(2):296-302.|
|||Mattosinho MMS, Coelho MS, Meirelles BHS, Souza SS, Argenta CE. World of work: some aspects experienced by recent college graduates in nursing. Acta Paul Enferm. 2010;23(4):466-71.|
|||Student nurses' attitudes to illicit drugs: A grounded theory study. Martyn R. Harling, Warren Turner. Nurse Education Today 32 (2012) 235-240.|
|In article||CrossRef PubMed|
|||Luis MAV, Mendes IAC, Carvalho EC, Mamede MV, Wright MGM, Chrisman AMcG. Partnership between university and enfermeiros international organization to train teachers for Latin American research fenômeno drugs. Rev. Latinoam Enferm. 2004;12(n.esp):307-15.|
|||Gómez MÁ, Rodrigués MLC, Garcia MTE, Rojas JC. Nursing Diagnosis, Clinical Social Profile em Adolescent Treatment for Drug Addiction Rehabilitation Center in Medellin 2006. SMAD. 2008;4(1):Art 07.|
|||Wetzel C, Pinho LB, Schwartz E, Lange C, Kantorski LP, Zillmer J. Evaluation of families of a Psychosocial Attention Center of the south area of brazil: a methodological proposal. 2010;9(1). Disponível em: http://www.objnursing.uff.br/index.php/nursing/issue/view/22.|
|||Sousa LB, Torres CA, Pinheiro PNC, Pinheiro AKB. Saude Práticas of educação no Brasil em: the nursing actions. Rev. Enferm UERJ 2010; 18(1):55-60.|
|||Sé CCS, Amorim WM. Nursing actions to front clinical implications of smoking in women's health. SMAD 2009;5(1):Art 04.|