Specialist substance misuse nurses' assessment and decision making in the management of drug misusers

Aims: To explore, in-depth, substance misuse nurses' roles in assessment and decision making, the relative role of the client, the nurse and others in this process and to consider policy implications.

Methods: Semi-structured, face- to-face interviews were conducted with a sample of substance misuse nurses managing individuals with drug problems across Scotland (n = 29). The sample was identified from respondents to a questionnaire distributed to all substance misuse nurses in a linked study. Interviewees were purposively sampled to cover a range of gender, years' experience, attitudes and NHS area. Twenty-nine interviews were conducted across six areas. Interviews focused on assessment and treatment decision making. Thematic Analysis was undertaken.

Findings: Nurses' descriptions of assessment and decision making reflected a client-centred approach with clients being the main influence in decision making. Protocols and guidelines provided an evidence-based background and nurses occasionally have to manage conflict between the client's objectives of treatment and the evidence. Other professionals were consulted for complicated cases. Additional policy issues included the time between assessment and implementing treatment.

Conclusions. Nurses demonstrated professional autonomy in treatment decision making. A model of consultation described in general medical literature as an 'evidence-based, patient-choice consultation' (Ford, Schofield, & Hope, 2003) was practised. Ongoing legislative changes to extend nurse prescribing to substance misuse would legitimize current practice.