Abstract：
BACKGROUND: Injectable opioid agonist treatment (iOAT) is an evidence-based treatment that serves an important minority of people with opioid use disorder who require specialized care. Unique to iOAT care is the consistency with which clients access treatment (up to three times daily), a condition that creates repeated opportunities for health care engagement. To date, no study has examined therapeutic relationships in this life saving, nurse-led treatment that can have lasting implications in the equitable delivery of other forms of addictions care.
METHODS: This study used grounded theory to generate a dynamic framework for therapeutic relationship building in iOAT. Researchers collected semi-structured interviews from registered nurses working in iOAT sites (n=24) form January 2020 through June 2022. The study analyzed collected data through a constant comparative analysis; explored through open, axial, and selective coding; and assessed in a conditional relationship matrix. The team reviewed key findings with stakeholders through formalized processes of engagement to confirm saturation of coding categories. Throughout data collection and analysis, researchers integrated feedback from additional knowledge users and member checking. Reported findings adhered to the COREQ1 standardized checklist.
RESULTS: We identified five interrelated categories that created a distinct culture of care for iOAT nurses: Ways of Knowing, Personal Investment, Leveraging Empathy, Finding Flexibility, and Collaborating to Overcome. Through creating a safe, nonjudgmental environment, nurses establish therapeutic relationships that build trust to identify client needs outside of medication administration. In turn, nurses participate in team-based problem solving to advocate for client needs. If nurses cannot find flexibility within and outside of the health care system to improve client engagement, tensions can arise and therapeutic relationships can be strained.
CONCLUSIONS: Therapeutic relationships are an integral part of building and maintaining trust with a population that has been precariously involved with other forms of health care. Nurses make a substantial effort to create a safe and nonjudgmental environment to manifest a culture of care that bridges client needs and program access. Without the expansion of access to iOAT programs and their embedded services, nurses are limited in their ability to provide individualized care for clients with diverse needs.
METHODS: This study used grounded theory to generate a dynamic framework for therapeutic relationship building in iOAT. Researchers collected semi-structured interviews from registered nurses working in iOAT sites (n=24) form January 2020 through June 2022. The study analyzed collected data through a constant comparative analysis; explored through open, axial, and selective coding; and assessed in a conditional relationship matrix. The team reviewed key findings with stakeholders through formalized processes of engagement to confirm saturation of coding categories. Throughout data collection and analysis, researchers integrated feedback from additional knowledge users and member checking. Reported findings adhered to the COREQ1 standardized checklist.
RESULTS: We identified five interrelated categories that created a distinct culture of care for iOAT nurses: Ways of Knowing, Personal Investment, Leveraging Empathy, Finding Flexibility, and Collaborating to Overcome. Through creating a safe, nonjudgmental environment, nurses establish therapeutic relationships that build trust to identify client needs outside of medication administration. In turn, nurses participate in team-based problem solving to advocate for client needs. If nurses cannot find flexibility within and outside of the health care system to improve client engagement, tensions can arise and therapeutic relationships can be strained.
CONCLUSIONS: Therapeutic relationships are an integral part of building and maintaining trust with a population that has been precariously involved with other forms of health care. Nurses make a substantial effort to create a safe and nonjudgmental environment to manifest a culture of care that bridges client needs and program access. Without the expansion of access to iOAT programs and their embedded services, nurses are limited in their ability to provide individualized care for clients with diverse needs.
摘要：
背景：可注射阿片类药物激动剂治疗（iOAT）是一种基于证据的治疗方法，适用于需要特殊护理的阿片类药物使用障碍患者中的一小部分。iOAT护理的独特之处在于客户获得治疗的一致性（每天最多三次），为医疗保健参与创造反复机会的条件。迄今为止,没有研究检查这种拯救生命的治疗关系，护士主导的治疗，可以对公平提供其他形式的成瘾护理产生持久影响。
方法：本研究使用扎根理论为iOAT中的治疗关系构建生成动态框架。研究人员收集了2020年1月至2022年6月在iOAT站点工作的注册护士（n=24）的半结构化访谈。这项研究通过持续的比较分析来分析收集到的数据；通过开放的方式进行探索，轴向，和选择性编码；并在条件关系矩阵中进行评估。该团队通过正式的参与过程与利益相关者一起审查了关键发现，以确认编码类别的饱和度。在整个数据收集和分析过程中，研究人员整合了来自其他知识用户和成员检查的反馈。报告的调查结果符合COREQ1标准化清单。
结果：我们确定了五个相互关联的类别，这些类别为iOAT护士创造了独特的护理文化：了解的方式，个人投资,利用同理心，寻找灵活性,合作克服。通过创建一个保险箱，非评判性的环境，护士建立治疗关系，建立信任，以确定客户需求之外的药物管理。反过来,护士参与以团队为基础的问题解决，以倡导客户需求。如果护士在医疗保健系统内外找不到灵活性来提高客户参与度，紧张关系可能会出现，治疗关系可能会紧张。
结论：治疗关系是建立和维持与其他形式的医疗保健不稳定的人群的信任的一个组成部分。护士做出了巨大的努力，以创造一个安全和非判断的环境，以体现一种桥梁客户需求和程序访问的护理文化。如果不扩大对iOAT程序及其嵌入式服务的访问，护士为不同需求的客户提供个性化护理的能力有限。
方法：本研究使用扎根理论为iOAT中的治疗关系构建生成动态框架。研究人员收集了2020年1月至2022年6月在iOAT站点工作的注册护士（n=24）的半结构化访谈。这项研究通过持续的比较分析来分析收集到的数据；通过开放的方式进行探索，轴向，和选择性编码；并在条件关系矩阵中进行评估。该团队通过正式的参与过程与利益相关者一起审查了关键发现，以确认编码类别的饱和度。在整个数据收集和分析过程中，研究人员整合了来自其他知识用户和成员检查的反馈。报告的调查结果符合COREQ1标准化清单。
结果：我们确定了五个相互关联的类别，这些类别为iOAT护士创造了独特的护理文化：了解的方式，个人投资,利用同理心，寻找灵活性,合作克服。通过创建一个保险箱，非评判性的环境，护士建立治疗关系，建立信任，以确定客户需求之外的药物管理。反过来,护士参与以团队为基础的问题解决，以倡导客户需求。如果护士在医疗保健系统内外找不到灵活性来提高客户参与度，紧张关系可能会出现，治疗关系可能会紧张。
结论：治疗关系是建立和维持与其他形式的医疗保健不稳定的人群的信任的一个组成部分。护士做出了巨大的努力，以创造一个安全和非判断的环境，以体现一种桥梁客户需求和程序访问的护理文化。如果不扩大对iOAT程序及其嵌入式服务的访问，护士为不同需求的客户提供个性化护理的能力有限。
