title: Enhancing the quality of nursing care in methadone substitute clinics using action research: a process evaluation.
abstract: OBJECTIVE
  This paper is a report of a study to answer the research question: can participative action research help to halt the deterioration in methadone substitution treatment and develop new care strategies which are better geared toward the patients' needs?
  
  
  BACKGROUND
  In the Netherlands, methadone substitute treatment has been the main medical treatment for heroin addiction since the early 1980s. Although effective at first, this methadone provision has deteriorated during the last 15 years. Over time, nursing staff have had to restrict their activities to simply dispensing methadone and have not been able to develop any other interventions, such as outreach care.
  
  
  METHODS
  A participative action research process was used in two outpatient methadone substitute treatment clinics. Using the four stages of the cooperative inquiry design of Heron and the knowledge development model of Johns, a diagnosis of all the bottlenecks was made and innovative care strategies were implemented. Reflection meetings were held to offer nursing staff maximum benefit in improving the quality of nursing care.
  
  
  RESULTS
  Action research partially succeeded in enhancing care strategies. Of the two clinics involved in the study, one improved both its care organization and patient-centred outcome. The other managed to improve the organization of the care.
  
  
  CONCLUSIONS
  Participative strategies can be, but are not always, a helpful method for enhancing professional care in addictions nursing. By setting out attainable goals in daily practice, some nurses were able to become active change agents. The development of knowledge is inextricably connected with the growth of new care strategies. Chronic opiate users can benefit from the expansion of professional nursing knowledge.
authors.affiliation: TACTUS Addiction Institute and Amsterdam Institute for Addiction Research, Deventer, The Netherlands. c.loth@tactus.nl
authors.forename: Christien
authors.initials: C
authors.lastname: Loth
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Schippers
authors.forename: Harm't
authors.initials: H
authors.lastname: Hart
authors.forename: Goof
authors.initials: G
authors.lastname: van de Wijngaart
mesh_terms: D005069:Evaluation Studies as Topic; D006556:Heroin Dependence / Q000188:drug therapy / Q000451:nursing*; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D009426:Netherlands; D015404:Nursing Methodology Research / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*
chemical_list: D009294:Narcotics; D008691:Methadone