title: The multifaceted vigilance - nurses' experiences of caring encounters with patients suffering from substance use disorder.
abstract: BACKGROUND
  Nursing care is guided by a value base focusing on promoting dignity and health by means of the caring relationship. However, previous research has revealed that negative attitudes towards 'addicted' patients, as well as these patients' behaviour, can give rise to negative emotions such as frustration and disappointment among nurses. This can contribute to a judgmental and controlling attitude towards patients. To preserve order, nursing interventions focusing on creating structure and stability could be applied in a way that challenges caring values.
  
  
  OBJECTIVE
  This study aimed to describe how nurses' working in inpatient psychiatric care experience caring encounters with patients suffering from substance use disorder (SUD).
  
  
  METHODS
  This qualitative study is part of a clinical application project focusing on value-based care of patients suffering from SUD. Data were obtained during four reflective group dialogues with six nurses in a psychiatric hospital.
  
  
  METHODS
  The transcribed dialogues were subjected to latent qualitative content analysis.
  
  
  RESULTS
  The analysis facilitated the organisation of the findings into a coherent pattern. A common thread of meaning was conceptualised as a theme labelled 'the multifaceted vigilance', describing how nurses strived to deliver good care, while at the same time being vigilant towards patients' behaviour as well as their own reactions to it. Within that theme, four categories described experiences related to different challenges nurses face in caring encounters.
  
  
  CONCLUSIONS
  We suggest that this perhaps unavoidable aspect of caring encounters can be an asset. Thus, if acknowledged and subject to reflection, being vigilant could be understood as a strength enabling nurses to safeguard caring values, and to use their authority to promote patients' health and alleviate suffering.
authors.affiliation: Mälarsjukhuset MSE, Eskilstuna, Sweden.
authors.forename: Louice
authors.initials: L
authors.lastname: Johansson
authors.affiliation: School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.|Faculty of Health and Society, Narvik University College, Narvik, Norway.
authors.forename: Lena
authors.initials: L
authors.lastname: Wiklund-Gustin
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D009723:Nurse-Patient Relations; D019966:Substance-Related Disorders / Q000451:nursing*
keywords: addiction; clinical application research; nurse-patient interaction; nursing care; qualitative content analysis