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An exploration of the role of substance misuse nurses in Scotland
Appendix 5: Further Observation Notes Structure
StructureRegardless of the type of consultation or NHS setting all followed a similar structure, consisting of the five stages below:
introduction
exploration of clients' history
main body of consultation
exploration of future goals
closure.
Consultations began with a brief interaction between nurse and client to build rapport. Conversations topics included the weather, the day so far and general well being of both parties. There seemed to be appropriate physical space between nurses and clients at all times. Both parties were seated at equal heights and there were never any physical barriers such as a desk or table placed between them. If such a barrier did exist nurses would direct clients to a chair strategically positioned so both parties were able to interact without a physical barrier between them.
Interaction with clients
Nurses tended to spend a lot of time listening to clients and asking them to reflect on what had been said. For example, field notes read "Allows client to answer in her own words and in her own time". Additionally, they encouraged clients to think more about their own ideas and feelings in relation to their drug misuse and to interpret and clarify the meaning of their statements. Clients were given plenty of time to define problems and answer questions. It appeared that nurses maintained an empathetic, non-judgemental attitude which was particularly evident when clients appeared distressed or confused. Additionally, appropriate use of silence was used when clients felt that they could not answer sensitive questions. Nurses appeared interested and sympathetic towards their clients. They showed good use of non-verbal prompts such as direct eye contact, facial expressions, and posture. In contrast some clients avoided direct eye contact, especially when admitting to drug misuse, criminal behaviour or traumatic experiences but in most cases clients appeared open and honest.
Overall consultations were client-centred and nurses encouraged and facilitated clients' participation in consultations, thus establishing joint-decision making.
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