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From cram care to professional care : from handing out methadone to proper
nursing care in methadone maintenance treatment : an action research into the
development of nursing care in outpatient methadone maintenance clinics in the
Netherlands
Loth, C.A.
Publication date
2009
Document Version
Final published version
Link to publication
Citation for published version (APA):
Loth, C. A. (2009). From cram care to professional care : from handing out methadone to
proper nursing care in methadone maintenance treatment : an action research into the
development of nursing care in outpatient methadone maintenance clinics in the Netherlands.
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Introduction
During my higher nursing education (the Dutch HBO-V), which at the time was still organized via the Institute for Health Care (Hogeschool voor Gezondheidszorg) in Leusden, a wise nurse taught me that nursing actually consisted of three concepts: head, heart and hands. Over the years I learnt that a theoretical knowledge of nursing cannot be applied just like that. Nursing care can only come from the hands of nurses showing compassion for the patient. I did not make that up myself; it was already written a long time ago by a wise predecessor of mine, Florence Nightingale. She is often referred to by the press as ‘the lady with the lamp’, as someone who sacrificed herself completely for doctor and patient. And as a ‘nurse’, someone who does not have their own opinion and always follows orders, without any knowledge of affairs. She also already realized that and wrote about it in 1860 in ‘Notes on Nursing: what it is and what it is not’. It was translated into Dutch in 1863 and republished in 2005.
‘It seems a commonly received idea among men and even among women themselves that it requires nothing but a disappointment in love, the want of an object, a general disgust, or incapacity for other things, to turn a woman into a good nurse’ (Florence Nightingale, 1860, page 74).
And not only that, she also had a clear opinion about it:
‘What cruel mistakes are sometimes made by benevolent men and women in matters of business about which they can know nothing and think they know a great deal’ (Florence Nightingale, 1860, page 75).
During her lifetime medicine was beginning to develop on the basis of a scientific vision. Less of a distinction was made between medicine, surgery and obstetrics, and diagnostic and therapeutic insights were growing as a result of research. The architecture of hospitals was adapted to these insights and nursing developed within this context.
During that time Florence Nightingale was inspired by the neo-Hippocratic vision of illness and health, whereby the fundamental vision to the study of infection was that people became ill because of the pathogenic influence of stale or contaminated air (the so-called ‘miasma’). She said:
'Bad sanitary, bad architectural and bad administrative arrangements often make it impossible to nurse.' (Florence Nightingale, 1860, page 3).
She also had a clear opinion about what a nurse should do and should not do:
‘I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet–all at the least expense of vital power to the patient’ (Florence Nightingale, 1860, page 3).
If you read these texts as a nurse in the year 2008/2009 it seems that not much has changed, even though the visions behind this have changed compared with then. The general image of a
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nurse in the Dutch health care system is still based on that old idea of ‘the lady with the lamp’. And I still hear opinions in the media about my profession which are not correct and are based on incorrect assumptions. Practicing my profession in the addiction care sector is still
hampered by what she called at the time ‘bad administrative arrangements’. In other words: financial structures and policy measures. As a nurse you cannot ignore this and in my personal opinion, as a nurse you must certainly play an active role in this as ‘spokesperson’ for the patient.
My thesis, based on participative action research, is an example of how the nursing discipline can gain control, and where that can lead, namely to a national guideline which has led to the national implementation of a new and improved form of care for drug-addicted patients. January 2009
