[The association between the patient-nurse relationship and patient perception of substance use control in an...

The aim of this study is to explore the association between the patient-nurse working alliance and the degree of how much substance use control is perceived as burdensome in an addiction therapy setting. Imogene King's theory and the working alliance concept were used as the theoretical framework. The investigation was undertaken using a self-administered questionnaire with the short-form of the working alliance inventory (WAI) translated and validated in French and targeting a convenience sample (n=28). In this sample the working alliance was evaluated by 12 questions on a Likert-Scale and perceived as generally good (x = 61.68, max = 84). A significant negative linear relation was found between the perception of the drug-controls as burdensome, evaluated by an additional question on a visual analogue scale (VAS), and the establishment of a working alliance (r = -0.67, p-value > 0.001). Furthermore, the form of admission is important as involuntarily hospitalized patients (n = 7) (t, p-value = 0.018) form poorer working alliances, and perceive the controls as more burdensome (Z, p-value = 0.004) as opposed to voluntarily hospitalized patients (n = 21). Even though these results cannot be generalized because of the small sample (n = 28), they raise important questions for nursing practice, especially for involuntarily hospitalized patients. These patients seem to be more susceptible to any disturbance of the relationship and possible consequences need to be taken into account. In addition, drug-control might have to be reassessed. The findings also raise questions about the use of camera supervision as an alternative to nursing supervision and about the need for the primary nurses to refrain from control interventions.