Nonmedical prescription opioid abuse (NPOA) is an ongoing problem in America, with data showing an increase in this phenomenon in every state (Paulozzi & Xi, 2008). This phenomenon found its genesis and growth within the masculine context of care. As this epidemic continues its threat on public health, it is time to consider alternative approaches to its treatment. One such approach is to implement a feminist ethic of care to improve the patient-provider relationship, foster autonomy, and nurture the national milieu through interdependence. The means to this end may vary, but the nature of this perspective demands effective communication. Motivational interviewing represents a consistent, evidence-based means for exercising this approach to care.
The current perspective in treating the rising threat of NPOA relies on the masculine ethic of care. This view derives its treatment approach from the obligation of justice. That is to say, the masculine ethic of care is strongly concerned a more "hands off" approach to treatment. This duty of justice considers the patient as the sole, responsible party and, therefore, the fundamental agent of change and wellness. The way in which this is carried out is via a power dynamic in which the provider maintains an omniscient, fatherly role that emphasizes provider knowledge and patient obedience. Put another way, the masculine view stresses the notion that strong willpower and knowledge give rise to success. This method routinely omits empathy and patience from treatment and discounts the addiction research demonstrating impaired freedom of will (Vohs & Baumesiter, 2009). The result is a sense of failure and hopelessness felt by the patient.
The feminist approach highlights the importance of the patient-provider relationship through the exercise of empathy. Central to this perspective is interdependence and the balance of power between the provider and the patient. By maintaining this symmetry, then the provider may foster open-communication, elicit change-talk, and identify barriers and strengths to recovery. Furthermore, the nurse and patient can work together to use those factors to tailor the treatment plan and evoke patient autonomy in a way that increases the chance of positive health outcomes. This framework arises from a fundamental philosophy demonstrated throughout feminist history in which the marginalized provide the best insight into the provision of care within a society (Green, 2012).
In this model, the provider lessens the burden of responsibility by sharing that weight with the patient through a feminist ethic of care. That is not to imply that the provider strips the patient of power, but, instead, nurtures that power within the patient. This "motherly" role stands in strong contrast to the masculinity of the "fatherly" role. In this way, the provider-patient relationship takes a similar shape as a mother-child relationship, in which the provider guides the patient through treatment, fostering more and more autonomy along the way, until the patient ultimately becomes the sole decision-maker. This enables coping mechanisms and caregiving that equip the patient with the necessary skills to maintain wellness, rather than metaphorically kicking the patient from the nest. This feminist lens sets up the philosophy of care, but practice must align with this framework.
Ultimately, there are many ways to implement this approach. No matter the means in which one seeks to do so, the most important factor will be communication. Communication remains a tool in which the provider can cultivate relationships, derive patient-centered data, and tailor the plan of care. One method for communication is motivational interviewing. This form of counseling has demonstrated success in addiction treatment and in agreement with the feminist perspective. Motivational interviewing is a goal-oriented method that facilitates change by provoking intrinsic motivation from the patient, preserving patient-centered care (Miller, 1996). The practitioner remains nonjudgmental and maintains an open, equal relationship with the patient. As the provider paces with the patient, then the provider consistent demonstrates empathy, and allows the patient to argue for behavioral change. This provides the same level of autonomy and interdependence relative to feminist care models and, therefore, a practical match in implementing such models.
In conclusion, the feminist perspective of care in the treatment of NPOA offers an approach predictive of success. This ethic focuses on the patient-provider relationship to foster patient autonomy. By exercising empathy, then the caregiving, interdependent nature of feminism is preserved in a way that is congruent with the most recent research into addiction. Although there are many ways in which one can implement the feminist model, communication must remain a central component. Because of the caring, empathetic nature of this perspective, a nonjudgmental approach is paramount. Motivational interviewing is consistent with feminist approaches to care and, therefore, can be a valuable tool in effective communication.
References
Green B (2012) Applying Feminist Ethics of Care to Nursing Practice. J Nurs Care 1:111. doi:10.4172/2167-1168.1000111
Miller, W. R. (1996). Motivational interviewing: Research, practice, and puzzles. Addictive Behaviors, 21, 835-842. doi:10.1016/0306-4603(96)00044-5.
Paulozzi LJ, Xi Y. Recent changes in drug poisoning mortality in the United States by urban-rural status and by drug type. Pharmacoepidemiol Drug Saf. 2008;17(10):997-1005.
Vohs, K. D., & Baumeister, R. F. (2009). Addiction and free will. Addiction Research & Theory, 17(3), 231-235.
