Nursing Inquiry. 2020;27:e12329. wileyonlinelibrary.com/journal/nin
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https://doi.org/10.1111/nin.12329
© 2019 John Wiley & Sons Ltd
1 | INTRODUCTION
Nursing has differentiated itself from other healthcare disciplines in
that nursing has widely adopted its own definition of pain. While
other health disciplines might rely on the International Association
for the Study of Pain (IASP) definition, ‘an unpleasant sensory and
emotional experience associated with actual or potential tissue
damage, or described in terms of such damage’ (Merskey & Bogduk,
1994, p. 209), a nursing definition of pain is whatever the experienc‐
ing person says it is, existing whenever and wherever the person
says it does (McCaffery, 1968). Approaching patient encounters with
this understanding of pain allows nurses to inherently provide pa‐
tient‐centered care that promotes human dignity. It enables nurses
to enter healing relationships with patients valuing the primacy of
patients’ interests and their right to self‐determination. The nurs‐
ing profession also distinguishes itself by strongly identifying with
unique ethical codes. The American Nurses Association (ANA)
adopted their first code of ethics in 1950, and the International
Council of Nurses’ (ICN) adopted theirs in 1953. Among the ethical
responsibilities of nurses, advocacy is identified as a defining ele‐
ment of nursing's ontology. It is a pillar of nursing according to the
American Nurses Association (n.d.). It appears in the ICN’s definition
of nursing (International Council of Nurses, 2002), and it is also one
of the provisions articulated in the ANA Code of Ethics for Nurses
(American Nurses Association, 2015).
Despite having a unique, patient‐centered definition of pain and
a role in which advocacy is central, the label drug‐seeking is used fre‐
quently by nurses in a variety of practice settings. In addition to, or
perhaps because of, the widespread use of the term, there are a va‐
riety of meanings nurses are attempting to communicate when using
the term; there is no single definition of the term drug‐seeking. It is
used as an adjective to describe patients and as a verb to describe
patient behavior itself, and it is also used to describe patients’ moti‐
vations for their behavior. In practice, it lacks conceptual clarity, yet
Received: 10 September 2019
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Revised: 9 October 2019
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Accepted: 15 October 2019
DOI: 10.1111/nin.12329
REVIEW
Drug‐seeking: A literature review (and an exemplar of
stigmatization in nursing)
Darcy Copeland
1,2
1
School of Nursing, University of Northern
Colorado, Greeley, CO, USA
2
St Anthony Hospital, Centura Health,
Lakewood, CO, USA
Correspondence
Darcy Copeland, School of Nursing,
University of Northern Colorado, Greeley,
CO, USA; St Anthony Hospital, Centura
Health, Lakewood, CO, USA.
Email: Darcy.copeland@unco.edu
Abstract
Despite its lack of conceptual clarity and uniform definition, the term drug‐seek‐
ing is used frequently by nurses from a variety of practice environments. The drugs
patients are referred to as seeking are often pain medications. This is important be‐
cause nursing has widely adopted a patient‐centric definition of pain. Nursing also
has a robust ethical code that places high value on human dignity and nurses’ role
in patient advocacy. A review of literature was conducted with the aims of describ‐
ing whether/how the term drug‐seeking has changed over time and to determine
whether the use of the term in nursing literature is consistent with nursing values.
Use of the term has shifted from objective counts of patient requests for medication
to a confusing mixture of observable patient behavior and subjective interpretations
of patient motivation. Its use is not consistent with nursing values. It is, in fact, a good
illustration of stigmatization in nursing. Stigmatization is contrary to nursing values.
Nurses in practice, research, education, authors, reviewers, and editors all have a role
in ending this stigmatization.
KEYWORDS
drug‐seeking, ethics, nurse, nursing practice, nursing values, patient relationship, stigma