Being Close, for Better or Worse: Nursing Staff's Experiences of Caring for Patients with Dual Diagnosis in Rural Areas.

Despite improvements in substance abuse care in Sweden, variations in accessibility persist, particularly in rural areas where patients with dual diagnosis receive fewer follow-ups than patients in urban areas. This study aims to illuminate nursing staff's experience when caring for patients with dual diagnosis in psychiatric outpatient care in rural areas. Eleven semi-structured interviews were conducted with nursing staff at psychiatric outpatient clinics in rural areas. Qualitative content analysis was used to analyze the data. The findings show that caring for patients with dual diagnosis in rural areas can mean being close for better or worse, dealing with unequal care at distance, and bridging barriers to accessibility. For good nurse-patient relationships, nursing staff need to be aware of power structures and strive to overcome stigma. Additionally, organizations could benefit from drawing on the implementation competence of RNs with master's level education. More research with an intersectional approach is needed on digital solutions for patients with dual diagnosis in rural areas.