Journal of addictions nursing最新文献

Background: Alcohol use continues to be a global public health concern that significantly contributes to economic burden and increased morbidity and mortality rates. Healthcare professionals, including nurses and behavioral health professionals, play a vital role in alcohol use prevention, screening, and management. The purpose of this study is to identify nurses' and behavioral health professionals' demographic and clinical characteristics and professional attitudes as predictors of their motivation toward providing care related to alcohol use.

Methods: A secondary analysis employing baseline data pooled across five interventional study cohorts was utilized to build a prediction model. Specifically, to identify the contribution of demographic and clinical characteristics, and professional attitudes in predicting motivation scores relative to alcohol use, a two-step hierarchical multiple linear regression was used.

Results: A total sample of 1,164 undergraduate, graduate, and professional nurses', and behavioral health professionals' baseline data were included in the final analyses. The final model demonstrated that specific demographic and clinical characteristics (age, sex, race, student status, and workplace) and professional attitudes (role legitimacy, task-specific self-esteem, and work satisfaction) significantly predicted nurses' and behavioral health professionals' alcohol use-related motivation ( p < .05). This predictive study revealed that all professional attitudes, except for role adequacy, were significant predictors of nurses' and behavioral health professionals' alcohol use-related motivation, which aligns with previous literature findings.

Conclusion: These findings can inform larger scale intervention studies targeting nurses' and behavioral health professionals' alcohol use-related motivation to promote timely identification and access to care.

This study aimed to explore and describe the experience of individuals with alcohol use disorder in the therapeutic community. The study was exploratory, with a qualitative design. Data were collected through in-depth interviews from 15 individuals with alcohol use disorder recovering in the therapeutic community and analyzed using Colaizzi's phenomenological method. There appear to be three categories: (1) feeling safe in an environment with structures and rules; (2) telling everything about myself without holding back; and (3) discovering the meaning of life. The healing elements in the therapeutic community are safety, talking, and discovering the meaning of life. Our findings show that the therapeutic community positively influenced individuals with alcohol use disorder and the changes in their attitudes toward life. Thus, we hope that these findings could contribute to the recovery and rehabilitation of individuals with alcohol use disorder in the community.

Background: Young adults exhibit a high prevalence of e-cigarette use and dual use despite the numerous physical and mental health risks associated with e-cigarettes. However, there is limited understanding of young adults' perceptions of e-cigarette use, particularly regarding their motivation to quit and their suggestions for cessation interventions, which are crucial for developing effective interventions.

Purpose: This study explored young adults' perceptions of e-cigarette use, focusing specifically on their reasons for using e-cigarettes, their motivation to quit, and their suggestions for e-cigarette cessation interventions.

Methods: A purposive sampling strategy was used to recruit 16 individuals between the ages of 18 and 26 who used e-cigarette products. The interviews were conducted either face to face or virtually using a semistructured interview guide. Thematic analysis was performed to identify themes.

Results: Two major themes were identified: reasons for using e-cigarettes and perceptions of vaping risks. Participants cited ease of purchase and use, the variety of flavors, perceived lower health risks than conventional cigarettes, social necessity, and using e-cigarettes as a method to quit smoking as reasons for their use. Most participants acknowledged being aware that e-cigarettes pose multiple health risks, including cardiovascular and pulmonary dangers. In addition, most participants expressed a desire to quit vaping and showed interest in participating in interventions to learn more about the harms of e-cigarettes.

Conclusion/implication: The findings provide valuable insights into the appeal of e-cigarettes among young adults and underscore the need for more comprehensive education and policy measures regarding e-cigarette use.

Abstract: Due to substance use disorder (SUD) being an occupational hazard to certified registered nurse anesthetists (CRNAs) and resident registered nurse anesthetists (RRNAs), the American Association of Nurse Anesthesiology (AANA) has strived to offer SUD-related support since 1983 with the goal to help safeguard CRNAs, RRNAs, and patients in their care. AANA provides many SUD resources including a 24/7, live, confidential helpline strengthened through a partnership with Parkdale Center for Professionals, a specialized treatment center for health care professionals. The AANA Helpline is answered by Parkdale's addiction professionals to improve and streamline access to help for drug- or alcohol-related concerns. This article explores the data, trends, and impact this resource has had on CRNAs, RRNAs, their families, their colleagues, and their workplace over a 5-year period. Through the analysis of the data and trends collected, the authors make several recommendations to continue to proactively address the occupational hazard of SUD, increase education, raise awareness of available help across the nurse anesthesiology profession, and decrease the stigma that surrounds CRNAs and RRNAs who suffer from SUD. A holistic wellness program can also be adopted by other associations to meet the needs of their professional members.

Abstract: Stigmatizing language used in the care of people with substance use disorder is prevalent despite efforts to establish preferred, patient-centered language alternatives for providers. Open notes policies and increased portal usage are expected to lead to patients reading chart notes written about them with potential impact on their care. Building on the research that demonstrates that stigmatizing language is present in patient chart notes, our study employs an exploratory sequential mixed methods design to describe and analyze the chart notes from a perinatal substance use disorder clinic. We analyzed 161 patient chart notes meeting our study criteria from a random sample of 300 notes, and those patients are 88% White, 91% use Medicaid insurance, and their median age was 29 years at delivery. Chart notes were found to comprise stigmatizing terms, patient-centered and non-patient-centered language. Language type varied by patient age, prior C-section, prenatal care quality, and time since conception. Our team developed an assessment tool for chart notes in response to our findings.

Introduction: The management of postoperative pain in patients with an opioid use disorder (OUD) is challenging. Hospitals are frequently not equipped to respond effectively to the pain of these patients following surgery. For example, many caregivers are reluctant to prescribe opioids to these patients because a relapse in their misuse of drugs may occur. Limited research is available on the management of pain in this population, particularly in relation to the transition from the hospital to the community.

Case report: A 28-year-old male with a long-standing OUD requiring cardiothoracic surgery to remove a right atrial myxoma was admitted to the hospital. He transitioned from intravenous heroin and fentanyl use to a stable dose of methadone to manage his addiction in anticipation of surgery. In collaboration with the Acute Pain Service, an addiction nurse coordinator, along with an interprofessional team, developed a transitional pain management plan (TPMP) in order to coordinate his care throughout the perioperative period and beyond discharge.

Discussion: Concepts to the TPMP were as follows: continuous interaction with a hospital-based addiction nurse coordinator, involvement of an acute pain specialist, a nonjudgmental approach to the patient, continuous teaching regarding his care, ensuring that caregivers worked within the TPMP, and interaction with a community-based addiction specialist.

Conclusion: Given that this patient's OUD (a) was controlled during his hospitalization, (b) his pain was effectively managed, and (c) he transitioned to an addiction specialist in the community upon discharge, it appears that this intervention, the development and use of a TPMP, was successful.

Abstract: Fatal and nonfatal overdoses (ODs) from illicit drugs continue to increase in U.S. emergency departments (EDs). Meanwhile, protocols that include best practices regarding interventions and discharge planning with this patient population remain inconsistent. A retrospective chart review was conducted with four EDs within one hospital system, during a 1-year period. There were N = 242 patient admissions for accidental, illicit, nonfatal drug ODs. Data regarding interventions, discharge planning, and education provided were extracted. Results included that primary drugs responsible for OD were opioids (e.g., heroin). The average length of stay in the ED was 2 hr and 25 min for stabilization and observation before discharge. Narcan was administered 70% of the time by either emergency medical services (EMS) or witnesses to the OD before the patient arrived at the ED. Drug information regarding opiates, sedatives, and stimulants was provided to patients 93% of the time. OD prevention education was provided 53% of the time. Narcan prescriptions were provided 25% of the time. Primary care provider (PCP) referrals were provided for 36% of patients, and 10% were referred to a medication-assisted therapy (MAT) treatment center. Although medication education was documented, there was no evidence found regarding specific MAT medications initiated in the ED. There were inconsistencies in what information was provided to patients at discharge. An evidence-based, standardized protocol for discharge should be identified for OD patients. This protocol should include four "gold standards," including planned follow-up with a PCP, OD prevention education, distribution of Narcan, and initiation of MAT when and where possible.

Background: The revised Clinical Institute Withdrawal Assessment (CIWA-Ar) and the Minnesota Detoxification Scale (MINDS) are two scales used to assess alcohol withdrawal symptom severity among hospitalized patients. There is a lack of data supporting the reliability of these scales in acutely ill patients.

Objective: The objective of this study was to measure the reliability of CIWA-Ar and modified MINDS (mMINDS) and the correlation of the two scales to each other.

Methods: A prospective, observational study was conducted to evaluate adult patients with an alcohol withdrawal order set within 48 hr of hospital admission at two community hospitals. During nursing hand-off, the outgoing and incoming nurse both completed a CIWA-Ar and mMINDS assessment consecutively and independently. Correlations between CIWA-Ar, mMINDS, and the two observers were calculated.

Results: A total of 114 hand-off observations were collected for 73 patients. The frequency of an "unable to assess" item resulting in an invalid total score was 34.2% with CIWA-Ar and 28.9% with mMINDS. The median scores for CIWA-Ar and mMINDS were both 6 (IQR 3 to 10) and correlated well to each other (r = .801). Correlations between the two nurse raters was moderate for both CIWA-Ar (r = .68) and mMINDS (r = .72). As withdrawal scores increased, the difference in score between nursing raters also increased for both instruments.

Conclusion: CIWA-Ar and mMINDS are moderately correlated to each other and produce similar total scores. Correlations between two nursing raters suggest similar performance in rater agreement for both instruments; however, performance diminished as withdrawal severity increased.