Terri Ivory MSNRNC Effectively treating substance abuse among health care professionals it is important to understand the components of addiction The word addiction is often used as an umbrella term to describe a group of problems such as ID: 678261
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Substance Use, Abuse & Addiction r/t Nursing Practice
Terri Ivory, MSN,RN,C
Effectively treating substance abuse among health care professionals it is important to understand the components of addiction.
The word addiction is often used as an umbrella term to describe a group of problems such as:
drug addiction
alcoholism
substance use disorder
chemical dependence
All of these terms describe an addiction to brain-rewarding chemicals.
Addiction a cunning, baffling and powerful disease.Slide2
Substance Use, Abuse & Addiction r/t Nursing Practice
Institute for Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. P100-7/2018
Planners and Presenters have declared that they have nothing to disclose.
To successfully earn a contact hour certificate, participants must stay for the entire program and complete an evaluation form.
Institute for Nursingthe foundation of the New Jersey State Nurses Association1479 Pennington Road, Trenton, New Jersey 08618Slide3
OUTCOMESSlide4
What is Addiction?
“Drug addiction is a brain disease that can be treated.”
National Institute on Drug AbuseSlide5
Substance Use, Abuse & Addiction r/t Nursing PracticeSlide6
Substance Use, Abuse & Addiction r/t Nursing Practice
These substances, along with alcohol, can produce a feeling of pleasure, relaxation or relieve negative feelings (Feltenstein & See, 2008). As the dependence or addiction progresses the benefits of using substances decreases and more drugs or alcohol are needed to feel the same level of pleasure.
There is a genetic component that is influenced by environmental and social factors.
The National Institute of Drug Abuse estimates that genetic factors account for 40 to 60 percent of a person’s vulnerability to addiction.
The estimate includes the projected effects of environment on gene expression and function (NIDA, 2008).Slide7
Substance Use, Abuse & Addiction r/t Nursing Practice
Source: From the laboratories of Drs. N. Volkow & H. SchelbertSlide8
Substance Use, Abuse & Addiction r/t Nursing Practice
Overall risk factors, especially those that tend to make all individuals more susceptible to developing a substance use disorder have been divided into general categories.Psychological factors:
Depression
Anxiety
Low self-esteem
Low tolerance for stress Other mental health disorders (such as learning disabilities) Feelings of desperation Loss of control over circumstances in one’s life Feelings of resentmentSlide9
Substance Use, Abuse & Addiction r/t Nursing Practice
Behavioral factors:
Use of other substances
Aggressive behavior in childhood
Conduct disorder (such as anti-social personality disorder)
Avoidance of responsibilities
Impulsivity and risk-taking behavior
Alienation and rebelliousness (such as reckless behavior)
School-based academic or behavioral problems (including dropping out, involvement with the criminal justice system or the first illegal use at an early age)
Peers using alcohol and drugs
Social or cultural norms’ acceptance of alcohol and drug use
Poor interpersonal relationshipsSlide10
Substance Use, Abuse & Addiction r/t Nursing Practice
Social factors:
Condoning the use of drugs and alcohol
Expectations about the positive effects of the drugs and alcohol
Access to or an availability of drugs
Demographic factors:
Male gender
Inner city or rural residence combined with a low socio-economic status
Lack of employment opportunitiesSlide11
Are Nurse Different?Slide12
Why Nurses?
Nurses also comprise the largest group of health care professionals, therefore those who do develop issues with abuse and addiction are not only more visible, they are usually more stigmatized in the general health care population and receive more severe sanctions than physicians
(Shaw, McGovern, Angres, & Rawal, 2004).Slide13
Scope of the Addiction Among NursesSlide14
Top Four Risk FactorsSlide15
Substance Use, Abuse & Addiction r/t Nursing Practice
Family factors:
Use of alcohol and drugs by parents, siblings or spouse
Family dysfunction such as inconsistent discipline
Lack of positive family rituals and routines
Poor parenting skills
Family trauma (such as a death or divorce)
Genetic factors:
Inherited genetic predisposition to alcohol or drug dependence
Deficits in natural neurotransmitters such as serotonin
Absence of aversive reactionsSlide16
Comparison of Relapse rates of Drug Addiction vs Other Chronic IllnessSlide17
Conspiracy of Silence
Conspiracy of
Silence
This Photo
by Unknown Author is licensed under
CC BY-NC-NDSlide18
Enabling the Nurse
1. Accepting the nurse’s responsibilities and duties
2. Avoiding, withdrawing from situation
3. Denying condition, minimizing severity of problem
4. Protecting the nurse from consequences of using by lying or protecting the nurse’s image
5. Accepting nurse’s rationalizations and excuses
6. Confronting with opinions or judgments
(Quinlin,1995)Slide19
Barriers to TreatmentSlide20
Impairment!Slide21
Be aware
Physical
Slurred speech
Nodding off or Napping
Unkempt, long sleevesSmell of alcohol on breath; excess use of mints/gum/ mouthwashBe aware
Behavioral
Defensiveness
Irritability
Frequent mood swings
Increased isolation from colleaguesSlide22
Be aware Frequent, long trips alone; Unexplained absences
Frequent tardiness
Inconsistent performance
Impaired memory or attention
Excessive number of mistakesSloppy or illogical charting Slide23
Be aware “Dedicated” worker always volunteering for overtime, stays late, medicates Leaving workplace on break
Coming into work on days off
Excessive uses of PRN medications
Patients report being under medicated for pain
Narcotic discrepancies, wastes. Slide24
The Beginning
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3.6 Addresses Patient Protection & Impaired Practice Slide28
HealthCare Professional Responsibility and Reporting Enhancement Act Slide29
Why Should We Act ? Slide30
What Can We Do!!! Slide31
A Health professionals addiction is typically advanced before identification and intervention
This Photo
by Unknown Author is licensed under
CC BY-NCSlide32
Alternative to Discipline Slide33
Common Goals of Alternative to Discipline Programs
Provide for the public’s safety & welfare through the early detection, treatment & monitoring of nurses with substance use disorders (SUDs)
Decrease time between identification, entry into treatment, compliance & practice monitoring
Provide a process for nurses to recover from substance abuse disorders through a non-punitive & non-public process
NCSBN2011Slide34
Discipline
Nurses are NOT eligible to participate in ATD:Patient care negligencePatient care abusePrescription fraud
Noncompliance
with RAMP contract will lead to report to BON and disciplinary action Slide35
What Happens When a Nurse Is Reported?Slide36
Five year Monitoring Components Slide37
RAMP Return to Work
Prior to returning, the nurse must: Complete treatment
Demonstrate a strong recovery
Be compliant with program
Have an active license
Collaborative process and decision to return to work between the: Nurse, RAMP staff, peers, facilitators, therapists, healthcare providers if appropriateSlide38
The Workplace
Supervised, supportive environmentLimitations on shifts and specialty areasRestrictions on hours and overtimeNarcotic restrictionsTemporary, usually lifted between 3-6 months after starting work, based on individualDecision is collaborative process including employer
Determined for each individual nurse
Maintaining the nurse’s confidentiality is essential.Slide39
THE “MESSAGE”
Slide40
RAMP
ATD
This Photo
by Unknown Author is licensed under
CC BY-NDSlide41
Peer Assistance
Established in 1981, the Peer Assistance Program has been conducting nurse led support groups for 30 years. The peer groups are self-help, smoke free groups facilitated by a nurse who understands substance use and mental health disorders and the recovery process. Nurses in RAMP are required to attend peer group meetings weekly.
24/7 hotline:
1-800-662-0108Slide42
Contact Information
RAMP www.njsna.org 609-883-5335Director-
Terri Ivory RN MSN ext. 152
Intake Coordinator
Emily Gannon, MA, CAADC ext. 124
Case ManagersBenita James, RN ext. 134Joan Peditto, RN, BSN ext. 123William Philhower, RN, BSN ext. 113Tamara Richards, RN, BSN, ext. 121 Communications Coordinator – Annemarie Edinger ext. 115 Case Manager Assistant – Deborah Robles ext. 102Peer Assistance Hotline 1-800-662-0108
Available 24/7 and Confidential
Answered by experienced Nurse Peer LeadersSlide43
Information
NJSNA website www.njsna.orgNJ Board of Nursing http://www.njconsumeraffairs.gov/nursing/NCSBN Substance Use Disorder Forum
https://www.ncsbn.org/2106.htmSlide44
Recovery & Monitoring Program
“If we are facing in the right direction, all we have to do is keep on walking.” – Zen proverbSlide45
References
American Society of Addiction Medicine (ASAM),(2011) Public Policy Statement: Definition of Addiction. Retrieved from http://www.asam.org/for-the-public/definition-of-addiction.Anthony, J. , W. and Trinkoff, A. (1991). The Prevalence of Substance Abuse Among Registered Nurses. Nursing Research, 40 (3). 172-175.
Epstein, P. , Burns , C. , Conlon, H. A. (2010). Substance Abuse among Register Nurses. AOHN, 58 (12). 513-516.
National Institute of Drug Abuse (NIDA).(2012).
Principles of drug addiction treatment: A research based guide
(3rd ed.)(NIH Publication No (.09-4180). Retrieved from http://drugabuse.gov/podat/podatindex.htmlNational Institutes of Health. Fourth printing, 2010.; The Brain :Understanding neurobiology. ( NIH Publication No ( 00-4871). Retrieved from http://science education.nih.gov/supplements/nih2/addiction/guide/pdfs/Entire.pdf Slide46
References
National Council of State Board of Nursing (2011) Substance Use Disorder in Nursing, A Resource Manual for Guidelines for Alternative and Disciplinary Monitoring Program.Quinlan, D. (2003). Impaired Nursing Practice: A National Perspective on Peer Assistance in the U.S. Journal of Addiction Nursing (14), 149-155.Substance Abuse and Mental Health Services Administration(SAMHSA) .Results from the 2007 National Survey on Drug Use and Health: National Findings. DHHS Publication No. (SMA) 08-4343. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, September 2008, p. 71.Slide47
References
Substance Abuse and Mental Health Services Administration.(SAMSHA).(7/2011)State Estimates of Substance Use and Mental Disorders from the 2008-2009 National Survey on Drug Use and Health (NSDUH). Retrieved from http://store.samhsa.gov/shin/content/SMA11-4641/SMA11-4641.pdf