Pregnant and Parenting Women's Experiences with Substance Use Disorder

PURPOSE

The purpose of the study was to describe and analyze the experience of women with substance use disorder during pregnancy and parenting to inform health care services that promote recovery.

STUDY DESIGN

Interviews of pregnant or parenting women with substance use disorder were used in this qualitative descriptive study.

METHODS

Participants were recruited from two recovery centers serving pregnant or parenting women with substance use disorder. Participants called a study cellphone to speak with the researchers about their substance use and recovery. Four independent reviewers conducted thematic analysis and were facilitated by Atlas.ti qualitative analysis program.

RESULTS

N = 15 women called the study cellphone; 10 met inclusion criteria and were interviewed. Researchers coded 81 themes with the common occurrence of prior trauma, multiple substances used, stigma and judgment from others, and having children as a motivation to seeking recovery. Co-occurrence of themes of positive social support and the pursuit of recovery was identified.

CLINICAL IMPLICATIONS

Positive social support co-occurring with recovery supports the need for strengthened social support structures. Health care professionals should intentionally address the culture of caring for pregnant and parenting women with substance use disorder through education, practice, advocacy, and research.

Addiction Nursing Competencies: A Comprehensive Toolkit for the Addictions Nurse

With the increased role of nurses in caring for patients with substance addiction, there was a clear need to develop the Addiction Nursing Competencies to guide and support the nursing workforce. A literature search revealed a lack of formal instruments to assess and guide nurses in caring for persons with substance use disorders. The Addiction Nursing Competencies were created using existing nursing education frameworks and addiction nurse care manager clinical guidelines.

Caregiver Stress, Perceived Stigma and Mental Health in Female Family Members of Drug Addicts: Correlational Study

OBJECTIVE

To investigate the relationship of caregiver stress and perceived stigma with mental health in female family members of drug addicts.

METHODS

The correlational study was conducted in Lahore, Pakistan, from February to August 2017, and comprised female family members of drug addicts from various rehabilitation and health facilities of the city. A brief interview form along with Perceived Stigma of Substance Abuse Scale, Kingston Caregiver Stress Scale and Mental Health Inventory was used for data collection. SPSS 20 was used for data analysis.

RESULTS

Of the 200 subjects, 66 (33%) were daughters, 66(33%) were sisters and 68(34%) were wives of drug addicts. The overall mean age was 30.57±8.07 years (range: 21-55 years). Perceived stigma and caregiver stress were significant predictors of mental health of the subjects (p<0.05 each). Moreover, daughters, sisters and wives of drug addicts did not significantly differ with respect to perceived stigma, caregiver stress and mental health (p>0.05). .

CONCLUSIONS

Perceived stigma and caregiver stress were found to be significant predictors of mental health of female family members of drug addicts.

Screening and interventions for substance use in primary care

NPs in primary care settings are well positioned to treat substance use disorders (SUDs). SUDs affect patients across the age spectrum and may be diagnosed and treated by NPs using brief interventions and pharmacologic therapies, or patients may be referred to specialty services. This article provides guidelines for screening, brief interventions, and pharmacologic therapies.

Trafficked

This first-person narrative describes some of the barriers to caring well for patients at the intersection of human trafficking and substance use disorder. I canvass some of the ethical considerations regarding these patients' autonomy and call for establishing and using evidence-based practice to manage these complex scenarios.

Safety Fears Held by Caregivers about Relatives with Psychiatric Disorders

In this period of post-deinstitutionalization, much of the care for people with severe psychiatric disorders (PD) is provided by their families. A primary stressor for caregivers is fears regarding their own safety and that of others, which has been virtually unexplored. To fill this gap, factors in three domains were assessed: (1) relatives with PD, (2) family caregivers, and (3) interactions with each other. This investigation was a secondary analysis of data obtained from a national survey of caregivers of adults with mental illness conducted by the National Alliance for Caregiving. A subsample of 1,505 was used in the present study. Fear of harm was positively associated with the following factors: relatives with PD-serious mental health problem, alcohol and substance abuse, receipt of crisis mental health treatment, history of arrest; interaction-greater difficulty getting relative to take medications as prescribed; and fear that relative would be hurt by others or die by suicide. Social workers need to be cognizant of risk of potential violence against caregivers and ensure the safety of these family members, even if they may not be their primary clients. The article includes recommendations for family inclusion in the treatment of people with PD.

Specialized Care of Women and Newborns Affected by Opioids With a CORE Team of Nurses

Staff on a mother-baby unit of a large suburban Level II facility identified the need to provide specialized nursing care to women affected by opioids. The manager of the unit recognized inconsistencies in care and frustration expressed by women and staff. She recruited a CORE (Champion for our Opiate patients using Respectful and Relevant Engagement and Education) group of staff nurses to care for these women. CORE nurses received specialized education and resources and served as the primary nurses for women admitted to the unit with a positive urine drug screening result or a history of drug use during pregnancy. Having a CORE team has brought a consistent approach when providing care to families affected by opioids.

Nurse practitioner LEADERSHIP in face of OPIOID CRISIS

Opioid misuse has been a growing problem in Alberta and throughout Canada and the U.S. in recent years. According to Alberta Health, the number of fentanyl-related overdose deaths in Alberta rose from six in 2011 to over 300 in 2016. This alarming increase in substance abuse is a national health crisis.

Nursing Care of Women Veterans of the Iraq and Afghanistan Wars

The Iraq and Afghanistan wars are unlike earlier wars, and the women veterans who have served in them are unlike veterans of earlier wars. Now these veterans are presenting with distinctive general, genitourinary, reproductive, and behavioral health issues. When seeking health care after deployment, they may be accessing multiple health care providers across numerous sites, including the Veterans Health Administration and civilian facilities. Enhanced levels of understanding, respect, and concern for the many combat-related health challenges experienced by these veterans will help civilian nurses and other clinicians provide optimum care. Provision of health care to women veterans should be multidisciplinary and effectively coordinated among various health care providers and facilities to ensure that their post-deployment health and wellness needs are met.

[Care pathway and life course of drug-addicted patients]

Placing drug addicts, notably heroin addicts, at the centre of their care project, itself part of a life project, is the objective of the Le Lac d'Argent association in Annecy. Caregivers have been able to reflect on their practices and help to fight against preconceived ideas. This article presents the experience of a global support approach.

Substance Use Disorder: Efficacy of Educational Strategies in Delaware

BACKGROUND

Substance use disorder (SUD) is a national epidemic. The problem is underreported and gaps exist in nurses' knowledge pertaining to recognizing and reporting nurses with an SUD. The purpose of this research was to examine the effects of an educational intervention on SUD to meet the continuing education (CE) requirement for relicensure.

METHOD

A quasi-experimental pretest-posttest design was used to determine whether an increase in scores occurred following completion of the National Council of State Boards of Nursing Learning Extension's online course, titled Understanding Substance Use Disorder in Nursing. Eighty-six nurses started the online course.

RESULTS

Sixty-eight of the 86 nurses completed the online course. An increase of 22% (p < .001) was observed when pre- and posttest scores were compared, suggesting an increase in nurses' knowledge about SUD.

CONCLUSION

Online CE courses are an effective means to increase SUD knowledge for nurses. J Contin Nurs Educ. 2018;49(1):42-48.

School Nurses on the Front Lines of Medicine: Uppers and Downers: The Approach to the Student With Altered Mental Status

Although a student presenting with altered mental status due to substance use may occur infrequently in the school setting, it is of utmost importance to develop a differential diagnosis and to initiate stabilization of the student. This article describes the initial assessment and management of a student presenting with altered mental status, focusing on the differential diagnosis of altered mental status, on the varying presentations associated with common intoxications and ingestions, and on the screening tools available for the detection of depression and substance use.

Internal Consistency and Convergent Validity of the Portuguese Versions of the Global Appraisal of Individual Needs-Initial and Short Screener: Validity of the Portuguese GAIN-I and SS

The goal of this article is to present evidence on the internal consistency and convergent validity of the Brazilian Portuguese versions of the Global Appraisal of Individual Needs-"Initial" and "Short Screener" versions.

METHODS

One hundred sixty-eight individuals from an inpatient service and/or a community-based outpatient service located in São Paulo were interviewed using the Brazilian Portuguese versions of the instruments. The internal consistency of the instruments scales was computed, along with evidence for the convergent validity between corresponding subscales of the Initial and Short Screener instruments.

RESULTS

Cronbach's alpha values for both instruments' total scale scores were greater than .7. The Short Screener scales showed strong-to-moderate correlations with corresponding subscales of the Initial. The General Individual Severity Scale from the Initial and Total Disorder Screener from the Short Screener have convergent validity with each other (ρ = 0.801).

CONCLUSIONS

The Brazilian Portuguese instrument scales showed evidence for internal consistency and convergent validity performing similarly to the American English versions.

Lessons Learned After Losing my Brother to an Overdose: A Call to Action for Nurse Leaders

The current overdose epidemic we are facing in Canada and internationally calls on nursing leaders to prioritize holistic and compassionate care for people who use drugs (PWUD) and their families. Nurses are well positioned to provide person-centred care and advocate with and for this population. To do so requires an examination of one's personal values and beliefs surrounding drugs and the people who use them. As a nurse leader, I was forced to confront my views about illicit drug use following the untimely death of my brother Brad from overdose. This paper chronicles my personal experience with his death and subsequent journey into advocacy for drug policy reform amidst an emerging overdose crisis. This short paper is written from my personal perspective, and informed by both personal and professional experiences in drug policy reform. It addresses strategies for challenging stigma and opportunities for partnering with PWUD through engagement in harm reduction.

Everybody Knows Somebody

Over the course of the last two decades, much progress has been made in the approaches to the care of people with mental health and addiction challenges. Yet there is still more work to do in terms of advocacy and the provision of meaningful and effective support for these individuals.

LITERATURE SEARCH: STI SCREENING AND DRUG USE IN YOUNG PEOPLE

Alcohol and other drug use are almost synonymous with increased risky sexual activity in young people (12-25 years). There is a direct correlation between initiation into methamphetamine use and an increase in sexual risk behaviours (Hoenigl et al. 2015).

ALCOHOL, TOBACCO AND OTHER DRUGS NURSING WITHIN A CORRECTIONAL SETTING

In Australia 67% of prisoners report previous illicit drug use (AIHW, 2015) with 39% reporting high risk of alcohol-related harm. The links between effective ATOD health programs and outcomes are clearly linked to reduced recidivism (Ombudsman report, 2015) and better biopsychosocial determinates. Correctional nurses' work in challenging environments but their adaptability and passion are key to the provision of community equivalent care.

NURSING ATTITUDES TOWARDS PEOPLE WITH COMORBID SUBSTANCE ABUSE: A BRIEF REVIEW OF LITERATURE

A new study in Melbourne aims to assess knowledge, skills and attitudes of mental health nurses employed in a large mental health service. The study will use an observation as well as surveys and interviews to explore knowledge, skills, and attitude of nurses towards consumers with comorbid substance use.

POLYSUBSTANCE USE IN A TERTIARY HOSPITAL EMERGENCY DEPARTMENT IN AUSTRALIA

Alcohol and Other Drug (AOD) presentations are common in the Emergency Department (ED) especially on weekends (Parkinson et al. 2016) and the presence of AOD use can account for substantial healthcare costs (Butler et al. 2016).

Dimensions of Culture Care for Substance-Dependent African American Women

Substance abuse, now in epidemic proportions in many cultures, is of major concern nationally and transculturally. It is important for nurses and other health care providers working with an increasingly multiculturally diverse client population to understand the cultural implications of caring for clients with alcohol and drug dependence. The purpose of this ethnonursing research study was to discover meanings and expressions of care for substance-dependent African American women in the research context of an inner-city transitional home. A convenience sample of 12 key and 18 general participants was included in this study. The study was conceptualized within Leininger’s culture care theory. Ethnonursing techniques of participant observation and focused in-depth interviews were used to collect data. Results included four universal care themes discovered in this study. Gender/cultural-specific care needs in relation to social structure, ethnohistory, and cultural context were discovered to influence the women’s health/well-being as they moved through recovery.

Efficacy of Therapeutic Touch in Treating Pregnant Inpatients Who Have a Chemical Dependency

Chemical dependency is known to complicate about 3.8% of pregnancies in Vancouver, British Columbia, Canada. In this study, 54 English-speaking, hospitalized women were randomly assigned to receive either (a) daily Therapeutic Touch over a 7-day period for 20 minutes each day, (b) shared activity with a registered nurse for 20 minutes over a 7-day period, or (c) standard ward care. Anxiety was measured using Spielberger’s State-Trait Anxiety Inventory. Withdrawal symptoms were measured using a standardized Symptom Checklist. Anxiety scores were significantly less on Days 1, 2, and 3 (p < .05) for the group receiving Therapeutic Touch. Therapeutic Touch may be of value as an adjunctive measure in the treatment of chemical dependency among pregnant women.

Substance misuse: can midwives really make a difference?

Substance misuse makes a woman vulnerable. During pregnancy, in particular, the issues surrounding Substance misuse and its treatment are very emotive. Pregnancy often prompts women who substance misuse to seek help for their addiction for the first time, but for some it is part of a cycle of failure and loss: failure at rehabilitation and facing the loss of yet another child, be it through child protection issues or from the medical complications of addiction. As a midwife only engages with a woman for a relatively short period of time, can their actions have a lifelong impact on the woman and her unborn child? This article aims to examine the stigma of substance misuse and the role a midwife plays, not just as a maternity care provider but also in the continued journey of the woman and her child.

[Pathway of a patient within a healthcare unit]

Care in prison must be based as much as possible on the model used for the general population. The system of psychiatric care in prisons comprises three levels of provision. The presentation of the pathway of a young patient with severe mental disorders shows the possibilities and the difficulties involved in caring within a healthcare unit.

The role of nurses in comprehensive care management of pregnant women with drug addiction

Drug addiction during pregnancy is a complex health and social issue that requires an interdisciplinary health care team providing nonjudgmental, comprehensive care. Critical challenges include onset of and attendance at prenatal care, potential obstetric complications, transition to extrauterine life and potential neonatal abstinence syndrome for the neonate, newborn feeding issues, postpartum depression and risk of relapse for women.

The Utility of Magnetic Resonance Spectroscopy for Understanding Substance Use Disorders: A Systematic Review of the Literature

The aim of this article is to present a systematic review of magnetic resonance spectroscopy (MRS) studies of substance use disorders. As a noninvasive and nonionizing imaging technique, MRS is being widely used in substance abuse research to evaluate the effects substances of abuse have on brain chemistry. Nearly 40 peer-reviewed research articles that focused on the utility of MRS in alcohol, methamphetamine, 3,4-methylenedioxymethamphetamine, cocaine, opiates, opioids, marijuana, and nicotine use disorders were reviewed. Findings indicate inconsistencies with respect to alterations in brain chemistry within each substance of abuse, and the most consistent finding across substances was decreased N-acetylaspartate and choline levels with chronic alcohol, methamphetamine, and nicotine use. Variation in the brain regions studied, imaging technique, as well as small sample sizes might explain the discrepancies in findings within each substance. Future well-designed MRS studies offer promise in examining novel treatment approaches in substance use disorders.