Transcript Substance Abuse Prevention Program 2011 Curriculum Susan Dahl MaryEllaDubreuil

Substance Abuse Prevention Program
2011 Curriculum
Susan Dahl
MaryEllaDubreuil
Moira Varone
Substance Abuse Prevention Program
American Nurses' Association Code of Ethics 3.6 on Addressing
impaired practice states: "Nurses must be vigilant to protect the patient,
the public, and the profession from potential harm when a colleague's
practice, in any setting, appears to be impaired. The nurse extends
compassion and caring to colleagues who are in recovery from illness
or when illness interferes with job performance."
Substance abuse prevention training and education is a crucial method
of helping to stop substance use and addiction before it starts. In an
effort to assure good patient care and safety it is important that we
provide student nurses with the skills and training to make wise
decisions and to identify and intervene when they see colleagues who
may be having issues with substance use and abuse. The purpose of
this education program is to decrease the risk factors associated with
substance use and addiction that challenges the nurses of today.
Substance Abuse Prevention Program
The student nurse will be able to list the
risk factors for substance use disorders
among nurses.
The student nurse will develop personal
insight into values, attitudes, behaviors, and
morals concerning substance abuse.
The student will be able to describe the
symptoms and patterns of use for an
impaired professional.
The student nurse will demonstrate an
active effort to change personal negative
attitudes and stereotypes regarding chemical
dependency and the substance abuser.
The student nurses will be able to identify,
through self assessment, early detection of
their own risk associated with substance use
disorders.
Nursing educators will integrate this
curriculum into the nursing school curriculum
for all nursing students in RI.
The student nurse will be able to describe
the legal, moral, and ethical implications of
an impaired professional as related to the
individual, the community, and society.
Nursing employers will have the
information and resources needed to provide
to any employee who has been identified with
a substance use disorder in their workplace.
Substance Abuse Prevention Program
Evaluation
Substance Abuse Prevention Program
Evaluation
Evaluation of the program, especially during the early stages of student
learning, should include
a. Evaluation by the instructor
of the student’s learning
progress.
b. Evaluation by the student
of his/her learning.
c. Evaluation of the
curriculum by the student and
faculty.
Substance Abuse Prevention Program
Script
We are presenting this topic today as nurses are not immune to abuse and
addiction of drugs and alcohol. We feel that if we can offer some education
on this topic it could be a means of preventing problems and will help nurses
make wise decisions for them and give some insight into when they may be
developing a problem. It may also help identify a colleague who may have a
problem thereby we can assure good patient care and safety and help for you
or another nurse.
We hope we can demonstrate why nurses are a vulnerable population for
substance abuse and addiction and decrease the risk factors involved. Nurses
are for several reasons more vulnerable than the general population, and we
will tell you why later in this talk.
But let us begin by defining both substance abuse and addiction.
Substance Abuse Prevention Program
Criteria for Substance Abuse
When there is one or more of the following in a 12 month period:
Recurrent use of a substance resulting in failure to meet obligations at
work or at home
Substance use in hazardous situations e.g. driving when impaired
Use resulting in legal problems e.g.: DUI
Persistent use of a substance despite having interpersonal problems e.g.
arguments, divorce, split ups.
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Criteria for Substance Dependence
All the above criteria plus:
Unsuccessful attempts to cut down.
Tolerance – a need for increasing amounts to reach the same effect.
When the substance is decreased or stopped there is physical
withdrawal e.g. shakes, DT’s.
Much time spent in activities to obtain the substance.
Social, occupational, and recreational activities are given up.
Substance Abuse Prevention Program
Criteria for Substance Dependence
The most important fact to remember is not how often or how much of the
substance is used but the loss of control.
For example, intending to go out and having two drinks but ending up
drinking five or using Percocet not as prescribed, but taking extra. Usually
there are elaborate excuses made to oneself or others. One of the
hallmarks of the disease is denial once again to oneself or others.
Addiction is a disease of the brain, not a matter of willpower.
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Attitudes
Factors that can affect our perception of addiction:
Let’s look now at how you know or feel about substance abuse and
addiction. Personal experience with friends family or patients, can color the
way we feel. Close your eyes for a moment.
What do you picture when I say “drug addict” or “Alcoholic “?
Let’s go through a check list
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Attitudes
Are these people?:
Street People
Female/Male
Age
Socio-economic status
Employed/Unemployed
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Attitudes
Are these people?:
Homeless
Professional/Blue Collared/Responsible Job?
Well Dressed/Scruffy?
Buy Drugs from the Street/Internet?
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Attitudes
What is your experience up to date with them?
NOW CAN YOU IMAGINE THAT MEDICAL
PROFFESIONALS CAN SUFFER FROM THIS
ILLNESS?
Substance Abuse Prevention Program
Substance Abuse Disorders in Nursing
Prevalence:
General Population
It is estimated that approximately 8.7% of the U.S. population over the
age of 12 are affected by illicit drug use. (SAMSHA, 2008)
Slightly more than half of Americans aged 12 or older reported being
current drinkers of alcohol in the 2009 survey (51.9 percent). (SAMSHA,
2009)
In 2009, an estimated 22.5 million persons (8.9 percent of the population
aged 12 or older) were classified with substance dependence or abuse in
the past year based on criteria specified in the Diagnostic and Statistical
Manual of Mental Disorders, 4th edition
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Substance Abuse Disorders in Nursing
Prevalence:
Nursing Population
The American Nurses Association estimates that 6%-8% of the
registered nurse population has a drug or alcohol-related problem,
similar to the 7-10% of the general population (Smith, 2001) and
interferes with the ability to practice nursing placing patients, the public,
organizations, the nursing profession, and nurses in harm’s way.
One study found that prescription opiate abuse was the drug of choice
for the majority of nurses. (Trinkoff and Starr, 1998)
According to a study conducted by 2 Maryland researchers the overall
prevalence of substance abuse among nurses is 32%. (Trinkoff and
Starr, 1998)
Substance Abuse Prevention Program
Substance Abuse Disorders in Nursing
Prevalence:
Nursing Population:
Among nurses working in women’s health, pediatrics, and general practice,
substance use is comparatively low.
a.
Compared with that group emergency room nurses were 3.5 times more
likely to use marijuana or cocaine.
b.
Oncology and administration nurses are twice as likely to binge drink
c.
d.
e.
Psychiatric nurse are more likely to smoke.
There were no specialty differences for prescription drug use.
The specialties with the highest prevalence of substance abuse uses are
ICU, ER, OR, and anesthesia.
f.
The availability and accessibility of medications has been linked to
substance abuse disorders among nurses. (Talbert, 2009)
Substance Abuse Prevention Program
Substance Abuse Disorders in Nursing
Prevalence:
Nurses believe erroneously that they have the ability to control their own
medication use because of their experience with administering medication
to their patients.
“Sometimes people believe they are immune to the
negative consequences of drug use because they are
familiar with drugs…nurses need to realize that they are
susceptible”.
~Trinkoff, 1998
Stress Response
Substance Abuse Prevention Program
Stress Response
Acute Stress
•
Has a beginning, middle and end
and you are aware of the stress.
•
The stress is
motivating and arousing.
Stress Response
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Stress Response
Episodic Stress
This is still acute stress that is
prolonged and increases fatigue,
but continues to be identifiable,
and thus, lends itself to
intervention and seeking out
solutions.
Stress Response
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Stress Response
Chronic Stress
This is prolonged stress that, after awhile, becomes unidentifiable to the
sufferer. Hyper arousal becomes the norm and solutions are no longer
sought. At this point every body system is at risk. Fatigue and
exhaustion are impending and total system breakdown is possible.
Physical and social functioning begins to suffer. Efficiency and
effectiveness begin to diminish and more stress results. This is a point
where a person becomes at higher risk for addictive behaviors.
Stress Response
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Stress Response
Signs of Chronic (long term)Stress
Hypertension
Chest pain
Breathing difficulties
Increased distractibility
Irritability
Compromised immune system
Depression
Increased pain experience
Migraine headaches
Backaches
Colitis, vomiting, diarrhea,
nausea, ulcers, stomach aches
Weight loss or gain
Sleep disturbance
Stress Response
Substance Abuse Prevention Program
Self Care
Understand you have the right to wellness, no matter what your role. Safe
care translates to self respect and needs to be in place before
attempting to help others.
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Substance Abuse Prevention Program
The 8 Laws of Self Care
By validating ourselves we promote
acceptance
By honoring past traumas and
hurts, we allow ourselves freedom
from the past that controls us.
By validating others, we elevate
ourselves
By “doing the work” we reclaim the
personal power that is rightfully ours.
By meeting our own physical and
emotional needs, we give care from a
place of abundance, not scarcity.
By practicing self-goodwill we
manifest it throughout our lives
By naming and taking ownership of
the core issues that limit our growth,
we celebrate authenticity.
By managing our self-care, we
welcome happiness into our lives
Stress Response
Substance Abuse Prevention Program
Regular Self-Care Assessment
 Review what you’re doing for stress reduction/relaxation
 Set goals at regular intervals
 Evaluate resources and blocks to achieving the goals
 Talk to a support person
 Activate your plan
 Evaluate weekly, monthly, annually
 Notice and appreciate any changes you’ve made
Include the STUNT Assessment
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Stress Management Interventions
Rest. Proper Nutrition. Exercise. Spiritual /Emotional Support.
Stress Response
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Stress Management Interventions
Restraint- what you take in
your body influences
performance
Share self-care efforts with
peers
Be okay with being
Set self-care goals and plan recognized for your work
for implementation
Learn to let go of work and
replace it with enjoyable
Develop outside
activities
interests/hobbies/balance
between work and leisure
Stress Response
Substance Abuse Prevention Program
Stress Management Assessment
Develop strategies to decrease stress during work hours:
Peer support, Supervision, Mentors
Stress Response
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Stress Management Assessment
Bodywork (partial list )
Massage, Deep Muscle Relaxation, Yoga, Pilates
Stress Response
Substance Abuse Prevention Program
Stress Management Interventions
Sleep Hygiene. Meditation. Music. Aroma Therapy
Stress Response
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Stress Management Interventions
•
Aroma Therapy
•
Assertiveness Skills
•
Relaxation Exercises
•
Stress Reduction Skills
•
Nature or Other Calming
Environment
•
Interpersonal Communication
Skills
•
Creative Expression
•
Time Management Skills
Stress Response
Substance Abuse Prevention Program
Developing Boundaries
Time
Personal
Therapeutic/Professional
Understanding Limitations in the ability to help/acceptance
Stress Response
Substance Abuse Prevention Program
Nurses and Substance Abuse
Personality Traits of Nurses Who Become Addicted
Compassionate, empathetic, feel
responsible for others, and want to
help them.
Caregivers
Some people have impulsive and
risk taking personalities
Often “model employees” who
are high achievers and
perfectionists
As nurses we learn not to show
our feelings around people and
relatives
Second hand trauma
Compassion fatigue
Emotionally draining
environment
Don’t take care of ourselves
High stress
Nurses consider themselves
invulnerable, as we have
knowledge of medications
Nurses are subject to injury,
lifting, turning patients leading to
pain and need to control pain
Genetics play in addiction
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Substance Abuse Prevention Program
Nurses and Substance Abuse
There are several reasons that can potentiate the issue
of substance abuse in the nursing profession:
Job Stress– long hours/stress related to caring for the sick/dying.
Job work area– you will notice in the above quote that nurses working in
ICU, ER, OR, or anesthesia have the highest prevalence of substance
abuse. These are considered VERY high stress work settings.
Easy access to medications
Workaholic personality leads to other addictions.
In general, nurses take care of others first and themselves last. This
leads to addiction to “hide” personal needs and tend to the needs of the
patients.
Stress Response
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What can I do as a nurse
if I suspect a co-worker
is addicted to drugs or
alcohol?
Stress Response
Substance Abuse Prevention Program
The worst thing you can do is NOTHING. You may be held liable if you
do nothing
Approaching the nurse directly will likely meet with resistance and denial.
Find out about your organizations policies and procedures for dealing
with chemically dependent nurses. Is an EAP available?
Consider reporting your suspicions to management or encourage your
co-worker to determine if the State Board of Nursing has a referral and
treatment program.
DO NOT feel guilty about reporting your suspicions. If you are wrong, no
harm done. But if your suspicions are correct, you have helped a fellow
nurse get his/her life back on track, have contributed to patient safety, and
have promoted the positives of the nursing profession.
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Speaking of patient safety: "Statistics indicate that employed people who
abuse substances are unreliable on the job" (Recoveringnurses.org).
Without going into more detail, this statement says it all. You owe it to your
patients to give them RELIABLE care. If you are working with an addicted
nurse, you are not being fair to your patients.
Another example? "Compared to nonusers, alcohol and illicit drug users
are more likely to have been involved in a workplace accident in the past
year." (Recoveringnurses.org) Again, think about the safety of the
potentially addicted nurse, your patients, coworkers, and YES, yourself!
Stress Response
Substance Abuse Prevention Program
Nurses and Substance Abuse
Behavior Regarding Administration of Medications
Un-witnessed waste; remember when you sign as a witness you are
stating that you actually witnessed the waste
Excessive administration of controlled substance
Discrepancies between nursing notes, medication records, controlled
drug records.
Giving medications to patients to whom they are not assigned
Patients complaining of pain in spite of supposedly having received
medication or saying they did get their pain meds
Stress Response
Substance Abuse Prevention Program
Nurses and Substance Abuse
Behavior Regarding Administration of Medications
Job Performance
Frequently late to work
Absenteeism, taking a day off sick following days off. Is there a pattern to
sick days?
Poor performance, disorganized, forgetful, making errors
Stress Response
Substance Abuse Prevention Program
Nurses and Substance Abuse
Warning sings of a nurse who might have a problem
Physical Signs
Complaints of GI symptoms
Shakiness, clumsy
Diaphoresis
Speech slurred or slowed
Drowsy
Stress Response
Substance Abuse Prevention Program
Nurses and Substance Abuse
Warning sings of a nurse who might have a problem
Behavior Changes
Mood Swings
Anxiety
Depression
Poor personal appearance
Lying
Defensive
Elaborate excuses
Stress Response
Substance Abuse Prevention Program
What if I am a nurse and
think I am addicted to
drugs or alcohol?
Stress Response
Substance Abuse Prevention Program
ASK FOR HELP Addiction is an illness. You need help in recovery.
There are organizations that can help, but not if you don't ask.
DON’T WAIT until you resort to stealing, cheating, or lying to feed your
addiction. Get help early. Your supervisors and peers will respect you for
your efforts.
PROTECT YOUR NURSING LICENSE By getting help and staying
clean, you protect what you have worked so hard to earn, in a profession
you are proud to be in!
BECOME AN ADVOCATE Help other nurses in your community with
addiction issues. (nursetogether.com)
Stress Response
Substance Abuse Prevention Program
Substance Abuse Case Presentation # 1
Jay Johnson is a 23 year old graduate of a leading school of nurse
anesthesia and presents with complaints of stress and requests something
to help him relax. He is an anesthesia practitioner working full-time and
studying for an advanced degree in the evenings. He has little time for
socialization and is currently divorced and has one child.
His parents are divorced and his father has had a chronic drinking
problem. Jay has also recently been named in litigation. He has two
brothers, one which has had frequent history of DWI and a second which
used illicit drugs while in the service.
Jay does not drink or use street drugs. He clearly states his position
as an anti-drinker and anti-drugs. He attends Al-Anon meetings every
couple of months. (Clark, 1994)
Stress Response
Substance Abuse Prevention Program
Substance Abuse Case Presentation #1
Risk Factors to Consider for this Young Adult
Exposure to drug users in social and work environments
Marital and work instability
 Unemployment
 Divorce
 Psychological or psychiatric difficulties or distress
 Low self-esteem
 Depression
 Peer support
 Substance abuse by parents
Stress Response
Substance Abuse Prevention Program
Self Screening Tool
The SHUNT Self-Survey for Nurses
No score indicates a total absence of risk, nor any certainty that anyone is, or ever will
become, chemically dependent.
YES – 1 NO - 0
Social withdrawal or self isolative behavior.
_______
Self care behaviors beneath societal, professional or the nurse’s
_______
own standards.
History of chemical dependency in the nurse’s immediate family.
_______
History of negative consequences related to the nurse’s
substance use.
_______
Untreated or unremitting emotional or physical pain.
_______
Using medication for a reason it was not intended or
In a manner not recommended.
_______
Nursing practice routinely in excess of 55 hours per week.
_______
Nursing duties include frequent access to controlled substances.
_______
Transitional period requiring major adjustment with in the past year.
_______
Turmoil or tragedy with unresolved conflict.
_______
Date: _________
Total: ________
Stress Response
Substance Abuse Prevention Program
References
Clark, G.D., (1994). A Model Didactic and Clinical Substance Abuse Curriculum
Developed for Schools of Nurse Anesthesia
Ponech, S. (2000). Telltale Signs (Cover story), Nursing Management, 31(5), 32.
Retrieved from EBSCOhost January 17, 2010.
Scimeca, P.D. (2008). Unbecoming A Nurse, The SHUNT Survey 53-4
Smith, L.L. (2001). The Role of the Nurse Manager. In National Council for State
Boards of Nursing. Chemical dependency handbook for nurse managers: A guide for
managing chemically dependent employees (pp. 21-28). Chicago: National Council
Publisher.
Talbert, J. (2009). Substance Abuse among Nurses, Clinical Journal of Oncology
Nursing, 13(1), 17-19. Retrieved from EBSCOhost January 17, 2011
Trinkoff, A. M., & Storr, C. L. (1998). Substance Use among Nurses; Differences
Between Specialties, American Journal of Public Health, 88(4), 581-585.
Retrieved from EBSCOhost January 17, 2010.
http://www. www.compassionfatigue.org accessed March, 2011
Heacock, S (2011) Nurses and Substance Abuse http://www.nursetogether.com
accessed March, 29 2011
http://www.Recoveringnurses.org accessed March 29, 2011