substance abuse prevention program 2011 curriculum susan dahl maryelladubreuil moira varone

Substance Abuse Prevention Program

2011 Curriculum

Susan Dahl

MaryEllaDubreuil

Moira Varone


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.


The student nurse will be able to list the risk factors for substance use disorders among nurses.

The student will be able to describe the symptoms and patterns of use for an impaired professional.

The student nurses will be able to identify, through self assessment, early detection of their own risk associated with substance use disorders.

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.

The student nurse will develop personal insight into values, attitudes, behaviors, and morals concerning substance abuse.

The student nurse will demonstrate an active effort to change personal negative attitudes and stereotypes regarding chemical dependency and the substance abuser.

Nursing educators will integrate this curriculum into the nursing school curriculum for all nursing students in RI.

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.


Evaluation


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.


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.


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 impairedUse resulting in legal problems e.g.: DUI

Persistent use of a substance despite having interpersonal problems e.g. arguments, divorce, split ups.


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.


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.


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


Attitudes

Are these people?:

Street People

Female/Male

Age

Socio-economic status

Employed/Unemployed


Attitudes

Are these people?:

Homeless

Professional/Blue Collared/Responsible Job?

Well Dressed/Scruffy?

Buy Drugs from the Street/Internet?


Attitudes

What is your experience up to date with them?

NOW CAN YOU IMAGINE THAT MEDICAL PROFFESIONALS CAN SUFFER FROM THIS

ILLNESS?


Substance Abuse Disorders in Nursing Prevalence:

General PopulationIt 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



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)



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.Psychiatric nurse are more likely to smoke.

d.There were no specialty differences for prescription drug use.

e.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)



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

Acute Stress

• Has a beginning, middle and end and you are aware of the stress.

• The stress is motivating and arousing.

Stress Response


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


Stress Response

Chronic Stress

Stress Response

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

Signs of Chronic (long term)Stress

Stress Response

HypertensionChest painBreathing difficultiesIncreased distractibilityIrritabilityCompromised immune systemDepression

Increased pain experienceMigraine headachesBackachesColitis, vomiting, diarrhea, nausea, ulcers, stomach achesWeight loss or gainSleep disturbance


Stress Response

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.


Stress Response

The 8 Laws of Self Care

By validating ourselves we promote acceptance

By validating others, we elevate ourselves

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 honoring past traumas and hurts, we allow ourselves freedom from the past that controls us.

By “doing the work” we reclaim the personal power that is rightfully ours.

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

Compassionfatigue .org


Stress Response

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


Stress Response

Stress Management Interventions

Rest. Proper Nutrition. Exercise. Spiritual /Emotional Support.


Stress Response


Restraint- what you take in your body influences performance

Set self-care goals and plan for implementation

Develop outside interests/hobbies/balance between work and leisure

Share self-care efforts with peers

Be okay with being recognized for your work

Learn to let go of work and replace it with enjoyable activities


Stress Response

Stress Management Assessment

Develop strategies to decrease stress during work hours:Peer support, Supervision, Mentors


Stress Response

Stress Management Assessment

Bodywork (partial list )Massage, Deep Muscle Relaxation, Yoga, Pilates


Stress Response


Sleep Hygiene. Meditation. Music. Aroma Therapy


Stress Response

• Aroma Therapy

• Relaxation Exercises

• Nature or Other Calming Environment

• Creative Expression

• Assertiveness Skills

• Stress Reduction Skills

• Interpersonal Communication Skills

• Time Management Skills



Stress Response

Developing Boundaries

Understanding Limitations in the ability to help/acceptance

Time

PersonalTherapeutic/Professional


Stress Response

Nurses and Substance Abuse

Personality Traits of Nurses Who Become Addicted

Compassionate, empathetic, feel responsible for others, and want to help them.CaregiversSome people have impulsive and risk taking personalitiesOften “model employees” who are high achievers and perfectionistsAs nurses we learn not to show our feelings around people and relativesSecond hand trauma

Compassion fatigueEmotionally draining environmentDon’t take care of ourselvesHigh stressNurses consider themselves invulnerable, as we have knowledge of medicationsNurses are subject to injury, lifting, turning patients leading to pain and need to control painGenetics play in addiction


Stress Response


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

What can I do as a

nurse if I suspect a co-worker is addicted to drugs or alcohol?


Stress Response

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.


Stress Response

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!

http://www.recoveringnurses.org/


Stress Response


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


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


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


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

What if I am a nurse and

think I am addicted to drugs or alcohol?


Stress Response

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 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 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

Self Screening ToolThe SHUNT Self-Survey for NursesNo 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

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

http://www.compassionfatigue.org/

http://www.nursetogether.com/

http://www.recoveringnurses.org/

substance abuse prevention program 2011 curriculum susan dahl maryelladubreuil moira varone

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