Picot Statement For Nursing

Over the years, substance abuse in the United States has become a persistent issue affecting many individuals. In 2008, it was estimated that 17.8 million Americans over the age of 18 where substance dependent (Epstein, Burns, & Conlon, 2010). Many of these individuals being affected are nurses. Ponech (2000) stated that "approximately 10% of the nursing population has alcohol or drug abuse problems, and 6% has problems serious enough to interfere with their ability to practice" (as cited in Talbert, 2009, p.17). Studies show that nurses have a 50% higher rate of substance abuse compared to the rest of the public (Epstein et al., 2010). Among the many factors that contribute to the nurse’s issue of substance abuse,

I believe to design a study in which my pico question can be addressed is very easy to perform. I performed a data based search using the terms central line, dressing change and risk of infection. The data based showed more than hundred results of study focusing on the topic of infection control in patient with central line.

A psychiatrist in a methadone clinic in Northeast Washington, D.C. works with patients who are addicted to drugs. Some of her patients suffering from addiction

Prescription opioid abuse not only affects the abusers, but it also affects the families of abusers. An example of this is a women named Erin Daly. She wrote a personal narrative story about her experience after her teenage brother overdosed on opioids. Erin gave up her career as a legal reporter to research for an answer on why opioid addiction is becoming a widespread problem in adolescents and young adults. Finally, Erin got ahold of her brother’s journal and saw how his problem that started with gateway drugs, then to prescription opioids from the street, and ended in a lethal overdose of IV heroine. Erin Daly wrote, “ In 2011, 4.2 million Americans ages 12 or older reported using heroin at least once in their lives, and like my brother,

America has a major problem with opioid addicts, and many facilities are helping the addicts by providing safer options to taking the drugs their bodies crave. Methadone clinics are places where people addicted to opioids can receive medicine-based therapy. Opioid use, drugs such as heroin, morphine, and prescribed painkillers, has increased in the US with all age groups and incomes. People become addicted to these drugs when they are prescribed, recreationally used with other addicts, or they are born addicted. Many health institutions are addressing this issue with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted

The specific prevalence of substance abuse among nurses seems to be up for discussion and thus far there hasn't been any factual irrefutable evidence (Chait, J., p.2). Although, “it has been estimated that ten to fifteen percent of all nurses in the United States are addicted to some type of illegal or controlled substance" (Heacock, S., 2013, p.1). Nauert believes that the incidence of substance abuse among nurses, and nursing students, is both under-researched and under-reported(2011). New research suggests as many as ten to twenty per cent of nurses and nursing students may have substance abuse and addiction problems (Nauert, R., 2011, p.1).

There are three predominate forms of Medication Assisted Treatment (MAT) that have proven effective in combating opioid use disorder. Methadone, buprenorphine, and naltrexone have all shown to be effective in the treatment of substance use. When prescribed and monitored properly, MAT has been shown to reduce illicit drug use and reduce the rate of accidental overdose. However, while as many as 2.5 million people are suffering from substance use disorder, less than 40% have access to MAT

It is no secret that the United States is currently experiencing a shortage of nurses . “The U.S. Department of Labor, Bureau of Labor Statistics ( 2009 ) estimated that more than one million new and replacement nurses will be needed by 2018 to meet the increased demands of the health care workforce” (). The stressful conditions under which nurses work, due in part to the nursing shortage, are among the risk factors that contribute to nurses’ abuse of illicit drugs and alcohol. Nurses are unique in that they work in an environment where they not only have access to controlled substances, but also are exposed to critically ill patients, traumatic situations, death and dying, the stress of which can increase the risk of substance abuse. (Epstein, Burns, & Conlon, 2010). Unfortunately, it is the patient that suffers the most.

In the United States, there has been upward swing of opioid abuse over the past decade. Overdose deaths involving opioids – both prescription pain relievers and heroin – almost quadrupled between 1999 and 2014. Well-intentioned efforts to curb prescription opioid abuse have yielded new policies with unfortunate, unforeseen consequences for the 15% of the US population that suffer from chronic pain – nearly 45 million people.

There are a variety of treatment modalities, both conservative and emerging, that clinicians, therapists, and doctors use to treat heroin and opioid dependence. Cognitive behavioral therapy (CBT), motivational interviewing (MI), 12 step programs, and acceptance and commitment therapy (ACT) are just a few that have been used in the past, and even today, in the treatment of substance dependence. Medication-assisted treatment (MAT) is yet another form of therapy; particularly for opioid and heroin dependence, that has been around for decades. However, it has recently begun to spark interest and controversy in light of the growing epidemic.

According to the SAMHSA (2010) report on the national survey on drug use and health almost 22.5 million people are reported to be associated with substance abuse disorder (SAMHSA, 2010). This illness was found to be very common in all age groups, both sex, and seniors. There are several effects on these individuals and their families. Many people who suffer from substance abuse disorders fail to acknowledge these serious consequences. First of all, no response of pain relief can be seen with smaller doses of pain medications, as their bodies are used to high levels of various substances at the same time. Nurses become frustrated when they try to treat and help these patients with pain. Sometimes it is difficult to think about ethical principles when nurses have to deal with such patients with pain and suffering.

Part of this team are pharmacy interns who distribute naloxone (Narcan) rescue kits to the patient every saturday morning. The naloxone rescue kits were donated by the Steve Rummler Hope Foundation. The Steve Rummler Hope Foundation partnered with HCMC with a mission to heighten awareness of the dilemma of chronic pain and the disease of addiction and to improve the associated care process.4 The pharmacy intern spends about fifteen minutes educating the patients on signs and symptoms of opioid overdose, how to respond and how to use the naloxone rescue kits. This program has been successful with distribution of a total of 150 kits as of October of 2016. In addition, patients often provide success stories of occasions when they saved the lives of a loved one or a friend using the naloxone rescue

Roughly 100 million Americans suffer from chronic pain with an annual cost of $600 billion dollars in health care and a limited number of pain specialist physicians (Harle, et al., 2015). The conditions require the daily use of opioid medications which are being prescribed by primary care providers and providers in the ED. Along with multiple prescribers of opioid medications, the number of prescriptions for these medications has quadrupled from 1999-2013 in correlation with an increase in deaths related to opioid use (Greenwood-Ericksen, Poon, Nelson, Weiner, & Schuur, 2016). The significant increase of opioid related deaths and complications is commonly being referred to as the prescription opioid epidemic and to blame for the most unintentional deaths in the US (Smith, et al., 2015). Though responsible for administering and prescribing opioids to provide pain management, nurse practitioners in the ED have limited patient history and are placed under time constraints. Improved education regarding pain management, clinical practice guidelines and the use of resource tools like the Prescription Drug Monitoring Programs (PDMP) have been proven effective for reducing opioid related complications (Greenwood-Ericksen et al.,

Many people have turned to substance abuse or experience chemical dependency for a variety of reasons. Nurses experience chemical dependency as well. According to Kunyk (2013), “healthcare professionals, including nurses, are also potentially vulnerable to substance use disorders regardless of any special knowledge, skills or insights they might have owing to their education and professional experiences” (p. 54). This paper will define what chemical dependency is, report causes of chemical dependency in nurses, describe behaviors associated with chemical dependency, and explain what needs to be done upon reentry into the work place.

Various levels of governments in different communities across North America have initiated programs to deal with the opioid epidemic and its effect. Some of these initiatives will be examined in more details below.