Educational intervention of undergraduate nursing students' confidence skills with alcohol and drug misusers

There is a paucity literature on the educational interventions and evaluation programmes in alcohol and drug with undergraduate nursing students in the United Kingdom and this study intends to add a body of knowledge to this area. The aim of the study was to assess the intervention confidence skills of undergraduate nursing students before and after an educational intervention on alcohol and drug misuse. The research study is a quasi-experimental, pre- and post-test design. The sample was made of four cohorts of undergraduate nursing students (n=110) enrolled at a course leading to a diploma or BSc in nursing from three educational institutions. A visual analogue scale was used to measure intervention confidence skills before and after the educational programme in alcohol and drug. The findings showed an improvement in the level of intervention confidence skills of undergraduate nursing students. Further research is needed to examine effectiveness of educational interventions in working with substance misusers and whether substance misuse education is the key predictor of changing in changing intervention confidence skills.

Piloting the community matron model with alcoholic homeless clients

This article describes a 13 week trial of the community matron model undertaken with homeless persons in Lambeth in early 2007. Six patients were selected for 'demand management' at a 'wet' hostel in South London. A reduction in acute service demand (A&E attendances and inpatient admissions), and an increase in Euroqol EQ-5D 'quality of life' scores were the outcome targets of the community matron intervention. The article describes what was achieved for the six patients during the 13 week pilot, and the lessons that were learned as a result of undertaking the pilot roject Recommendations for future practice are made.

Prevention and health promotion and evidence-based fields of nursing - a literature review

This paper summarizes the evidence constituting the foundation for preventive and health promotive work performed by nurses in primary care. This is a systematic literature review in six scientific databases. Forty original articles and 16 literature reviews met the inclusion criteria. After both authors independently read the articles, 25 were excluded and 15 included. One article was judged to be of high quality, five of medium quality and 10 of low quality. The articles of high and medium quality focused on alcohol counselling, coronary heart disease and diabetes. Of the 16 literature reviews from the Cochrane Library, 10 were found to be relevant and presented evidence. The subjects included smoking cessation, breast-feeding, prevention of falls among the elderly, asthma in children, diabetes and cardiovascular disease. Few studies in the area of prevention and health promotion are of adequate scientific quality, resulting in limited evidence for the effects of interventions.

Managing depressive symptoms in the context of abstinence: findings from a qualitative study of women

PROBLEM

In both community and clinical studies, higher rates of co-occurring depression and substance use disorder have been found in women. Within the past decade, there has been a plethora of research addressing co-occurring depression and substance abuse. However, comparatively few studies include individuals who suffer with depressive symptoms, which may not meet specific diagnostic criteria despite the significant impairment they may experience.

METHOD

An ethnographic method was used to elicit the experiences of women dependent on alcohol and/or other substances and who have stopped drinking and/or using.

FINDINGS

Findings corroborated those from previous studies in which depressive symptoms preceded substance abuse and continued during sustained abstinence. Separation in services between mental health and substance abuse resulted in fragmented care.

CONCLUSION

Based on these findings, recommendations for screening, assessment, and treatment implications are forwarded.

Stress, coping, and alcohol expectancies in rural African-American women

African-American women report less alcohol and other drug (AOD) use compared with Caucasian women. However, health care professionals cannot afford to dismiss AOD use as a significant problem for some African-American women. Although we know much more about AOD problems in women in general, we still lack information on AOD disorders and associated factors among rural African-American women. This article focuses on examining rural African-American women (n=142) with and without AOD disorders on the following variables: stressors, uplifts, coping, and alcohol expectancies.

Motivational interviewing with hazardous drinkers

PURPOSES

To test the effectiveness of motivational interviewing in a population of hazardous drinkers utilizing community health care centers in rural southeastern Idaho.

DATA SOURCES

This study targeted rural people at risk for alcohol dependence utilizing low-income community health care centers in rural southeastern Idaho. The Alcohol Use Disorders Identification Test (AUDIT) was used to screen interested clients' alcohol use. Clients achieving an AUDIT score indicating hazardous alcohol use were recruited into the study and randomized into a control or treatment group. Twenty-six hazardous drinkers attending five low-income community health centers participated in the study. The experimental group participated in one motivational interviewing session with the investigator, a family nurse practitioner (NP). The comparison group received no treatment. Alcohol use was tracked for 6 weeks after successful recruitment into the program.

CONCLUSIONS

Participants in the study significantly decreased their average number of drinks per day. At time 1 (pretreatment), the control group drank 4.37 drinks per day and the treatment group drank 4.65 drinks per day. At time 2 (posttest), the control group drank 3.77 drinks per day and the treatment group drank 1.95 drinks per day. The effects of the motivational interviewing treatment on hazardous drinking also were measured by serum gamma-glutamyltransferase (GGT), a liver function test. There was also a significant decrease in the GGT from pretest to posttest in the treatment group.

IMPLICATIONS FOR PRACTICE

The results of this investigation found that motivational interviewing shows promise as an effective intervention for hazardous drinkers attending low-income community clinics. Although other possible explanations could be postulated for the positive changes in sample participants, the data indicate that the motivational interviewing approach was responsible for a significant portion of the positive changes within the current sample. The information collected from the study adds to the literature on hazardous drinking, research, and treatment of this significant problem. Negotiating change in behavior is part of the practice of NPs. People struggling with alcohol use are more likely to encounter NPs, family doctors, or social workers than counselors specializing in alcohol treatment. Motivational interviewing is specifically designed for preparing people for change. Because most people resist being told what to do, that is, "you have to stop drinking," use of motivational interviewing principles can decrease resistance and optimize change. Additionally, identifying and intervening with hazardous drinking in a primary care setting can reduce healthcare costs and reduce the stigma of specialist care. Adding this valuable communication skill to the competencies of NPs is important to both clients and NPs.

Training primary care nurses to conduct alcohol screening and brief interventions in South Africa

Although progress has been made in developing a scientific basis for alcohol screening and brief intervention (SBI), training packages are necessary for its widespread dissemination in primary care settings in developing societies. Using a training package developed by the World Health Organisation 121 nurses from one rural site (29 clinics in Vhembe District) and one urban site (3 clinics and 6 mobile clinics in Polokwane/ Seshego) in South Africa were compared before and after SBI training regarding knowledge and attitudes, and the subsequent practice of SBI in routine clinical practice. Although the training effects were at times moderate, all changes were in a direction more conducive to implementing SBI. Health care providers significantly increased in knowledge, confidence in SBI and higher self-efficacy in implementing SBI at follow-up after 9 months after receiving the training. When delivered in the context of a comprehensive SBI implementation programme, this training is effective in changing providers' knowledge, attitudes, and practice of SBI for at-risk drinking.

Correlates of caregiver burden for Korean elders according to cognitive and functional status

BACKGROUND

Caregiver strain was investigated in a community sample of Korean elders with cohabiting caregivers, and factors associated with this were compared between groups classified by cognitive and functional impairment.

METHODS

The study sample consisted of 484 elders and their cohabiting caregivers resident in Kwangju, South Korea. Caregiver burden was measured by the Zarit Burden Interview. Data on the elders' socio-demographics (age, gender, education, and religion) and clinical characteristics (cognitive function (MMSE), activities of daily living (IADL), depressive symptoms, alcoholism, and physical illness), and caregivers' socio-demographic characteristics (age, gender, education, relation to elders, and current employment) and caregiving environments (living area, alternative caregiver, number of rooms, monthly income, and social network) were gathered. Participants were classified into those with (n=61) or without cognitive impairment. The second group was classified into those with (n=68) or without (n=355) functional impairment.

RESULTS

Caregiver strain was significantly associated with cognitive impairment. In the group without cognitive impairment, caregiver strain was significantly associated with participant characteristics (IADL impairment, and symptoms of depression and alcoholism). In those with cognitive impairment, caregiver strain was associated with both participant status (depressive symptoms and IADL impairment) and caregiver characteristics (a child caregiver, lower social support, and urban environment).

CONCLUSIONS

Individual mental and physical health characteristics predict caregiver strain regardless of cognitive impairment. Caregiver characteristics are most important in the presence of cognitive impairment.

[An evidence-based guideline to support HIV/AIDS patients with alcohol problems]

It is estimated that 300,000 people with alcohol problems and alcohol-related illnesses are presently living in Switzerland. Many of these are infected with HIV. Yet, the number is unknown. At the HIV outpatient department of the University Hospital in Basel, nurses are assessing patients and it is evident that alcohol intake is a serious health problem for some of them. In order to provide evidenced-based care to these patients, a clinical practice guideline was developed based on a comprehensive literature review and synthesis. The guideline has been implemented and helps nurses and other healthcare providers to effectively assess and provide a short-term intervention to those patients with HIV who have alcohol-related problems. For the assessment, two instruments are utilized: the AUDIT and the CAGE. These instruments were selected after evaluation as being the most sensitive and specific for patients in an ambulatory setting. Patients are also assessed for their readiness to change. In this article, the literature will be reviewed and the guideline introduced, as a basis for nurses and other health care providers to provide evidence-based care for HIV-infected patients who have alcohol-related problems.

Effectiveness of nurse-led brief alcohol intervention: a cluster randomized controlled trial

AIM

This paper reports an evaluation of the effectiveness and cost-effectiveness of nurse-led screening and brief intervention in reducing excessive alcohol consumption among patients in primary health care.

BACKGROUND

Excessive alcohol consumption is a major source of social, economic and health problems. However, such consumption is responsive to brief alcohol intervention. To date, brief intervention research in primary health care has focused on general practitioner-led interventions, and there is only circumstantial evidence of effectiveness in nurse-led interventions. However, nurses are increasingly taking a lead in health promotion work in primary care.

METHODS

A pragmatic cluster-randomized controlled trial was carried out between August 2000 and June 2003 to evaluate the effects of a brief intervention compared with standard advice (control condition). A total of 40 general practice clusters (intervention = 21 and control = 19) recruited 127 patients (intervention = 67 and control = 60) to the trial. Excessive consumption was identified opportunistically via the Alcohol Use Disorders Identification Test. After baseline assessment, patients received either a 5-10 minutes brief intervention using the 'Drink-Less' protocol or standard advice (control condition). Follow-up occurred at 6 and 12 months postintervention.

RESULTS

Analysis of variance weighted for cluster size revealed no statistically significant differences between intervention and control patients at follow up. A majority of patients in both conditions reduced their alcohol consumption between assessment and subsequent measurement. Economic analysis suggested that the brief intervention led to no statistically significant changes in subsequent health service resource use relative to standard treatment.

CONCLUSION

The brief intervention evaluated in this trial had no effect over standard advice delivered by nurses in primary health care. However, there was a reduction in excessive drinking across both arms of the trial over time. Due to nurse drop-out, this trial was significantly underpowered. Future research should explore barriers to nurses' involvement in research trials, particularly with an alcohol focus. A larger trial is required to evaluate the effectiveness of nurse-led screening and brief alcohol intervention in primary care.

Standardizing the Care of Detox Patients to Achieve Quality Outcomes

Providing appropriate treatment for detoxification patients is both challenging and difficult because alcohol abuse and dependence are largely underestimated in the acute hospital setting. Alcohol withdrawal syndrome is treated not only by addictionologists on chemical dependency units, but also by primary care physicians in acute inpatient settings. The need for consistent inpatient treatment through the use of identified protocols can help provide safe and effective care. The need for consistent, inpatient medical-surgical detoxification treatment in our organization became apparent with the staff's identification of patient care concerns. Using an organizational approach, a multidisciplinary team was created to standardize the care of detoxification patients, beginning with patient admission and ending with discharge and referral for outpatient management. Standardization would ensure consistent assessment and intervention, and improve communication among the clinical team members. A protocol was developed for both the emergency department and the inpatient units. The goals of the team were to decrease the adverse events related to detoxification, such as seizures and aggression, and provide a consistent method of treatment for staff to follow.

Admission Variables as Predictors of Completion in an Adolescent Residential Drug Treatment Program

PROBLEM

Understanding of the pretreatment characteristics of drug-dependent adolescents to better match clients to treatment models that serve their needs for successful recovery.

METHODS

A random sample of (N = 91) clients records were selected for this outcomes pilot. Chi-square analysis examined differences between groups and multivariate logistic regression analysis determined which variables best predicted completion status.

FINDINGS

Several admission variables were associated with noncompletion and included: fire setting, sex for drugs, or addicted parents. Variables associated with completion included: first time admission to treatment or referral to treatment by peer.

CONCLUSIONS

Findings suggest that adolescents admitted to treatment with preexisting major depression might have unique treatment needs. Peer education treatment referral systems may be viable ways to encourage adolescents with drug-dependency problems to seek treatment.

Critical ethnographic methodology in nursing research: issues and solutions

Five methodological issues were encountered in a study using critical ethnography to investigate nurses' attitudes, knowledge and practices towards patients with alcohol and drug related problems in a general hospital. These issues related to the recording of field notes, over-identification with participants, the role of being a researcher, the effect of the researcher's presence - the Hawthorne effect, and cultural differences. The latter issue was viewed from the personal perspective as an international student from Denmark conducting the research in an Australian setting. This paper discusses the issues in turn and concludes with recommendations on how they might be effectivley addressed by other researchers considering to use critical ethnography.

[Working with alcoholic patients: satisfaction of nurses at a general hospital]

It is about a psychometric study involving 171 nurses at a general hospital in the inland of São Paulo state, Brazil, and aimed at verifying these professionals' satisfaction upon working with alcoholics. The results have indicated the nurses 'feelings of confusion and discomfort upon working with people who have alcohol problems. 70% of the studied subjects have indicated that they do not work well with alcoholic patients, 80%prefer not working with them and 60% face difficulties to talk about the problem with their patients. The authors suggest in site training as a strategy to better face this issue.

Brief interventions for alcohol problems in hospital settings

Many patients present to general hospitals with alcohol-related problems, but most of them are not identified as such. This article summarises the evidence base for screening and brief interventions delivered by nurses in general hospital medical/surgical wards and A&E departments. It also suggests how screening and brief interventions can operate in these environments.

Caring for clients with dual diagnosis in rural communities in Australia: the experience of mental health professionals

This paper identifies and describes the experiences of 13 rural mental health professionals who care for clients diagnosed with a mental illness and a coexisting alcohol and other drug disorder (dual diagnosis). Dual diagnosis is a common problem which is often poorly understood and managed by mental health professionals. The effect of excessive substance use on a person's mental well-being can present as a diagnostic challenge as each condition may mask symptoms of the other. The authors utilized a phenomenological approach to discover the experiences of a group of mental health professionals working in rural communities in Victoria, Australia. Caring for clients diagnosed with dual diagnosis was found to be a complex and stressful role that involved high levels of skill and knowledge. Despite the fact that health professionals in rural areas are expected to deliver the most appropriate care to individuals with a dual diagnosis, a number of these rural health professionals have limited preparation and experience in dealing with arising clinical diagnosis issues. Clinicians experience frustration, resentment and powerlessness in their attempt to understand their clients' drug misuse whilst simultaneously endeavouring to provide a quality mental health service.

Under what circumstances are nurses willing to engage in brief alcohol interventions? A qualitative study from primary care in Sweden

To improve alcohol prevention in primary health care, it has been suggested that primary care nurses are an under-utilised resource. The aim of this study was to identify under what circumstances primary care nurses in Sweden are willing to engage in alcohol prevention. All nurses at three primary health care centres in Ostergötland, Sweden were invited to participate in focus group interviews; 26 nurses participated. The nurses considered primary health care to be just one among other sectors within the community with responsibility for alcohol prevention. The role of health care in alcohol prevention was perceived to be important but mainly secondary preventive. The nurses felt justified screening all patients' alcohol habits only when they could refer to an obligation or a time-limited project. Otherwise, they mainly wanted to engage in screening patients with alcohol-related symptoms or diagnoses and other risk groups. Reasons for refraining from alcohol screening and intervention included lack of self-efficacy, time consumption and fear of harming their relationship with the patient. New strategies for alcohol prevention in primary care are discussed.

Nursing students' personal experiences involving alcohol problems

This article discusses the views and beliefs of nursing students toward people who abuse alcohol. An original study published in a separate article [Archives of Psychiatric Nursing , (2003); (4) 17 : 156-164.] examined this relationship with both a quantitative and a qualitative design. Three open-ended questions allowed for further qualitative exploration about relationships with others who have alcohol problems and beliefs about recovery. The chronic nature of alcoholism was clearly identified by students who described it as a lifelong process. Most students (79%) expressed belief that recovery was possible whether they had personal experience with people who have alcohol problems or not. The level of optimism was surprisingly high in this sample of nursing students, especially because many had had a personal experience with someone who abused alcohol. Students come to the educational setting with a clear and accurate view of the lifelong commitment that may be needed to recover from alcohol addiction, but they also come with an overly optimistic view of recovery. How this optimism impacts future care is unknown. If nursing students hold an unrealistically positive view of recovery, they may be ill prepared to handle the disappointments associated with treatment such as relapse, interpersonal conflict, health deterioration, or other related sequelae.