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Balmuth EA, Iyer S, Scales DA, Avery J. Perspectives and Recommendations from Hospitalized Patients with Substance Use Disorders: A Qualitative Study. J Gen Intern Med 2024:10.1007/s11606-024-08745-3. [PMID: 38698295 DOI: 10.1007/s11606-024-08745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/25/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Individuals with substance use disorders (SUDs) are hospitalized in growing numbers. Stigma is pervasive among their hospital providers, and SUD management during medical admissions is often inadequate. However, little is known about how these patients perceive their care quality. In particular, few studies have explored their positive care perceptions or recommendations for improvement. OBJECTIVE To explore perspectives on positive aspects, negative aspects, and consequences of care, as well as recommendations for improvement among hospitalized patients with SUDs. DESIGN AND PARTICIPANTS We conducted semi-structured, in-depth bedside interviews (n = 15) with patients who have been diagnosed with a SUD and were admitted to medical or surgical floors of an urban academic medical center. APPROACH Interviews explored patients' hospital experiences and recommendations for improvement. The interviews were audio-recorded, transcribed verbatim, and imported into NVivo software. Two reviewers independently coded the transcripts using interpretative phenomenological analysis and inductive thematic analysis according to grounded theory, and recurring themes were identified from the data. Patients' demographic and clinical data were analyzed with descriptive statistics. KEY RESULTS Perceived clinical and emotional proficiency were the most important components of positive experiences, whereas perceived bias and stigmatized attitudes, clinical improficiency, and inhumane treatment were characteristic of negative experiences. Such care components were most consequential for patients' emotional well-being, trust, and care quality. Recommendations for improving care included specific suggestions for initiating and promoting continued recovery, educating, and partnering in compassionate care. CONCLUSIONS Hospitalized patients with SUDs often experience lower quality and less compassionate care linked to pervasive stigma and poor outcomes. Our study highlights under-recognized perspectives from this patient population, including socioemotional consequences of care and recommendations grounded in lived experiences. By striving to advance our care in accordance with patients' viewpoints, we can turn hospitalizations into opportunities for engagement and promoting recovery.
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Affiliation(s)
| | - Sonali Iyer
- Weill Cornell Medical College, New York, NY, USA
| | - David A Scales
- Department of Medicine, Division of General Internal Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
| | - Jonathan Avery
- Department of Psychiatry, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
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Pinchess C, Pauli R, Tully J. Knowledge and attitudes about conduct disorder of professionals working with young people: The influence of occupation and direct and indirect experience. PLoS One 2023; 18:e0292271. [PMID: 37768972 PMCID: PMC10538712 DOI: 10.1371/journal.pone.0292271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Knowledge and attitudes of professionals both pose a potential barrier to diagnosis and treatment of mental disorders. However, knowledge and attitudes about conduct disorder in professionals working with young people are poorly understood. Little is known about the impact of occupation, direct and indirect (training and education) experience, or the interrelationship between knowledge and attitudes. METHODS We conducted an online survey of 58 participants, including Psychology Staff, Teaching Staff, Care Staff, and Other Non-Clinical Staff. A questionnaire comprising three subscales (causes, treatments, and characteristics) measured knowledge. A thermometer scale measured global attitudes. Open-ended response measures were used to measure four attitude components: stereotypic beliefs (about characteristics), symbolic beliefs (about the holder's traditions), affect, and past behaviour. Primary analysis explored the impact of occupation, direct experience, and indirect experience on outcome measures. A secondary exploratory analysis was conducted to explore the relationship between knowledge and attitudes. RESULTS Psychology Staff had significantly more favourable global attitudes (F = 0.49, p = 0.01) and symbolic beliefs (F = 0.57, p = 0.02) towards those with conduct disorder than Teaching Staff; there were no other significant group differences in attitudes. Psychology staff had more knowledge about conduct disorder than other groups, though the differences were not significant. Direct and indirect experience were associated with greater knowledge (direct: d = 0.97, p = 0.002; indirect d = 0.86, p = 0.004) and favourable global attitudes (direct: d = 1.12, p < 0.001; indirect: d = 0.68, p = 0.02). Secondary exploratory analyses revealed significant positive correlations between: all knowledge variables with global attitudes; total knowledge with past behaviour; and affect and knowledge of causes with past behaviour. CONCLUSIONS Psychology-based staff may have more favourable attitudes towards children with conduct disorder than teachers, primarily due to direct and indirect experience with the disorder. Our sample may have been too small to detect overall or within-group effects of knowledge or attitudes, however exploratory analyses showing a positive correlation between knowledge and attitudes suggest education may be critical in supporting teachers and other groups in their approaches to this challenging group of young people.
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Affiliation(s)
- Chloe Pinchess
- Centre for Forensic and Family Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Clayfields House, Nottinghamshire County Council, Nottingham, United Kingdom
| | - Ruth Pauli
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - John Tully
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottinghamshire Healthcare NHS Trust, Nottingham, United Kingdom
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3
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Wyler H, Maisch A, Berger T, Kieser U, Schleifer R, Liebrenz M. Alcohol use disorder and disability insurance in Switzerland: the attitudes and views of lawyers, insurance medical experts, and addiction-specialist therapists. Subst Abuse Treat Prev Policy 2022; 17:69. [PMID: 36303216 PMCID: PMC9615404 DOI: 10.1186/s13011-022-00495-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND According to a landmark decision by the Swiss Federal Supreme Court, people with a substance use disorder (SUD) are now eligible for disability benefits if their disorder impairs their ability to work. Alcohol use disorder (AUD) is one of the most common SUDs in Switzerland and is associated with high societal and economic costs. This study aimed to gain an in-depth understanding of the views of professional stakeholder groups regarding AUD and their opinions on the new legal precedent. METHODS Swiss social insurance lawyers, insurance medical experts, and addiction-specialist therapists (N = 79) answered an online questionnaire. Due to violations of the assumption of normality, non-parametric tests are reported in most cases. RESULTS Therapists held significantly higher regard for patients with AUD than both lawyers and insurance medical experts. All three groups strongly supported a disease view of AUD but agreed significantly less that it was a disease like cancer, suggesting that AUDs might be seen as at least partially self-inflicted. Overall, moralist views of AUD received considerably less support than the disease view, with lawyers agreeing with moralist views more than therapists. All groups were well-informed and largely supportive about the new legal precedent. When asked about stipulating participation in medical treatment to mitigate damages associated with a claim, attending therapy was supported the most amongst the groups (80% of participants felt this was somewhat or fully appropriate), followed by a reduction in drinking quantity (58%), and abstinence (18%). In all three groups, we identified associations between certain views and opinions on AUD and support for the new legal precedent. CONCLUSIONS Whilst there were differences between the stakeholder groups in their regard for and views of AUD, all three adopted a clear harm-reduction approach with respect to measures to mitigate damages associated with the insurance disability claim. A possible connection of this stance with the Swiss national drug policy in recent years is discussed together with limitations of the study and practical implications of the findings.
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Affiliation(s)
- Helen Wyler
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Anja Maisch
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Thomas Berger
- grid.5734.50000 0001 0726 5157Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ueli Kieser
- grid.15775.310000 0001 2156 6618Institute for Legal Studies and Legal Practice, University of St. Gallen, St. Gallen, Switzerland
| | - Roman Schleifer
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Michael Liebrenz
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
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Nurses' Practices With Persons Experiencing Opioid Use Disorder: A Narrative Literature Review. J Addict Nurs 2022; 33:3-12. [PMID: 35230055 DOI: 10.1097/jan.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Millions of persons globally use opioids, and more than two million persons in the United States report having opioid use disorder (OUD). Increases in overdose deaths associated with opioids have led to a declaration of an opioid epidemic in the United States. Many healthcare professionals are involved in the treatment of persons experiencing OUD; several discipline-specific (e.g., medicine and public health) interventions are available. Nurses comprise large portions of the global and national healthcare workforces; therefore, investigating their unique, disciplinary contributions for addressing the opioid epidemic is warranted. This narrative literature review was undertaken to understand nurses' actions, practices, and work with persons with OUD. Using several databases and keywords, 21 research studies met the inclusion criteria. Most studies used qualitative designs; most quantitative studies were nonexperimental. The studies were conducted mostly in Europe and North America. Descriptions of nurses' practices with people with OUD varied in their levels of specificity and aligned well with the scopes of practice outlined by the American Nurses Association and the International Nurses Society on Addictions. The absence of theories (specifically nursing theories) used in the studies was notable. Theoretically informed studies that move beyond descriptions of nurses' practices are needed to advance discipline-specific knowledge and to showcase the unique contributions of nurses who make significant contributions to lessening adverse outcomes associated with OUD.
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Lucero Jones R, Fife ST, Cravens JT. Contextual Factors’ Impact on the Reception of Substance Use Disorder Treatment Language: An Interpretative Phenomenological Analysis. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2021.1917323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rebecca Lucero Jones
- Department of Community, Family and Addiction Sciences, Texas Tech University, Lubbock, Texas, USA
- Department of Human Development, Family Studies, and Counseling, Texas Woman’s University, Denton, Texas, USA
| | - Stephen T. Fife
- Department of Community, Family and Addiction Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Jason T. Cravens
- Department of Human Development, Family Studies, and Counseling, Texas Woman’s University, Denton, Texas, USA
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Patel K, Bunachita S, Agarwal AA, Lyon A, Patel UK. Opioid Use Disorder: Treatments and Barriers. Cureus 2021; 13:e13173. [PMID: 33717718 PMCID: PMC7938868 DOI: 10.7759/cureus.13173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 01/15/2023] Open
Abstract
Over the last decade, opioid use around the world has risen considerably and is projected to continue to rise at an alarming rate. As opioid use rises, so too does the number of people who suffer from opioid use disorder (OUD) and opioid overdose-related deaths. As science and medicine progresses, new medications and therapies have arisen in order to help treat patients suffering from addiction. Treatment can be split into two main domains: pharmacological and non-pharmacological. Buprenorphine and methadone, currently the most prescribed medications for patients suffering from OUD, have been shown to be extremely effective in clinical trials but have significant real-world limitations. Geographical disparities between various locations, physician stigma with prescribing these medications, and training required to prescribe medication can make access to these treatments difficult for patients. Non-pharmacological interventions have also been shown to help with limited efficacy when combined with pharmacological interventions. However, the time and resources required to implement these strategies may be a difficult barrier to overcome. In this review, we assess pharmacological interventions, non-pharmacological treatments, examine barriers to treatment for patients, and propose solutions to bypass these barriers.
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Affiliation(s)
- Karan Patel
- Medicine, Cooper Medical School, Camden, USA
| | | | | | - Aaron Lyon
- Medicine, Brigham Young University-Idaho, Rexburg, USA
| | - Urvish K Patel
- Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
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James JR, Marolf M, Klein JW, Blalock KL, Merrill JO, Tsui JI. Staff Attitudes toward Buprenorphine before and after Implementation of an Office-Based Opioid Treatment Program in an Urban Teaching Clinic. Subst Use Misuse 2021; 56:1569-1575. [PMID: 34282999 DOI: 10.1080/10826084.2021.1928206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Improving access to buprenorphine treatment is necessary to address the national opioid use disorder (OUD) crisis. This study investigates attitudes about buprenorphine prescribing among staff at a primary care clinic and compares attitudes before and after implementation of an office-based opioid treatment (OBOT) program. METHODS Providers and staff in an academic primary care clinic were surveyed prior to and one year following implementation of an OBOT program. Descriptive statistics, Pearson's Chi-2 tests and logistic regression models were used to compare staff and provider attitudes about use of buprenorphine for OUD and to compare attitudes before and after OBOT implementation. RESULTS At baseline, 20% of staff indicated strong belief that buprenorphine is an effective treatment for OUD and 16% indicated strong belief that primary care providers should prescribe it. Staff appeared less likely than providers to believe strongly that buprenorphine is effective (OR 0.24, 95% CI= 0.08-.78, p = 0.02; aOR 0.28, 95% CI=.08-1.0, p = 0.05 adjusted for age, race and gender). Following implementation of an OBOT program, the percentage of staff who believed strongly in the effectiveness of buprenorphine for OUD increased from 20% to 40% (p = 0.31), and the percentage who believed that primary care providers (PCPs) should prescribe it increased from 16% to 30% (p = 0.52). CONCLUSIONS Staff in a primary care clinic were less likely than providers to believe in the effectiveness of buprenorphine treatment or that PCPs should prescribe it for OUD. That their beliefs substantially changed after implementation of an OBOT program suggests that direct experience impacts attitudes.
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Affiliation(s)
- Jocelyn R James
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Marissa Marolf
- Department of Medicine, University of Washington Internal Medicine Residency Program, Seattle, Washington, USA
| | - Jared W Klein
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Kendra L Blalock
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Joseph O Merrill
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Judith I Tsui
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA
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Williams R, Farquharson L, Rhodes E, Dang M, Butler J, Quirk A, Baldwin DS, Crawford MJ. Impact of Substance Use Disorder on Quality of Inpatient Mental Health Services for People With Anxiety and Depression. J Dual Diagn 2021; 17:80-93. [PMID: 33048661 DOI: 10.1080/15504263.2020.1825892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: Substance use disorders are commonly comorbid with anxiety and depressive disorders and are associated with poor treatment outcomes. The mechanisms underlying this association remain unclear-one possibility is that patients with anxiety/depressive disorders and substance use disorders receive poorer treatment. Concerns have been raised about the quality of inpatient care received by patients with substance use disorders. The purspose of this research was to examine the quality of care received by inpatients with an anxiety or depressive disorder, comparing subgroups with or without a comorbid substance use disorder. Methods: This was a retrospective case-note review of 3,795 patients admitted to inpatient psychiatric wards in England. Data were gathered on all acute admissions with anxiety/depressive illness over a 6-month period, for a number of measures of quality of care derived from national standards. Association of coexisting substance use disorders with a variety of quality of care outcomes (relating to assessment, care planning, medication management, psychological therapies, discharge, crisis planning, and follow-up) was investigated using multivariable regression analyses. Results: In all, 543 (14.3%) patients in the study had a secondary diagnosis of a substance use disorder. Patients with substance use disorders were less likely to have had care plans that were developed jointly (i.e., with input from both patient and clinician; odds ratio [OR] = 0.76, 95% confidence interval [CI] [0.55, 0.93], p = .034) and less likely to have had their medication reviewed either during the admission (OR = 0.83, 95% CI [0.69, 0.94], p = .030) or at follow-up after discharge (OR = 0.58, 95% CI [0.39, 0.86], p = .007). Carers of patients with substance use disorders were less likely to have been provided with information about available support services (OR = 0.79, 95% CI [0.57, 0.98], p = .047). Patients with substance use disorders were less likely to have received adequate (at least 24 hours) notice in advance of their discharge (OR = 0.72, 95% CI [0.54, 0.96], p = .033), as were their carers (OR = 0.63, 95% CI [0.41, 0.85], p = .007). They were less likely to have a crisis plan in place at the point of discharge (OR = 0.85, 95% CI [0.74, 0.98], p = .044). There was also strong evidence that patients with substance use disorders were less likely to have been referred for psychological therapy (OR = 0.69, 95% CI [0.55, 0.87], p = .002). Conclusions: We found evidence of poorer quality of care for inpatients with anxiety and depressive disorders with comorbid substance use disorders, highlighting the need for more to be done to support these patients. Discrepancies in care quality may be contributed to the poor treatment outcomes experienced by patients with substance use disorders, and strategies to reduce this inequality are necessary to improve the well-being of this substantial patient group.
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Affiliation(s)
- Ryan Williams
- Imperial College London & College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Lorna Farquharson
- University of East London & College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Ellen Rhodes
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Mary Dang
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Jessica Butler
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Alan Quirk
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - David S Baldwin
- University of Southampton, Southampton, UK & College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Mike J Crawford
- Imperial College London & College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
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Kruis NE, Merlo AV. A Preliminary Assessment of Stigma in Law Enforcement Officers’ Responses to Opioid Overdoses. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620974076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prior work has suggested that provider-based stigma of substance use disorders may be one barrier to fighting the opioid epidemic. However, to date, provider-based stigma has been afforded little attention in the context of the criminal justice system. The goal of the current study was to extend this line of research by examining the impact of provider-based stigma toward opioid using persons to beliefs about help that should be provided to persons experiencing an overdose among a sample of 208 police officers working in departments in the Northeastern Region of the United States. In addition, this study explores the relationship between provider-based stigma and the anticipated on-duty behavioral responses to opioid overdoses. Results from multivariable analyses indicate that certain dimensions of social stigma are significantly related to officers’ perceptions of help in varying directions, along with officers’ experiences with naloxone administration and departmental policy pertaining to the use of naloxone.
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Shedding Light on the Barriers to Providing Quality Nursing Care for Patients With Substance Abuse: A Qualitative Content Analysis. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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A Biopsychosocial Approach to Analyzing Inpatient Falls. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Solberg H, Nåden D. It is just that people treat you like a human being: The meaning of dignity for patients with substance use disorders. J Clin Nurs 2019; 29:480-491. [PMID: 31738471 DOI: 10.1111/jocn.15108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/02/2019] [Accepted: 11/09/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Patients who suffer from substance use disorder (SUD) might receive services from different service providers in an opioid maintenance treatment programme (OMT) and have a widespread and complex need for nursing. BACKGROUND Literature reveals that prejudices against people with SUD exist. There is a lack of studies exploring patients with SUD experiences of preserving their dignity in the encounter with healthcare staff. The aim of the study was to gain insight into the meaning of dignity for patients with SUD. METHODS The research design was descriptive and interpretative. In the interpretation of qualitative in-depth interviews with six patients, a hermeneutical approach based on Gadamer (Truth and method, Sheed & Ward, London, UK, 1989) was used. RESULTS Analysis resulted in three mains themes about the meaning of dignity: (a) The material dimension. (b) To be respected by others. (c) The inner experience. Factors enhancing dignity in the encounters were as follows: (a) Being respected and acknowledged. (b) Being cared for. (c) Knowledge and persistent relation. Factors depriving dignity were as follows: (a) Stigma and prejudice. (b) Insufficient relations and lack of confirmation. (c) Experiencing disrespectful/patronising attitudes and lack of knowledge. CONCLUSIONS The material dimension of dignity containing an aesthetically aspect was important for these patients. Dignity was also experienced as strongly connected to respect. Dignity can be enhanced by treating patients with SUD with understanding and respect, and dignity can be inhibited through stigmatization of patients with SUD, as well as by caregivers' lack of knowledge. RELEVANCE TO CLINICAL PRACTICE The study clarifies a need for more knowledge about SUD among healthcare staff, as well as promotes ethical awareness in encounters with patients regardless of their background.
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Affiliation(s)
- Hege Solberg
- Inland Norway University of Applied Sciences, Elverum, Norway
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13
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Heckroth A, Pludra V, Johannssen C, Guest C, Wiedermann F, Bantel C. The influence of personal values and patient intoxication on nurses concerns about opioids: results of a prospective cross-sectional multi-centre study. Br J Pain 2019; 15:40-53. [PMID: 33628441 PMCID: PMC7882770 DOI: 10.1177/2049463719880333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Nurses are the main administrators of opioids in hospitals and enjoy some autonomy when using them to manage pain. Nevertheless evidence suggests they exercise this freedom restrictively with the reasons for this self-limitation remaining unclear. Nurses are influenced by personal and professional values and by patients’ attributes. Intoxicated patients pose a particular challenge. This study therefore investigated whether cautious attitudes towards opioids were aggravated in intoxicated patients and influenced by personal values. Methods: A two-version questionnaire was developed. Each presented a case vignette describing a patient in acute pain who was either intoxicated or not intoxicated. Questionnaires contained identical case statements inquiring about concerns regarding opioids, preferred analgesics and statements about opioids and personal values. They were distributed prospectively in a cross-sectional, multi-centre design. Equal distribution of both questionnaires was achieved through randomization of wards. Regression analysis was employed to determine predictors for responses to the case statements. Results: In total, n = 374 (26%) nurses returned questionnaires, 85% were female, 39% worked in surgery and 64% had >10 years experience. A total of 78% were concerned using opioids in the intoxicated patient and 70% preferred non-opioids instead. Most nurses agreed familiarity with an opioid gives them more confidence and they were more concerned in patients with a history of drug abuse. They neither associated opioids with helping patients to die nor with drug abuse. The majority endorsed value statements representing ‘universalism’, ‘hedonism’ and ‘benevolence’ while disagreeing with ‘power’ and ‘stimulation’. Nurses concerns were predicted by values indicating ‘conformity’ and ‘achievement’. Conclusion: Nurses were concerned giving opioids to intoxicated patients and preferred non-opioids instead. These concerns were predicted by personal values representing ‘Conservation’ (‘conformity’) and ‘Self-Enhancement’ (‘achievement’). Therefore, stigmatizing mental models likely contribute to nurses’ reluctance to use opioids. Interestingly, personal ambition might protect nurses from discriminatory thoughts and practice.
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Affiliation(s)
- Antje Heckroth
- Carl von Ossietzky Universitat Oldenburg, Oldenburg, Germany
- Hanse Institut Oldenburg, Oldenburg, Germany
| | | | - Christian Johannssen
- Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany
- Hanse Institut Oldenburg, Oldenburg, Germany
| | | | | | - Carsten Bantel
- Carl von Ossietzky Universitat Oldenburg, Oldenburg, Germany
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Witham G, Yarwood G, Wright S, Galvani S. An ethical exploration of the narratives surrounding substance use and pain management at the end of life: a discussion paper. Nurs Ethics 2019; 27:1344-1354. [PMID: 31526085 PMCID: PMC7406987 DOI: 10.1177/0969733019871685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This discussion article examines narrative positioning related to pain management for people who use substances at the end of life. We explore how dominant narrative genres associated with biomedicine, such as ‘restitution’ and narratives common within the context of drug services such as ‘recovery’ can hinder effective pain management within this population. We argue that these discourses can marginalise the ethical self-identity of patients who use substances at the end of life. It can also trouble health and social care professionals in supporting patients and generating counter-narratives that challenge those often associated with substance use. Stigma is a common experience for this population with stereotyping as ‘junkies’ and associated with criminality. They are positioned as drug-seeking, and this requires more surveillance at the end of life when opioid therapy is potentially more available and authorised. This can make it challenging to generate ‘companion’ stories that are positive and maintain moral adequacy. Dominant biomedical narrative genres often prevent the recognition of the fractured stories that people using substances can often present with. This can lead to narrative silencing and to the under treatment of pain. The person’s self-identity is invested in narratives of recovery, and opioid use symbolises their addicted past because for practitioners, this population is at clinical risk with the potential for drug seeking behaviours. Whilst not requiring formal ethical review this discussion paper was constructed in accordance with good scientific practice with the work of other researchers respected and cited appropriately.
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Collom JRD, Davidson J, Sweet D, Gillard S, Pinfold V, Henderson C. Development of a peer-led, network mapping intervention to improve the health of individuals with severe mental illnesses: protocol for a pilot study. BMJ Open 2019; 9:e023768. [PMID: 31256018 PMCID: PMC6609054 DOI: 10.1136/bmjopen-2018-023768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Adults with severe mental illness (SMI) have reduced life expectancy and many have comorbid physical health conditions. Primary care providers are experiencing increased demands for care for people with SMI. Barriers to accessing physical healthcare have been identified which negatively affect quality of care. We propose that peer support workers (PSWs) could deliver an intervention to service users to promote their physical health by drawing on existing social support. The aim of this research was to pilot a novel PSW-led intervention, including personal well-being network mapping, to improve access to primary care for physical health needs. METHODS AND ANALYSIS Twenty-four participants will be recruited from community-based mental health teams in two boroughs of London. Each participant will be offered a six-session intervention. Quantitative data will be collected before and after intervention (at 4-month follow-up). Qualitative interviews will be conducted with PSWs after completion of the intervention and with participants at a 4-month follow-up. Some intervention sessions will be observed by a member of the research team. This is a pilot study with a small sample aiming to assess acceptability and feasibility of an intervention. We aim to use the results to refine the existing theory of change and to optimise the intervention and its evaluation in a future randomised controlled trial. This study is strengthened by its potential clinical importance and origin in previous research where service users engaged with well-being network mapping. ETHICS AND DISSEMINATION This study has been approved by the London-Chelsea Regional Ethics Committee (ref: 17/LO/0585). The findings will be disseminated to participants, the National Health Service trusts that we recruited from, primary care mental health leads, commissioners and in peer-reviewed journals and academic conferences.
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Affiliation(s)
| | - Jonathan Davidson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Steve Gillard
- Division of Population Health Sciences and Education, St George's University of London, London, UK
| | | | - Claire Henderson
- King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Salamat S, Hegarty P, Patton R. Same clinic, different conceptions: Drug users’ and healthcare professionals’ perceptions of how stigma may affect clinical care. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2019. [DOI: 10.1111/jasp.12602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Peter Hegarty
- School of Psychology University of Surrey Guildford UK
| | - Robert Patton
- School of Psychology University of Surrey Guildford UK
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Paquette CE, Syvertsen JL, Pollini RA. Stigma at every turn: Health services experiences among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 57:104-110. [PMID: 29715589 DOI: 10.1016/j.drugpo.2018.04.004] [Citation(s) in RCA: 283] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/08/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND People who inject drugs (PWID) encounter varying forms of stigma in health services contexts, which can contribute to adverse outcomes. We explored the lived experience of stigma among PWID to elucidate pathways by which stigma influences health care access and utilization. METHODS We conducted 46 qualitative interviews with PWID in California's Central Valley between March and December 2015, as part of a multi-phase, multi-method study examining implementation of a new pharmacy syringe access law. A "risk environment" framework guided our data collection and we used a deductive/inductive approach to analyze the qualitative data. RESULTS Participants repeatedly cited the impact of stigma on syringe access, particularly in the context of meso-level pharmacist interactions. They described being denied syringe purchase as stigmatizing and embarrassing, and these experiences discouraged them from attempting to purchase syringes under the new pharmacy access law. Participants described feeling similarly stigmatized in their meso-level interactions with first responders and hospital staff, and associated this stigmatization with delayed and substandard medical care for overdoses and injection-related infections. Drug treatment was another area where stigma operated against PWID's health interests; participants described macro-level public stigma towards methadone (e.g., equating methadone treatment with illicit drug use) as discouraging participation in this evidence-based treatment modality and justifying exclusion of methadone patients from recovery support services like sober living and Narcotics Anonymous. CONCLUSION Stigma played an undeniably important role in PWID's experiences with health services access and utilization in the Central Valley. Our study illustrates the need to develop and test interventions that target drug use stigma at both structural and individual levels to minimize adverse effects on PWID health.
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Affiliation(s)
- Catherine E Paquette
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Calverton, MD, 20705, USA; Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599, USA.
| | - Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Ave., Columbus, OH, 43210, USA; Department of Anthropology, University of California, Riverside, 1334 Watkins Hall, Riverside, CA, 92521, USA.
| | - Robin A Pollini
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Calverton, MD, 20705, USA; Injury Control Research Center and Department of Behavioral Medicine and Psychiatry, West Virginia University, 3606 Collins Ferry Road, Suite 201, Morgantown, WV, 26505, USA.
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Braciszewski JM, Tran TB, Moore RS, Bock BC, Tzilos Wernette GK, Chamberlain P, Stout RL, Vose-O’Neal A. Feeling Heard and Not Judged: Perspectives on Substance Use Services Among Youth Formerly in Foster Care. CHILD MALTREATMENT 2018; 23:85-95. [PMID: 28931306 PMCID: PMC5788282 DOI: 10.1177/1077559517729486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Youth in foster care have limited access to substance use services for a variety of reasons. Attempts to unpack this health disparity have focused on foster care systems, administrators, providers, and foster parents. This study seeks to understand the perspectives of youth themselves, with the hope of understanding their experiences with and preferences for such services. Analyses of focus groups with youth who had recently left foster care suggested concrete and perceptual facilitators/barriers to treatment. Concrete facilitators/barriers included the need for expanding social support, access to multiple service options, and tailored intervention approaches. Perceptual concerns revolved around understanding each individual's readiness to change, feeling judged by authority figures, and desiring help from people with lived experience. Participants also described novel intervention ideas, including a focus on technology-based approaches. By relying on youth voices, we can improve upon the current state of substance use interventions within foster care.
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Affiliation(s)
- Jordan M. Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | | | - Roland S. Moore
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, USA
| | | | | | | | - Robert L. Stout
- Decision Sciences Institute, Pacific Institute for Research and Evaluation, Pawtucket, RI, USA
| | - Adam Vose-O’Neal
- Decision Sciences Institute, Pacific Institute for Research and Evaluation, Pawtucket, RI, USA
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Janlöv AC, Johansson L, Clausson EK. Mental ill-health among adult patients at healthcare centres in Sweden: district nurses experiences. Scand J Caring Sci 2017; 32:987-996. [PMID: 29131370 DOI: 10.1111/scs.12540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mental ill-health among the general population is increasing in Sweden. Primary Health Care (PHC) and Healthcare Centres (HCC), where district nurses (DNs) work, bear the basic responsibility for treatment of mental ill-health, while severe mental ill-health fall under the responsibility of psychiatric specialist care. The increased prevalence of mental ill-health in the community means that DNs increasingly encounter people with mental health problems - not least as a comorbidity. How well DNs are equipped to deal with mental ill-health is currently unclear. AIM The purpose of this study was to explore district nurses' experience of encountering and dealing with mental ill-health among adult patients at healthcare centres. DESIGN A qualitative explorative approach was used to capture the experiences of the phenomena under study. METHODS Individual interviews were conducted with 10 DNs working at six HCCs. The interviews were transcribed and analysed by qualitative content analysis. RESULTS The result emerged as several subcategories captured by three categories: (i) having competence - a prerequisite for feeling confident; (ii) nursing mental ill-health requires time and commitment; and (iii) working in an organisation without preparedness, encompassed by the synthesising theme; nursing mental ill-health requires specific competence and organisational support. CONCLUSION Working as a DN requires formal and informal competence when encountering patients with complex health needs. The findings revealed that the DNs could feel insecure regarding how to deal with patients with mental ill-health due to lack of knowledge. Assessment of patients with mental ill-health is time- and energy-consuming and calls for improved teamwork at HCCs as well as effective collaboration with psychiatric specialist care and other care givers. The DNs responsibility to fulfil their work considering the increasing number of mental ill-health among people that seeks help at HCCs needs to be acknowledged and met by the PHC organisation.
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Affiliation(s)
- Ann-Christin Janlöv
- Department of Health and Society, Kristianstad University, Kristianstad, Sweden
| | - Linda Johansson
- Department of Health and Society, Kristianstad University, Kristianstad, Sweden
| | - Eva K Clausson
- Department of Health and Society, Kristianstad University, Kristianstad, Sweden
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20
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Shamsalinia A, Norouzi K, Fallahi-Khoshknab M, Farhoudian A, Ghaffari F. Experiences of substance abusers from methadone maintenance therapy. Med J Islam Repub Iran 2017; 31:45. [PMID: 29445674 PMCID: PMC5804444 DOI: 10.14196/mjiri.31.45] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Indexed: 02/03/2023] Open
Abstract
Background: Substance abusers are not able to withdraw drugs eternally despite the abundance of different treatments; therefore, withdrawal programs are not quite successful and notwithstanding all the successes of methadone maintenance therapy, there are some defects found in the manner this treatment is applied. Thus, this study was conducted to explore the experience of drug abusers regarding methadone maintenance therapy. Methods: This is a qualitative study using content analysis methodology. The research community includes drug abusers admitted to the treatment centers of the western cities of Mazandaran Province, Iran in 2016. The sampling was purposive and the data were collected by face-to-face single interviews with 20 patients. The interviews were continued up to data saturation. Finally, the Lundman and Grenheim method was used to analyze the interviews and the four criteria of Guba and Lincoln were applied to check data integrity. Results: "Buying time," "methadone dependence," and "looking from a narrow view to the patient" were the main three categories that fit the results. Conclusion: Governmental free services for drug abusers; paying attention to different aspects of treatment such as mental, emotional, and social recovery; lifelong support of the family and society members; and balance in prescribing and following the treatment process prescribed by health care providers can enhance both the quality and safety of the treatment process. Psychological consultation alongside social services can facilitate the recovery process in methadone maintenance therapy.
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Affiliation(s)
- Abbas Shamsalinia
- Ramsar Nursing Care Research Center, Babol University of Medical Sciences, School of Nursing and Midwifery. Babol, Mazandaran, Iran
| | - Kiyan Norouzi
- Nursing Department, University of Social Welfare and Rehabilitation Sciences. Tehran, Iran
| | | | - Ali Farhoudian
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Ghaffari
- Ramsar Nursing Care Research Center, Babol University of Medical Sciences, School of Nursing and Midwifery. Babol, Mazandaran, Iran
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Glass JE, Andréasson S, Bradley KA, Finn SW, Williams EC, Bakshi AS, Gual A, Heather N, Sainz MT, Benegal V, Saitz R. Rethinking alcohol interventions in health care: a thematic meeting of the International Network on Brief Interventions for Alcohol & Other Drugs (INEBRIA). Addict Sci Clin Pract 2017; 12:14. [PMID: 28490342 PMCID: PMC5425968 DOI: 10.1186/s13722-017-0079-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/14/2017] [Indexed: 11/29/2022] Open
Abstract
In 2016, the International Network on Brief Interventions for Alcohol & Other Drugs convened a meeting titled “Rethinking alcohol interventions in health care”. The aims of the meeting were to synthesize recent evidence about screening and brief intervention and to set directions for research, practice, and policy in light of this evidence. Screening and brief intervention is efficacious in reducing self-reported alcohol consumption for some with unhealthy alcohol use, but there are gaps in evidence for its effectiveness. Because screening and brief intervention is not known to be efficacious for individuals with more severe unhealthy alcohol use, recent data showing the lack of evidence for referral to treatment as part of screening and brief intervention are alarming. While screening and brief intervention was designed to be a population-based approach, its reach is limited. Implementation in real world care also remains a challenge. This report summarizes practice, research, and policy recommendations and key research developments from our meeting. In order to move the field forward, a research agenda was proposed to (1) address evidence gaps in screening, brief intervention, and referral to treatment, (2) develop innovations to address severe unhealthy alcohol use within primary care, (3) describe the stigma of unhealthy alcohol use, which obstructs progress in prevention and treatment, (4) reconsider existing conceptualizations of unhealthy alcohol use that may influence health care, and (5) identify efforts needed to improve the capacity for addressing unhealthy alcohol consumption in all world regions.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Sara Wallhed Finn
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ann-Sofie Bakshi
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, ICN, Hospital Clínic, IDIBAPS, RTA, Barcelona, Spain
| | - Nick Heather
- Department of Psychology, Faculty of Health & Social Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Marcela Tiburcio Sainz
- Department of Social Sciences in Health, Ramón de la Fuente Muñiz, National Institute of Psychiatry, Mexico City, Mexico
| | - Vivek Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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Taylor D, Ho A, Mâsse LC, Van Borek N, Li N, Patterson M, Ogilvie G, Buxton JA. Assessment of Capacity to Consent by Nurses Who Deliver Health Care to Patients Who Misuse Substances. Glob Qual Nurs Res 2017; 3:2333393616671076. [PMID: 28462344 PMCID: PMC5342852 DOI: 10.1177/2333393616671076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/22/2016] [Accepted: 08/31/2016] [Indexed: 11/30/2022] Open
Abstract
This qualitative study explored the current practice that nurses use to assess capacity to consent to health care (CTC-HC) in street outreach settings. Key informant interviews were conducted with a purposive sample of nurses from each of British Columbia’s five regional health authorities, allowing nurses to describe their lived experiences with assessing CTC-HC. Content analysis was used to summarize information captured in the data. A total of 19 nurses participated in the study. Five themes emerged from the data: (a) internal guiding forces that contribute to the nurses’ assessment, (b) external influences that contribute to the nurses’ assessment, (c) measures that are important for assessing CTC-HC, (d) threshold setting, and (e) context (physical and interpersonal) within which assessment of capacity takes place. These elements will be incorporated into a capacity assessment tool that can be used in nursing best practices.
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Affiliation(s)
- Darlene Taylor
- University of British Columbia, Kelowna, British Columbia, Canada
| | - Anita Ho
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Louise C Mâsse
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Neville Li
- Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Gina Ogilvie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane A Buxton
- University of British Columbia, Vancouver, British Columbia, Canada
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Harling MR. Comparisons between the attitudes of student nurses and other health and social care students toward illicit drug use: An attitudinal survey. NURSE EDUCATION TODAY 2017; 48:153-159. [PMID: 27816009 DOI: 10.1016/j.nedt.2016.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/25/2016] [Accepted: 10/18/2016] [Indexed: 06/06/2023]
Abstract
In the context of a recent emphasis on compassion in the delivery of health care, the current study set out to measure the attitudes of different groups of health and social care students toward illicit drug users. Previous research has identified variations in the attitudes of different groups of health and social care professionals toward working with illicit drug users. Nurses, in particular, have been reported as holding moralistic or stereotypical views of illicit drug users. However, few studies have measured the attitudes of student nurses or compared their attitudes to other health and social care students. This article describes the use of a bespoke attitude scale to measure the attitudes of cohorts of student nurses, clinical psychology trainees, health and social care, social work and midwifery students at the start of their course (N=308). Results indicated that student nurses had the least tolerant attitudes, reinforcing the need for a specific educational focus on working with illicit drug users in nurse education. Variations between student groups indicate that Interprofessional Education can provide an opportunity to improve attitudes toward illicit drug users, particularly amongst student nurses.
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Affiliation(s)
- Martyn R Harling
- The University of Nottingham, Division of Medical Sciences and Graduate Entry Medicine, The School Of Medicine, Royal Derby Hospital Centre, Room 3020, Uttoxeter Road, Derby DE22 3DT, United Kingdom.
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Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, Schulze B, Druss B, Thornicroft G. Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry 2014; 1:467-82. [PMID: 26361202 DOI: 10.1016/s2215-0366(14)00023-6] [Citation(s) in RCA: 353] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This Review considers the evidence for mental-health-related stigma in health-care and mental-health-care settings. Do mental-health-care and other health-care professionals stigmatise people using their services? If so, what are the effects on quality of mental and physical health care? How can stigma and discrimination in the context of health care be reduced? We show that the contact mental-health-care professionals have with people with mental illness is associated with positive attitudes about civil rights, but does not reduce stigma as does social contact such as with friends or family members with mental illness. Some evidence suggests educational interventions are effective in decreasing stigma especially for general health-care professionals with little or no formal mental health training. Intervention studies are needed to underpin policy; for instance, to decrease disparity in mortality associated with poor access to physical health care for people with mental illness compared with people without mental illness.
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Affiliation(s)
- Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Jo Noblett
- Springfield Hospital, South West London and St George's NHS Mental Health Trust, London, UK
| | - Hannah Parke
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sarah Clement
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alison Caffrey
- Springfield Hospital, South West London and St George's NHS Mental Health Trust, London, UK
| | | | - Beate Schulze
- Institute of Social Medicine, Occupational Medicine and Public Health, University of Leipzig, Atlanta, GA, USA
| | - Benjamin Druss
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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van Boekel LC, Brouwers EPM, van Weeghel J, Garretsen HFL. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend 2013; 131:23-35. [PMID: 23490450 DOI: 10.1016/j.drugalcdep.2013.02.018] [Citation(s) in RCA: 978] [Impact Index Per Article: 88.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/18/2013] [Accepted: 02/18/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Healthcare professionals are crucial in the identification and accessibility to treatment for people with substance use disorders. Our objective was to assess health professionals' attitudes towards patients with substance use disorders and examine the consequences of these attitudes on healthcare delivery for these patients in Western countries. METHODS Pubmed, PsycINFO and Embase were systematically searched for articles published between 2000 and 2011. Studies evaluating health professionals' attitudes towards patients with substance use disorders and consequences of negative attitudes were included. An inclusion criterion was that studies addressed alcohol or illicit drug abuse. Reviews, commentaries and letters were excluded, as were studies originating from non-Western countries. RESULTS The search process yielded 1562 citations. After selection and quality assessment, 28 studies were included. Health professionals generally had a negative attitude towards patients with substance use disorders. They perceived violence, manipulation, and poor motivation as impeding factors in the healthcare delivery for these patients. Health professionals also lacked adequate education, training and support structures in working with this patient group. Negative attitudes of health professionals diminished patients' feelings of empowerment and subsequent treatment outcomes. Health professionals are less involved and have a more task-oriented approach in the delivery of healthcare, resulting in less personal engagement and diminished empathy. CONCLUSIONS This review indicates that negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care for these patients. However, few studies have evaluated the consequences of health professionals' negative attitudes towards patients with substance use disorders.
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Affiliation(s)
- Leonieke C van Boekel
- Department Tranzo, Tilburg University, Tilburg School of Social and Behavioral Sciences, Tilburg, The Netherlands.
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26
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Lloyd C. The stigmatization of problem drug users: A narrative literature review. DRUGS-EDUCATION PREVENTION AND POLICY 2012. [DOI: 10.3109/09687637.2012.743506] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Frazer K, Glacken M, Coughlan B, Staines A, Daly L. Hepatitis C virus in primary care: survey of nurses' attitudes to caring. J Adv Nurs 2010; 67:598-608. [PMID: 21320157 DOI: 10.1111/j.1365-2648.2010.05516.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study measuring attitudes of primary care nurses towards caring for people with hepatitis C. BACKGROUND Hepatitis C is a major public health problem. Attitudes to caring for people with hepatitis C vary and can have an impact on nursing care practices. International literature has identified discriminating practices amongst healthcare professionals including nurses. There is limited research examining primary care nurses' attitudes to caring for people with hepatitis C. METHODS A cross-sectional postal census survey of 981 nurses working in one health board region in the Republic of Ireland was conducted during the period March 2006 to June 2006. RESULTS A response rate of 57.1% (n=560) was achieved. Exploratory factor analysis of an attitude scale identified three latent variables: 'infection control behaviour', 'caring' and 'fear'. Attitudes were generally positive towards caring for persons with hepatitis C; however, 51.7% of respondents would use additional infection control precautions if caring for someone with known hepatitis C. Younger nurses and those educated to degree level and above held significantly more positive attitudes to caring. Nurses agreed that they have a central role in managing and treating people with hepatitis C; however, many agreed that they lack the knowledge and skills to care for persons with hepatitis C. CONCLUSIONS Negative attitudes can result in discriminatory experiences for persons with hepatitis C or at risk. Nurses require ongoing education on hepatitis C to improve knowledge, to limit concerns and ensure adherence to infection control guidelines.
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Affiliation(s)
- Kate Frazer
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Ireland.
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28
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Frazer K, Glacken M, Coughlan B, Staines A, Daly L. Hepatitis C virus infection in primary care: survey of registered nurses' knowledge and access to information. J Adv Nurs 2010; 67:327-39. [PMID: 21044133 DOI: 10.1111/j.1365-2648.2010.05489.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIM This paper is a report of a study conducted to compare knowledge of hepatitis C virus infection amongst three groups of registered nurses working in primary care, to identify their current sources of information and access to educational resources. BACKGROUND Hepatitis C virus infection is a public health problem; no vaccine exists to prevent the disease. Previous studies identified limitations in nurses' knowledge of hepatitis C virus infection and the impact on care. Limited research has been conducted in primary care. METHODS A cross-sectional postal census survey of 981 nurses working in one Irish health board region was conducted March-June 2006. Questionnaires measured knowledge of hepatitis C virus infection. Data were collected on demographics, current working practices, information resources and previous education. RESULTS The response rate was 57·1% (n = 560). A minority (27·3% 145/531) of respondents agreed they were well informed about the virus. Almost 40% reported having contact with clients with the virus; however, information and service provision differed. Factors influencing higher knowledge included: contact with clients with hepatitis C virus infection (P < 0·0001), working in the addiction services (P < 0·0001), educated to degree level and above (P < 0·010) and previously attending education programmes (P < 0·0001). Only 21·5% (119/553) of respondents had attended any form of education on hepatitis C virus infection. CONCLUSION Gaps in nurses' knowledge exist and can limit information and advice. Educational and information resources need to be developed for registered nurses working in primary care; care for clients with hepatitis C virus infection is not the sole remit of the addiction services.
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Affiliation(s)
- Kate Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
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Wylie LWJ. Assessing user perceptions of staff training requirements in the substance use workforce: A review of the literature. DRUGS: EDUCATION, PREVENTION AND POLICY 2010. [DOI: 10.3109/09687631003705538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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30
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Scullion PA. Models of disability: their influence in nursing and potential role in challenging discrimination. J Adv Nurs 2010; 66:697-707. [PMID: 20423405 DOI: 10.1111/j.1365-2648.2009.05211.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper presents a discussion of medical and social models of disability associated with experiences of disabled people as citizens and patients. BACKGROUND Disability is fairly universally a negative concept. Disabled people have frequent contact with health services, however much of this experience is viewed as discriminatory. DATA SOURCES Literature was obtained using the Psych-INFO, Medline and CINAHL databases for the years 1989-2009, using derivatives of the concept 'disability' and associated 'models', and then these terms combined with 'nursing'. DISCUSSION Nursing as a profession embraces the need to avoid discrimination, yet disability as an equal opportunity issue is relatively neglected in nursing. Nursing has a moral, professional and, in some countries, a legal responsibility to promote disability equality in the provision of nursing services. Insights offered by the social model of disability may be instrumental in empowering nurses to respond to this obligation. While some groups may not be well-represented in this model and there is risk in embracing the social model of exposing a policy-practice divide, it nevertheless represents a powerful tool for strengthening nurses' advocacy role. In particular, 'social advocacy' may be enhanced by a paradigm shift away from the medical model of disability. IMPLICATIONS FOR NURSING Nurses have an obligation to promote disability equality in relation to the provision of health care. Adoption of the social model of disability in nursing practice, education and research as a strategy to challenge discrimination should be seriously considered. CONCLUSION The utility value of the social model of disability in strengthening the social advocacy role of nurses should be investigated.
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Affiliation(s)
- Philip Andrew Scullion
- Department of Nursing, Midwifery and Healthcare, Faculty of Health and Life Sciences, Coventry University, UK.
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Natan MB, Beyil V, Neta O. Nurses' perception of the quality of care they provide to hospitalized drug addicts: testing the theory of reasoned action. Int J Nurs Pract 2010; 15:566-73. [PMID: 19958412 DOI: 10.1111/j.1440-172x.2009.01799.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A correlational design was used to examine nursing staff attitudes and subjective norms manifested in intended and actual care of drug users based on the Theory of Reasoned Action. One hundred and thirty-five nursing staff from three central Israeli hospitals completed a questionnaire examining theory-based variables as well as sociodemographic and professional characteristics. Most respondents reported a high to very high level of actual or intended care of drug users. Nurses' stronger intentions to provide quality care to drug users were associated with more positive attitudes. Nursing staff members had moderately negative attitudes towards drug users. Nurses were found to hold negative stereotypes of drug addict patients and most considered the management of this group difficult. Positive attitudes towards drug users, perceived expectations of others and perceived correctness of the behaviour are important in their effect on the intention of nurses to provide high-quality care to hospitalized patients addicted to drugs.
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Affiliation(s)
- Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yafe Medical Centre, P.O. Box 169, Hadera 38100, Israel.
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Ford R, Bammer G, Becker N. Improving nurses' therapeutic attitude to patients who use illicit drugs: Workplace drug and alcohol education is not enough. Int J Nurs Pract 2009; 15:112-8. [DOI: 10.1111/j.1440-172x.2009.01732.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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