The Nurse and the Alcoholic: Redefining an Historically Ambivalent Relationship

Nurses' attitudes toward clients with substance use problems

PURPOSE

This study aimed to examine factors associated with nurses' attitudes toward clients with substance use problems.

DESIGN AND METHODS

A cross-sectional design was used, and 489 nurses working in two medical centers in Taiwan participated in this study.

FINDINGS

Age, total nursing experience, work unit, personal experience, experience of taking care of clients with substance use problems, substance use education in school, and continuing education were significantly associated with nurses' attitudes. Hierarchical regression revealed that continuing education predicted nurses' overall attitudes. However, the model explained a low variance.

PRACTICE IMPLICATIONS

Education-focused training alone may not be adequate. Nursing workforce development needs to incorporate multiple strategies, including clinical supervision, when designing substance use education for clinical nurses in order to generate better improvements on attitudes.

Project Hope: changing care delivery for the substance abuse patient

Project Hope is a program designed to assist healthcare providers in the assessment, care, referral, and follow-up of the hospitalized substance abuse patient. First implemented in 1990 at what is now called University Hospital in San Antonio, Texas, the program has influenced care in a positive way through change in the attitude and knowledge of personnel, administrators, and community. In this paper, the authors provide an overview of the approaches utilized, improvement process, and outcomes obtained from this project. To formally evaluate the effectiveness of Project Hope, a quasi-experimental, Solomon-Four design study was conducted. Eighty nurses from various educational backgrounds and experience with alcohol were divided into groups by nursing unit. A normative-reeducative intervention was applied as described by Chin and Benne. Test of cognition showed significant change (p < .01) in the experimental group; no significance was found for attitudes change. Reasons for these findings and lessons learned from the process are described.

The challenge of change: rethinking alcohol abuse

Nurses usually conceptualize alcohol abuse and dependence as a progressive disease that can be managed but never cured. Yet there are millions of Americans for whom this approach is not helpful. Impressive results have been reported by the alcohol research community with interventions that are guided by the assumption that many alcohol problems are learned habits that can be changed. This article reviews the clinical research in the area of brief interventions and moderation training with alcohol abusers. Nursing's vital role in advocating for and delivering such interventions is identified. Resistance to implementing alternative approaches for the treatment of alcohol problems is explored.

Efficacy of a Substance Abuse Primary Prevention Skills Conference for Nurses

A conference on substance abuse prevention skills was presented by the New York State Nurses Association (NYSNA) to provide nurses with skills to help patients in various practice settings. Information covered assessment, intervention, and tools for interviewing and identifying resources. A six-month follow-up evaluation showed that the majority of the participants incorporated the skills in their nursing practice primarily in interviewing and use of assessment questions. Directions for future conferences were identified.

Alcoholism Nursing: Toward a Policy Perspective

Nurses remain relatively uninvolved with the number-one health problem of alcoholism due to ambivalence and/or ignorance. Efforts to change this dilemma have been primarily in the form of passive recommendations. A more direct and powerful action of mandating alcoholism education is suggested. This recommendation successfully meets the major criteria of policy.