The prevalence of substance abuse among nurses is rising and continues to rise. The American Nurses' Association (ANA, 2002) estimates that six to eight percent of nurses use alcohol or other drugs to the extent that they impair their professional performance (ANA, 2002). Because of the incidence of drug abuse among nurses, it is important all nurses to be aware that drug abuse exists among nurses and should know the proper steps to assist their co-worker get the support they need.
Some startling recent statistics show that in the United States, the problems in productivity and employment among individuals with substance abuse problems cost the American economy $80.9 billion. Of this, $66.7 billion was attributed to alcohol and $14.2 billion to other drugs (NIH, 2007). Of course, this does not include the emotional costs to families and individuals such as divorce, alcohol, and drug-related domestic and child abuse, automobile injuries, etc. One out of every ten nurses has engaged in substance abuse and this is a defiant problem for the nursing community. A great strategy for combating substance abuse is being aware of the signs of drug abuse; new nurses can be better equipped to take action against an ever growing issue. An additional strategy is knowledge of factors that contribute to drug abuse among nurses. Finally, learning early on how to manage one’s own stress level can greatly decrease the pervasiveness of drug abuse in the nursing community.
The majority of nurses who receive treatment for problems related to chemical abuse became addicted as students, and were academically in the top third of their class. A majority also hold advanced degrees. It has been estimated that approximately ten percent of nurses are chemically impaired and most disciplinary problems that are addressed by Boards of Nursing are related to nurses in this ten percent (Uris, 2002). Nurses should be educated on the signs and symptoms of substance abuse among their peers. It is important for all nurses to be aware of signs and symptoms of substance abuse, such as, mood swings, diminished alertness, increasing forgetfulness, defensiveness, decreased concentration. Additionally signs of withdrawal, impaired cognition, isolation or withdrawal from colleagues. Substance abuse issues in nursing usually are first noted by staff members. Whether a staff nurse acts on his or her knowledge or chooses to remain silent, directly affects patient care, safety and the reputation of the institution. It also ultimately affects the impaired colleague's level of functioning (Dunn, 2005). By the time a nurse demonstrates negative or inappropriate work habits, the problem already has reached a serious stage. It is advantageous for institutions to create systems that allow for reporting and tracking substance-abuse incidents and provide education and support to help nurses participate in rehabilitation and avoid placing patients in harm's way (Blair, 2003).
Being aware of signs and symptoms is important; however being aware of factors that contribute to substance abuse is another important step in understanding its prevalence. Some of the factors that have been identified as contributing to substance abuse are: psychological or physical pain, emotional problems, a demanding high-pressure and stressful work environment, and family problems. Additional factors that have been known to contribute are previous emotional or mental health problems, family members with chemical dependency, depression, anxiety, or mental, emotional, or sexual abuse (George, 2003). Some recent studies have shown that nurses who work in oncology have overall high substance use rates. One theory for this behavior is that controlled substances serve as a coping mechanism to help nurses distance themselves from the emotional pain they may experience while working with dying patients (Dunn, 2005). Psychiatric nurses also experience high levels of substance use. Nurses working in psychiatric areas may consider self-medication more acceptable because they work in a culture that accepts using psychotropic medications to cope with life (Anderson, 2004). Additionally, psychiatric nurses may be more willing to report their use of substances than other specialty nurses because they perceive this as an acceptable form of treatment. Pediatric and women's health nurses report the lowest use of addictive substances. This could be due to the lack of availability of these substances on their units, or it could be that this population of nurses is emotionally expressive (NIH, 2003). People who are able to express their feelings may have less need for substance use.
Learning about the signs and symptoms and knowledge about contributing factors are great ways to decrease the prevalence of substance abuse Furthermore, increasing education about management of stress levels is another strategy that can help reduces substance abuse in the workplace. Stress provides another explanation for why some nurses abuse substances. Increased workloads, decreased staffing, double shifts, mandatory overtime, rotating shifts, and floating to unfamiliar units all contribute to feelings of isolation, fatigue, and, ultimately, stress (Ponech, 2005). Each person feels stress and handles it in different ways; learning early on how to effectively manage stress can be extremely beneficial in finding alternative ways to decrease stress. Chronic stress can result in increased sensitivity to stress and cause more susceptible to the effects of stress. Research indicates that increased sensitivity to stress actually alters physical patterns in our brain, thus if stress is uncontrolled it can lead to emergency measure to decrease it, and thus leading to the use of substance abuse (Anderson, 2004). To aid in learning how to decrease stress here are a few strategies for decreasing stress: learning to take time out for self care, regular exercise, good communication with family, friends and co-workers, planning productive solutions to problems, ask for support when feeling stressed out, and learning to set clear limits.
To actively combat this issue of substance abuse that imperils patients and gives rise to a bad reputation toward nurses, all nurses should be aware of the signs and symptoms of substance abuse; to strive for better communication in their homes and within the work place. To find out what helps them manage their stress levels and to fervently practice self care that will aid in the decrease of physical, emotional, and psychological stress. By being aware of the signs and symptoms nurses’ know what signs may point to the need for intervention for their co-worker. By being knowledgeable about factors that contribute to substance abuse nurse can identify those factors if present in their own lives and can get help before those issues become uncontrolled. Understanding how stress correlates with substance abuse nurses’ can utilize alternative means to reduce stress in their life, ultimately reducing the prevalence of substance among the nursing community.
“Helping the impaired nurse is difficult, but not impossible. The choices for action are varied. The only choice that is clearly wrong is to do nothing.”
National Council of State Board of Nursing
Intervention # 1 Being aware of signs & symptoms of substance abuse.
Intervention # 2 Knowledge of factors that contribute.
Intervention #1
~ Disadvantages
a.) If nurses are aware of signs and symptoms they may be better able to hide there problem. Nurses may become more capable of masking there substance abuse by being more cautions not to exhibit the signs and symptoms that they were taught are associated with substance abuse in the workplace (Dunn). Examples of signs and symptoms that are taught are as follows, and being aware of these can contribute to the ability to facade the issue in a nurse set on not getting caught. Attendance. Look for sporadic absences, a day at a time and usually on a Friday or Monday. Appearance. Take note of a nurse who shows a sudden dramatic change in her personal grooming. Affect. Watch for disturbing shifts in a nurse's personal traits-her facial expressions, voice, posture, and gestures. For example, an outgoing nurse may suddenly become stone-faced and uncommunicative. Attitude. Pay attention to any changes in a nurse's attitude toward work. A staff member noted for her efficiency may suddenly begin taking longer to complete tasks. And listen closely to patients' complaints: A neglectful nurse may have a drug or alcohol problem.
b.) While researching this paper it became unambiguous to see all the many different, well thought out, techniques nurses use to steal medications. It is outlined in many different articles step-by-step how nurses go about obtaining controlled substances. By merely researching the signs and symptoms it could potential lead to an open door for someone who might be interested in obtaining medication to be aware of techniques that others have tried (NIH). Below is an example of how knowledgeable impaired nurses are about their addiction habits.
More than 15 years of my life are a blur I remember only a few landmarks through the fog of alcohol, cocaine. Dilaudid, Demerol, heroin, and other drugs. I was in and out of psychiatric units and drug treatment programs. I cycled through a dozen or so boyfriends. For extra money, I waited on tables or tended bar. But mostly I worked in hospitals-as a nurse. Yes, I took vital signs, changed dressings, gave medications, charted-the same things you do
every day. Many of the drugs I used came from the medication cabinets of some very well run hospitals.
But no one ever confronted me about my addiction. It's easy for an impaired nurse to "hide." I preferred to work the night shift, when staffing was minimal and there were no supervisors or visitors around. I also liked neurosurgery units; patients with head or spinal cord injuries were less likely to complain about taking a p.r,n medication. The final turn of events came one night when I told a patient with a spinal cord injury he needed medication he didn't want, I gave myself the Demerol, and then tried to give him sterile water. He refused it, so I put the syringe back in the drawer. Apparently, my nurse-manager suspected me because as soon as I put the syringe in the drawer, she confiscated it. I knew she'd fire me once she found out it contained only water, so I quit. I participated in group meetings with other recovering doctors and nurses. That was one of the toughest parts of treatment. I told them I felt good about the work I'd done as a nurse. Immediately, they confronted me, pointing out that 1 couldn't be an addicted nurse and a good nurse at the same time. I was surprised by their frankness. They knew about lying to yourself. And they knew that only friends who cared enough to be tough and honest could break through that denial. My recovery hasn't been easy. I haven't made it without stumbling but I wanted to live my life without taking drugs-and I've reached that goal. Today, I counsel adolescents at the treatment center that helped me recover. It's the best job I've ever had. Now I'm grateful that I have the chance to give back some of what I've been given. That's one reason I'm telling my story. If you have a problem with drugs or alcohol, you can get help. Recovery isn't easy, but it's worth the price.
(Alexander).
Intervention # 2
~ Disadvantages
a) By being aware of the all the contributing factors, nurses might tend to think that anyone that has some of these factors are suspicious of substance abuse. Therefore, being untrusting of their colleague, and constantly watching over there back, which in turn may bring down the units trust and moral (Ponech). Nurses are at risk for drug abuse because of the availability of medications in the workplace and the cultural acceptance within nursing that pharmacologie agents provide a desirable method to cure one's ills. Health care provides a permissible climate in which to use exogenous substances to correct internal feelings or illnesses. Nurses have been taught that medications solve problems. They have seen medications alleviate pain, cure infections, and diminish anxiety. Not only are prescription medications accessible, but nurses also have a mistaken belief about their personal skills and level of knowledge to self-medicate without becoming addicted. Self-medicating behaviors may only be viewed as inappropriate when the magnitude and regularity of these behaviors increases. Access creates a familiarity with controlled substances that can increase the likelihood that nurses will use them on their own. Nurses may erroneously believe that they have the ability to control and monitor their own use of medications because of their experience with administering medications and observing their effects on patients Some nurses "believe that they are immune to the negative consequences of drug use because they are so familiar with drugs." (Dunn).
b.) Nurses that may have contributing factors, or who are at high risk for substance abuse may feel that they are being targeted or looked down on by their nursing peers. Thereby, discouraging them form asking for help if needed, or feel un-apart of the team because they don’t feel comfortable discussing their personal life with any of their co-workers; which may lead to depression and feelings of inadequacy in their careers (ANA). Recognizing that substance abuse is a medical illness that requires treatment is the first step in removing the stigma associated with it. Current philosophies of the ANA and boards of nursing support helping addicted nurses seek treatment and rehabilitation to become productive members of society and nurses again. Certainly, communication and information sharing are paramount for this process to be effective.
It is only logical that a nurse who is suspected of abusing substances should be reported. It is the emotional aspect that undermines the reporting process. Being fearful that a colleague may lose his or her job or terminate a friendship are powerful motivators to withhold or dismiss anecdotal or subjective information. As social beings, people are motivated by emotions; the ability of nurses to report a colleague would be less hampered, however, if one of their loved ones was being cared for by a nurse who was impaired. As patient advocates, this is the level of nursing at which all nurses should practice.
References:
Alexander, D. (2005). When nurses are addicted to drugs. Nursing. (2) 50-58 Retrieved for Proquest February 29th 2008.
American Nurses Association (2002). ANA code of ethics for nurses. Washington DC.
Anderson, J. (2004). Treatment considerations for the addicted nurse. Behavioral Health Management. (14) 22-26. Retrieved from Proquest September 30, 2007
Blair, P. (2003). Report impaired practice-stat. Nursing management. (33) 23-25. Retrieved from Proquest October 12, 2007
Dunn, D. (2005). Substance abuse among nurses-defining the issue. Association of operating room nurses. (82) 592-596. Retrieved from Proquest October 1, 2007.
George, M. (2003). Substance abuse among healthcare professionals. Nursing Ethics. (14) 843-849. Retrieved from Proquest October 9, 2007
National Institute of Health (2007) www.drugabuse.gov/infofacts/costs.html
Ponech, S. (2005). Telltale signs. Nursing Management. (31) 32-37. Retrieved from Proquest October 12, 2007
Uris, P. (2002). Chemical dependency handbook for nurse managers. National Council of State
Boards of Nursing. Retrieved from www.dora.state.co.us/nursing October 12, 2007
Friday, February 29, 2008
Substance abuse among nurses
Autoethnography and Mental Health Nursing
It is no secret that it takes a special kind of person to be a mental health nurse. Qualities and abilities such as well-developed self-awareness, acceptance of self and others’ feelings, an understanding of the complexity of the human experience, an ability to accept ambiguity and uncertainty, willingness to take responsibility for self, and provision of trust and respect are crucial for the effective psychiatric mental health nurse (Foster, McAllister & O’Brien, 2006). But how does one integrate all these qualities effectively in practice? How does one become an effective mental health nurse? Foster, McAllister & O’Brien, 2006, state that autoethnography is the answer. According to them, autoethnography, the study of "self" should be an integral part of every mental health nurse's practice to ensure the highest level of care. There has been little research, and little literature has been written on the topic of autoethnography, and its use. Foster, McAllister & O’Brien, 2006, in their article “Extending the Boundaries: Autoethnography as an Emergent Method in Mental Health Research”, talk about the use of autoethnography as a new approach to caring for the mentally ill, as well as a research method, with the emphasis on mental health nursing research. The same authors, in an article published in December 2006, talk about the experiences of a doctoral student whose mother is mentally ill, and the process through which she used autoethnography to generate new research in the field, and relate to other mentally ill patients. Other articles such as “Nursing Student Attitudes to Psychiatric Nursing and Psychiatric Disorders in New Zealand” (Surgenor, Dunn & Horn, 2005) and “A Survey of Mental Health Nurses’ Experiences of Stalking” (Ashmore, Jones & Jackson, 2006) talk about the different experiences that nurses have with mental health patients. These articles show how different interactions with mental health patients change nurses’ attitudes, and the way that they interact with their patients thereafter. It is a well known fact that attitudes, beliefs, values, life experiences and even religious practices greatly impact nurses’ ability to care. In most areas of nursing practice, attitudes and beliefs are mostly positive. When it comes to mental health however, nurses attitudes and beliefs may be less positive. This in turn, may negatively impact the level of care that mental health patients receive. Research by Reed & Fitzgerald, 2005, found that attitudes were found to be linked to issues that influence nurses’ ability to provide care. Dislike was also apparent from nurses who suggested mental health care was not their role. One of the most prevailing feelings however was fear, which caused avoidance. James & Cowman, 2007, identified attitudes towards clients with bipolar disorder to be less then favorable. The authors recognize that mental health patients are more difficult to care for than other patients. As a result, these patients receive care that is inadequate. Autoethnography has been defined as “the study of self” (Foster, McAllister & O’Brien, 2006). A process through which a nurse looks at herself and identifies her own attitudes, beliefs and values about mental health, and issues that are involved in mental health nursing in order to improve their care of the mentally ill. This way, psychiatric mental health nursing is seen as being directed by the nurse’s own characteristics, who is working together with the client to create a therapeutic relationship and to improve or maintain the client’s health. In order for the nurse to effectively interact with the client, the nurse needs to first be able to understand that her character has been constructed by a set of experiences that is different from the patient’s. Social constructivism is a perspective that maintains that people develop a sense of what is real through conversation with, and observations of others (Foster, McAllister & O’Brien, 2006). This means that whatever the nurse holds to be real, might not be real for the patient, because his experiences have been different. Thus a nurse cannot impose her perception of reality onto the patient because of her different experiences. A nurse cannot be therapeutic until she realizes that what is real, and what makes sense to her, might not be real, or not make sense to a patient. Autoethnography works by having the nurse look at what her reality is, takes note of what the patients’ reality is, and only then, can the nurse make a final judgment. “Psychiatric mental health nursing research literature also recognizes the importance of the quality of engagement between nurse and the client as being integral to the nurses effective use of self” (Foster, McAllister & O’Brien, 2006). The way that a nurse interacts with the patient, and the quality of their relationship, is crucial for a therapeutic environment. Foster, McAllister & O’Brien, 2006, also state that clients themselves have reported that provision of respect, security, confirmation, and companionship are some of the most valuable aspects of the nurse-client relationship. How can nurses provide these to the patients, when the nurses are afraid of patients, avoid patients and or believe that it is not their role to take care of these patients? It is impossible for the nurse to provide security for these patients when they themselves are scared. It is impossible for the nurse to provide companionship to these patients when the nurse avoids them. If the nurse cannot effectively talk to, listen to, and empathize with the patient, there is no therapeutic relationship. Using autoethnography, the nurse first needs to understand that she dislikes these patients, is afraid of these patients, and avoids these patients. The nurse than must think and identify the reasons for these behaviors. Why is it that the nurse fears and avoids these patients? Then she must remedy the problem By doing so, the nurse just went from a nurse who fears and avoids a patient, to a caring nurse who can develop a healthy therapeutic relationship with the patient. By doing so, the nurse becomes a caring nurse who can develop a healthy therapeutic relationship with the patient. Autoethnography is the process through which nurses evaluate their own attitudes and beliefs towards mental health. This way they can correct any misconceptions or false beliefs about mental health patients they might have. In this manner they can provide the best care possible. It is a process which should be applied by every nurse that has a mental health patient in her care. Disadvantage 1 Knowledge deficit Knowledge deficit is a big problem in mental health nursing. Many research studies have concluded that most nurses are undereducated about how to care for mentally ill patients. Because of the limited amount of education, nurses rely on their own beliefs, perceptions and values when setting standards in their care for the mentally ill clients (Reed & Fitzgerald, 2005). A lot of nurses have their preset beliefs that mentally ill patients are difficult to take care of, assaultive and non cooperative and simply hard to take care of. A lot of times nurses attribute these qualities to all mentally ill patients (Reed & Fitzgerald, 2005). It is hard for them to understand that this is not necessarily true and that she needs to set these feelings aside. Because of the lack of education in caring for these clients, these nurses make further mistakes in their care which in turn reinforces their false beliefs. The nurse goes on attribute these qualities to the patient’s condition and does not perceive them as their own beliefs and perceptions. This makes it even harder for the nurse to implement this nursing intervention while caring for the mentally ill client. Reed F. & Fitzgerald L. (2005, December). The mixed attitudes of nurse’s to caring for people with mental illness in a rural general hospital. International Journal of Mental Health Nursing, 14, 249-257. Retrieved November 1, 2007 from CINAHL database. Disadvantage 2 Pt. discrimination/dislike. Dislike and discrimination of mentally ill clients has been thoroughly studied and documented. Most of the time, this attitude stems as a result of the choices the patients make. Choices which make it more difficult for the nurse to provide care (Reed & Fitzgerald, 2005). Mentally ill clients can become easily agitated, non cooperative, resistive and paranoid (Reed & Fitzgerald, 2005). They also make poor choices and judgment calls. In most cased hygiene standards are usually very low also. This leads the nurse to develop a sense of dislike towards these patients. This attitude makes the nurse more reluctant to identify her own attitude as a barrier in quality care. As a result, there is a further increase in the nurses' anxiety, dislike and avoidance of the patients. This type of attitude also increases the use of medical and mechanical restraints which can be very detrimental to the patient. Reed F. & Fitzgerald L. (2005, December). The mixed attitudes of nurse’s to caring for people with mental illness in a rural general hospital. International Journal of Mental Health Nursing, 14, 249-257. Retrieved November 1, 2007 from CINAHL database. The nurse will sit with the mentally ill pt. for at least 20 minutes to listen to the pt’s “story”, identify the pt’s belief system, thoughts, perceptions and degree of cooperativeness to help nurse better understand patient and increase comfort level with patient. Disadvantage 1 NEGATIVE PAST EXPERIENCES. Past experiences with mentally ill clients can either strengthen or ruin the perception of these clients to the nurse. Negative experiences heavily influence the nurses’ perception of these patients, the care they deserve, and even the nurses own perspective on her ability to provide care for these patients (Ashmore, Jones & Jackson, 2006). Nurses who had negative experiences with mentally ill clients experienced an increase in their level of anxiety, increased feelings of unhappiness and anger. They also said they felt less relaxed, outgoing, happy and competent in their care (Ashmore, Jones & Jackson, 2006). The same article stated that 37.5 percent of nurses who had a stalking experience ignored the patient afterwards, 14.3 percent of nurses yelled at the person, and 19.6 percent pleaded the person to stop (Ashmore, Jones & Jackson, 2006). Experiences as such, can make the nurse avoid a situation where she has to sit and talk with the mentally ill client. She will also be reluctant to develop nursing interventions in which the nurse has to spend time with the patient. This can make the relationship even worse and have a negative outcome on the plan of care. Ashmore R., Jones J., Jackson A. & Smoyak S. (2006, March). A survey of mental health nurses’ experiences of stalking. Journal of Psychiatric and Mental Health Nursing, 13, 562-569. Retrieved November 1, 2007 from CINAHL database Disadvantage 2 FEAR. Fear is the biggest barrier in providing quality care for the mentally ill patient. The nurses are worried about their physical safety and the safety of other coworkers on the ward. They also feel vulnerable professionally, ethically and legally about the action they might have to take to avoid harm if such action should be necessary (Reed & Fitzgerald, 2005). This can cause a gap in between the nurse and the patient. As a result, the nurse can end up avoiding the patient, keep their distance and take shortcuts when interviewing them. For communication to be effective in the nurse/mentally ill client relationship, the nurse has to show empathy, warmth, respect, patience and trustworthiness (Foster, McAllister & O’Brien, 2006). When the nurse fears these patients, she can’t show any of these qualities to these patients, thus making it hard to implement this intervention. Foster K., McAllister M. & O’Brien L. (2006, March). Extending the boundries: Autoethnography as an emergent method in mental health nursing research. International Journal of Mental Health Nursing,15, 44-53. Retrieved October 4, 2007 from CINAHL database References: Foster K., McAllister M. & O’Brien L. (2006, March). Extending the boundries: Autoethnography as an emergent method in mental health nursing research. International Journal of Mental Health Nursing,15, 44-53. Retrieved October 4, 2007 from CINAHL database. Surgenor, L., Dunn, J. & Horn, J. (2005, June). Nursing student attitudes to psychiatric nursing and psychiatric disorders in Reed F. & Fitzgerald L. (2005, December). The mixed attitudes of nurse’s to caring for people with mental illness in a rural general hospital. International Journal of Mental Health Nursing, 14, 249-257. Retrieved November 1, 2007 from CINAHL database. Ashmore R., Jones J., Jackson A. & Smoyak S. (2006, March). A survey of mental health nurses’ experiences of stalking. Journal of Psychiatric and Mental Health Nursing, 13, 562-569. Retrieved November 1, 2007 from CINAHL database. James P. & Cowman S. (2007 October). Psychiatric nurses' knowledge, experience and attitudes towards clients with borderline personality disorder. Journal of Psychiatric and Mental Health Nursing, 14, 670-678. Retrieved November 1, 2007 from CINAHL database. Foster K., McAllister M. & O’Brien L. (2005 December). Coming to Autoethnography: A mental health nurse’s experience. International Journal of Qualitative Methods, 1-13. Retrieved November 1, 2007 from CINAHL database.INTERVENTION 1
The nurse will identify her own thoughts, feelings and perceptions about the mentally ill client and the disease process that can interfere with the quality of care provided and set them aside while caring for the mentally ill client.
INTERVENTION 2
Paste the rest of your old paper plus the new part and all the references over these words. Leave the following text intact.