Psychometric Properties of the Person-Centered Version of the Alcohol and Alcohol Problems Perceptions Questionnaire (PC-AAPPQ).

AIMS: Given the importance of addressing provider attitudes toward individuals with unhealthy alcohol use and the current emphasis on person-centered language to help decrease stigma and mitigate negative attitudes, the aim of this study was to evaluate the psychometric properties of a contemporary version of the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) that uses person-centered language and addresses the spectrum of alcohol use. METHODS: The authors created a person-centered version of the AAPPQ (PC-AAPPQ) and conducted a cross-sectional study of its psychometric properties in academic settings in the Northeastern United States. The PC-AAPPQ was administered to 651 nursing students. Reliability analysis of the new instrument was performed using the total sample. Only surveys with complete data (n = 637) were randomly split into two datasets, one used for the exploratory factor analysis (EFA) (n = 310) and the other for confirmatory factor analysis (CFA) (n = 327). RESULTS: Compared to all the models generated from the EFA, neither the original six-factor structure nor the five-factor structure was superior to any of the other models. The results indicate that a seven-factor structure with all 30 items is the best fit for the PC-AAPPQ. CONCLUSIONS: The PC-AAPPQ represents a positive effort to modernize the four-decade-old AAPPQ. This 30-item instrument, which adds one additional subscale, offers a means to assess providers' attitudes using respectful wording that avoids perpetuating negative biases and reinforces efforts to affirm the worth and dignity of the population being treated.

A Concept Analysis of Substance Misuse to Inform Contemporary Terminology.

Previous diagnostic categories of substance abuse and dependence have given way to the current view that substance use disorders occur on a continuum with a broad range of severity. This current view is featured in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V). In recognizing the role of stigma in preventing persons from seeking substance use treatment, advocates have called attention that particular terminology can fuel such stigma. To mitigate the negative effects of such stigmatizing language, the International Society of Addiction Journal Editors (ISAJE) recommends against using previously-used and possibly pejorative terminology for substance abuse and dependence, unless a particular scientific justification exists. The purpose of this paper is to: (1) present a concept analysis of the term substance misuse and (2) recommend an alternate term for substance misuse that is neither pejorative nor inadvertently stigmatizing: at-risk substance use.

Assessing nurses' continuing education preferences in rural community and urban academic settings.

Continuing education programs that increase nursing knowledge and collaboration are needed across urban and rural settings. A survey was distributed to determine interest in nursing grand rounds and preferred educational modalities at two unaffiliated hospitals. Results revealed that nurses from the urban and rural hospitals were interested in nursing grand rounds as a recorded online offering, thus providing valuable information used to develop a nursing grand rounds program.

Changes in Nursing Students' Attitudes and Perceptions After Receipt of Enhanced Substance Use-Related Curricular Content.

BACKGROUND: Negative attitudes toward persons who use alcohol and other drugs contribute to suboptimal care. Nurses are in key roles to address the needs of this population, yet they lack the education needed to identify persons who may be at risk because of substance use and intervene accordingly. The purpose of this study was to evaluate the impact of a substance-use-related curriculum on nursing students' attitudes and therapeutic commitment for working with patients with alcohol- and drug-use-related problems. METHODS: Data were collected for four cohorts of 169 nursing students enrolled in a Master's Entry into Nursing program. Questionnaires included the Person-Centered Alcohol and Alcohol Problems Perception Questionnaire and the Drug and Drug Problems Perception Questionnaire, completed before and after completing the curriculum. Paired samples t test were used to examine pre/post differences for each measure's subscale. RESULTS: Four of the seven Person-Centered Alcohol and Alcohol Problems Perception Questionnaire subscales showing significant increases were role adequacy, role support, role legitimacy, and general perceptions. Four of the five Drug and Drug Problems Perception Questionnaire subscales showing significant increases were role adequacy, role support, job satisfaction, and role legitimacy; there was a significant change in role-related self-esteem, however, in a negative direction. CONCLUSIONS: This study adds to the growing evidence of the positive impact of providing evidence-based information and skill development, which enhance alcohol- and drug-related knowledge and competence for nurses entering professional practice.

The Essentials Competencies: A Framework for Substance Use-Related Curricula.

BACKGROUND: The use of substances including alcohol, tobacco, and other drugs increases the risk for injury, noncommunicable disease, and premature death and contributes to the global burden of disease. PROBLEM: The morbidity and mortality rates among patients with at-risk substance use point to the need for future nurses to have the requisite knowledge and competencies to provide care for this population. APPROACH: This article provides guidance for nurse educators in designing curricula that include content related to substance use, including screening, brief intervention, and referral to treatment. OUTCOMES: Expected outcomes for baccalaureate, master's, and doctor of nursing practice programs are informed by the corresponding American Association of Colleges of Nursing Essentials. CONCLUSION: The overall goal of this guidance for nursing education is to advance the knowledge and competencies of the future nursing workforce to address the continuum of substance use and improve the health of the nation.

Hazardous Drinking Prevalence and Correlates in Older New Zealanders: A Comparison of the AUDIT-C and the CARET.

Objectives: The study compared the proportion of older adults identified as drinking hazardously based on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) with the older adult-specific Comorbidity Alcohol Risk Evaluation Tool (CARET) and investigated whether sociodemographics, comorbidities, health, medication use, and alcohol-related risk behaviors explained discrepancies between the screens in classification of hazardousness. Method: The AUDIT-C and the CARET were administered to 3,673 adults aged 55 to 89 years. Classification agreement between the screens was evaluated using Cohen's kappa. Hazardous drinking groups were compared using logistic regression. Results: Analysis indicated moderate agreement between the screens. Drinkers classified as "hazardous on the CARET only" consumed less alcohol, but were more likely to drink-drive. Introducing a drink-driving criterion into the calculation of hazardousness on the AUDIT-C substantially decreased the classification discrepancy between the measures. Discussion: Standard screening can be improved by investigating comorbidities, medication use, and alcohol-related risk behaviors in those initially identified as nonhazardous drinkers.

Is Alcohol Use Associated With Increased Risk of Developing Adverse Health Outcomes Among Adults Living With Human Immunodeficiency Virus: A Systematic Review.

BACKGROUND: Alcohol use is associated with many HIV-related behaviors that are associated with increased risk of reinfection, transmission, and poorer health outcomes in people living with HIV (PLHIV). The population of middle-aged and older PLHIV is growing because of increased life longevity and aging trend. METHODS: A systematic review across three databases was conducted to evaluate existing studies that examined the association between alcohol use and medication adherence, high-risk sex behaviors, HIV progression, depression, resource utilization, and survival among studies of PLHIV with an average age of 40 years and above. RESULTS: Among the 47 included studies, most found a positive association between alcohol use and depression, risky sex behaviors, medication nonadherence, and healthcare resource utilization among PLHIV. The association between alcohol use and response to treatment was variable. The association between alcohol use and survival warrants further study because of lack of existing studies. CONCLUSIONS: The results of this review support that alcohol use negatively impacts middle-aged and older PLHIV in many aspects; however, there is lack of studies exclusively targeting older PLHIV, and more relevant studies in the future are needed.

Time-Conscious Alcohol Screening and Brief Intervention for Students, Nurses, and Nurse Leaders.

Alcohol is the third leading cause of death and a preventable risk factor contributing to more than 200 diseases and conditions. Unquestionably, health care practitioners should routinely screen and give patients brief feedback on alcohol consumption related to health outcomes; however, they rarely ask patients about alcohol use. Alcohol screening and brief intervention (SBI), a public health model of prevention and identification of at-risk alcohol use, has not been widely disseminated. The nursing profession, the largest and most trusted sector of the health care workforce, is perfectly poised to close this gap. This article describes the development of a two-university, grant-funded collaborative online educational program with unique and time-conscious simulation and testing components to increase the knowledge and skills of nurses. The goal of the program is to promote alcohol SBI as a standard of practice in all settings. J Contin Educ Nurs. 2018;49(10):467-473.

Integrating Substance Use Content in an "Overcrowded" Nursing Curriculum.

Various factors have compelled nurse educators to address the lack of substance use-related content in nursing curriculum. Initiatives to add this content are often met with resistance because of an already crowded curriculum. This article describes a 4-phase process that guided the integration of this specialty content into a prelicensure nursing curriculum and a master's level advanced practice nursing curriculum. Lessons learned and recommendations from those experiences are provided to guide nurse educators undertaking similar efforts.

The culture of pregnancy and infant care in African American women: an ethnographic study.

In Hamilton County, Ohio, the infant mortality rate for African American infants in 2002 was 18.1 per 1,000 live births compared with 14.4 for the United States. It is essential to engage community residents and leaders in identifying the underlying cultural factors contributing to this disparity. The purpose of the study was to explore the cultural contexts of prenatal and infant care practices among African American women of childbearing age living in an urban community located in Hamilton County, Ohio. This was an ethnographic community-based participatory research study. Seven participants were recruited for the study. Family support from mothers and sisters in obtaining needed resources related to pregnancy and child care emerged as the central theme. A strong family-based social network was core to the culture of pregnancy and infant care for these women. Nurses should consider developing family-centered interventions to reduce disparity in infant health.

Substance Use and Substance Abuse--What's in a Name?

PURPOSE: What's in a name? Because the Diagnostic Statistical Manual of Mental Disorders, 5th Edition, no longer uses the terms dependence and abuse (American Psychiatric Association, 2013a), does the continued use of these terms impact how issues related to at-risk substance use are presented in the literature? The purpose of this review is to explore the implications of the continued use of the term substance abuse in the clinical literature through the review of three articles published in 2015 that used the term substance abuse in the title. REVIEW: The use of the term substance abuse in the articles reviewed resulted in presenting a narrow focus on substance use disorders rather than the broader issues of harm that occur across the full continuum of substance use. In addition, the term "substance abuse" in one article lent itself to the use of pejorative language and stigmatization. CONCLUSION: It is imperative that we stop using the term substance abuse in clinical articles, because it is no longer clinically relevant and presents a narrow focus of the risks associated with substance use.

Alcohol and Substance Use Disorder Screening, Brief Intervention, and Referral to Treatment Among People Living With HIV/AIDS.

PURPOSE: The purpose of this review is to inform nurses on the prevalence of substance use screening with screening, brief intervention, and referral to treatment; its use in the primary care setting; and its effectiveness on HIV-related risk behaviors to prevent adverse health consequences among people living with HIV/AIDS (PLWH). REVIEW: For PLWH, identification of at-risk substance use is important because of the association between substance use and HIV infection both in terms of acquiring HIV and in further transmission of HIV. CONCLUSION: Alcohol and substance use disorders continue to be a burden for PLWH and are associated with poor health outcomes. Implementation of screening, brief intervention, and referral to treatment in the primary care setting is critical for promoting positive health outcomes in this population and provides an opportunity for nurses to intervene.

Improving health status of homeless patients at a nurse-managed clinic in the Midwest USA.

Homeless adults have a higher rate of morbidity and mortality than their housed counterparts. Improving the health of homeless adults is a complex problem because of the overlay of individual risk factors, social issues and lack of economic resources. Due to the increased morbidity and mortality rate in homeless adults, it is imperative to develop interventions with demonstrated efficacy that result in improved health outcomes. The purpose of this pre-post pilot study was to compare pre- and post-test scores on specific health outcomes in a group of homeless adults receiving a nurse intervention when utilising a nurse-managed clinic located in the urban core of a Midwestern city in the USA. Between September of 2004 and January 2006, 43 homeless adults completed a health survey at baseline and 2 months later that included measures of health-related quality of life (HRQOL), substance use and health resource use. There was a significant improvement on the post-test scores including substance use, perceived quality and availability of health care, and on two domains of HRQOL: mental health and vitality. This study provides evidence that a nursing intervention can result in improved health outcomes for adult homeless persons.

Health care needs of homeless adults at a nurse-managed clinic.

Up to 55% of the homeless population report health problems. They often use the emergency department (ED) to obtain care when the health needs are not urgent. Nurse-managed clinics have the potential to reduce nonurgent ED use and improve the health of the homeless. The purpose of this study was to establish baseline health data on homeless persons prior to attending a nurse-managed clinic.(1) This study was a cross-sectional, retrospective health survey of homeless clients at a nurse-managed clinic. A total of 110 participants completed a baseline health survey. Of these, 61% reported that prior to coming to the clinic, they used the ED as a source of health care. The most frequent medical diagnoses reported were substance use disorders, depression, back pain, hypertension, and asthma. Providing care for chronic conditions at a nurse-managed clinic has the potential to improve health and reduce use of the ED.

A case study in the use of community-based participatory research in public health nursing.

There is growing demand for research using a community-based participatory (CBPR) approach. CBPR requires that the academic research team actively partner with community members and stakeholders in the entire research process. The community members are full partners with the researchers in relation to the development and implementation of the study, analysis of the data, and dissemination of the findings. The purpose of this article is to review four basic principles of CBPR and provide an example of how these CBPR principles were used in an ethnographic study related to the culture of African American infant health. In the pilot study, CBPR provided the framework for recruitment and retention of participants, ongoing data analysis, and dissemination of findings. Using CBPR provided the researchers an introduction into the selected community. Community members served as key informants about the culture of the community and provided access to potential participants. The community partners contributed to analysis of emerging themes and in the dissemination of findings to the community, stakeholders, and the scientific community. CBPR provides opportunities for community health nurse researchers to conduct research with vulnerable populations and sets the stage for implementing evidenced-based nursing interventions in the community.

Measurement of maternal alcohol consumption in a pregnant population.

Alcohol is a known teratogenic substance that operates under a dose-response mechanism. Before we conducted a larger study that examines the use of alcohol both before pregnancy and during pregnancy, it was important to pilot our method for measuring a pregnant mother's alcohol use that would allow us to capture the number of drinks consumed per day while addressing recall bias. The purpose of this study was 1) to pilot the Time Line Followback (TLFB) method developed by Sobell and Sobell (1992, Measuring Alcohol Use. Totowa, NJ: Humana Press) as a method for examining alcohol use during pregnancy and 2) to determine if the use of a study protocol that included biological markers of alcohol use would affect our ability to recruit subjects. Using a descriptive design, we tested our protocol for collecting alcohol use data with 10 mothers receiving prenatal care. We measured alcohol use using the TLFB method (Sobell and Sobell, 1992, Measuring Alcohol Use. Totowa, NJ: Humana Press, 1996). We also collected collected biological blood markers for heavy alcohol use. Of the 10 maternal subjects we recruited, 5 mothers (50%) reported alcohol use during pregnancy. We successfully recruited 10 out of 11 mothers approached and had a 100% retention rate for the second interview. The TLFB method is viable for measuring fetal alcohol exposure over the pregnancy, and the collection of blood samples did not impact our ability to recruit or retain mothers.