Personal and professional attitudes associated with nurses' motivation to work with patients with opioid use and opioid use-related problems.

Background: Opioid use and opioid use-related problems contribute significantly to increased morbidity rates and premature deaths as well as an increased economic burden. Nurses have key roles in providing care to this patient population; however, they often report low motivation toward working with these patients. Examining personal and professional attitudes associated with nurses' motivation to work with this population can present a valuable opportunity to enhance their willingness to intervene at an earlier stage when patients do not have a diagnosable opioid use disorder. Methods: A descriptive, correlational design was used. Nurses were recruited from four hospital settings in Southwestern Pennsylvania. Data on nurses' demographic/background characteristics, personal attitudes, professional attitudes, and motivation related to working with patients with opioid use and opioid use-related problems were collected via a paper/pencil survey and analyzed using linear regression. Results: A sample of 234 nurses were included in the final analyses. Personal attitudes associated with nurses' motivation included personal experience with a family member related to alcohol and/or other drugs, and stigma perceptions (familiarity, perceived dangerousness, fear, social distance and personal responsibility beliefs). Professional attitudes associated with nurses' motivation included working experience with substance use (SU), SU education as continuing education or other educational resources, role security, therapeutic commitment, role responsibility, and self-efficacy. Conclusions: This study's findings provide valuable information regarding the bivariate relationships between nurses' personal attitudes, professional attitudes, and motivation to work with patients with opioid use and opioid use-related problems. The study provides a base for future studies aimed at developing interventions to enhance nurses' motivation to work with this patient population particularly related to preventing the progression of opioid use to a diagnosable disorder.

Nurses and Fetal Alcohol Spectrum Disorders Prevention.

Women of reproductive age who are drinking alcohol and not using effective contraception are at-risk for an alcohol-exposed pregnancy, which could result in a child with a fetal alcohol spectrum disorder (FASD). Nurses are an important partner in addressing at-risk alcohol use. It is imperative for alcohol education to be incorporated into nursing curricula so that future nurses have the tools to identify at-risk alcohol use. Three universities have worked together to create Fetal Alcohol Spectrum Disorders: A Toolkit. This toolkit was designed for nurses to facilitate the recognition and prevention of FASD and address gaps that exists around alcohol use.

Evaluation of an Opiate Overdose Educational Intervention and Naloxone Prescribing Program in Homeless Adults Who Use Opiates.

Opiate overdose deaths are considered an epidemic by the Centers for Disease Control and Prevention. Homeless adults are disproportionately affected by opioid overdoses. The purpose of this project was to implement an opiate overdose training and routine naloxone prescribing program for patients at a Health Care for the Homeless clinic. Education consisted of overdose risk factors, signs of overdose, how to respond to an opiate overdose, and how to administer naloxone. Knowledge was measured with a pretest and a posttest. Intranasal naloxone was prescribed for each person who received the education, and prescription fill rates were tracked 1 week after the clinic visit. Patients had a significant increase in knowledge, and the overall naloxone fill rate was 33%. Fill rates varied by housing, insurance, and other prescription status. Opiate overdose education can effectively be delivered in a homeless medical clinic, although more research is needed regarding barriers to naloxone fill rates.

Effect on Dental Hygiene Students of a Substance Use Simulation Conducted with Nursing Students.

Dental professionals have an opportunity to screen for substance use, provide targeted feedback based on patients' oral health, provide patient education, and refer for further assessment as needed. The aim of this study was to assess the impact on dental hygiene students of an interprofessional Screening, Brief Intervention, and Referral to Treatment (SBIRT) educational intervention with standardized patients as a tool for initiating discussions on alcohol and drug use with patients. Starting in 2015, dental hygiene students in two classes at the University of Pittsburgh participated with nursing students in one and a half hours of didactic instruction followed within a ten-week period by SBIRT simulation scenarios utilizing standardized patients, with subsequent debriefing of students by faculty. Students' attitudes were assessed before and after the didactic session and immediately after the SBIRT simulation, using the Alcohol and Alcohol Problems Perceptions Questionnaire and the Drug and Drug Problems Perceptions Questionnaire. All 67 dental hygiene students in the program at the time participated in the educational intervention and surveys. The results showed significant positive changes in role security, defined as the acceptance of SBIRT delivery as part of their role identity as dental hygienists, following the intervention. This study found that the IPE intervention with dental hygiene and nursing students improved the dental hygiene students' attitudes through using SBIRT.

Changing BSN Students' Stigma Toward Patients Who Use Alcohol and Opioids Through Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education and Training: A Pilot Study.

BACKGROUND: Stigma associated with substance use is considered a barrier to implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) and assisting patients to receive appropriate treatment. OBJECTIVES: To test the efficacy of SBIRT education and training in changing undergraduate nursing students' attitudes about working with patients who have problems with alcohol and opioid use. DESIGN: A sample of 49 undergraduate nursing students were surveyed, using five subscales, at three time points. RESULTS: After a 15-week semester that included (a) SBIRT education and (b) weekly clinical experiences with patients who had alcohol use problems the undergraduate nursing students' stigma decreased as measured by three of the five subscales. The students' attitudes toward working with patients who had opioid use problems exhibited favorable change as measured by four of the five subscales. CONCLUSION: SBIRT education and training for undergraduate nursing students might help mitigate some of their stigma toward working with patients who have mild to moderate alcohol and opioid use problems.

Undergraduate Nursing Students' Perceptions of Individuals With Drug Use Problems: Confirming the Factor Structure of the Drug and Drug Problems Perception Questionnaire.

The Drug and Drug Problems Perception Questionnaire (DDPPQ) is a multidimensional instrument that measures healthcare providers' attitudes toward working with patients who use drugs. Five- and six-subscale versions of the DDPPQ have been published. Although the reliability of the DDPPQ subscales was reported to be satisfactory, the factor structure of either version was not validated by a confirmatory factor analysis. The aim of this study was to examine the internal factor structure of the 22-item DDPPQ instrument using a sample of undergraduate nursing students. This study was a secondary analysis that utilized baseline data from the Addiction Training for Nurses using Screening, Brief Intervention, and Referral to Treatment Program. The DDPPQ was administrated during the undergraduate nursing students' junior year in a single university setting in southwestern Pennsylvania. A sample of 473 students was used in this study. The sample was split equally to conduct both principal component analysis (n = 237) and confirmatory factor analysis (n = 236). On average, the sample had a mean age of 22.9 years and was predominantly female (87.2%) and Caucasian (90.9%). A principal component analysis revealed that a five-factor structure had the best fit after the removal of two items. Reliabilities of the five subscales ranged from α = .696 to α = .904. Thus, a five-factor structure with removal of Items 9 and 19 is recommended when using the DDPPQ with undergraduate nursing students.

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.

Trigeminal neuralgia: pain, pricks, and anxiety.

Trigeminal neuralgia (TN) is one of the most common forms of neuralgia experienced by older adults. Early in the course of the illness, individuals may be misdiagnosed, with associated delays in treatment. The current article uses an individual example to provide a framework for assessment and clinical management. Because pain associated with TN may be chronic, specific quality of life issues and related management approaches are presented, as well as guidelines for monitoring response to treatment. Targeted strategies to prevent pain triggers and suggestions for supportive coaching provide direction for health providers caring for older adults with TN.

Identifying at risk individuals for drug and alcohol dependence: teaching the competency to students in classroom and clinical settings.

Alcohol use and other drug use affect patient healthcare outcomes. This article describes a classroom-to-clinical approach teaching nursing students to utilize motivational interviewing techniques to support patient behavior change. Through the lens of a universal prevention method, nursing students learned about reward circuit activation leading to risky substance use and the difference between addiction and at-risk use. Specific assessment tools and motivational interviewing techniques were presented in the classroom. Students then applied their knowledge in simulation laboratories and clinical rotations.

Student assistance program outcomes for students at risk for suicide.

Pennsylvania's response to adolescent suicide is its Student Assistance Program (SAP). SAP has been funded for 27 years although no statewide outcome studies using case-level data have been conducted. This study used logistic regression to examine drug-/alcohol-related behaviors and suspensions of suicidal students who participated in SAP. Of the 46 services, 10 best predicted (p<.01) that these undesirable outcomes would cease. Although no study subjects died by suicide, 42 of 374,626 referred students did die by suicide. Suicidal students who did not participate had double the rate of suicide of suicidal participants of SAP. Students referred for other reasons also killed themselves. Further work must be done to assess all referred students for suicide risk, examine educational outcomes, monitor substance-related crimes and overdoses, and examine school-related factors postmortem. Evidence from this study can be used by researchers to plan future studies and by Pennsylvania's school nurses when planning services.

Confirming the factor structure of the alcohol and alcohol problems questionnaire (AAPPQ) in a sample of baccalaureate nursing students.

The Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) is a multi-dimensional measure of clinicians' attitudes toward working with patients with alcohol problems. In the past 35 years, five- and six-subscale versions and a short version of the AAPPQ have been published. While the reliability of the AAPPQ subscales has remained acceptable, the factor structure has not been verified using confirmatory techniques. In the current study, we split a sample of 299 baccalaureate nursing students to use exploratory (EFA) and confirmatory factor analyses (CFA). When compared to the original six-factor solution and an imposed six-factor structure in CFA, the EFA seven-factor solution with three original items (19, 20, and 25) removed had the best model fit.

Understanding content and process: guidelines for group leaders.

PURPOSE: To discuss basic concepts of group therapy as a treatment modality. CONCLUSIONS: The psychiatric nurse group leader uses concepts of content and process at his/her disposal as powerful tools of change, adaptation, and recovery. PRACTICE IMPLICATIONS: Group therapy is a common modality in treating mental disorders that is both evidence based and cost-effective. Group therapy is practiced in inpatient, outpatient, partial hospitalization, and residential treatment facilities. Because of their understanding of the bio-psycho-social origin of mental illness, psychiatric nurses are uniquely prepared to assist in many roles as facilitators of change.

THE LIFE EVENTS OF ADOLESCENTS: IMPLICATIONS FOR RURAL SCHOOL NURSES.

The purpose of this study was to describe life events of rural adolescents and their relationship to depression. The design was a cross sectional survey. The sample included 193 students attending three rural high schools in southwestern Pennsylvania. Measures included The Life Events Checklist and The Reynolds Adolescent Depression Scale (RADS-2). Results showed that the mean number of life events was eighteen. Females reported more life events and more negative life events than males. There was a moderate, linear correlation between negative life events and depression (r = .361; p < 0.0001). Rural school nurses should include adolescents' recent life events in the health history. Awareness of negative life events as a precipitating factor in depression constitutes appropriate screening and referral by rural school nurses.

Teaching kids to cope with anger: peer education.

Anger could be an early warning signal of violent behavior. Early peer education health promotion in relation to anger management could help children before uncontrolled anger becomes a problem in adolescence and adulthood. Peer education has been identified as a viable intervention strategy worldwide with various prevention programs for youth. The purpose of this article is to describe an anger management program (Teaching Kids to Cope with Anger, TKC-A 4th-8th graders) co-led by high school peer educators in an urban school district's summer school enhancement program. A program of five modules will be described. This paper discusses the peer educator implementation and recommendations for future implementation.

Self-esteem and optimism in rural youth: gender differences.

AIM: To identify and describe gender-related differences in the self-esteem and optimism levels of rural adolescents. BACKGROUND: Self-esteem and optimism have been broadly examined and are associated with health-practices, social interaction, attachment, resiliency, and personal identity. Information describing the relationship of self-esteem and optimism as it relates to gender is limited. METHODS: Using a cross-sectional survey design, students (N = 193) from three high-schools in rural Pennsylvania, USA completed the Rosenberg Self-Esteem Scale and the Optimism Scale-Life Orientation Test-Revised as part of a National Institute of Health, National Institute of Nursing Research funded study. RESULTS: Both instruments' mean scores were in the range of average for this population, with females scoring lower than males in both self-esteem (p < 0.0001) and optimism (p < 0.0001). The results of this study have nursing implications for evidenced based interventions that target self-esteem and optimism. Attention to self-esteem and optimism in female youth is recommended.

Identification of suicide risk among rural youth: implications for the use of HEADSS.

INTRODUCTION: Nurse practitioners have the power to assess psychosocial risk and detect and prevent suicide, a problem plaguing rural areas of the United States. Suicide risk assessment can be completed using the Home, Education, Activities, Drug use and abuse, Sexual behavior, and Suicidality and depression (HEADSS) interview instrument. The purpose of this study was to determine if HEADSS is appropriate for guiding suicide risk assessment of rural adolescents. METHOD: High school students in Southwestern Pennsylvania completed qualitative questions from the Child Behavior Checklist and Coping Response Inventory as part of the Intervention to Promote Mental Health in Rural Youth. Qualitative content analysis was performed. RESULTS: Prominent themes identified by participants included academic performance, relationships, dislikes about school, friends, death, mental health, and the future. Several minor themes concerned safety. Most known risk factors for suicide were concerns of participants. DISCUSSION: The expansion of HEADSS to include death and safety should be considered. The modified version-HEADDSSS-can be used to guide suicide risk assessment of youth in rural Pennsylvania, ensuring both thoroughness of assessment and safety.

Considerations to implement holistic groups with the elderly.

The group modality is a viable holistic treatment consideration for the elderly, given the steady increase in the elderly population, the presence of various psychiatric and/or medical conditions in this cohort, and cost concerns. The holistic nurse and group leader share similar role definitions of being a facilitator in the healing process. They embrace the concept that the person and group are greater than the sum of the parts. Using a group modality can increase the number of people served by one nurse, thereby making it cost-effective. Incorporating the holistic mind-body-spirit approach addresses the Healthy People 2010 goal of increasing the quality of life. Tips on conducting groups with the elderly are reviewed, including types of groups, setting, goals, composition, duration, and frequency. Theme-centered groups are discussed from a holistic perspective. Yalom's 11 therapeutic factors that account for group functions are explained, along with other group concepts that reflect holistic nursing concepts.

Rural adolescents' coping responses: implications for behavioral health nurses.

The purpose of this paper is to identify coping responses of rural adolescents. The sample included 193 students attending three high schools in southwestern Pennsylvania. Family and peer relationships were the most common stressful situations described by the adolescents. Coping responses were measured by the Coping Responses Inventory-Youth Form (CRI-Y). The results indicate that males most often report the coping response of logical analysis and females report the coping response of cognitive avoidance most often. Mental health programs, led by behavioral health nurses, may teach a variety of coping strategies to rural adolescents.