Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus): A Novel Interprofessional Training for Rehabilitation Science Professional Students.

IMPORTANCE: With the increasing amount of substance use-related health conditions in the United States, it is important for rehabilitation science professionals to receive screening and prevention training. OBJECTIVE: To describe and examine the preliminary effectiveness of a novel educational program, Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus), that combines traditional SBIRT training with new modules for cannabis, stimulant, and opioid use. DESIGN: Prospective, cohort design. SETTING: Academic institution. PARTICIPANTS: One hundred eighty-one rehabilitation science graduate students. INTERVENTION: SBIRT-Plus curriculum. OUTCOMES AND MEASURES: Outcomes included satisfaction with training, perception of interprofessional training, attitudes, knowledge, and stigma, as assessed with the Readiness for Interprofessional Learning Scale, Alcohol and Alcohol Problems Perception Questionnaire, Drug and Drug Problems Perception Questionnaire, Knowledge Screening Scale, and two stigma instruments. RESULTS: Most students (>80%) expressed satisfaction with their training, would recommend the training to a colleague, and believed that the training would influence and change the way they practiced with patients at risk for substance use disorders. Students' attitudes and knowledge increased from pre- to post-training, and stigma perceptions were significantly reduced. CONCLUSIONS AND RELEVANCE: SBIRT-Plus is an evidence-based interprofessional training that is feasible to implement in graduate-level education programs. Integrating SBIRT-Plus into professional graduate programs may be an optimal and low-cost model for training rehabilitation health care professionals. Plain-Language Summary: Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus) is an evidence-based interprofessional training that can be easily adopted in curricula to train professional students about the importance of screening for substance use disorders.

Psychometric evaluation of a contemporary version of the drug and drug problems perception questionnaire.

BACKGROUND: More than 20 years ago, the Drug and Drug Problems Perception Questionnaire (DDPPQ) was developed to examine healthcare providers' attitudes and perceptions towards individuals who use drugs. In alignment with recommended terminology respectful of this patient population, the 20-item measure was revised using person-centered language. Therefore, this study aimed to examine the psychometric properties of the person-centered DDPPQ (PC-DDPPQ) version among undergraduate nursing students. METHODS: Exploratory and confirmatory factor analyses were used to examine the PC-DDPPQ factor structure using a cross-sectional design. A convenience sample of 400 students from two nursing schools located in the Northeast and Mid-Atlantic regions of the US participated in the study. The sample (N = 400) was divided equally between the exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA). RESULTS: After applying principal axis factoring (PAF) with oblique (Promax) rotation, the EFA yielded a five-factor, 20-item structure that explained 70.0% of the variance. The CFA revealed that the final model, derived from the EFA, which yielded a 19-item, five-factor structure adequately fit the data (Comparative Fit Index (CFI) = 0.959, the Tucker-Lewis Index (TLI) = 0.951 and Root Mean Square Error of Approximation (RMSEA) = 0.058). CONCLUSIONS: Except for one item (item #14), the five-factor structure aligned with the original 20-item version. This study contributes to promoting the use of a more appropriate and less stigmatizing language among healthcare providers working with patients who use drugs.

Factors Associated with Nurses' Motivation to Provide Care for Patients with Alcohol Use and Alcohol Use-Related Problems.

BACKGROUND: There is a high human and economic cost associated with alcohol use and alcohol use-related problems. Nurses have a pivotal role in addressing the needs of this patient population. Purpose: The study aimed to examine the correlation between nurses' demographics/background characteristics, personal attitudes, professional attitudes, and their motivation to provide care to patients with alcohol use and alcohol use-related problems. METHODS: A descriptive, cross-sectional correlational design was utilized. Nurses were recruited from four Southwestern Pennsylvania hospitals. The study variables were examined using questionnaires that explored nurses' demographic/background characteristics, their personal and professional attitudes, and motivation to care for patients with alcohol use and alcohol use-related problems. RESULTS: The sample included 234 nurses. Demographic/background characteristics were identified as associated with nurse's alcohol use-related motivation, including gender, primary work setting and specialization. Previous personal experience with alcohol use-related problems (nurses themselves or co-workers), familiarity, perceived dangerousness, fear, social distance, personal responsibility beliefs and disease model were also associated with nurses' alcohol use-related motivation to care for these patients. In addition, all professional attitudes were associated with nurses' motivation toward caring for patients with alcohol use and alcohol use-related problems. CONCLUSIONS: The study revealed that certain demographic/background characteristics and personal and professional attitudes were associated with nurses' motivation to provide care to this patient population. This study provides the foundation for future studies aimed at exploring predictors of nurse's motivation to care for patients with alcohol use and alcohol use-related problems.

Buprenorphine Program Evaluation in a Private Psychiatric Office-Based Practice.

PURPOSE: The opioid crisis has contributed to the mortality, morbidity, and rising healthcare costs in the United States. Buprenorphine (BUP) is an effective medication for opioid use disorder. The aims of this quality assurance evaluation of a BUP program were to (a) evaluate the clinic's performance in illicit opioid abstinence and (b) identify patient risk and resilience characteristics to improve patient success in recovery with BUP. METHODS: A retrospective chart review of open (n = 35) and closed (n = 21) cases and a cross-sectional survey in open cases were completed. Adults (aged ≥18 years) who completed 6 months of BUP treatment at a psychiatric clinic were included. Clinical performance was measured with percentages of opioid-negative urine and completed monthly urine drug tests (UDTs) for the first 6 months. Open cases were surveyed regarding risk and resilience characteristics (frequency of opioid cravings and triggers, therapy participation, and coping skills). Descriptive statistics, t test, and chi-square test were used to analyze data. RESULTS: Average opioid-negative urine was significantly higher in open cases than closed cases (88.57% vs. 74.82%; t = 2.885, p = .004). There was no significant association between open cases (61.4%) and closed cases (73.8%) in completed monthly UDT. Opening and closing of cases stabilized with mandatory monthly UDT. Most individuals reported therapy participation, minimal opioid cravings, and use of distraction to cope with chronic-pain-induced cravings. CONCLUSIONS/IMPLICATIONS: This clinic met benchmarks leading to improved substance recovery. Recommendations include regular evaluations of UDT, cravings, and chronic pain; therapy participation; and continuous quality assurance activities.

Bridging the Gap Between Individualized Inpatient Safety Planning and Postdischarge Efficacy.

INTRODUCTION: Implementation of programs that increase both psychiatric patient education and their involvement in treatment programming can lead to positive outcomes postdischarge. Patients involved in programs focusing on skills, recovery, and that are individualized show a reduction in symptoms as well as an increase in engagement, treatment, and recovery posthospitalization. AIMS: This quality improvement project examines (1) the effectiveness of a safety planning group on an inpatient psychiatric unit for developing individualized safety plans, (2) the usefulness of the safety plans upon discharge, and (3) how helpful the patient found them. METHODS: A standardized safety plan was presented during 1-hour groups on an adult inpatient unit. Completed safety plans scored using a rubric to determine how patients individualized the content. One week postdischarge, patients were contacted to determine location and use of the safety plan since discharge. RESULTS: Patient's (n = 124) safety plans were relatively individualized when compared to the standardized safety plan (mean [SD] = 32.85 [8.27] on a 44-point rating). Of those patients who were contacted postdischarge (n = 76), 73 (96.1%) had a copy of their safety plan 1-week postdischarge while 28 (36.8%) reported using their safety plan since discharge. Many of the patients who used their safety plan reported that it was helpful (n = 19; 67.9%). CONCLUSIONS: Developing a safety plan can be a helpful tool for individuals admitted to a psychiatric inpatient unit.

Support Methods for Healthcare Professionals Who Are Second Victims: An Integrative Review.

A second victim is a healthcare provider who has been involved in a critical event. A critical event is a clinical situation in which an unforeseen clinical outcome occurs, or the clinical deterioration of the patient takes place for many different reasons. The patient and his/her family are the first victims. The healthcare provider(s) involved in the event are second victims. After such an event, the healthcare provider may experience a constellation of negative emotions, such as guilt, sadness, depression, somatic symptoms, hypervigilance, and fear. Most second victims require support to cope with the adverse clinical situation. Many of the studies addressed in this integrative review, revealed that having a trusted colleague or staff member with whom to discuss the critical event is therapeutic. Some organizations have developed programs to support second victims in which specially trained staff members are deployed to discuss critical events with those involved, if the participant(s) desire the support. Other clinical facilities do not have established support programs; however, healthcare providers have expressed desire to discuss the critical event with supportive colleagues.

Learning From the Lived Experiences of People With Opioid Use Disorder: A Pilot Study of the Impact on Students' Stigma Perceptions and Attitudes.

BACKGROUND: Opioid use disorder (OUD) is a national public health crisis causing more than 130 daily deaths and costing over $78 billion annually. Medication-assisted treatment is one of the available treatments for OUD. However, stigma associated with opioid use is a main barrier to patients' access to treatment and recovery. It is critical to address OUD-related stigma and its impact on interdisciplinary undergraduate students' knowledge and attitudes. OBJECTIVE: The purpose of this pilot study was to examine the impact of a recovery-oriented educational intervention highlighting individuals who have lived experiences with OUD to address OUD-related stigma among undergraduate students. METHODS: A pretest-posttest design was utilized. Before and after this intervention, students received a questionnaire derived from three established tools related to exposure, personal stigma, and perceptions of public stigma toward opioids and people who use them. These categories were also assessed qualitatively using open-ended questions. RESULTS: Nine students completed the pretest and posttest. Overall, there were small positive changes in students' personal stigma and public stigma perceptions. Students displayed prior knowledge and exposure to people with OUD through clinical experience, personal relationships, and the media. CONCLUSION: Further studies should evaluate the impact of learning from the lived experiences of individuals with OUD on larger undergraduate student populations with the goal of incorporating these educational interventions utilizing lived experiences in college-level curriculum.

Creating an operational definition for prolonged postoperative opioid use through the use of concept analysis.

AIM: To develop an evidence-based operational definition for Prolonged Postoperative Opioid Use (PPOU). BACKGROUND: In the United States, opioids are a mainstay of postoperative pain management, and are prescribed to over 90% of patients following surgery. Recent literature has highlighted the risk for prolonged postoperative opioid use (PPOU) after many surgical procedures. However, reported rates of PPOU vary greatly across studies, due in part to inconsistent operational definitions. Recent literature identified 29 distinct definitions for PPOU, which resulted in incidence ranging from 0.01% to 14.7% when applied to the same cohort of opioid naïve patients. METHODS: We followed the eight-step method described by Walker & Avant, using an iterative literature search process with the following databases: PubMed, CINAHL, Google Scholar. English-language peer-reviewed publications through August 2020 were included in the analysis. RESULTS: The four defining attributes of PPOU are (1) use of opioids greater than 90 days following surgery, (2) treatment of postoperative (non-cancer) pain, (3) in opioid-naïve patients, (4) with legal prescription use. We identified four antecedents and four consequences to PPOU. CONCLUSION: The definition of PPOU in current literature varies greatly and has had significant impact on the interpretation and reliability of research findings. We propose the following working definition: PPOU is the legal prescription use of any opioid for greater than 90 days following surgery, for the purposes of treating post-operative pain, by a patient who opioid naïve in the year prior to surgery.

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.

Retrospective Analysis of Demographic, Psychiatric, and Physical Characteristics That Impact Length of Stay on an Inpatient Geriatric Psychiatric Unit.

Currently, the aging adult population is rising fast and presenting multiple challenges for the US healthcare system. Older adults present unique challenges in their care of medical and psychiatric conditions. This study retrospectively examined characteristics that are associated with length of stay on an inpatient geriatric psychiatric unit in an urban located psychiatric hospital. A sample of 74 individuals was examined. Factors that influenced length of stay included commitment status and discharge to a different level of care. Reducing the length of stay for geriatric patients can help reduce costs and improve health outcomes.