Does the Length of Time to Complete an Online Program Matter?

Health care providers are challenged to meet the simultaneous demands of delivering clinical care and acquiring new information, especially in the context of the coronavirus disease 2019 pandemic, the opioid epidemic, and concurrent escalation in alcohol and other drug use. To address the gap in knowledge related to substance use, screening, brief intervention, and referral to treatment (SBIRT), a self-paced online educational program, was developed and delivered to 169 learners. Posttest knowledge scores increased for all learners and did not differ based on their pace of completion. Results indicated that this module provides a means for busy clinicians to increase their ability to manage substance use, even if their learning occurs in multiple sessions interrupted by other pressing demands. Future iterations of this course could further enhance clinical competency by addition of an online clinical simulation component. [J Contin Educ Nurs. 2021;52(11):505-510.].

Educating Ambulatory Care Nurses to Address Substance Use.

BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) for substance use has an impact on morbidity and mortality and health care cost. LOCAL PROBLEM: Nurses in ambulatory care settings may lack knowledge about evidence-based substance use SBIRT. METHODS: A comparison of pre- and postintervention data was performed to determine whether knowledge improved and to identify facilitators and barriers to SBIRT implementation. INTERVENTIONS: Nurses completed an online self-paced program focusing on alcohol and drug use screening, motivational interviewing used in a brief intervention, and referral to specialty treatment. RESULTS: Postintervention knowledge scores increased (P < .001). Facilitator and barrier themes included time, education, resources, receptivity, and interprofessional collaboration. CONCLUSIONS: The implementation of the SBIRT online program was feasible for nurses to complete during work hours and resulted in increased SBIRT-related knowledge.

Nurse-Led Delivery of Brief Interventions for At-Risk Alcohol Use: An Integrative Review.

BACKGROUND: Nurses are in key positions to reduce the global burden associated with alcohol, yet many are ill-prepared to screen for alcohol use and intervene accordingly. The purpose of this integrative review was to identify best practices for educating nurses to work with patients who are at risk for alcohol-related adverse consequences, implement alcohol screening, and deliver alcohol brief interventions (ABIs). AIMS: To identify and synthesize findings from randomized control trials of ABIs delivered by nurses to patients identified through screening to be at risk because of alcohol use. METHOD: The results of 11 published randomized control trials identified from a multi-database search were synthesized. RESULTS: The Alcohol Use Disorder Identification Test was used for alcohol screening in more than half of the studies. Most of the ABIs were based on motivational interviewing and delivered in 30 minutes or less. While there was limited information on the characteristics of nurses who delivered the interventions and how nurses were prepared to deliver the ABIs, the exemplar was a full day workshop teaching nurses on an evidence-based framework for the ABI. All studies measured alcohol consumption as an outcome, yet few used rigorous methods for obtaining this self-reported data. CONCLUSIONS: A 1-day workshop is recommended as an educational modality to prepare nurses to implement the Alcohol Use Disorder Identification Test for identification of persons who are at risk because of alcohol use, deliver a structured brief intervention in less than 30 minutes, and utilize a standard measure of alcohol consumption for evaluation.

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.

A call to action: Managing the neural pathway of disgust, bias, prejudice, and discrimination that fuels stigma.

Stigma has long been cited as a barrier to individuals seeking treatment for alcohol and other drug use-related problems. This paper focuses on the foundation upon which stigma sits: the brain-based, neural and structural engine of prejudice and stereotyping, processes that lead to stigma. Research findings on the neural underpinnings of disgust, prejudice, bias, and discrimination are discussed. This commentary suggests the need to promote increased awareness of the neural drivers of stigma as a basis for managing responses to persons who use substances. The commentary challenges the use of the term "stigma," calling for a new approach in lieu of foisting a badge of dishonor upon this population.

Alcohol Screening and Brief Intervention for Persons Living with HIV.

Alcohol use among persons living with HIV (PLWH) is consequential. More than half of PLWH have reported having a drink of alcohol and about 8% have reported heavy drinking. Alcohol use in PLWH has been associated with a higher risk of nonadherence to antiretroviral treatment (ART) and poor treatment outcomes. We provide guidance to clinicians for using an evidence-based approach to intervene and ensure follow-up for PLWH who drink alcohol. This set of clinical strategies, known as screening, brief intervention, and referral to treatment, when fully disseminated may help address the 90-90-90 targets proposed by the Joint United Nations Programme on HIV/AIDS, in particular in the receipt of sustained ART and the attainment of viral suppression.

Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters.

OBJECTIVE: Little attention has been given to factors contributing to firefighters' psychosomatic well-being. The purpose of this descriptive study was to examine such contributing factors in a sample of professional firefighters. METHODS: Measures assessing sleep, depression, substance use, social bonding, and quality of life were examined in 112 firefighters. RESULTS: Overall, many firefighters reported sleep deprivation (59%), binge drinking behavior (58%), poor mental well-being (21%), current nicotine use (20%), hazardous drinking behavior (14%), depression (11%), poor physical well-being (8%), caffeine overuse (5%), or poor social bonding (4%). CONCLUSIONS: Small-to-medium correlations were identified between sleep deprivation, depression, physical/mental well-being, and drinking behaviors. High-risk behaviors that impact psychosomatic well-being are prevalent in professional firefighters, which require environmental and individual-based health promotion interventions. The inter-correlation relationships between such behaviors, therefore, need to be explored in further details.

Decision aids for surgical treatment of early stage breast cancer: a narrative review of the literature.

OBJECTIVE: To review and critique the published empirical research on decision aids for women actually facing surgical treatment of early stage breast cancer, synthesize findings across studies related to outcomes of decision aids use with specific attention to the influence of system and client characteristics, and identify opportunities for further research. METHODS: A systematic and reproducible search was carried out to identify studies evaluating decision aids for women making breast cancer surgical treatment decisions. All included studies were appraised. RESULTS: Most studies evaluated the outcomes of decision aids use in terms of final treatment decisions, patients' knowledge of treatment options, anxiety, decisional conflict, satisfaction and quality of life. Included studies varied in design, measures used to assess effectiveness, format of the aids, patient populations and clinical settings. Studies yielded mixed results related to the effect of the decision aids on the outcomes measured. CONCLUSION: Despite the mixed findings of the studies, some support exists for the use of decision aids with women diagnosed with early stage breast cancer. PRACTICE IMPLICATIONS: To ensure successful implementation of decision aids in clinical practice, healthcare providers should be educated on their use. Greater allocation of time, space and access to decision aids is also needed.

Family caregivers and cancer pain management: a review.

Due to the critical role of family caregivers in cancer pain management, this systematic review was undertaken to examine what is known about of their experiences and needs. Searches were conducted using electronic databases, and research reports from 1991 to 2007 were analyzed using a matrix method. Family caregivers were actively engaged in assisting with pain management and experienced significant needs and concerns related to this role. Myths and fears about opioid use remain widespread across cultures studied and across care settings. Family caregivers need education about pain management, training in problem-solving skills, and recognition from providers about their role in pain management. When clinicians better understand and respond to the needs of the family caregivers, they can enhance the quality of life and care outcomes for both patients and their caregivers.