Chemical Dependency and Nursing Students: A Complicated Process Calling for Nurse Educator Involvement.

Chemical use and dependency is a prevalent problem in society and among the members of the nursing profession. Nursing students, as the novice representatives of the profession, may be particularly vulnerable to chemical use. Nursing leaders in both educational institutions and practice settings must recognize highly vulnerable individuals, which nursing activities are most vulnerable, and interventions to assist and support the vulnerable individual while assuring a safe practice environment. As nurses, it is our responsibility, both ethically and legally, to provide a safe working environment not only for our patients but also for ourselves by reporting the behaviors of nurses who may be impaired through the proper channels according to your state's Nurse Practice Act. Through a united approach, nurse leaders from both the academic and practice environments should provide a safe and effective rehabilitation approach.

Fitness to practise in pharmacy: a study of impairment in professional practice.

OBJECTIVE: To explore the opinions and knowledge of Australian pharmacists about impairment in the profession, and their awareness of new legislation regarding impairment and mandatory reporting. SETTING: Pharmacy practice in Australia. METHOD: Pharmacists' opinions and knowledge were explored using a purposively designed, de-identified survey distributed by an intermediate mailing house to randomly selected pharmacists registered with the Pharmacy Board. Descriptive statistics and thematic analyses were conducted on the data. KEY OUTCOME MEASURES: This being an explorative study, we analysed various items using standard statistical methods and qualitative thematic analysis for responses to open-ended questions. RESULTS: Responses from 370 registered pharmacists were obtained. Of these, nearly 60% were not confident in their knowledge of legislation relating to impairment. The vast majority stated they would consider reporting an impaired colleague in principle, but only after consulting the colleague. Older pharmacists demonstrated increased awareness of new legislation; this was accompanied however, by a marked decrease in confidence regarding knowledge about impairment. Thematic analysis of the qualitative data revealed four main themes: (1) perception of impairment and support systems available (2) stigma related to implications of impairment and whistle-blowing (3) factors affecting reporting of impairment and (4) management of impairment. CONCLUSION: Australian pharmacists in this study recognised the importance of the issue of impairment, but appeared to lack confidence and/or awareness of legislative requirements regarding impairment in the profession. There is a need for educative programs and accessible, profession-specific rehabilitative programs to be instigated for management of impairment in the profession of pharmacy in Australia.

Substance abuse issues in oral and maxillofacial practice.

Substance abuse has far-reaching consequences for individuals, their families, and the community. Medications with abuse potential play an important role in the management of pain and are widely prescribed by the oral and maxillofacial surgeon. Reducing the likelihood of abuse and providing appropriate pain management for the known abuser are critical aspects of perioperative patient management. Health care providers are not immune to substance abuse and may, in fact, be at an elevated risk. Identification of impaired providers is essential to help them find the appropriate treatment and counseling and to prevent harm to their patients, family, friends, or associates.

Superficial supervision: are we placing clinicians and clients at risk?

Mental heath nurses recognise the importance of professional boundaries and therapeutic relationships and understand that clinical supervision is an important component to good clinical practice and their ongoing professional development. This qualitative constructivist grounded theory research has uncovered a potential risk in contemporary mental health clinical practice, where the desire for expedient answers may compromise the outcome of formal structured supervision. The notion of a new concept 'superficial supervision' and its implications for formal structured supervision are explored.

Physician wellness: a missing quality indicator.

When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

Nullified: women's perceptions of being abused in health care.

OBJECTIVE: In a study performed with The NorVold Abuse Questionnaire (NorAQ) among Nordic gynecological patients, the prevalence of lifetime abuse in health care (AHC) was 13 - 28%. In the present study we chose a qualitative approach. Our aim was to develop a more in-depth understanding of AHC; as experienced by female Swedish patients. STUDY DESIGN: Qualitative interviews with 10 Swedish gynecological patients who had experienced AHC. The interviews were analyzed through Grounded Theory. RESULTS: Saturation was reached after six interviews. In the analyses four categories emerged which explain what AHC meant to the participating women: felt powerless, felt ignored, experienced carelessness, and experienced non-empathy. To be nullified is the core category that theoretically binds the four categories together. The women's narratives described intensive current suffering even though the abusive event had taken place several years ago. CONCLUSIONS: The fact that AHC exists is a critical dilemma for an institution that has the society's commission to cure and/or to alleviate pain and suffering. In their narratives, women described the experience of 'being nullified', a core category that embodies AHC.

A moral dilemma in the emergency room: confidentiality and domestic violence.

A professional colleague presents for treatment at an Emergency Department. Investigations reveal signs that indicate the possibility of domestic violence. This is subsequently confirmed in confidence. Personal reflections identify and explore the dilemmas and the ethical issues involved.

Substance abuse among nurses--defining the issue.

The prevalence of substance abuse in the nurse population is believed to parallel that in the general population (i.e. approximately 10%). Nurses with substance abuse problems need help. They are in danger of harming patients, the facility's reputation, the nursing profession, and themselves. The consequences of not reporting concerns can be far worse than those of reporting the issue. Part one of this two-part series discusses how society views addiction and the nursing profession, signs and symptoms of substance abuse, reasons nurses should report an impaired colleague, the code of silence that exists among nurses, and board of nursing jurisdiction.

Satisfaction of impaired health care professionals with mandatory treatment and monitoring.

OBJECTIVE: To measure the satisfaction of impaired health professionals with treatment and monitoring programs in Michigan and Indiana. METHOD: Mailed surveys assessed overall program satisfaction, usefulness of various aspects of monitoring, and several miscellaneous items. Persons active in the Michigan (n = 620) and Indiana (n = 267) programs in July 2002 were included. Anonymous responses were received from 263 (43%) of Michigan and 120 (45%) of Indiana participants. RESULTS: Means on the 1 to 5 satisfaction subscale were 3.6 (SD = .94) for Michigan and 4.1 (SD = .86) for Indiana. Means on the 1 to 4 monitoring subscale were 2.7 (SD = .62) for Michigan and 2.7 (SD = .57) for Indiana. 40% of Michigan respondents and 53% of Indiana respondents lacked insurance coverage for program costs. 39% of Michigan and 35% of Indiana respondents reported substance abuse or mental health difficulties prior to their professional career.

Drug use/misuse among health professionals.

Health professionals are among special populations in need of substance use/misuse prevention and treatment services. The behavior of impaired health professionals often have dire consequences to one's social, financial, and psychological life. This presentation will outline the epidemiology of substance use/misuse among health professionals, the consequences of the problem, and treatment issues. The work of Dr. Robert Coombs of the University of California, Los Angeles, School of Medicine and other United States and international scholars will be reviewed. Cross-national policies in this field will be highlighted. Unresolved critical issues will be noted and future needed research will be suggested.