Effectiveness of Clinical Practicum Experience in Drug Addiction Treatment Facilities in Nursing Students' Attitudes Toward Alcohol, Alcohol Use Disorders, and Alcoholics: Systematic Review and Meta-Analysis.

ABSTRACT: The aim of this study was to identify, analyze, and synthesize the best evidence on the effectiveness of clinical practicum experience in drug addiction treatment facilities on nursing students' attitudes toward alcohol, alcohol use disorder (AUD), and persons with AUD. This systematic review followed the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses and used the System for the Unified Management of the Assessment and Review of Information to assess methodological quality and extract data for meta-analysis. A comprehensive literature search of the EBSCO databases, Embase, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, PsycINFO, Scopus, Web of Science, Mednar, Coordenadoria de Aperfeiçoamento de Pessoal de Nível Superior, and ProQuest Dissertations & Theses catalog was conducted. The System for the Unified Management of the Assessment and Review of Information tool was used for the extraction and critical evaluation of the selected articles followed by a meta-analysis. After removing duplicates, 2,831 publications were identified, and eight met the inclusion criteria. More positive attitudes were observed after performing practicum experience in specialized services (-1.27, 95% confidence interval [-2.85, -0.30]), and an increase in the motivation and satisfaction among the students to care for patients with AUD was also noted. In conclusion, the review suggests that clinical practicum experience in a drug addiction treatment facility has the potential to change the attitudes of nursing students toward AUD and persons with AUD.

Understanding Nurse Perceptions of Caring for Patients With Alcohol Use Disorder: A Cross-Sectional Study.

BACKGROUND: Alcohol use disorder (AUD), the problematic consumption of alcohol, affects 107 million people worldwide. Individuals with AUD experience high morbidity and increased mortality. Nurses practicing in acute care are ideally positioned to deliver quality interventions to patients with AUD, including screening and brief intervention; formal training and assessment of baseline knowledge, attitudes, and perceptions are necessary. AIMS AND OBJECTIVES: The aim of this study was to explore the knowledge, attitudes, and perceptions of acute care nurses caring for patients with AUD. DESIGN: This study used a cross-sectional survey design. METHODS: The Survey of Attitudes and Perceptions was completed by 93 nurses working in six acute care centers (seven medicine units) across Alberta. Data were analyzed using descriptive and inferential statistics. RESULTS: Few participants reported receiving any prior structured training on AUD, with the majority reporting limited knowledge of alcohol and the effects of alcohol consumption. Although most participants said that caring for patients with AUD was a part of their professional role, few felt satisfied or motivated to work with this group of patients. Responses to individual questions or subdomains of the survey did not significantly differ by length of time in professional role, employment status, or sex. CONCLUSION: Our results indicate that nurses need to learn more about caring for patients with AUD. Developing tailored educational interventions that are mindful of the importance of knowledge, support, satisfaction, and motivation is necessary to improve the quality of care for patients with AUD.

Supporting older adults who misuse alcohol.

Older adulthood is a unique time of transition often referred to as the 'golden years'. It is characterised by positive life experiences such as retirement but also by a loss of routine, identity and meaning. The literature identifies alcohol misuse as a growing issue in this population. However, the stigma, perceptions and patterns of drinking associated with alcohol misuse among older people can be a barrier to individuals seeking health advice. This article identifies that older adulthood is a period when nurses can offer health education and support using their unique relationships with patients to encourage healthy drinking behaviours.

Strategies for Alcohol Screening, Brief Intervention, and Referral to Treatment Sustainability in the Emergency Department.

Alcohol misuse remains the fourth leading cause of preventable death in the United States, with nearly 90,000 deaths occurring annually as a consequence of alcohol misuse. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based strategy that includes initial screening using a valid tool, determining the need for intervention, a brief motivational interview, and referral to treatment leading to follow-up care when necessary. Although an abundance of evidence-based practices now exist as a guideline for quality patient care, an inconsistency persists between protocols supported by research and those actually integrated into daily clinical practice. Currently, there is little in the literature examining the sustainability of SBIRT programs in emergency departments. The authors examine challenges to SBIRT implementation in the emergency department and propose a number of strategies to ensure continued sustainability of this evidence-based practice.

Considering "the more" of patients suffering from alcohol use disorders. An illustration of acute nursing care from a lifeworld-led perspective.

PURPOSE: The purpose of this study is to illustrate a theoretical value framework for humanisation of healthcare, a lifeworld-led care that has the potential to support nurses in acute medical units in addressing and meeting both challenges and care needs expressed by patients suffering from alcohol use disorders. Providing care to these patients means working with a very divergent and complex group of patients. When hospitalised in an acute medical unit, nurses are often these patients' first encounter, which gives a unique opportunity to initiate and establish a successful care alliance. METHOD:  The present study is a qualitative study based on an amplified secondary analysis of 25 pre-conducted interviews. Following a hermeneutic approach, the analysis was structured in accordance with the conceptual value framework for humanisation of care, drawing on the recognition of the patients' lifeworld as an aspect of importance. FINDINGS: The study showed that while there were examples of humanising care guided by the patients' lifeworld present, there were also situations of care that were dehumanising. Conclusion: When letting the patients' perspective of well-being be the centre of care, the patients' experience of meaningfulness and sincerity within the provided care was nurtured, and they felt more humanly met.

Nurse-Delivered Screening and Brief Intervention Among College Students with Hazardous Alcohol Use: A Double-Blind Randomized Clinical Trial from India.

AIM: To determine the effectiveness of individual-based, nurse-delivered, on-campus screening and brief intervention (SBI) for hazardous alcohol use among college students. METHODS: It was a parallel-design, double-blind, randomized controlled trial. Out of 793 students screened, 130 met the selection criteria of hazardous alcohol use, defined by alcohol use disorder identification test (AUDIT) score 8-19. Participants were randomly allocated to either SBI or general advice group. Both interventions were delivered by one specially trained nurse. Outcome was assessed after 3 months. Primary outcome was the change in the mean AUDIT score and the secondary outcome was difference in the proportion of students transited from the high- to low-risk category of AUDIT. General linear model with repeated measures and logistic regression were used to determine the primary and secondary outcome, respectively. RESULTS: Majority (80.7%) of the participants were men. Among all the baseline demography and clinical characteristics, only family history of alcohol use was significantly different in the groups. Intention to treat analysis showed a significant but small effect (0.16) of SBI on the mean AUDIT score. Gender did not moderate the effect. SBI was also observed to have a significant effect (adjusted odds ratio 3.7 95% CI 1.529-8.850) on shifting the students from high- to low-risk AUDIT zone. CONCLUSION: SBI among college students is acceptable and has a small but significant effect on alcohol use. In countries like India, where despite the increasing magnitude of hazardous drinking in students no formal system exists to deal with the problem, SBI might be useful.

Do the carers care? A phenomenological study of providing care for patients suffering from alcohol use disorders.

Excessive alcohol consumption can have adverse effects on health, and patients who suffer from alcohol use disorders are subject to much stigmatization. Nurses are often the first point of contact when patients enter the acute medical unit, and it is pivotal that this contact establishes the basis for future collaboration. The aim of this study is to elucidate nurses' lived experience of providing care to patients suffering from alcohol use disorders. This present study has a qualitative research design, anchored in phenomenological and hermeneutical methodology as described in reflective lifeworld research. Ten in-depth, open-ended interviews with nurses working in an acute medical unit were conducted. The analysis showed that providing care to patients suffering from alcohol use disorders was a highly complex task to accomplish. This required the nurse to engage with the patient in a sensitive cooperation in order to be dealing with the intricacy of the patient's life situation and balancing care between standardized procedures and the complexity of the patients. Further, a two-sided feeling of responsibility emerged: a professional responsibility and a personal responsibility causing the provision of care as being caught between feelings of despondency and resignation. Nurses lack opportunities for being creative in determining how to provide care; instead, patients' perspectives of well-being should be taken into account and should guide the provision of a meaningful care. Nurses must call for opportunities to deviate from the firmly established procedures restraining the care of this population.

Nursing: Addressing substance use in the 21st century.

Over the past two decades, there has shift from focusing on the most severe end of the substance use continuum to earlier detection of persons who are at risk given the consequences associated with alcohol and other drug use. In 2017, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) undertook the development of core competencies for specific disciplines addressing substance use in the 21st century. This article presents the core competencies for nursing in accord with the 16 standards of practice and performance for nursing. The competencies for the registered nurse and the advanced practice nurse are intended to inform and guide nursing practice with a focus on prevention, intervention, treatment, and recovery supports for persons who are affected by substance.

Risk Factors for Severe Alcohol Withdrawal Syndrome in an Acute Hospital Population.

BACKGROUND: The literature lacks consensus to the factors that increase the risk of a patient developing severe alcohol withdrawal syndrome (SAWS). AIM: The study set out to identify the variables that increase the risk of SAWS in patients who have alcohol dependence syndrome. METHODS: A case-control study was designed to investigate the variables associated with SAWS in an acute hospital setting. Three hundred eighty-two case and 382 control patients were randomly selected retrospectively from referrals to the acute addiction liaison nursing service during a 12-month period (January 1, 2015, to December 31, 2015). Statistical significance (p < .05) and association with SAWS were calculated using chi-square, Cramer's V test, odds ratio, and Levene's test. RESULTS: Twenty-four variables have been identified as associated with SAWS development. Five of the 24 variables had a moderate-to-strong association with SAWS risk: Fast Alcohol Screening Test, Glasgow Modified Alcohol Withdrawal Scale score, AWS admission, hours since the last drink, and systolic blood pressure. The study also identified that comorbidity was associated with not developing SAWS. CONCLUSION/RECOMMENDATIONS: These findings confirm that noninvasive variables collected in the emergency department are useful in identifying a person's risk of developing SAWS. The results of this study are a useful starting point in the exploration of SAWS and the development of a tool for use in the emergency department that can stratify risk into high and low and is the next stage of this program of work.

Consumo de alcohol en estudiantes de Enfermería. Una experiencia vivida / Consumption of alcohol among nursing students. A lived experience

OBJETIVO PRINCIPAL: evidenciar la problemática de consumo de alcohol en estudiantes de Enfermería de una universidad privada de Bogotá, desde la perspectiva de una joven que estuvo involucrada en el abuso del consumo de alcohol. METODOLOGÍA: relato biográfico. RESULTADOS PRINCIPALES: se identificaron tres categorías: contexto familiar (ausencia del padre, antecedentes de consumo de alcohol, conflictos familiares, embarazo no deseado), detonantes y condiciones de consumo de alcohol (estrés académico, lugares de consumo, productos que se consumen, comportamientos autodestructivos de las mujeres por el consumo de alcohol) e Interés en evitar que otros jóvenes se conviertan en consumidores de alcohol. CONCLUSIÓN PRINCIPAL: la presente investigación da cuenta de los riesgos a que está abocada la población universitaria, especialmente las mujeres. Lo cual constituye una voz de alerta para las universidades y para los padres de familia, a fin de que fortalezcan estrategias de prevención de consumo de alcohol y demás sustancias psicoactivas

OBJECTIVE: to demonstrate the problem of alcohol consumption among nursing students of a private university in Bogotá, from the point of view of a young woman who was involved in the abuse of alcohol consumption. METHODS: biographical story. RESULTS: three categories were identified: family context (father absence, history of alcohol consumption, family conflicts, and/or unwanted pregnancy), triggers and conditions of alcohol consumption (academic stress, places of consumption, products that are consumed, self-destructive behaviors of women for alcohol consumption) and interest in preventing other young people from becoming alcohol users. PRINCIPAL CONCLUSION: this research gives an account of the risks to which the university population is facing, especially women. This is a warning voice for universities and parents, in order to strengthen prevention strategies for alcohol consumption and other psychoactive substances

Conquering the Craving: Treatment to Curb Alcohol Use Disorder.

Largely underutilized in North America, the use of medications to treat alcohol dependence is frequently a successful method of reducing alcohol craving and promoting abstinence. Recovery from alcohol addiction can be a complicated process, requiring nutritional, social, psychological, spiritual, and physical aspects of healing and self-directed behavioral change. Nurses can intervene in alcohol use disorder via screening, referrals, support of medical and behavioral treatments, and spiritual care that emphasizes hope, forgiveness, and relief from shame and guilt.

Effectiveness of Providing Education About Alcohol Use Disorders and Compassion Fatigue for Emergency Department Nurses.

BACKGROUND: Emergency departments (EDs) treat over 20,000 patients daily with alcohol use disorders (AUDs). However, nurses receive limited education about AUDs. Studies have shown that ED nurses have negative attitudes about patients with AUDs. Negativity can contribute to the symptoms of compassion fatigue (CF) and to dissatisfaction with work. PURPOSE: The aim of this study was to design, implement, and evaluate education about AUDs and CF for ED nurses. DESIGN: This study used a quasi-experimental pretest-posttest within-subjects design. SAMPLE: A convenience sample of 44 nurses was recruited at a large urban ED. METHODS: Nurses completed demographics, Professional Quality of Life: Compassion Satisfaction and Fatigue (ProQOL), and Short Alcohol and Alcohol Problems Perceptions Questionnaire. Then, the nurses participated in 5 hours of an online educational program and a 1-hour live class about AUDs and CF. The surveys were readministered. RESULTS: The difference in pretest and posttest Short Alcohol and Alcohol Problems Perceptions Questionnaire subscales of role security (expected value = 8.5, p < .006) and therapeutic commitment (expected value = 7.50, p = .018) was statistically significant. For ProQOL constructs, no statistical significance was found. The ProQOL subscales were compared with norms and were statistically significantly different. CONCLUSION: Nurses' attitudes about patients with AUDs improved after completing the curriculum. Studied nurses had higher levels of professional satisfaction at baseline.

Alcohol Withdrawal Syndrome: Improving Recognition and Treatment in the Emergency Department.

Alcoholism continues to be a persistent health problem in the United States, accounting for up to 62% of emergency department (ED) visits. This quality improvement (QI) project examined whether identifying the benefit for early use of Alcohol Use Disorders Identification Test (AUDIT C) and Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIW-ar) in the ED would avoid escalation of care and offset poor outcomes of alcohol withdrawal syndrome (AWS). A preimplementation chart review (N = 99) showed an average of 12%-15% of patients requiring escalation of care at the project site. The QI project utilized a single-group, pre-/posttest design. The setting was a Southwest Veterans Affair tertiary care referral center. Thirty-five ED staff members were surveyed for baseline knowledge and attended education sessions, led by an advanced practice nurse, on the use of AUDIT-C and CIWA-ar. Posteducation, patients admitted to the hospital were screened with AUDIT-C and treated with CIWA-ar. Postimplementation, charts were reviewed for admitted patients (N = 42) on the use of AUDIT-C, CIWA-ar, length of stay (LOS), and area patient treated. Although the test scores after didactic education were statistically significant (p ≤ 0.050), there was no significant difference in the use of AUDIT-C or CIWA-ar in the ED, nor a significant decrease in LOS for those patients with CIWA-ar ordered. However, the potential for clinical benefit could not be disavowed. Barriers to implementation included survey fatigue, inability to embed AUDIT-C in the electronic medical record, inconsistency in completing AUDIT-C, interrater reliability, and patient fear of stigmatization. Advanced practice nurses provide an integral role to augment early identification and treatment of AWS in the ED.

Can Screening, Brief Intervention, and Referral to Treatment Education and Clinical Exposure Affect Nursing Students' Stigma Perception Toward Alcohol and Opioid Use?

BACKGROUND: Alcohol and/or opioid stigma perceptions are barriers to screening, brief intervention, and referral to treatment (SBIRT) implementation. AIM: To examine SBIRT education and clinical exposure efficacy at decreasing nursing students' stigma perceptions toward caring for patients affected by alcohol and/or opioid use problems. METHOD: A single-sample, pretest-posttest design with N = 124 nursing students. The students had a 1.5-hour SBIRT education session and a 12-week clinical experience with some patients who had alcohol and/or opioid use problems. RESULTS: The participants' stigma perceptions improved toward patients who had alcohol and/or opioid use problems. CONCLUSIONS: SBIRT education and clinical exposure may provide a basis for promoting understanding of alcohol and/or opioid use-related stigma and can be used as an intervention to decrease some of stigma's negative effects.

Effectiveness of brief group intervention in the harmful alcohol use in primary health care / Efetividade da intervenção breve grupal no uso nocivo de álcool na atenção primária à saúde

ABSTRACT OBJECTIVE To verify the effectiveness of brief group intervention, performed by nurses, in reducing the hazardous or harmful alcohol use in users of a primary health care service. METHODS Clinical and randomized trial with follow-up of three months. The sample had 180 individuals with a pattern of hazardous or harmful alcohol use, recruited in a Basic Health Unit in the city of São Paulo. A sociodemographic questionnaire and the Alcohol Use Disorders Identification Test (Audit) were applied. The experimental group underwent the Brief Group Intervention, which had four group sessions, with weekly meetings. The control group received an information leaflet about issues related to alcohol consumption. Both groups participated in the follow-up of three months. The linear mixed model was used for data analysis, in which a 5% significance level was adopted. RESULTS Forty-four individuals under hazardous or harmful alcohol use completed all phases of the research. The experimental group had a statistically significant reduction (p < 0.01) of about 10 points in Audit score after the brief group intervention [before BGI = 15.89 (SD = 6.62) - hazardous use; after BGI = 6.40 (SD = 5.05) - low hazardous use] maintaining the low hazardous use in follow-up [6.69 (SD = 6.38) - low hazardous use]. The control group had a statistically significant reduction (p ≤ 0.01) of about three points in Audit score [before BGI = 13.11 (SD = 4.54) - hazardous use; after BGI = 9.83 (SD = 5.54) - hazardous use] and in follow-up presented the mean score of 13.00 (SD = 5.70), indicative of hazardous use. Differences between the two groups (experimental group versus control group) in reduction of consumption were statistically significant (p ≤ 0.01). CONCLUSIONS Our evidence showed that the brief group intervention performed by the nurse in the primary health care context was effective to reduce alcohol consumption in individuals with patterns of hazardous or harmful use.

RESUMO OBJETIVO Verificar a efetividade da intervenção breve grupal realizada por enfermeiros, na redução do uso de risco e nocivo de álcool em usuários de um serviço de atenção primária à saúde. MÉTODOS Ensaio clínico, randomizado, comfollow-up de três meses. A amostra foi composta de 180 indivíduos que apresentaram padrão de uso de risco ou nocivo de álcool, recrutados em uma Unidade Básica de Saúde do município de São Paulo. Foi aplicado um questionário sociodemográfico e o Alcohol Use Disorders Identification Test (Audit). O grupo experimental foi submetido à Intervenção Breve Grupal, a qual foi composta por quatro sessões grupais, com encontros semanais. O grupo controle recebeu um folheto informativo sobre problemas relacionados ao consumo de álcool. Ambos os grupos participaram do seguimento de três meses. O modelo linear misto foi utilizado para análise dos dados, em que foi adotado nível de significância de 5%. RESULTADOS Quarenta e quatro indivíduos que faziam uso de risco ou nocivo de álcool, completaram todas as fases da pesquisa. O grupo experimental apresentou redução estatisticamente significativa (p ≤ 0,01) de cerca de 10 pontos no escore do Audit após a intervenção breve grupal [antes IBG = 15,89 (dp = 6,62) - uso de risco; após IBG = 6,40 (dp = 5,05) - uso de baixo risco] mantendo o uso de baixo risco no seguimento [6,69 (dp = 6,38) - uso de baixo risco]. O grupo controle apresentou redução estatisticamente significativa (p ≤ 0,01) de cerca de três pontos no escore do Audit [antes = 13,11 (dp = 4,54) - uso de risco; após = 9,83 (dp = 5,54) - uso de risco] e no seguimento apresentou o escore médio de 13,00 (dp = 5,70) indicativo de uso de risco. As diferenças entre os dois grupos (grupo experimental versus grupo controle) na redução do consumo foram estatisticamente significativas (p ≤ 0,01). CONCLUSÕES Evidenciou -se que a intervenção breve grupal realizada pelo enfermeiro no contexto da atenção primária à saúde foi efetiva para a redução do consumo de álcool em indivíduos com padrão de uso de risco ou nocivo.

A nurse-led FibroScan® outreach clinic encourages socially deprived heavy drinkers to engage with liver services.

AIMS AND OBJECTIVES: To determine whether a portable FibroScan® device can be an acceptable screening tool for chronic liver disease in a community alcohol support service, through recording uptake, determining apparent prevalence of undiagnosed fibrosis/cirrhosis in participants and report engagement following referral to specialist liver services of those individuals referred because of a FibroScan® reading ≥ 7.1 kilopascals (kPa). BACKGROUND: Alcohol-related liver disease, including cirrhosis, is a major cause of death in the UK. Liver disease is silent and usually presents late. Socially deprived patients with alcohol-related liver disease are a "hard to engage" population and at higher risk of death than less deprived. A FibroScan® device is a non-invasive tool for measuring liver stiffness. A result of ≥7.1 kPa can indicate possible chronic liver disease. DESIGN: Prospective observational study. METHOD: Individuals who self-identified as harmful drinkers were recruited. Consented individuals attended for a liver FibroScan® . Those with a reading ≥7.1 kPa were referred to a nurse-led liver clinic for further investigations, results of which determined referral to a liver specialist in secondary care. Participants referred were monitored for compliance over a 6-month period. RESULTS: Seventy-nine consented individuals participated, an uptake of 67% of those informed of the study. Of the 79 scans performed, three were unreliable leaving 76 participants. After scanning, 20/76 (26%) had a FibroScan® ≥7.1 kPa requiring referral on to the nurse-led clinic. All 20 (100%) engaged in further assessment. Of those, 12 required onward referral to specialist services. Subsequent compliance with specialist services in this sample (n = 12) was ≥90%. CONCLUSION: A nurse-led FibroScan® outreach clinic encourages socially deprived drinkers to engage with liver services. RELEVANCE TO CLINICAL PRACTICE: A 67% uptake suggests a nurse-led FibroScan® service in a community alcohol service is acceptable. High engagement gives potential for early intervention and improved health outcomes.