The Healthy Addiction Treatment Recovery Model: Developing a Client-Driven, Nurse-Led Addiction Nursing Model.

ABSTRACT: The current model of nursing within international addiction services has been described as task oriented and reactive. Yet, it is known that nursing models should be led by client need and operate within the domain of the client and their wider environment. The aim of this study was to address this gap within addiction nursing and to develop an evidence-based addiction nursing model.To objectively assess the needs of clients, a cross-sectional survey was implemented within a representative selection of six drug treatment clinics and a sample of clients in receipt of opiate agonist treatment in Dublin, Ireland. The Opiate Treatment Index with the General Health Questionnaire embedded was used to measure heroin use, polydrug use, infectious disease risk, physical health, psychological adjustment, criminality and social well-being. To develop the addiction model, a mapping of relevant features of potential nursing models was conducted by nurses working in addiction services.The key finding from the client assessments was a lack of psychological adjustment; a cutoff score of 4 was recommended. The mean score among women was 11 (95% CI [8, 14]), and that among men was 8 (95% CI [6, 10]). Findings from the mapping of models highlighted the benefits of the BRENDA, FRAMES, and Tidal models. A focus on practical implementation and measurable outcomes was stressed. Results informed the development of the Healthy Addiction Treatment Recovery Model. The model refocused services on clients' objective needs and eradicated entrenched practices.

Clients' Views on the Importance of a Nurse-Led Approach and Nurse Prescribing in the Development of the Healthy Addiction Treatment Recovery Model.

Globally, from America to Europe and beyond, the need for the expansion of the role of nurse practitioners has been recognized within the healthcare professions. However, little emphasis has been placed on assessing the views of clients, and within the addiction services, the voice of clients can be additionally marginalized as a result of treatment philosophies, stigma, and resource constraints. The aims of this study were to establish from clients their nursing needs and to use these findings alongside an objective measurement of clients' health, to inform the development of a nurse-led treatment model.A cross-sectional survey with open-ended questions on client nursing needs was conducted in 2017 within a representative sample of six clinics in Dublin, Ireland. A convenience sample of 131 clients were interviewed. Interviews were analyzed using thematic analysis.Findings were both as expected and surprising. Clients articulated the role of the nurse in their physical care; however, unexpectedly, clients identified nurses as an essential source of psychological support and expressed the wish for the role to be expanded in terms of managing methadone treatment and accessing additional services and resources.Results contributed to the formation of the nurse-led, client mental-health-focused, Healthy Addiction Treatment Recovery Model for addiction nursing services. In terms of national policies, findings provided new evidence articulated by service users on their desire for the expansion of nurse prescribing in addiction services and an expansion of the role to more adequately address client needs.

Hidden Harms and the Number of Children Whose Parents Misuse Substances: A Stepwise Methodological Framework for Estimating Prevalence.

Background: Globally, the problem of hidden harms to children of parents who use drugs and alcohol has been recognized. However, it is at a community level that resources must be allocated. Objective: The aim of this research was to provide a methodological framework for estimating the prevalence of children with potential hidden harms, in a community setting. Methodology: Benchmark-multiplier methods were used. Alcohol dependency was measured using the Rapid Alcohol Problem Screen tool. A retrospective audit of records combined with a multisource enumeration to remove duplicates was used to derive a minimum benchmark and a multiplier for the number of children to known adults. Further benchmarks were derived from the localized data of a general population survey. Community services were consulted for estimate validation, needs, and recommendations. The setting was an Irish urban disadvantaged region in 2016. Results: From the audit and multisource enumeration, a ratio of 0.88 children to every one client known to local treatment services was estimated. This provided a minimum estimate of 3.7% of children at risk of being impacted by illicit drug use where parents were known to services. From the general population survey and the local multiplier, an estimate of 15-24% of children potentially impacted by illicit drug use was derived. Finally, from the alcohol dependency data, an estimate of 14-37% of children possibly impacted by parental alcohol dependency was derived. Conclusions: Estimates were accepted as realistic by service providers who highlighted the need to improve interagency and interdisciplinary communication between drug and family services.

The BREATHE Project, a mobile application, video-monitoring system in family homes as an aid to the caring role: Needs, acceptability and concerns of informal carers.

INTRODUCTION: Family carers provide 80% of care to older people in Europe. Our aim was to explore the needs and acceptability among informal carers, of a live video home monitoring system. METHODS: A descriptive qualitative design was implemented with nine interviewees and a focus group of five informal carers in Ireland in 2014. A thematic analysis of the data was conducted. RESULTS: Ten hours of data were recorded. Three themes emerged: routine, risk, and acceptance. Although all assisted persons had a routine, carers not living in the home stated that cameras would assist with less tangible concerns such as nutrition and loneliness. Carers were interested in monitoring risks in specific situations rather than general monitoring. The majority of carers, while expressing concerns about privacy, accepted camera technology for monitoring emergencies and, in-spite of concerns, favoured a real video view. Acceptance in non-emergencies was mixed and concerns about the privacy of the assisted person were expressed. DISCUSSION: While video monitoring is contentious, informal carers did express a willingness for real video-footage monitoring under strict conditions that addressed specific needs. CONCLUSION: The challenge for technology is to address these needs while maintaining personal dignity.

Jigsaw: engaging communities in the development and implementation of youth mental health services and supports in the Republic of Ireland.

BACKGROUND: Irish young people exhibit high levels of psychological distress, but community-based services and supports are often unavailable or inaccessible. AIM: To describe efforts to engage communities in systematic and data-based processes of planning, programme design, implementation, and evaluation. METHOD: Details system-building initiatives in five communities (four counties and a distressed urban site) that will serve as a springboard for full national deployment. RESULTS: Extensive community engagement and planning has occurred in all sites, systems change efforts grounded in detailed business plans have begun, and process and outcome evaluation is underway. CONCLUSION: Needs and resource assessment processes confirmed the magnitude of need, but also suggested the creative re-allocation of local resources. Young people provided invaluable guidance for system design. Creating and sustaining a culture of innovation at each site was challenging, requiring leadership and continuous dialogue.