Educating Nurses on the Use of the Clinical Opiate Withdrawal Scale to Improve Care of Adult Patients Undergoing Buprenorphine Induction.

INTRODUCTION: Opioid addiction disease has become a global health and social problem complicated by drug misuse and abuse (Pearlman, 2016; Rettig & Yarmolinsky, 1995; Watkins, 2016). Buprenorphine, a partial opioid agonist, is an effective treatment for opioid addiction disease (Loreck et al., 2016). Its induction can trigger severe precipitated withdrawal in opioid-dependent patients whose mu receptors are occupied opioids (American Society of Addiction Medicine, 2015). Knowledge of assessing a patient's level of withdrawal using a validated tool is key to successful transition from other opioids to buprenorphine. AIM: The aim of this study was to evaluate the effectiveness of training nurses on the use of the Clinical Opioid Withdrawal Scale (COWS) screening instrument by assessing their confidence in assessing and satisfaction with communicating withdrawal information crucial for patient safety. METHOD: Ten registered nurses and three nurse practitioners working at a mental health community service center completed two surveys at three time points (Pre, Post, and Post-90 days). The first survey measured nurses' confidence in assessing, whereas the second survey measured their satisfaction with communicating withdrawal symptoms. RESULTS: The means' (M) magnitude for both assessment and satisfaction scores increased with time (across Pre, Post, and Post-90). Standard deviations tended to become smaller. Improvements were noted in nurses' confidence in the assessment of and satisfaction in communicating withdrawal symptoms after the intervention. CONCLUSION: Participants expressed increased knowledge, confidence, and satisfaction with the COWS screening instrument. Ultimately, the patients benefited from the participants having more experience, education, skills, and confidence in monitoring withdrawal symptoms depicted by aggregate data of COWS screenings postintervention.

Neonatal Opioid Withdrawal Syndrome: A Developmental Care Approach.

Tens of thousands of infants are impacted yearly by prenatal opioid exposure. The term neonatal opioid withdrawal syndrome (NOWS) is now replacing the more familiar term neonatal abstinence syndrome (NAS). Ongoing debate continues related to standard regimens for treatment of this oftentimes perplexing condition. Historically, treatment has focused on pharmacologic interventions. However, there is limited research that points to nonpharmacologic methods of treatment as viable options, whether alone or in addition to pharmacologic interventions. This article, utilizing a review of pertinent literature, outlines the physical aspects of NOWS, including its pathophysiology and the resulting physical clinical signs. In addition, we present an overview of how age-appropriate, nonpharmacologic interventions, centered on developmental care, may be a valuable approach to organize and prioritize routine care for these infants, their families, and the health care team facing the challenges of NOWS. Finally, the need for further research to better define evidence-based standards of care for these infants and their families is discussed.

Satisfaction with nursing care in drug users: the evolution of a scale. / Satisfação com os cuidados de enfermagem em usuários de drogas: evolução de uma escala.

OBJECTIVES: To identify the degree of satisfaction with nursing care, the significant variables and contribute to the evolution of the scale. METHODS: Descriptive, correlational, cross study, with 180 drug users. Data collected using the scale called "Satisfaction of users with the Nursing Health Center26", between February and December 2012 in three treatment units in the region of Lisbon and Vale do Tejo, Portugal. RESULTS: Users indicated 83.3% satisfaction. The dimension "Information individualization" was the most marked (98.5%). The more stability in the programs, abstinence from stimulants and benzodiazepines and more nursing interventions, the greater the satisfaction. Better working conditions, specializing in mental health, younger ages and less experience of nurses also contributed to satisfaction. Four items of the scale were extracted, assuming new SUCECS22 designation. CONCLUSIONS: Satisfaction was high, influenced by structural variables of users, nurses and working conditions. The scale has proved suitable for assessment in this population.

The Opioid Epidemic: What Does it Mean for Nurses?

The United States is facing a major crisis with the current opioid epidemic. Tens of thousands of individuals are dying each year due to abuse and misuse of heroin and prescription opiate drugs. Nurses play an integral role in these aspects of health care and offer solutions by providing education; preventive measures; treatments, including medication-assisted treatments (MATs); and ongoing recovery options for individuals with opioid use disorders. Nurses provide education, issue prescriptions and dispense medications, and provide overall physical and mental health care to patients struggling with this "disease of the brain," and with the signing of the Comprehensive Addiction and Recovery Act, advanced practice RNs will soon be able to include MATs related to buprenorphine as part of their treatment plan. The current article explores the anatomy, physiology, and genetics of addiction and how they relate to the pharmacological MATs used to treat opioid use disorders. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 18-23.].

Satisfação com os cuidados de enfermagem em usuários de drogas: evolução de uma escala / Satisfacción con la atención de enfermería en los consumidores de drogas: evolución de una escala / Satisfaction with nursing care in drug users: the evolution of a scale

RESUMO Objetivos Identificar o grau de satisfação com os cuidados de enfermagem, as variáveis significativas e contribuir para a evolução da escala. Métodos Pesquisa descritiva, correlacional, transversal com 180 usuários de drogas. Dados coletados com a escala "Satisfação dos Utentes com os Cuidados de Enfermagem no Centro de Saúde26", entre fevereiro e dezembro de 2012, em três unidades de tratamento na região de Lisboa e Vale do Tejo, em Portugal. Resultados Os usuários assinalaram 83,3% de satisfação. A dimensão "Individualização da informação" foi a mais assinalada (98,5%). Quanto mais estabilidade nos programas, abstinência de estimulantes e benzodiazepinas e mais intervenções de enfermagem, maior a satisfação. Contribuíram ainda para a satisfação, melhores condições de trabalho, especialização em saúde mental, menor idade e menor experiência profissional dos enfermeiros. Extraíram-se 4 itens da escala assumindo nova designação SUCECS22. Conclusões A satisfação foi elevada, influenciada por variáveis estruturais dos usuários, dos enfermeiros e das condições de trabalho. A escala revelou-se adequada à avaliação nesta população.

RESUMEN Objetivo Identificar el grado de satisfacción con la atención de enfermería, las variables significativas y contribuir a la evolución de la escala. Método Estudio descriptivo, correlacional, transversal, con 180 usuarios de drogas. Datos recogidos con la escala "Satisfacción del paciente con el cuidado comunitario de enfermería26", entre febrero y diciembre de 2012, en tres unidades de tratamiento, en la región de Lisboa y el Vale do Tejo, Portugal. Resultados Los usuarios indicaron 83.3% de satisfacción. La dimensión "Individualización de la formación" fue la más marcada (98,5%). La mayor estabilidad en los programas, la abstinencia de estimulantes y benzodiacepinas y más intervenciones de enfermería, mayor es la satisfacción. Contribuyeron a la satisfacción, mejores condiciones de trabajo, especialidad en salud mental, más joven y menos experiencia de las enfermeras. Se extrajeron cuatro ítems de la escala asumiendo nueva designación SUCECS22. Conclusiones La satisfacción es alta, influenciada por las variables estructurales de los usuarios, de las enfermeras, y las condiciones de trabajo. La escala se reveló adecuada a la evaluación en esta población.

ABSTRACT Objectives To identify the degree of satisfaction with nursing care, the significant variables and contribute to the evolution of the scale. Methods Descriptive, correlational, cross study, with 180 drug users. Data collected using the scale called "Satisfaction of users with the Nursing Health Center26", between February and December 2012 in three treatment units in the region of Lisbon and Vale do Tejo, Portugal. Results Users indicated 83.3% satisfaction. The dimension "Information individualization" was the most marked (98.5%). The more stability in the programs, abstinence from stimulants and benzodiazepines and more nursing interventions, the greater the satisfaction. Better working conditions, specializing in mental health, younger ages and less experience of nurses also contributed to satisfaction. Four items of the scale were extracted, assuming new SUCECS22 designation. Conclusions Satisfaction was high, influenced by structural variables of users, nurses and working conditions. The scale has proved suitable for assessment in this population.

CE: Acute Pain Management for Inpatients with Opioid Use Disorder.

OVERVIEW: Like most hospital inpatients, those with opioid use disorder (OUD) often experience acute pain during their hospital stay and may require opioid analgesics. Unfortunately, owing to clinicians' misconceptions about opioids and negative attitudes toward patients with OUD, such patients may be inadequately medicated and thus subjected to unrelieved pain and unnecessary suffering. This article reviews current literature on the topic of acute pain management for inpatients with OUD and dispels common myths about opioids and OUD.

Adolescents at risk: pain pills to heroin: part II.

Casually exposing adolescents to prescription opioid agents may escalate to daily use. A trend exists for adolescents using prescription opioid agents to substitute heroin because it is significantly cheaper than pills (approximately half of the cost) and is often more readily available. Additionally, it is more potent than most prescription opioid agents and carries increased risks of overdose and death. Although treatment for substance use disorders has traditionally centered on total abstinence, opioid replacement therapy (ORT) is an option that saves lives and prevents overdose deaths. In the United States, ORT is based on two medicines: methadone and buprenorphine. These drugs can be substituted for other opiate agents and have much lower overdose risks. Nursing implications and web-based resources for teaching are presented.

Tratamiento del dolor crónico no oncológico con opiáceos / Non-oncologic chronic pain treatment with opiates

El dolor crónico no oncológico es un trastorno muy frecuente y que causa gran impacto en la vida diaria de quien lo padece. Su incidencia está en aumento debido en gran parte al incremento de la esperanza de vida, ya que la población más afectada es la geriátrica. El dolor de espalda, el dolor derivado de la osteoartritis y el dolor neuropático son los más prevalentes. Para aliviar el dolor crónico no oncológico se utilizan, entre otros analgésicos, los fármacos opioides. Estos se dividen en opioides menores (tramadol, codeína) y opioides mayores (morfina, fentanilo, oxicodona, metadona). Son fármacos muy efectivos contra el dolor, pero también tienen importantes efectos adversos que hay que conocer y evitar en la medida de lo posible. Uno de estos efectos adversos es la capacidad de los opioides de causar dependencia, tolerancia, adicción y otras conductas aberrantes. La terminología alrededor de estos conceptos puede ser a veces confusa. Para evitar la aparición de este tipo de conductas es necesario tomar precauciones y controlar el paciente de forma periódica. Sin embargo, si los profesionales sanitarios toman las medidas necesarias para evitar estos comportamientos, el riesgo de que aparezcan se reduce considerablemente. Por tanto, monitorizar a los pacientes en tratamiento con opiáceos es fundamental para lograr un buen uso de estos fármacos (AU)

Non-oncologic chronic pain is a very common symptom. It causes great impact on daily activities of people who suffer it. The incidence of this type of pain is rising due to the increase in life expectancy. The most affected population is geriatric population. Back pain, osteoarthritic pain and neuropathic pain are the most prevalent types of non-oncologic chronic pain. Opiates, among other analgesic drugs, are used to alleviate this type of pain. Opiates are divided into minor opiates (tramadol, codeine) and major opiates (morphine, fentanyl, oxycodone, methadone). Opiates are very effective to treat pain, but they also have important adverse effects that we must know and try to prevent. One of these adverse effects is the opiates ability to cause dependence, tolerance, addiction and other aberrant behaviors. Terminology of these concepts is sometimes confusing. It is necessary to be careful and control the patient periodically in order to avoid these aberrant behaviors. However, if health professionals take precautions to prevent these behaviors, the risk is considerably reduced. Controlling patients on opiate treatment is essential to achieve a correct use if these drugs (AU)

Guided by priority: how clinicians manage access to opioid replacement therapy.

Access to opioid replacement therapy is a problem in some parts of Australia and it is not known how clinicians respond to this situation. The aim of this study is to develop a conceptual understanding of how clinicians apply clinical judgements in managing access to treatment. Grounded theory methodology was used to guide this study. Thirty-five clinicians were interviewed. The substantive theory presented to explain the process is Guided by Priority. By presenting this understanding of practice, clinicians can reflect on their actions related to the task and determine if they are beneficial or detrimental to consumers, which may influence their future practice.

Accessibility versus quality of care plus retention: the formula for service delivery in Australian opioid replacement therapy?

The aim of this paper is to investigate how Australian Opioid Replacement Therapy (ORT) policy influences access to ORT treatment, including the resources required for implementation. In doing so, we also compare the accessibility of ORT treatment in Australia (AU) with ORT in the United Kingdom (UK) and United States (US). A review of government data and policy that influence service delivery was undertaken. When comparing across AU, the UK, and the US, we found several differences. To improve access to treatment in Australia more general practitioners need to provide ORT. Additionally, criteria for quality care, a centralised intake system, a national ORT treatment outcome measure, and a shift towards a recovery focus are recommended.

NICU nurses' lived experience: caring for infants with neonatal abstinence syndrome.

PURPOSE: The primary aim of this qualitative methods study was to describe the lived experiences of neonatal intensive care unit (NICU) nurses with ethical and morally challenging issues. SUBJECTS: The target population for the study was registered nurses working in the NICU. Interviews were completed with 16 nurses from 1 hospital. DESIGN: A phenomenological method design was used to describe NICU nurses' lived experiences with ethical and moral issues encountered in the NICU. METHODS: After obtaining signed consent, the principal investigator interviewed all participants, using a semistructured interview guide consisting of open-ended questions. MAIN OUTCOMES: Ethical and moral distress related to neonatal abstinence syndrome was the predominant outcome. PRINCIPAL RESULTS: Caring for infants, coping with families, and discharging infants home were the major concerns voiced by nurses in this study. CONCLUSIONS: Nurses in this study struggled with issues of beneficence and nonmaleficence and were not aware of scientific evidence that guides methadone management of pregnant women.

The prescribing of buprenorphine by advanced practice addictions nurses.

In order to increase safe access to buprenorphine treatment for patients with opioid dependence, it is the position of the International Nurses Society on Addictions (IntNSA) that the Drug Addiction Treatment Act of 2000 (DATA 2000) be amended to allow for the prescribing of buprenorphine by qualified advanced practice nurses who have both prescriptive authority and specialty certification in addictions nursing.