Substance Use Disorders and the American Nurses Association Code of Ethics for Nurses.

Substance use disorder is a serious problem in nursing that is often invisible and not well understood or well handled. It tears at the social contract between nursing and society and disrupts the trust so essential to that contract. The American Nurses Association Code of Ethics contains clear language about a nurse's duty to take action to protect patients and to ensure the impaired nurse gets assistance. Specific interpretive statements provide useful guidance in dealing with this problem.

Testing a Model of Functional Impairment in Telephone Crisis Support Workers.

BACKGROUND: It is well known that helping professionals experience functional impairment related to elevated symptoms of psychological distress as a result of frequent empathic engagement with distressed others. Whether telephone crisis support workers are impacted in a similar way is not currently reported in the literature. AIMS: The purpose of this study was to test a hypothesized model of factors contributing to functional impairment in telephone crisis support workers. METHOD: A national sample of 210 telephone crisis support workers completed an online survey including measures of emotion regulation, symptoms of general psychological distress and suicidal ideation, intentions to seek help for symptoms, and functional impairment. Structural equation modeling was used to test the fit of the data to the hypothesized model. RESULTS: Goodness-of-fit indices were adequate and supported the interactive effects of emotion regulation, general psychological distress, suicidal ideation, and intentions to seek help for ideation on functional impairment. CONCLUSION: These results warrant the deliberate management of telephone crisis support workers' impairment through service selection, training, supervision, and professional development strategies. Future research replicating and extending this model will further inform the modification and/or development of strategies to optimize telephone crisis support workers' well-being and delivery of support to callers.

La ignorancia como conocimiento potencial / Ignorance as potential knowledge

El artículo propone reflexionar acerca de los procesos de aprendizaje instando a reconocer lo que no se sabe y activando la voluntad de aprender. Para ello se propone revisar patrones mentales que lo pueden dificultar. Superar el pensamiento newtoniano para desarrollar un pensamiento dual y relacional, cuántico, que permita dilucidar y comprender mejor las situaciones complejas (AU)

This article invites us to think about the learning process, giving special attention to what we do not know, the recognition of ignorance, and the activation of the desire to learn. It proposes to revisit the mental patterns that might interfere with the learning process. To go beyond the Newton thought and to develop instead a thinking process that can be dual and quantic, which allows us to elucidate and comprehend complex situations (AU)

Adverse Childhood Experiences, Support, and the Perception of Ability to Work in Adults with Disability.

OBJECTIVE: To examine the impact of adverse childhood experiences (ACEs) and support on self-reported work inability of adults reporting disability. PARTICIPANTS: Adults (ages 18-64) who participated in the Behavioral Risk Factor Surveillance System in 2009 or 2010 and who reported having a disability (n = 13,009). DESIGN AND MAIN OUTCOME MEASURES: The study used a retrospective cohort design with work inability as the main outcome. ACE categories included abuse (sexual, physical, emotional) and family dysfunction (domestic violence, incarceration, mental illness, substance abuse, divorce). Support included functional (perceived emotional/social support) and structural (living with another adult) support. Logistic regression was used to adjust for potential confounders (age, sex and race) and to evaluate whether there was an independent effect of ACEs on work inability after adding other important predictors (support, education, health) to the model. RESULTS: ACEs were highly prevalent with almost 75% of the sample reporting at least one ACE category and over 25% having a high ACE burden (4 or more categories). ACEs were strongly associated with functional support. Participants experiencing a high ACE burden had a higher adjusted odds ratio (OR) [95% confidence interval] of 1.9 [1.5-2.4] of work inability (reference: zero ACEs). Good functional support (adjusted OR 0.52 [0.42-0.63]) and structural support (adjusted OR 0.48 [0.41-0.56]) were protective against work inability. After adding education and health to the model, ACEs no longer appeared to have an independent effect. Structural support remained highly protective, but functional support only appeared to be protective in those with good physical health. CONCLUSIONS: ACEs are highly prevalent in working-age US adults with a disability, particularly young adults. ACEs are associated with decreased support, lower educational attainment and worse adult health. Health care providers are encouraged to screen for ACEs. Addressing the effects of ACEs on health and support, in addition to education and retraining, may increase ability to work in those with a disability.

Nurses facing fitness to practise hearings 'pushed to breaking point'.

Suicidal nurses facing fitness to practise investigations by the Nursing and Midwifery Council are among about 100 nurses supported by the RCN's counselling service each year.

Understanding Universal Elements in Mental Health Recovery: A Cross-Examination of Peer Providers and a Non-Clinical Sample.

In our study, we examined underlying human elements embedded in mental health recovery, by exploring shared positive change among peer providers with serious mental illnesses in recovery and a normative sample in spiritual growth following adversity. We conducted secondary analysis based on two independent qualitative study samples consisting of 31 American peer providers and 27 Israeli adults. We identified three shared and two distinct enablers of positive change: peer groups, significant mentor, self-transcendent experiences. Distinct enablers were having meaningful task/role (clinical sample) and deliberate choice to commit to change in face of uncertainty (non-clinical sample). Enablers facilitated positive processes of meaning making and enhancement of agency. Enablers provided opportunities to which the person responded and made use of--thus, enacting a positive reinforcement of change processes. The findings highlight the value of examining mental health recovery in a broad holistic perspective and have implications for practice.

Reasons Why Physicians and Advanced Practice Clinicians Work While Sick: A Mixed-Methods Analysis.

IMPORTANCE: When clinicians work with symptoms of infection, they can put patients and colleagues at risk. Little is known about the reasons why attending physicians and advanced practice clinicians (APCs) work while sick. OBJECTIVE: To identify a comprehensive understanding of the reasons why attending physicians and APCs work while sick. DESIGN, SETTING, AND PARTICIPANTS: We performed a mixed-methods analysis of a cross-sectional, anonymous survey administered from January 15 through March 20, 2014, in a large children's hospital in Philadelphia, Pennsylvania. Data were analyzed from April 1 through June 1, 2014. The survey was administered to 459 attending physicians and 470 APCs, including certified registered nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives. MAIN OUTCOMES AND MEASURES: Self-reported frequency of working while experiencing symptoms of infection, perceived importance of various factors that encourage working while sick, and free-text comments written in response to open-ended questions. RESULTS: Of those surveyed, we received responses from 280 attending physicians (61.0%) and 256 APCs (54.5%). Most of the respondents (504 [95.3%]) believed that working while sick put patients at risk. Despite this belief, 446 respondents (83.1%) reported working sick at least 1 time in the past year, and 50 (9.3%) reported working while sick at least 5 times. Respondents would work with significant symptoms, including diarrhea (161 [30.0%]), fever (86 [16.0%]), and acute onset of significant respiratory symptoms (299 [55.6%]). Physicians were more likely to report working with each of these symptoms than APCs (109 [38.9%] vs 51 [19.9%], 61 [21.8%] vs 25 [9.8%], and 168 [60.0%] vs 130 [50.8%], respectively [P < .05]). Reasons deemed important in deciding to work while sick included not wanting to let colleagues down (521 [98.7%]), staffing concerns (505 [94.9%]), not wanting to let patients down (494 [92.5%]), fear of ostracism by colleagues (342 [64.0%]), and concern about continuity of care (337 [63.8%]). Systematic qualitative analysis of free-text comments from 316 respondents revealed additional reasons why attending physicians and APCs work while sick, including extreme difficulty finding coverage (205 [64.9%]), a strong cultural norm to come to work unless remarkably ill (193 [61.1%]), and ambiguity about what constitutes "too sick to work" (180 [57.0%]). CONCLUSIONS AND RELEVANCE: Attending physicians and APCs frequently work while sick despite recognizing that this choice puts patients at risk. The decision to work sick is shaped by systems-level and sociocultural factors. Multimodal interventions are needed to reduce the frequency of this behavior.

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.

Am I my brother's keeper? A survey of 10 healthcare professions in the Netherlands about experiences with impaired and incompetent colleagues.

BACKGROUND: Dealing with poor individual performance of healthcare professionals is essential in patient safety management. The objective of the current study was to explore potential differences regarding experiences with impaired and incompetent colleagues between a broad range of healthcare professions. METHODS: A survey of 10 legally regulated professions in the Netherlands on knowledge on dealing with impaired/incompetent colleagues, experiences with such colleagues, action taken upon an impaired and incompetent colleague and reasons for not taking action. RESULTS: We approached 4348 professionals, of whom 1238 responded (28.5%). One-third of the respondents (31.3%) had an experience with an impaired or incompetent colleague in the preceding 12 months, and 84% of these reported cases concerned incompetence. Even under the extreme assumption that all non-respondents had no such experiences, our results indicate that at least 9% of the total sample had dealt with an impaired or incompetent colleague in the previous 12 months. Two-thirds of the professionals (68.6%) who had an experience reported having acted upon it. Respondents significantly less often reported to have acted (49.6% vs 79.1%, p=0.000) when the colleague was working at a different organisation. The primary reason for not taking action was that impairment/incompetence could not be proven. CONCLUSIONS: Even using an extreme correction for our low response rate, at least 9% of healthcare professionals reported dealing with impaired or incompetent colleagues in the past year. Creating and clarifying reporting opportunities when confronted with an incompetent or impaired colleague should be a priority for professional organisations, policymakers and regulatory bodies.

Substance use and mental illness among nurses: workplace warning signs and barriers to seeking assistance.

BACKGROUND: Although some studies have examined the prevalence of substance use among nurses, few have assessed substance use in the workplace or early cues for identifying these health conditions. Primary data collected as part of a larger program evaluation were examined with the purpose of better understanding (a) the context and perceived consequences of substance use and mental illness among nurses and (b) barriers and opportunities for earlier identification and treatment of these issues among nurses, their colleagues, and employers. METHODS: Anonymous surveys were mailed to 441 active and recent participants of a peer health assistance program in the summer of 2010. The survey examined drug-related behaviors in the workplace; behavioral cues that may permit earlier identification of substance use and mental illness; perceptions of barriers to seeking assistance; and strategies for preventing problems and overcoming barriers to seeking assistance. RESULTS: Responses were received from 302 nurses (69%). Nearly half (48%) reported drug or alcohol use at work, and two fifths (40%) felt that their competency level was affected by their use. More than two thirds of respondents thought their problem could have been recognized earlier. The most highly rated barriers to seeking assistance for substance use and mental illness included fear and embarrassment and concerns about losing one's nursing license. Respondents recommended greater attention be paid to early identification of risk factors during nurses' professional training as a prevention strategy. CONCLUSIONS: Findings from this study provide preliminary data that can be used by schools of nursing and health care employers to improve early identification of nurses' substance use and mental illness treatment needs. These data also suggest a need for more research to explore the prevention and early identification of co-occurring disorders in health care settings where nurses practice.