The power of nursing: An innovative course in values clarification and self-discovery.

Teaching for a practice is more than the dissemination of knowledge and information to the learner. Professional nursing education requires teachers to facilitate students' self-reflection and awareness and assimilation of core professional and personal values in order for the new nurse to anchor and internalize these values as part of a professional identity. To achieve this, nursing educators recognize the importance of learning opportunities centered in the affective domain and the importance of teaching for professional formation that supports nursing students' commitment to the values of their chosen community of practice. This paper describes the development, implementation and evaluation of a learning innovation for pre-RN students. The Power of Nursing: Embracing the Healer's Art, a five-session, 15-hour discovery model course that uses guided reflection and personal sharing is described, as are course outcomes for 68 students from four nursing schools in the U.S. Overall students' reports were strongly favorable and the learning experience was valued and identified as unique within the nursing curriculum.

Significant life events and their impact on alcohol and drug use: a qualitative study.

This study used a life-course perspective to identify and understand life events related to long-term alcohol and other drug (AOD) use trajectories across the life span. Using a purposive sample, we conducted semi-structured telephone interviews with 48 participants (n = 30 abstinent and 18 non-abstinent) from a longitudinal study of AOD outcomes 15 years following outpatient AOD treatment. A content analysis was conducted using ATLAS.ti software to identify events and salient themes. Caregiving for an ill or dependent family member was related to better AOD outcomes by reinforcing abstinence and reduced drinking, and contributing to alcohol cessation in most individuals who cited caregiving as a pivotal event. Grandparenting and parenting an adult child were motivational for sustaining abstinence and reduced drinking. Findings were mixed on death of a loved one, which was related to abstinence in some and relapse in others. Redemption and mutual fulfillment as caregivers, reconciliations with adult children, and legacy-building as grandparents were themes associated with maintaining abstinence and reduced drinking. AOD treatment has the opportunity to employ motivational interventions for relapse prevention that address the meaning and lifelong reach of intimate relationships for individuals and their AOD use across the life span.

Unmet mental health and substance abuse treatment needs of sexual minority elders.

In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indicated that elders 55-64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utilization was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed.

Smoking and behavioral health of women.

BACKGROUND: Using data from a study of reliability and validity of a screening tool for co-occurring substance abuse and mental health problems, our objective was to compare behavioral health issues of female smokers and nonsmokers and explore correlates of smoking. METHODS: Using a convenience sample (n=1021), we recruited participants to complete an online survey conducted in substance abuse treatment, primary care, mental health services, senior, and public settings. The survey included demographic questions, smoking status, the co-occurring disorders screening tool, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) and the Postraumatic Stress Disorder Checklist (PCL)-Civilian. RESULTS: One third of participants self-identified as smokers, and African American, American Indian, and bisexual women reported the highest rates of smoking. Seventy-two percent of women reported at least one mental health problem in the past year; 29% had a past year substance abuse problem, and 26% reported a past year co-occurring disorder of both. Smokers had significantly higher rates of posttraumatic stress disorder (PTSD), past year depression and anxiety, suicidality, past year substance abuse, and co-occurring disorders. Smokers also had significantly higher rates of lifetime intimate partner violence (IPV) and childhood abuse. CONCLUSIONS: Smoking in women was associated with significantly higher rates of mental health and substance abuse problems. Substance abuse, being in a treatment setting, IPV, African American and mixed ethnicity, Medicaid insurance status, reduced income, and no home ownership were identified as predictors of smoking. Screening and evaluation of smoking status, mental health, substance use disorders, and the presence and impact of violence are essential for women's health.

Validity and reliability of the COJAC screening tool for co-occurring disorders.

This study explored the reliability and validity of a nine-item screening tool (Co-Occurring Joint Action Council [COJAC] Screening Tool [CST]) for co-occurring disorders (COD). Using a convenience sample (n=1,951), an online survey was conducted in multiple settings and included demographic questions, the CST, the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), and the Posttraumatic Stress Disorder Checklist-Civilian version. The CST substance abuse (SA) scale performed well with a Cronbach's alpha of .84 and a correlation of .71 with GAIN-SS SA (past year). The CST mental health and trauma items did not perform well as scales with Cronbach's alphas of .64 and .56, respectively. The CST-SA is a short, reliable, and valid measure of SA. Further study is needed to determine the best evaluation tool for the mental health portion of the COD screening instrument.

The Place of Adoption in the NIDA Clinical Trials Network.

The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) was established in 1999 to determine effectiveness of drug abuse treatment interventions among diverse client populations and settings. To address dissemination of research findings, the CTN also has as its mission the transfer of research findings to treatment providers. In a qualitative study of adoption of evidence based practice in the context of two CTN clinical trials, we interviewed 29 participants from seven organizational levels of the multisite study organization about post-trial adoption, their role in the clinical trial, and interactions between the research initiative and clinic staff and setting. Analysis of interview data revealed a range of opinion among participants on the place of adoption within the CTN. Innovation within the CTN to support adoption and further observational research on dynamics of adoption within the CTN can increase dissemination of evidence-based drug abuse treatment interventions in the future.

Tobacco-related practices and policies in residential perinatal drug treatment programs.

Despite serious health consequences from high rates of smoking among perinatal women, smoking cessation and/or nicotine treatment practices have yet to be broadly adopted into perinatal substance abuse treatment settings. This correlational cross-sectional survey examined tobacco-related policies, practices, knowledge, and attitudes of 31 directors of perinatal residential substance abuse treatment programs in California. We found that the directors' programs had limited on-site adoption of evidence-based practices for smoking cessation, and that directors had gaps in their knowledge of perinatal tobacco effects. Implications for tobacco policy initiatives in perinatal substance abuse treatment are discussed.

Organizational change in a perinatal treatment setting: integration of clinical practice and policies on tobacco and smoking cessation.

Perinatal smoking presents serious health risks to the fetus, mother, and child. Despite extensive evidence of risk and high rates of smoking among in-treatment perinatal women substance abusers, tobacco-related practice and policy change has not been widely transferred for application in drug abuse treatment programs for pregnant and parenting women. This qualitative study investigated the process of change and the resultant adoption of clinical policy and treatment innovation in a residential drug abuse treatment program that converted from tobacco-tolerant to tobacco-free with provision of smoking cessation services. Informed by the Organizational Readiness for Change Model, staff interviews and data analysis were conducted to examine program characteristics affecting adoption. An organizational climate of openness to change and the program's clarity of mission, expressed in perinatal-specific motivators for change, influenced the adoption of tobacco-related clinical practice and policy. Re-allocation of time, previously occupied by smoking behaviors, allowed for added promotion of maternal-child interaction and positive role-modeling for children.

Evaluation of Probation Case Management (PCM) for Drug-Involved Women Offenders.

Based on availability of case management services, drug-involved women offenders entered either a probation case management (PCM) intervention (n = 65) or standard probation (n = 44). Participants were placed in the case management condition until all slots were filled, then placed in standard probation until case management slots opened. Participants were interviewed at program entry and at 6 and 12 month follow-up using measures of substance abuse, psychiatric symptoms, and social support. Results showed modest change over time in both conditions, but PCM did not result in more services or treatment, or in better outcomes, than standard probation. These findings are discussed in the context of study limitations, and in the context of state initiatives like those in Arizona and California designed to apply treatment as an alternative to incarceration.