Adult Cannabis Use: An Exploratory Case Study.

Cannabis use is on the rise among adults and older adults managing chronic health conditions in the United States. There is limited understanding of this trend and the factors influencing cannabis use in the health care community. The current study explores the perceptions and experiences of adults and older adults with chronic health conditions who use cannabis regularly. Case study data were gathered through interviews guided by the Biopsychosocial Model. Biological, psychological, and social reasons for cannabis use emerged in the interviews. Despite reporting adverse events, cannabis was reported as an effective treatment for participants' chronic health issues, and participants were more comfortable with its use compared to prescription medications. A feeling of autonomy contributed to cannabis use being perceived as positive. Cannabis use is rising in the United States. Primary care providers must regularly screen older adults to identify appropriate and inappropriate use patterns. [Journal of Gerontological Nursing, 49(8), 19-26.].

NPs caring for people who are incarcerated and negatively impacted by social determinants of health.

ABSTRACT: This article explores roles filled and care provided by NPs in diverse carceral settings along with the impact of health disparities experienced as a result of social determinants of health on the chronic disease burden of people who are incarcerated. Opportunities abound for NPs to positively influence this patient population's health, but specialized education is needed.

Student Nurse Screening, Brief Intervention and Referral to Treatment Training Program: Analysis 2016-2019.

BACKGROUND: Screening, brief intervention and referral to treatment (SBIRT) is an evidence-based set of skills and strategies used by health care providers. Data have suggested SBIRT should be used in detecting persons at risk for substance use and be included in every primary care encounter, as many needing substance abuse treatment do not receive it. METHODS: This descriptive study evaluated data for 361 undergraduate student nurses who participated in SBIRT training. Pretraining and 3-month posttraining surveys were used to evaluate changes in trainees' knowledge, attitudes, and skills toward people with substance use disorder. A satisfaction survey immediately after the training measured satisfaction with and usefulness of the training. RESULTS: Eighty-nine percent of students self-reported that the training increased their knowledge and skills related to screening and brief intervention. Ninety-three percent reported that they intended to use these skills in the future. Pre-post measures indicated statistically significant increases in knowledge, confidence, and perceived competence on all measures. CONCLUSIONS: Both formative and summative evaluation assisted in improving trainings each semester. These data confirm the need to integrate SBIRT content across the undergraduate nursing curriculum and include faculty and preceptors to improve rates of screening in clinical practice.

Electronic Alcohol Screening and Brief Intervention and Referral to Treatment for College Students With Increased Alcohol Use Risk.

OBJECTIVE: The purpose of this study was to provide an understanding of the health care provider's perceptions and experiences with technology adoption in alcohol use disorder and clinical Screening, Brief Intervention, and Referral to Treatment (SBIRT). METHOD: The study used an exploratory, multimethod strategy to gain a comprehensive understanding of facilitators and barriers to technology adoption in alcohol SBIRT in a primary care setting. However, although providers state that they understand the importance of screening patients for alcohol use disorder, only 15.4% of providers consistently screen. This study's primary aim was to gain insights of the study participants and what events or experiences help them with SBIRT adoption. RESULTS: The findings show a gap in the understanding of how to integrate behavioral health screenings in the primary care workflow using the electronic health record system. Providers want to do SBIRT in clinical care, yet time-constrained visits remain an issue. CONCLUSIONS: Taking the time to map the workflow in advance of a practice change is a critical first step toward implementing it in a primary care setting. Time-constrained patient visits remain an ongoing problem and require novel methods to address issues, particularly in early identification of alcohol use disorder.

Substance Use Disorder and Correctional Health: Social Justice Course Development.

The purpose of this study was to evaluate how well a Faculty First-Year Seminar incorporated criminal justice health (CJH) and substance use disorder (SUD) content. Students completed a survey during the first and last classes of the semester, evaluating their level of knowledge, skills, and attitudes regarding SUD in criminal justice (CJ) involved persons. Answers to both open-ended and close-ended questions were evaluated. Students reported significantly higher confidence in course content after the semester compared with baseline. Findings indicated students' increased confidence in knowledge of CJH in individuals with SUD, and of CJ policy and advocacy. Social justice course content can be successfully developed and evaluated for nursing curricula.

Supportive Interventions During Treatment of Chronic Hepatitis C: A Review of the Literature.

There are an estimated 3 million people living with chronic hepatitis C, yet many have limited access to healthcare and treatment due to a variety of behavioral/lifestyle determinants of health. The aim of this literature review was to examine care models and innovations for people successfully treated from 2011 to 2018. We searched PubMed, PsycINFO, and CINAHL to identify care models for people undergoing treatment of chronic hepatitis C. Ten articles met criteria for inclusion and included multiple types of care models, including nurse initiated (n = 2), telemedicine care (n = 3), group visit (n = 1), concurrent treatment (n = 1), community health center care (n = 1), and integrated care (n = 2). Eight of the studies focused on people with mental health challenges and/or substance use disorder. Sustained virological response was the primary outcome of all studies; adherence was a secondary outcome measured in 8 studies.This search occurred during a period where treatment moved from interferon-based therapy to all-oral direct-acting antiviral medications, representing a paradigm shift in treatment of chronic hepatitis C. As new treatments offer cure for up to 95% of patients, these studies provided strong evidence of benefit for innovative care models for patients with mental health and substance use disorder to complete treatment.

Lactulose Management of Minimal Hepatic Encephalopathy: A Systematic Review.

Minimal hepatic encephalopathy has been shown to increase risk of involvement in road traffic accidents and alter quality of life. This systematic review focused on the role of nonabsorbable disaccharides for the management of minimal hepatic encephalopathy. Randomized clinical trials that evaluated medical management of minimal hepatic encephalopathy were considered for inclusion. Individual studies compared lactulose with usual care and lactulose with probiotics and L-ornithine-L-aspartate. The outcome for examination was the neuropsychiatric test for cognitive function. Search strategies outlined by the Johanna Briggs Institute were used, and articles and references of selected articles were reviewed according to that methodology. Meta-analyses and narrative synthesis of the included studies were undertaken. Treatment of minimal hepatic encephalopathy with lactulose, probiotics, or L-ornithine-L-aspartate was seen to be equally effective in reducing abnormal tests at 1, 3, and 12 months post-treatment. All patients with minimal hepatic encephalopathy should be screened using a neuropsychiatric test and receive treatment as needed. Treatment can delay or eliminate risky automobile accidents and harm to self. Lactulose, probiotics, and L-ornithine-L-aspartate are a low-cost alternative compared with antibiotic treatment.

Hepatitis C Point-of-Care Testing in Vulnerable Populations: A Human Factors Study.

One third of all hepatitis C virus (HCV) cases in the United States are incarcerated in jails and prisons. Hepatitis C virus testing is primarily accomplished through a clinical laboratory, yet point-of-care (POC) testing is less invasive and results are available in 20 minutes compared with up to 3 weeks. The purpose of this article was to describe the findings of a collaborative project between the Colleges of Engineering and Nursing at the University of Massachusetts Amherst in executing a human factors study for HCV antibody testing and screening. Observation and recording of three-step human factors data included length of time and resources required to execute a POC test and technology use data. In the three-step process, more time is spent on filling out paperwork (4.27 minutes) than is spent on the procedure (1.24 minutes) or on counselling (0.55 minutes). The majority of high-risk respondents had access to smart technology within the previous 3 years. Human factors data will enhance the capabilities of testing, data storage, self-management, and aid in formulating an efficient screening model for marginalized patients with liver disease.

Concept clarification of grief in mothers of children with an addiction.

AIM: To report an analysis of the concept of grief in mothers of children with an addiction. BACKGROUND: The concept of grief in this context is poorly understood and often synonymously used with concepts depression, loss and chronic sorrow. In the US, the core concept grief has been recently revised by both NANDA and the DSM-V in efforts to better understand and characterize the concept. The plethora of literature on grief worldwide often characterizes grief as a response to a death. DESIGN: Concept analysis. DATA SOURCES: Search terms 'parental grief' and 'substance abuse' yielded 30 articles. A second review using terms 'grief' and 'substance abuse' yielded 323 articles, in PsychInfo, CINAHL, PubMed databases from 1980-2013. Limits for articles in English and for the terms 'death' and 'child' yielded 13 usable articles. METHODS: The hybrid model of concept analysis, using a theoretical phase, an empirical phase and a final phase when a clarified definition of grief emerged. RESULTS: Definitions in the literature and defining characteristics of grief outline bio-psycho-social aspects of the concept. For one mother grief was accompanied by recurring feelings of sadness across time, while for the other mother grief was seen as coping, after having passed through a variety of stages of grief. For both, grief was seen to fall on a continuum. CONCLUSIONS: Grief is a universal concept and has a trajectory. Case study data have been essential in clarifying understandings of grief as experienced by mothers of addicted children and will provide direction for meaningful and tailored interventions.

Self-assessment of nursing informatics competencies for doctor of nursing practice students.

This study examined the informatics competencies of doctor of nursing practice (DNP) students and whether these competencies differed between DNP students in the post-baccalaureate (BS) and post-master's (MS) tracks. Self-reported informatics competencies were collected from 132 DNP students (68 post-BS and 64 post-MS students) in their first year in the program (2007 to 2010). Students were assessed in 18 areas of 3 competency categories: computer skills, informatics knowledge, and informatics skills. Post-BS students were competent in 4 areas (computer skills in communication, systems, documentation, and informatics knowledge about impact of information management), whereas post-MS students were competent in only 1 area (computer skills in communication). Students in both tracks reported computer skills in decision support as their least competent area. Overall, post-BS students reported slightly higher than or similar competency scores as post-MS students, but scores were statistically significant in only 3 of 18 areas. The assessment indicated that knowledge and skills on informatics competencies need to be improved, especially in computer skills for data access and use of decision support systems. Strategies are suggested to integrate competencies into existing informatics course and DNP curricula. Further studies are recommended using an objective measure of informatics competencies.

The evolution of a labyrinth walking program in corrections.

The development and expansion of labyrinth walking in corrections has signaled a milestone in the treatment of offenders, particularly those incarcerated for substance abuse-related offenses. In this article we describe the evolution of the labyrinth walking program from its inception highlighting: curriculum development and refinement, evidence-based and program evaluation findings. Methods used in working with key stakeholders are illustrated to both implement and evaluate labyrinth walking, and to identify future directions.

Labyrinth walking in corrections.

A 6 week labyrinth walking program was pilot tested in a correctional setting and goals were to: 1) determine the feasibility of a labyrinth walking curriculum; 2) pilot test measures of health related quality of life (QOL) (pre and post-surveys) and blood pressure; and 3) examine the influence of relationship-centered teaching on subject satisfaction. Relational communication was used as a framework for this study, emphasizing concepts of trust, competency and similarly in the teacher. A pretest/posttest descriptive design was used. The sample was 14 offenders at a Massachusetts county jail. The intervention included six 90 minute sessions, composed of a lecture, a labyrinth walk, and journal writing. Measures included a demographic survey; pre and post session walk blood pressures; pre and post program QOL measures; and a post program measure of satisfaction. The sample was 57% Caucasian, 36% Hispanic, and 7% African American, with an average age of 34, mostly high school educated and single. Drug of choice was alcohol with age of use at 12 and 1/2 years. Seventy-nine percent were previously incarcerated more than twice. QOL data were not changed pre to post. BP data trended in a healthy direction from weeks 1 to 6. Satisfaction with the teacher and the program was high. The labyrinth walking pilot program was proven feasible, low cost and satisfying for the participants. Recommendations for future studies are discussed.

Mobile outreach strategies for screening hepatitis and HIV in high-risk populations.

OBJECTIVES: To screen, counsel and offer hepatitis A and B vaccination for subjects at high risk for hepatitis C virus (HCV) and HIV, and determine any relationship between risk factors and HCV positivity. DESIGN AND SAMPLE: A descriptive correlational design. We correlated risk factors and HCV positivity and measured vaccination completion rates. Two hundred and two unduplicated subjects in 4 locations in Western Massachusetts: a walk in substance abuse clinic, a homeless shelter, a county jail, and a community corrections facility. MEASURES: Demographic data and a standard HCV risk- screening survey were used. RESULTS: Significantly higher rates of HCV were found in subjects who were currently using injection drugs (83.3% HCV positive, χ2(1) = 20.85, p<.001), who had a history of sharing needles for drug use (75% HCV positive χ(2) (1)=83.20, p<.001), or a history of receiving treatment for drug abuse/alcoholism (38.4% HCV positive χ2(1) = 12.14, p<.001). Vaccination completion ranged by setting between 18% and 38%. CONCLUSIONS: Targeted outreach to hard to reach groups is effective in providing access for those at high risk for HIV and HCV infection. A mobile outreach strategy can focus needed resources for a variety of groups in a community.

An intervention to prevent symptoms associated with hepatitis C: a pilot study.

The objectives of this study were to (a) pilot test instruments measuring fatigue and quality of life (QOL); (b) pilot test an exercise intervention; and (c) estimate the effect size of this intervention relative to completion of combination therapy, fatigue, QOL, and walking distance in 20 patients with chronic hepatitis C about to begin interferon alpha and ribavirin treatment. Alpha reliabilities for both the Schwartz Cancer Fatigue Scale and Hepatitis Quality of Life Questionnaire were moderately high. Power analyses of all outcome measures indicated a small effect size and sample size estimate of 30-40 per group to achieve power of >.80.

Peer education for hepatitis C prevention.

The purpose of this article is to describe a model of education about hepatitis C virus prevention tested in a county correctional facility. The Teach One Method and Relational Communication models inform this work. Using a one-group pretest-posttest prospective design our aims were to (1) convey education about prevention, protection, and safety; (2) provide this information through relationship-centered communication; (3) test the reliability and validity of the instruments; and (4) measure changes in behavior, knowledge, and relationship in the learner. A convenience sample of 25 men was recruited at a Massachusetts county jail. Subscale reliability was 0.78 and 0.79 for the relationship and behavior subscales, respectively. Knowledge questions were evaluated using face and content validity by teachers before and during this study. All subscale mean scores improved in the posttest condition. The level of significance of the calculated t value for the behavior subscale was 0.16. The level of significance for the relationship t value was nonsignificant at 0.65. Knowledge, behavior, and relationship scores improved after the intervention. Recommendations include retesting study instruments on a larger sample and using a control group.

The suitability of mindfulness-based stress reduction for chronic hepatitis C.

As incidence of chronic hepatitis C (CHC) in the United States increases, management of physical and psychological symptoms over the long term becomes crucial. Research has shown meditation to be a valuable tool in reducing such symptoms for various chronic illnesses. In particular, the Mindfulness-Based Stress Reduction (MBSR) program offers curriculum that has been shown to influence both physiology and perception of disease states. Although there has been no direct research to date on the effectiveness of the MBSR program for CHC, several studies have shown significant findings affecting other chronic conditions, including heart disease, fibromyalgia, and HIV. The purpose of this literature review is to examine recent research, summarize findings, and indicate appropriate inclusion of MBSR as a primary, secondary, and tertiary treatment option in conjunction with biomedical care for those diagnosed with CHC. Thusly, nurses can better inform their clients with this condition.

A case of health disparity: treatment issues in women with hepatitis C.

Although the incidence of hepatitis C virus (HCV) in women is only slightly less than in men, women are poorly represented in research trials. As a result, not much is known about them as a subgroup. The specific aims of this article were to report on the problem, study methods, and findings focusing on HCV-positive women's health beliefs, how they identify and understand their health and illness states, and their explanatory models of illness behavior. A pilot study using three focus groups was conducted with women in the community, in recovery, and incarcerated. Two groups emerged: those with and those without access to knowledge and HCV services. Latinas emerged as a prominent subgroup. Women in all three groups wanted more information and to stay clean, were worried about contagion, and stated that they were secretive and ashamed of their disease. Due to the small study design, this study should be repeated with a larger sample and in a wider geographic area. The results suggest that immediate interventions for this health disparity are needed, including dissemination of this information to primary and specialty care providers and the legislature.