Atención de enfermería a usuarios de drogas en prisión / Nursing care for drug users in prison

En los centros penitenciarios de Cataluña, las enfermeras juegan un papel fundamental en los equipos de atención a las drogodependencias. Sin embargo, no se conocen trabajos sobre este modelo de cuidados. El objetivo de este artículo es describir y reflexionar sobre la atención de enfermería a usuarios de drogas en prisión. Sus pilares son la promoción de programas de reducción de daños, la necesidad de establecer una buena relación terapéutica enfermera-usuario y la defensa del acceso a la salud. Este trabajo pone de manifiesto la importancia de la intervención de enfermería para mejorar la calidad de vida de los usuarios de drogas. Por esta razón, es importante que las enfermeras reciban formación especializada para una actuación sobre drogas más eficaz en el medio penitenciario. (AU)

In the prisons of Catalonia, nurses play a fundamental role in drug addiction care teams. However, there are no known works about this topic. The aim of this article is to describe and think about nursing care for drug users in prison. This model of intervention that we propose is based on the promotion of harm reduction programs, the need to establish a good therapeutic nurse-patient relationship and the defense of access to health. This work highlights the importance of nursing intervention to improve the quality of life of drug users. For this reason, it is important these professionals receive specialized training for a more effective drug treatment in the prison environment. (AU)

Usuários de substâncias psicoativas: desafios à assistência de enfermagem na Estratégia Saúde da Família / Usuarios de sustancias psicoactivas: desafíos para la atención de enfermería en la Estrategia de Salud de la Familia / Users of psychoactive substances: challenges to nursing care in the Family Health Strategy

RESUMO Objetivo analisar a assistência de Enfermagem ao usuário de substâncias psicoativas na Estratégia Saúde da Família. Método estudo descritivo e qualitativo realizado com sete enfermeiros da Estratégia Saúde da Família de Juiz de Fora, Minas Gerais. Os dados foram obtidos por meio de entrevistas guiadas por um roteiro semiestruturado e a Análise Temática de Conteúdo foi utilizada para o seu tratamento. Resultados a assistência prestada pelos entrevistados é pautada na demanda espontânea, sem estratégias de busca ativa, com a valorização de práticas orientadas pela medicalização da pessoa e o encaminhamento aos serviços especializados. A inclusão da família no processo de reabilitação, o atendimento imediato e o exercício da escuta terapêutica foram mencionados como estratégias que podem ser adotadas para uma assistência integral. Os desafios mencionados referiram-se à falta de formação em saúde mental, à fragmentação do conhecimento acerca da especialidade, à ausência de capacitações e ao desejo do paciente em participar do tratamento. Considerações finais e implicações para a prática os enfermeiros referiram um cuidado insuficiente para a garantia da integralidade da assistência permeado pela falta de conhecimentos e habilidades para lidar com esse público, o que leva ao encaminhamento para serviços especializados como principal intervenção, reforçando a necessidade de capacitação desses profissionais.

RESUMEN Objetivo analizar la atención de Enfermería a usuarios de sustancias psicoactivas en la Estrategia Salud de la Familia. Método estudio descriptivo y cualitativo realizado con siete enfermeros de la Estrategia Salud de la Familia en Juiz de Fora, Minas Gerais. Los datos fueron obtenidos a través de entrevistas guiadas por un guion semiestructurado y se utilizó el Análisis de Contenido Temático para su tratamiento. Resultados la asistencia proporcionada por los entrevistados se basa en la demanda espontánea, sin estrategias de búsqueda activa, con la valoración de prácticas guiadas por la medicalización de la persona y la derivación a servicios especializados. La inclusión de la familia en el proceso de rehabilitación, la atención inmediata y el ejercicio de la escucha terapéutica fueron mencionadas como estrategias que pueden ser adoptadas para la atención integral. Los desafíos mencionados se refirieron a la falta de formación en salud mental, la fragmentación del conocimiento sobre la especialidad, la falta de formación y el deseo del paciente de participar en el tratamiento. Consideraciones finales e implicaciones para la práctica los enfermeros mencionaron cuidados insuficientes para garantizar una atención integral permeada por la falta de conocimientos y habilidades para el trato con este público, lo que lleva a la derivación a servicios especializados como principal intervención, reforzando la necesidad de formación de estos profesionales.

ABSTRACT Objective to analyze the nursing care provided to users of psychoactive substances in the Family Health Strategy. Method a descriptive and qualitative study carried out with seven nurses from the Family Health Strategy of Juiz de Fora, Minas Gerais. Data was obtained through interviews guided by a semi-structured script and the Thematic Content Analysis was used for its treatment. Results the care provided by the interviewees is based on spontaneous demand, without active search strategies, with the valorization of practices guided by the medicalization of the person and the referral to specialized services. The inclusion of the family in the rehabilitation process, immediate care, and therapeutic listening were mentioned as strategies that can be adopted for an integral assistance. The challenges mentioned referred to the lack of training in mental health, the fragmentation of knowledge about the specialty, the absence of training, and the patient's desire to participate in the treatment. Final considerations and implications for the practice the nurses reported insufficient care to ensure comprehensive care permeated by a lack of knowledge and skills to deal with this public, which leads to referral to specialized services as the main intervention, reinforcing the need to train these professionals.

Pregnant and Parenting Women's Experiences with Substance Use Disorder.

PURPOSE: The purpose of the study was to describe and analyze the experience of women with substance use disorder during pregnancy and parenting to inform health care services that promote recovery. STUDY DESIGN: Interviews of pregnant or parenting women with substance use disorder were used in this qualitative descriptive study. METHODS: Participants were recruited from two recovery centers serving pregnant or parenting women with substance use disorder. Participants called a study cellphone to speak with the researchers about their substance use and recovery. Four independent reviewers conducted thematic analysis and were facilitated by Atlas.ti qualitative analysis program. RESULTS: N = 15 women called the study cellphone; 10 met inclusion criteria and were interviewed. Researchers coded 81 themes with the common occurrence of prior trauma, multiple substances used, stigma and judgment from others, and having children as a motivation to seeking recovery. Co-occurrence of themes of positive social support and the pursuit of recovery was identified. CLINICAL IMPLICATIONS: Positive social support co-occurring with recovery supports the need for strengthened social support structures. Health care professionals should intentionally address the culture of caring for pregnant and parenting women with substance use disorder through education, practice, advocacy, and research.

Addiction Nursing Competencies: A Comprehensive Toolkit for the Addictions Nurse.

With the increased role of nurses in caring for patients with substance addiction, there was a clear need to develop the Addiction Nursing Competencies to guide and support the nursing workforce. A literature search revealed a lack of formal instruments to assess and guide nurses in caring for persons with substance use disorders. The Addiction Nursing Competencies were created using existing nursing education frameworks and addiction nurse care manager clinical guidelines.

Substance Abuse Disorder in Nursing: Evaluation and Recommendation for Regulatory Monitoring Program Performance Measures and Enhancement.

ABSTRACT: Outcome measures for individual states' nursing professional alternative-to-discipline (ATD) programs have historically ceased beyond successful fulfillment of active program monitoring, leaving a gap in affirmation of sustained postprogram efficacy. The project objective challenges the absence of profession-specific postmonitoring practice, affording qualitative evaluation of the program's impact to professional nursing. The pilot study's 8-week process improvement PICO(T) seeks validation of incorporating postprogram monitoring to validate program efficacy, conceptualizing framework guidelines established by the Federation of State Physician Health Programs' Performance Enhancement Review. Study efforts encompass identified needs assessment, current practice through outcome recommendations, and access of developed online mixed-methods appraisal with an emphasis on qualitative analysis, questioning the alumni's state of sobriety, perspective related to program participation, workforce contribution to professional practice, and intent to remain in nursing. The proposed alumni graduate status between 2 and 5 years from program completion resulted in an 11% response rate: 90% reported zero relapse since program completion; greater than 50%, willingness to participate as ATD or peer mentors; 90%, nursing licensure in good standing; and 66%, intent to remain working in profession over the next 5 years. Limitations constitute sample size, inception groundwork, and project constraints. Findings offer insight from alumni perspective, validation of literary support, and organizational interest for implementation. Contributions to nursing practice embody care of the caregiver ideology and offer future collaboration with ATD programs at state, national, and global levels to support sustained recovery of professionals affected with substance use disorder.

The effect of mindfulness-based education given to individuals with substance-use disorder according to self-efficacy theory on self-efficacy perception.

The aim of this research is to find the effect of mindfulness-based education given to individuals with substance-use disorder according to self-efficacy theory on self-efficacy perception. The research was planned as a test model with pretest-posttest control groups. Individuals who have been diagnosed with substance abuse in the substance abuse clinic of Turgut Ozal Medical Center, and at the Substance Abuse Treatment and Education Centre of Gaziantep 25 Aralik State Hospital formed the core of this study. The research was conducted between January 2018-May 2019. 112 patients, 56 in the treatment and 56 in the control group, participated in the study. Scientific research started after ethical approval. Mindfulness therapy was applied to experimental group patients. For the data collection, the Socio-Demographic Characteristics Questionnaire and Self-Efficacy-Sufficiency scale were used. t-Test for dependent variables to compare the mean scores of experimental and control groups and t-test for independent variables were used. It was seen that the average total Self-Efficacy-Sufficiency score of the patients in the treatment group was 76.50 ± 12.62 before the intervention and increased to 85.50 ± 14.95 after the intervention. There is a significant difference between the average scores. Even when the treatment and control groups are compared, a significant difference was still detected between the groups. There was no significant difference between the groups in two of the Self-Efficacy-Sufficiency steps after the intervention in the experimental group, but there were significant differences between the other two factors and total score averages.

The significance of the nursing actions in psychiatric hospitalization of female adolescent users of psychoactive substances / El significado de las acciones de enfermería en la internación psiquiátrica de mujeres adolescentes usuarias de sustancias psicoactivas / O significado das ações de enfermagem na internação de adolescentes usuárias de substâncias psicoativas

ABSTRACT Objective To understand the significance of the actions developed by the nursing team in a Psychiatric Inpatient Unit for adolescent female users of psychoactive substances in the light of Alfred Schutz's phenomenological sociology framework. Method Qualitative study with Alfred Schutz's Phenomenological Sociology approach. Four nurses and 17 nursing assistants and technicians from a General Hospital in the city of Porto Alegre participated in the study. Results Three concrete categories emerged: nursing actions as being-with-the-other; collective nursing actions as a potential for shared act and nursing actions as expectations and challenges. Final considerations The actions developed by the nursing team are established through intersubjective relationships, based on bonding and dialogue, but there is still a need for nursing to enhance its actions by expanding the offer of collective therapeutic activities aligned with the psychosocial care model.

RESUMEN Objetivo Comprender el significado de las acciones desarrolladas por el equipo de enfermería en Unidad de Internación Psiquiátrica para mujeres adolescentes usuarias de sustancias psicoactivas, considerando el referencial de la sociología fenomenológica de Alfred Schutz. Método Estudio cualitativo basado en la Sociología Fenomenológica de Alfred Schutz. Participaron cuatro enfermeros y 17 auxiliares de enfermería y técnicos de una unidad de hospitalización psiquiátrica en hospital general de la ciudad de Porto Alegre. Resultados Surgieron tres categorías concretas: acciones de enfermería sobre estar-con-el-otro; operaciones colectivas de enfermería como potencial de acción compartida y las acciones de enfermería como expectativas y desafíos. Consideraciones finales Las acciones desarrolladas por el equipo de enfermería se establecen a través de relaciones intersubjetivas, guiadas por el vínculo y el diálogo, pero aún se demarca la necesidad de la enfermería de potencializar sus acciones ampliando la oferta de actividades terapéuticas colectivas alineadas con el modelo de atención psicosocial.

RESUMO Objetivo Compreender o significado das ações desenvolvidas pela equipe de enfermagem em uma Unidade de Internação Psiquiátrica de adolescentes usuárias de substâncias psicoativas à luz do referencial da sociologia fenomenológica de Alfred Schutz. Método Estudo qualitativo com abordagem da Sociologia Fenomenológica de Alfred Schutz. Participaram do estudo quatro enfermeiros e 17 auxiliares e técnicos de enfermagem de um Hospital Geral do município de Porto Alegre. Resultados Emergiram três categorias concretas: ações de enfermagem enquanto ser-com-o-outro; ações coletivas de enfermagem enquanto potencial do agir compartilhado e ações de enfermagem enquanto expectativas e desafios. Considerações finais As ações desenvolvidas pela equipe de enfermagem são estabelecidas por meio de relações intersubjetivas, pautadas pelo vínculo e diálogo, porém ainda há a necessidade de a enfermagem potencializar suas ações mediante a ampliação de oferta de atividades terapêuticas coletivas consoantes com o modelo de atenção psicossocial.

"The Future of Nursing: Accelerating gains made to address the continuum of substance use".

PURPOSE: Guided by four key messages from the decade-old Institute of Medicine (IOM) report, "The Future of Nursing," this paper highlights the progress made by the nursing profession in addressing substance use and its related disorders and offers recommendations to sustain and advance efforts to enhance care for persons who use substances, one of the most stigmatized and vulnerable populations. RESULTS: Patterns of substance use have shifted over the past 10 years, but the associated harms remain consequential. As awareness of the continuum of substance use has expanded, the care of persons with substance use has also expanded, from the domains of psychiatric-mental health and addictions nursing specialties to the mainstream of nursing. Now, greater efforts are being undertaken to identify and intervene with persons at risk for and experiencing substance use disorders. Nurses have advanced the knowledge and skills necessary for substance-related nursing care including education and training, leadership, care innovations, and workforce expansion and can drive efforts to increase public knowledge about the health risks associated with substance use. Recommendations aligned with each of the four IOM key messages are offered. CONCLUSIONS: As a profession, nursing has a responsibility to expand the progress made in addressing substance use - from prevention and early intervention to tertiary care. Nurses at all levels of education and practice are in key positions to carry out the recommendations herein to accelerate the changes needed to provide high quality care for persons impacted by substance use.

Nursing Attitudes Toward Patients With Substance Use Disorders: A Quantitative Analysis of the Impact of an Educational Workshop.

BACKGROUND: Negative healthcare provider attitudes toward patients with substance use disorder (SUD) may adversely impact the quality of care and treatment outcomes. PURPOSE: In this article, we aim to characterize the effects of an 8-hour educational workshop on attitudes toward patients with SUD among nurses from an urban inpatient psychiatric hospital. METHODS: The Drug and Drug Problems Perceptions Questionnaire, a 22-item scale consisting of six subscales, was used to assess nurse attitudes to patients with SUD at pretest (n = 38), posttest (n = 36), and 30-day follow-up (n = 20). Generalized estimating equation models adjusted for gender and years of work experience were used to measure changes in Drug and Drug Problems Perceptions Questionnaire scores. RESULTS: Positive attitudes significantly increased at posttest (ß = -12.09, 95%CI [-16.83, -7.34]; p < .001) and were sustained at 30-day follow-up (ß = 1.71, 95% CI [-3.11, 6.53]; p = .49). Subscales of motivation (ß = -0.26, 95% CI [-0.87, 0.35]; p = .41) and task-specific self-esteem (ß = -0.56, 95% CI [-1.44, 0.32]; p = .21) did not significantly change at posttest. CONCLUSIONS: Our findings show workshop effectiveness in improving nurse attitudes toward patients with SUD. Future research may test similar interventions at a larger scale and with other health professionals.

Reasons of drug use among adolescents: implications for clinical nursing care.

This is a theoretical essay which aims to reflect on the reasons for and why adolescents use drugs and their implications for clinical nursing care. It used the referential of social phenomenology of Alfred Schutz. The main reasons identified were: to attenuate existential crisis, form social bonds and to have fun. The reasons for this are related to the characteristics of adolescence, a breakdown in social and family ties and the conditions of programmatic vulnerability. Motivations provide important information for developing person-centered, not drug-abuse-centered care strategies. Nurses' caregiving action is based on emancipatory health education strategies grounded on the strategy of reducing harm and risks related to drug use and the possibility to help adolescents become aware of their biographical situation in a face-to-face relationship, so that they can (in knowing yourself) act to promote their health.

Nurse-Led Initiative to Improve Addiction Services: An Interdisciplinary Approach.

Local efforts to provide treatment for individuals with substance use disorder have had some success in addressing the continued nationwide drug epidemic. A nurse-led withdrawal and stabilization program was developed that includes an interdisciplinary team of physicians, advanced practice providers, nurses, social workers, and substance abuse counselors. Utilizing a shared vision of optimal patient care, we describe how principles of high reliability were incorporated to build a successful program within a community hospital setting from the design of the unit, development of treatment protocols, staffing, and ongoing program refinement that is based on patient and program staff feedback to final thoughts for future program changes.

Midwives Uniquely Suited to Deliver Woman-Centered Care and Decrease Stigma for Women With Substance Use Disorders.

Midwives are being called to serve a growing population of vulnerable women, those with substance use disorders (SUDs). Increasing numbers of women across the lifespan are being diagnosed with SUDs. In addition, women with SUDs are experiencing very unique and distinct differences in stigma related to their substance use. This stigma is coming from varied sources and through many different forms including mislabeling, misinformation, the media, and a devalued maternal/child relationship. Mothers frequently experience different types of adverse health encounters during the perinatal and postpartum period that also contribute to stigma. Midwives are positioned to provide woman-centered care in a variety of practice settings as integral members of interprofessional teams. Midwives can decrease the stigma women with SUDs are experiencing while improving the health of women, mothers, and families worldwide.

The physical and psychological wellbeing of caregivers of individuals suffering from substance addiction.

OBJECTIVE: This paper seeks to examine the physical and psychological wellbeing of caregivers of individuals suffering from substance addiction. METHOD: To obtain knowledge of the needs of caregivers of substance addicted individuals and investigating their wellbeing, this paper presents a systematic literature review. Both electronic and manual searches were done on EBSCO host, eBooks collection, Academic search complete, CINAHL Plus, Health source (academic, nursing and consumer edition), Medline, Masterfile, PsycARTICLES and Google Scholar. Books relevant to the topic searched were also used. RESULTS: The results gave an overview of needs and wellbeing issues concerning the caregivers of individuals suffering from substance addiction and what can be implemented to address their wellbeing such as confidence, maintenance of relationships, engaging with the world, being productive and coping with stress. CONCLUSIONS: This review indicated that future research should aim to ensure the psychological and physical wellbeing of caregivers of individuals addicted to substances as these individuals' experiences and perspectives are almost always neglected. Avenues for avoidance and early intervention of deterioration of wellbeing of these individuals should be explored.

Addiction, childhood experiences and nurse's role in prevention: a qualitative study.

BACKGROUND: Parenting approach and early childhood experiences are thought to be two important factors in the initiation of substance use. AIMS: We aimed to explore the nurse's role in the prevention of childhood addiction. METHODS: In this qualitative study we conducted in-depth interviews with young men and women who were either in treatment for their addiction or were active drug users as well as with family members and nurses. The data analysis followed Strauss and Corbin's constant comparison method. RESULTS: The data analysis revealed six categories: traumatic events during childhood, inappropriate parenting approach, Lack of knowledge and a tolerant attitude toward drug use, turning a blind eye on the threat of drug use, nurses' poor experience of drug use prevention, and the lack of a clear definition of the nurse's role in prevention of drug use. CONCLUSIONS: Nurses who work with young people and their families have a special opportunity for prevention, early detection and timely intervention for drug dependency.

It is just that people treat you like a human being: The meaning of dignity for patients with substance use disorders.

INTRODUCTION: Patients who suffer from substance use disorder (SUD) might receive services from different service providers in an opioid maintenance treatment programme (OMT) and have a widespread and complex need for nursing. BACKGROUND: Literature reveals that prejudices against people with SUD exist. There is a lack of studies exploring patients with SUD experiences of preserving their dignity in the encounter with healthcare staff. The aim of the study was to gain insight into the meaning of dignity for patients with SUD. METHODS: The research design was descriptive and interpretative. In the interpretation of qualitative in-depth interviews with six patients, a hermeneutical approach based on Gadamer (Truth and method, Sheed & Ward, London, UK, 1989) was used. RESULTS: Analysis resulted in three mains themes about the meaning of dignity: (a) The material dimension. (b) To be respected by others. (c) The inner experience. Factors enhancing dignity in the encounters were as follows: (a) Being respected and acknowledged. (b) Being cared for. (c) Knowledge and persistent relation. Factors depriving dignity were as follows: (a) Stigma and prejudice. (b) Insufficient relations and lack of confirmation. (c) Experiencing disrespectful/patronising attitudes and lack of knowledge. CONCLUSIONS: The material dimension of dignity containing an aesthetically aspect was important for these patients. Dignity was also experienced as strongly connected to respect. Dignity can be enhanced by treating patients with SUD with understanding and respect, and dignity can be inhibited through stigmatization of patients with SUD, as well as by caregivers' lack of knowledge. RELEVANCE TO CLINICAL PRACTICE: The study clarifies a need for more knowledge about SUD among healthcare staff, as well as promotes ethical awareness in encounters with patients regardless of their background.