Benefits and adverse effects of cannabis use among adults with persistent pain.

BACKGROUND: Increasingly, states are legalizing cannabis for recreational use. Improved accessibility may allow adults with pain to use cannabis more liberally. Greater understanding is needed about how adults with pain perceive the effects of cannabis, particularly those who also use opioid analgesics. PURPOSE: To examine the perceived effects of cannabis among adults who have been prescribed opioids for persistent pain. METHODS: A survey-based study was conducted on 150 adults with persistent pain. Data from two open-ended questions were analyzed using a qualitative descriptive approach and content analysis. FINDINGS: Data analysis led to identification of two main categories and five subcategories: (a) cannabis benefits with two subcategories of "physiological" and "mental health"; (b) adverse effects with three subcategories of "physiological," "mental health," and "social and economic concerns." DISCUSSION: Both positive and negative effects of cannabis were described. Nursing practice, including open communication with patients, can be guided by patient perspectives surrounding benefits and adverse effects of cannabis use.

Opioid Initiation to Substance Use Treatment: "They Just Want to Feel Normal".

BACKGROUND: Opioid use disorder has drastically increased in recent years within adult populations. Limited understanding exists regarding how people enter medication-assisted treatment (MAT) for opioid use disorder-particularly those who initiate opioid use to treat a painful condition. OBJECTIVES: This research examines the process involved when adults first initiate the use of opioid medicines to treat pain through enrollment in an outpatient MAT program. METHODS: Grounded theory methodology guided the study. Data analysis included interpretation of interview transcripts from 10 adults who were enrolled in a single outpatient MAT program in the Pacific Northwest. Inclusion criteria were adults in MAT reporting that their initial use of opioids was to treat their pain. Corbin and Strauss' approach to theory development was followed. RESULTS: A newly developed theory titled Living With Persistent Pain: From Opioid Initiation to Substance Use Treatment was supported by three predominant categories emerging from the data: "addiction pathway," "becoming normal," and "relationship spectrum." The core category "living with pain" was described as a complex and tumultuous process spanning the emergence of pain, to the initial use of opioid medicines, through opioid addiction and MAT. A notable aspect of this process was the turning point to enter MAT, which was both helped and hindered by significant relationships. CONCLUSIONS: The decision to enter MAT for opioid addiction was key to helping participants gain a sense of normalcy. Insights gained from participants' experiences-particularly in relationships with healthcare providers-can be used to guide treatment approaches.

Student support in accelerated nursing programs: Gender-based perspectives and impact on academic outcomes.

BACKGROUND: Factors that contribute to student success in accelerated degree nursing programs are poorly understood and may vary by gender. PURPOSE: Examine associations between satisfaction with peer and mentor support, gender, and academic outcomes among students in accelerated degree nursing programs. METHODS: We used data (demographic variables, satisfaction with peer and mentor support, graduation, and attempts of National Council Licensure Examination for Registered Nurses) from the American Association of Colleges of Nursing and Robert Wood Johnson Foundation's New Career in Nursing Program. Multivariable mixed effects regression models were used to examine associations among gender, satisfaction with support, and academic outcomes. FINDINGS: Males had an increased probability of reporting high satisfaction with peer support. Both males and females who were very dissatisfied with peer support were less likely to graduate than students who were very satisfied with peer support. Gender did not moderate the relationships between satisfaction with peer and mentor support and academic outcomes. CONCLUSION: Peer support is an important aspect of graduation among students in accelerated degree nursing programs. Continuous quality improvement strategies to improve student peer support may be warranted.

Engagement in online pain self-management improves pain in adults on medication-assisted behavioral treatment for opioid use disorders.

INTRODUCTION: Persistent pain has been recognized as an important motivator that can lead individuals to misuse opioids. New approaches are needed to test pain treatments that can improve outcomes for people with persistent pain in medication-assisted behavioral treatment for opioid use disorder. This study piloted an online pain self-management program to explore acceptability and treatment effects. METHODS: A sample of 60 adults diagnosed with chronic non-cancer pain and receiving medication-assisted behavioral treatment at one of two clinics were randomized into either treatment group with access to an online pain management program or waitlist attention control. Participants received online surveys via email at baseline and post-treatment at week 8. RESULTS: The majority of participants (n = 44; 73%) reported that their first use of opioids was in response to a painful event. Those who engaged in the online program had significantly lower pain interference, pain severity, opioid misuse measures, and depressive symptoms after eight weeks while pain self-efficacy was increased. CONCLUSION: Our results suggest the online pain self-management program content may be helpful for managing physical and emotional symptoms experienced by individuals with co-occurring pain and opioid use disorders. To improve online engagement, more support is necessary to assist with technology access and completion of online activities.

Othering in the nursing context: A concept analysis.

AIM: 'Othering' is described as a social process whereby a dominant group or person uses negative attributes to define and subordinate others. Literature suggests othering creates exclusive relationships and puts patients at risk for suboptimal care. A concept analysis delineating the properties of othering was conducted to develop knowledge to support inclusionary practices in nursing. DESIGN: Rodgers' Evolutionary Method for concept analysis guided this study. METHODS: The following databases were searched spanning the years 1999-2015: CINAHL, PUBMED, PsychINFO and Google. Search terms included "othering", "nurse", "other", "exclusion" and "patient". RESULTS: Twenty-eight papers were analyzed whereby definitions, related concepts and othering attributes were identified. Findings support that othering in nursing is a sequential process with a trajectory aimed at marginalization and exclusion, which in turn has a negative impact on patient care and professional relationships. Implications are discussed in terms of deriving practical solutions to disrupt othering. We conclude with a conceptual foundation designed to support inclusionary strategies in nursing.