Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus): A Novel Interprofessional Training for Rehabilitation Science Professional Students.

IMPORTANCE: With the increasing amount of substance use-related health conditions in the United States, it is important for rehabilitation science professionals to receive screening and prevention training. OBJECTIVE: To describe and examine the preliminary effectiveness of a novel educational program, Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus), that combines traditional SBIRT training with new modules for cannabis, stimulant, and opioid use. DESIGN: Prospective, cohort design. SETTING: Academic institution. PARTICIPANTS: One hundred eighty-one rehabilitation science graduate students. INTERVENTION: SBIRT-Plus curriculum. OUTCOMES AND MEASURES: Outcomes included satisfaction with training, perception of interprofessional training, attitudes, knowledge, and stigma, as assessed with the Readiness for Interprofessional Learning Scale, Alcohol and Alcohol Problems Perception Questionnaire, Drug and Drug Problems Perception Questionnaire, Knowledge Screening Scale, and two stigma instruments. RESULTS: Most students (>80%) expressed satisfaction with their training, would recommend the training to a colleague, and believed that the training would influence and change the way they practiced with patients at risk for substance use disorders. Students' attitudes and knowledge increased from pre- to post-training, and stigma perceptions were significantly reduced. CONCLUSIONS AND RELEVANCE: SBIRT-Plus is an evidence-based interprofessional training that is feasible to implement in graduate-level education programs. Integrating SBIRT-Plus into professional graduate programs may be an optimal and low-cost model for training rehabilitation health care professionals. Plain-Language Summary: Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus) is an evidence-based interprofessional training that can be easily adopted in curricula to train professional students about the importance of screening for substance use disorders.

Factors Associated with Nurses' Motivation to Provide Care for Patients with Alcohol Use and Alcohol Use-Related Problems.

BACKGROUND: There is a high human and economic cost associated with alcohol use and alcohol use-related problems. Nurses have a pivotal role in addressing the needs of this patient population. Purpose: The study aimed to examine the correlation between nurses' demographics/background characteristics, personal attitudes, professional attitudes, and their motivation to provide care to patients with alcohol use and alcohol use-related problems. METHODS: A descriptive, cross-sectional correlational design was utilized. Nurses were recruited from four Southwestern Pennsylvania hospitals. The study variables were examined using questionnaires that explored nurses' demographic/background characteristics, their personal and professional attitudes, and motivation to care for patients with alcohol use and alcohol use-related problems. RESULTS: The sample included 234 nurses. Demographic/background characteristics were identified as associated with nurse's alcohol use-related motivation, including gender, primary work setting and specialization. Previous personal experience with alcohol use-related problems (nurses themselves or co-workers), familiarity, perceived dangerousness, fear, social distance, personal responsibility beliefs and disease model were also associated with nurses' alcohol use-related motivation to care for these patients. In addition, all professional attitudes were associated with nurses' motivation toward caring for patients with alcohol use and alcohol use-related problems. CONCLUSIONS: The study revealed that certain demographic/background characteristics and personal and professional attitudes were associated with nurses' motivation to provide care to this patient population. This study provides the foundation for future studies aimed at exploring predictors of nurse's motivation to care for patients with alcohol use and alcohol use-related problems.

Bridging the Gap Between Individualized Inpatient Safety Planning and Postdischarge Efficacy.

INTRODUCTION: Implementation of programs that increase both psychiatric patient education and their involvement in treatment programming can lead to positive outcomes postdischarge. Patients involved in programs focusing on skills, recovery, and that are individualized show a reduction in symptoms as well as an increase in engagement, treatment, and recovery posthospitalization. AIMS: This quality improvement project examines (1) the effectiveness of a safety planning group on an inpatient psychiatric unit for developing individualized safety plans, (2) the usefulness of the safety plans upon discharge, and (3) how helpful the patient found them. METHODS: A standardized safety plan was presented during 1-hour groups on an adult inpatient unit. Completed safety plans scored using a rubric to determine how patients individualized the content. One week postdischarge, patients were contacted to determine location and use of the safety plan since discharge. RESULTS: Patient's (n = 124) safety plans were relatively individualized when compared to the standardized safety plan (mean [SD] = 32.85 [8.27] on a 44-point rating). Of those patients who were contacted postdischarge (n = 76), 73 (96.1%) had a copy of their safety plan 1-week postdischarge while 28 (36.8%) reported using their safety plan since discharge. Many of the patients who used their safety plan reported that it was helpful (n = 19; 67.9%). CONCLUSIONS: Developing a safety plan can be a helpful tool for individuals admitted to a psychiatric inpatient unit.

Personal and professional attitudes associated with nurses' motivation to work with patients with opioid use and opioid use-related problems.

Background: Opioid use and opioid use-related problems contribute significantly to increased morbidity rates and premature deaths as well as an increased economic burden. Nurses have key roles in providing care to this patient population; however, they often report low motivation toward working with these patients. Examining personal and professional attitudes associated with nurses' motivation to work with this population can present a valuable opportunity to enhance their willingness to intervene at an earlier stage when patients do not have a diagnosable opioid use disorder. Methods: A descriptive, correlational design was used. Nurses were recruited from four hospital settings in Southwestern Pennsylvania. Data on nurses' demographic/background characteristics, personal attitudes, professional attitudes, and motivation related to working with patients with opioid use and opioid use-related problems were collected via a paper/pencil survey and analyzed using linear regression. Results: A sample of 234 nurses were included in the final analyses. Personal attitudes associated with nurses' motivation included personal experience with a family member related to alcohol and/or other drugs, and stigma perceptions (familiarity, perceived dangerousness, fear, social distance and personal responsibility beliefs). Professional attitudes associated with nurses' motivation included working experience with substance use (SU), SU education as continuing education or other educational resources, role security, therapeutic commitment, role responsibility, and self-efficacy. Conclusions: This study's findings provide valuable information regarding the bivariate relationships between nurses' personal attitudes, professional attitudes, and motivation to work with patients with opioid use and opioid use-related problems. The study provides a base for future studies aimed at developing interventions to enhance nurses' motivation to work with this patient population particularly related to preventing the progression of opioid use to a diagnosable disorder.

Creating an operational definition for prolonged postoperative opioid use through the use of concept analysis.

AIM: To develop an evidence-based operational definition for Prolonged Postoperative Opioid Use (PPOU). BACKGROUND: In the United States, opioids are a mainstay of postoperative pain management, and are prescribed to over 90% of patients following surgery. Recent literature has highlighted the risk for prolonged postoperative opioid use (PPOU) after many surgical procedures. However, reported rates of PPOU vary greatly across studies, due in part to inconsistent operational definitions. Recent literature identified 29 distinct definitions for PPOU, which resulted in incidence ranging from 0.01% to 14.7% when applied to the same cohort of opioid naïve patients. METHODS: We followed the eight-step method described by Walker & Avant, using an iterative literature search process with the following databases: PubMed, CINAHL, Google Scholar. English-language peer-reviewed publications through August 2020 were included in the analysis. RESULTS: The four defining attributes of PPOU are (1) use of opioids greater than 90 days following surgery, (2) treatment of postoperative (non-cancer) pain, (3) in opioid-naïve patients, (4) with legal prescription use. We identified four antecedents and four consequences to PPOU. CONCLUSION: The definition of PPOU in current literature varies greatly and has had significant impact on the interpretation and reliability of research findings. We propose the following working definition: PPOU is the legal prescription use of any opioid for greater than 90 days following surgery, for the purposes of treating post-operative pain, by a patient who opioid naïve in the year prior to surgery.

Retrospective Analysis of Demographic, Psychiatric, and Physical Characteristics That Impact Length of Stay on an Inpatient Geriatric Psychiatric Unit.

Currently, the aging adult population is rising fast and presenting multiple challenges for the US healthcare system. Older adults present unique challenges in their care of medical and psychiatric conditions. This study retrospectively examined characteristics that are associated with length of stay on an inpatient geriatric psychiatric unit in an urban located psychiatric hospital. A sample of 74 individuals was examined. Factors that influenced length of stay included commitment status and discharge to a different level of care. Reducing the length of stay for geriatric patients can help reduce costs and improve health outcomes.

Psychometric Properties of the Person-Centered Version of the Alcohol and Alcohol Problems Perceptions Questionnaire (PC-AAPPQ).

AIMS: Given the importance of addressing provider attitudes toward individuals with unhealthy alcohol use and the current emphasis on person-centered language to help decrease stigma and mitigate negative attitudes, the aim of this study was to evaluate the psychometric properties of a contemporary version of the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) that uses person-centered language and addresses the spectrum of alcohol use. METHODS: The authors created a person-centered version of the AAPPQ (PC-AAPPQ) and conducted a cross-sectional study of its psychometric properties in academic settings in the Northeastern United States. The PC-AAPPQ was administered to 651 nursing students. Reliability analysis of the new instrument was performed using the total sample. Only surveys with complete data (n = 637) were randomly split into two datasets, one used for the exploratory factor analysis (EFA) (n = 310) and the other for confirmatory factor analysis (CFA) (n = 327). RESULTS: Compared to all the models generated from the EFA, neither the original six-factor structure nor the five-factor structure was superior to any of the other models. The results indicate that a seven-factor structure with all 30 items is the best fit for the PC-AAPPQ. CONCLUSIONS: The PC-AAPPQ represents a positive effort to modernize the four-decade-old AAPPQ. This 30-item instrument, which adds one additional subscale, offers a means to assess providers' attitudes using respectful wording that avoids perpetuating negative biases and reinforces efforts to affirm the worth and dignity of the population being treated.

"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: Addressing substance use in the 21st century.

Over the past two decades, there has shift from focusing on the most severe end of the substance use continuum to earlier detection of persons who are at risk given the consequences associated with alcohol and other drug use. In 2017, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) undertook the development of core competencies for specific disciplines addressing substance use in the 21st century. This article presents the core competencies for nursing in accord with the 16 standards of practice and performance for nursing. The competencies for the registered nurse and the advanced practice nurse are intended to inform and guide nursing practice with a focus on prevention, intervention, treatment, and recovery supports for persons who are affected by substance.

Relationship Between Control Over Nursing Practice and Job Satisfaction and Quality of Patient Care.

BACKGROUND: Control over nursing practice (CONP) in the work setting is associated with several positive consequences such as increased job satisfaction, support of teamwork, decreased patient mortality, and improved quality of care. PURPOSE: The purpose of this study was to examine the level of perceived CONP among Jordanian registered nurses (RNs) and determine its relationship with their job satisfaction and quality of patient care. METHOD: A descriptive, cross-sectional correlational design was used. A convenience sample of 230 RNs was recruited from 4 hospitals. RESULT: The RNs had a moderate level of perceived CONP. This control was positively correlated with their work satisfaction and perception of the quality of patient care that they delivered. CONCLUSION: Nurse managers should be encouraged to take into consideration nurses' perceived CONP to improve working conditions for nurses.

Screening, brief intervention, and referral to treatment (SBIRT) education of residential care nursing staff: Impact on staff and residents.

Approximately 40% of older adults drink alcohol. Older adults living in community care residences are a vulnerable population at risk for alcohol use related problems especially for those age 65 years and older who are taking medications, have health problems, and have risky alcohol consumption. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach for individuals at risk for alcohol use disorders. A quality improvement project evaluated SBIRT education effects on nursing staff knowledge and attitudes related to alcohol use, and resident alcohol use. The staffs' SBIRT knowledge and alcohol related attitudes increased significantly. The staff documented SBIRT intervention 231 times in three months' post training.

Nurses and Fetal Alcohol Spectrum Disorders Prevention.

Women of reproductive age who are drinking alcohol and not using effective contraception are at-risk for an alcohol-exposed pregnancy, which could result in a child with a fetal alcohol spectrum disorder (FASD). Nurses are an important partner in addressing at-risk alcohol use. It is imperative for alcohol education to be incorporated into nursing curricula so that future nurses have the tools to identify at-risk alcohol use. Three universities have worked together to create Fetal Alcohol Spectrum Disorders: A Toolkit. This toolkit was designed for nurses to facilitate the recognition and prevention of FASD and address gaps that exists around alcohol use.

Can Screening, Brief Intervention, and Referral to Treatment Education and Clinical Exposure Affect Nursing Students' Stigma Perception Toward Alcohol and Opioid Use?

BACKGROUND: Alcohol and/or opioid stigma perceptions are barriers to screening, brief intervention, and referral to treatment (SBIRT) implementation. AIM: To examine SBIRT education and clinical exposure efficacy at decreasing nursing students' stigma perceptions toward caring for patients affected by alcohol and/or opioid use problems. METHOD: A single-sample, pretest-posttest design with N = 124 nursing students. The students had a 1.5-hour SBIRT education session and a 12-week clinical experience with some patients who had alcohol and/or opioid use problems. RESULTS: The participants' stigma perceptions improved toward patients who had alcohol and/or opioid use problems. CONCLUSIONS: SBIRT education and clinical exposure may provide a basis for promoting understanding of alcohol and/or opioid use-related stigma and can be used as an intervention to decrease some of stigma's negative effects.

Implementation of a School-Based Bullying Program.

A bully is defined as anyone who participates in any form of repetitive negative and hurtful behavior, with the intent of inflicting harm (Highmark & Center for Safe Schools, 2013). PURPOSE: The purpose of this project was to evaluate the feasibility of implementing a bullying awareness, prevention, and screening program for teachers and school nurses. METHODS: The sample included 174 fifth-graders from a public-school district in rural, southwestern Pennsylvania. Teachers received an educational program and students were screened for bullying using the PIPSQ. RESULTS: Although not a significant finding, there was an increase in teacher's knowledge post-education (p = 0.515). Although findings were not significant, the results of the PIPSQ revealed greater victimization in this school (M = 6.93), with bullying behaviors greater among boys (p = 0.000). CONCLUSIONS: The educational program and the PIPSQ tool appear to be a promising method to identify victimization and bullying within an elementary school setting; further research can determine significance of screening and faculty education.

An Environmental Scan of the Role of Nurses in Preventing Fetal Alcohol Spectrum Disorders.

Nurses are in an ideal position to talk to their patients of reproductive age about alcohol use and encourage the prevention of alcohol-exposed pregnancies. Effective conversations can be efficiently included in the clinical encounter to identify alcohol misuse and offer appropriate follow-up. This report presents results of an environmental scan of resources relevant to nursing professionals and nurses' role in addressing alcohol misuse. Gaps in nursing education and practice guidelines with regard to defining the nursing role in preventing alcohol-exposed pregnancies were revealed. Findings identified a need to promote adoption among nurses of evidence-based preventive practices to prevent alcohol misuse.

A Quality Improvement Project to Improve Education Provided by Nurses to ED Patients Prescribed Opioid Analgesics at Discharge.

BACKGROUND: The opioid crisis continues to take an unprecedented number of lives and is the top cause of injury death in the United States. The emergency department is a setting where patients with pain seek care and may be prescribed an opioid, yet many patients do not receive evidence-based education about taking their opioid safely. Like many communities across the country, Allegheny County, Pennsylvania, has experienced an increased rate of opioid overdoses; from 2015-2016, the number of opioid-related overdose deaths in the county increased by 44%. METHODS: This quality improvement project is the implementation of a nurse-delivered, evidence-based education initiative for patients prescribed an opioid in an emergency department. Nurses were briefly trained on opioid safety and patient education, then over 12 weeks, delivered the dual-modal (verbal and written) education with a patient teach-back to verify comprehension. RESULTS: Nurses who completed the project training on opioid safety and patient education had a statistically significant improvement in their knowledge. Patient satisfaction surveys showed 100% of patients reported clear understanding of how to take their pain medication, and out of the patients receiving the opioid pain education for the first time, 88.2% learned something new about how to safely take, store, or dispose of their pain medication. IMPLICATIONS FOR PRACTICE: Improving the delivery of opioid prescription education at emergency department discharge will enhance patient knowledge and promote safety, which may help mitigate the opioid crisis by reducing the rate of opioid use disorder and accidental overdoses.

Motivational Interviewing to Increase Outpatient Attendance for Adolescent Psychiatric Patients.

Motivational interviewing (MI) is a therapeutic technique that has been demonstrated to increase adherence to various treatment regimens. Nonattendance at outpatient appointments is associated with read-mission to psychiatric hospitals. The purpose of the current study was to examine the effectiveness of MI in promoting treatment adherence and increasing pediatric attendance rates at patients' first follow-up appointment after inpatient admission. A sample of 111 patients discharged from one of two child and adolescent units at an urban, inpatient psychiatric hospital in Southwestern Pennsylvania participated in the MI discharge process. Compared to hospital population data from 1 month prior to the current study, the MI discharge process demonstrated an increase of approximately 10% in attendance at the scheduled follow-up appointments and a decrease of approximately 4% in cancellations and no-show appointments. It was concluded that particularly for adolescents, MI may be a valuable treatment approach grounded in partnerships with health care providers, patients, and families to enhance outpatient appointment attendance. [Journal of Psychosocial Nursing and Mental Health Services, 56(6), 31-35.].

Changing BSN Students' Stigma Toward Patients Who Use Alcohol and Opioids Through Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education and Training: A Pilot Study.

BACKGROUND: Stigma associated with substance use is considered a barrier to implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) and assisting patients to receive appropriate treatment. OBJECTIVES: To test the efficacy of SBIRT education and training in changing undergraduate nursing students' attitudes about working with patients who have problems with alcohol and opioid use. DESIGN: A sample of 49 undergraduate nursing students were surveyed, using five subscales, at three time points. RESULTS: After a 15-week semester that included (a) SBIRT education and (b) weekly clinical experiences with patients who had alcohol use problems the undergraduate nursing students' stigma decreased as measured by three of the five subscales. The students' attitudes toward working with patients who had opioid use problems exhibited favorable change as measured by four of the five subscales. CONCLUSION: SBIRT education and training for undergraduate nursing students might help mitigate some of their stigma toward working with patients who have mild to moderate alcohol and opioid use problems.

Bullying: Effects on School-Aged Children, Screening Tools, and Referral Sources.

Bullying is not a new concept or behavior, and is now gaining national attention as a growing public health concern. Bullying leads to short- and long-term physical and psychological damage to both the victims and the bullies. The serious implications of bullying drive a clinical mandate for teachers and school nurses to be educated and adequately trained to identify and address bullying within schools. This review of the literature describes screening tools that can be utilized to identify both victims and bullies. In addition, referral services utilizing collaborative intervention measures are discussed. This literature review will help school nurses and teachers to identify and expand their role in school-wide bullying prevention and intervention measures.

A Concept Analysis of Substance Misuse to Inform Contemporary Terminology.

Previous diagnostic categories of substance abuse and dependence have given way to the current view that substance use disorders occur on a continuum with a broad range of severity. This current view is featured in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V). In recognizing the role of stigma in preventing persons from seeking substance use treatment, advocates have called attention that particular terminology can fuel such stigma. To mitigate the negative effects of such stigmatizing language, the International Society of Addiction Journal Editors (ISAJE) recommends against using previously-used and possibly pejorative terminology for substance abuse and dependence, unless a particular scientific justification exists. The purpose of this paper is to: (1) present a concept analysis of the term substance misuse and (2) recommend an alternate term for substance misuse that is neither pejorative nor inadvertently stigmatizing: at-risk substance use.