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Substance Abuse Prevention Program

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Title: Substance Abuse Prevention Program


1
Substance Abuse Prevention Program
  • 2011 Curriculum
  • Susan Dahl
  • MaryEllaDubreuil
  • Moira Varone

2
Substance Abuse Prevention Program
Introduction
  • American Nurses' Association Code of Ethics
    3.6 on Addressing impaired practice states
    "Nurses must be vigilant to protect the patient,
    the public, and the profession from potential
    harm when a colleague's practice, in any setting,
    appears to be impaired. The nurse extends
    compassion and caring to colleagues who are in
    recovery from illness or when illness interferes
    with job performance."
  • Substance abuse prevention training and
    education is a crucial method of helping to stop
    substance use and addiction before it starts. In
    an effort to assure good patient care and safety
    it is important that we provide student nurses
    with the skills and training to make wise
    decisions and to identify and intervene when they
    see colleagues who may be having issues with
    substance use and abuse. The purpose of this
    education program is to decrease the risk factors
    associated with substance use and addiction that
    challenges the nurses of today.

3
Substance Abuse Prevention Program
Course Objectives
  • The student nurse will be able to list the risk
    factors for substance use disorders among nurses.
  • The student will be able to describe the symptoms
    and patterns of use for an impaired professional.
  • The student nurses will be able to identify,
    through self assessment, early detection of their
    own risk associated with substance use disorders.
  • The student nurse will be able to describe the
    legal, moral, and ethical implications of an
    impaired professional as related to the
    individual, the community, and society.
  • The student nurse will develop personal insight
    into values, attitudes, behaviors, and morals
    concerning substance abuse.
  • The student nurse will demonstrate an active
    effort to change personal negative attitudes and
    stereotypes regarding chemical dependency and the
    substance abuser.
  • Nursing educators will integrate this curriculum
    into the nursing school curriculum for all
    nursing students in RI.
  • Nursing employers will have the information and
    resources needed to provide to any employee who
    has been identified with a substance use disorder
    in their workplace.

4
Evaluation
Substance Abuse Prevention Program
Evaluation is a process which should be
implemented throughout the entire process.
Eliciting feedback at the end of session from
learners and facilitators will provide valuable
information for effective change.
5
Evaluation Evaluation of the program,
especially during the early stages of student
learning, should include
Substance Abuse Prevention Program

a. Evaluation by the instructor of the students
learning progress.
b. Evaluation by the student of his/her learning.
c. Evaluation of the curriculum by the student
and faculty.
6
Script
Substance Abuse Prevention Program

We are presenting this topic today as nurses are
not immune to abuse and addiction of drugs and
alcohol. We feel that if we can offer some
education on this topic it could be a means of
preventing problems and will help nurses make
wise decisions for them and give some insight
into when they may be developing a problem. It
may also help identify a colleague who may have a
problem thereby we can assure good patient care
and safety and help for you or another nurse. We
hope we can demonstrate why nurses are a
vulnerable population for substance abuse and
addiction and decrease the risk factors involved.
Nurses are for several reasons more vulnerable
than the general population, and we will tell you
why later in this talk. But let us begin by
defining both substance abuse and addiction.
7
Criteria for Substance Abuse
When there is one or more of the following in
a 12 month period
Substance Abuse Prevention Program
  • Recurrent use of a substance resulting in failure
    to meet obligations at work or at home
  • Substance use in hazardous situations e.g.
    driving when impaired
  • Use resulting in legal problems e.g. DUI
  • Persistent use of a substance despite having
    interpersonal problems e.g. arguments, divorce,
    split ups.

8
Criteria for Substance Dependence
All the above criteria plus
Substance Abuse Prevention Program
  • Unsuccessful attempts to cut down.
  • Tolerance a need for increasing amounts to
    reach the same effect.
  • When the substance is decreased or stopped there
    is physical withdrawal e.g. shakes, DTs.
  • Much time spent in activities to obtain the
    substance.
  • Social, occupational, and recreational activities
    are given up.

9
Criteria for Substance Dependence

Substance Abuse Prevention Program

The most important fact to remember is not
how often or how much of the substance is used
but the loss of control. For example, intending
to go out and having two drinks but ending up
drinking five or using Percocet not as
prescribed, but taking extra. Usually there are
elaborate excuses made to oneself or others. One
of the hallmarks of the disease is denial once
again to oneself or others. Addiction is a
disease of the brain, not a matter of willpower.
10
Attitudes
Substance Abuse Prevention Program


Factors that can affect our perception of
addiction Lets look now at how you know or
feel about substance abuse and addiction.
Personal experience with friends family or
patients, can color the way we feel. Close your
eyes for a moment. What do you picture when I
say drug addict or Alcoholic ? Lets go
through a check list
11
Attitudes

Substance Abuse Prevention Program


Are these people? Street People Female/Male Ag
e Socio-economic status Employed/Unemployed
12
Attitudes

Substance Abuse Prevention Program


Are these people? Homeless Professional/Blue
Collared/Responsible Job? Well
Dressed/Scruffy? Buy Drugs from the
Street/Internet?
13
Attitudes

Substance Abuse Prevention Program


What is your experience up to date with
them?
NOW CAN YOU IMAGINE THAT MEDICAL PROFFESIONALS
CAN SUFFER FROM THIS ILLNESS?
14
Substance Abuse Disorders in Nursing Prevalence

Substance Abuse Prevention Program

  • General Population
  • It is estimated that approximately 8.7 of the
    U.S. population over the age of 12 are affected
    by illicit drug use. (SAMSHA, 2008)
  • Slightly more than half of Americans aged 12 or
    older reported being current drinkers of alcohol
    in the 2009 survey (51.9 percent). (SAMSHA, 2009)
  • In 2009, an estimated 22.5 million persons (8.9
    percent of the population aged 12 or older) were
    classified with substance dependence or abuse in
    the past year based on criteria specified in the
    Diagnostic and Statistical Manual of Mental
    Disorders, 4th edition

15
Substance Abuse Disorders in Nursing Prevalence

Substance Abuse Prevention Program

  • Nursing Population
  • The American Nurses Association estimates that
    6-8 of the registered nurse population has a
    drug or alcohol-related problem, similar to the
    7-10 of the general population (Smith, 2001) and
    interferes with the ability to practice nursing
    placing patients, the public, organizations, the
    nursing profession, and nurses in harms way.
  • One study found that prescription opiate abuse
    was the drug of choice for the majority of
    nurses. (Trinkoff and Starr, 1998)
  • According to a study conducted by 2 Maryland
    researchers the overall prevalence of substance
    abuse among nurses is 32. (Trinkoff and Starr,
    1998)

16
Substance Abuse Disorders in Nursing Prevalence

Substance Abuse Prevention Program

  • Nursing Population
  • Among nurses working in womens health,
    pediatrics, and general practice, substance use
    is comparatively low.
  • Compared with that group emergency room nurses
    were 3.5 times more likely to use marijuana or
    cocaine.
  • Oncology and administration nurses are twice as
    likely to binge drink
  • Psychiatric nurse are more likely to smoke.
  • There were no specialty differences for
    prescription drug use.
  • The specialties with the highest prevalence of
    substance abuse uses are ICU, ER, OR, and
    anesthesia.
  • The availability and accessibility of medications
    has been linked to substance abuse disorders
    among nurses. (Talbert, 2009)

17
Substance Abuse Disorders in Nursing Prevalence

Substance Abuse Prevention Program


Nurses believe erroneously that they have the
ability to control their own medication use
because of their experience with administering
medication to their patients. Sometimes people
believe they are immune to the negative
consequences of drug use because they are
familiar with drugsnurses need to realize that
they are susceptible. Trinkoff, 1998
18
Stress Response

Substance Abuse Prevention Program


Stress Response
  • Acute Stress
  • Has a beginning, middle and end and you are aware
    of the stress.
  • The stress is

    motivating and arousing.

19
Stress Response

Substance Abuse Prevention Program


Stress Response
  • Episodic Stress
  • This is still acute stress that is prolonged
    and increases fatigue, but continues to be
    identifiable, and thus, lends itself to
    intervention and seeking out solutions.

20
Stress Response

Substance Abuse Prevention Program


Stress Response
  • Chronic Stress
  • This is prolonged stress that, after awhile,
    becomes unidentifiable to the sufferer. Hyper
    arousal becomes the norm and solutions are no
    longer sought. At this point every body system is
    at risk. Fatigue and exhaustion are impending and
    total system breakdown is possible. Physical and
    social functioning begins to suffer. Efficiency
    and effectiveness begin to diminish and more
    stress results. This is a point where a person
    becomes at higher risk for addictive behaviors.

21
Stress Response

Substance Abuse Prevention Program


Stress Response
  • Signs of Chronic (long term)Stress
  • Hypertension
  • Chest pain
  • Breathing difficulties
  • Increased distractibility
  • Irritability
  • Compromised immune system
  • Depression
  • Increased pain experience
  • Migraine headaches
  • Backaches
  • Colitis, vomiting, diarrhea, nausea, ulcers,
    stomach aches
  • Weight loss or gain
  • Sleep disturbance

22
Stress Response

Substance Abuse Prevention Program


Self Care
Understand you have the right to wellness, no
matter what your role. Safe care translates to
self respect and needs to be in place before
attempting to help others.
23
Stress Response

Substance Abuse Prevention Program


The 8 Laws of Self Care
  • By validating ourselves we promote acceptance
  • By validating others, we elevate ourselves
  • By meeting our own physical and emotional needs,
    we give care from a place of abundance, not
    scarcity.
  • By practicing self-goodwill we manifest it
    throughout our lives
  • By honoring past traumas and hurts, we allow
    ourselves freedom from the past that controls us.
  • By doing the work we reclaim the personal power
    that is rightfully ours.
  • By naming and taking ownership of the core issues
    that limit our growth, we celebrate authenticity.
  • By managing our self-care, we welcome happiness
    into our lives


Compassionfatigue .org
24
Stress Response

Substance Abuse Prevention Program

Regular Self-Care Assessment
  • Review what youre doing for stress
    reduction/relaxation
  • Set goals at regular intervals
  • Evaluate resources and blocks to achieving the
    goals
  • Talk to a support person
  • Activate your plan
  • Evaluate weekly, monthly, annually
  • Notice and appreciate any changes youve made


Include the STUNT Assessment
25
Stress Response

Substance Abuse Prevention Program


Stress Management Interventions

Rest. Proper Nutrition. Exercise. Spiritual
/Emotional Support.
26
Stress Response

Substance Abuse Prevention Program


Stress Management Interventions

Share self-care efforts with peers
Restraint- what you take in your body influences
performance
Be okay with being recognized for your work
Set self-care goals and plan for implementation
Learn to let go of work and replace it with
enjoyable activities
Develop outside interests/hobbies/balance between
work and leisure
27
Stress Response

Substance Abuse Prevention Program


Stress Management Assessment

Develop strategies to decrease stress during work
hours Peer support, Supervision, Mentors
28
Stress Response

Substance Abuse Prevention Program


Stress Management Assessment

Bodywork (partial list ) Massage, Deep Muscle
Relaxation, Yoga, Pilates
29
Stress Response

Substance Abuse Prevention Program

Stress Management Interventions


Sleep Hygiene. Meditation. Music. Aroma Therapy
30
Stress Response

Substance Abuse Prevention Program

Stress Management Interventions
  • Aroma Therapy
  • Relaxation Exercises
  • Nature or Other Calming Environment
  • Creative Expression
  • Assertiveness Skills
  • Stress Reduction Skills
  • Interpersonal Communication Skills
  • Time Management Skills


31
Stress Response

Substance Abuse Prevention Program

Developing Boundaries

Time
Therapeutic/Professional
Personal
Understanding Limitations in the ability to
help/acceptance
32
Stress Response

Substance Abuse Prevention Program

Nurses and Substance Abuse
Personality Traits of Nurses Who Become Addicted
  • Compassionate, empathetic, feel responsible for
    others, and want to help them.
  • Caregivers
  • Some people have impulsive and risk taking
    personalities
  • Often model employees who are high achievers
    and perfectionists
  • As nurses we learn not to show our feelings
    around people and relatives
  • Second hand trauma

  • Compassion fatigue
  • Emotionally draining environment
  • Dont take care of ourselves
  • High stress
  • Nurses consider themselves invulnerable, as we
    have knowledge of medications
  • Nurses are subject to injury, lifting, turning
    patients leading to pain and need to control pain
  • Genetics play in addiction

33
Stress Response

Substance Abuse Prevention Program
There are several reasons that can potentiate
the issue of substance abuse in the nursing
profession

Nurses and Substance Abuse
  • Job Stress long hours/stress related to caring
    for the sick/dying.
  • Job work area you will notice in the above quote
    that nurses working in ICU, ER, OR, or anesthesia
    have the highest prevalence of substance abuse.
    These are considered VERY high stress work
    settings.
  • Easy access to medications
  • Workaholic personality leads to other addictions.
  • In general, nurses take care of others first and
    themselves last. This leads to addiction to
    hide personal needs and tend to the needs of
    the patients.


34
Stress Response

Substance Abuse Prevention Program

What can I do as a nurse if I suspect a co-worker
is addicted to drugs or alcohol?

35
Stress Response

Substance Abuse Prevention Program
  • The worst thing you can do is NOTHING. You may
    be held liable if you do nothing
  • Approaching the nurse directly will likely meet
    with resistance and denial.
  • Find out about your organizations policies and
    procedures for dealing with chemically dependent
    nurses. Is an EAP available?
  • Consider reporting your suspicions to management
    or encourage your co-worker to determine if the
    State Board of Nursing has a referral and
    treatment program.
  • DO NOT feel guilty about reporting your
    suspicions. If you are wrong, no harm done. But
    if your suspicions are correct, you have helped a
    fellow nurse get his/her life back on track, have
    contributed to patient safety, and have promoted
    the positives of the nursing profession.


36
Stress Response

Substance Abuse Prevention Program
  • Speaking of patient safety "Statistics indicate
    that employed people who abuse substances are
    unreliable on the job" (Recoveringnurses.org).
    Without going into more detail, this statement
    says it all. You owe it to your patients to give
    them RELIABLE care. If you are working with an
    addicted nurse, you are not being fair to your
    patients.
  • Another example? "Compared to nonusers, alcohol
    and illicit drug users are more likely to have
    been involved in a workplace accident in the past
    year." (Recoveringnurses.org)  Again, think about
    the safety of the potentially addicted nurse,
    your patients, coworkers, and YES, yourself!



37
Stress Response

Substance Abuse Prevention Program

Nurses and Substance Abuse
Behavior Regarding Administration of
Medications
  • Un-witnessed waste remember when you sign as a
    witness you are stating that you actually
    witnessed the waste
  • Excessive administration of controlled substance
  • Discrepancies between nursing notes, medication
    records, controlled drug records.
  • Giving medications to patients to whom they are
    not assigned
  • Patients complaining of pain in spite of
    supposedly having received medication or saying
    they did get their pain meds


38
Stress Response

Substance Abuse Prevention Program

Nurses and Substance Abuse
Behavior Regarding Administration of
Medications
  • Job Performance
  • Frequently late to work
  • Absenteeism, taking a day off sick following days
    off. Is there a pattern to sick days?
  • Poor performance, disorganized, forgetful, making
    errors


39
Stress Response

Substance Abuse Prevention Program

Nurses and Substance Abuse
Warning sings of a nurse who might have a problem
  • Physical Signs
  • Complaints of GI symptoms
  • Shakiness, clumsy
  • Diaphoresis
  • Speech slurred or slowed
  • Drowsy

40
Stress Response

Substance Abuse Prevention Program

Nurses and Substance Abuse
Warning sings of a nurse who might have a problem
  • Behavior Changes
  • Mood Swings
  • Anxiety
  • Depression
  • Poor personal appearance
  • Lying
  • Defensive
  • Elaborate excuses

41
Stress Response

Substance Abuse Prevention Program

What if I am a nurse and think I am addicted to
drugs or alcohol?

42
Stress Response

Substance Abuse Prevention Program
  • ASK FOR HELP Addiction is an illness. You need
    help in recovery. There are organizations that
    can help, but not if you don't ask.
  • DONT WAIT until you resort to stealing,
    cheating, or lying to feed your addiction. Get
    help early. Your supervisors and peers will
    respect you for your efforts.
  • PROTECT YOUR NURSING LICENSE By getting help and
    staying clean, you protect what you have worked
    so hard to earn, in a profession you are proud to
    be in!
  • BECOME AN ADVOCATE Help other nurses in your
    community with addiction issues.
    (nursetogether.com)


43
Stress Response

Substance Abuse Prevention Program
  • Substance Abuse Case Presentation 1

  • Jay Johnson is a 23 year old graduate of a
    leading school of nurse anesthesia and presents
    with complaints of stress and requests something
    to help him relax. He is an anesthesia
    practitioner working full-time and studying for
    an advanced degree in the evenings. He has little
    time for socialization and is currently divorced
    and has one child.
  • His parents are divorced and his father has had
    a chronic drinking problem. Jay has also recently
    been named in litigation. He has two brothers,
    one which has had frequent history of DWI and a
    second which used illicit drugs while in the
    service.
  • Jay does not drink or use street drugs. He
    clearly states his position as an anti-drinker
    and anti-drugs. He attends Al-Anon meetings every
    couple of months. (Clark, 1994)

44
Stress Response

Substance Abuse Prevention Program
  • Substance Abuse Case Presentation 1
  • Exposure to drug users in social and work
    environments
  • Marital and work instability
  • Unemployment
  • Divorce
  • Psychological or psychiatric difficulties or
    distress
  • Low self-esteem
  • Depression
  • Peer support
  • Substance abuse by parents

Risk Factors to Consider for this Young Adult

45
Stress Response

Substance Abuse Prevention Program

Self Screening Tool The SHUNT Self-Survey for
Nurses No score indicates a total absence of
risk, nor any certainty that anyone is, or ever
will become, chemically dependent.

YES
1 NO - 0 Social withdrawal or self isolative
behavior.
_______ Self care behaviors beneath societal,
professional or the nurses _______ own
standards. History of chemical dependency in
the nurses immediate family.
_______ History of negative consequences related
to the nurses substance use.

_______ Untreated or
unremitting emotional or physical pain.
_______ Using medication for
a reason it was not intended or In a
manner not recommended.

_______ Nursing practice routinely in excess of
55 hours per week.
_______ Nursing duties include frequent access to
controlled substances.
_______ Transitional period requiring major
adjustment with in the past year.
_______ Turmoil or tragedy with unresolved
conflict.
_______ Date _________

Total ________

46
Stress Response

Substance Abuse Prevention Program

References Clark, G.D., (1994). A Model
Didactic and Clinical Substance Abuse Curriculum
Developed for Schools of Nurse Anesthesia
Ponech, S. (2000). Telltale Signs (Cover story),
Nursing Management, 31(5), 32. Retrieved from
EBSCOhost January 17, 2010. Scimeca, P.D.
(2008). Unbecoming A Nurse, The SHUNT Survey
53-4 Smith, L.L. (2001). The Role of the
Nurse Manager. In National Council for State
Boards of Nursing. Chemical dependency handbook
for nurse managers A guide for managing
chemically dependent employees (pp. 21-28).
Chicago National Council Publisher. Talbert,
J. (2009). Substance Abuse among Nurses, Clinical
Journal of Oncology Nursing, 13(1), 17-19.
Retrieved from EBSCOhost January 17, 2011
Trinkoff, A. M., Storr, C. L. (1998). Substance
Use among Nurses Differences Between
Specialties, American Journal of Public Health,
88(4), 581-585. Retrieved from EBSCOhost
January 17, 2010. http//www.
www.compassionfatigue.org accessed March, 2011
Heacock, S (2011) Nurses and Substance Abuse
http//www.nursetogether.com accessed March, 29
2011 http//www.Recoveringnurses.org
accessed March 29, 2011
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