Question

You are an acute care nurse practitioner who works in an urban emergency room (ER). You see many people who come to the ER who have overdosed (OD) on heroin. Emergency medical services personnel may administer a drug that might reverse the overdose such as naloxone (Narcan). You may see three ODs during each 12-hour shift; some of these patients are admitted to the hospital, and others are sent home with a consultation for psychiatric followup. You are becoming hardened to the issue and have begun to question what you can do to address this epidemic.

Discussion Points

1. Identify three issues that might be brought up at a meeting that could derail a focus on public safety. Which tactics can the nurse use to bring the discussion back to the issue of safety?

2. Which design tactics could be considered when writing a policy to address this issue?

3. How can information about this issue be disseminated within the profession and to those outside the profession?

Answer 1

1.Drug addiction is a chronically relapsing disorder that has been characterized by the compulsive use of addictive substances despite adverse consequences to the individual and society. Addiction to drugs and alcohol is increasingly becoming a worldwide trend in lifestyle that is prevalent in rich and poor countries alike. Addiction to alcohol, drugs and cigarette smoking is now regarded as a major public health problem. However, the idea that they aren’t hurting anyone except for themselves is an excuse that many individuals who abuse drugs use in order to justify their addiction. Drug addiction is not a one-person phenomenon, and it creates a domino effect on the lives of those around them. It is a social problem that normalizes drug use and affects individuals and their families. These are the some issues that might effect public safety by drug addiction

• Increase in child custody losses
• Increase in child abuse and neglect
• Increase in addiction risks for children of drug-addicted parents
• Increase in domestic disputes
• Increased rates of homelessness and poverty
• Substantial financial health care burden
• Increased rates of co-occurring mental disorders
• Increased strain on co-workers
• Increase in the number of people incarcerated in state and federal prisons
• Increase in rates of violent crimes on college campuses.

2. Nurses have a particular contribution to make to recovery outcomes, in particular through addressing the range of co-existing health problems that people present to alcohol and drug treatment. Following tactics could be made.

Provide comprehensive assessments for people with a range of complex and coexisting mental health and physical health needs

• Provide physical healthcare including wound dressing and abscess care and promote better personal health care

• Provide pharmacological management, which may include dispensing, advice and support in relation to the service user’s prescription for their drug and alcohol problem and additional advice around interactions with other prescribed and over the-counter medicines and illicit drugs

• Provide expert clinical advice for commissioners, service users, families and carers, health and other professionals • Provide a clinical perspective to reducing harm from alcohol and drug misuse, promoting and enabling recovery and wellbeing

• Mobilise and co-ordinate resources in managing alcohol and drug-related clinical crises, for example, intoxication, overdose, acute withdrawal states

• Promote evidence based and recommended interventions in order to ensure quality of care for service users

• Provide psychosocial interventions across a range of settings.

Provide blood borne virus screening (hepatitis C and HIV) and hepatitis B vaccination

• Provide clinical assessments which may include interpretation of test results for example, electro cardiograms (ECG), urinalysis results, blood results

• Provide non-medical prescribing once appropriate training has been completed.

3. Drug addiction is a serious matter that carves our society. So special measures to be made from every levels. From nursing point of view these matter can be addressed in many ways.

Supervision: Effective supervision is a key element of professional regulation and also of quality governance arrangements that underpin safe and effective alcohol and drug services. Supervision structures should be provided within all provider organisations. Nurses may require specific clinical supervision in areas of specialist practice, and this may need to be sourced outside the organisation, particularly in the case of smaller provider organisations. Experienced nurses in alcohol and drug services can offer a valuable resource in the delivery of clinical supervision to other staff within the service. The nurse can provide a holistic perspective when reviewing clinical cases with colleagues in the context of supervision and given their training will be mindful of the biological, psychological and social aspects of care.

Workforce development: Ensuring effective workforce development for both existing and future staff to prevent loss of expertise. Another component of the wider nursing role, which forms part of a nurses’ preparation during training, is that of ‘educator’, either as a health educator for service users, their families or wider community, or as a trainer/mentor for nursing students and/or junior staff. In this role nurses can support and enhance in-house workforce development by offering direct teaching/mentoring for new and early career addiction nurses, and/or other junior frontline workers, including: 1) Facilitating the development of new skills. 2) improving existing knowledge, skills and abilities. 3) Facilitating evidence-based practice.

There are many organization which are formed by different nurses associations for example:Association of Nurses in Substance Abuse(ANSA), Royal College of Nursing(RCN), International nurses society on addiction(IntNSA) play a vital role for prevention, intervention, treatment, and management of addictive disorders from our society.