Madeline Naegle

Abstract

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.

Abstract

Older people living with HIV (OPLWH) have higher rates of substance use (tobacco, alcohol and other drugs) than their HIV-negative peers. Addressing health care needs of OPLWH who use substances is more challenging than for those who do not: they are highly impacted by comorbid conditions, substance use can interact with other medications (including antiretroviral therapy-ART) and reduce their effectiveness, and substance use has been associated with reduced adherence to ART and increased risky behaviors (including sexual risks). People who use substances also suffer disparities along the HIV continuum of care, resulting in lower viral suppression rates and poorer health outcomes. They are especially impacted by stigma and stress, which have implications for HIV treatment and care. Recommendations for health care providers working with OPLWH who use substances include: 1) the need to screen and refer for multiple associated conditions, and 2) training/continuing education to enhance care management and maximize health outcomes.

Abstract

In the last ten years primary care providers have been encouraged to implement integrated models of care where individuals’ medical and mental health needs are addressed holistically. Many integrated models use Psychiatric Mental Health (PMH) nurses as case managers and select exemplars use PMH Advanced Practice Nurses (APNs) as providers. However, the potential value of PMH nurses in integrated health care remains unrealized by health care planners and payers, limiting access to services for the populations most in need of comprehensive care approaches. This current situation is partially fueled by insufficient knowledge of the roles and skill sets of PMH nurses. In this paper, the PMH RN and APN skill sets are detailed, demonstrating how effective use of these nurses can further the aims of integrated care models. Finally, outlined are barriers and enabling factors to effective use of PMH RNs and APNs and attendant policy implications.

Abstract

BACKGROUND: Efforts to decrease adverse effects of tobacco use are affected by emergence of new nicotine delivery products. Advertising, product promotion, and social media promote use of these products, yet a lack of evidence regarding safety leaves nurses unprepared to counsel patients. OBJECTIVES: To critically evaluate current research, reviews of literature, expert opinion, and stakeholder policy proposals on use and safety of electronic nicotine delivery systems (ENDS). DESIGN: A targeted examination of literature generated by key stakeholders and subject matter experts was conducted using key words, modified by risk factors, and limited to the past 8 years. RESULTS: Current knowledge gaps in research literature and practice implications of the literature are discussed. CONCLUSIONS: The safety of ENDS is questionable and unclear. There are clear health risks of nicotine exposure to developing brains. Potential health risks of ENDS secondhand emissions exposure exist. Using ENDS to facilitate total tobacco cessation is not proven.

Abstract

Background: We developed and implemented the Substance Abuse Research Education and Training (SARET) program for medical, dental, nursing, and social work students to address the dearth of health professionals pursuing research and careers in substance use disorders (SUD). SARET has 2 main components: (1) a novel online curriculum addressing core SUD research topics, to reach a large number of students; (2) a mentored summer research experience for in-depth exposure. Methods: Modules were integrated into the curricula of the lead institution, and of 5 external schools. We assessed the number of Web modules completed and their effect on students’ interest in SUD research. We also assessed the impact of the mentorship experience on participants’ attitudes and early career trajectories, including current involvement in SUD research. Results: Since 2008, over 24,000 modules have been completed by approximately 9700 individuals. In addition to integration of the modules into curricula at the lead institution, all 5 health-professional partner schools integrated at least 1 module and approximately 5500 modules were completed by individuals outside the lead institution. We found an increase in interest in SUD research after completion of the modules for students in all 4 disciplines. From 2008 to 2015, 76 students completed summer mentorships; 8 students completed year-long mentorships; 13 published in SUD-related journals, 18 presented at national conferences, and 3 are actively engaged in SUD-related research. Mentorship participants reported a positive influence on their attitudes towards SUD-related clinical care, research, and interprofessional collaboration, leading in some cases to changes in career plans. Conclusions: A modular curriculum that stimulates clinical and research interest in SUD can be successfully integrated into medical, dental, nursing, and social work curricula. The SARET program of mentored research participation fostered early research successes and influenced career choice of some participants. Longer-term follow-up will enable us to assess more distal careers of the program.

Abstract

Background: Publications on translation are almost all about the translation and cultural adaptation of tools developed by English speakers for use in non-English speaking cultures and languages. The reverse process, where translation goes from a native language to English, is rare. Purpose: Translate to English, culturally adapt, and content validate the Attitudes Scale on Alcohol, Alcoholism, and Alcoholic Persons (EAFAA). Methods: A methodological study with analysis including the conceptual, semantic, and item equivalencies. Results: Satisfactory content validity coefficients (FVI = 0.97; CVI = 0.93) were obtained. Conclusions: The EAFAA was adequately translated into American English, and the content validity was confirmed by empirical tests yielding satisfactory validity coefficients. These results provide direction for further studies to examine the factor structure and the psychometric qualities of the EAFAA-English Version.

Abstract

Links between HIV and substance use were identified early in the U.S. HIV epidemic. People who use drugs are at risk of HIV infection through shared injection equipment and risky sexual behaviors. In addition, substance use has negative health consequences for people living with HIV. The prescription opioid misuse epidemic, linked to injection drug use, hepatitis C infection, and HIV, poses a new threat to declining HIV rates. We reviewed evidence-based interventions that decrease HIV risk in people who use drugs (needle/syringe programs, medication-assisted treatment, engagement in HIV care, and preexposure prophylaxis/postexposure prophylaxis). The critical roles of nurses in HIV prevention/care for this population are described, including applying the principles of harm reduction, screening for substance use, and undertaking implementation and research efforts. As the nation's largest health care profession, nurses are positioned to contribute to the quality of HIV-related prevention/care for people who use drugs and to lead practice initiatives.