working with the impaired nurse sharon s. parker ona convention, 2015
DESCRIPTION
“impaired” is a questionable term since most nurses are high functioning and high achievingTRANSCRIPT
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Substance abuse is not a disease of choice
Continuous use actually causes changes in the brain
More then half of those with a SA disorder have another co-occurring disease of the brain.
The Disease of Substance Use Disorder
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“impaired” is a questionable term since most nurses are high functioning and high achieving
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PrimaryChronicDysfunction of the brainTreatable
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Rise of prescription misuse has caused most concern recently
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AbuseDependencyAddiction Negative aspects of SA affect the
nurse, patients, familiesANA estimates that 6-8% of
nurses misuse drugsRecent studies say 10-15%
Substance Use Disorder
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Medical disorder where a person has a compulsion to take a drug/alcohol in order to experience the effects.
Chemical Dependency
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Medical disorder marked by compulsive use of drugs/alcohol
Inability to stop using no matter what the consequences
Neurological changes
Addiction
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The phenomena of needing more and more of a substance of abuse in order to get the same effect
Tolerance
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DepressionLow self-esteemLow tolerance for stressFeelings of resentmentAccess or availability of drugsGenetic predisposition
Predisposing factors
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Family traumaPhysical, mental abuse or dysfunction of family
PTSD
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AlcoholOpioidsStimulantsMarijuana Rise of prescription misuse has
caused most concern recently
Drugs of Abuse
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Substance use is seen as acceptableFaith in drugs to promote healingSense of entitlement “special” status of health care providers makes them invulnerable to illness that patients get
Problematic attitudes
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Self-diagnosisNeed to continue workingNot taking care of self
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AccessAttitudeStressLack of education
Top 4 Risk Factors
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Differentiate between impairment and stress-related behavior
Escalating behavior
Identification of a Substance Use Disorder
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Impaired cognitive functioning and memory
Altered motor skillsDifficulty making decisions Inability to copy with stressful situations
Escalating Impairment Behavior
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Slurred speech Lack of coordinationFrequent tardiness or poorly
explained absencesSmell of alcohol on breath Impaired memory—”blackouts”
Signs and symptoms
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Sloppy chartingAttireGeographic cure soughtDiversion of patient drugs for own use
Job performance
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Excessive use of sick timeCalling in sick on MondaysUnexplained absences from the unit
Consistently volunteering to be the medication nurse
Job Related Behavior
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Patients need more narcoticsDiscrepancies Opioid countOrdering for patients that have been discharged or died
More “spills” than others
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Emergency room nurses ICU, ER, ORPsychiatric nursesNurse anesthetists Night nurses
Rates of Abuse among Specialties
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Women more likely to abuse prescription drugs
Males more likely to abuse illegal drugs and alcohol
Oncology nurses more inclined to drink alcohol
Gender
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Developing a culture of transparency and support
Nurse managers being aware of own stereotypes and misconceptions about “drug users”
Examining the code of silence among colleagues
What helps?
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A cluster of behaviors that allow the person with a substance abuse problem to keep usingFamily membersColleagues
Co-dependence
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Being proactiveScreening Regular monitoringGuidelinesReferral to treatment
What to do?
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Have basic understanding of SA as a disease
Know common indicators of unsafe practice
Know workplace policies and procedures
Know in-house resources
Accountability of Administration
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Recognize personal valuesKnow in-house resourcesDocumentFeel capable of coordinating nurses re-entry at work
Recognize signs of relapse
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Planned meeting with nurse and family, colleagues to break through the pattern of denial
intervention
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Alternative ProgramMonitoring Return to work guidelines
Board of Nursing
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Legally?Morally?Ethically?
Obligations to colleagues
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Substance Use Disorder Nursing: a Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs
National Council of State Boards of Nursing
Reference