ABSTRACT
Human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) are rising among today's lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) adolescents, specifically, men who have sex with men (MSM) and transgender adolescents. There are numerous barriers to practicing safe sex among LGBTQ adolescents. The goal of this article is to raise awareness of the critical role nurses can play in educating this population and their parents on approaches to practicing safe sex to prevent HIV and other STIs. In addition, this article aims to encourage baccalaureate nursing education programs to incorporate LGBTQ issues in their curricula, such as providing better access to health care and prevention of HIV and other STIs for LGBTQ adolescents. Nurses have unique access to these patients, and with better understanding of how to educate and communicate with LGBTQ adolescents on the prevention of HIV and STIs, nurses can have a positive protective effect on their patients.
ABSTRACT
PURPOSE: Methadone maintenance treatment is a life-saving treatment for people with opioid use disorders (OUD). The coronavirus pandemic (COVID-19) has introduced many concerns surrounding access to opioid treatment. In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued guidance allowing for the expansion of take-home methadone doses. We sought to describe changes to treatment experiences from the perspective of persons receiving methadone at outpatient treatment facilities for OUD. METHODS: We conducted an in-person survey among 104 persons receiving methadone from three clinics in central North Carolina in June and July 2020. Surveys collected information on demographic characteristics, methadone treatment history, and experiences with take-home methadone doses in the context of COVID-19 (i.e., before and since March 2020). RESULTS: Before COVID-19, the clinic-level percent of participants receiving any amount of days' supply of take-home doses at each clinic ranged from 56% to 82%, while it ranged from 78% to 100% since COVID-19. The clinic-level percent of participants receiving a take-homes days' supply of a week or longer (i.e., ≥6 days) since COVID-19 ranged from 11% to 56%. Among 87 participants who received take-homes since COVID-19, only four reported selling their take-home doses. CONCLUSIONS: Our study found variation in experiences of take-home dosing by clinic and little diversion of take-home doses. While SAMSHA guidance should allow expanded access to take-home doses, adoption of these guidelines may vary at the clinic level. The adoption of these policies should be explored further, particularly in the context of benefits to patients seeking OUD treatment.
Subject(s)
COVID-19 , Methadone/therapeutic use , Opiate Substitution Treatment , Opioid-Related Disorders/rehabilitation , Patient Satisfaction , SARS-CoV-2 , Adolescent , Adult , Drug Dosage Calculations , Female , Humans , Male , Methadone/administration & dosage , North Carolina , Surveys and Questionnaires , Young AdultABSTRACT
BACKGROUND: Nurse-sensitive quality indicators have historically been used as a metric of nursing care quality in health care organizations. PROBLEM: At our academic medical center, critically ill COVID-19 patients led to a dramatic change in the organizational standard of care resulting in an increase in nurse-sensitive health care-associated infections. APPROACH: Nursing performance improvement teams provided the structure for development of innovative strategies implemented in real time by our frontline clinicians to address the quality and safety issues found with these elevated health care-associated infections. OUTCOMES: A new COVID-19 CLABSI (central line-associated bloodstream infection) Tip Sheet and a Prone Positioning Kit for HAPI Prevention are strategies developed to address quality of care issues experienced with the COVID-19 patients. CONCLUSIONS: Deployment of these innovative practice strategies has led to a decline in health care-associated infections and instituted a new care standard for the COVID-19 patients.