Dog-assisted interventions in care homes: A qualitative exploration of the nature, meaning and impact of interactions for older people.

Dog-assisted interventions (DAI) have been shown to have a wide-range of potential benefits for older adults living in care homes. Yet, there is a lack of published qualitative research which explores the experiences of care home residents, staff and dog-owner volunteers involved in DAI to fully understand its meaning, impact and value. This study aimed to explore the impact of a DAI on the social and emotional wellbeing of older residents living in care homes. The research employed a qualitative study design comprising overt, naturalistic researcher observation of weekly DAI sessions with 54 older adult residents across four participating care homes in the South East region of England over 3 months in 2018. Data were also collected through focus groups with 12 care home staff and 7 dog-owner volunteers. The data from the observations and focus groups was individually coded followed by thematic analysis across the three data sources. Findings demonstrated there were clear benefits for older people who engaged with DAI, as well as for dog-owners and to some extent for care home staff members. Benefits included sensory, emotional stimulation and opportunities for social interaction, reminiscence on early life experiences and these were supported by the development of some new social relationships. While there were some environmental challenges to implementing DAI, the findings confirm its value for care home residents, with minimal drawbacks from an organizational standpoint. As a low cost intervention, adoption of DAI in care home settings appeared to strengthen relationships between residents and staff and enable wider relationships with an external community resource.

Community Based Interventions for Problematic Substance Use in Later Life: A Systematic Review of Evaluated Studies and Their Outcomes.

Problematic substance use (PSU) in later life is a growing global problem of significant concern in tandem with a rapidly ageing global population. Prevention and interventions specifically designed for older people are not common, and those designed for mixed-age groups may fail to address the unique and sometimes complex needs of ageing communities. We report findings from a systematic review of the empirical evidence from studies which formally evaluated interventions used with older people and reported their outcomes. Nineteen studies were included, of which thirteen focused solely on alcohol-related problems. Eight interventions utilised different types of screening, brief advice and education. The remaining drew on behavioural, narrative and integrated or multi-disciplinary approaches, which aimed to meet older people's needs holistically. Quality assessment of study design helped to review evaluation practice. Findings point to recommendations for sustainable and well-designed intervention strategies for PSU in later life, which purposefully align with other areas of health and well-being and are delivered in locations where older people normally seek, or receive, help. There is further scope for engagement with older people's own perspectives on their needs and help-seeking behaviours. Economic evaluation of the outcome of interventions would also be useful to establish the value of investing in targeted services to this underserved population.

Getting Addiction Into the Nursing Education "Water Supply": A U.K. Case Study.

Evidence remains fundamentally unchanged over the last 30 years that nurses are not sufficiently prepared during their undergraduate education to work with alcohol and other drug (AOD) use. Employing a mixed-methods longitudinal panel design, our study objectives were to (a) explore perceptions among entry level nursing students regarding AOD work and (b) explore whether current alcohol and drug education efforts impact on the perception of AOD by nursing students over time. Two hundred forty-two students were recruited (94% response rate). Most (86%) of the study participants identified AOD training as relevant/extremely relevant to their future practice. After exposure to AOD sessions in the nursing curriculum, there was no significant change to participants' score on either alcohol or drug role security between T1 and T2/T3. However, there was a statistically significant improvement in alcohol therapeutic commitment between T1 and T2/T3 (F(2, 136) = 5.87, p < .01), but not between T2 and T3; conversely, drug therapeutic commitment was significantly higher at T2 but signficantly lower at T3 (F(2, 149) = 254.19, p < .0001). There was no significant difference in alcohol or drug role security between the three nurse training pathways. However, alcohol and drug therapeutic commitment scores at T1 were significantly higher in students taking the mental health field/track (F(2, 160) = 9.45, p < .001, and F(2, 236) = 15.23, p < .0001). Although the positive message is that students recognize the importance of the topic to their future practice, concerns remain regarding the impact and efforts of readiness for practice. Over a 3-year training period, no significant gains were made in increasing students' knowledge and skills, and their training experiences in clinical practice appear to have a negative effect on "therapeutic commitment" influenced by exposure/contact to patients with drug use disorders specifically and less than positive mentoring experiences with qualified nursing staff. How to address these issues is explored including the need to perhaps shift the focus of attention from "negative attitudes" held by students to exploring the barriers and obstacles in upskilling nursing faculty and clinical mentors so that they feel able and willing to teach and be a role model of good practice in this area.

State of the Art in European Addictions Nursing: Perspectives From the United Kingdom, Ireland, and the Netherlands.

In this article, we discuss the state of the art of addiction nursing in Europe. This state is viewed throughout the United Kingdom, Ireland, and the Netherlands and has a direct link to the future. Despite differences, the three countries share nursing values. The start of International Nurses Society in Addictions Nursing Ireland and the Netherlands is only the beginning of a new connection and cooperation Europe-wide.

The International Nurses Society on Addictions: Strategic Plan for Global Development to Shape Policy and Strengthen Addictions Nursing Influence.

The International Nurses Society on Addictions (IntNSA) believes that nurses are key to improving the well-being of individuals affected by substance use, including their families and friends and the society within which they live. It is essential that nurses are able to effectively influence change at local, organizational, systems, national, regional, and international levels.Historically, IntNSA has drawn its membership from within the United States, reflective of its origins as a national organization. In recognition of the potential for a wider international impact, members voted to formally expand its membership and status to international in 2000. In 2014, members elected its first international member to the Board, and the Board established an International Development Task Force.In 2015, the IntNSA Board outlined its plan for increasing opportunities for nurses around the world to collaborate to change and shape responses to addictions at all levels. In 2019, IntNSA's Board reviewed its progress, updated its plan, and developed consensus for further actions to be undertaken.This Policy Watch column provides a transparent overview of IntNSA's plans for global development and an update on its current progress. Its aim is to keep current and potential IntNSA members, our agency partners and interdisciplinary colleagues, and nurses in all specialties, including addictions nurses, informed about this important work. These strategies will ensure that IntNSA will achieve its stated vision "to be a global leader in addictions nursing" and accomplish its mission "to advance excellence in addictions nursing practice through advocacy, collaboration, education, research and policy development" (www.intnsa.org).

Self-injurious behaviour, traumatic life events and alexithymia among treatment-seeking opiate addicts: prevalence, pattern and correlates.

OBJECTIVE: Aim of this study was to determine the prevalence and pattern of self-injurious behaviour (SIB) and identify the predictors of SIB among treatment-seeking opiate addicts. METHODS: Participants were 80 consecutively consenting opiate addicts admitted into community and inpatient treatment programmes of a large South London National Health Service (NHS) Mental Health Trust. Substance dependence was diagnosed with ICD-10. The following instruments were administered: self-injurious behaviour questionnaire, traumatic life events questionnaire, Toronto alexithymia scale and substance abuse assessment questionnaire. RESULTS: Lifetime SIB prevalence rate was 49% (95% CI=37-60). There was no difference in lifetime SIB rates of male (50%) and female (46%) patients. The predominate function of SIB among opiate addicts was affect-regulation followed by self-punishment. Using a logistic regression, sexual harassment and difficulty identifying feelings were the only independent significant predictors of SIB, with the influence of age of first traumatic event and gender partialled out. CONCLUSION: Given these findings, there is strong evidence to suggest that treatment of opiate addiction should involve routine screening for adult sexual trauma, deficits in emotional regulation and SIB. Where these problems are identified, appropriate psychological intervention should be integral to routine care for affected patients.

Prevalence and associated factors in burnout and psychological morbidity among substance misuse professionals.

BACKGROUND: Studies of psychological stress among substance misuse professionals rarely describe the nature of burnout and psychological morbidity. The main aim of this study was to determine the extent, pattern and predictors of psychological morbidity and burnout among substance misuse professionals. METHODS: This study was a cross-sectional mail survey of 194 clinical staff of substance misuse services in the former South Thames region of England, using the General Health Questionnaire (GHQ-12) the Maslach Burnout Inventory (MBI) as measures of psychological morbidity and burnout, respectively. RESULTS: Rates of psychological morbidity (82%: 95% CI = 76-87) and burnout (high emotional exhaustion - 33% [27-40]; high depersonalisation - 17% [12-23]; and diminished personal accomplishment - 36% [29-43]) were relatively high in the study sample. High levels of alienation and tension (job stressors) predicted emotional exhaustion and depersonalisation (burnout) but not psychological morbidity. Diminished personal accomplishment was associated with higher levels of psychological morbidity CONCLUSION: In the sample of substance misuse professionals studied, rates of psychological morbidity and burnout were high, suggesting a higher level of vulnerability than in other health professionals. Furthermore, pathways to psychological morbidity and burnout are partially related. Therefore, targeted response is required to manage stress, burnout and psychological morbidity among substance misuse professionals. Such a response should be integral to workforce development.

Role development and career stages in addiction nursing: an exploratory study.

AIM: This paper reports a study to explore factors influencing recruitment and retention in addiction nursing, and the stages and features of role acquisition and personal qualities important to that role. BACKGROUND: Specialist addiction nurses engage in a number of roles in the care of individuals with problematic use of psychoactive substances. These include assessment, outreach, prescribing, counselling, and harm reduction. In a climate of increasing demand for specialist substance misuse workers, and a trend to identify key occupational competencies, there is a need for a framework in which career progression can be supported. Studies exploring the roles of addiction nurses are minimal, and there is less comment on how these roles are developed in the context of career stages. METHOD: A qualitative study using focus groups was undertaken with specialist addiction nurses between March and June 2004. The data were transcribed verbatim and analysed using Burnard's six content analysis stages. FINDINGS: Positive factors identified as influencing recruitment and retention included: prior knowledge of the working environment (as a nursing student), opportunities for autonomous practice, the client profile, and associated treatment philosophy and care approach. There was consensus that nurses choosing to work in the field of addiction needed, in addition to being non-judgmental, personal qualities including hardiness, patience and tolerance. Five role development stages, with a set of descriptors, were identified: encounter, engagement, stabilization, competency and mastery. CONCLUSION: Identification of these five role development stages for addiction nurses offers employers, nurse managers, educators and addiction nurses a starting point from which specific occupational competencies can be further explored. In addition, continuing professional development needs can be mapped to specific role development stages. Employers and nurse managers may wish to offer increased learning opportunities to student nurses to gain work experience within specialist addiction units.

Self-harm and suicide: care, interventions and policy.

This article aims to raise awareness about self-harming behaviours and suicide. It explores their complex nature, social context, why they have become a central issue in public health and the challenges they present. The assessment of patients who self-harm is discussed, together with psychological and social policy interventions that may be used.

Treating an opiate-dependent inpatient population: a one-year follow-up study of treatment completers and noncompleters.

INTRODUCTION: The aim of this study was to compare the characteristics of patients who completed (completers) inpatient treatment of drug dependence with those who failed to complete this programme (noncompleters). METHOD: Participants were assessed at admission using the Substance Abuse Assessment Questionnaire (SAAQ) to obtain information about the sociodemographic background, history of drug and alcohol use, physical health, mental health, offending behaviour, and interpersonal relationships. Follow-up interviews were carried out 3, 6, 9, and 12 months after discharge using the SAAQ-Follow-up. To form the three comparison groups, participants were divided on the basis of completion of detoxification and receipt of aftercare. RESULTS AND CONCLUSIONS: Significantly better treatment outcome was observed amongst those who completed detoxification and went on to spend at least 6 weeks in a recovery and/or residential rehabilitation unit. In contrast, there were no significant differences between noncompleters and completers who had no aftercare on the majority of measures of drug use during follow-up.