Changes in Nursing Students' Attitudes and Perceptions After Receipt of Enhanced Substance Use-Related Curricular Content.

BACKGROUND: Negative attitudes toward persons who use alcohol and other drugs contribute to suboptimal care. Nurses are in key roles to address the needs of this population, yet they lack the education needed to identify persons who may be at risk because of substance use and intervene accordingly. The purpose of this study was to evaluate the impact of a substance-use-related curriculum on nursing students' attitudes and therapeutic commitment for working with patients with alcohol- and drug-use-related problems. METHODS: Data were collected for four cohorts of 169 nursing students enrolled in a Master's Entry into Nursing program. Questionnaires included the Person-Centered Alcohol and Alcohol Problems Perception Questionnaire and the Drug and Drug Problems Perception Questionnaire, completed before and after completing the curriculum. Paired samples t test were used to examine pre/post differences for each measure's subscale. RESULTS: Four of the seven Person-Centered Alcohol and Alcohol Problems Perception Questionnaire subscales showing significant increases were role adequacy, role support, role legitimacy, and general perceptions. Four of the five Drug and Drug Problems Perception Questionnaire subscales showing significant increases were role adequacy, role support, job satisfaction, and role legitimacy; there was a significant change in role-related self-esteem, however, in a negative direction. CONCLUSIONS: This study adds to the growing evidence of the positive impact of providing evidence-based information and skill development, which enhance alcohol- and drug-related knowledge and competence for nurses entering professional practice.

Psychometric Properties of the Person-Centered Version of the Alcohol and Alcohol Problems Perceptions Questionnaire (PC-AAPPQ).

AIMS: Given the importance of addressing provider attitudes toward individuals with unhealthy alcohol use and the current emphasis on person-centered language to help decrease stigma and mitigate negative attitudes, the aim of this study was to evaluate the psychometric properties of a contemporary version of the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) that uses person-centered language and addresses the spectrum of alcohol use. METHODS: The authors created a person-centered version of the AAPPQ (PC-AAPPQ) and conducted a cross-sectional study of its psychometric properties in academic settings in the Northeastern United States. The PC-AAPPQ was administered to 651 nursing students. Reliability analysis of the new instrument was performed using the total sample. Only surveys with complete data (n = 637) were randomly split into two datasets, one used for the exploratory factor analysis (EFA) (n = 310) and the other for confirmatory factor analysis (CFA) (n = 327). RESULTS: Compared to all the models generated from the EFA, neither the original six-factor structure nor the five-factor structure was superior to any of the other models. The results indicate that a seven-factor structure with all 30 items is the best fit for the PC-AAPPQ. CONCLUSIONS: The PC-AAPPQ represents a positive effort to modernize the four-decade-old AAPPQ. This 30-item instrument, which adds one additional subscale, offers a means to assess providers' attitudes using respectful wording that avoids perpetuating negative biases and reinforces efforts to affirm the worth and dignity of the population being treated.

The Essentials Competencies: A Framework for Substance Use-Related Curricula.

BACKGROUND: The use of substances including alcohol, tobacco, and other drugs increases the risk for injury, noncommunicable disease, and premature death and contributes to the global burden of disease. PROBLEM: The morbidity and mortality rates among patients with at-risk substance use point to the need for future nurses to have the requisite knowledge and competencies to provide care for this population. APPROACH: This article provides guidance for nurse educators in designing curricula that include content related to substance use, including screening, brief intervention, and referral to treatment. OUTCOMES: Expected outcomes for baccalaureate, master's, and doctor of nursing practice programs are informed by the corresponding American Association of Colleges of Nursing Essentials. CONCLUSION: The overall goal of this guidance for nursing education is to advance the knowledge and competencies of the future nursing workforce to address the continuum of substance use and improve the health of the nation.

Hazardous Drinking Prevalence and Correlates in Older New Zealanders: A Comparison of the AUDIT-C and the CARET.

Objectives: The study compared the proportion of older adults identified as drinking hazardously based on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) with the older adult-specific Comorbidity Alcohol Risk Evaluation Tool (CARET) and investigated whether sociodemographics, comorbidities, health, medication use, and alcohol-related risk behaviors explained discrepancies between the screens in classification of hazardousness. Method: The AUDIT-C and the CARET were administered to 3,673 adults aged 55 to 89 years. Classification agreement between the screens was evaluated using Cohen's kappa. Hazardous drinking groups were compared using logistic regression. Results: Analysis indicated moderate agreement between the screens. Drinkers classified as "hazardous on the CARET only" consumed less alcohol, but were more likely to drink-drive. Introducing a drink-driving criterion into the calculation of hazardousness on the AUDIT-C substantially decreased the classification discrepancy between the measures. Discussion: Standard screening can be improved by investigating comorbidities, medication use, and alcohol-related risk behaviors in those initially identified as nonhazardous drinkers.

Time-Conscious Alcohol Screening and Brief Intervention for Students, Nurses, and Nurse Leaders.

Alcohol is the third leading cause of death and a preventable risk factor contributing to more than 200 diseases and conditions. Unquestionably, health care practitioners should routinely screen and give patients brief feedback on alcohol consumption related to health outcomes; however, they rarely ask patients about alcohol use. Alcohol screening and brief intervention (SBI), a public health model of prevention and identification of at-risk alcohol use, has not been widely disseminated. The nursing profession, the largest and most trusted sector of the health care workforce, is perfectly poised to close this gap. This article describes the development of a two-university, grant-funded collaborative online educational program with unique and time-conscious simulation and testing components to increase the knowledge and skills of nurses. The goal of the program is to promote alcohol SBI as a standard of practice in all settings. J Contin Educ Nurs. 2018;49(10):467-473.

Is Alcohol Use Associated With Increased Risk of Developing Adverse Health Outcomes Among Adults Living With Human Immunodeficiency Virus: A Systematic Review.

BACKGROUND: Alcohol use is associated with many HIV-related behaviors that are associated with increased risk of reinfection, transmission, and poorer health outcomes in people living with HIV (PLHIV). The population of middle-aged and older PLHIV is growing because of increased life longevity and aging trend. METHODS: A systematic review across three databases was conducted to evaluate existing studies that examined the association between alcohol use and medication adherence, high-risk sex behaviors, HIV progression, depression, resource utilization, and survival among studies of PLHIV with an average age of 40 years and above. RESULTS: Among the 47 included studies, most found a positive association between alcohol use and depression, risky sex behaviors, medication nonadherence, and healthcare resource utilization among PLHIV. The association between alcohol use and response to treatment was variable. The association between alcohol use and survival warrants further study because of lack of existing studies. CONCLUSIONS: The results of this review support that alcohol use negatively impacts middle-aged and older PLHIV in many aspects; however, there is lack of studies exclusively targeting older PLHIV, and more relevant studies in the future are needed.

Integrating Substance Use Content in an "Overcrowded" Nursing Curriculum.

Various factors have compelled nurse educators to address the lack of substance use-related content in nursing curriculum. Initiatives to add this content are often met with resistance because of an already crowded curriculum. This article describes a 4-phase process that guided the integration of this specialty content into a prelicensure nursing curriculum and a master's level advanced practice nursing curriculum. Lessons learned and recommendations from those experiences are provided to guide nurse educators undertaking similar efforts.

A Concept Analysis of Substance Misuse to Inform Contemporary Terminology.

Previous diagnostic categories of substance abuse and dependence have given way to the current view that substance use disorders occur on a continuum with a broad range of severity. This current view is featured in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V). In recognizing the role of stigma in preventing persons from seeking substance use treatment, advocates have called attention that particular terminology can fuel such stigma. To mitigate the negative effects of such stigmatizing language, the International Society of Addiction Journal Editors (ISAJE) recommends against using previously-used and possibly pejorative terminology for substance abuse and dependence, unless a particular scientific justification exists. The purpose of this paper is to: (1) present a concept analysis of the term substance misuse and (2) recommend an alternate term for substance misuse that is neither pejorative nor inadvertently stigmatizing: at-risk substance use.

Implementing HIV Testing in Substance Use Treatment Programs: A Systematic Review.

People who use drugs are at increased risk for HIV acquisition, poor engagement in health care, and late screening for HIV with advanced HIV at diagnosis and increased HIV-related morbidity, mortality, and health care costs. This systematic review evaluates current evidence about the effectiveness and feasibility of implementing HIV testing in U.S. substance use treatment programs. The literature search identified 535 articles. Full text review was limited to articles that explicitly addressed strategies to implement HIV testing in substance use programs: 17 met criteria and were included in the review; nine used quantitative, qualitative, or mixed-method designs to describe or quantify HIV testing rates, acceptance by clients and staff, and cost-effectiveness; eight organization surveys described barriers and facilitators to testing implementation. The evidence supported the effectiveness and feasibility of rapid, routine, and streamlined HIV testing in substance use treatment programs. Primary challenges included organizational support and sustainable funding.

Alcohol and Substance Use Disorder Screening, Brief Intervention, and Referral to Treatment Among People Living With HIV/AIDS.

PURPOSE: The purpose of this review is to inform nurses on the prevalence of substance use screening with screening, brief intervention, and referral to treatment; its use in the primary care setting; and its effectiveness on HIV-related risk behaviors to prevent adverse health consequences among people living with HIV/AIDS (PLWH). REVIEW: For PLWH, identification of at-risk substance use is important because of the association between substance use and HIV infection both in terms of acquiring HIV and in further transmission of HIV. CONCLUSION: Alcohol and substance use disorders continue to be a burden for PLWH and are associated with poor health outcomes. Implementation of screening, brief intervention, and referral to treatment in the primary care setting is critical for promoting positive health outcomes in this population and provides an opportunity for nurses to intervene.

Substance Use and Substance Abuse--What's in a Name?

PURPOSE: What's in a name? Because the Diagnostic Statistical Manual of Mental Disorders, 5th Edition, no longer uses the terms dependence and abuse (American Psychiatric Association, 2013a), does the continued use of these terms impact how issues related to at-risk substance use are presented in the literature? The purpose of this review is to explore the implications of the continued use of the term substance abuse in the clinical literature through the review of three articles published in 2015 that used the term substance abuse in the title. REVIEW: The use of the term substance abuse in the articles reviewed resulted in presenting a narrow focus on substance use disorders rather than the broader issues of harm that occur across the full continuum of substance use. In addition, the term "substance abuse" in one article lent itself to the use of pejorative language and stigmatization. CONCLUSION: It is imperative that we stop using the term substance abuse in clinical articles, because it is no longer clinically relevant and presents a narrow focus of the risks associated with substance use.

The Use of Haddon's Matrix to Plan for Injury and Illness Prevention at Outdoor Music Festivals.

INTRODUCTION: Mass-gathering music events, such as outdoor music festivals (OMFs), increase the risk of injuries and illnesses among attendees. This increased risk is associated with access to alcohol and other drugs by young people and an environment that places many people in close contact with each other. AIM: The purpose of this report was to demonstrate how Haddon's matrix was used to examine the factors that contributed to injuries and illnesses that occurred at 26 OMFs using data from the Ranse and Hutton's minimum data set. METHODS: To help understand the kinds of injuries and illnesses experienced, Hutton et al identified previous patterns of patient presentations at 26 OMFs in Australia. To develop effective prevention strategies, the next logical step was to examine the risk factors associated with each illness/injury event. The Haddon matrix allows event practitioners to formulate anticipatory planning for celebratory-type events. RESULTS: What was evident from this work was that the host, the agent, and the physical and social environments contributed to the development of injuries and illness at an event. The physical environment could be controlled, to a certain extent, through event design, safety guidelines, and legislation. However, balancing cultural norms, such as the importance placed on celebratory events, with the social environment is more difficult. DISCUSSION: The use of the Haddon matrix demonstrates that interventions need to be targeted at all stages of the event, particularly both pre-event and during the event. The opportunity to promote health is lost by the time of post event. The matrix provided vital information on what factors may contribute to injury at OMFs; form this information, event planners can strategize possible interventions.

A pilot study: retention of adults experiencing homelessness and feasibility of a CDSM diabetes program.

INTRODUCTION: The study purpose was to evaluate the feasibility of a chronic disease self management/case management intervention for adults experiencing homelessness and diabetes and the ability to retain subjects. METHODS: Participants with type 2 diabetes were recruited at a homeless clinic and a subset received the intervention. Analysis included calculating a retention rate and evaluating the intervention implementation process. RESULTS: Of the nine participants, five were retained for 12 weeks and two of three participants completed the full intervention. CONCLUSIONS: Study retention is feasible for adults experiencing homelessness. Further intervention refinement is needed to address relevancy of content and time constraints.

Alcohol and health content in nursing baccalaureate degree curricula.

Globally, a paradigm shift has occurred in the field of alcohol and health from treatment of alcoholism to reducing at-risk drinking. The purpose of this study was to determine if schools of nursing include content reflective of the new paradigm in their Bachelor of Science in Nursing curricula. This was a cross-sectional electronic survey of schools of nursing to determine the mean number of alcohol-related content hours presented, the content offered, and the inclusion of strategies aimed at reduction of at-risk drinking such as screening and brief intervention. The schools (n = 66) reported a mean of 11.3 hours of alcohol-related content, with most of the content related to the treatment of alcohol dependence. Less than 10% required competency in screening and brief intervention. This gap in Bachelor of Science in Nursing curricula carries serious implications in that nurses may not have the knowledge and competencies needed to provide interventions to patients with at-risk alcohol use.

Assessing nurses' continuing education preferences in rural community and urban academic settings.

Continuing education programs that increase nursing knowledge and collaboration are needed across urban and rural settings. A survey was distributed to determine interest in nursing grand rounds and preferred educational modalities at two unaffiliated hospitals. Results revealed that nurses from the urban and rural hospitals were interested in nursing grand rounds as a recorded online offering, thus providing valuable information used to develop a nursing grand rounds program.

The effectiveness of a staff education program on the use of continuous EEG with patients in neuroscience intensive care units.

Approximately a third of patients in neuroscience intensive care units (ICUs) experience subclinical seizures and, as a result, are at higher risk for poor outcomes. The use of continuous electroencephalography (cEEG) monitoring can help nurses detect seizure activity and initiate early prevention. Nurse competency in the use of cEEG is important to facilitate effective bedside monitoring. The objective of this study was to evaluate the effectiveness of a staff educational program aimed at improving the knowledge of nurses in the use of cEEG monitoring in adults. A quasi-experimental pretest/posttest 1-group design was utilized. Neuroscience ICU registered nurses, whose experience ranged from 2 months to 24 years, participated in the study. Participants completed a pretest on seizure knowledge and the use of cEEG monitoring. Participants received a 4-hour educational session on the use of cEEG monitoring. Immediately after the program and again 1 month later, they completed a posttest. Test scores improved significantly from pretest to the first posttest (t = -15.093, p < .001). Although there was a slight decline in the mean score from the posttest to the 1-month follow-up, posttest scores were significantly better than the pretest score (t = -12.42, df = 44, p < .001). Whereas years of experience correlated positively to the pretest score, after the intervention, no such correlation was evident. The results demonstrated that an educational program improved the competency of nurses in the use of cEEG with adult patients in a neuroscience ICU and that this knowledge was sustained over time. Further research is needed to demonstrate the effectiveness of this intervention in other settings.

The influence of secondhand smoke exposure on birth outcomes in Jordan.

This study investigates how secondhand smoke (SHS) exposure influences neonatal birth weight in Jordan, a country with high smoking prevalence. The findings revealed that as the average number of SHS exposure hours per week increased in the second trimester, the neonatal birth weight decreased while holding all covariates constant. Women who reported a higher average number of SHS exposure hours per week from work in the second trimester, home in the third trimester, and outside in the third trimester were at greater risk for having a low birth weight neonate than women who reported a lower average number of SHS exposure hours.