Law Enforcement Perceptions About Naloxone Training and Its Effects Post-Overdose Reversal.

BACKGROUND: Law enforcement officers (LEOs) often are the first responders to arrive at a scene of an opioid overdose. Thus, equipping LEOs as first responders with naloxone is necessary to prevent overdose deaths and a recommended strategy. However, little is known about how LEOs perceive naloxone training and their feelings after using naloxone to save a life. It is important to understand LEOs' experiences with naloxone so as to develop additional training materials that are relevant to the LEO experience. METHODS: A descriptive exploratory study was conducted to explore the perceptions of LEOs about using naloxone in the field and to identify areas that should be included in future naloxone trainings. Interview data were obtained through face-to-face interviews with LEOs (N = 14) and analyzed using manifest content analysis. RESULTS: LEOs changed their attitudes and beliefs toward naloxone after receiving training and experiencing a successful resuscitation. The change in attitudes was enhanced after saving a life. However, misconceptions about naloxone and lack of understanding about disease of addiction persisted even after training. CONCLUSION: Future naloxone curriculum could benefit from additional lessons on the stigma of addiction, the disease of addiction, misconceptions about the safety of naloxone, strategies for postoverdose responses, and the role naloxone, which might play in a hopeful recovery.

Recovery opioid overdose team (ROOT) pilot program evaluation: A community-wide post-overdose response strategy.

Background: Effective interventions for overdose survivors are needed in the emergency departments (EDs). One promising model is the use of peer recovery coaches to engage with survivors in EDs, followed by partnering with community case management navigators to connect survivors to recovery support and treatment services. This paper describes the evaluation of a pilot program, the Recovery Opioid Overdose Team (ROOT), a warm hand-off system that links survivors to treatment services post-ED discharge. Methods: The ROOT program is composed of a peer recovery coach who is in long-term recovery, and a case management navigator who specializes in mental health care and provides guidance for accessing community services. After an overdose reversal, law enforcement contacts a county 24/7 Crisis Team, who then notifies ROOT. The peer recovery coach engages with the survivor in the ED, and then follow up continues with the case management navigator and the peer recovery coach for up to 90 days post-ED discharge. Retrospective chart reviews were conducted to evaluate ROOT in two Midwest EDs from September 2017 through March 2019. Results: Of the 122 referrals, 77.0% (n = 94) of the survivors initially engaged with ROOT in the ED or in the community. The remaining 23.0% (n = 28) left the ED against medical advice or were unengaged. The majority of overdose survivors were male (63.9%; n = 78), White (43.4%; n = 53), had housing (80.2%; n = 48), and access to transportation (48.4%; n = 59). From the 122 referrals, 33.6% (n = 41) received ongoing treatment services (n = 20 outpatient, n = 17 residential, n = 2 detoxification facility, n = 1 recovery housing, n = 1 medication treatment for opioid use disorder), 2.5% (n = 3) were incarcerated, 2.5% (n = 3) died, and 61.5% (n = 75) declined services. Conclusions: The ROOT, a community-wide coordinated program in the EDs, shows promise in linking overdose survivors to recovery support and treatment services post-overdose.

Current state of screening high-ACE youth and emerging adults in primary care.

BACKGROUND AND PURPOSE: Trauma comes in many forms, including interpersonal, community, and institutional trauma. The adverse childhood event (ACE) studies demonstrated that adverse experiences in childhood can have a profound, cumulative impact on the course of health and development over a lifetime. It is critical for healthcare providers, such as nurse practitioners (NPs), working in primary care to screen adolescents and emerging adults for a history of ACEs and trauma. A review of current assessment tools used in assessing this population in health settings is needed to determine how screening for ACEs is being performed. CONCLUSIONS: Clinically efficient tools for screening and assessment of high-ACE youth in primary care settings are lacking.  Developing a process to assess ACEs, risk behaviors, and physical and mental health status that is efficient to use during a time limited clinical visit is an important step in providing holistic care to a challenging population. IMPLICATIONS FOR PRACTICE: Primary care NPs are in the perfect position to implement assessments of ACEs through trauma-informed nursing care. ACE assessment in clinical practice will provide vital information to guide the development of tailored interventions for reducing risk behaviors and mitigate the long-term impacts of ACEs.

Beyond rescue: Implementation and evaluation of revised naloxone training for law enforcement officers.

OBJECTIVE: This study describes the implementation and evaluation of revised opioid overdose prevention and education of naloxone training for law enforcement officers (LEOs) that added: (1) a recovery testimony and (2) the process for deputy-initiated referrals postnaloxone administration. DESIGN AND SAMPLE: Evaluation regarding the naloxone training included a pre- and postopioid overdose knowledge surveys (N = 114) and subsequent 1-year postnaloxone training outcomes. RESULTS: Pre- and posttest scores for all knowledge outcome measures were statistically significant (p < .001) with favorable comments pertaining to the recovery testimony. Out of 31 individuals who received naloxone, 6 individuals (19.4%) continue to be in treatment or received some treatment services. The most common symptoms reported were unconsciousness/unresponsiveness (40.5%), abnormal breathing patterns (24.3%), and blue lips (16.2%). The majority of the calls (65.6%) were to a residential area, and the time for naloxone revival ranged <1-10 min (M = 3.48; SD = 2.27). CONCLUSION: As nearly 20% of individuals sought treatment after a LEO-initiated referral, it is recommended that other agencies consider the referral process into the training. Future research will investigate the impact of the recovery testimony in reducing the stigma of addiction.

Scholarly productivity for nursing clinical track faculty.

Recent years have yielded substantial advancement by clinical track faculty in cohort expansion and collective contributions to the discipline of nursing. As a result, standards for progression and promotion for clinical faculty need to be more fully developed, articulated, and disseminated. Our school formed a task force to examine benchmarks for the progression and promotion of clinical faculty across schools of nursing, with the goal of guiding faculty, reviewers, and decision makers about what constitutes excellence in scholarly productivity. Results from analyses of curriculum vitae of clinical professors or associate professors at six universities with high research activity revealed a variety of productivity among clinical track members, which included notable diversity in the types of scholarly products. Findings from this project help quantify types of scholarship for clinical faculty at the time of promotion. This work provides a springboard for greater understanding of the contributions of clinical track faculty to nursing practice.