Understanding Ohio X-Waivered Advanced Practice Registered Nurses' Rate of Naltrexone Prescription for Alcohol Use Disordered Patients.

BACKGROUND: Alcohol use disorder (AUD) is overrepresented within the United States. Naltrexone, a recommended treatment for AUD, is underutilized. However, the prescribing behaviors of advanced practice registered nurses (APRNs) regarding naltrexone for AUD patients have not been studied. The purpose of our study was to explore the prescriptive practices of a sample of APRNs. AIMS: To describe and analyze survey responses of a sample of Ohio APRNs with training in medication for addiction treatment (MAT) for substance use disorders (as evidenced by DEA x-waiver receipt) regarding prescribing practices of naltrexone for AUD patients. METHOD: Public information collected from the first author's Nursing Board (list of APRNs in Ohio) was checked against the public information of x-waivered providers nationally from the Substance Abuse and Mental Health Services Administration's (SAMHSA) website. This generated a potential sample size of 824 APRNs, all of whom were sent email solicitations to complete a Qualtrics survey. After 3 weeks, 55 surveys were completed, and the data were analyzed. Descriptive statistics were generated as well as a logistic regression with five potential predictor variables against the outcome variable (defined as use of naltrexone for AUD patients). RESULTS: Years practicing as an APRN was found to negatively predict naltrexone prescribing behavior for AUD patients. Practice setting and work experience with an addiction specialist physician were not found to predict naltrexone prescribing behavior for AUD patients. CONCLUSION: Implications for further study were discussed, with emphasis on regulatory variance between states.

Full-time employed and a family caregiver: a profile of women's workload, effort, and health.

BACKGROUND: Women provide care for elderly family members while managing their other responsibilities, including full-time employment. METHODS: This descriptive study used an inductively derived workload-effort-health theoretical model to examine workload, effort, and health among 46 full-time employed family caregivers [CG] of community-dwelling older adults from a larger, nonprobability, cross-sectional sample of 110 CGs. FINDINGS: The women's caregiving workload (time, difficulty, care recipient's [CR] function), effort (perceived exertion of energy experienced in doing a workload), self-assessed health [SAH], depressive symptoms, and sources of help were richly described, and several associations were found, including higher physical and mental effort, were significantly correlated with higher workload time and difficulty and lower CR function, but not SAH. Higher mental effort and workload, and poorer SAH were significantly correlated with high depressive symptoms. Worse effort, workload, and health experiences were reported by daughters and by women who lived with their CR; those who did not have family or formal caregiving help had higher mental effort and were more depressed, suggesting an area for further study. CONCLUSIONS: Suggestions are offered for richer measurement of employment status, caregiving workload, and effort. Findings provide a unique profile of full-time employed women CGs' workload, effort (that is, how they do the work), and health, toward a stronger understanding of how women manage multiple workloads. Workplace policies are needed to address workload, effort and health in this informal caregiving workforce.

Effort, workload, and depressive symptoms in family caregivers of older adults: conceptualizing and testing a work-health relationship.

Increasing effort in response to a complex workload is detrimental to workers' health and may explain the negative health consequences experienced by millions of family caregivers who are the primary workforce for older adult care in the United States. This cross-sectional, descriptive correlational study used survey data from 110 family caregivers of community-dwelling older adults to theoretically explain caregiving effort (as perceived exertion) and to examine the relationship between effort and depressive symptoms, a particularly persistent adverse caregiver health outcome. Visual analog scales and exemplar quotes explicated physical, mental, emotional, and time-related effort. Notably, effort was considered too multidimensional by several caregivers to discretely categorize. Among the relationships tested, effort was statistically significantly correlated with workload proxies (time, difficulty, overload), caregiver health and depressive symptoms, and care receiver function. Using regression analysis, effort and workload did not have direct effects on depressive symptoms. Surprisingly, effort was not decreased for caregivers who had formal or informal caregiving help. These findings support an energetical conceptualization in caregiving and highlight the complexity of a caregiving workload assessment. Practice suggestions are offered toward tailored health promotion strategies to benefit the families who constitute this essential, global caregiving workforce.