Family history of substance use disorder and chronic pain management.

The use of family history of substance use disorder information as part of a comprehensive assessment of chronic pain can provide important data for treatment. This case example illustrates assessment, patient education, and brief motivational interviewing with referral to appropriate resources.

Impact of Family History of Substance Abuse on Admission Opioid Dose, Depressive Symptoms, and Pain Catastrophizing in Patients with Chronic Pain.

The objectives of this study were to examine association between a family history of substance abuse and admission morphine equivalent dose, depression and pain catastrophizing screening scores, as well as reported personal history of substance use. The retrospective research was completed in an interdisciplinary three-week pain rehabilitation center. The subject cohort included admissions from January through December 2014 with 351 datasets for family history of substance abuse and oral morphine equivalency and 341 for depression, pain catastrophizing and use of substances. Outcome measures included admission self-reported data on family history of substance abuse and past and current substance use, admission morphine equivalency dose, and scores on the Center for Epidemiologic Studies-Depression Scale and the Pain Catastrophizing Scale. One hundred forty-seven patients were using opioid medications on admission and those with a positive family history of substance abuse had an oral morphine equivalency (M = 92.12, SD = 95.32) compared to a negative history (M = 80.34, SD = 64.86); the difference was not statistically significant, t (120.01) =.87, p = .39. Patients with a positive family history reported higher levels of both depression, t (327.40) = 3.15, p = .002 and pain catastrophizing, t (338) = 2.76, p = .01. Those with a positive family history endorsed greater frequency of past alcohol use χ2 (1, N = 326) = 6.67, p = 0.1 and marijuana use χ2 (1, N = 341) = 4.23, p = .04 and past χ2 (1, N = 329) = 9.90, p = .002 and current tobacco use χ2 (1, N = 327) = 8.81, p = .003. Use of family history of substance abuse information may help provide data for multimodal treatments of chronic non-cancer-pain. The findings from this study can be used to guide future research.

Advocating for the Use of Pharmacogenomics: One Nurse's Story.

The current article describes the experiences of a motivated nurse who gained an understanding of pharmacogenomics and advocated for the use cytochrome P450 testing for patients in her clinical practice, her family members, herself, and for changing the health care delivery system to more readily recognize and address drug-metabolizing-enzyme abnormalities. Recommendations for nurses interested in promoting the use of pharmacogenomics include learning as much as possible about testing and implications, networking with other providers, identifying a knowledgeable pharmacist, assessing for a family history of problems with medication side effects or lack of efficacy, and keeping records of relevant medical and medication information to share with providers. [Journal of Psychosocial Nursing and Mental Health Services, 54(7), 38-42.].

Nurses' attitudes, abilities and educational preference related to using family pedigrees in clinical practice.

There is growing worldwide interest in using family pedigrees to assess health risks for diseases and implementing potential preventive interventions for health promotion. Nurses have been identified as key professionals in the process of collecting family history information and constructing pedigrees, and there is a gap in the literature related to these activities. The purpose of this study was to determine nurses' knowledge about, attitudes towards, perceived ability to use, and educational preference related to inclusion of family pedigrees in clinical practice. The study utilized a survey method with 174 nurses and correlational descriptive design. Results showed 74% of the nurses were interested in learning about family pedigrees and 64% responded positively to including them in clinical practice with the belief by 88% that they are helpful for preventive health care. Findings may be used to advance education and utilization of family pedigrees for nurses in clinical practice.

Nurses' perceived benefits, barriers, and educational recommendations for using family pedigrees in clinical practice.

BACKGROUND: There is growing emphasis on the use of genetics and genomics, including family pedigrees, in nursing education. This study explored nurses' perceptions of the benefits, barriers, and educational recommendations related to family pedigrees. METHODS: A qualitative design using focus group methods was used to gather data from a convenience sample of 28 nurses working at a large medical center in the Midwestern United States. RESULTS: Nurses believed that factors supporting the use of family pedigrees are clearly identified patient benefits, an electronic tool initiated in primary care, and use by multiple disciplines. Barriers include lack of ongoing support and possible ethical, legal, social, and cultural issues. Educational recommendations include clinically relevant patient and family decision making regarding care. CONCLUSION: These nurses had positive perceptions of the use of family pedigrees in clinical nursing practice. They identified a need for education and stressed the importance of specialty-specific case examples to maximize relevance.

Enhancing safety in behavioral emergency situations.

The implementation of a behavioral emergency response team (BERT) at a large midwestern health care organization is described. The BERT is a resource supporting nurses and other health care staff in managing behavioral emergencies. The Joint Commission (2010) reported an increasing rate of violence by patients toward health care staff, reinforcing a need for the BERT. No published reports were found in the literature of a BERT utilizing multidisciplinary mental health experts and security officers as responders. Development strategies, response data, and outcomes of this successful initiative are highlighted.

Use of genomic assessments and interventions in psychiatric nursing practice.

The purpose of this study was to determine the impact of a genomic educational session by measuring participants' application of the class content to their nursing care. A sample of 65 psychiatric nurses participated in a staff development activity and completed a survey. Every respondent reported use of a genomic assessment or intervention with a patient from their clinical practice. The mean use of genomic assessment and intervention items was 5.5 out of the possible 10 which were identified and described in the educational session, providing evidence that nurses are able to include genomic assessments and interventions when caring for a patient with a psychiatric disorder.

Are you including genomics in nursing practice?

A national consensus panel representing 48 nursing organizations, including the American Psychiatric Nurses Association, identified and endorsed essential genetic and genomic competencies for all registered nurses regardless of academic preparation, role, or clinical specialty. The competencies were designed to guide academic curricula, continuing education, and specialty certification. A 5-year implementation plan for these competencies includes components applicable to practicing psychiatric nurses, regulatory and quality control issues, and academics. This article will describe the implementation strategies identified, some examples of genetics and genomics nursing activities in the psychiatric specialty, and recommendations that support the national implementation plan. J Am Psychiatr Nurses Assoc, 2008; 14(1), 63-68. DOI: 10.1177/1078390307311974.

Cytochrome P450 testing for better psychiatric care.

Genotyping for CYP2D6 and CYP2C19 variations is emerging as a potentially useful clinical tool to help mental health professionals prescribe psychiatric medications for their patients. Cytochrome P450 testing uses a blood sample to determine an individual's required dosage of identified drugs that are metabolized by the two enzymes. To provide care for patients and families, nurses should be able to demonstrate identified essential nursing competencies related to genetics and genomics, which include an understanding of cytochrome P450 testing. As patient advocates, nurses are expected to understand how to identify patients most likely to benefit from CYP2D6 and CYP2C19 testing, how to ensure informed consent for such testing, and how to educate patients about testing and test results.

International collaboration on genomics education for nurses.

The International Society of Nurses in Genetics began in 1988 as a venue for nurses around the world to advance their knowledge and practice related to genomics. This article discusses how the organization has conducted an annual international nursing conference, promoted the incorporation of genomics topics into continuing education programs and professional nursing journals, assisted with the incorporation of genomics content into undergraduate and graduate nursing curricula, and defined genetics as a clinical nursing specialty. Genomics education is relevant to nursing practice in all specialty areas and significant to the future of health care.

Genomics education for nurses in practice.

Genomics information will make it possible to identify individuals who have, or are at risk to develop, health problems and to diagnose and treat them in ways that until recently were not possible. The majority of nurses in practice today do not have adequate knowledge about genomics. This article describes a diverse and extensive education program initiated to provide information to nurses. Important aspects to consider for all nursing genomics education programs are that they need to be relevant to practice, multifaceted, and ongoing as information continues to unfold about the human genome and application to healthcare.