Home care for patients with opioid use disorders: A qualitative study of registered nurses' experiences of pain management.

AIM: To explore registered nurses' experiences with pain management in patients with opioid use disorder (OUD) in home care. DESIGN: Qualitative explorative-descriptive design. METHODS: Data were collected via nine individual semi-structured interviews with registered nurses working in home care meeting patients with OUD. Data were analysed using systematic text condensation. RESULTS: Three categories were identified: Reciprocity in relationships and a professional approach enhance pain management; Discrepancies between guidelines, patient-reported pain and RNs' observations challenge pain management; and Interprofessional collaboration makes or breaks pain management.

Impact of the COVID-19 Pandemic on Functions of Nursing Professionals in the Care of Opioid Use Disorder: Systematic Review.

BACKGROUND: Nursing professionals are vitally involved in the cascade of care for opioid use disorders (OUDs). The global spread of COVID-19 has had complex effects on public health aspects of major diseases, including OUDs. There are limited data on the major ways in which the COVID-19 pandemic has affected the functions of nursing professionals in the care of OUDs. METHOD: This systematic review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and examined published data for trends in OUD care during the first 2 years of the COVID-19 pandemic, focusing on nursing functions. The National Library of Medicine PubMed database and the EMBASE database were examined for peer-reviewed studies with primary data published between January 1, 2020, and December 31, 2021. REVIEW FINDINGS AND CONCLUSIONS: Rapid changes were observed in numerous aspects of OUDs during the early pandemic stage, as well as its care by nursing and other health professionals. These changes include increased overdoses (primarily from synthetic opioids such as fentanyl) and emergency department visits. These trends varied considerably across U.S. jurisdictions, underscoring the importance of region-specific examinations for public health policy and intervention. Out of necessity, healthcare systems and nursing professionals adapted to the challenges of OUD care in the pandemic. These adaptations included increases in telehealth services, increases in take-home doses of methadone or buprenorphine/naloxone, and expansion of layperson training in the use of naloxone for overdose reversal. It is likely that some of these adaptations will result in long-term changes in standards of care practices for OUDs by nursing professionals.

A qualitative exploration of the use of telehealth for opioid treatment: Implications for nurse-managed care.

AIM: To characterise experiences with telehealth for Medications for Opioid Use Disorder (MOUD) services among patients, prescribers, nurses and substance use counsellors to inform future best practices. DESIGN: We engaged a qualitative descriptive study design. METHODS: Semi-structured interviews were conducted with prescribers (nurse practitioners and physicians, n = 20), nurses and substance use counsellors (n = 7), and patients (n = 20) between June and September 2021. Interviews were verbatim transcribed. Thematic analysis was conducted using a qualitative descriptive method. RESULTS: Among both providers and patients, four themes were identified: (1) Difficulties with telehealth connection (2) Flexibility in follow-up and retention, (3) Policy changes that enabled expanded care, (4) Path forward with telehealth. Two additional findings emerged from provider interviews: (1) Expansion of nurse-managed office-based opioid treatment, and (2) Novel methods to engage patients. CONCLUSIONS: Patients and providers continued to view telehealth as an acceptable means for delivery and management of MOUD, particularly when utilised in a hybrid manner between in-person visits. Nurse-managed care for this service was evident as nurses extended the breadth of services offered and utilised novel methods such as text messages and management of 'call-in' lines to engage patients. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Use of telehealth for MOUD should be incorporated into practice settings to reach patients in a flexible manner. Nurses in particular can use this medium to extend office-based opioid treatment by conducting assessments and expanding capacity for other wrap-around services. IMPACT: We identify recommendations for best practices in the use of telehealth for opioid use disorder management and highlight the value of nurse-managed care. REPORTING METHOD: The consolidated criteria for reporting qualitative research. PATIENT OR PUBLIC CONTRIBUTION: Patients with opioid use disorder and prescribers with experience using telehealth were interviewed for this study.

Pandemic-Related Disruptions in Nursing Education: Zooming Out for an Innovative Interprofessional Simulation.

When the COVID-19 global pandemic began, many higher education systems had to restructure their educational delivery system and transition to online learning. This posed a challenge for students in health professions education programs as it impacted their ability to participate in hands-on learning regarding patient care. As a result, the University of Cincinnati College of Nursing developed and implemented simulation-based learning experiences to allow graduate-level social worker, counselor, and psychiatric-mental health nurse practitioner students the opportunity to learn as an interdisciplinary team in a virtual format. The Opioid Use Disorder Simulation Case Study discussed in this article was developed as part of the Serving At-risk Youth Fellowship Experience Training program with the overarching aim to prepare culturally competent providers to deliver direct patient care and education around prevention and recovery services to individuals with substance use disorders.

COVID-19 and opioid use disorder: Expanding treatment access in rural settings.

ABSTRACT: Substance use treatment inequities among rural populations are well documented and the COVID-19 pandemic has exacerbated these inequalities, forcing healthcare providers to be creative in the delivery of treatment. Systematic reviews on the use of telehealth to treat patients with substance use disorder indicate that it is a promising alternative to in-person services. This article examines the evidence supporting the use of telehealth in treating patients with opioid use disorder and explores other promising options that can help overcome pandemic-related barriers to treatment.

Expanding access to nurse-managed medication for opioid use disorder.

BACKGROUND: Advanced practice registered nurses (APRNs) are increasingly caring for individuals with opioid use disorder. Advances have been made to increase APRN education, outreach, and prescribing privileges, but as demand for medication for opioid use disorder (MOUD) grows, evidence suggests that policy and care barriers inhibit the ability of APRNs to support MOUD. PURPOSE: This paper highlights the significant challenges of expanding access to buprenorphine prescribing by APRNs. FINDINGS: Barriers and recommendations were derived from the culmination of literature review, expert consensus discussions among a diverse stakeholder panel including patient representatives, and feedback from community webinars with care providers. DISCUSSION: We provide an overview of existing care barriers, promising practices, and proposed recommendations to enhance the care of individuals and communities with opioid use disorder.

Understanding ED Buprenorphine Initiation for Opioid Use Disorder: A Guide for Emergency Nurses.

Opioid use disorder is a critical public health problem that continues to broaden in scope, adversely affecting millions of people worldwide. Significant efforts have been made to expand access to medication therapy for opioid use disorder, in particular buprenorphine. As the emergency department is a critical point of access for many patients with opioid use disorder, the initiation of buprenorphine therapy in the emergency department is increasing, and emergency nurses should be familiar with the care of these vulnerable patients. The purpose of this article is to provide a clinical review of opioid use disorder and opioid withdrawal syndrome, medication treatments for opioid use disorder, best clinical practices for ED-initiated buprenorphine therapy, assessment of withdrawal symptoms, discharge considerations, and concerns for special populations. With expanded understanding of opioid use disorder, withdrawal, and available treatments, emergency nurses will be better prepared to deliver and support life-saving treatments for patients and families suffering from this disease. In addition, emergency nurses are well positioned to play an important role in public health advocacy around opioid use disorder, providing critical support for destigmatization and expanded access to safe and efficacious treatments.

Increasing Access to Buprenorphine in Safety-Net Primary Care Clinics: The New York City Buprenorphine Nurse Care Manager Initiative.

The Buprenorphine Nurse Care Manager Initiative (BNCMI) sought to increase access to opioid use disorder treatment in underserved New York City populations by expanding buprenorphine treatment capacity in safety-net primary care clinics.During 2016 to 2020, BNCMI added 116 new buprenorphine providers across 27 BNCMI clinics, and 1212 patients were enrolled; most patients identified as Latinx or Hispanic and were Medicaid beneficiaries.BNCMI increased access to buprenorphine, reached underserved populations, and is part of the New York City Health Department's multipronged approach to reducing opioid overdose deaths.

Opioid training development: Cultivating nurse competence through education.

TOPIC: Mental illness and substance use have become areas of concern throughout society. One of the greatest concerns affecting the United States is the increased prevalence of opioid use and accidental overdose. The opioid epidemic not only impacts adults, it also affects the nation's most vulnerable youth. Children and adolescents are at high risk for substance abuse due to multiple risk factors including negative life events, family dysfunction, and parental substance abuse. PURPOSE: Pediatric nurses must be prepared to care for children and families who experience opioid addiction and overdose. The aim of the quality improvement project was to improve the skill set of nurses working with children and adolescents with substance use disorders (SUDs) in a pediatric psychiatric hospital. SOURCES USED: Nurses attended a 2-hr workshop focused on nursing interventions related to SUD utilizing Orlando's Nursing Theory and Brief Intervention Therapy. Following the workshop, nurses reported their perceived competence in caring for individuals at risk for or identified with SUD increased. CONCLUSION: The workshop appeared to be effective in increasing nurses' competence and confidence if working with youth and their families dealing with substance use issues.

Opioid use disorder education for acute care nurses: An integrative review.

AIMS AND OBJECTIVES: The purpose of this study was to explore opioid use disorder (OUD) education programmes presented to practicing nurses working in medical-surgical settings and identify the methods used to evaluate their effectiveness. BACKGROUND: Health professionals often express negative attitudes towards patients with OUD which can lead to suboptimal care. Education decreases negative attitudes of healthcare workers. Despite this, few educational programmes are offered to promote knowledge among acute care nurses who work in medical-surgical settings and provide care to patients with OUD. DESIGN: An integrative review. METHODS: The framework by Whittemore and Knafl was used to examine empirical literature between 1995-2019 to answer the research questions, (a) What types of education do acute care nurses receive regarding OUD? (b) What methods are used for measuring educational intervention effectiveness? CINAHL, ERIC, PsycINFO and MEDLINE were searched using combinations of search terms and PRISMA guidelines. The initial 394 articles were narrowed to nine from the United States and Australia that met the search criteria and purpose of the review. RESULTS: Educational programmes used to promote knowledge included interactive workshops, case studies, online modules, simulation sessions, real-time coaching and in-service trainings. Methods used to measure effectiveness of educational interventions were self-assessment tools that measured pre/postknowledge, attitude surveys, alcohol and drug scales and individual researcher-developed instruments. CONCLUSIONS: Additional research is needed to determine best teaching strategies for increasing knowledge of OUD and OUD patient care. Valid and reliable methods for measuring effectiveness of OUD educational interventions are inadequate. RELEVANCE TO CLINICAL PRACTICE: Knowledge of OUD has been linked to positive patient outcomes and nurses would benefit from up-to-date educational offerings. Opioid use disorder is a growing global concern. Translation of current OUD nursing science to acute care nurses would promote health equity in practice for individuals with OUD.

Opiate Addiction and the NICU: A Mom's Story That Changes Stereotypes.

Opioid addiction and the NICU are common themes in the news. Yet, we never hear from the mothers in these situations. I interviewed Victoria, a Mom who had an addiction and had desperately wanted to be clean. She got pregnant and was desperate to help her baby not have the same affliction. Enter the ICON (Improving Care for the Opiate-exposed Newborn) program, which not only turned her life around but gave her son a chance at a normal life. The ICON program changes the stereotype of the addicted mother in the NICU for the better. We all have something to learn here.

Implementing an Unfolding Case Study Throughout the Nursing Curriculum to Increase Opioid Addiction Education.

BACKGROUND: Opioid use disorder (OUD) will touch the careers of future generations of nurses no matter their chosen setting of work. It is critical to incorporate OUD education into the nursing school curriculum to prepare these future nurses. METHOD: Research has shown that the unfolding case study is a beneficial pedagogical modality. It allows for the building of new information and the expansion of critical thinking by encouraging the student to assess and ask questions to receive further information. RESULTS: An unfolding case study was created that centered on a person who develops OUD and their family. It includes simulations, activities, and discussion topics. CONCLUSION: The unfolding case study can be integrated throughout the undergraduate curriculum from assessment to critical care. The unfolding case study can continue into the graduate program, which allows for interdisciplinary use. [J Nurs Educ. 2020;59(4):235-238.].

The 21st Century Opioid Addiction: A Concept Analysis and Implications for Nursing.

INTRODUCTION: Opioid addiction is a mounting problem and concern in all parts of the world. Drug overdose related to opioid addiction was the leading cause of accidental death in the United States in 2015; this extends to people across all ages, races, genders, and socioeconomic statuses. It is estimated that 21 million Americans aged 12 years or older has one form of substance use disorder, of which 2 million involves the use of prescription pain relievers. The cost of opioid misuse is estimated to be $78.5B based on 2013 data. This amount has exponentially increased more than $20 billion per year compared with 6 years ago. PURPOSE: We conducted a concept analysis of opioid addiction in the 21st century and present its implications for nursing. METHODS: Walker and Avant's eight steps for analyzing a concept were utilized. RESULTS: Uses of opioid addiction from the perspectives of healthcare, sociology, law, and economics are presented. Defining attributes of opioid addiction based on review of the literature include physical dependence to opioids, psychological craving for opioids, habitual use, and lack of self-control. Antecedents, consequences, and empirical referents are also identified. Model, related, and contrary cases are developed. CONCLUSION: This concept analysis article enhances understanding of the current opioid addiction crisis that is affecting the country. IMPLICATIONS TO NURSING: Nurses are in a position to play critical roles in the fight against opioid addiction. Nursing opportunities exist starting from the bedside and can reach up to the White House.

The Advantages and Disadvantages of Medication-Assisted Treatment in Primary Care Offices.

Substance use disorder (SUD), more specifically opioid use disorder, is a national epidemic. Although there is an emphasis on treatment and increasing treatment locations, there continues to be a gap between the number of people with SUD and the number of treatment centers. To help narrow this gap, some primary care clinicians started providing medication-assisted treatment (MAT) on an outpatient basis in their offices. This option enables clinicians to provide treatment in their own communities, which increases access to treatment and decreases costs. It also enables the clinician and the person with SUD/opioid use disorder to build a relationship, which many clinicians believe is the foundation of successful treatment. The clinician, whether a doctor, a physician assistant, or an advanced practice nurse, has to obtain a Drug Addiction Treatment Act 2000 waiver to provide MAT beyond naltrexone, which has a required educational program and includes a limitation on the number of clients. Conversely, a possible drawback to this type of treatment is the potential for the disruption of continuity of care with regard to psychotherapy treatment. Federal law mandates that therapy is available and provided to people receiving MAT. The clinician may not be able to provide this service and would need to refer the person with SUD for psychotherapy treatment. It may be clinically significant for a type of follow-up communication to be implemented so that the clinician and the therapy provider can maximize SUD treatment success.