The Attending Nurse: An Evolving Model for Integrating Nursing Education and Practice

The discipline of nursing continues to evolve in keeping with the dramatic expansion of scientific knowledge, technology, and a concomitant increase in complexity of patient care in all practice settings. Changing patient demographics require complex planning for co-morbidities associated with chronic diseases and life-saving advances that have altered mortality in ways never before imagined. These changes in practice, coupled with findings from sophisticated nursing research and the continuous development of new nursing knowledge, call for realignments of the relationships among academic faculty in schools of nursing, advanced practice nurse administrators, and staff nurses at the forefront of practice. This article offers a model designed to bridge the gaps among academic settings, administrative offices and the euphemistic “bedsides” where staff nurses practice. Here we describe the nurse attending model in place at the New York University Langone Medical Center (NYULMC) and provide qualitative data that support progress in our work

Identified gaps and opportunities in perinatal healthcare delivery for women in treatment for opioid use disorder.

Pregnancy and the delivery of an infant mark a unique time of engagement in healthcare for women in treatment for opioid use disorder (OUD). The American College of Obstetrics and Gynecology calls for a comprehensive approach to perinatal healthcare delivery for pregnant women with OUD in order to facilitate improved health outcomes and increase patient-provider collaboration. Yet, there is little knowledge regarding the perceptions of women with OUD regarding the current delivery of healthcare which could inform a personalized, tailored approach to perinatal healthcare delivery. Methods: Four focus groups consisting of 22 women with OUD were conducted, transcribed, and analysed using qualitative thematic analysis methodology. Results: Women reported an overall lack of preparation for the birth and neonatal healthcare experiences and identified opportunities for greater support by the healthcare team. Women emphasized the desire for evidence-based preparation from trusted sources about delivery, neonatal abstinence syndrome, breastfeeding, and how their medications affect their pregnancy and baby. Women reported receiving a varied amount of support from healthcare providers in their transition to motherhood, but women predominantly reported receiving emotional and informational support from their mothers and partners. Conclusions: The knowledge obtained in this study points to gaps in perinatal healthcare delivery for women with OUD. Improving the delivery of perinatal healthcare may contribute to increased engagement by women with OUD, and ultimately improve outcomes for a vulnerable population

Substance Use Among Older People Living With HIV: Challenges for Health Care Providers

Older people living with HIV (OPLWH) have higher rates of substance use (tobacco, alcohol, and other drugs) than their HIV-negative peers. Addressing health care needs of OPLWH who use substances is more challenging than for those who do not: they are highly impacted by comorbid conditions, substance use can interact with other medications (including antiretroviral therapy-ART) and reduce their effectiveness, and substance use has been associated with reduced adherence to ART and increased risky behaviors (including sexual risks). People who use substances also suffer disparities along the HIV continuum of care, resulting in lower viral suppression rates and poorer health outcomes. They are especially impacted by stigma and stress, which have implications for HIV treatment and care. Recommendations for health care providers working with OPLWH who use substances include: (1) the need to screen and refer for multiple associated conditions, and (2) training/continuing education to enhance care management and maximize health outcomes

Consumo de álcool e qualidade de vida em idosos na saúde da família

O estudo tem como objetivo avaliar a associação entre o consumo de álcool e qualidade de vida em idosos. Trata-se de estudo transversal envolvendo idosos (n = 593), usuários de unidades básicas de saúde. Foram utilizados os instrumentos Alcohol Use Disorders Identification Test-Consumption para avaliar o consumo de álcool e World Health Organization Quality of Life-Bref para avaliar a qualidade de vida. Regressão logística foi utilizada para verificar associação entre consumo de álcool e variáveis independentes; e técnica de análise de agrupamentos para análise de possíveis grupos homogêneos entre idosos com rastreamento positivo para alcoolismo e qualidade de vida. Foi encontrado prevalência de consumo de bebida alcóolica de 8,9%. As variáveis escore Qualidade de Vida Geral 60, depressão e faixa etária 70 a 79 anos mantiveram associação significativa com o desfecho. Obteve-se dois grupos homogêneos distintos dispostos em cinco subgrupos. Estratégias de enfrentamento devem ser contempladas nos planos de ações das políticas públicas e alerta metodológico na forma de expor a variável alcoolismo é necessário

Competencies for nursing care of patients with substance related disorders

Enfermeros y parteras, que constituyen el mayor grupo de profesionales de la salud, prestan atención básica y especializada en todo el mundo. Poseen potencial único con vistas a intervenciones en casos de uso, abuso y dependencia de drogas. Sin embargo, pocos entre ellos prestan ese tipo de atención porque, en su educación básica, faltaron informaciones y enseñanza clínica sobre el uso de drogas, tratamiento de dependencias y salud. Este artículo identifica competencias de enfermería y sugiere estrategias para su desarrollo. El desarrollo de competencias entre profesionales generales y especializados debe ser basado en evidencias actuales de enfermería y otras áreas científicas, productos de investigaciones, declaraciones de consenso y directivas. Son descritos ejemplos de intervenciones basadas en evidencias. Para fines de este artículo, el alcohol es identificado como tal, y drogas se refiere a la nicotina, drogas ilícitas y prescritas.Enfermeiros e parteiras, que constituem o maior grupo de profissionais da saúde, prestam assistência básica e especializada ao redor do mundo. Têm potencial único com vistas a intervenções em casos de uso, abuso e dependência de drogas. Contudo, poucos entre eles prestam essa assistência porque, na sua educação básica, faltaram informações e ensino clínico sobre o uso de drogas, tratamento de dependências e saúde. Este artigo identifica competências de enfermagem e sugere estratégias para seu desenvolvimento. O desenvolvimento de competências entre profissionais gerais e especializados deve ser baseado em evidências atuais de enfermagem e outras áreas da ciência, provenientes de pesquisas, declarações de consenso e diretrizes. São descritos exemplos de intervenções baseadas em evidências. Para fins deste artigo, o álcool é identificado como tal, e drogas diz respeito à nicotina, drogas ilícitas e prescritas.Nurses and midwives, the largest group of providers, deliver basic and specialty healthcare worldwide. They are uniquely positioned to deliver interventions for drug use, abuse and dependence. Few provide such care however, because their basic educations lacked information and clinical teaching on drug use, treatment of addictions and health. This paper identifies nursing competencies, and gives suggestions for strategies for their development. Competencies development for nurse generalists and nurse specialists should be based on current nursing and other scientific evidence from research studies, consensus statements and practice guidelines. Exemplars of evidence based interventions are described. For purposes of this paper, alcohol is identified as such; drugs refers to nicotine, illegal and prescription drugs

Implementation of the High-Risk Alcoholism Relapse Scale in a Liver Transplant Clinic.

Because of the high prevalence of alcohol relapse after liver transplantation, transplant programs are challenged to evaluate alcoholism among liver transplant patients. Relapse after liver transplantation can have detrimental outcomes such as organ rejection, medical and social resource exhaustion, financial burden to the family and society, and negative public perception of organ transplantation. The purpose of this project was to improve post-liver transplant assessment for the risk of relapse to heavy alcohol use by implementing a protocol using the High-Risk Alcoholism Relapse (HRAR) scale (DiMartini et al., 2000; Yates et al., 1993). The project was conducted in an urban organ transplant center's outpatient post liver transplant clinic. Chart reviews assessed the process of patients identified as being at high risk and the transplant providers' completion of the HRAR scale. Eleven percent of patients assessed were identified as being at high risk for relapse of heavy alcohol use and 85% of providers used the HRAR scale in their clinic interviews. This project demonstrates that further refinements in techniques of predicting the risks of relapse are necessary, and nurses are in ideal positions to screen patients for alcohol use

Opioid Misuse Epidemic: Addressing Opioid Prescribing and Organization Initiatives for Holistic, Safe, and Compassionate Care

The U.S. Centers for Disease Control (CDC) (2016a) state that the misuse and illicit use of prescription analgesic drugs and use of heroin have skyrocketed to epidemic proportions. Former Surgeon General Vivek Murtha’s report, Facing Addiction in America (2016) notes that 12.5 million Americans use opioid pain relievers in ways other than those intended by prescription (USHHS, 2016). Notably, about 61% of the US drug overdose deaths in 2014 involved an opiate (Rudd, Seth, David, & Scholl, 2016). To address the opioid crisis requires the coordinated responses of all health care providers. Multiple disci- plines and professional nursing organizations have recommended strategies and published policy state- ments. Efforts to stem the opioid crisis include the development of provider education and dissemination of opioid prescribing guidelines, protocols for adher- ence to these guidelines, effective use of non-opioid treatment modalities for chronic pain, and initiatives to increase access to opioid addiction treatment. Nursing leadership in these initiatives must be broad based and unequivocal in order to engage all levels of the nursing workforce and to promote collaboration among organizations and agencies

Electronic Nicotine Delivery Systems (ENDS): What Nurses Need to Know

BACKGROUND: Efforts to decrease adverse effects of tobacco use are affected by emergence of new nicotine delivery products. Advertising, product promotion, and social media promote use of these products, yet a lack of evidence regarding safety leaves nurses unprepared to counsel patients. OBJECTIVES: To critically evaluate current research, reviews of literature, expert opinion, and stakeholder policy proposals on use and safety of electronic nicotine delivery systems (ENDS). DESIGN: A targeted examination of literature generated by key stakeholders and subject matter experts was conducted using key words, modified by risk factors, and limited to the past 8 years. RESULTS: Current knowledge gaps in research literature and practice implications of the literature are discussed. CONCLUSIONS: The safety of ENDS is questionable and unclear. There are clear health risks of nicotine exposure to developing brains. Potential health risks of ENDS secondhand emissions exposure exist. Using ENDS to facilitate total tobacco cessation is not proven