It can be difficult for nurses to know how to best care for patients who are recovering from addiction. In order to provide the best possible care, it is important to ask the right questions. In this blog post, we will discuss five questions that every nurse should ask patients in addiction recovery.
Addiction is a complex disease that affects people in many different ways. Before we get into the questions let’s cover some signs of early addiction recovery. Early addiction recovery is a time when patients are learning how to cope with their sobriety and make lifestyle changes. They may still be adjusting to life without drugs or alcohol and may be dealing with the trauma they had been trying to erase, signs of this are:
Anxiety
Depression
Irritability
Insomnia
Fatigue
While yes, treating individuals possibly going through such emotional instability can be infuriating, nurses must remember to put themselves in the shoes of the patient and not single them out. If any of these signs are noticeable in the patients, it is important to ask questions and get to the root of the problem. Here are five questions that every nurse should ask patients in addiction recovery:
1. Are you suffering from any withdrawal symptoms?
It is important to ask this to gauge how long they have been sober and if this could be why the patient is seeking medical attention. Symptoms of withdrawal are:
Cold sweats
Body pain
Fatigue
Headaches
Insomnia
Irritability
If the patient is displaying any of these symptoms, it is important to ask follow up questions about what makes them feel better or worse and if they have ever went to rehab and experienced withdrawal before. It is also crucial to know if the patient has detoxed before and if so, how long ago that was.
2. What is your typical daily routine?
By getting an understanding of what the patient’s day looks like, nurses can better understand if there is something about their regular schedule that could be causing the medical issue.
3. Do you have any triggers that make you want to use drugs or alcohol?
If the patient is aware of their triggers, they can be more mindful of avoiding them. However, if the patient is not aware of their triggers, this question can open up a dialogue about what may cause a relapse. It also helps nurses know what procedures or comments to avoid when treating the patient. Some triggers could be:
Someone screaming in pain
Seeing a needle
Being around people who are ingesting drugs
Feeling stressed or anxious
3. Do you have any other medical conditions that we should be aware of?
Many times, patients in addiction recovery are also dealing with other medical issues. It is important for nurses to be aware of these conditions so that they can better treat the patient as a whole. Common medical conditions individuals in recovery also have:
PTSD
Depression
Chronic pain
Heart disease
Lung disease
Anxiety
4. What are your thoughts on your current treatment plan?
This question allows nurses to gauge how well the patient is responding to their current treatment. If the patient is not receptive to their treatment plan, it may be necessary to make changes. However, if the patient is doing well, this question can help nurses understand what is working and why.
Nurses play a vital role in the addiction recovery process. As an individual on the front lines nurses have a unique opportunity to help patients in a way that other health care professionals cannot. By asking these five questions, nurses can gain valuable insights into the lives of their patients and help them on their road to recovery.
Four years ago, when Karen Giuliano, Ph.D., MSN, MBA, FAAN went to a Boston hospital for hip replacement surgery, she was given a pale-pink bucket of toiletries issued to patients in many hospitals. Inside were tissues, bar soap, deodorant, toothpaste, and, without a doubt, the worst toothbrush she’d ever seen.
“I couldn’t believe it. I got a toothbrush with no bristles,” she said. “It must have not gone through the bristle machine. It was just a stick.”
To most patients, a useless hospital toothbrush would be a mild inconvenience. But to Giuliano, a nursing professor at the University of Massachusetts Amherst, it was a reminder of a pervasive “blind spot” in U.S. hospitals: the stunning consequences of unbrushed teeth.
Hospital patients not getting their teeth brushed, or not brushing their teeth themselves, is believed to be a leading cause of hundreds of thousands of cases of pneumonia a year in patients who have not been put on a ventilator. Pneumonia is among the most common infections that occur in health care facilities, and a majority of cases are non-ventilator hospital-acquired pneumonia, or NVHAP, which kills up to 30% of those infected, Giuliano and other experts said.
But unlike many infections that strike within hospitals, the federal government doesn’t require hospitals to report cases of NVHAP. As a result, few hospitals understand the origin of the illness, track its occurrence, or actively work to prevent it, the experts said.
When nurses help patients brush their teeth, it’s not just to give them “kissing fresh breath”
Many cases of NVHAP could be avoided if hospital staffers more dutifully brushed the teeth of bedridden patients, according to a growing body of peer-reviewed research papers. Instead, many hospitals often skip teeth brushing to prioritize other tasks and provide only cheap, ineffective toothbrushes, often unaware of the consequences, said Dian Baker, a Sacramento State nursing professor who has spent more than a decade studying NVHAP.
“I’ll tell you that today the vast majority of the tens of thousands of nurses in hospitals have no idea that pneumonia comes from germs in the mouth,” Baker said.
NVHAP is often caused by bacteria from the mouth that gathers on unbrushed teeth and is aspirated into the lungs. Patients face a higher risk if they lie flat or remain immobile for long periods, so NVHAP can also be prevented by elevating their heads and getting them out of bed more often.
Pneumonia occurs when germs trigger an infection in the lungs. Although NVHAP accounts for most of the cases that occur in hospitals, it historically has not received the same attention as pneumonia tied to ventilators, which is easier to identify and study because it occurs among a narrow subset of patients.
NVHAP, a risk for virtually all hospital patients, is often caused by bacteria from the mouth that gathers in the scummy biofilm on unbrushed teeth and is aspirated into the lungs. Patients face a higher risk if they lie flat or remain immobile for long periods, so NVHAP can also be prevented by elevating their heads and getting them out of bed more often.
According to the National Organization for NV-HAP Prevention, which was founded in 2020, this pneumonia infects about 1 in every 100 hospital patients and kills 15% to 30% of them. For those who survive, the illness often extends their hospital stay by up to 15 days and makes it much more likely they will be readmitted within a month or transferred to an intensive care unit.
John McCleary, 83, of Millinocket, Maine, contracted a likely case of NVHAP in 2008 after he fractured his ankle in a fall and spent 12 days in rehabilitation at a hospital, said his daughter, Kathy Day, a retired nurse and advocate with the Patient Safety Action Network.
McCleary recovered from the fracture but not from pneumonia. Two days after he returned home, the infection in his lungs caused him to be rushed back to the hospital, where he went into sepsis and spent weeks in treatment before moving to an isolation unit in a nursing home.
He died weeks later, emaciated, largely deaf, unable to eat, and often “too weak to get water through a straw,” his daughter said. After contracting pneumonia, he never walked again.
“It was an astounding assault on his body, from him being here visiting me the week before his fall, to his death just a few months later,” Day said. “And the whole thing was avoidable.”
“Could this be the tip of the iceberg? … Probably.”
While experts describe NVHAP as a largely ignored threat, that appears to be changing.
Last year, a group of researchers — including Giuliano and Baker, plus officials from the Centers for Disease Control and Prevention, the Veterans Health Administration, and the Joint Commission — published a “call-to-action” research paper hoping to launch “a national healthcare conversation about NVHAP prevention.”
The Joint Commission, a nonprofit organization whose accreditation can make or break hospitals, is considering broadening the infection control standards to include more ailments, including NVHAP, said Sylvia Garcia-Houchins, its director of infection prevention and control.
Separately, ECRI, a nonprofit focused on health care safety, this year pinpointed NVHAP as one of its top patient safety concerns.
James Davis, an ECRI infection expert, said the prevalence of NVHAP, while already alarming, is likely “underestimated” and probably worsened as hospitals swelled with patients during the coronavirus pandemic.
“We only know what’s reported,” Davis said. “Could this be the tip of the iceberg? I would say, in my opinion, probably.”
To better measure the condition, some researchers call for a standardized surveillance definition of NVHAP, which could in time open the door for the federal government to mandate reporting of cases or incentivize prevention. With increasing urgency, researchers are pushing for hospitals not to wait for the federal government to act against NVHAP.
Baker said she has spoken with hundreds of hospitals about how to prevent NVHAP, but thousands more have yet to take up the cause.
“We are not asking for some big, $300,000 piece of equipment,” Baker said. “The two things that show the best evidence of preventing this harm are things that should be happening in standard care anyway ― brushing teeth and getting patients mobilized.”
We know that brushing teeth + more mobility lowers infection rates
That evidence comes from a smattering of studies that show those two strategies can lead to sharp reductions in infection rates.
At Orlando Regional Medical Center in Florida, a medical unit and a surgical unit where patients received enhanced oral care reduced NVHAP rates by 85% and 56%, respectively, when compared with similar units that received normal care. A similar study is underway at two hospitals in Illinois.
And the most compelling results come from a veterans’ hospital in Salem, Virginia, where a 2016 oral care pilot program reduced rates of NVHAP by 92% — saving an estimated 13 lives in just 19 months. The program, the HAPPEN Initiative, has been expanded across the Veterans Health Administration, and experts say it could serve as a model for all U.S. hospitals.
Michelle Lucatorto, a nursing official who leads HAPPEN, said the program trains nurses to most effectively brush patients’ teeth and educates patients and families on the link between oral care and preventing NVHAP. While teeth brushing may not seem to require training, Lucatorto made comparisons to how the coronavirus revealed many Americans were doing a lackluster job of another routine hygienic practice: washing their hands.
“Sometimes we are searching for the most complicated intervention,” she said. “We are always looking for that new bypass surgery or some new technical equipment. And sometimes I think we fail to look at the simple things we can do in our practice to save people’s lives.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
In 2010, the American Heart Association (AHA) defined “Life’s Simple 7TM,” the seven health behaviors and factors people can improve to help achieve optimal cardiovascular health. And now they’re adding an eighth: sleep.
“Sleep is related to every single one of the other seven elements—it’s closely tied to weight, blood pressure, glucose metabolism, what we choose to eat,” said AHA president Dr. Donald Lloyd-Jones, chair of the department of preventive health at Northwestern University Feinberg School of Medicine. “But sleep is both correlated and also independent. There’s newer research that shows when we take the old seven and add sleep, we can predict cardiovascular disease and stroke even better.”
Now called “Life’s Essential 8TM,” the full list of the AHA’s important health factors includes blood pressure management, cholesterol control, blood sugar reduction, maintaining a healthy weight, increased physical activity, healthier eating, avoiding nicotine in all forms, and now sleep duration.
Although some individuals have a harder time modifying their sleep hygiene, such as those working two jobs or on the night shift, Lloyd-Jones said an important contributor to better cardiovascular health is focusing on ways to get the healthiest amount of sleep (seven to nine hours a night on average) by avoiding caffeine, screens and bright light for several hours before bedtime, putting away your phone and creating a more regular schedule.
A paper on Life’s Essential 8 and the status of cardiovascular health in U.S. adults and children will be published June 29 in Circulation, the flagship journal of the AHA.
“Healthier kids become healthier adults”
A key focus of the re-invigorated list of risk factors is the importance of measuring and monitoring children’s cardiovascular health and learning how to maintain it as they age, Lloyd-Jones said.
“When we create healthier kids, they become healthier adults who then go on to have healthier pregnancies, and the benefits continue with their kids being healthier simply because their parents were healthier,” Lloyd-Jones said. “We get this virtuous cycle of improvement of cardiovascular health generation by generation.”
Additional research published online in Circulation at the same time evaluated the cardiovascular health of U.S. children and adults. Those results showed that as U.S. children ages 2 to 5 grew into the 12- to 19-year-old age group, the healthy diet score fell markedly from 61 to 28 (out of 100 possible points).
“We’re losing a lot of cardiovascular health in the eating patterns as our kids age into later childhood and adolescence,” Lloyd-Jones said. “That doesn’t have to be, but we’re not serving them well…pun intended.”
He said school food programs focused on healthier eating, improving the health of our food supply, helping children choose water over sugary drinks and taxing sugar-sweetened beverages are proven strategies the U.S. can be taking to maintain and improve cardiovascular health in children.
2,500 scientific papers since 2010
The introduction of “Life’s Simple 7” in 2010 was novel, Lloyd-Jones said.
“No one had really tried to quantify health as a concept before that, and it’s been transformative for public health advocacy and for individuals to think about their long-term health,” said Lloyd-Jones, who also is a Northwestern Medicine cardiologist.
Since 2010, more than 2,500 scientific papers have been published about the AHA’s cardiovascular health construct and what it means for improving lifelong health.
“We’ve learned a ton about how important it is to have higher cardiovascular health at every stage of life,” he said. “It affects your risk of stroke, heart attack, cancer, dementia, cognitive functioning, pretty much everything we care about.”
This “cutting-edge research” has paved the way for adding the eighth element of sleep.
More sensitive tools to measure heart health
Also, since 2010 scientists have developed more sensitive tools to determine a person’s cardiovascular health, such as better questionnaires that measure eating patterns in different populations (i.e. the DASH diet versus the Mediterranean diet), Lloyd-Jones said. The new scoring system, he explained, will also better give credit to people who are working to improve their cardiovascular health—something the old scoring system did not do well.
Two elements that affect cardiovascular health are not included in the measurement system: social determinants of health and psychological health characteristics such as optimism, purpose in life, environmental mastery, perceived reward from social roles and resilient coping. Scientists also now know more about how social determinants of health (education, neighborhood environment, community, economic security, access to health care) can affect people’s opportunity for better cardiovascular health. Lloyd-Jones said while policymakers, clinicians and individuals should be mindful of these elements, they’re difficult to quantify and are, therefore, not part of the list of Life’s Essential 8.
Nurse of the Week May Parsons – who delivered the world’s first Covid jab on December 8, 2020 – was among the recipients of the George Cross Award at Windsor Castle (a setting also calculated to cast the White House in the shade) on Tuesday. The award, created by King George VI to recognize brave civilians in WWII Britain, was bestowed in honor of UK health care providers’ “courage, compassion, and dedication in circumstances of extreme danger.” In addition to Parsons, the award was also presented to her sister and fellow nurse Joanna Hogg, the first person in Northern Ireland to receive the vaccine and one of the first nurses to administer the life-saving shots.
Parsons recently earned an MSc in Global Healthcare Management at the Coventry University School of Nursing Midwifery and Health and is a Modern Matron for Respiratory at University Hospitals Coventry and Warwickshire Trust. She moved to the UK from the Philippines in the early 00s and has been a nurse in the UK Midlands district for about 18 years.
A shot seen round the world
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When her turn in the spotlight arrived in late 2020, the Coventry nurse found out just a day before her big moment. And initially, she said, “I assumed it [the shot] was going to be the first in the West Midlands. I didn’t realize until afterward that it was the first in the country, never mind the world!”
The choice of Parsons was apropos. As a committed participant in her hospital’s flu Peer Vaccinator program, she held a three consecutive year record for having administered more flu jabs than any other person on the staff, with a personal best in which she vaccinated 140 patients in a single day.
Parsons put her one-day warning about the history-making shot to good use. The person scheduled to receive the world’s first Covid jab was 90-year-old Margaret Keenan, so Matron Parsons visited her patient and tried to put her at ease before she bared her arm to the needle for the world to see. She told a Royal College of Nursing reporter, “I went to see Margaret to build a rapport with her, making sure that she was aware the vaccine was new, and that there’d be a lot of press there.” Parsons added little comforting touches the next day as well, encouraging Keenan to wear her favorite color and helping her get her hair right before meeting the cameras. She recalled, “She [Keenan] was keen to have it – she wanted to get back to normal, see her grandchildren and the rest of her family.”
“It’s all about integrity”
After the momentous public jab, Parsons dove into the Midlands rollout of the Covid-19 vaccine, “managing the vaccination hub – the flow, mixing the vaccine,” as well as “staffing – recruiting people, training them, making sure they’re assessed properly and have the right information to give to patients.”
As a nurse, her role in encouraging vaccination seems obvious to her. “As a nursing profession, we have a relationship with patients where they trust us. It’s important for the rollout because we want them to be able to say, ‘Tell me straight, what will this do to me?’ I say to my family: I’m not going to tell you to have it if I wouldn’t have it myself. It’s all about integrity.”
Like New York’s Sandra Lindsay, who received the first US Covid jab six days after her, Margaret Keenan has persistently failed to experience frightening or bizarre side effects from her historic jab. She has apparently not been surveilled via a sinister 5G network courtesy of Bill Gates, and her grandchildren must have been dismayed to learn that magnetic toys did not adhere to her skin. Instead, when she got her booster last September, Keenan, now 91 years old, enjoyed her moment of fame and expressed immense relief to see the efficacy of the vaccines.
After she and her famous nurse reunited for their booster shots and enjoyed their first hug, Keenan remarked, “I’m happy now that I can be free, it’s like the good old times. It was great to have May here, we have become a double act! It was such big news all around the world.” Then, with a lack of sympathy one might expect from a woman who never feared that forks and spoons might suddenly start sticking to her arms, she added, “Go and get the jab, it will save lives. I don’t really know what stops people from having it because it’s so quick. Do go and get your vaccination!”
Nurses who think tapering opioid patients entails a long period of Defcon 2 or 3 vigilance now have more data to support that position.
Researchers from the UC Davis Center for Healthcare Policy and Research conducted a 10-year study to examine the potential long-term risks of opioid dose tapering. They found that patients on stable but higher-dose opioid therapy who had their doses tapered by at least 15% had significantly higher rates of overdose and mental health crisis in the second year after tapering compared to their pre-tapering period.
Opioid therapy and the push to reduce the dose of pain medication
Changes in prescribing guidelines and regulatory policies driven by the rise in opioid-related deaths have led many physicians to reduce daily doses for patients on stable opioid therapy for chronic pain. The dose reduction process – called tapering – has been linked to worsened pain, symptoms of opioid withdrawal and depressed mood among some patients.
“While patients may struggle during the early tapering period, we reasoned that many may stabilize with longer-term follow-up and have lower rates of overdose and mental health crisis once a lower opioid dose is achieved,” said Joshua Fenton, professor and vice-chair of research in the Department of Family and Community Medicine at UC Davis School of Medicine and lead author of the study. “Our findings suggest that, for most tapering patients, elevated risks of overdose and mental health crisis persist for up to two years after taper initiation.”
Pain management and the risks of dose changes
To draw associations between dose reductions and changes in the risk for overdose and mental health visits, the researchers used a database covering a 10-year period (2008-2017) for more than 28,000 patients prescribed long-term opioids. They examined enrollment records and medical and pharmacy claims for patients prescribed stable high opioid doses (the equivalent of at least 50 morphine milligrams per day) and who had their doses reduced by at least 15%.
From this patient cohort, they selected those who had at least one month of follow-up during the second year of their post-tapering period. They identified a total of 21,515 tapering events for 19,377 patients.
Those events included emergency department visits or inpatient hospital admissions for drug overdose, withdrawal, or mental health crisis events, such as depression, anxiety or suicide attempts. The team compared rates of these events in the pre-tapering period with those during the second taper year of follow-up after tapering initiation.
“We used an innovative observational study design to understand the patients’ experience before and after opioid dose reduction. We compared outcome rates in pre- and post-taper periods with patients serving as their own controls,” said pediatrics professor Daniel Tancredi, co-author of the study. “This design has the advantage of controlling for patient characteristics that may influence relationships between tapering and adverse events.”
The study found that for every 100 patients, there was an average of 3.5 overdose or withdrawal events and 3 mental health crises during the pre-tapering period, compared to 5.4 events and 4.4 crises in the 12-24 months post-tapering period. That’s a 57% increase in overdose or withdrawal incidents and a 52% increase in mental health crises. The risks of tapering were greatest in patients with the highest baseline doses.
Long-term follow-up and support for patients on reduced pain therapy
In 2018, the Department of Health and Human Services (HHS) issued guidelines to advise clinicians to monitor patients carefully during tapering and provide psychosocial support. They recommended close follow-up and cautioned about the potential risks of rapid dose reduction, including withdrawal, transition to illicit opioids, and psychological distress.
This new study emphasized the need for clinicians and patients to discuss dose reduction and carefully weigh the risks and benefits of opioid continuation and tapering. Tapered patients would benefit from close follow-up and monitoring not only in the short term but in the long term too, to make sure they’re coping well on lower doses.
“We hope this work will inform a more cautious approach to decisions around opioid dose tapering,” Fenton said. “While our results suggest that all tapering patients may benefit from monitoring and support up to two years after taper initiation, patients prescribed higher doses may benefit from more intensive support and monitoring, particularly for depression and suicidality.”
Other UC Davis Health collaborators include Elizabeth Magnan, Iraklis Erik Tseregounis, Guibo Xing and Alicia Agnoli. The study was supported by a University of California–OptumLabs Research Credit, the Department of Family and Community Medicine at UC Davis, and the UC Davis School of Medicine Dean’s Office (Dean’s Scholarship in Women’s Health Research BIRCWH/K12).
Viewing cancer misinformation on social media negatively influenced patients’ decisions and adversely affected their mental health, according to a new study published in the journal Cancer. While online social networks can be useful resources for cancer patients, they’re also scattered with potentially dangerous misinformation.
Researchers at Huntsman Cancer Institute at the University of Utah (U of U) created a resource for scientists that lays the foundation for building clinical and patient-friendly tools called the Online Cancer Nutrition Misinformation (ONC-M). The tool tracks and organizes cancer misinformation that comes from social media.
Echo Warner, PhD, MPH, researcher at Huntsman Cancer Institute and assistant professor of nursing at the U of U, asked patients and caregivers how they used social media during their cancer experiences. “The benefits of their social media use were mired by exposure to cancer misinformation. They were met with misinformation from many sources, all the way from well-intentioned friends and family to shadow scams selling ‘cancer cures’ to the highest bidder,” Warner says.
ONC-M provides a way for researchers to document how exposure to health misinformation online influences patients and caregivers.
“It’s the first framework to document the process by which exposure to health misinformation online influences patient and caregiver health behaviors and health outcomes,” says Warner. “Before now, the lack of a clear conceptual process, and the factors that influence that process, has been a major roadblock in the study of online health misinformation.”
The ONC-M describes how cancer misinformation is organized, and also creates potential pathways linking misinformation exposure, health behaviors, and cancer health outcomes. Researchers identified several primary cancer misinformation categories and factors that associate with each type of claim. Researchers found untrue claims about cancer prevention, treatment, and cures. These claims were backed by false disclaimers, anecdotes, and misinterpreted scientific articles.
“While still somewhat early in refinement, ONC-M has broad applicability and likely extends beyond cancer-related misinformation to other health domains as well,” says Warner. “We plan to test each part of the framework and study new ways of using technology to measure how much cancer patients are exposed to misinformation online.”
Warner recommends discussing any treatment or therapy questions with healthcare providers. Patients can also use an information quality tool to help identify potential biases, financial incentives, and misleading content about cancer treatments or therapies. One example is the CRAAP test.
The study was supported by the National Institutes of Health/National Cancer Institute including P30 CA042014, the University of Arizona Cancer Center Cancer Health Disparities Training Program (T32CA078447), University of Arizona College of Nursing Eleanor Bauwens’s Research Award, University of Arizona Postdoctoral Research Development Grant, the U.S. Department of Agriculture, Agricultural Research Service under Cooperative Agreement No. 58-3092-0-001, the MD Anderson Cancer Center Support Grant (P30CA16672), the Center for Energy Balance in Cancer Prevention and Survivorship, Duncan Family Institute, and Huntsman Cancer Foundation. Key collaborators included Margaret Raber Ramsey, DrPH, Baylor College of Medicine, Tracy Crane, PhD, University of Miami Sylvester Comprehensive Cancer Center, Terry Badger, RN, PhD, University of Arizona College of Medicine, and Karen Basen-Engquist, PhD, MD Anderson Cancer Center.
