Expert: Forget Detox for Substance Use Disorder

LAS VEGAS — There’s a lot more to substance abuse disorder than physical dependence, which means that acute detox treatment by itself isn’t an effective therapy, a researcher said here.

The real key, said Debra Gordon RN, DNP, of the University of Washington in Seattle, in a talk here at the annual PAINWeek conference, is establishing a relationship with patients so that behavioral changes can be implemented.

Withholding opioids from patients with substance use disorder will not cure their addiction, she said. Moreover, providing them with opioids will not necessarily worsen their addiction and may help them accept behavioral therapies.

“There is no evidence that detoxing someone in an acute situation or hospital setting is going to impact that disease,” Gordon said in a presentation. “In fact, the evidence seems to be they will be more at risk for using at their discharge and having an overdose, some of that being in the prison system, but you see that in hospitals too.”

Patients with substance use disorder continue to use drugs despite recurrent problems in their social, workplace, or familial spheres that occur because of their use. Many take multiple substances and have underlying mental health disorders, both of which need to be screened for, Gordon said.

These patients have a higher pain threshold and the prevalence of chronic pain is also much higher in patients with drug abuse disorder. As such, using the Numeric Rating Scale (NRS-11) to define their pain will be insufficient, and providers should determine whether the source of pain is acute, chronic, or related to the patient’s addiction.

Clinicians should also anticipate that patients with substance abuse disorder may have had negative experiences with the healthcare system previously, Gordon said, and asking open-ended questions without judgment may mitigate feelings of shame or fear that prompt them to withhold information.

Seemingly obvious physical comforts, like turning off the lights or keeping a room quiet, also go a long way as well, Gordon said. Cognitive behavioral therapy can also help patients change their perception of pain and help with sleep, mood, and anxiety issues co-occurring with substance use disorder.

Still, some patients may not be willing to change, and others may try to use within the hospital. When encountering patients who deny having a problem, or who recognize the disorder but are unwilling to change, providers should focus on helping them transition out of the hospital when the time comes and providing naloxone emergency overdose kits to patients who may return to illicit drug use.

“Failure to engage in treatment is not a failure,” Gordon said. “It’s part of the process and it’s part of the disease.”

But despite the treatment options available for patients with substance abuse, some providers may be unaware they exist, or may be unsure of what they are authorized to provide, Gordon said.

“There are barriers in the healthcare system in terms of the way we’ve traditionally been trained and traditionally work in silos, and to care for this population we have to really have a team approach,” Gordon told MedPage Today. “It’s one thing to say stuff on paper and another to try and find out how it works in the real world.”

Gordon did not report any disclosures.

by Elizabeth Hlavinka, Staff Writer, MedPage Today

Primary Source: PAINWeek
Source Reference: Gordon D “Acute pain in patients with active substance use disorder” PAINWeek 2019; Abstract ACU-01.

Nurse of the Week: First-Generation Community Health Worker Maria Elena Valdez Prepares for Nursing Career

Nurse of the Week: First-Generation Community Health Worker Maria Elena Valdez Prepares for Nursing Career

Our Nurse of the Week is Maria Elena Valdez, a first-generation community health worker who is preparing to graduate from nursing school at the end of this year and embark on her career as a nurse.

Valdez was born in Eagle Pass, Texas to seasonal immigrant workers from Coahulla, Mexico. She traveled between Mexico and the US with her parents when she was young while her father worked in Wisconsin fields in the summers and then took his family to Mexico each winter when the work season ended. Her parents had a better plan for her future so they eventually settled in San Antonio, which now feels like home to Valdez.

During her junior of high school, Valdez started volunteering for the University of Texas at San Antonio (UTSA) Pathway to Health Professions program, which is housed under the Policy Studies Center within the UTSA College of Public Policy. She earned her associate’s degree from Northeast Lakeview College and enrolled at UTSA in fall 2017 where she studied to earn her certification as a community health worker. She can now practice in the field while she works to obtain her bachelor’s degree.

Valdez is currently leveraging her Community Health Worker certification at the Children’s Hospital of San Antonio where she counsels emergency room patients so that they leave the hospital with better awareness of the resources available to them at home. She will graduate from UTSA in December with her Bachelor’s of Science in Community Health from the College of Education and Human Development.

Miguel Bedolla, the director of the UTSA Health Career Opportunity Program, tells utsa.edu, “Maria Elena is absolutely committed to serving the population of San Antonio, she has already been certified by the State of Texas as a Community Health Worker through the Pathways to Health Professions Program, she is one of the best students in the program and is unwaveringly committed to be an excellent nursing professional.”

To learn more about Maria Elena Valdez, a first-generation community health worker who is preparing to graduate from nursing school at the end of this year and embark on her career as a nurse, visit here

Healthcare Heroes: Dialysis Nurses

Healthcare Heroes: Dialysis Nurses

In honor of “Nephrology Nurses Week,” September 8-14, 2019, Daily Nurse is highlighting two very special dialysis nurses.

At 25 years old, Jackson, KY resident Bridgette Chandler was living with her husband and raising two young children while enjoying a satisfying career as a nursing tech.

Bridgette’s life changed forever after she rushed to the emergency room with what she thought was a case of the flu. Instead of flu, doctors informed her, she was actually suffering from kidney failure. During the long wait for a transplant she underwent arduous four-hour dialysis treatments three times a week.

Despite finding that dialysis made her “a completely different kind of tired that sleep doesn’t fix,” in her determination to remain actively involved with her young family, Bridgette opted for at-home dialysis at the Fresenius Kidney Care clinic in Kentucky. With her home treatments, Bridgette managed to experience all of the special events that happen in a family, from games and recitals to the hubbub of birthdays and holiday seasons. She remarks, “For me, being able to take part in special moments with my family was most important and that’s why I chose home therapy. It gave me the opportunity to take back some of the control of my health.”

Five years later Bridgette found a donor and had her kidney transplant surgery. Even before the hospital had discharged her, she asked her doctor how long she had to wait before she could start school and become an RN. Now, Bridgette is working alongside her former nurses, treating home dialysis patients at the same clinic that treated her. “Because of my personal experience, my intention had always been to become a nephrology nurse” she says. “I stayed in touch with my nurses and doctors who made such a difference in my life. When a position became available in the clinic with those nurses and doctors, I jumped on it.”

Bridgette’s experience also creates a special bond with her patients: “helping patients find ways to make dialysis work for them has definitely been beneficial. I’ve had so many patients tell me they respected me so much more because I understand what they are going through. Many of my patients have even told me that I give them hope.  That is just as important to me as it is to them. That’s why I wanted to be a nurse.”

Anne Diroll was also destined to become a nephrology nurse.

A year after losing her father to a sudden heart attack, 15-year-old Anne was hospitalized for a week after being struck by a car.

During her time in the hospital, unable to walk, and suffering from a “huge hematoma,” she had plenty of time to think and look around. She saw—and deeply admired—the nurses who cared for her, and was inspired by fellow patients stories, learning of “tragedies and hardships in others’ lives that I had never experienced or been aware of at a young age, and [I] thought ‘this is a part of life that needs healing.’”

Anne began her nursing studies almost as soon as she was discharged from the hospital. Initially working as a pulmonary nurse, when she sought a new job, she “didn’t know anything about kidneys, except that they made urine. In my interview for a dialysis nurse position, my interviewer explained that the reason dialysis nurses exist is because [failing] kidneys don’t make urine, so I was able to understand that dialysis is to kidneys as ventilators are to lungs. I got the job and have been a nephrology nurse ever since.”

Today Anne manages a Fresenius Kidney Care clinic in California, overseeing the care of 50 patients.

The American Nephrology Nurses Association (ANNA) launched Nephrology Nurses Week in 2005 to give employers, patients and others the opportunity to thank nephrology nurses for their life-saving work. In addition, ANNA seeks to interest other nurses in the career opportunities available in nephrology.

About 30 million adults in the United States suffer from chronic kidney disease. The nephrology nurses who treat them make a positive difference in the lives of patients and their families every day. Caring for kidney patients requires nurses to be highly skilled, well educated, and motivated, and nephrology nurses cite the variety and challenges of the specialty as fueling their ongoing passion.

For more information nephrology nursing, the Nephrology Nurses Week celebration, and more, visit www.annanurse.org/

University of Maryland School of Nursing Receives $500,000 Donation from Alumna

University of Maryland School of Nursing Receives $500,000 Donation from Alumna

The University of Maryland School of Nursing (UMSON) recently received a $500,000 donation from alumna Mary Catherine Bunting, MS, CRNP, RN. Bunting received her master’s degree from UMSON in 1972. Her donation will help the university continue the work of UMSON’s Community and Public Health Environmental Initiative (CPHEI) to provide health oversight for children and families served by Baltimore City Early Head Start (EHS) and other Head Start centers.

CPHEI is a collaborative effort from the Maryland Family Network to improve overall health and environmental health for EHS and Head Start center children from birth through age 5, including programs that support mental, social, and emotional development. The program was established in 2016 thanks to a $750,000 donation from Bunting.

Many UMSON students and faculty participate in CPHEI as part of the school’s ongoing service learning commitment, including Bachelor of Science in Nursing and RN-to-BSN program students, entry-into-nursing Clinical Nurse Leader master’s students, Community/Public Health Nursing master’s students, and Doctor of Nursing Practice students.

This new funding will support continued efforts for CPHEI, which will include UMSON students and faculty reviewing more than 1,000 child health records and identifying children with chronic health conditions and those behind on preventative care required under Maryland’s Medicaid program. They will also provide direct care services including health screenings and home visits for children with chronic conditions.

Laura Allen, MA, MS, RN, CPHEI program director, tells umaryland.edu, “CPHEI has brought much needed nursing services and environmental health oversight to a highly vulnerable population. If we weren’t there, there wouldn’t be as strong an emphasis on health, well-being, and how they relate to education. These families would be missing out on health screenings, health education, and general health literacy.”

Thanks to the new funding, CPHEI has set a goal of helping all 47 of Baltimore’s Head Start centers become Eco-Healthy Child Care-certified and to continuing its work of providing nursing services in EHS centers.

To learn more about the $500,000 donation given to the University of Maryland School of Nursing by alumna Mary Catherine Bunting, visit here.

Nurse of the Week: Seattle Nurse Karin Huster Says Battling Ebola Outbreaks in Africa Is “The Best Job in the World”

Nurse of the Week: Seattle Nurse Karin Huster Says Battling Ebola Outbreaks in Africa Is “The Best Job in the World”

Our Nurse of the Week is Karin Huster, a Seattle-based nurse and field coordinator for Doctors Without Borders. Huster spends six to 12 weeks at a time away from home, helping the world’s most vulnerable populations. Most recently she was in the Democratic Republic of Congo (DRC) helping battle Ebola outbreaks.

Even though she regularly encounters dying patients, Huster tells seattletimes.com, “It’s the best job in the world. And I don’t mean this lightly…My goal in life is nothing else but to try to improve people’s lives.”

Ebola has killed over 2,000 individuals and sickened almost 3,000 individuals in the DRC since August 2018. The World Health Organization declared the outbreak a global health emergency in July 2019 while Huster was on her fourth trip there.

Helping those in need has been Huster’s dream since she was a child. She grew up on Réunion Island, a French island in the Indian Ocean, and in 1991 she moved to Seattle for a job translating English to French for Microsoft. Feeling unfulfilled, she left her job at Microsoft to enroll in nursing school at the University of Washington (UW). She spent eight years as a nurse in the intensive care unit at Harborview Medical Center before going back to UW to earn her master’s degree in global health. In 2012, Huster went to Lebanon on a trip with UW to work with Syrian refugees. It was there that she found her passion for traveling to help the world’s most vulnerable populations.

To learn more about Karin Huster, a Seattle-based nurse and field coordinator for Doctors Without Borders who considers her job battling Ebola outbreaks in Africa the “best job in the world,” visit here.  

Frontier Nursing University Makes its Impact on Diversity

Frontier Nursing University Makes its Impact on Diversity

Under the aegis of the Diversity Impact (DI) Program at Frontier Nursing University, faculty and students are the vanguard of the movement to diversify the ranks of nurse practitioners and nurse-midwives and improve health care conditions among the underserved and marginalized.

Frontier’s current Chief Diversity and Inclusion Officer, Dr. Maria Valentin-Welch, takes great pride in the students’ achievements during and after their participation in the DI program, and says: “they are applying what is taught here in regard to diversity, inclusion, and equity, not only within their new areas of employment as graduates but across their communities. Some have established underserved programs, birth centers, and international programs. These students are passionate advocates for the underserved and disenfranchised people. They are the future catalyst of change.”

In addition to distributing some $300,000 in scholarship funds received through their Health Resources and Services Administration’s Nursing Workforce Diversity Grant, the program has implemented diversity training sessions for all faculty and staff and added diversity discussions to student orientation sessions. DI participants are also encouraged to attend annual conferences dedicated to fostering a more diverse, culturally aware health care workforce—where, under the guidance of a faculty mentor, students explore the benefits of active participation in professional nursing organizations.

The thriving program at Frontier received a 2018 Health Professions Higher Education Excellence in Diversity (HEED) Award from INSIGHT Into Diversity magazine, and was cited as a “Top College for Diversity.” In addition, the magazine added Dr. Valentin-Welch herself to their Top 25 Women in Higher Education roster of standout diversity advocates at US colleges and universities.

For an experienced professional proponent of diversity and inclusion, the most daunting challenge, according to Valentin-Welch, is maintaining belief in the goal of “uniting folks while our nation is receiving messages of division and promoting actions of division and lack of compassion… However, I feel midwifery and nursing have always held an important role in not only listening to people, but also advocating for what is right.”

For further details on the Diversity Impact Program at Frontier Nursing University, visit here.

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