Role of the Nurse in Substance Misuse - Literature review Example

?Role of the Nurse in Substance Misuse Introduction Nurses are preferably assigned to work with patients who have problems with substance misuse because they are ones who initially deal with patients in primary care (Kim & Kollak 2006). Hence, the nurse occupies the most important position in primary care. Working with substance-dependent patients can be very difficult but usually fulfilling. Patients with issues of substance misuse frequently show varied and complicated health requirements and addressing these obliges the nurse to use professional and personal skills to build productive solutions to complex health issues. While education and health response should constantly be designed individually to suit the unique needs of patients, this is particularly vital to those who are experiencing substance misuse problems. This paper discusses the role of nurses in substance misuses and reflects on how this role can benefit clients/patients and can meet the demands of best practice guidelines and legislation challenges. Self-reported substance misuse in the UK indicates that roughly ten percent of adolescents and older adults use drugs yearly, and more than ninety percent drink consume alcohol (Straussner 2004). A few of these people experience working with primary care nurses. Individuals with substance misuse problems encounter a broad array of social care and health practitioners. Expectedly, several practitioners have recognised inadequacies in the education and training for treating substance misuse (Cann & De Belleroche 2002). All these issues are discussed here. Corresponding to the widespread enlarged demand for nursing services for patients with substance misuse issues, the role of the nurse has expanded remarkably in the recent decade. Nurses working with substance misusers work in diverse contexts with substance misusers, and have varied health care perceptions and strategies. According to Joel and Kelly (2002), their tasks involve assessing the needs of substance misusers, determining best possible treatment, counselling, and performing required treatment methods. Nursing Substance Misusers Several empirical findings show that the role of the nurse working with substance misusers can be especially nerve-racking and challenging (Wagner & Waldron 2001). This is primarily because of the growing demand for expert skills and knowledge in areas like counselling, assessment, promoting the participation of patients in the decision-making process, communication, organisational aspects like lack of support, education and training for staff, loss of financial assistance, and modifications in services (Sullivan 1995). The roles of the substance misuse nurse, as stated by Mike Bell (as cited in Newell 1998): (1) nurses interact personally with substance misusers; (2) nurses evaluate the patient’s needs and develop their strong points; (3) nurses operate within specific areas; (4) nurses are responsible for their own decisions and actions; and (5) nurses collaborate with one another to provide the best services to substance misusers. Florence Nightingale (1912) expressed the importance of the nurse’s role in his statement: I solemnly declare that I have seen or known of fatal accidents, such as suicides in delirium tremens, bleedings to death, dying patients dragged out of bed by drunken medical staff corps men and many other things less patent and striking, which would not have happened in London Civil Hospitals nursed by women (Nightingale 1912, 28). It is probable that there are differences in the expectations and role of substance misuse nurses all over the UK, relying on context and setting. For instance, health organisations may follow different guidelines; different groups in primary care may also differ in the extent of decision making entrusted to drug specialist nurses, concerning recommendation and treatment (Shaw 2002). The following sections discuss the professional and personal skills needed by substance misuse nurses to adequately fulfil their challenging roles and satisfy best practice guidelines. Empathy Empathy is defined as the ‘ability to understand the meaning of life for another person’ (Petersen & McBride 2002, 46). This implies ‘putting yourself in their shoes’ while sustaining an impersonal grasp on the present clinical condition. Apparently, it is difficult to empathise with a substance misuser, particularly if this includes worldviews and ways of life we could not imagine ourselves having or living because this will make our lives miserable (Abbott 2003). The challenges of empathy are not an issue just for practitioners. Previous substance misusers usually make perfect therapists and may be capable or relating to specific facets of another individual’s condition simply too well; however, being an ex-substance misuser does not qualify for best practice (Abbott 2003). Involvement in substance misuse is always personal. Nurses who had previous experience of substance misuse and who is incapable of detaching their personal experiences from the experiences of their patients cannot exercise needed empathy. Several scholars, such as Reynolds and colleagues (1999), re-examined and discussed literature on empathy, emphasising the difficulty of quantifying it. They proposed that patients themselves should be asked to take part in defining and assessing empathy. Attitude There is a definite level of reality in the assumption that attitudes are ‘caught not taught’ (Hall, Amodeo, Shaffer & Bilt 2000, 141). Working with individuals who have unpleasant attitudes can complicate the task of sustaining an optimistic disposition. This does not imply that individuals should not be permitted to communicate negative thoughts but this should be carried out in a manner that allows the problem to be examined and procedures established for handling this. Promoting an inquiring viewpoint of pessimistic attitudes as a component of team working is an effective way of accomplishing this. Substance misuse nurses require time for self-reflection, growth, and contemplation. Support and supervision are vital elements. Attitude may be influenced by the nature of the relationship with the patient. Several nurses have a tendency to pay attention to individuals only in times of crisis (Abbott 2002). It is quite simple to disregard the fact that there are large numbers of individuals who are capable of resolving their problems with substance misuse, frequently without professional intervention (Connors, Donovan & DiClemente 2001). Potential justifications for change in this group involve a broad assessment of the advantages and disadvantages of prolonging and key incidences like alcohol induced health problems (Connors et al. 2001). It is essential to keep in mind that people and situations can change. Interpersonal Skills The role of substance misuse nurses is interactive. Excellent communication abilities are a fundamental factor. Communication is non-verbal and verbal (Petersen & McBride 2002). The latter includes tone, speed, and pitch as well as the language rules and terminologies used. Communication between a nurse and patient with substance misuse problems diverges from that applied in common conversation (Petersen & McBride 2002). Essential to the nurse-patient communication rests one or more objective. This might be a prerequisite to acquire responses to inquiries, as would be needed during an evaluation interview, or the requirement to direct the conversation towards a specific objective such as conveying information to the patient or assessment of emotions (Joel & Kelly 2002). Communication requires listening as well. The capacity to keenly ‘listen’, a commitment to understand, and express empathy, in contrast o merely ‘hearing’, is a competence as such (Abbott 2003). Non-verbal communication involves the exercise of individual space, eye contact, body language, touch, and gesture. The communication abilities exercised by nurses in working with substance misusers are similar to those exercised in any other therapeutic relationship (Joel & Kelly 2002). The following are some of the important aspects for the substance misuse nurse to consider (Kim & Kollak 2006): (1) An individual who has lately used a stimulant will not be able to calm down; they may be restless and find it difficult to relax. They may grind their teeth and grit their jaws; their oral communication prone to be forceful and brisk. On the contrary, a person using opium may appear sleepy and tranquil. Their cognitive performance seems retarded and their verbal communication may be slow. Withdrawal may bring uneasiness to the individual. They may be yearning and bad-tempered, in a rush to end the session and leave (Kim & Kollak 2006). (2) Articulations of unusual or negative thoughts or delusions may be a sign of major mental health problem or may be an outcome of substance misuse. Inability to establish good eye contact may be an indication of social unease and nervousness or a sign that a person is not disclosing the facts and is ill at ease about it. It may be a sign that they think their private space has been breached, or they may be humiliated. It may be also a deliberate way on the part of the patient to prevent the nurse from seeing their dilated pupils (Werkle & Wall 2002). (3) Several substance use nurses communicate interest in the kind of language they think they should apply to substance misusers. The vernacular of substance misuse can be varied and perplexing, changing in accordance to physical location. Knowing this can help substance misuse nurses make sense of what the patient tells them; however, they should avoid, as much as possible, the appeal to use vernaculars to make the patient comfortable. If the nurse feels awkward using the same language as that of the patient, s/he should then avoid it; the nurse will only become uncomfortable in the end (Petersen & McBride 2002). Good communication abilities necessitate practice. Substance misuse nurses can accomplish this through video recording or role play. Recording and observing your interactions with a patient can reveal weaknesses and strengths. Working with Substance Misusers Several patients are difficult to deal with. Such patients are at times called ‘problem’ or ‘difficult’ patients (Petersen & McBride 2002, 52). This type of labelling is usually unsupportive. Patients can manifest difficult behaviours for different causes, but specifically sense of helplessness and fear. Sullivan (1995), in an effort to help substance misuse nurses in their goal to fruitfully work with substance misusers, enumerates three general defence mechanisms used by substance misusers (Petersen & McBride 2002, 52): (1) denial- the person does not acknowledge the effects of their behaviour. Denial may be demonstrated by lying about, minimising, or blaming others for drug use and other behaviours; (2) projection- the person attributes their own characteristics or behaviour to others; (3) rationalisation- the person may give the impression of having made a considered choice, justifying behaviour and not giving the ‘real’ reasons for their continued use. Another type of ‘problem’ behaviour identified by Sullivan (1995) is manipulation. He defines it as ‘an enduring use of patterns of behaviour aimed at immediately satisfying one’s own needs while disregarding the rights and needs of others’ (Sullivan 1995, 129). Individuals who are skilful in manipulating other people are seldom trapped in it; people, whose social abilities refer to them as ‘manipulative’ (Sullivan 1995), seldom realise their objectives in relationships and depend on downgrading people around them to equally inadequate communication levels and depression. These ‘manipulative’ actions generate emotional responses, particularly resentment, in everyone (Kim & Kollak 2006). Expectations and limitations should be clear-cut to the patient and nurse. The substance misuse nurse should avoid being caught into the problem and disarray. Messages have to be reliable, clear, plain and simple and the outcomes of ‘boundary breaking’ (Petersen & McBride 2002, 53) have to be sensible, feasible, and monitored. Several patients will unavoidably try to challenge every boundary created, and several attain amazing ability at spoiling their own intentions in this manner. It is vital that substance misuse nurses have access to support through clinical supervision and team deliberation (Spence, Unsworth & Burke 2001). As perceptively argued by Gossop (1993): The drug addict is not an evil, vicious and depraved individual; nor is he a perfectly normal person suffering from a metabolic disease. Addicts are individuals. Some are friendly, others are hostile; some are law abiding, many are not. There is no such thing as a single addictive personality nor is there is a single addict lifestyle (ibid, p. 181). The vocation of nursing is obviously dynamic. Family Systems and the Role of Substance Misuse Nurse There are more than one million adults in the UK misusing substances. The numbers of pathological substance misusers in the UK are more difficult to approximate, but statistics indicate that there are more than 200,000 in 1997 (Petersen & McBride 2002, 145). Traditionally presuming that every substance misuser will harmfully influence at least two direct family members, this indicates at least five million family members in the UK are experiencing harmful impacts of substance misuse (Petersen & McBride 2002, 145). Family members suffer social, psychological, and physical problems as an outcome of living in this situation, which may affect mental and physical health and result in the growth of problems for their family members and themselves (Abbott 2002). This is a universal trend. These family members require support, both for themselves and so as to cope positively with their connection with substance misuse. Hence, one of the most important roles of substance misuse nurses is to promote the involvement of family members in interventions intended for the substance misuser. Services which engage family members, either as clients in their own rights, dealing with their own difficulties, or as a component of a broader family intervention, are very few (Abbott 2002). A current finding by the Alcohol Recovery Project (ARP) and the National Society for the Prevention of Cruelty to Children (NSPCC) explained the outcomes of a concise national study within the UK of service provisions available for family members (Petersen & McBride 2002, 146). The role of the substance misuse nurses is then to strengthen the idea that family members are an important part of interventions for substance misusers. Systemic nursing theory proposes that family members should be engaged in the intervention in order to persuade substance misusers to conform with and stay with the treatment and to make sure that changes which are initiated affect the entire system (Kim & Kollak 2006). Nevertheless, in the UK, these interventions are not yet popular even though Vetere (1998) has supported a systemic family and couples service as component of every community substance misuse service. A large number of these more current nursing paradigms adopt systemic or behavioural perspectives, proposing that the family becomes skilled at coping with substance misuse, or functions as a scheme where the behaviour of each individual affect everyone else, so that specific behaviour function to prevent, promote, or regulate substance misuse conduct (Kim & Kollak 2006). Even unpleasant actions can function to sustain stability in such a family structure. Substance misuse nurses working with family members can take advantage of family interactions and relationships, and modify behaviour to promote a new, more ‘normal’ stability to that structure, or to modify reinforcement patterns in order to reinforce positive behaviours (Joel & Kelly 2002). Numerous of the couples and family interventions which originate from behavioural or systemic theories propose that family members should be given support together with the substance misuser. Unilateral family therapy is a quite current development in family interventions. This nursing model also uses the systemic paradigm, but indicates that it is feasible for a substance misuse nurse to change the functioning of a family unit without every family member participating in therapy sessions (Joel & Kelly 2002). It is doable for a substance misuse nurse to modify a person’s substance misuse though they never attend or comply with treatments. Substance misuse nurses working with other people in the system and facilitating behavioural change will involuntarily affect the behaviour of the user as well (Petersen & McBride 2002). This paradigm was developed to be most appropriate for drawing the most ‘unmotivated, treatment-resistant’ (ibid, 147) substance misusers. Yates (1988) discovered that problems with another person’s substance misuse were more likely to be reported than those linked to personal substance misuse. Due to this, a ‘co-operative’ counselling paradigm was implemented and assessed, which dealt with substance misusers and those affected by this problem behaviour. Findings showed that family members valued the support that was given to them by substance misuse nurses, particularly the relief experienced by the family member, substantiating that the substance misuse was a severe problem and the suggestion on how to create useful interventions for the substance misuser to aid the situation (Yates 1988). Involvement of substance misuse nurses encouraged a number of substance misusers to comply and stay with the treatment. According to Petersen and McBride (2002), even though viewed as comparatively effective, the study of Yates has been hardly reproduced in the UK. Community reinforcement training is another case of a paradigm that stresses the role of the substance misuse nurse to collaborate with other practitioners to promote healthy behaviour through a process of positive reinforcement (Kim & Kollak 2006). Therefore, the substance misuser and major significant others and the substance misuse nurse are all involved in work on an individual’s problem with substance misuse. The family in these models is viewed as a vital component of the substance misuse nurse’s role. The main emphasis of the nursing approaches discussed above thus far is to engage the family member to persuade the conformity of the substance misuser to the treatment, and to develop on the constructive family functioning to end the substance misuse. Outcome indicators for substance misuse nurses are mainly related to the withdrawal or decreased substance misuse of a patient, in contrast to indicators of family or couple functioning (Abbott 2003). Little or no consideration is given to collaborating with family members as individuals with difficulties in their own right as an outcome of having a relative with substance misuse issues. A Reflection of a Substance Misuse Nurse We learn from our experiences. This is usually not accomplished through an established procedure but through a more broad understanding of what works and does not. We jumble our way around, basing our behaviour and actions on several sources, such as common sense, experiences, hunch, and research. This is the reality of practicing substance misuse nurses. A person who admits only ever to take steps that are wholly planned and based on analysis can be safely regarded to lack self-understanding. At times, particularly when a condition has been difficult, or the consequence unfavourable, it can be hard to reflect precisely on the event that has transpired. The nurse may be lured to view the condition in crude ways or turn to the most evident ‘cause.’ It is usually these circumstances which are the most capably rewarding learning sources. It can be useful to have knowledge of a more established way of learning (Abbott 2003). A variety of effective reflective tools are available to the substance misuse nurse, such as the one developed by Schon (1983). The following items can be used by the substance misuse nurse to assess whether s/he is effectively fulfilling his/her roles (Petersen & McBride 2002, 54): (1) description- what was the event, how did you decide to deal with it and why? (2) reaction- what happened? How did you and other people feel and think about this? (3) analysis- how do you account for what happened? (4) evaluation- how can you make sense of this? Could you have done anything else? (5) synthesis- if this situation arose again what would you do? Would you change anything? The substance misuse nurse can work through these items, reconsidering, learning and ultimately employing knowledge acquired during this process of reflection (Petersen & McBride 2002). The application of an organised model can be a useful component of clinical management. The substance misuse nurse has three roles in clinical management (Kim & Kollak 2006): (1) an educational or decisive role which intends to build understanding, competencies, and skills; (2) a recuperative role, which provides assistance and allows the nurse to deal with the desolation and discomfort that can be caused by clinical functions; (3) a supervision or regulatory role, which is basically a quality control task, facilitating the fulfilment and maintenance of standards. Supervision is a vital component of substance misuse nursing practice. It is enticing, when demands at work are excessive, to ‘avoid’ the role of supervision. Clinical supervision is frequently performed by a high-level substance misuse nurse; but other alternatives, such as external and peer supervision, can be especially useful in a number of contexts (Cann et al. 2002). Learning should be a fundamental feature of substance misuse nurses’ professional growth. Personal development plan should be one of the priorities of substance misuse nurses, alongside needed assessment of their role and evaluation of their performance. This plan should be re-examined on a regular basis to make sure that outdated strategies and new competencies and knowledge are regularly improved. For nurses these procedures will eventually be important for reconfirmation, and continuous permission to practice (Straussner 2004). As pointed out by The United Kingdom Central Council for Nursing, Midwifery and health (UKCC 2001): Lifelong learning is more than simply keeping up to date. It requires an enquiring approach (to the practice of nursing, midwifery and health visiting), as well as to issues which impact on practice (ibid, p. 22). The above passage clearly obliges professional growth and competency, in particular requiring all practitioners, including nurses, to show responsibility for their personal and professional learning and be capable of identifying when additional learning is needed. Several nursing groups have a binding obligation to exhibit continuous training (Wagner & Waldron 2001) but the fundamental significances of lifelong learning are relevant and appropriate to any professional group. There are numerous means available to substance misuse nurses to assess their roles and practice, such as performance assessment, feedback, and individual supervision. Best practices can be conveyed locally through group deliberation, or on a broader level through conference presentations, publication, or other public forum (Connors et al. 2001). A number of health organisations have ‘journal clubs’ (ibid, p. 86) which are intended to become an effective way of communicating current information with other nurses. Similarly, interest groups are formed in several areas for nurses from an array of expertises and backgrounds (Werkle & Wall 2002). Majority of professional organisations in the UK have individual forum for area or expertise issues and certain bodies like the Association of Nurses in Substance Abuse (Petersen & McBride 2002) are formed to support nurses in their task of building a network of professionals and to encourage and advance best practices on a national scale. Conclusions Good substance misuse nursing practice requires attitudes, competencies, skills, and knowledge. Best practices in nursing are multifaceted, with an abundant combination of practical and theoretical facets and an array of treatment strategies. Nurses may be non-professional or professional, founded on social and health care contexts. There are quite favourable prospects for professional growth, speciality, career advancement, reflective practice and continuous learning, which strengthen the roles of substance misuse nurses. Substance misuse nurses are in an excellent position to deal with the increasing prevalence of substance misuse among adolescents and adults in the UK. Identification of vulnerable populations, knowledge of symptoms and indications of substance misuse, and collaborations that provide support for substance misusers, family members, and other practitioners are major roles of the substance misuse nurse. One of the major roles of substance misuse nurses is to be an advocate for the safety and wellbeing of adolescents and adults. The substance misuse nurse should enhance their personal understanding and knowledge of the motivations for and indications of substance misuse in order to put into effect best practice guidelines. The ability to present compelling empirically based findings substantiates the substance misuse nurse’s reliability with regard to the issue. In addition, it would be advantageous for the substance misuse nurse to identify what goods are accessible to adolescents and adults in the Internet or locally. The substance misuse nurse may help explain arising mainstream developments among adolescents and adults concerning substance misuse. Deceptive media messages and inappropriately performed or prejudiced investigations usually just confuse the jumble of existing information. Service users and practitioners may be perplexed about what information is reliable and what is not. Hence, substance misuse nurses should be regularly informed of these developments and be a representative of reason and present trustworthy, precise health recommendation and information for the safety and wellbeing of service users. 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