Community Nursing Practicum on Heroin in the County of Philadelphia PA - Research Paper Example

Community nursing practicum on heroin in the county of Philadelphia pa of affiliation submission Table of Contents A.Assessment 4 1.Description the County of Philadelphia PA where Heroin fieldwork was conducted 4 2.Discuss the Heroin in Philadelphia County as studied during fieldwork 5 3.Description of the population of interest affected by heroin as studied in the fieldwork 7 4.Community resources and partners involved in heroin control in Philadelphia 8 B.Diagnosis 9 C.Outcomes identification 9 D.Planning 10 1.Recommended nursing actions 10 2.Nurses’ role in improving heroin use amongst young adults and adolescents 10 3.Potential public and private partnership formed to implement recommendations 11 4.Overall objective 11 5.Timeline 11 E.Evaluation 11 F.Conclusion 12 References 13 Appendix 14 Table of figures Figure 1: substance abuse primary treatment admissions in Pennsylvania in 2001. Heroin was the most commonly cited drug among primary treatment admissions Source: Pennsylvania drug control update. 6 Figure 2: heroin seized in Pennsylvania, in Kilograms, 2007-2010. Source: The United States Department of Justice, 2012 6 Figure 3: illustration of education level of heroin patients. Source: Gordon, 2001 7 Figure 4: Race of heroin addicted patients. Source: Gordon, 2001 8 Figure 5: Employment Status of heroine addicted patients. Source: Gordon, 2001 8 Community nursing practicum on heroin in the county of Philadelphia pa A. Assessment 1. Description the County of Philadelphia PA where Heroin fieldwork was conducted The county of Philadelphia is located on the eastern border of Pennsylvania at the convergence of rivers Schuylkill and Delaware (World Population Review, 2014). The west of this county borders Appalachian Mountains while the east borders the Atlantic Ocean. Consequently, the mountains and the ocean moderate the area’s climate and eradicate tremendously cold or hot weather while promoting evenly distributed precipitation in the area all year round. Winter months are more advanced in the north where snow fall coupled with high winds unlike in the city. Philadelphia consolidated city-county covers an area of about 141.6 Square Miles or 367 km2, with elevation above sea level ranging from 5 feet to 431 feet or 120 meters. Philadelphia is a great commercial and industrial center which makes it the largest city in Pennsylvania. This is possible due to accessibility to raw materials, close proximity to the large North eastern market, and excellent transport facilities. According to World Population Review (2014), the population of Philadelphia as at 2013 was about 1,556,600 and a density of 11, 379.6 people per square mile contributed by the county’s fast-growing population over the last few years. The World Population Review (2014) defines Philadelphia as having a mixed racial composition comprising of whites, African Americans, Native Americans, Asians, other race, Hispanic, and native Hawaiian and Pacific Islanders. The African Americans form about 43.4% of the area population followed by White ate 41.0% and Hispanics at 12.3%. All other races constitute of a percentage less than 10%. For the county’s age population, less than 18 years comprised of 22.5%, 18-25 years were 13.3%, 25-44 years at 28.5%, 45-64 years at 23.5%, and 65 years and over were 12.2% as of 2010 population census. The physical environment at Philadelphia is characterized by far-reaching parks, outdoor activities for all ages, and community centers for recreation and relaxation. The most outstanding park is Fairmount Park that is about 9,200 acres characterized by golf courses, picnic sites, outdoor courts, and athletic fields all of which work towards sustaining an active, sporty, and relaxed population. The population of Philadelphia is aging and increasingly getting diverse in terms of race, income, ethnicity, health status, educational background, and original nationality. 2. Discuss the Heroin in Philadelphia County as studied during fieldwork Although substantive progress in lowering substance abuse has been achieved, mid- and behavior-changing substances are still in use tolling the health of individuals, communities, and County (HealthyPeople, 2014). According to HealthyPeople (2014), there are numerous determinants of substance abuse which are social, environmental, psychological, biological, and genetic factors. Other factors linked to substance abuse are gender, age, ethnicity, race, education, and sexual orientation while the major influences to substance abuse amongst young people are family, peer pressure, and social networks. . Report from drugabuse (2014), indicate a predominance of heroin amongst trends and patterns of drug abuse in Philadelphia. This predominance was evident from 2012 and 2013 findings. From the fieldwork, I realized that the myth about Philadelphian heroin was actually true with the most affected streets being Kensington and Somerset Streets, Third and Indiana sts., Fairhill, and Fifth and Westmoreland Sts., Fairhill amongst others. According to various other sources, the increased predominance of heroin in Philadelphian streets makes it second in the ranking of mortality cases with drug presence. In addition, increasing heroine treatment admissions ranked heroine the second for first time total admissions. In 2013, primary heroin treatment admissions accounted for 22% of the total admissions for the first half. Compared to 2012, this percentage was an increase from 20% of the total. From the fieldwork, it is evident that substance abuse especially Heroin use is driven by the presence of prescription of heroin-containing drugs over-the-counter. Painkillers like Percocet and Oxycontin are legally prescribed yet they are lethal. Since these drugs are expensive, addicts seek for alternative in less costly heroin. Again, Philadelphia is a port city and surrounded by numerous other cities and this makes is a good market for drugs. Data from State profile: Pennsylvania (2011) reveals that by 2010, Heroin in Pennsylvania had the highest number of primary drug abuse treatment episodes. Figure 1: substance abuse primary treatment admissions in Pennsylvania in 2001. Heroin was the most commonly cited drug among primary treatment admissions Source: Pennsylvania drug control update. According to The United States Department of Justice (2012), the amount of heroin seized increased from 2007-2010 with 2010 having 263.68 kilos as shown in the diagram below. Figure 2: heroin seized in Pennsylvania, in Kilograms, 2007-2010. Source: The United States Department of Justice, 2012 3. Description of the population of interest affected by heroin as studied in the fieldwork The increased number of suburban youths commencing heroin use has been attributed to increasing rates of heroin abuse (Gordon, 2001). The average first use of heroin for young adult patients is 21 years while that of adolescent initiation to heroin is 17 years at 15.6% and 18 years at 18.6% (Gordon, 2001). The age groups are mostly addicted to prescription opioids which are at first intended for legitimate reasons before translating into addictions.In philadelphia, the most heroin affected areas are suburbs where young adults have access to powerful prescription drugs and opiate overdoses are becoming common everywhere. Recent national trends on gender of Heroin addicts is that males have higher chances of addiction compared to females. Between adolescent males and females, the differences are however very minor with males at 52% and females at 48% admissions. The graph below shows the educationa of patients addicted to heroin. Figure 3: illustration of education level of heroin patients. Source: Gordon, 2001 Figure 3 indicates that high school students (both male and females) have higher addiction percentages compared to other age groups including college students, post high school, and less than high school. In addition, heroin addiction varies from one race to the other with whites taking the lead with 88% as shown below. Figure 4: Race of heroin addicted patients. Source: Gordon, 2001 In addition, the socioeconomic status of heroin addicts has also shifted to include the fulltime and part time employees, students, and homemakers. The shift means that even middle class families have taken up the use of heroin (Gordon, 2001). Figure 5: Employment Status of heroine addicted patients. Source: Gordon, 2001 For the addicts, heroin use is a complex disease that affects biological, psychological and social effects. Biological issues include medical complications like withdrawal symptoms like restlessness, insomnia, vomiting and bone pain among others. Social issues include inability to maintain long-term relations, poor family life, socioeconomic status degradation. Psychologically, heroin addiction is seen to result to higher chances of psychiatric issues amongst women than amongst men (Gordon, 2001). 4. Community resources and partners involved in heroin control in Philadelphia There are numerous activities involving treatment and rehabilitation of heroin addicts. One best website is sobberrecovery.com. This website comprises of information on Philadelphia heroin addiction treatment programs which a patient can easily access and get help, visit blogs, or forums and raise concerns. This website offers heroin victims a variety of options to choose from in order to have their addiction dealt with and not just lose hope. B. Diagnosis For adolescents in or yet to get to high school, much more needs to be done unlike the current offer of rehabilitation and treatment centers. The rehabilitation and treatment mean a lot especially since heroin takes time to detox. However, further programs are needed to engage the youths in suburban areas and adolescent on the disadvantages associated with taking heroin. Such education would be an effective proactive measure to reduce the number of adolescents engaging in heroin, other than too much investment in reactive measures like treatment from heroin. In collaboration with elementary and high schools, Philadelphia heroin treatment and rehabilitation centers should focus more on reducing the number of pupils addicted into heroin by providing educational programs or sessions that would assist in informing the young adults, adolescents, and the community on the dangers of being addicts. Education is crucial since students will manage to suppress pressure whether from home or from friends that requires them to get into drugs. C. Outcomes identification With rehabilitation and medication assisted treatment of opioid addiction, the patient’s retention is increased while the use of drug is decreased. In addition, reduced drug use results minimized infectious disease transmission, and criminal activity. According to National Institute of Drug Abuse (2000), effective treatment of heroin addiction is not confined to a single treatment. This is because, after patient screening, the level of addiction severity differs from one patient to the other and the ultimate success of having the patient productive again depends on identifying severity levels. In addition, National Institute of Drug Abuse (2000) reveals that ultimate outcomes of heroin addiction treatment are evident in other improvements in the patient other than the drug addiction. The implication is that treatment has to be appropriate for the gender, age, culture, and ethnicity of the patient as well as address other associated medical, social, psychological and legal problems. Such improvements are notable for patients especially during counseling and during other behavioral therapies. D. Planning 1. Recommended nursing actions The public health nurse’s responsibilities include working in schools, homes, clinics, jails, and mobile vans amongst other locations (Minnesota Department of Health, 2001). For effective contribution in improving heroin addiction reduction and treatment, the recommendable actions include outreach, social marketing, advocacy, referral and follow-up, counseling, and coalition building. 2. Nurses’ role in improving heroin use amongst young adults and adolescents Together, we will identify heroin addicted young adults and adolescents and those at risk and offer relevant information to both about the nature of heroin abuse in their county, the risks involved, how to avoid getting addicted, and how the addicted can gain treatment and rehabilitation services (Minnesota Department of Health, 2001). For the addicted, counseling will be offered inclined towards their not losing hope and track the number of adolescents and young adults who responded to the outreach message. When used together with health teaching, social marketing will raise community awareness about Heroin dependency and addiction amongst young adults and adolescents. 3. Potential public and private partnership formed to implement recommendations Local health department is participating in federal heroin addiction treatment and rehabilitation program that offer low-cost heroin addiction screening, brief intervention, and referral to treatment to young adults and adolescents (Minnesota Department of Health, 2001). We will convince pharmacists and grocers in Philadelphia County to display information about heroin screening prominently on the shelves where prescription drugs are sold. The display could also consist of brochures with explanations of where and how young adults and adolescents can access affordable heroin abuse screening, treatment, and rehabilitation, and counseling. 4. Overall objective To increase community awareness on heroin addiction in their Philadelphia, inform them and the young adults and adolescents on the risks involved, how to access heroin abuse screening, and how to avoid for those not affected or recover from addiction for those affected. 5. Timeline Outcome / Week 1 2 3 4 5 6 7 8 9 10 Case finding X X Outreach X Social marketing X X X Health teaching X X X Counseling X X X Referral and follow-up X X X Surveillance X X X E. Evaluation Evaluation is a principal tool in the improvement of drug treatment or rehabilitation. Effective evaluation should meet the interests of the public health nurse and other stakeholders, for identification of relative advantages present in the measures used, and assist in the identification of issues arising. One outcome evaluation tool would be The Addiction Severity Index or ASI which in this case will be useful in heroin dependence severity assessment (Patient, 1992). This tool uses 30 day duration as the foundation for heroin dependence frequency and intensity assessment while collecting longer term misuse patterns. Another treatment outcome monitoring tool is TOPs or The Treatment Outcomes Profile. TOPs consists of one page of simple questions with intentions of advancing clinical practice through augmenting assessment and patient care plan reviews and offering performance monitoring data. F. Conclusion Based on my fieldwork, I have understood that heroin issue in Philadelphia is not just for the federal, state, or local governments alone. However, it is an issue of the entire county and the public health nurses as well. While the government is making efforts to offer rehabilitation and treatment to heroin abusers, community awareness of the risks involved and the necessary measures needed to acquire the right intervention for addicts is the role of public health nurses. With a well informed community, the levels of first time users and initiation into heroin will be reduced especially since the affected are students who need to go on with their studies. The right outreach programs mean best interventions for each group hence successful outcomes obtained. References Clark, K., & Glicksmann, A. (2010). A summary of Age Friendly Philadelphia. Philadelphia: Philadelphia Corporation for Aging. drugabuse. (2014). Drug Abuse Trends and Patterns in Philadelphia—Update: January 2014. Retrieved from Philadelphia, Pennsylvania: National Institute on Drug Abuse or NIDA: http://www.drugabuse.gov/about-nida/organization/workgroups-interest-groups-consortia/community-epidemiology-work-group-cewg/meeting-reports/highlights-summaries-january-2014-6 Gordon, S. M. (2001). Heroin: challenge for the 21st Century. New York: Caron Foundation. HealthyPeople. (2014). Substance Abuse. Retrieved from healthypeople.gov: http://healthypeople.gov/2020/LHI/substanceAbuse.aspx?tab=determinants Minnesota Department of Health. (2001). Public Health Interventions: Applications for Public Health Nursing Practice. Minnesota: Public Health Section. National Institute of Drug Abuse . (2000). Principles of Drug Addiction Treatment: A Research-based. United States: National Institute of Drug Abuse . Patient, H. A. (1992). Addiction Severity Index Lite. (P. H. Nurse, Interviewer) State profile: Pennsylvania. (2011). Pennysylvania Drug Control update. Pennsylvania: Pennysylvania Drug Control. The United States Department of Justice. (2012). Eastern Pennsylvania Drug and Gang Threat Assessment 2011. Philadelphia: National Drug Intelligence Center. World Population Review. (2014). Philadelphia Population 2014. United States: World Population Review. Appendix Community Genogram or profile on the county’s health status ‘54 ‘58 ‘56 ‘57 grandfather grandma grandpa grandma M 1976 M 1979 ’76 ’78 ‘80 Uncle aunt Aunt still birth ‘77 ‘77 Father Mother M= 2002 ’03 ‘05 Son daughter Read More