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What is something you learned about yourself as you’ve progressed through this course?

One of the biggest things I’ve learned about myself throughout this course is that my passion in psych nursing is multifaceted and truly does dive into the aspect of substance use and abuse. Furthermore, this course has provided with a better understanding and much more knowledge for advanced practice in regards to prescribing, policy, and ethical dilemmas all of which are important. 

What topic did you find the most interesting?

The most interesting topic would have been the ethical considerations. My reason is because as a future psych nurse this is super important in substance use disorder patients or even patients who do not abuse them. Ensuring that we are correctly assessing and of course doing our duty to manage a patients pain but also ensuring they do not become addicted to it is a very fine line that only through experience and time you can develop a good strategy. The use of Narcan is also another important topic that I feel is super useful but some individuals views are it are not the same. Although, Ohio has launched a study called HEALing Communities, which I feel will highlight the importance of Narcan. This program will enable policy makers to see the true effects of trying to incorporate this into the counties within Ohio and can be adopted by other states. 

What topic did you find to be the most uncomfortable?

There wasn’t a topic that was uncomfortable for me in my opinion. Overall, all of the topics were all realistic things that we as primary care nurses may come across one way or another. Substances are within our communities and although we cannot get them out we can find ways to help the people undergoing addiction and teach them safe ways to use at the very least.

Share 1 thing learned that you will adopt into your practice as a nurse?

Non-Opioid pain management techniques is something that I will develop into my nursing practice. Although the majority of them incorporated exercise of some sort or massage there were also mindfulness strategies and simple things that can be taught such as deep breathing. Again it may not alleviate all of the pain but in some instances I feel these techniques can go a long way with the pediatric psych population. 

The barriers mentioned in treating SUD, I feel are all understandable as to why they are barriers. Lack of nursing support across all fields is prevalent across the nation. The fact the SUD is more of a complex specialty within nursing that lack of support is understandable because not everyone is trained to know how to handle patients with SUD. Insufficient office support and staff knowledge just adds on to the complexity of SUD and individuals who have never been exposed or have any knowledge on the approaches that need to be taken for SUD patients causes the lack of support. Payment issues I can also understand because not all insurances cover certain cost of treatment for SUD but hiring individuals or looking for individuals who have a certain competency towards health insurance can change those numbers. In regards to institutional support, I feel that again since this disease is complex these institutions still have not developed a way to help from an office-based setting compared to the hospital.

The elements listed for successful management of treatment of SUD, I feel are great points! Frequent follow-ups, brief counseling, social support, and patient navigation I feel are very much a good approach to trying to treat this population. Case management and trying to provide the best resources and tailoring each resource to each patient unique needs I feel is a huge component. As nurses we need to be aware of any and every resource even if we need to ask for help or call someone who handles a different aspect of care for the patient such as social workers. Furthermore, as nurses and advanced practice nurses we must try to help our counterparts who also work with the same population. This I feel is also vital because we all can become overwhelmed by the case load that the quality of care may be hindered because we have gotten out of touch of the real reason, we are trying to help these patients. I feel this has become way to common with nurses and physicians alike becoming burnt out in the primary care setting because they have such a large case load that they feel they cannot help everyone.

Personally, I feel that I would love to see myself in this role especially from a psychiatric perspective by going out to see these patients in their home. I feel that doing house calls helps you develop a better picture of what that patient may be going through or whether they are progressing because they are in the comfortability of their own home. Furthermore, I feel that involving other healthcare professionals along during each house call can truly help provide a holistic type of care and truly help those patients who cannot leave their home or just are not comfortable in an office-based setting.

In my opinion there is a difference amongst both groups. Patients with chronic conditions such as diabetes more specifically type 2 for example. The reason being is that a good portion of diabetics have chosen a sedentary lifestyle coupled with obesity, which results in negative judgement being passed between healthcare professionals unfortunately. For the select few of individuals who lead a relatively healthy lifestyle judgement is not passed quite as bad as those who have other conditions that could be hindering their diabetes even more. Furthermore, for individuals with chronic conditions such as COPD that has been acquired due to their long history of smoking, those patients will not be treated quite as well as an individual with history alcoholism. I feel that in medicine prognosis has a huge part in determining how well healthcare professionals will treat you. For the example with the COPD patient cannot reverse or treat the alveoli that have been affected but for alcoholics they can reverse their complication they can solely maintain it and become healthier individuals with the support they need. Another example, they healthy type 2 diabetic may acquire more resources and much more support as to individuals with a chronic opioid addiction. Although opioid addiction can be reversed and this individual can also become a healthy individual the social determinants of health that each individual has chosen is different amongst both individuals. For the diabetic they are choosing to remain healthy and may have no issues that can prevent them from keeping compliant with their plan of care whereas, for the opioid addict they may have a multiple factor that have caused them to seek opioids and now that they are addicted the prognosis is relatively lower.

The healthcare system in general I feel looks at the amount of money it will take to each group of patients, which can cause fragmented care. According to Connecting care for patients, “Fragmented care wastes money. It is well documented that health care is a major drain on the U.S. economy and money wasted by inefficient health care could be used to improve the quality of life for all Americans” (2018). It is well known that the U.S. spends the most money on healthcare than any other country but it doesn’t seem to truly be effective at resolving a better way to treat chronic conditions or the substance use rise occurring. The similarity between both groups in the healthcare system is that they are continuing to cost more and more money due to the multiple readmissions rates that are occurring and the effectiveness of the approaches they are taking currently are not as effective as they could be. The difference between them both is the approach that is taken. With chronic conditions the approach is more so medically based focusing on a medication regiment but age appropriate education for each individual I feel is lacking, which leaves some or most patients unclear causing the readmissions. Whereas, with substance abuse the approach is more so focused on seeking help or providing resources for the individuals to independently go too. Substance use disorders should focus on a holistic approach such as focusing on mental health, being an advocate to help provide access to specialized mental health care, and the screenings should be just as important as it is with chronic conditions.

Overall, multiple factors I feel persuade someone to seek judgement and amongst chronic conditions and substance use disorders the similarity they have between them both is the aspect of prognosis. The main difference between both I feel is the social determinants of health that healthcare professional may or may not take into account.

Katz, B. (2018). Connecting care for patients. Retrieved from https://ebookcentral-proquest-com.proxy.lib.ohio-state.edu

I feel that the stigma between patients with a substance use disorder isn’t getting better. For those “frequent flyer” patients who are in and out of the hospital I feel that healthcare professionals try not to be judgmental but they are in some way. This hinders the quality of patient care they receive especially if they are aggressive, obnoxious, and overstimulating patients. The healthcare team especially the PCA’s and nurses take the brunt of the abuse from these patients, which can be a lot if you have more than one patient like that. As the opioid epidemic continues to worsen the stigma with patients has not gotten better. As mentioned in the lecture video society states things are a war against drugs but in reality, they are doing more damage to the health of these abusers instead of seeking out ways to better combat this epidemic. One way I feel we can combat this issue is having more long-term care facilities in Ohio dedicated to substance abuse. Awareness seems to always be an ongoing approach that can help in a sense but if individuals do not learn to be understanding and truly hear these substance abusers’ stories if they have one then they will not be able help them. I also feel that prescription regiments should be better tailored to prevent substance abuse. Some individuals become hooked onto these substances because they were removed suddenly or just continued to be prescribed heavy dose medications. Furthermore, in my opinion from what I’ve experienced in the clinical setting and what my friends’ experiences are who work on renal and liver units the stigma is very high because patients do not want to help themselves. They are chronic substance abusers and only a select few go on to try and become better. My other experiences are from old friends who have gotten into abusing substances and becoming dependent on those drugs. Unfortunately, this stigma that institutions have is concerning