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What to Include in Reflection Blog 4

• What is something you learned about yourself as you’ve progressed through this course?
• What topic did you find the most interesting?
• What topic did you find to be the most uncomfortable?
• Share 1 thing learned that you will adopt into your practice as a nurse?

During this course, I’ve learned that (sometime in the near future) I want to work with patient’s with SUD.  I have a passion for this subject already, and this class has just cemented that desire to help.

The topic that I found most interesting was toward the beginning; the facts and stats about SUD and the medications used to treat it. It was not shocking overall, due to the epidemic there is currently, but still sad that there is such a prevalence and so little help available.

None of the topics made me uncomfortable, to be honest. I have a passion and soft spot for this topic and these patients. With my personal family history of this issue, I do not have any issue with hitting this topic, head on, and addressing it.

I hoping, in the near future, to either start the path to become a APRN, and gain a specialty it substance abuse. This is a large, long term goal, but something i feel passionate about and I feel a calling to do. In the mean time, I plan to continue to advocate for these patients, and be as supportive as I can.

The barriers for prescribing Buprenorphine are not surprising, however the fact that lack of nursing support is #1, is surprising.  We have more nurses in primary care now than ever before. To be able to help and make an impact in the OUD epidemic, we need to utilize these APRNs. The fact that most institutions are not supportive of prescribing buprenorphine, is also a big barrier. There are very few institutions/offices where you can get MAT treatment, and they are full and have long wait lists. We are truly doing a disservice to this epidemic by not putting support into prescribing these medications and by not training more providers to prescribe them.

The critical elements of supporting the nurse management model are the ability for frequent follow up visits, the patient’s having access to case management (for other needs) and supporting physicians with high case loads (by being able to take on a case load of their own). Also, if we can integrate this program into the primary care clinics, the patients can get comprehensive medical care (instead of just OUD treatment).

I can definitely see myself in one of these roles, or at least assisting these programs and clinics. I have a person investment in the treatment of SUD/OUD; and I do feel a calling to help eliminate the stigmas associated with this disease and help expand the available treatments.  Due to my personal investment, I have already had this conversation (with my husband), that somehow my calling in nursing is entwined with SUD and it’s treatment and advocacy. Ultimately, my goal would be education to the public, to help reduce the stigma, and help support MAT facilities.

Patient’s with SUD are definitely treated differently, in regards to being treated as a chronic disease. Providers have no issues with treating diabetes or heart disease as chronic, but SUD isn’t given the same attention.  Patient’s with SUD are thought to be choosing the disease or “lazy” and not wanting to get better. Also, the treatment for SUD is only acute; there is not a proper system for long term help. “Historically, addiction treatment systems and research have been organized to provide and improve the outcomes of acute episodes of care. The conceptual model has been that an addicted person seeks treatment, completes an assessment, receives treatment, and is discharged, all in a period of weeks or months,” (Dennis, Scott, 2007). Mental health care in general, is severely lacking in long term care and accessibility. “In sum, most patients in publicly funded addiction treatment have SUDs and require multiple treatment episodes over several years to reach stable recovery. For optimal outcomes, treatment systems and interventions should be able to address the long-term aspects and cyclical dynamics of the disorder,” (Dennis, Scott, 2007).  Patient’s are having to undergo acute treatments over and over, due to the lack of long term/chronic assistance available.

Overall, I feel like there are very few, if any, similarities in how patients with SUD and other chronic diseases are treated by healthcare providers. Again, SUD is mainly treated in acute exacerbation’s, and there is little long term treatments.  While there are MAT programs, which can be longer term, these are still limited in availability. There are mental health resources also available, but the waiting times to get an appointment are growing by the day. It’s easier to get an appointment with Endocrinology or Cardiology than it is Psychiatry or Psychology. “The growing body of empirical evidence demonstrating the chronicity of SUDs, coupled with increasing awareness among various stakeholders about the need for change, represents genuine progress. Formal and informal efforts to address the problems continue to expand; it is hoped that this enhanced awareness will lead to increased dialogue and action among the numerous stakeholders to improve the treatment and long-term management of chronic SUDs,” (Dennis, Scott, 2007).

References

Dennis, M., & Scott, C. K. (2007, December). Managing addiction as a chronic condition. Retrieved November 3, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797101/.

What to Include in Reflection Blog 1

• Share your thoughts on the stigma patients with a substance use disorder face within the healthcare system and how this impacts patients.  Feel free to share examples you have seen in the media and/or your own practice. Please omit names/places/any identifying information in any personal/professional stories you share.

Substance use disorder is a very touchy topic for a lot of people; even health care providers.  One of the biggest stigmas  patient’s experience, with SUD diagnosis, is that they are “drug seeking” or “junkies,” and they are choosing this disease.  Personally, I very much dislike these terms, as they put people, with a serious disease, into a category that is negative and hurtful.  SUD is a serious mental condition, which needs long term treatment, like any other chronic disease. These patients are stigmatized as being poor, dirty, uneducated, etc…  This is certainly not always the case. SUD is non-discriminatory; it affects all races, ages, genders, and social status’.  These stigmas impact this population of patients negatively.  They are often pushed aside, and not given the help they desperately need. Especially in the Emergency rooms, patients are labeled as drug seeking and shuttled back out the door with very little help or resources.  Sadly, even if appropriate attention is given to their disease, there are very limited resources for any mental health conditions.

• Share 1 tip that might help combat stigma.

One tip that can help this population, and help combat the stigmas; education.  We as health care professional need to educate ourselves on the disease of Substance Use.  We need to better understand the physiology of the disease and how the brain functions for these people. We need to educate ourselves on the resources and assistance available in the community. We need to understand Medication Assisted Therapy (MAT) and how it works and can help (especially with opiate dependence). We need see SUD just like we do any other chronic health condition (CHF, DM, COPD), and starting treating patients the same. We need to be more open minded and willing to help, by looking at our own biases.

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