Running_head_NURSING_RESEARCH_1NURSING_RESEARCH_7Nursing

Running head: NURSING RESEARCH 1

NURSING RESEARCH 7

Nursing Research

Student's Name

Institutional Affiliation

Nursing research

Obesity and Weight Management Programs

Introduction to the Problem

The problem under investigation in this research is the issue of obesity and weight management. This topic was selected because it the issues is affecting many people today around the world and most significantly in the United States. Thousands of people worldwide are dying from obesity and overweight related illnesses such as diabetes, cancer, high blood pressure among many others (Obesity & weight control: Health risks, weight loss & bariatric surgery, n.d.). Therefore, it has a huge impact on the healthcare system since it has increased the problems that healthcare professionals and facilities are facing. Hospitals are now congested mainly due to diet related illnesses, obesity being at the top of the list, which causes short staffing due to the increasing patients numbers relative to providers’ numbers. The providers, especially nurses, may then suffer from burnout and thus affecting the quality of care that they provide. Several weight management programs have then been created in order to tackle the serious problem of obesity. Therefore, conducting a proper research on obesity and weight management programs is very crucial since it will help in providing in-depth understanding of the whole issue and thus useful in developing and implementing ways that can curb the problem by proper implementation of these programs. This will improve the conditions of healthcare facilities and eventually the quality of care provided.

The Problem

The problem is obesity and weight management programs. Obesity is a medical condition that occurs when an individual has excess body fat or weight that might have some significant effect on his or her health (Hu, 2008). On the other hand, weight management is the process of embracing long-term lifestyle modification to keep a healthy body weight on depending on the age, gender, and height of an individual. They include methods such as eating heathy food and increasing the levels of physical activity. Weight management programs are then the initiatives that are created in controlling the weight of individuals in order to control such conditions as obesity. Managing one’s weight through these programs is very important part of their health because they avoid being overweight and obese to reduce the risks of medical conditions such as heart disease, diabetes, high blood pressure and stroke. The intake of diet considered unhealthy, lack of physical exercise and practicing unhealthy lifestyles such as too much intake of alcohol, smoking may lead to increase in weight, and thus a person is considered overweight. This is when the body contains too much body fat above the required amount. Obesity then occurs after being overweight when the calorie intake of a person goes higher than the amount of energy that is burnt off every day. This obesity issue is then being mitigated in many countries through the weight management programs. The programs are categorized into three many groups that include, clinical, non-clinical, and do-it-yourself programs (The National Academies Press, n.d.).

Significance of the problem to Nursing

Obesity has become a pandemic in the United States and many healthcare professionals including nurses have considered being the most pressing issues of health currently. It has become the top of the priorities in the US since about two-thirds of adults are either obese or overweight. Since nurses have the most important role in health care, they are most affected by this epidemic and are also in the forefront of managing the problem because they responsible for implementing the programs in the facilities and among their patients. Nurses are affected by obesity in that it increases the number of patient they attend that might wear them out, as they are required to provide care to many patient beyond their ability. This then affects the quality of care that they provide and may eventually result in poor patient outcomes. Moreover, obesity may complicate the basic nursing interventions to the affected patients such as skin care, resuscitation and assessment measures, intravenous access, altered drug absorption, and respiratory challenges. Therefore, these professionals should take action in becoming more informed concerning obesity and to put themselves in a position as the educators and role models to their patient and their families as well as the community (Rowen, 2009). Besides, nurses play a significant role in ensuring the success of the weight management programs since they can effectively implement them and educate their patients concerning these programs in order to manage their weight and avoid health complications.

Purpose of the research

The purpose of this research is to identify the health risks and effects of overweight and obesity in people, and the essential role of obesity and weight management programs. For example, individuals who are overweight or obese are at an increased risk of developing serious illnesses. Besides, it may lead to many chronic conditions. The conditions are such as hypertension, type 2 diabetes, stroke, coronary heart disease, or high levels of triglycerides, cholesterol (The health effects of overweight and obesity, 2020). It also causes diseases such as gallbladder disease, mental illnesses such as anxiety, and depression. There are also breathing problems and sleep apnea, including body pain and physical functioning difficulties.

There are essential programs such as do-it-yourself, nonclinical, and clinical programs. The programs. The programs have a variety of interventions, which include the treatment intensity, cost, and the degree of the involvement (Programs for and approaches to treating obesity, n.d.). The do it yourself programs are individually formulated. Hence, they involve varying interventions. The category involves any form of effort, which an individual does, to loose weight by herself or himself. For example, an individual may decide to loose weight by decreasing the amounts of calorie intake. In the case of the nonclinical programs, they are often franchised commercially. They are often developed by a company, and often involve guidance and instructional materials, which are typically prepared in consultation with the health care providers. Besides, such programs are often managed by licensed or qualified health care providers (Programs for and approaches to treating obesity, n.d.). In the case of the clinical programs, they involve programs which hare provided by a licensed professional. The professional may or be or may not be part of a system of a commercial franchise. Hence, the services are provided by an individual professional.

Research questions

The research question is essential in enquiring about overweight and obesity management programs. The research question will enhance efficient groundwork for the entire research process; hence, it requires good research questions to prevent the research from suffering from errors. The research questions are such as:

· Is obesity a serious problem?

· What are some of the factors, which cause or expose one to obesity?

· Is obesity harmful to an individual's health?

· What are some of the economic consequences of obesity and overweight in society?

· What are some of the steps to be taken to fight obesity?

· What is the importance of obesity and overweight management programs?

· What are some of the interventions employed by management programs for overweight and obesity?

The questions will help in providing a focus on the entire research process. They also decide on what direction the research takes. Moreover, they enhance the identification of resources, such as other scholarly studies, as reference materials.

Master's Essentials that aligned with your topic

Some of the master's essentials, which aligned with my topic: obesity and weight management programs are such as quality improvement and safety, clinical prevention, and population health for improving health. Therefore, continuous quality improvement in the management of the area of overweight and obesity in the healthcare organization is essential (A guide to baccalaureate education for nursing, 2015). For instance, the skills and knowledge concerning the management of overweight and obesity, enhance quality care. Hence, improve safety among individuals. Moreover, quality improvement through evidence-based practice, in areas concerning the management of obesity and overweight is essential for the welfare of the people.

In the case of clinical prevention and population health for improving health, it focuses on the prevention and treatment of illnesses, such as chronic diseases, communicable diseases, including the health disparity and inequity (A guide to baccalaureate education for nursing, 2015). Most chronic illnesses are often caused by obesity and overweight. Hence, implementation of clinical prevention and population health activities is important in ensuring the safety of the people.

References

Programs for and approaches to treating obesity | Weighing the options: Criteria for evaluating weight-management programs | The National Academies Press. (n.d.). The National Academies Press. https://www.nap.edu/read/4756/chapter/5#65

Obesity & weight control: Health risks, weight loss & bariatric surgery. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/11209-weight-control-and-obesity

Rowen, L. (2009). Overview and summary: Obesity on the rise: What can nurses do?. OJIN: The Online Journal of Issues in Nursing, 14(1).

Hu, F. (2008). Obesity epidemiology. Oxford University Press.

A guide to a baccalaureate education for nursing. (2015, July 27). Ameritech College of Healthcare. https://www.ameritech.edu/blog/a-guide-to-the-essentials-of-baccalaureate-education-for-nursing/

The health effects of overweight and obesity. (2020, April 11). Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/effects/index.html

Chapter 27

Violence

Overview of Violence

Violence is a national public health problem.

WHO (2013) defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.”

Injuries from violence are referred to as intentional injuries.

2

Factors That Contribute to Violence

Poverty, unemployment, economic dependency

Substance abuse

Dysfunctional family and/or social environment and lack of emotional support

Mental Illness

Media influence (e.g., violent video games, television shows, and movies)

Access to firearms

Political and/or religious ideology

Intolerance and ignorance

3

History of Violence

Long history of human violence.

In the Bible, Cain killed his brother Abel out of jealousy and anger

Audience pleasure (e.g., gladiators in Rome)

Infanticide—if child was female, a twin, sickly, or deformed

Children, especially firstborn, sacrificed for religious reasons

4

History of Violence (Cont.)

Corporal punishment used to control children

“Spare the rod and spoil the child” (Proverbs, 13:24)

“Beating some sense into him”

First legal protection in the United States in 1874

Spousal abuse/marital rape

“Rule of thumb”

“Wives be subject to your husband” (Ephesians, 5:22)

Assault against women not explored until 1960s

Elder abuse

Often undetected because of lack of awareness of HCP

Lack of mandatory reporting

5

Interpersonal Violence

Crosses all ethnic, racial, socioeconomic, and educational lines

Interpersonal Violence (IPV) is about control, not anger.

Includes:

Homicide and suicide

Intimate partner violence

Child maltreatment

6

Interpersonal Violence: Homicide

Homicide

One of the leading causes of death in the United States.

For black males aged 15 to 34, homicide is the leading cause of death.

Young people, women, and African American and Hispanic males at higher risk than the general population.

African Americans were more likely to commit homicide than whites and were more likely to be victims of homicide than whites (2010 data)

7

Interpersonal Violence: Suicide

Suicide is 10th leading cause of death for all Americans in all age groups (2010)

More people die from suicide than homicide.

Men often use firearms.

Women use poisoning.

In Native Americans and Alaska Natives, suicide is the second leading cause of death in persons 15 to 34 years of age.

8

Interpersonal Violence: Suicide (Cont.)

Risk factors for suicide

Psychiatric disorders such as major depression, bipolar disorder, and/or schizophrenia

Substance abuse

Posttraumatic stress disorder (PTSD)

Bulimia or anorexia nervosa

Past history of attempted suicide

Genetic disposition to suicide

Age, such as elderly, and white males (highest rate)

9

Interpersonal Violence: Partner

Intimate partner violence (IPV)

A pattern of coercive behaviors perpetrated by someone who is or was in an intimate relationship with the victim

May include battering, resulting in physical injury, psychological abuse, and sexual assault to progressive social isolation and intimidation of the victim

Typically repetitive and often escalates in frequency and severity

10

Interpersonal Violence: Partner (Cont.)

Risk factors for IPV

Low self-esteem

Poverty

Risky sexual behavior

Eating disorders and/or depression

Substance abuse

Trust and relationship issues

Victims often suffer in silence and accept abuse as a transgenerational pattern of normal behavior

11

Interpersonal Violence: Partner (Cont.)

Pregnancy

May increase stress within the family

All pregnant women should be routinely screened for abuse for commons sign of IPV

Delay in seeking prenatal care

Unexplained bruising or damage to breasts or abdomen

Use of harmful substances (cigarettes, alcohol, drugs)

Recurring psychosomatic illnesses

Lack of participation in prenatal education

12

Interpersonal Violence: Dating

Abusive, controlling, or aggressive behavior in an intimate relationship that takes the form of emotional, verbal, physical, or sexual abuse

May involve the use of date rape drugs

Studies have linked alcohol with dating violence

Stalking—a pattern of repeated and unwanted attention, contact, harassment, or any type of conduct directed at a person that instills fear

Bullying—a repeated oppression, psychological or physical, of a less powerful person by a more powerful person or group of persons

13

Wheel of Power and Control

14

Figure 27-1

Developed by the Domestic Abuse Intervention Project. 206 West Fourth Street, Duluth, MN 55806. Used with permission.

Impact of Interpersonal Violence

Victims often experience…

Chronic fatigue and tension

Disturbed sleeping and eating patterns

Vague gastrointestinal and genitourinary complaints

Misdiagnosis often occurs because of the obscurity of symptoms and/or failure to adequately assess

Victims stay in abusive relationships because of cultural, religious, and economic factors

15

Impact of Interpersonal Violence (Cont.)

Victims who are most likely to leave a battering situation:

Have resources and power

No children

No personal history of abuse (themselves or their mother)

Most dangerous time for victim is when he or she leaves or attempts to leave the relationship

More likely to be killed at this time than any other time in the relationship

16

Interpersonal Violence: Child

Child maltreatment

Most child maltreatment occurs within the family.

More often abused by parents than other relatives or caregivers.

More commonly seen in families in poverty, families in disorganization, or with parents who are younger and who are substance abusers.

17

Interpersonal Violence: Child (Cont.)

Child maltreatment

Risk factors include but are not limited to

Special needs children

Children less than 4 years of age

Family history of violence

Substance abuse

Poverty

Social isolation

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Interpersonal Violence: Child (Cont.)

Child maltreatment

Four types of child abuse:

Neglect

Physical abuse

Includes beating, burning, biting, and bruising

Abusive head trauma/shaken baby syndrome is leading cause of death in the United States from abuse

Emotional abuse

Sexual abuse

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Interpersonal Violence: Elderly

Elder abuse

Society fails to recognize the cruelty many older adults experience.

Elders are an “invisible” segment of the population.

Reasons for underreporting of elder abuse

Shame on part of victim

Social and physical isolation from resources

Failure of health care provider to routinely assess during points of contact

No uniform reporting system

20

Interpersonal Violence: Elderly (Cont.)

Elder abuse

Types of abuse and neglect

Physical abuse

Psychological-emotional abuse

Sexual abuse

Neglect

Financial exploitation

Health care fraud and abuse

21

Community Violence

Community violence usually occurs suddenly and without warning and can potentially destroy entire segments of the population

Community violence includes

Workplace violence

Youth violence

Gang-related violence

Hate crimes

Terrorism

22

Community Violence: Workplace

Risk factors include:

Increasing number of acute and chronically mentally ill patients

Working alone

Availability of drugs at worksite

Low staffing levels

Poorly lit parking areas and corridors

Long waits for service

Inadequate security

Increasing number of substance abusers

Access to firearms

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Workplace violence includes physical assaults, muggings, and verbal and written threats

Community Violence: Youth

Youth-Related Violence

Concentrated in minority communities and inner cities, causing a disproportionate burden on these communities

Adolescents and youth increasingly use violence to settle disputes.

Even when taught peaceful ways of resolving differences, learn by what they observe at home, on television, and in movies.

Schools have become common sites for violence.

24

Risk Factors for Youth Violence (from Textbook, Table 27-3)

25

Individual Risk Factors	Community Risk Factors
Involvement with drugs, alcohol, or tobacco	Diminished economic opportunities
Antisocial beliefs and attitudes	High concentration of poor residents
Low IQ	High level of family disruption
History of violent victimization	Low levels of community participation
History of early aggressive behavior	Socially disorganized neighborhoods

Risk Factors for Youth Violence (from Textbook, Table 27-3—Cont.)

26

Individual Risk Factors	Community Risk Factors
Attention deficits, hyperactivity, or learning disorders	High level of transiency
Poor behavioral control
Deficits in social, cognitive or information-processing abilities
Exposure to violence and conflict in the family
High emotional distress
History of treatment of emotional problems

Risk Factors for Youth Violence (from Textbook, Table 27-3—Cont.)

27

Family Risk Factors	Peer/Social Risk Factors
Poor family functioning	Association with delinquent peers
Low emotional attachment to parents of caregivers	Involvement in gangs
Low parental education and income	Social rejection by peers
Parental substance abuse or criminality	Lack of involvement in conventional activities
Poor monitoring and supervision of children	Poor academic performance
Harsh, lax, or inconsistent disciplinary practices	Low commitment to school and school failure
Authoritarian childrearing practices

Community Violence: Gangs

Reasons that young people join gangs:

Believe that gangs will protect them

Peer pressure

The need for respect

A sense of belonging

Increasingly responsible for crimes and violence throughout the United States

Crimes include illegal alien smuggling, armed robbery, assault, auto theft, drug and weapon trafficking, identity theft, and murder.

28

Community Violence: Prison

Prison violence

The United States has one of the world’s highest rates of incarceration

Inmates are both victims and perpetrators of violence.

Includes allegations of physical abuse and reports of rape by corrections officers and inmates

Little sympathy for this population for a variety of reasons, including indifference, disbelief, and denial

29

Community Violence: Trafficking

Human trafficking is a global problem and a public health issue.

Involves:

Prostitution

Sexual exploitation

Forced labor

Slavery

Removal of organs

30

Community Violence: Hate Crimes

Crimes in which offender is motivated by

An individual’s race*1

Sexual orientation*3

Religious beliefs*2

Ethnic background

National origin

*Rank—most commonly reported

Hate crimes may include

Murder

Rape

Sexual or physical assault

Harassment

Attacks on homes or on places of worship

Vandalism

31

Community Violence: Terrorism

“The calculated use of unlawful violence or threat of unlawful violence to inculcate fear; intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological.”

(Department of Defense)

All terrorist acts include at least three key elements—violence, fear, and intimidation.

32

Factors Influencing Violence

Firearms

A gun in the home…

…triples the risk for homicide in the home

…increases the risk for suicide 3 to 5 times

…increases risk for accidental deaths by 4

Firearms are the number one weapon of choice in homicides in the United States.

Direct and indirect costs are staggering.

“Right to bear arms” arguments persist.

33

Factors Influencing Violence (Cont.)

Media violence includes exposure to and participation in …

…violent video games

…music and music videos that depict date rape or violence

…virtual violence that allows subscribers to harm or kill victims

Repeated exposure to media violence leads to emotional desensitization to real-life violence

34

Factors Influencing Violence (Cont.)

Mental illness is considered by many to be a major factor in violence.

Studies are inconclusive that all violence is committed by mentally unstable persons.

Increasing push for legislation to fund public health strategies that identify and treat mental illness across the country

Funding issues have forced states to eliminate or reduce availability of mental health services

35

Violence Is a Public Health Epidemic

The public health system is challenged to go beyond its traditional programs to include prevention and management of violence.

Efforts being made with

Public health strategies

Community approaches

Local, state, and federal governments

Addressed by Healthy People 2020

36

Prevention of Violence: Primary Prevention

Goal: to stop violence, abuse, or neglect before it occurs

Education may include life skills training:

Parenting and family wellness

Anger management

Conflict resolution

Nurses should:

Increase awareness of violence

Identify cases

Work with the community

37

Prevention of Violence: Primary Prevention (Cont.)

Must begin at community level to change attitudes

Focuses on stopping transgenerational aspect of abuse

Start with young children

Continue across the lifespan

Mentoring and peer programs to promote healthy relationships and decrease conflict

Work with high-risk individuals

38

Prevention of Violence: Secondary Prevention

Goal: assess, diagnose, and treat victims and perpetrators of violence.

Consideration of safety of potential victim is critical

Begins with assessment

Once identified, victims must be offered…

Resources to increase their safety

Legal options and how to access them

39

Prevention of Violence: Secondary Prevention (Cont.)

Nurses must screen for abuse. Ask questions

Within the last year, have you been hit, slapped, kicked, or otherwise physically hurt by someone?

Since you’ve been pregnant, have you been hit, slapped, kicked, or otherwise physically hurt by someone?

Within the last year, has anyone forced you to have sexual activities?

Intervene when essential

Interdisciplinary approach leads to optimal outcomes.

40

Prevention of Violence: Tertiary Prevention

Goal: Aimed at rehabilitation of individuals, families, groups, or communities and includes both victims and perpetrators of violence

May take months or even years

Nurses must work in conjunction with a variety of mental health professionals and social service agencies to provide coordinated care

Self-care and recognition of own limitations and needs

41

Chapter 26

Substance Abuse

More deaths, illnesses, and disabilities are attributed to substance abuse than to any other preventable health conditions in the United States.

– Substance Abuse and Mental Health

Services Administration (SAMSHA)

2

Social Consequences of Substance Abuse

Crimes while under the influence of drugs, alcohol, or both

Need for money to buy substances

Specific theft of drugs

Almost 75% of inmates report prior drug use

All aggregates in society are potentially affected by substance abuse problems regardless of age or economic level

3

Etiology of Substance Abuse

Numerous theories try to explain it

Combination of many factors

Genetics within families

Individual (impulsivity and ease of disinhibition)

Environmental factors

Medical models

Biopsychosocial models

4

Historical Overview of Alcohol and Illicit Drug Use

Alcohol use has gained more social acceptance than other drug use.

Public attitudes and governmental policies have also influenced the history of illicit drug use.

5

Historical Overview of Alcohol and Illicit Drug Use (Cont.)

Consumption and laws affected by:

Alcohol-related deaths after lowered drinking age

Less tolerant national attitudes toward drinking

Increased societal and legal pressures and actions against drinking and driving

Increased health concerns among Americans

Knowledge of addictive properties

Counterculture acceptance of hallucinogens, cannabis, and heroin

The “War on Drugs”

Renewed interest in prevention/treatment efforts

6

Laws Impacting Substance Abuse

Anti–Drug Abuse Acts of 1986 and 1988

Increased funding for treatment and rehabilitation

Created the Office of National Drug Control Policy (“drug czar”)

Worked on a public health approach to drug control

National Institute on Drug Abuse (NIDA)

Science on drug abuse and addiction

Prevention

Treatment

Decreasing the spread of HIV/AIDS

Other priority areas

7

Laws Impacting Substance Abuse (Cont.)

Substance Abuse and Mental Health Services Administration (SAMHSA)

Builds and sustains programs, policies, information and data, contracts, and grants toward helping the nation act on the knowledge that promotes behavioral health treatment through all levels of prevention

8

Prevalence, Incidence, and Trends

Alcohol use by persons aged 12 or older:

Slightly more than half (52.8%) drink alcohol

Binge drinking at least once in prior 30 days— (22.6%)

Heavy drinking—6.2%

Young adults ages 18-25 had highest prevalence of binge and heavy drinking—39.8%

Drove under the influence of alcohol at least once in past year—11.1%

– SAMHSA (2011)

9

Prevalence, Incidence, and Trends (Cont.)

Illicit drug use by persons aged 12 or older:

About 8.7% were current drug users, used an illicit drug during the past month

Illicit drugs used

Marijuana was the most commonly used drug

Others included cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics (pain relievers, tranquilizers, stimulants, and sedatives) used nonmedically

– SAMHSA (2011)

10

Prevalence, Incidence, and Trends (Cont.)

Nonmedical use of prescription-type psychotherapeutics

There is a significant increase in the lifetime nonmedical use of pain relievers—specifically Percocet®, Percodan®, Vicodin®, Lortab®, Darvocet®, Darvon®, Tylenol® with Codeine, Propoxyphene, or Codeine Products, Oxycodone, and Hydrocodone

– NIDA (2010)

11

Prevalence, Incidence, and Trends (Cont.)

Hallucinogen, inhalant, and heroin use

LSD (d-lysergic acid diethylamide)

Peyote cactus

Psilocybin

PCP (phencyclidine)

Inhalants of choice are amyl nitrite, “poppers,” followed by glue, shoe polish, or toluene; correction fluid, degreaser, or cleaning fluid; gasoline or lighter fluid; and spray paints and other aerosols.

12

Prevalence, Incidence, and Trends (Cont.)

Gender difference

Males more likely to be current illicit drug users

Female illicit drug use (12 and older) increasing

Geographic trends

Highest in West > Midwest > Northeast > South

Racial/ethnic groups

Highest among American Indians or Alaska natives > African Americans> whites > Hispanics > Asians

– SAMHSA (2010)

13

Trends in Substance Abuse

May or may not relate to classically or clinically defined dependence or addiction.

Many are turning to recovery before they have developed physiological dependence.

Need to differentiate between use and misuse/abuse.

Use of harmful substances is indirectly and directly related to all of the leading health indicators targeted in Healthy People 2020.

14

Methamphetamine (MA)

Most widely produced controlled substance in the United States.

Illegal street names of the drug (crank, crystal, meth, ice, or glass).

Can be injected, inhaled, taken orally, or smoked.

Used predominantly by white young persons, with an overrepresentation of females.

15

Methamphetamine (MA) (Cont.)

Pleasurable effects are caused by the release of high levels of dopamine in the brain, leading to increased energy, a sense of euphoria, and increased productivity.

Short-term effects: increased heart rate, insomnia, excessive talking, excitation, and aggressive behavior

Prolonged use results in tolerance and physiological dependence

Negative consequences range from anxiety, convulsions, and paranoia, to brain damage.

16

Methamphetamine (MA) (Cont.)

The impact of MA abuse on communities, families, and social networks is considerable.

Young children of users are at risk for abuse and neglect.

Prenatal use puts children at risk for developmental problems, aggression, and attention disorders.

Exposure to combustible second-hand fumes.

Associated with increased incidence of violence (e.g., domestic abuse, homicide, and suicide)

17

Steroids

Anabolic steroids are synthetic variants of male sex hormone testosterone

Build muscle and said to be androgenic

Most commonly used in athletes and other individuals willing to risk potential and irreversible health consequences to build muscle

Potentially fatal risks

Blood clots, liver damage, premature cardiovascular changes, increased cholesterol

Increased potential for suicide and aggressive and risky behaviors

18

Inhalants

Contain volatile components with psychoactive properties

Many products found in home or workplace (e.g., spray paints, markers, glues, and cleaning fluids)

Produce a rapid high that may resemble alcohol intoxications; may progress to loss of sensation and even unconsciousness

Irreversible effects:

Hearing loss, limb spasms, CNS or brain damage, or bone marrow damage; may result in death from heart failure or suffocation

19

Adolescent Substance Abuse

Highest prevalence of illicit drug use during lifetime between 18 and 25 years

Teen use of cigarettes and smokeless tobacco has declined

Nearly half of teens try marijuana before they graduate—skepticism about drug’s danger

As harmful, illicit substances come in and out of vogue, CHN needs a good understanding of drug culture, terminology, and differing signs and symptoms

20

Conceptualizations of Substance Abuse

Conceptualizations have changed over the years, often for political and social reasons rather than for scientific reasons.

“Dependence” or “abuse”

What substances can be abused?

APA focuses on alcohol, amphetamines, caffeine, cannabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, and hypnotics or anxiolytics

21

Defining Substance Abuse

Substance abuse: a maladaptive pattern of substance use that is manifested by recurrent and significant adverse consequences related to repeated use of a substance.

Failure to fulfill major role obligations

Repeated use in physically hazardous situations

Multiple legal problems

Recurrent social and interpersonal problems

22

Defining Substance Abuse (Cont.)

Dependence: a cluster of cognitive, behavioral, and physiological symptoms that indicate continued use of the substance despite significant substance-related problems

Pattern of repeated, self-administered use

Tolerance, withdrawal, and compulsive drug-taking behaviors

A craving or strong desire for the substance

Preoccupation with supply, money to purchase, and getting through time between periods of use

23

Sociocultural and Political Aspects of Substance Abuse

Determined largely by economic, cultural, and political conditions of potential users

Cultural conditions create ambiguity in clearly determining when a problem exists.

Competing value systems lead to cultural disintegration and a sense of powerlessness and hopelessness.

24

Course of Substance-Related Problems

Path from initiation to dependency is multidimensional.

Person + substance + context/environment

Progression varies—from initiation to continuation, transition to abuse, and finally, addiction and dependency

Critical point is transition from use to abuse

Addiction/dependency marked by changes in both behavior and cognition

Once addiction is established, withdrawal symptoms are strong motivators to continue use

25

Legal and Ethical Concerns

U.S. policy based on prohibition and criminal sanctions against use and sale of illicit drugs

Criminal activities (violence and drug trafficking)

Drinking and driving, working while intoxicated

Impact on fetus (FAS)

Modes of intervention

Limit access

Media campaigns

Educational programs

National organizations that promote community education, research, and support

26

Prevention Strategies

Primary prevention

Needs assessment to identify high-risk situations and potential problems

Decriminalization and legalization of drugs(?)

Community-based programs

Training of health professionals

Faith-based initiatives

Volunteer consumer groups

Organized sports programs

Employer programs

Often overshadowed by “War on Drugs”

27

Prevention Strategies (Cont.)

Secondary prevention

Screening and finding resources

CAGE: an alcoholism screening test

Clinical Institute Withdrawal Assessment (CIWA)

Use evidence-based programs

Efforts should be specific to aggregates, rather than directed at the “general public”

Incorporate culturally sensitive and appropriate interventions and strategies

Work toward improving individuals’ general competencies, communication skills, and self-esteem

28

Treatment

For individuals, consider:

Cultural and educational background

Resources of the person

Attitudes of significant others

Degree of invasiveness of the effects of the substance use The existence of alternatives

Relapse prevention

29

Treatment (Cont.)

Inpatient and outpatient treatment programs

May or may not include detoxification component

Voluntary vs. compulsory

Pharmacologically based vs. drug free

Treatment approaches and models vary

Assessment process is of primary importance.

Therapeutic relationship based on trust is essential.

Physical examination is a valuable tool.

Nonjudgmental attitude minimizes defensiveness.

30

Treatment (Cont.)

Programs usually include:

Group and individual therapy and counseling

Motivational interviewing

Family counseling

Education

Socialization into 12-step mutual self-help groups

Integrate psychotherapy with pharmacotherapy

May include other strategies:

Hypnosis, occupational therapy, confrontation, assertiveness training, blood alcohol level discrimination training, behavior modification approaches

31

Treatment (Cont.)

Pharmacotherapies

Used in detoxification, stabilization, maintenance, as antagonists, and as treatment for coexisting disorders

Mutual help groups

Operate through face-to-face supportive interaction focusing on a mutual goal; AA was first

Harm reduction

Elimination of the more harmful effects of substance use through behavior and policy modifications

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Social Network Involvement

Therapy that involves the family has proved to be most effective in aiding recovery.

Family and friends

Highly influential or aid and abet

Codependency and enabling

Effects on the family

Functional or dysfunctional families

Psychological and financial burdens

Professional enablers

Treatment of symptoms by medication

Reluctant to bring up this taboo subject

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Vulnerable Aggregates: Preadolescents and Adolescents

Times of experimentation, searching, confusion, rebellion, poor self-image, alienation, and insecurity

Use of legal substances (e.g., tobacco, alcohol) almost always precedes use of illegal drugs.

Poor school performance and drug use among peers are strongest predictors of subsequent drug involvement, followed by lack of strong family bond.

The younger the initiation, the greater the probability of prolonged and accelerated use.

Feeling of powerlessness; selling drugs seen as a viable economic solution to poverty.

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Vulnerable Aggregates: Preadolescents and Adolescents (Cont.)

Primary prevention focuses on:

Advocating for these vulnerable children

Educating teachers on the vital importance of maintaining a validating, nonjudgmental attitude toward these students

Supporting strong families in the community

Improving knowledge through education and media

Early detection of predisposing factors

Providing structured clubs and organizations

Facilitating school success, career skills, family communication skills, and conflict resolution

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Vulnerable Aggregates: Elderly

Elderly experience

Diminished physiological tolerance

Increased use/misuse of medically prescribed drugs

Cultural and social isolation

Misuse of prescription drugs may be the most common form of drug abuse among the elderly

Use prescription medications approximately three times as frequently as general population

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Vulnerable Aggregates: Women

Alcohol use and abuse affects women much differently than men.

Women absorb and metabolize alcohol differently.

Body composition differences and production of less gastric alcohol dehydrogenase

Metabolize alcohol at a different rate

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Vulnerable Aggregates: Women (Cont.)

Increased risk stems from economic, social, and cultural factors.

Marginalization of certain groups

History of child abuse

Physical and medical problems related to reproductive systems

Use during pregnancy has long-term developmental consequences for the newborn

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Vulnerable Aggregates: Ethnocultural Considerations

African Americans, Hispanics, and Native Americans—increased risk for substance abuse.

Economically disenfranchised groups

Discrimination and racism

Socioeconomic, political, and historical realities

Myths and stereotypes

Social support—positive effect on treatment/outcome

Environmental cues and conditioned reinforcement

Treatment poses special challenges.

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Vulnerable Aggregates: Other Aggregates

Substance abuse is most common psychopathological problem in the general population.

Dual-diagnosis individuals

Psychiatric disorder + substance abuse disorder

Risk for multiple vulnerabilities in one individual

Impact of substance abuse on STDs

Substance abuse among health care professionals

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Nursing Interventions in the Community

Understand own experiences and prejudices.

Routinely assess substance use patterns when performing client histories.

Be alert to environmental cues in the home that indicate substance abuse.

Increase the individual’s and family’s awareness of the problem.

Involve the social network in getting the client into treatment.

Develop a caring nursing relationship.

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Other Traditional Nursing Roles and Interventions

Health teaching regarding addictive illness and addictive effects of different substances

Advocating that EBP treatment works in special populations through problem-solving courts (drug courts), specialized adolescent treatment, and other community case management programs.

Providing direct care for abuse- and dependence-related medical problems

Educating clients and families about problems related to substance abuse

Collaborating with other disciplines to ensure continuity of care

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Other Traditional Nursing Roles and Interventions (Cont.)

Coordinating health care services for the client to prevent prescription drug abuse and avoid fragmentation of care

Providing consultation to nonmedical professionals and lay personnel

Facilitating care through appropriate referrals and follow-up

Knowing how to use community resources for working with substance abuse, mental health, and other issues

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