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Frances Russo-Avena, RN, MSN, MSM
Born and raised in Brooklyn, NY, Frances and her husband Robert moved to Delaware in 1989. Together they have raised 4 children. Fran graduated in 1981 from Hunter-Bellevue School of Nursing in NYC earning her BSN. She has received her MSN, MSM degree from Wilmington University. Fran is employed as a full time school nurse at Warner Elementary School in Wilmington and continues her clinical practice part-time at Wilmington Hospital. Prior to school nursing, her career had primarily been in emergency room and critical nursing. Fran has seen, firsthand, the devastating effects of addiction both in her personal life as well as her professional one. It was school nursing that nurtured her passion for public health. She has developed enduring partnerships with local, state and government agencies while advocating for those afflicted with the disease of addiction. Fran believes no child is too young to learn about the negative impact of prescription drug abuse. Along with a determined group of colleagues, she has devoted much time to engaging the public
Sarah J. Carmody, MBA
Happy Fall! Every 2-3 years ANCC updates its standards to ensure continual improvement to the process of awarding contact hours for educational activities. Hooray! The 2015 revised criteria stream lines requirements for Approved Providers and Individual Activity Applicants. Revisions were based on Nurse Planner feedback to address concerns regarding documentation burden and redundancy experienced with the 2013 criteria. The new forms, manuals, infographics, and information can be found on the DNA website: www.denurses.org.
The Continuing Education Committee has several workshops scheduled for October to review the new standards with anyone wanting to learn more about CNE. Requests for additional workshops are accepted.
DNA has also completed its re-accreditation for both the Approver Unit (Continuing Education Committee) and the Provider Unit (Professional Development). As of this writing, DNA is waiting for the decision on the applications.
Constituent member of ANA The mission of the Delaware Nurses Association is to advocate for the interest of professional nurses in the state of Delaware. The Delaware Nurses
Association is dedicated to serving its membership by defining, developing, promoting and advancing the profession of nursing as an art and science.Quarterly publication direct mailed to approximately 12,000 RNs and LPNs in Delaware.
Volume 41 • Issue 4 November, December 2016, January 2017
Inside DNA REPORTER
Reporter The Official Publication of the Delaware Nurses Association
Smart Moves, Smart Choices
Page 4
Nursing Role in the Use of Opioids
Page 8Leslie Verucci,
MSN, RN, APRN-BCDenise L. Buffin, RN, MEd, MSN
current resident or
Presort StandardUS Postage
PAIDPermit #14
Princeton, MN55371 New and Returning Members . . . . . . . . . . 2
President’s Message . . . . . . . . . . . . . . . . . . 3
Smart Moves, Smart Choices . . . . . . . . . . . 4
Delaware Fighting the Opioid Epidemic: How did we get here? . . . . . . . . . . . . . . . . . 6
Family Wellness and Addiction . . . . . . . . . . 7
Nursing Role in the Use of Opioids. . . . . . . . 8
Developmental Impact on Children Born with Neonatal Abstinence Syndrome . . . . 10
Guest Editor
Substance Abuse continued on page 4 Executive Director’s Column continued on page 2
Substance Abuse
Frances Russo-Avena
education system in implementing substance prevention programs for all school aged children in the state of Delaware. Fran has actively worked in creating awareness among her fellow health care providers about the abuse of prescription medications in our communities. She is a Fellow of the Johnson & Johnson School Health Leadership Program, chair of the Public Education Sub-committee of Delaware’s Prescription Drug Action Committee (PDAC), an advisory board member of Healthy Delawarean’s With Disabilities (HDWD)/ Governor’s Health Care Commission as well as Healthy Kids Delaware (HKD). She is an honored board member of atTAcK. Fran is also a Red Clay School District Wellness Champion and co-chair of Delaware’s Fetal Alcohol Spectrum Disorders (FASD) Task Force. Frances can be reached by phone at 302-651-2744 or email at [email protected].
Substance abuse, in particular Prescription Drug Abuse (PDA), has overwhelmed our communities, health care, and criminal justice systems. It has touched our most vulnerable population, school-aged children. Substance abuse knows no boundaries. It does not discriminate based on one’s race, religion, ethnicity, gender or age. Substance Use Disorder (SUD), has been classified as a chronic brain disease. Its devastating effects are no different than that of other illnesses such as heart disease,
Executive Director’s Column
Sarah Carmody
Page 2 • DNA Reporter November, December 2016, January 2017
Vision: The Delaware Nurses Association is dedicated to serving its membership by defining, developing, promoting and advancing the profession of nursing as an art and science.
Mission: The Delaware Nurses Association advocates for the interest of professionalnurses in the state of Delaware.
Goals: The Delaware Nurses Association will work to:1. Promote high standards of nursing
practice, nursing education, and nursing research.
2. Strengthen the voice of nursing through membership and affiliate organizations.
3. Promote educational opportunities for nurses.
4. Establish collaborative relationships with consumers, health professionals and other advocacy organizations.
5. Safeguard the interests of health care consumers and nurses in the legislative, regulatory, and political arena.
6. Increase consumer understanding of the nursing profession.
7. Serves as an ambassador for the nursing profession.
8. Represent the voice of Delaware nurses in the national arena.
OFFICIAL PUBLICATIONof the
Delaware Nurses Association
4765 Ogletown-Stanton Road, Suite L10Newark, DE 19713
Phone: 302-733-5880Web: http://www.denurses.org
The DNA Reporter, (ISSN-0418-5412) is published quarterly every February, May, August and November by the Arthur L. Davis Publishing Agency, Inc., for the Delaware Nurses Association, a constituent member association of the American Nurses Association.
ExECUTIVE COMMITTEE
President TreasurerKaren Panunto, Bonnie Osgood, Ed.D, MSN, RN, APRN MSN, RN-BC, NE-BC
President-Elect SecretaryLeslie Verucci, RN, MSN, Christopher E. Otto, CNS, CRNP-A, APRN-BC BSN, RN, CHFN, PCCN
COMMITTEE CHAIRS
Continuing Education CommitteeWayne Voelmeck, MSN, PhD on Nomination Jon M. Leeking, MSN, RN
Professional Development May Oboryshko, DNP, RN
LegislativeMembers of the Board of Directors
CommunicationsWilliam T. Campbell, Ed.D, RN
Jennifer Hargreaves, BA, MSN, RN, NE-BC
Executive DirectorSarah J. Carmody, MBA
Subscription to the DNA Reporter may be purchased for $20 per year, $30 per year for foreign addresses.
For advertising rates and information, please contact Arthur L. Davis Publishing Agency, Inc., 517 Washington Street, PO Box 216, Cedar Falls, Iowa 50613, (800) 626-4081, [email protected]. DNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.
Acceptance of advertising does not imply endorsement or approval by the Delaware Nurses Association of products advertised, the advertisers, or the claims made. Rejection of an advertisement does not imply a product offered for advertising is without merit, or that the manufacturer lacks integrity, or that this association disapproves of the product or its use. DNA and the Arthur L. Davis Publishing Agency, Inc. shall not be held liable for any consequences resulting from purchase or use of an advertiser’s product. Articles appearing in this publication express the opinions of the authors; they do not necessarily reflect views of the staff, board, or membership of DNA or those of the national or local associations.
Managing EditorsWilliam T. Campbell, Ed.D, RN
Jennifer Hargreaves, BA, MSN, RN, NE-BC
The DNA Reporter welcomes unsolicited manuscripts by DNA members. Articles are submitted for the exclusive use of The DNA Reporter. All submitted articles must be original, not having been published before, and not under consideration for publication elsewhere. Submissions will be acknowledged by e-mail or a self-addressed stamped envelope provided by the author. All articles require a cover letter requesting consideration for publication. Articles can be submitted electronically by e-mail to Sarah J. Carmody, MBA @ [email protected].
Each article should be prefaced with the title, author(s) names, educational degrees, certification or other licenses, current position, and how the position or personal experiences relate to the topic of the article. Include affiliations. Manuscripts should not exceed five (5) typewritten pages and include APA format. Also include the author’s mailing address, telephone number where messages may be left, and fax number. Authors are responsible for obtaining permission to use any copyrighted material; in the case of an institution, permission must be obtained from the administrator in writing before publication. All articles will be peer-reviewed and edited as necessary for content, style, clarity, grammar and spelling. While student submissions are greatly sought and appreciated, no articles will be accepted for the sole purpose of fulfilling any course requirements. It is the policy of DNA Reporter not to provide monetary compensation for articles.
Reporter
Did you know the DNA Reporter goes
to all registered nurses in
Delaware for free?
Arthur L. Davis Publishing does a great job of contacting advertisers, who support the publication of our newsletter. Without Arthur L. Davis Publishing and advertising support, DNA would not be able to provide the newsletter to all the nurses in Delaware.
Now that you know that, did you know receiving the DNA Reporter does not automatically provide
membership to the Delaware Nurses Association?
DNA needs you! The Delaware Nurses Association works for the nursing profession as a whole in Delaware. Without the financial and volunteer support of our members, our work would not be possible. Even if you cannot give your time, your membership dollars work for you and your profession both at the state and national levels. The DNA works hard to bring the voice of nursing to Legislative Hall, advocate for the profession on regulatory committees, protect the nurse practice act, and provide educational programs that support your required continuing nursing education.
At the national level, the American Nurses Association lobbies, advocates and educates about the nursing profession to national legislators/regulators, supports continuing education and provides a unified nationwide network for the voice of nurses.
Now is the time! Now is the time to join your
state nurses association! Visit www.denurses.org to join or
call (302) 733-5880.
Commitment to excellence. Passion about their work. Trustworthy and respected. These are the qualities that make a nurse a leader and ones that are evident in Senator Bethany Hall-Long, who recently won the Democrat nomination for Lt. Governor of Delaware. The Nurses on Boards Coalition goal is to bring nurses’ valuable perspective to governing boards, as well as state-level and national commissions, with an interest
Executive Director’s Column continued from page 1
Welcome New & Returning Members!
Bogonko Achenchi Dover DELa Donna Allen Smyrna DEKaren Andrea Hockessin DEBridget Bieber Willow Street PATeri Carter Milford DEReinette Charles New Castle DEGuirlene Clervoix New Castle DEAnne Cloud Hockessin DEKarin Cooney-Newton Middletown DEKatrina Cooper Wilmington DEFelicia Cruz Dover DEFaithwin Daniel-Nwosuocha Smyrna DETeMyra Davis Millsboro DEKathleen Ellis Wilmington DEKathleen Ferber Seaford DERachel Fields Seaford DEMegan Fioravanti Hockessin DEElena Hardin Newark DEKennisha Holloman Townsend DECaroline Hutchinson-Hendricks Middletown DELori Irelan Harbeson DEMara Jefferies Collingswood NJDenise Jones Dover DE
Ann Karanja Bear DEKimkeshia Knight Dover DEDenise Larson Milton DEAmanda Latina Wilmington DEKaren McDonald Wilmington DEMarykate McGUrk Wilmington DEEmily McHugh Milton DECortney Mendez Newark DEDenise Owen-Fabricius Middletown DEKathryn Palena Newark DEHope Pansuelo Smyrna DECynthia Reid New Castle DESteve Rhone Lewes DEAnastasia Robinson Ocean View DEDeborah Streeter New Castle DEKim-Marie Talley Newark DESusana Tettey New Castle DEKristen Thompson Wilmington DEPamela Tyranski Wilmington DERuth Wamwati Middletown DELisa Ward Newark DEBrittany Woltemate Newark DE
in health. Senator Hall-Long’s commitment in making Delaware stronger and healthier through her participation in state government demonstrates that nurses can make a difference in improving the health of citizens, communities, and our state. DNA and the nursing community offer our applause and congratulations! To be considered for Delaware Boards and Commissions, visit http://governor.delaware.gov/boards-comms.shtml for a list of the boards and commissions and to access the application.
November, December 2016, January 2017 DNA Reporter • Page 3
Karen L. Panunto, Ed.D, MSN, RN, APRN
Welcome to another edition of the DNA Reporter. Can you believe we are into the fall season…what happen to summer? Even though I will miss summer, fall is my favorite time of year. I love the colors of the season and the crisp air – it feels refreshing and invigorating. With the holidays just around the corner, energy is what will be needed!
I want to extend a special thank you to Frances Russo-Avena, RN, MSN, MSM for her willingness to serve as the current Guest Editor. This edition of the DNA Reporter is focused on the alarming rise of substance abuse and misuse in Delaware and in particular, the abuse of prescriptive drugs. The articles presented will provide a very clear depiction of what is occurring in our communities in regards to substance abuse within our most vulnerable populations - children, youth, and young adults.
Fall ConferenceAnother great DNA conference was held this
past October. Presentations were very informative with topics focused on the leadership role of nurses within the community. A special thank you to the members of the conference planning team in working to facilitate this educational opportunity for nurses.
President’s Message
Karen L. Panunto
General Membership Meeting
Our next General Membership meeting will be held on Tuesday, November 29, 2016 at Dover Downs from 6:00 pm to 8:00 pm. Please plan to attend and discuss your concerns with members of the Board of Directors. This is an open meeting for all nurses to attend. It will be at this meeting when I will turn over the presidency of the DNA to Leslie Verucci who I know will be an outstanding president. I have enjoyed the past two years as president of the DNA and have experienced first-hand the effort and commitment that is involved in maintaining an effective organization. Thank you to all the members of the Board of Directors and committee members for your willingness to serve the organization and the help you provided me during the past two years. In particular, I want to thank Sarah Carmody, Executive Director of DNA, for all that she does on a daily basis to keep the office and operations of the organization running as smoothly as it does.
Have a wonderful, healthy, and safe holiday season!
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Job Board: Search job listingsin all 50 states.
Publications: New publicationsand articles added weekly!
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Page 4 • DNA Reporter November, December 2016, January 2017
Denise L. Buffin, RN, MEd, MSN
Denise L. Buffin earned her BSN from Neumann University, MEd with certification in School Nursing from Widener University and MSN-FNP degree from Wilmington University. She started her nursing career at the Veterans Administration Medical Center and has also worked as a home care nurse for Visiting Nurse Association and Bayada Nurses. Denise has been a school nurse in the Brandywine School District for 20 years and is currently at Mt. Pleasant Elementary. In her role as School Nurse, Denise has taught Smart Moves Smart Choices at the elementary level. She currently serves on the board EDGE Toward the Future working toward improving an impoverished neighborhood in her school’s feeder pattern. Denise also serves on the National Community Reinvestment Coalition for Wilmington, Delaware. Denise can be reached by email at [email protected] or at her office at (302) 762-7110.
If you are a medical professional in Delaware, you should be well aware of the epidemic of drug abuse, especially opioids, in our state. The National Institute on Drug Abuse (NIDA) (2003) reported that some children ages 12 to 13 are already abusing drugs NIDA reported on studies that showed children and adolescents who experimented with early substance abuse continued on to greater drug involvement. While the majority of most youth do not progress to abusing other drugs, as medical professionals, it is our responsibility to work at preventing any experimentation that may lead to abuse of drugs in our children.
School nurses are on the front lines of children’s health and have accepted a role in the prevention of drug abuse among our youth. The National Association of School Nurses, along with Janssen
Pharmaceuticals, Inc., developed a prevention program called Smart Moves, Smart Choices (SMSC). This program provides education about drug abuse and misuse for parents, educators, and students in grades kindergarten through high school. The SMSC website offers free tools and resources to help schools, families, and communities to begin a dialogue with students at all grade levels (National Association of School Nurses, 2014).
According to Embrey (2014), school nurses provide critical support as prevention agents: Their education and assessment skills provide them with an added advantage in addressing substance-related issues. In addition, school nurses are often considered the most trusted school professional, and they have a better than average understanding of student behaviors and culture due to their daily interactions with students outside of the classroom. In an effort to start the conversation about the dangers of prescription drug abuse and misuse, the SMSC program encourages parents and relatives to monitor their own medicine cabinets and have open and honest conversations with their children. The materials are free to educators to use and designed to raise awareness of safe and proper use of medications (National Association of School Nurses, 2014a).
The following are examples of how a school nurse can utilize the SMSC’s materials in the elementary classroom. The materials used from the SMSC’s website included infographics, posters, parent fact and tip sheets, and student workbooks (National Association of School Nurses, 2012). School nurses can work with students to complete the workbooks included in SMSC. The school nurse can supplement the workbooks with other illustrations and activities like the poster from https://laughingsquid.com/is-it-candy-or-medicine/. This is an excellent tool that provides additional information about how medicine can look very similar to candy and directs students to always ask an adult first before eating something that is not in a labeled container and looks like candy (Beale, 2009). Students can work in pairs to practice saying “no” to peer-pressure. Creative skits can be used where one student tries to convince the other student to take medication found in a parent’s room. This is a fun way for the students to learn and practice skills needed to resist possible pressure from peers to experiment with drugs. Students are encouraged to share and discuss their workbooks and lessons with their family.
Smart Moves, Smart ChoicesThe toolkit for middle and high schools include
school assembly tools, lesson plans, and videos featuring Dr. Drew Pinsky, who the students may remember from “Celebrity Rehab with Dr. Drew,” posters, stickers, parent fliers and more (National Association of School Nurses, 2012c). Beth Mattey, President of the National Association of School Nurses and a high school nurse, has taught SMSC at the secondary level. She noted that the students engage in meaningful conversation after viewing the videos. Mrs. Mattey also noted, “High school students understand that abusing drugs can be harmful. However many don’t recognize that abuse is taking any medication, even if it is prescribed by a health care provider, in a manner that is not directed by the health care provider.” A student may not see the harm if they use the medication, even if it not their own. “It is important for school nurses and other responsible adults to educate students on substance use and abuse, so they remain safe, finish school and lead productive lives.”
The National Association of School Nurses and Janssen Pharmaceuticals, Inc. created an evidence-informed program that is free for all users to begin and continue a discussion with students at all grade levels about misuse and abuse of medications. SMSC encourages open and continued dialogue between youth, educators, families and communities.
ReferencesBeale, S. (2009). Is it candy or medicine? Retrieved
from: https://laughingsquid.com/is-it-candy-or-medicine/
Embrey, M. L. (2014). Commentary: School nurses know that it’s time for students to make “Smart Moves, Smart Choices.” Partnership for Drug-Free Kids. Retrieved from http://www.drugfree.org/news-service/commentary-school-nurses-know-time-students-make-smart-moves-smart-choices/
National Institute on Drug Abuse (2003). Preventing drug use in children and adolescents: A research guide for parent, educators and community leaders (2nd ed.). Bethesda, MD: National Institute of Health.
National Association of School Nurses (2014a). Smart moves, smart choices. Retrieved from http://www.smartmovessmartchoices.org/about
National Association of School Nurses (2014a). Smart moves, smart choices. Retrieved from http://www.smartmovessmartchoices.org/start-smart/tools
National Association of School Nurses (2014c). Smart moves, smart choices. Retrieved from http://www.smartmovessmartchoices.org/school-tool-kit
Denise L. Buffin
Substance Abuse continued from page 1
diabetes, and obesity. Time has taught us that SUD is not a disease of choice, but one that requires treatment, prevention, and a sincere understanding (National Institute on Drug Abuse, 2015). A sense of urgency is upon us and we, together, can weaken this epidemic.
The need for a holistic and integrated approach to educating today’s children, youth, and young adults is crucial to their academic and social-emotional success. School nurses are in a unique position to foster this education. School nurses are the bridge between health and education. Developing enduring and sustaining public-private partnerships strengthens our influence in addressing the widespread plague of substance abuse. These relationships are vital to empower change.
Research demonstrates that a multi-dimensional, interactive approach to prevention education is most effective. This requires participation from family members as well as the entire school community (Executive Office of the President of the United States, 2011). Addressing the risk taking behavioral trends of our youth is critical to supporting their successful academic and emotional transition into adulthood. Public service announcements, collaboration amongst healthcare providers, and building robust public-private partnerships are just a few means by which to distribute prevention education and awareness.
Each county in the state of Delaware faces their own unique challenges, but all agree that prescription drug abuse is a significant concern in their respective school communities (Delaware Department of Health and Social Services, Division of Public Health, 2013). Erasing the stigma of addiction is a key factor to an open and empathetic
conversation about substance abuse. Providing resources appropriate to the developmental and cognitive abilities of students in elementary, middle and high schools is a parallel step to increasing awareness. This aligns with Delaware’s already existing Comprehensive Health Education Requirements and Standards (Delaware Department of Education, 2015). The prevalence of prescription drug abuse is just as concerning on college and university campuses as it is in secondary schools (Campus Coalition for Alcohol and Other Drug Abuse Prevention Strategic Plan, 2015).
It is also imperative to screen and intervene when appropriate. Often providers are not confident or prepared to address substance use disorders with their patients. Screening, Brief Interventions and Referral to Treatment, or SBIRT, is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drug (SAMHSA, 2016).
Examples of screening tools include the CAGE and CAGE-AID questions used to identify a substance abuse condition and the T-ACE screening tool highly recommended and specifically developed for use with pregnant women. For more information and details on these screening tools, please visit www.helpisherede.com.
It is with great pride and respect that I introduce you to a number of school nurses and practitioners from across our state that have dedicated themselves to addressing the alarming rise of substance abuse and misuse in Delaware. Our school nurses serve diverse populations. These articles will confirm the reach school nurses have in the role of health promotion and disease prevention. Denise Buffin will introduce to you the Smart Moves, Smart Choices Program. This program is free to all children, adults and educators. Megan Fioravanti will share with
you the Developmental Impact on Children Born of a substance exposed pregnancy. Becky King will inform you of Delaware’s efforts in Fighting the Opioid Epidemic. Stacy Robinson will reveal the impact of Family Wellness and Addiction. Rose Sarkissian will discuss how we are Educating High School Students on The Use of Naloxone. School nurses are not alone in the efforts to weaken the prevalence of this disease. We are part of a greater profession that cares for all. Leslie Verucci will remind us of Nursing’s Role in the Use of Opioids.
ReferencesCampus Coalition for Alcohol and Other Drug Abuse
Prevention Strategic Plan. (2015). Retrieved from www.udel.edu/
Delaware Department of Health and Social Services, Division of Public Health. (2013). Community health status. Retrieved from www.dhss.delaware.gov/dhss/dph/files/shachsa.pdf
Delaware Department of Education. (2015). Delaware health education standards. Retrieved from www.doe.k12.de.us
Executive Office of the President of the United States. (2011). Epidemic: responding to America’s prescription drug abuse crisis. Retrieved from https://www.whitehouse.gov/sites/.../rx_abuse_plan.pdf
National Institute on Drug Abuse. (2015). Drugs, brains, and behavior: the science of addiction. Retrieved from https://www.drugabuse.gov/.../drugs-br
Substance Abuse and Mental Health Services Administration. (2016). SBIRT. Retrieved from www.samhsa.gov/sbirt
Page 6 • DNA Reporter November, December 2016, January 2017
Rebecca King, MSN, RN, NCSN
Becky, a Nationally Board Certified School Nurse, has practiced school nursing for 17 years and has worked in K-12 settings, most recently in a technical high school where she is also a clinical nursing instructor. She is also adjunct nursing faculty at Immaculata University, Immaculata, PA. Becky is a board member of the grassroots organization “atTAcK addiction.” She is a 2012 Johnson & Johnson School Health Leadership Fellow. Becky is a member of the Delaware Nurses Association, the Delaware School Nurses Association, the National Association of School Nurses and the American Public Health Association. She has been the Delaware NASN Director for four years and just completed a two-year term on the NASN Executive Committee. Becky was the Delaware School Nurse of the Year in 2007 and received the Delaware Nurses Association Excellence in Nursing Award for Community Nursing in 2008. She is co-author of the NASN position document about naloxone use in the school setting and has presented at several state and national conferences on the topic of substance use disorder. Becky is the mother of a daughter in long-term recovery; together they work to help erase the stigma associated with addiction and mental health by going into schools and communities to provide education. Becky can be contacted by email at [email protected] or phone 302-547-8913. Also, visit the “atTAcK addiction” website at www.attackaddiction.org
The United States is in the midst of an opioid epidemic (CDC, 2015a). Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin) (Rudd, Aleshire, Zibbell, & Gladden, 2016). The opioid epidemic is one of unintended consequences. Many factors have contributed to the severity of the current prescription drug abuse problem we face. They include drastic increases in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies. The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies. The number of prescriptions written for opioid pain relievers escalated from around 76 million in 1991 to nearly 207 million in
Rebecca King
2013, with the United States their biggest consumer globally, accounting for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet) (Volkow, 2014).
Many nurses can remember when pain was declared the 5th vital sign in the late 1990’s and no patient was to leave the hospital without a significant prescription for painkillers. We tried to measure pain with scales that used smiling and frowning faces or a 1-10 scale. But pain is not a vital sign, not a disease, but instead is a symptom. The concept of pain as the 5th vital sign originated in the VA hospital system in the late 1990s and became a Joint Commission standard in 2001. Pain was allegedly being under treated forcing hospitals to emphasize the assessment of pain for all patients on every shift with the (mistaken) idea that all pain must be closely monitored and treated and the patients made completely pain free. Pain management clinics sprung up everywhere. Doctors and hospitals were caught in the middle and criticized if they didn’t alleviate pain completely (Physicians Weekly, 2013). In June 2016, during their annual meeting, the American Medical Association (AMA) publicly recommended that pain be removed as the 5th vital sign.
Every day at least forty-four people will die from an overdose of prescription pain medication. The rise in deaths mirrored the quadrupling of pain killers prescribed in the US (CDC, 2015b). In response to this public health crisis, many state laws are being enacted or amended to increase access to the opioid reversal antidote naloxone and encourage bystanders to summon medical assistance right away in the event of overdose. There are laws aimed at increasing lay access to naloxone by reducing barriers to prescription and administration and laws that address criminal concerns for Good Samaritans who summon aid in overdose situations.
Delaware’s Efforts to Fight the EpidemicDelaware has been on the front lines for several
years in regards to opioid awareness, education, and legislation. Data in 2008 caught the state of Delaware’s attention: the number of poisoning deaths had exceeded the number of motor vehicle traffic deaths for the first time since at least 1980. According to the National Center for Health Statistics (NCHS) 2011 data brief, poisoning had become the leading cause of death from injuries in the United States and nearly nine out of ten poisoning deaths were caused by drugs (Warner, et al, 2011). State committees and task forces were formed to examine this issue and in November 2012, Delaware held its first summit hosted by the state Attorney General’s office to address this growing concern. The summit brought together a multitude of healthcare providers including school nurses, physicians, pharmacists, addiction treatment professionals, legislators, and state and federal law enforcement to discuss next steps to address the causes and rapid increase of the prescription drug epidemic.
In December of 2012, a local family Don and Jeanne Keister, lost their youngest son Tyler to an accidental heroin overdose on 12/23/12. The Keisters decided not to remain silent about the cause of their beloved son’s death and they decided to speak out in effort to help others. In February of 2013, they founded the grassroots organization atTAcK addiction; the three capitalized letters symbolizing the initials of their son Tyler Armstrong Keister. As an organization they vowed to work to provide education and awareness to communities in effort to help erase the stigma associated with the disease of addiction. atTAcK addiction joined forces with a multitude of stakeholders including the Delaware Department of Health and Social Services (DHSS), Delaware Department of Public Health (DPH), and a group of Delaware school nurses who as Johnson & Johnson School Health Leadership Fellows had chosen the prescription drug epidemic in 2012 as their community project. Subsequently, many public and private partnerships were formed in Delaware to develop a strategic plan to make thoughtful, data-informed, and deliberate policy decisions around the opiate epidemic.
Several important pieces of legislation followed. On, July 2, 2013 Delaware became the 14th state to enact a 911 Good Samaritan law aimed at saving lives, Delaware Senate Bill 116. On August 4th, 2014 Delaware Governor Markell signed legislation authorizing departments of peace officers (law enforcement officers) to carry naloxone. House Bill 388, allowed peace officers who completed a DHSS approved training course to receive, carry,
and administer the drug naloxone, and provided immunity to those officers who administer the drug in good faith. Recognizing education and awareness about substance use disorder must start early, Governor Markell called for resources for education in his 2014 State of the State address. $50,000 was allotted to allow the DPH to work closely with Delaware school nurses to expand the National Association of School Nurses (NASN) endorsed “Smart Moves, Smart Choices” prescription drug abuse education and prevention program statewide (Delaware.gov, 2014).
After passage of the 911 Good Samaritan and naloxone laws, Delaware’s Senate Concurrent Resolution No. 11 (2015) provided school nurses, who are first responders, access to naloxone. In response to the legislation, the Delaware DPH developed “Naloxone Standing Orders for School Nurses” and all public Delaware high school nurses were provided with auto-injectable naloxone (Evzio) at the start of the 2015 school year. The standing orders are a nine page document and include the following sections: indications for use, who should use the orders, order to dispense, signs and symptoms of opioid overdose, school nurse actions, administration instructions, responsibilities, naloxone method of actions, side effects, etc., and references for the standing orders.
NASN has always called school nurses to the forefront of action. Part of nursing advocacy is being informed and educated. NASN supports school nurse objectives by publishing position statements on subjects affecting student health and school nursing to keep their members updated on issues affecting their school communities. In June of 2015 the NASN Board of Directors adopted a national position document supporting the emergency use of naloxone in the school setting (NASN, 2015).
It is vital to understand that an overdose of opioids (either from prescribed pain killers or heroin) decreases respirations and if not reversed, will cause death. Communities must make every effort to prevent any death from an overdose. Every nurse has the opportunity to talk about the potential for addiction when interacting with clients. Any nurse can guide a patient to obtaining naloxone. We need to make our community aware of our Good Samaritan legislation so no one is ever afraid to call for help. Delaware has made great strides attacking the opioid epidemic and it is requisite we ensure progress continues to help those suffering from substance abuse and mental health disorders.
References:Centers for Disease Control, (2015a). Injury
Prevention and Control: Prescription Drug Abuse. Retrieved from http://www.cdc.gov/drugoverdose/
CDC, 2015b. Data Overview. Retrieved from: http://www.cdc.gov/drugoverdose/data/index.html
Delaware.gov (2014). Governor Announces Expansion of Addiction Treatment Services, Date Posted: Tuesday, October 28th, 2014. Retrieved from www.news.delaware.gov
H.B. 388, 147th General Assembly, (Delaware 2014). Allowing peace officers who have completed a DHSS approved training course to receive, carry, and administer the drug naloxone.
National Association of School Nurses. (2015). Naloxone use in the school setting: The role of the school nurse (Position Statement). Silver Spring, MD: Author.
Physicians Weekly (2013). Is Pain Really The 5th Vital Sign? Oct 28, 2013 | Articles, Doctor’s Voice, Pain, Skeptical Scalpel. Retrieved: www.physiciansweekly.com
Rudd R. A., Aleshire, N., Zibbell, J. E., & Gladden, M. (1 January, 2016). Increases in Drug and Opioid Overdose Deaths-United States, 2000–2014. MMWR Morb Mortality Wkly Rep / 64(50); 1378-82.
S.B. 116, 147th General Assembly, (Delaware 2014). Kristen L. Jackson & John M. Perkins, Jr. 911 Good Samaritan Law.
S. C. R. No. 11, 148th General Assembly, (Delaware 2015). Endorsing increased access to naloxone in schools in Delaware.
Volkow, N. D. (14 May, 2014). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse, United States Senate Caucus on International Narcotics Control, Hart Senate Office Building, Washington, DC.
Warner M., Chen L. H., Makuc, D.M., Anderson R. N., & Miniño, A. M. Drug poisoning deaths in the United States, 1980-2008. NCHS data brief, no 81. Hyattsville, MD: National Center for Health Statistics. 2011.
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Anastasia “Stacy” Robinson, BSN, RN
Anastasia “Stacy” Robinson, BSN, RN came to the nursing profession later in life. A 2011 graduate of Beebe School of Nursing, Stacy received the Rising Star Scholarship and many other accolades during her time both at Beebe and at Wilmington University, where she completed her BSN in 2013. Now more than half way to completing a dual master’s degree MSN/MSM, Stacy is actively involved with a number of community groups and initiatives regarding addiction. With her prompting, the state of Delaware has initiated the creation of a Family Wellness Pilot Program, and she is involved in creating community awareness in Sussex County both through atTAcK Addiction and in conjunction with state representatives and the Department of Substance Abuse and Mental Health. Stacy is entering her second year as a nurse at Sussex Central High School.
The student comes to my high school nurse’s office every day. When I see her face, a sinking feeling comes upon me. The student needs help, and I am at a loss to help her. The disease of addiction plagues her family. It insinuates itself into every aspect of her life: her relationship with her mother, grandmother, and siblings. Everyone is angry and frustrated. The student’s solution is to give up, to think she is worthless, to predict that she will end up like her mother, just another addict, probably dead from an overdose by age thirty. These are the student’s words. I need to help her, but how?
In the last decade, the disease of addiction has reached epic proportions in the United States. With the increased prescribing of prescription painkillers, to the readily available nature of street drugs, the impact of addiction is taking new and greater tolls on families in our communities. Delaware, although one of the smallest states in the union geographically, posts some of the highest numbers when it comes to addiction and overdose. According to Rita Landgraf (2015), Delaware Secretary of the Department of Health and Social Services, there were 185 overdose deaths in Delaware in 2014 and an additional 110 through July of 2015 alone. How families respond to the issue is greatly influential on
Anastasia “Stacy” Robinson
Family Wellness and Addictionhow the addict, and the family, recovers from this disease. In Delaware, there is limited availability when it comes to resources. As nurses, we are becoming more and more pivotal in the education and protection of our vulnerable community populations, and our most valuable resource in recovery: the family unit.
When we consider the families that are impacted by addiction, the numbers are astronomical. As a state, we focus heavily on the education and prevention for our youth, encouraging them to abstain from drug and alcohol use. The addiction epidemic is spreading into older adults, as well. With the prescribing and misusing of prescription pain medication, substance abuse among adults age 60 and over has risen by 17%, and is expected to double by 2020 (Hazelden Betty Ford Foundation, 2015). Prescriptions for opioids written in 1991 topped out at 76 million, which pales in comparison to the 219 million of 2012 (Nolan & Amico, 2016). This means that not only is the disease of addiction on grand scales affecting parents and siblings, but children, grandchildren and spouses.
The Substance Abuse and Mental Health Services Administration of the United States (SAMHSA) stated in 2004 that:
It is important to understand the complex role that families can play in substance abuse treatment. They can be a source of help to the treatment process, but they also must manage the consequences of the IP’s [identified person’s] addictive behavior. Individual family members are concerned about the IP’s substance abuse, but they also have their own goals and issues. Providing services to the whole family can improve treatment effectiveness. (para. 4)
Based on this definition, most recovery and rehabilitation programs encourage a certain level of family involvement. Family members suffer much at the hands of those suffering from addiction. When an person is in the throes of addiction, their behaviors may become violent, or they may withdraw and isolate themselves from family members, turn to crime, or neglect and abuse their children. These behaviors have a great impact on the emotional health and mental wellbeing of all family members. Children of addicts may become emotionally impaired, have cognitive and behavioral difficulties, and even develop substance use disorders of their own (SAMHSA, 2004). The aging population of addicts lends itself to parents becoming dependent on their children for support, and disturbing the family maturational processes. Ignoring or cutting ties with the person may be difficult due to feelings of anxiety, guilt, embarrassment and concern (SAMHSA, 2004). Financial strain and provider
issues become increasingly difficult for spouses. Impaired or inappropriate sexual behaviors are common, as well as shame and isolation for the non-addicted partner (SAMHSA, 2004). Schools are placed in a position of providing awareness, educational and counseling services for their students and families. Families may be facing financial hardships due to time loss from their workplace, exorbitant legal bills, and facing high tax burdens for recovery programs. Communities need to have a place to go to effectively and efficiently navigate the systems in place to help them, and access the available resources to provide them with the help they need to maintain functionality and homeostasis within their constructs. With so much potential for disaster to those living with addiction, it is imperative that supports are offered to balance the potentially destructive effects of addiction to our communities.
Multidimensional Family Therapy (MDFT) models are frequently recommended as the basis for family wellness, with additional guidance taken from SAMHSA’a Treatment Improvement Protocol (TIP) 39 (2004). MDFT integrates, “several different techniques with emphasis on the relationships among cognition, affect (emotionality), behavior, and environmental input” (SAMHSA, 2004, para. 41). TIP 39 was written in 2004 to provide a guideline for the best practices in treatment of substance use disorders, and family therapy is a large focus of this document. TIP 39 addresses how substance abuse affects the family, provides models for professionals to use in practice, and identifies resources for future practice and follow-up (SAMHSA, 2004).
MDFT identifies the family as a system, and attempts to address how each part acts in the composition of the system as a whole (SAMHSA, 2004). Three family therapy models are used to comprise the MDFT model. The family disease model, which identifies substance abuse as a disease that affects the family; the family systems model, in which the family’s actions are organized around the substance abuse and abuser; and the cognitive behavioral approach, which states that abuse behaviors are reinforced by family interactions (SAMHSA, 2004).
As nurses, our greatest challenge is the ability to assist our patients and their families in navigating the resources available in Delaware. Every day, new programs and organizations are implemented and offered throughout the community. atTAcK Addiction has chapters in each county across the state. They offer help and resources for addicts and family members of addicts, as well as awareness and influence on legislation. HelpIsHereDE.org is an online tool available for anyone seeking information
Family Wellness and Addiction continued on page 11
Page 8 • DNA Reporter November, December 2016, January 2017
Leslie Verucci, MSN, RN, APRN-BC
Leslie Verucci, MSN, RN, APRN-BC earned her BSN from Wilmington University and her Masters from the University of Delaware. She is board certified as an Adult Nurse Practitioner and has a post-masters in family medicine. She presently is a nurse practitioner and works at the Helen F. Graham Cancer Center in Radiation Oncology and for Christiana Care Medical Aid Unit. She has been a nurse practitioner for 14 years. She is President-elect of Delaware Nurses Association, a member of the American Nurses Association, and legislation liaison for Delaware Diamond Oncology Nurses Association. She is a member of the Delaware Prescription Drug Monitoring Program and active in legislative issues surrounding both nursing and advanced practice. Leslie can be reached at [email protected] and by phone at 302-623-4862.
As we have all seen in the news lately, prescription drug use has become a top issue and concern for the United States (Norwood.et el., 2015). National quality improvements efforts are changing the prescribing methods used by practitioners and nurses pay a critical role in caring for patients and successful implementation of these guidelines. A major factor to the increase in unintentional drug overdose death rate in recent years is the expanded use of opioid analgesics. Opioid analgesics have caused more overdose deaths than heroin and cocaine combined (CDC, 2012). In the 2013-2014 National Survey on Drug Use and Health (NSDUH) 50.5% of people who misused prescription painkillers obtained them from a friend or relative for free and 22.1% obtained them from their health care provider as noted by the Substance Abuse and Mental Health Administration (samhsa.gov, 2016 ). The CDC notes that nearly 2 million Americans, aged 12 or older, have either abused or become dependent on prescription opioids in 2014. Opioid overdose is now the second leading cause of unintentional deaths in the United States. As the largest segment of the healthcare workforce, nurses play a critical role in treating and counseling individuals suffering from drug addiction. Advanced Practice Nurses are the third largest opioid prescribing form for individual with Medicare Part D and according to the Centers for Medicare and Medicaid Services and need to commit to adopting safe and responsible prescribing practices (Taratine, 2016).
So what can nurses do to safely treat their patients? Visit www.cdc.gov/drugoverdose/prescribing/
guidelines.html for more information.
Nursing Role in the Use of Opioids1. First DO NO HARM. Balance risks against
the benefits of using an opioid.2. Participate in educational offerings on pain
management and pharmacotherapy to improve knowledge related to pain assessment and management. A requirement of Continuing Education Credits is required for license renewal. Have appropriate information on safe administration and dosages and potential adverse effects as well as expert contacts to call with questions and concerns.
3. Take a concise medical history and perform physical examination including assessment of pain, physical and psychological function, substance abuse history, assessment of underlying or coexisting diseases or conditions and should also include the presence of a recognized medical indication for the use of a controlled substance
4. Conduct pain assessments that include duration of the pain (acute versus chronic), the type of pain, the patients age and pain history, the reported pain intensity, previous use of and response to opioids, comorbidities, and risk for excessive sedation and respiratory depression. Link pain management to pain intensity. Use the same tool consistently.
5. Consider screening all patients annually or upon entry to your practice to assess potential risk for substance abuse.
6. Become familiar and compliant with Delaware’s law and guidelines on controlled substance prescribing along with Medicaid and Medicare’s guidelines on prior authorization and quantities for both high dose narcotics and long and short acting narcotics.
7. Review Delaware Prescription Drug Monitoring Program regularly on patients who you prescribe or are planning to prescribe opioids. All prescribers who hold a Delaware CSR must register with the PMP.
8. Only one medical provider should provide all opioids to treat a patient’s chronic pain. Patients who are found to receive prescriptions for controlled substances from multiple providers should not receive additional prescriptions. Make a treatment plan that is discussed with the patient. The plan should state objectives by which treatment success can be evaluated and indicate further diagnostic evaluations or other treatments planned.
9. Start low and go slow with dosing. Patients who have not taken opioids in the past may react strongly to higher doses. Lower daily opioid doses are safer. Doses greater then 90MME/day are associated with significant risks.
10. Start an opioid trial by advising your patient to try a medication for short period of time and reassess the effectiveness. If not making progress, consider other options.
11. Prescribe proportionately. Only prescribe the amount of pain medicine reasonably expected to be needed. Large prescriptions allow for
a longer period of time before the patient is evaluated by their primary care provider for response and also increases the potential for diversion and abuse.
12. Extend analgesic choices to nonnarcotic options. Ibuprophen and Tylenol can be used around the clock as the foundation for pain control.
13. Include the use of nonpharmacologic interventions such as ice, heat, repositioning, relaxation, guided imaging, etc.
14. Avoid concurrent prescribing of opioid and benzodiazepines.
15. The use of opioids should not be first line therapy for chronic pain. There are other treatments that can be effective with less harm. If prescribing opioids for chronic pain, follow state guidelines and administer a urine drug screening at least twice a year. Discuss alternative treatment options and conduct a risk assessment to identify patient that are or may be at risk for dependence or misuse of a prescribed opioid. Chronic pain treatment requires monitoring the effects of medication on pain relief and patient level of functioning.
16. Prescriptions for controlled substances given from emergency rooms and Urgent care centers should not exceed 72 hours and health care providers in these settings should not order long-acting opioids as they cannot provide close monitoring. Patients should be referred back to their primary care providers and if they do not have a primary care provider supply them with a list of area PCP’s or clinic resources and assist in helping them coordinate care with a PCP.
17. Methadone replacement should only be ordered by the methadone treatment center
18. Do not replace lost, destroyed, or stolen control substance prescriptions. Check the PMP and if needed send prescription electronically.
19. Refer as needed. The prescriber should be willing to refer the patient as necessary for additional evaluation and treatment in order to achieve treatment objectives.
20. Remember that pain is a multifaceted, subjective experience that is unique for each individual and needs to assessed and treated appropriately.
21. Monitor closely, particularly when Initiating and titrating opioids. Respiratory depression more likely in elderly, cachectic, or debilitated patients. Consider reducing starting dose to 1/3 or 1/2 the usual dosage in debilitated non-opioid tolerant patients and titrate dose cautiously
22. Prescribing opioids to children the health care provider needs to be aware that opioids are a common source of drug errors in this population. Consider consulting a pediatric palliative care team or pediatric pain specialist or refer to a specialized multidisciplinary pain clinic if you are unfamiliar.
23. EDUCATE your patients on the use of opioids, side effects, concerns and disposal. Also discuss the need and requirement for follow up care and assessments. Patients should also be educated on not sharing their medications with family or friends and to keep medications in a safe area.
24. Document, Document, Document. Keep accurate records
25. Consider becoming involved in community and state activities to combat this issue and development of provisions for safe and responsible prescribing.
References:Norwood, C, Biviji-Sharma, R, Knotts, A, Omenka,
I, Sone, C, Purviance, D. (2015). Fighting prescription drug abuse through state policy: The role of nursing in successful implementation. Journal of Addictions Nursing, 26(4): 203-207.
Substance Abuse and Mental Health Administration (SAMHSA). (2016). Opioids. Retrieved from: www.samhsa.gov/atod/opioids
Taratine, R (2016) How nursing is helping to combat the opioid epidemic. Retrieved from www.huffingtonpost.com/ruth-tarating-dnp-rn/how-nursing-is helping-to_b_10637130.html
US Dept of Health and Human Services – SAMHSA and RTI International. (2014). National Survey on Drug Use and Health (NSDUH). (2014). Retrieved from https.nsduhweb.rti.org
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Page 10 • DNA Reporter November, December 2016, January 2017
Megan S. Fioravanti, RN, BSN, NCSN
Megan is a Nationally Board Certified School Nurse. She has practiced school nursing for 19 years and currently works at the Meadowood Program for special needs students in the Red Clay Consolidated School District and part-time at the University of Delaware in Student Health Services. Megan previously worked in a high school for 17 years and at Christiana Care Health System. She is a 2012 Johnson and Johnson School Health Leadership Fellow and was named the 2015 Delaware School Nurse of the Year. Megan is a member of the Delaware School Nurses Association, National Association of School Nurses (NASN), American Nurses Association, Delaware Nurses Association and most recently was elected to be the Delaware Director to NASN. She also serves as the school nurse liaison to the Sports Medicine Advisory Committee of DIAA and is on the Board of Directors for The ARC of Delaware. Megan can be contacted at [email protected].
Nurses who care for children who have been affected by the public health epidemic of Substance Use Disorders (SUD) are well positioned to positively
Megan S. Fioravanti
Developmental Impact on Children Born with Neonatal Abstinence Syndrome
affect the health care and educational support of these children who are often born with Neonatal Abstinence Syndrome (NAS). Annual opinion polls repeatedly show that nurses are the most trusted professionals. The Future of Nursing Campaign for Action (2016) stated that, “Nurses have a direct effect on patient care. They provide the majority of patient assessments, evaluations, and care in hospitals, nursing homes, clinics, schools, workplaces, and ambulatory settings. They are at the front lines in ensuring that care is delivered safely, effectively, and compassionately” (p. 24). We need to stand ready to provide care in the acute, public health, and prevention arenas.
Over the last decade, there has been increasing public health, medical, and political attention paid to the parallel rise in two trends: an increase in the prevalence of prescription opioid abuse and an increase in the incidence of NAS.
Neonatal abstinence syndrome is a group of problems that occur in a newborn who was exposed to addictive illegal or prescription drugs while in the mother’s womb. Two major types of NAS are recognized: NAS due to prenatal or maternal use of substances that result in withdrawal symptoms in the newborn and postnatal NAS secondary to discontinuation of medications such as fentanyl or morphine used for pain therapy in the newborn.
Symptoms of NAS depend on various factors including the type of drug the mother used, how much of the drug she used, how long she used the drug, and how the mother’s body breaks down the drug. Symptoms may include the following: High-pitched cry, jitteriness, tremors, generalized convulsions, sweating, fever, mottling, excessive sucking or rooting, poor feeding, vomiting, and diarrhea (Hamdan, 2016).
There has been a significant increase in the prevalence of NAS, from 1.20 per 1,000 U.S. hospital births in 2000 to 3.39 per 1,000 U.S. hospital births in 2009 (ASTHO, 2014). The population of pregnant women with opioid dependence is varied, and their circumstances span the spectrum from heroin addiction, polydrug abuse, prescription opioid abuse, MAT (methadone maintenance or buprenorphine maintenance), and chronic opioid use prescribed for medical indications (ASTHO, 2014). There was also a five-fold increase in the proportion of babies born with NAS from 2000 to 2012, when an estimated 21,732 infants were born with NAS—equivalent to one baby suffering from opiate withdrawal born every 25 minutes (Patrick, 2012).
According to Fisher (2015), almost 3 out of every 100 babies born in Delaware will experience NAS. In Delaware in 2004, 39 babies were born opiate addicted and in 2015 that number rose to over 300. In 2016, we are on track to reach almost 600 babies experiencing NAS. Due to these staggering statistics, Christiana Care Health System is working to meet
the needs of this special population and is spending $260 million for a new addition for woman’s and children’s services. This will include a unit for high risk infants, such as those exposed to opiate drugs during pregnancy.
States across the U.S. are now seeing the developmental and educational impact of children born with NAS. Opiate-exposed infants at both 18 and 36 months using the Bayley Scales of Infant Development, Second Edition (BSID-II), showed that the Mental Development Index (MDI) was significantly lower in opiate-exposed children at 12 and 18 months. Significant differences in birth weight and head circumference between methadone-exposed infants and matched controls showed no BSID-II difference at 6 months of age (Logan, 2013).
Prenatal exposure to drugs such as alcohol and opiates has been associated with behavioral disorders, attention problems, hyperactivity, aggressiveness and lack of social inhibition in children, assuming an increased risk of Attention Deficit and Hyperactivity Disorder (ADHD). The mental health of children and adolescents born to drug addicted parents has been also a topic of interest in recent years. Many published studies about mental disorders in these children have documented an increased risk of axis I psychiatric disorders. A recent study that evaluated the offspring of parent consumers of heroin and alcohol concluded that the children born of a substance exposed pregnancy had 8 times more risk of suffering a depressive disorder, 3 times more risk of ADHD, and 16 times more risk of SUD than controls (Herranz, Vilchez, Ledo, & Mur et al., 2014).
Early intervention for a child living with NAS can greatly impact their academic and social-emotional success. It is also critical for children living with a parent suffering from a SUD. Children exposed to a parent’s substance use commonly experience educational delays and inadequate medical and dental care. Almost a quarter of children of mothers with identified SUDs do not receive routine child health maintenance services in their first 2 years of life. Children of parents with SUDs are also at greater risk of later mental health and behavioral problems, including SUD (Smith, 2016).
Nurses can make community and medical referrals. They can be advocates in educational and job settings to help develop goals on an IEP or an employment plan. Nurses can screen for visual or hearing deficits and can refer as indicated. Nurses can screen for SUD in teens and can offer counseling and referral for treatment as well.
In Delaware, we have a framework for children from birth to age three where early intervention is provided for children who have been identified with disabilities and/or developmental delays. Child Development Watch (CDW) is under Department of Health and Human Services (DHSS), Division
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of Management Services (DMS) and Delaware Public Health (DPH). Children are identified through Child Find, public awareness endeavors, and early identification and screening. Nurses are key to the multidisciplinary services that are delivered to these identified children. Children continue to receive nursing services through the Department of Education (DOE) and school nurses and in the Division of Developmental Disability Service (DDDS).
School, public health, community and acute care nurses can make a difference. Nurses are on the front lines. As care coordinators and case managers many nurses sit on interdisciplinary teams and know how to assure appropriate transition planning. We perform primary prevention by ensuring safe environments, responding to immediate needs of families, and by treating the parent-child relationship. Nurses are leaders and change agents. We are recognized community and public health providers who facilitate access to care, cultural competency, and population-based health delivery to our patients. We know the social determinants of health and we can have a positive impact on the lives and health of these children.
ReferencesASTHOS- Association of State and Territorial Health Officials. (2014). Neonatal
Abstinence Syndrome: How States can Help Advance Knowledge Base for Primary Prevention and Best Practices of Care. Retrieved from www.astho.org
Fisher, James. (2015). Delaware’s heroin babies: Starting life in withdrawal. The News Journal. Retrieved from: http://www.delawareonline.com/story/news/local/2015/11/20/heroin-babies-starting-life-withdrawal/75208368
Future of Nursing: Campaign for Action.(2016). Retrieved from http://campaignforaction.org
Hamdan, A. (2016). Neonatal Abstinence Syndrome. Medscape. Retrieved from: http://emedicine.medscape.com/article/978763-overview
Herranz, G., Vilchez, M., Ledo, J.,& Mur Sierra, A. (2014). Children born to heroin-addicted mothers: What’s the outcome 25 years later. Journal of Addiction Research and Therapy. 05(2); 25-29.
Patrick, S, Schumacher, R., Benneyworth, B., Krans, E., McAllister, J., & Davis, M. (2012). Neonatal abstinence syndrome and associated health care expenditures. JAMA; 307(18); 1934-40.
Smith, V., Wilson, M. (2016). AAP Committee on Substance Use and Prevention. Families affected by parental substance use. Pediatrics; 138(2); 1-15.
on addiction and how to get help, either for the addict or themselves. Evidence-based research has proven that family involvement in recovery from addiction is necessary for sobriety maintenance. It is up to nurses to help to take part in this. Addiction has touched many of our families here in Delaware, including my own. We are the force that can make the difference.
ReferencesHazelden Betty Ford Foundation (2015). Substance abuse among the elderly: A
growing problem. Retrieved from http://www.hazeldenbettyfordfoundation.org/articles/ubstance-abuse-among-the-elderly-a-growing-problem
Landgraf, R. (2015, October). Responding to Delaware’s addiction epidemic. Power point presentation for Delaware Health and Social Services, Delaware Grantmaker’s Association, Wilmington, DE.
Nolan, D., & Amico, C. (2016). How bad is the opioid epidemic?. Frontline. Retrieved from http://www.pbs.org/wgbh/frontline/article/how-bad-is-the-opioid-epidemic
Substance Abuse and Mental Health Services Administration (US) (2004). Chapter 1 substance abuse treatment and family therapy. In Center for Substance Abuse Treatment (Ed.), Treatment improvement protocol (TIP) Series, No. 39. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64269/
Family Wellness and Addiction continued from page 7
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pair for home and for work. They have the same EZ-FLEX
fabric you’ve come to love from the rest of Med Couture’s
line, with the added comfort of a knit waistband. Front side
pockets, double cargo pockets and an extra accessory
pocket mean these pants aren’t just stylish, they’re highly
functional.
Page 12 • DNA Reporter November, December 2016, January 2017
