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Nursing Responses to the Full Spectrum of Alcohol Use among Hospitalized Patients Lauren Matukaitis Broyles, PhD, RN Research Health Scientist VA Pittsburgh Healthcare System Assistant Professor University of Pittsburgh School of Medicine. - PowerPoint PPT Presentation
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Nursing Responses to the Full Spectrum of Alcohol Use among
Hospitalized Patients Lauren Matukaitis Broyles, PhD, RNLauren Matukaitis Broyles, PhD, RN
Research Health Scientist Research Health Scientist VA Pittsburgh Healthcare System VA Pittsburgh Healthcare System
Assistant Professor Assistant Professor University of Pittsburgh University of Pittsburgh
School of MedicineSchool of Medicine
Mainstreams conversations about alcohol
Promotes professional nursing
Prevents alcohol-related harm for our patients and their families
An overall change in nursing practice that:
Question 1: Regarding the package of strategies known as alcohol SBIRT(select one)
a) b) c) d)
0% 0%0%0%
0 of 5
a) I have absolutely no idea what this is.
b) I’ve heard of it, but don’t know a lot about it.
c) I’m pretty familiar with it.d) I’m very familiar with it—
I’ve done it, implemented it, or, studied it.
Drinkers PyramidDrinkers Pyramid
3 - 7 % Drinkers with Abuse 3 - 7 % Drinkers with Abuse or Dependenceor Dependence
40% Abstainers40% Abstainers
35 - 40% Low-risk 35 - 40% Low-risk DrinkersDrinkers
10 - 15% Hazardous 10 - 15% Hazardous DrinkersDrinkers
BI
RT
Positive feedback, prevention message
S
Question 2: My biggest concern about bringing alcohol SBIRT into the inpatient setting is: (Select one)
a) b) c) d) e)
0% 0% 0%0%0%
0 of 5
a) How well it even fits with the acute care setting and mission
b) Whose responsibility it would be—who has the knowledge, skills, time, and motivation
c) Reimbursement d) How patients would reacte) Something else
Question 3: My initial thoughts about nurses taking on more active roles in alcohol SBIRT in inpatient settings are: (Select all that apply)
a) Nurses won’t have an interest in doing it, or they are already too busy/ overwhelmed.
b) I’m not sure if it’s really compatible with the nursing role or scope of practice.
c) Inpatients won’t go for it—talking about alcohol with a nurse, or, talking about it at all.
d) I don’t think we can get paid for it if nurses do it.
e) Something else
The PropositionThe Proposition
1.1. Spectrum orientationSpectrum orientation
2.2. Role for every nurseRole for every nurse
3.3. Workforce development starting Workforce development starting with pre-licensure studentswith pre-licensure students
4.4. Shaping organizational contextShaping organizational context
Drinkers PyramidDrinkers Pyramid
3 - 7 % Drinkers with Abuse 3 - 7 % Drinkers with Abuse or Dependenceor Dependence
40% Abstainers40% Abstainers
35 - 40% Low-risk 35 - 40% Low-risk DrinkersDrinkers
10 - 15% Hazardous 10 - 15% Hazardous DrinkersDrinkers
BI
RT
Positive feedback, prevention message
S
1.1. Spectrum orientationSpectrum orientation
2.2. Role for every nurseRole for every nurse
3.3. Workforce development starting Workforce development starting with pre-licensure studentswith pre-licensure students
4.4. Shaping organizational contextShaping organizational context
The PropositionThe Proposition
Nurse and System Readiness for
RN-SBIRT
RN-SBIRT Training Effectiveness and Implementation
Patient Acceptability for Nurse-delivered
SBIRT
Postdoctoral Fellowship
Assessing Readiness for Nurse Assessing Readiness for Nurse Implementation of Alcohol Implementation of Alcohol
Screening, Brief Intervention, Screening, Brief Intervention, and Referral to Treatment and Referral to Treatment
(SBIRT)(SBIRT)
DesignDesign
Phase I: Survey of inpatient nursesPhase I: Survey of inpatient nurses Knowledge, attitudes, and current clinical Knowledge, attitudes, and current clinical practice around alcohol-related carepractice around alcohol-related care
Phase II: Focus groups with med-surg Phase II: Focus groups with med-surg nursesnurses Anticipated facilitators and barriers to Anticipated facilitators and barriers to inpatient SBIRTinpatient SBIRT
Broyles LM, et al. (2012). Addiction Science and Clinical Practice, 7:7
Broyles LM et al. (2011). Qualitative Health Research, 21(12):1705-1718
Implementing a Nurse Implementing a Nurse Training Program for Alcohol Training Program for Alcohol Screening and Intervention Screening and Intervention
in Inpatient Medical Settingsin Inpatient Medical Settings
DesignDesign
Phase I: DevelopmentPhase I: Development
Phase II: ImplementationPhase II: Implementation
Phase III: Evaluation of Phase III: Evaluation of effectiveness and implementationeffectiveness and implementation
Results and ImplicationsResults and Implications
Broyles LM, et al. (2013). Journal of Addictions Nursing, 24(1): 8-19.Broyles LM, et al. (2013). Journal of Addictions Nursing, in press
Patient Acceptability for Patient Acceptability for Nurse-delivered Alcohol Nurse-delivered Alcohol
Screening, Brief Screening, Brief Intervention, and Referral to Intervention, and Referral to Treatment in the Inpatient Treatment in the Inpatient
SettingSetting
Results and ImplicationsResults and Implications
AcceptabilityAcceptability for individual nurse- for individual nurse-delivered SBIRT care tasks was:delivered SBIRT care tasks was:high (>84%) and associated with perceived ability to high (>84%) and associated with perceived ability to determine own alcohol risks, concern about usedetermine own alcohol risks, concern about use
Personal discomfort Personal discomfort with individual with individual nurse-delivered SBIRT care tasks was:nurse-delivered SBIRT care tasks was:~20% and associated with white race, age >60, positive AU DIT-C, and lower ability to reduce risk
Broyles LM et al. (2012). Alcoholism: Clinical and Experimental Research, 36(4):727-731
Nurse and System Readiness for
RN-SBIRT
RN-SBIRT Training Effectiveness and Implementation
Patient Acceptability for Nurse-delivered
SBIRT
Postdoctoral Fellowship
VA Career Development
Award
Efficacy of Nurse-Delivered Alcohol BI
for Hospitalized Veterans with
Hazardous Drinking
Trial of Nurse-delivered Trial of Nurse-delivered Alcohol Brief Intervention Alcohol Brief Intervention
for Hospitalized for Hospitalized VeteransVeterans
ClinicalTrials.gov Identifier: ClinicalTrials.gov Identifier: NCT01602172NCT01602172
3-arm RCT3-arm RCT
Primary outcomes at 6 months:Primary outcomes at 6 months:
drinks/week, binge drinking episodes, drinks/week, binge drinking episodes, alcohol-related problems, and alcohol-related problems, and motivation to change drinking behaviormotivation to change drinking behavior
Sample: 320 medical-surgical patients Sample: 320 medical-surgical patients with hazardous drinkingwith hazardous drinking
Nurse and System Readiness for
RN-SBIRT
RN-SBIRT Training Effectiveness and Implementation
Patient Acceptability for Nurse-delivered
SBIRT
Postdoctoral Fellowship
VA Career Development
Award
Efficacy of Nurse-Delivered Alcohol BI for Hospitalized Veterans
with Hazardous Drinking
Early Independent
CareerPrimary Care Studies
• Substance Use Care in Medical Homes
•Medical Residency Training in SBIRT
•Computerized Clinical Decision Support Systems for Alcohol BI Delivery
Implementation and Effectiveness of Nurse-delivered
Alcohol SBIRT Across Transitions of Care
[email protected]@va.gov Broyles LM, Gordon AJ. (2010). SBIRT implementation: Moving
beyond the multidisciplinary rhetoric. Substance Abuse, 31(4):221-223.
Broyles LM, Rodriguez KL, Price PA, Bayliss NK, Sevick MA. (2011). Overcoming barriers to the recruitment of nurses as participants in health care research. Qualitative Health Research, 21(12):1705-1718.
Childers JW, Broyles LM, Hanusa BH, Kraemer KL, Conigliaro J, Spagnoletti C, McNeil M, Gordon AJ. (2012). Teaching the teachers: Faculty preparedness and evaluation of a retreat in Screening, Brief Intervention, and Referral to Treatment. Substance Abuse, 33(3):272-277.
Broyles LM, Rosenberger EM, Hanusa BH, Kraemer KL, Gordon AJ. (2012). Hospitalized patients’ acceptability of nurse-delivered Screening, Brief Intervention, and Referral to Treatment (SBIRT).Alcoholism: Clinical and Experimental Research, 36(4):727-731.
Broyles LM, Rodriguez KL, Kraemer KL, Sevick MA, Price PA, Gordon AJ. (2012). A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcohol screening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center. Addiction Science and Clinical Practice, 7:7, open access at:http://www.ascpjournal.org/content/pdf/1940-0640-7-7.pdf.
Broyles LM, Gordon AJ, Kengor C, Kraemer KL. A tailored curriculum of alcohol screening, brief intervention, and referral to treatment (SBIRT) for nurses in inpatient settings. Journal of Addictions Nursing, in press.
Broyles LM, Gordon AJ, Rodriguez KL, Kengor C, Kraemer KL. Evaluation of a pilot training program in alcohol screening, brief intervention, and referral to treatment (SBIRT) for nurses in inpatient settings. Journal of Addictions Nursing, 24(1): 8-19.
Broyles LM, Conley JW, Harding JD, Gordon AJ. A scoping review of interdisciplinary collaboration in addictions education and training. Journal of Addictions Nursing, 24(1): 29-38.
http://www.jointcommission.org/substance_use/http://www.jointcommission.org/substance_use/
http://hospitalsbirt.webs.com/http://hospitalsbirt.webs.com/
RE-AIMRE-AIM
