1

Group #7: Names: Hannah Coles, Haylie Hamilton, Jaleh Nault, Maggie Spindel, Brittany
Turner, Benjamin Van Der Hyde
PICO Do nurses who abuse narcotics have better recovery using peer support groups or medical
interventions?

Part 1 Evidenced Based Table

Author, Study Purpose Sample Intervention Instruments of Results/Statistical Summary/Conclusion

Yr. Description/ Validity/ Evidence
LOE Size Reliability

Bozimo Assess The sample size Electronic survey Reliability and The prevalence is The prevalence had not
wski G., characteristics was 2,349 nurse to program validity not 0.65%. Of the 16 changed since the original
et.al.(20 of substance anesthesia directors of 111 available reported students, the study in 1997. The
14). abuse in nurse students in 23 nurse anesthesia majority were white wellness promotion
Level 6 anesthesia different programs, to female, ages 20- 29 education strategy was
students, accredited assess the and had completed the best for prevention.
prevalence, programs in the prevalence of between 13-24 Future studies could
interventions, United States. substance abuse, months of academic evaluate and identify a
and prevention and prevention training. standardized best practice
measures. measures taken. approach.

Braqueh Health care 9 subjects. All Received Reliability and 7 patients abstinent. 6 Maintenance treatment
ais, M., professionals patients met the Buprenorphine- validity not patients went back to with Buprenorphine-
et. al. response to DSM-IV criteria Naloxone. available work safely. 1 Naloxone is feasible and
(2015). substance for opioid Followed for 2 remained effective for healthcare
Level 4 abuse with dependence. years after. unemployed. One professionals.More
Buprenorphine- Received patient reported research should be
Naloxone. group/individual unsuccessful conducted.
therapy. Drug test pharmacologic
one time per treatment before
week. testing.

Cares, This study The sample size A survey was Reliability and The study identified It discussed that proper
A., et al. evaluates was 441. All of administered validity not commonalities education and support on
(2015). substance the participants upon completion available between substance how to seek help when
Level 6 abuse among were involved in of the program to abusers.The biggest drug issues arise should
nurses, a peer health analyze the barrier to seeking be implemented in the
investigates assistance participants assistance is that the lives of all nurses. Also to
barriers in program (PHA). common abuser felt too provide them with ways
seeking help characteristics embarrassed to to do so without losing
and and mindsets discuss the issue with their license and
opportunity for about their anyone (82%). promoting
early substance abuse. confidentiality.
identification

Freeman Issues within 41 nurses A scale to The University of Area of nursing The minority groups had
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- the treatment of recovering from measure change Rhode Island practice had an impact a higher incidence of
McGuire substance substance abuse in the nurses since Change on substance abuse substance abuse. Nurses
, M. abuse among from 7 focus entering recovery. Assessment Scale and ability to maintain who are currently seeking
(2010). nurses, factors groups in the San Three research (URICA) was sobriety. Barriers for treatment are also
Level 2 relating to Francisco Bay questions were used to gather obtaining treatment unemployed. Trends and
reasons for area. also used to information about were emotionally themes occurred within
barriers to stimulate the nurses driven. Employers the research questions
treatment, and conversation opinions on played a large role in asked such as the barriers
potential for about experiences change since the decision to seek for seeking treatment and
long-term and barriers. recovery. treatment. decision to seek
recovery treatment.

Kunyk, Investigating 4064 of Alberta A survey was sent The Medical The amount of A disciplinary
(2015). the prevalence registered nurses. out to nurses Outcomes Study substance abuse environment is not
Level 3 of impaired working at Short-Form 12- among Alberta considered effective. A
nurses in Alberta Hospital. Item Health registered nurses was supportive environment
disciplinary The completed Survey. The found to be similar to for nurses is more
jurisdictions. surveys were Alcohol Use the general beneficial for the
analyzed. Disorder and population. impaired nurse.
Associated
Disabilities
Interview
Schedule. The
Perceived
Organizational
Support. The
Perceptions of
Nursing
Impairment
Inventory.

Wright, Qualitative 6 nurse Qualitative Reliability and Different internal and This particular study
E., et al. inquiry on how practitioner descriptive validity not external factors are a showed the different
(2012). to prevent participants who inquiry described available part of recovery-- factors that nurses see as
Level 6. addiction were suspended the participants major factor is 12-step helpful for their
relapse for for opioid answers and program participation continued recovery. The
nurse addiction identified themes. results showed that a
practitioners. completed a form combination of
after online therapeutic efforts was
advertisement most effective
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Part II Synthesis

Substance abuse among nurses is a prevalent problem occurring in the United States.

Nurses who are under the influence while at work pose a threat to patient safety and quality of

care. There have been many discussions about different treatment options to rectify the substance

abuse among nurses, however there have been no definitive conclusions about the best approach

to treatment. Different methods that have been suggested for treatment include, but are not

limited to, medical management and peer support groups. The purpose of our investigation was

to determine if nurses who abuse narcotics have better recovery using peer support groups or

medical interventions.

In our research, we found a number of commonalities as well as differences. All six

articles that were researched found that an element of peer support was effective in treating

nurses with substance abuse. However many articles found problems with social stigma of the

health care workers which in turn was not effective in finding participants for the studies.

Kunyks level III study, Substance Use Disorders Among Registered Nurses: Prevalence, Risk

and Perceptions in a Disciplinary Jurisdiction, found that disciplinary action was a barrier to

treatment of substance abuse and presented with worse outcomes in the end of the study. Further

Kunyk encouraged more supportive measures should be implemented into nursing practice

regarding substance among. The level VI study by Alexa Cares titled; Substance Use and

Mental Illness Among Nurses: Workplace Warning Signs and Barriers to Seeking Assistance is

one of the articles that discussed social stigma as a big issue associated with not seeking help.

Embarrassment was the most prevalent barrier found in the study, with 82% of the sample stating

that it was the biggest reason that they did not seek help (Cares, 2015). This study also briefly

touched on the idea that many people do not seek assistance because of fear that it might
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compromise their licensure, which is similar to concepts discussed in the Kunyk study. When it

comes to early identification, the study listed many behaviors to take note of, the top three being

change in physical or emotional condition, increased documentation of narcotic use in patients

charts, and excessive absenteeism or tardiness (Cares, 2015). The level II study conducted by

Freeman-McGuire related to barriers to seeking treatment and factors leading to treatment

focused more on the actual decision to seek treatment which may correspond to the efficacy of

the treatment itself. In this study, emotions such as fear, shame, anger, and disgust were

identified as reasons for not seeking treatment. More importantly, loneliness, fear, and isolation

in relationship to the stigma associated with nursing and substance abuse were identified as

barriers to seeking treatment (Freeman-McGuire, 2010). This finding further agrees with the

general trend of the stigma against nurses and substance abuse as a large part in not seeking

treatment at all. Freeman-McGuires study also outlined the threat of termination of employment

as a diversion from seeking treatment. The study went further to say that there was a general

feeling of institutional denial pertaining to substance abuse as a problem within the nursing

profession (Freeman-McGuire, 2010). The level VI study conducted by Bozimowski (2014)

about substance abuse amongst anesthesia students discussed the worries that the study did not

reflect the proper amount of students afflicted by substance addiction. Some key deterrents

identified were the possibility that the substance abuse would develop later in time, post-

graduation, and the fact that an instructor was facilitating information gathering (Bozimowski et

al., 2014). Braquehais level VI study, Buprenorphine-Naloxone Treatment in Physicians and

Nurses with Opioid Dependence discussed whether treatment with Naloxone was an effective

treatment for opioid dependent health care workers. Although there were not many subjects

studied in this article, it found that those it did study had effective treatment with Naloxone.
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However, it concluded that more research is necessary and that treatment with Naloxone alone is

not as effective as it would be if combined with peer support therapy (Braquehais et al., 2015).

Similar to Freeman-McGuires study, all of the participants in Braquehais study were

terminated from their position in the hospital. After treatment, eight out of nine participants were

able to return to work (Braquehais et al., 2015). When a group of six Nurse Anesthetists, who

were disciplined for opioid abuse, were examined in a level VI study, it was revealed that both

internal and external factors were inherent to the success of the recovery. A combination of

therapies, peer and pharmacological, combined with a 12-step program was found to be most

effective in treatment (Wright et al., 2012).

As for differences among the studies, Kunyks research focused on the ineffectiveness of

disciplinary action, whereas the Cares and Freeman-McGuire focused on barriers to seeking

assistance. The studies focused on different populations such as registered nurses, nurse

anesthetists, nursing student in anesthetists programs, and licensed practical nurses. The different

groups surveyed also varied depending on whether they were reporting people they witnessed

with an abusive behavior, or whether they themselves had been disciplined due to abusive

behavior. Some studies were based in one hospital or area, while other studies sent out surveys

all over the country. A majority of the studies found data by sending out surveys while one study

conducted interviews.

Many of the studies identified that more research needs to be conducted in order to

obtain more realistic results. Some limitations with the studies included that there were not

enough participants to effectively study, many of the participants were in one area and were not

particularly randomized, and all studies suggested the idea that there were many barriers to

conducting this experiment in a confidential space. In the study performed by Michael G.

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Freeman-McGuire regarding the barriers to treatment and factors leading to seeking treatment,

the limitation of finding participants for the study itself was identified. A convenience sample

was used in this instance, which presents limitations in sample diversity. Other limitations

included the nature of the focus groups used which resulted in a small sample size, and that the

study drew inferences about the nursing population in general (Freeman-McGuire, 2010).

Another article found the biggest limitation was response rate and convenience sampling

(Kunyk, 2015). One of the biggest limitations of the Alexa Cares study has to do with the idea

that those in the support groups were asked to recall instances when they were most likely under

the influence or experiencing mental illness, therefore their recollections may not necessarily be

accurate (2015). This study was also conducted with one focus group in a single geographic

location.

Part III Linking Evidence to Practice

Initially more research studies should be conducted to gather more information on the

prevalence and severity of the substance abuse rate and causing factors. To decrease the

prevalence of substance abuse among nurses, education about signs and symptoms of impaired

nurses needs to be taught to all nurses. This will help nurses to recognize and identify what is

happening to either themselves or their fellow coworkers. The education could be done when a

nurse is first hired by the medical facility while they are also learning all of the expectations and

regulations of the facility. Yearly meetings then can be conducted by the entire medical staff to

ensure that everyone on staff are still knowledgeable about the subject. Facilities should

implement a confidential reporting system to encourage early identification. This will encourage

people to come forth, when they haven't before, without risking losing their employment or

status. Education should be provided to both policy makers and staff member about how a sense
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of community can improve outcomes and stigmatizing can worsen outcomes. Additionally,

therapeutic support groups should be offered by each facility to provide support and treat nurses

who are impaired. This will help to build a sense of community among the nurses, not only

helping those recover from addiction, but also creating a closer, stronger working team.

Employers should regulate confidentiality to secure jobs and avoid disciplinary actions.

Providing this non judgemental support without being quick to terminate the employee will

encourage individuals to seek help, rather than continuing to hide this detrimental issue. Being

able to identify and intervene early in these situations will not only benefit the hospital, but will

also greatly influence the lives of those dealing with addiction. Additionally, having the hiring

facility initiate these actions and providing these resources for their employees will create a sense

of security and support for the people affected and encourage participation and compliance.

Through these measures we can change attitudes toward substance abuse amongst nurses and

help these people receive the care they need to recover and continue giving care to the public.
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References

Bozimowski G., Groh C., Rouen P., Dosch M. (2014). The prevalence and patterns of substance

abuse among nurse anesthesia students. AANA Journal, 82(4), p.277-283.

Braquehais, M., Fadeuilhe, C., Hakansson, A., Bel, M., Navarro, M., Roncero, C., Bruguera, E.,

& Casas, M. (2015). Buprenorphine-Naloxone treatment in physicians and nurses with

opioid dependence. Substance Abuse, 36, 138-140.

Cares, A., Pace, E., Denious, J., & Crane, L. A. (2015). Substance use and mental illness among

nurses: workplace warning signs and barriers to seeking assistance. Substance Abuse,

36(1), 59-66. doi:10.1080/08897077.2014.933725

Freeman-McGuire, M., RN, MSN. (2010). An investigation into the barriers to treatment and

factors leading to treatment and long-term recovery from substance abuse among

registered nurses (Doctoral dissertation, The Fielding Graduate University, 2010) (pp.

44-96). Ann Arbor, MI: ProQuest.

Kunyk, D. (2015). Substance use disorders among registered nurses: prevalence, risk and

perceptions in a disciplinary jurisdiction. Journal of Nursing Management, 23(1), 54-64.

Wright, E. L., McGuiness, T., Moneyham, L. D., Schumacher, J. E., Zwerling, A., &

Stullenbarger, N. E. N. (2012). Opioid abuse among nurse anesthetists and

anesthesiologists. American Association of Nurse Anesthetists Journal, 80(2), 120.