By Debra Wood, RN, contributor
Nurses specializing in the care of patients with addictions must draw on their acute clinical skills to safely manage detoxification regimens and also use their mental health experience to help their patients overcome a dependence on alcohol, drugs or other substances.
Catherine (Kitty) Kromrie, RN, BSN, finds the recovery-relapsing nature of addiction challenging, but said that patients who stay clean provide the rewards for all of her efforts.
“Addictions are all consuming,” said Catherine (Kitty) Kromrie, RN, BSN, a treatment nurse at the L.E. Phillips Libertas Treatment Center at St. Joseph's Hospital in Chippewa Falls, Wisconsin. “They consume a person’s life and to help someone get their whole life back together again is rewarding.”
Nurses at L.E. Phillips Libertas manage detoxification and help patients begin their 12-step journey toward recovery. They assess and evaluate vital signs and electrolyte levels, and watch for seizure activity.
“We need to use all of our nursing skills,” Kromrie said. “[Patients] can have any medical condition that anyone else has—congestive heart failure, chronic obstructive pulmonary disease—plus all of the needs of the addict and the withdrawal process.”
Patients also may have sustained an injury prior to their admission, requiring nurses to tend to wounds and change dressings.
“The patients we encounter don’t just have addiction as the only issue,” explained Berthilde Dufrene, MSN, RN, CARN, a nurse administrator at the R.E. Blaisdell Addiction Treatment Center in Orangeburg, New York, and an adjunct nursing faculty at SUNY Rockland Community College in Suffern, New York. “The addicts of the ’80s, ’70s and ’60s are aging and they come in with a great deal of med-surg issues, chronic diseases and the acquired diseases resulting from their addiction.”
Sonya Bell, RN, nursing supervisor at the Henry Ford Health System’s Maplegrove Center in Detroit, added that substance abuse adversely affects all body systems, including cardiovascular and endocrine function.
In addition, addicts often have underlying psychiatric issues, such as post-traumatic stress disorder, depression and anxiety.
“Mental health is a big piece in addiction,” said Dufrene, explaining that many mentally ill patients self medicate with street drugs. Patients also may be involved in the criminal justice system.
Vicki Stoker, RN, MSN, believes that more people are accepting addictions as a disease and treating it accordingly.
Some centers employ pharmacological approaches to treating addiction, such as Suboxone for opioid addiction and Vivtitrol, as a monthly alcohol therapy, to physiologically temper the desire for a substance while the patient receives talk therapies.
“[We use] these innovative medications for cravings and withdrawal stabilization,” said Vicki Stoker, RN, MSN, chief nursing officer of Enterhealth’s Life Recovery Center in Van Alstyne, Texas.
“Our nurses have to be trained in those medications, how to administer them and what to look for.”
Relapse is a hallmark of addiction, a chronic, progressive disease and nurses often find it disheartening when patients return time and again.
“Our aim is always for them to gain insight into their problem,” said William Lorman, Ph.D., PMHNP-BC, CARN-AP, president of the International Nurses Society on Addictions.
Once patients gain that insight, they can begin making a plan to change their lives going forward, he said.
“We always try to find something to make it click,” Kromrie added.
When they succeed and a patient stays sober for extended periods, nurses feel a sense of satisfaction.
“I have seen clients at their absolute worst, at the bottom of the barrel, and seeing them come from that to where they become a functioning and productive member of society is so rewarding,” Stoker said.
The International Nurses Society on Addictions offers registered and licensed practical nurses education and networking opportunities to develop addiction treatment skills. The society offers a certification exam for those specializing in the field and is reaching out to nurses in other practice settings who care for patients with addictions.
Many nurses might not even know their patients use or abuse substances and may not feel comfortable asking or addressing it, Lorman said, adding that all staff nurses can screen for addiction and refer as appropriate.
“Addictions are found across the lifespan and all specialties in nursing,” Lorman said. “Our organization’s mission is not only to be supportive in education, research and practice for nurses who work specifically with addicted populations but also for all nurses who encounter addictions.”
© 2009. AMN Healthcare, Inc. All Rights Reserved.