Expressions of Compassion Fatigue by Emergency Department Nurses Caring for Patients With Opioid and Substance Use Disorders

IntroductionThe misuse of and addiction to opioids are a national public health crisis. The complexity of delivering patient care in emergency departments exposes nurses to stressful work situations with complex patient loads and increasing levels of compassion fatigue. Emergency nurses were asked about their feelings of compassion fatigue while caring for patients with opioid use and/or substance use disorders.MethodsTwenty-four focus groups with emergency nurses (N = 53) at a level I trauma center were conducted in late 2019 and early 2020 are used in this qualitative study using thematic analysis that identified 1 main theme of compassion fatigue with 3 subthemes (nurse frustration with addicted patients, emotional responses, and job satisfaction).ResultsFindings highlight that emergency nurses working with patients with opioid use and/or substance use disorders are dealing with a number of negative emotional stressors and frustrations, which in turn has increased their levels of compassion fatigue. These nurses repeatedly expressed feelings of increasing frustration with addicted patients, negative emotional responses, and decreasing levels of job satisfaction as components of their compassion fatigue.DiscussionThese emergency nurses identified 3 areas to improve their compassion: improved management support with encouragement across all work shifts, debriefing opportunities, and more education. Fostering a high level of self-awareness and understanding of how the work environment influences personal well-being are necessary strategies to avoid the frustrations and negative emotional responses associated with compassion fatigue.     

Opioid Use in End-of-Life Care in Patients With Interstitial Pneumonia Associated With Respiratory Worsening

ABSTRACT

The authors investigated the treatment outcome of patients with severe interstitial pneumonia (IP) who received opioids during end-of-life care. Twenty-two consecutive patients were retrospectively evaluated before and after continuous administration of opioids for 24 hours. All subjects died within 21 days; the mean survival period after opioid administration was 5.6 days. Six of the 22 patients (27%) died within 24 hours after opioids were initiated. In the other 16 patients, respiratory rate was significantly decreased after opioid use and there was a small, nonsignificant improvement in dyspnea measured by the Borg scale without adequate evaluation and records (n = 6). However, hypercapnia with over 10 mm Hg of Paco₂ developed in two patients. Paco₂ tended to be elevated after opioid use in all patients, although the change was not significant. An extremely poor outcome was attributable to the disease progression of IP in six of the patients with Pao₂/F_Io₂ levels below 100. The other 16 patients showed both positive and negative effects as expected. Clinicians should assess dyspnea prior to opioid administration, since the purpose of the opioid administration is to relieve dyspnea. Dyspnea should be monitored and recorded in routine clinical practice, at least after hospitalization.     

Understanding ED Buprenorphine Initiation for Opioid Use Disorder: A Guide for Emergency Nurses

Opioid use disorder is a critical public health problem that continues to broaden in scope, adversely affecting millions of people worldwide. Significant efforts have been made to expand access to medication therapy for opioid use disorder, in particular buprenorphine. As the emergency department is a critical point of access for many patients with opioid use disorder, the initiation of buprenorphine therapy in the emergency department is increasing, and emergency nurses should be familiar with the care of these vulnerable patients. The purpose of this article is to provide a clinical review of opioid use disorder and opioid withdrawal syndrome, medication treatments for opioid use disorder, best clinical practices for ED-initiated buprenorphine therapy, assessment of withdrawal symptoms, discharge considerations, and concerns for special populations. With expanded understanding of opioid use disorder, withdrawal, and available treatments, emergency nurses will be better prepared to deliver and support life-saving treatments for patients and families suffering from this disease. In addition, emergency nurses are well positioned to play an important role in public health advocacy around opioid use disorder, providing critical support for destigmatization and expanded access to safe and efficacious treatments.     

Systematic Review and Meta-Analysis of the Prevalence of Chronic Pain Among Patients With Opioid Use Disorder and Receiving Opioid Substitution Therapy

To assess studies examining the prevalence of chronic pain (CP) in patients treated with Opioid Substitution Treatment (OST - buprenorphine or methadone) for Opioid Used Disorder (OUD), we conducted a systematic review and meta-analysis of the literature between the years 2000 and 2020. We searched EMBASE, PsycINFO, Cochrane, and MEDLINE databases and included studies assessing the prevalence of CP in OUD adults treated with OST. The studies were assessed for risk of bias and overall quality and the results were pooled using a random-effects model. Subgroup analyses and meta-regressions were used to identify possible factors associated with CP. Twenty-three studies reported data on the prevalence of CP in patients treated with OST were evaluated. The prevalence obtained was 45.3% (CI95% [38.7; 52.1]). Overall, 78.3% of the studies had a low risk of bias. Subgroup analysis estimates did not vary according to gender, OST, and CP duration. However, it appeared that the clinical settings was associated with a lower CP prevalence when assessed in primary care sites. Our study provided an estimate regarding the prevalence of CP among OST patients. These patients deserve specific attention from health professionals and health authorities. Thus, the real challenge in OST patients is the implementation of a multidisciplinary approach to manage CP.PerspectiveOur meta-analysis provided an estimate of CP prevalence, reaching almost 50% of OUD patients with OST. Thus, the urgent challenge in OST patients is to pay systematic attention to chronic pain diagnosis, along with the implementation of a multidisciplinary patient-focused approach for an appropriate management of CP.RegistrationPROSPERO (CRD42021284790)     

Naltrexone Treatment for Pregnant Women With Opioid Use Disorder Compared With Matched Buprenorphine Control Subjects

PurposeThe use of the opioid antagonist naltrexone (NTX) for pregnant women with opioid use disorder (OUD) remains understudied. The purpose of this pilot study was to examine pregnancy and neonatal outcomes in a cohort of NTX-treated women.MethodsThis single-center, retrospective cohort study included 6 mother–infant dyads taking NTX compared with 13 taking buprenorphine (BUP) between 2017 and 2019. Maternal demographic characteristics, any unprescribed or illicit opioid use per urine toxicology or provider report during the pregnancy or 6 months’ postdelivery, delivery outcomes, gestational age, birth weight, Apgar scores, neonatal intensive care unit admission, and neonatal abstinence syndrome (NAS) outcomes (NAS diagnosis, pharmacologic treatment, and total hospital length of stay) were compared.FindingsMaternal and infant demographic characteristics were similar between the 2 groups, with the exception of cigarette smoking in the BUP group being more common (92% vs 33%; P = 0.02). None of the women on NTX versus 23% of the women on BUP had documented opioid misuse (P = 0.52). No infants in the NTX group had a NAS diagnosis versus 92% in the BUP group (P < 0.001). Forty-six percent of the BUP-exposed infants were treated for NAS versus 0% in the NTX group (P < 0.001). NTX-exposed infants had a shorter length of stay (mean [SD], 3.2 [1.6] vs 10.9 [8.2] days; P = 0.008).ImplicationsMaintaining women on NTX during pregnancy was associated with favorable outcomes. These results support the need for larger multicenter studies sufficiently powered to detect possible differences between the medications on long-term maternal and child safety and efficacy outcomes.     

244名合同制护士心理授权及其影响因素分析

目的 了解合同制护士心理授权状况,探讨潜在的影响因素,为护理管理者实施心理授权提供依据,以有效提高合同制护士心理授权水平.方法 采用中文版心理授权量表对湖北省襄阳市3 所三级甲等综合性医院的244 名合同制护士进行调查.结果 合同制护士心理授权问卷总分(40.70±4.96)分,不同年龄、婚姻状态、护龄、学历、职称、科室的合同制护士心理授权总分差异无统计学意义,而工作目的 不同的合同制护士心理授权总分差异有统计学意义(P<0.01).结论 合同制护士的心理授权水平有待提高,认识合同制护士心理授权的重要性,培养合同制护士热爱护理专业有助于提高合同制护士心理授权水平.     

低年资护士的职业态度及其影响因素

目的了解低年资护理人员的职业态度及其影响因素,为护理管理者针对性制定管理策略提供依据。方法采用自行设计的低年资护士职业态度调查问卷对新疆医科大学第五附属医院324名低年资护理人员进行调查。结果低年资护士总体职业态度中立偏积极,得分为（5．55±1．21）分;不同学历、职称、所在科室、民族、工作年限、婚姻状况及出生地的低年资护士,其职业态度得分差异均有统计学意义（均P〈0．01）。低年资护士的职业态度受多种因素影响,其中影响最大的是职称,其次是同事关系、患者对护理人员的看法及不同工作科室。结论内外环境均可影响低年资护士职业态度,护理管理者应采取针对性的措施,转变其专业观念,提高其工作责任心,引导其形成积极、正确的职业态度。     

Methadone Prescribing Caveats for Chronic Pain and Opioid Use Disorder

Methadone is an opioid agonist with unique pharmacologic and pharmacokinetic properties to consider when prescribing. Similar to other opioids, methadone is a Schedule II controlled substance; however, its indication for opioid use disorder includes additional federal regulations. Methadone has several serious boxed warnings that require providers to closely evaluate patient risk factors and perform a thorough assessment. Providers must also take into consideration all possible drug interactions before prescribing methadone; the patient could be placed at risk if not considered. Involving the patient in the decision to prescribe methadone will assist in ensuring a full history has been gathered.     

Perioperative Pain Management for Surgical Patients with Opioid Use Disorder: A Program Development Initiative

PurposeOver the last decade an increased number of individuals have been diagnosed with Opioid Use Disorder (OUD) and state-level regulatory pressure has mounted to develop the capability to provide opioid-free anesthesia (OFA) on clinical indication or at patient request.DesignA program initiative for OUD patients who require OFA was developed and implemented in two phases.MethodPhase I assessed the needs and knowledge of licensed nurse anesthetists in the state of Florida. Phase II recruited volunteers for a day-long event which involved both didactic and simulation training. Data collection for phase II included: demographics, knowledge, evidence-based practice belief scale (EBPBS), and evidence-based practice implementation scale (EBPIS) which measures the perceived ability to implement those beliefs. Phase II training was divided into three domains: Preoperative, Intraoperative and Postoperative with didactic and simulation experiences for each domain.FindingsThe phase II participants pre-simulation median total knowledge assessment score was 9 with median scores of 5 for questions 1 to 6 and 4 for questions 7 to 12. After participating in simulation, median knowledge assessment scores increased to 11, with median scores of 6 for questions 1 to 6 and 5 for questions 7 to 12. Before simulation training, median scores for the EBPBS and EBPIS were 66 (IQR 8) and 22 (IQR 24) respectively. After simulation, the median EBPBS score increased to 76 (IQR 7.5), a significant improvement from pre-simulation (P = .002).ConclusionThere is a lack of knowledge and training of anesthesia providers on how to manage the growing population of patients with OUD. This program initiative increased perceived ability to provide OFA care to patients with OUD presenting for surgery.     

Development of the Revised Opioid Risk Tool to Predict Opioid Use Disorder in Patients with Chronic Nonmalignant Pain

The Opioid Risk Tool (ORT) is a commonly used measure of risk of aberrant drug-related behaviors in patients with chronic pain prescribed opioid therapy. In this study, the discriminant predictive validity of the ORT was evaluated in a unique cohort of patients with chronic nonmalignant pain (CNMP) on long-term opioid therapy who displayed no evidence of developing an opioid use disorder (OUD) and a sample of patients with CNMP who developed an OUD after commencing opioid therapy. Results revealed that the original ORT was able to discriminate between patients with and without OUDs (odds ratio = 1.624; 95% confidence interval [CI] = 1.539–1.715, P < .001). A weighted ORT eliminating the gender-specific history of preadolescent sexual abuse item revealed comparable results (odds ratio = 1.648, 95% CI = 1.539–1.742, P < .001). A revised unweighted ORT removing the history of preadolescent sexual abuse item was notably superior in predicting the development of OUD in patients with CNMP on long-term opioid therapy (odds ratio = 3.085; 95% CI = 2.725–3.493; P < .001) with high specificity (.851; 95% CI = .811–.885), sensitivity (.854; 95% CI = .799–.898), positive predictive value (.757; 95% CI = .709–.799), and negative predictive value (.914; 95% CI = .885–.937).Perspective: The revised ORT is the first tool developed on a unique cohort to predict the risk of developing an OUD in patients with CNMP receiving opioid therapy, as opposed to aberrant drug-related behaviors that can reflect a number of other issues. The revised ORT has clinical usefulness in providing clinicians a simple, validated method to rapidly screen for the risk of developing OUD in patients on or being considered for opioid therapy.     

Examination of Knowledge About and Nursing Interventions for the Care of Patients in Pain of Nurses Who Work at Çukurova University Medical Faculty Balcali Hospital

Pain is a concept that goes back into distant history and is something that is faced by every person in different degrees and at different times in their lives. A definition of pain, adopted by the International Association for the Study of Pain and the American Pain Society, is: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Although pain is one of the most common reasons for needing health care, it is not well understood and continues to be one of the most important health problems today. The pain experience is dynamic, and the nurse is responsible for understanding this. Nurses need to cooperate with the patient and other members of the health care team to be able to control pain. Nurses are ethically responsible for the management and easing of pain. This study was conducted to investigate what nurses know about the care of patients in pain and what nursing actions are used. There were 198 nurses working day shift at Çukurova University Balcali Hospital who were included. The data were collected using a questionnaire that described the nurses and measured the nurses' knowledge about care. The mean age of the nurses was 30.89 years, they had a mean 12.0 years of experience in the profession, 52.0% did not have experience with chronic pain, 42.4% stated that they frequently encountered patients in pain, 70.2% had received education about pain in school, 88.4% had not received education about pain outside of school and did not read about pain in journals, 88.9% used pharmacologic management, 85.4% evaluated patients' pain based on verbal statements, 96.5% knew the important points in the use of opioid analgesics, and 3% knew pain theory. As a result of this study, it is seen that nurses have inadequate knowledge about care of patients in pain and pain control methods. After evaluation of the conclusions, they will be used in education to increase the quality of the nursing care.