Bakgrund: Substansbrukssyndrom är en sjukdom som påverkar flera miljoner individer i världen idag, varav sjuksköterskor är en särskilt utsatt grupp. Detta bland annat på grund av tillgängligheten till narkotika på arbetsplatserna. Trots detta råder det stor kunskapsbrist kring ämnet. Det medför att omvårdnadsarbetet kan påverkas negativt, och patienter, kollegor och den missbrukande sjuksköterskan själv kan utsättas för risker. Syfte: Att beskriva sjuksköterskans upplevelse av personligt substansmissbruk och missbruksrehabilitering. Metod: Litteraturstudien baserades på åtta kvalitativa studier inhämtade genom databassökningar i CINAHL och PubMed. Analyserades med Fribergs femstegsmodell.Resultat: Fyra huvudkategorier framkom ur analysen: ”Orsaker till missbruket”, “missbrukets konsekvenser”, “Att konfrontera missbruket” samt “rehabilitering”. Huvudkategorierna delades upp i 8 underkategorier. Konklusion: Missbruk leder till sociala och ekonomiska konsekvenser för sjuksköterskan samt kan negativt påverka kvaliteten på patientens vård. Det finns effektiva interventioner men upplevelsen av dessa varierar och är beroende av flera faktorer. Det finns ett kunskapsgap och det behövs mer forskning kring frågan. / Background: Substance use disorder is a disease that afflicts millions of individuals worldwide today, of which nurses are vulnerable as a group because of the easy access to narcotics amongst other reasons. Despite this, there is a great lack of knowledge about the subject. This affects the nursing care negatively, and patients, colleagues and the substance abusing nurse themselves can be put at risk. Aim: To describe the nurses’ experience of personal substance abuse and rehabilitation. Methods: This literature study is based on eight qualitative studies acquired through database-searches in CINAHL and PubMed, the analysis was conducted using Friberg`s five step model. Results: Four main categories were found through the analysis: “Causes for substance abuse”, “consequences of substance abuse”, “Confronting the substance abuse” and “rehabilitation”. The main categories were divided into 8 subcategories. Conclusion: Substance abuse leads to social and economic consequences for the nurse and can negatively affect the quality of the patient's care. There are effective interventions but the experiences of these vary and are dependent on multiple variables. There is a lack of research on the subject, and more is needed.

Introduktion: Substansmissbruk är ett stort folkhälsoproblem samt en global humanitär kris. Personer med substansmissbruk är en sårbar patientgrupp då de lider av både fysisk och psykisk samsjuklighet vilket leder till behov av både somatisk och psykiatrisk och vård.  Substansbrukssyndromet bidrar till att vårdpersonal inom sjukvården upplever denna patientgrupp som komplex och svårbehandlad.  Syfte: Syftet var att studera vilka erfarenheter personer med substansmissbruk hade av bemötandet i somatisk vård. Metodbeskrivning: En litteraturstudie med deskriptiv design och kvalitativ ansats, där 13 original studier inkluderades i tematisk analys. Resultat: Resultatet visade på att personer med substansmissbruk upplevde brister i bemötande inom vården. Dessa upplevelser beskrevs som stigmatisering, fördomar samt bristande vård. Resultatet visade även att personer med substansmissbruk uppskattar ett professionellt bemötande där vårdpersonal var engagerad, empatisk, tog sig tid att lyssna samt var icke-dömande.Slutsats: Bemötande är en viktig del av omvårdnad då upplevelser av bemötande påverkar patientens vårdupplevelse samt hur de hanterar sin ohälsa. Genom en bättre förståelse för denna patientgrupps upplevelser av bemötande samt hur bemötandet brister kan förutsättningar skapas för att personer med substansmissbruk ska erhålla en god, trygg och jämnlikvård. / Introduction: Substance abuse is a significant public health problem and global humanitarian crisis. People who suffer from substance use disorder are a vulnerable patient group as they suffer from both physical and mental co-morbidities that lead them to seek somatic and psychiatric care. Substance use disorder contributes to health professionals perceiving this patient group as complex and challenging. Purpose: The purpose was to study what experiences people with substance abuse had of interactions and treatment in somatic care. Method description: A literature review with a descriptive design including 13 qualitative studies in the thematic analysis. Results: The results showed that people with substance use disorder had negative treatment and interactions experiences in health care. The result describes experiences of stigmatization, prejudice, and neglect. The results also showed that people with substance use disorder appreciate a professional approach where the healthcare staff is committed, empathetic, takes the time to listen and is non-judgmental.Conclusion: Interaction is essential to nursing, as perceptions of interaction affect the patient's care experience and how they deal with their illness. A better understanding of this patient group's experiences in treatment and how it is lacking creates an environment for healthcare professionals to provide good, safe, and equal care; healthcare professionals must know the specific needs of this patient group.

Bakgrund Patienter med substansbrukssyndrom har ofta behov av sjukhusvård på grund av trauma, psykisk problematik eller fysiska skador som uppkommit på grund av substansbruk. Sjukdomen skapar ett sjukdomslidande för patienten som är svår att ta sig ut. Utöver sjukdom upplever patienterna sig ofta stigmatiserade både från samhället, sig själva samt vårdare vilket bidrar till livslidande såväl som vårdlidande. Sjuksköterskan har ett ansvar att vårda sina patienter personcentrerat med respekt. Syfte  Syftet är att beskriva mötet mellan patienten med substansbrukssyndrom och hälso-och sjukvårdspersonal. Metod Studien byggs på en icke-systematisk litteraturstudie baserad på 16 vetenskapliga originalartiklar. Inkluderade artiklar är av kvalitativ design. Datat är insamlad under hösten 2021 från databaserna PubMed och CINAHL, sökningarna genomfördes med booleska sökkombinationer. Alla inkluderade artiklar är kvalitetsgranskade utifrån Sophiahemmets Högskolas bedömningsinstrument. En integrerad dataanalys står till grund för teman i studiens resultat. Resultat Patienter såväl som sjuksköterskor uppvisar beteende och attityder påverkade av stigma. Den stigmatiserade patienter upplever förminskande samt diskrimination i mötet med hälso-och sjukvårdspersonal vilket gör patientgruppen mindre benägen att söka vård. Hälso-och sjukvårdspersonal som stigmatiserar patienten har svårt att vårda patienten utifrån ett personcentrerat synsätt och upplever svårigheter att se hela patienten i mötet. Hälso-och sjukvårdspersonal med specialistkompetens inom området visar att mer kunskap är av hjälp i mötet med patienter, samt att kunskap leder till avstigmatisering. Mötet med specialister leder till trygghet för patienten som i sin tur vågar vara sig själv. Slutsats Mer kunskap om substansbrukssyndrom behövs hos grundutbildad hälso-och sjukvårdspersonal för att kunna möta patienten utifrån ett personcentrerat synsätt, fritt från stigma. / Background Patients suffering from substance use disorders tend to hold a high frequency of hospitalizations, due to trauma, psychiatric instability or physical damage associated with substance use. The patient often experiences stigmatization, from the community, nurses and other ward personne. The nurse holds responsibility to treat their patients with respect as well as exercise a person-centered ward to ensure the best possible care for their patients.  Aim The aim is to describe the encounter of patients suffering from substance use disorder and healthcare personnel.  Method The study was implemented with a non-systematic literature study, based on 15 scientific articles. The included articles are based on qualitative design. The data was collected during the autumn of 2021 from the databases PubMed and CINAHL, the search was made with boolean search combinations. The included articles have been quality reviewed according to the Sophiahemmet assessment instrument. Data Analysis was made with an integrated data analysis, which contributed to the themes presented in the result of the study. Results Patients as well as nurses exhibit behaviour and attitudes affected by stigma. The stigmatized patient experiences diminishing behaviour together with dicrimination when they meet healht-care providers, which makes them less prone to approach hospital care. Health-care providers, who stigmatize patients, experience difficulties in the exercise ward of a patient centered point of view. Professions with specialist competens, within substance use disorders, shows that more knowledge leads to destigmatizing. Conclusions Better knowledge about substance use disorders is needed within healthcare-providers to be able to provide care out of a person centered point of view, free from stigma, in the meet with patients suffering from substance use disorder.

Background: Current national prevalence estimates of DSM-5 diagnosed substance use disorders (SUDs) among adults with justice system involvement are lacking. Methods: This study drew from NESARC-III data (n = 36,309; 2012–2013), a nationally representative U.S. sample, to examine current and lifetime alcohol use disorder (AUD) and drug use disorder (DUD) diagnoses among adults reporting current or prior drug-related, alcohol-related, and general legal problems. Results: Adults reporting current alcohol-related legal problems were 22 times more likely to have a current AUD diagnosis (AOR = 22.0, 95% CI = 12.1; 40.1) and 15 times more likely to have had a lifetime AUD diagnosis (AOR = 15.2, 95% CI = 7.5; 30.9) than adults without alcohol-related legal problems. Adults with lifetime drug-related legal problems were 3–5 times more likely to have a current (AOR = 2.6, 95% CI = 2.1; 3.2) and lifetime (AOR = 5.1, 95% CI = 4.3; 6.1) DUD diagnosis, with stimulant use disorder being the most prevalent (AOR = 5.4, 95% CI = 4.5; 6.5). Adults with general legal problems were around 3 times more likely to have a current AUD (AOR = 3.2, 95% CI = 2.6; 4.0) or DUD (AOR = 3.5, 95% CI = 2.8; 4.4). Women with any type of legal problem were more likely to have SUD diagnoses than men. Conclusions: SUD diagnoses are prevalent among adults reporting legal problems, particularly those involving alcohol. There is a continued need for community-based addiction prevention and intervention efforts, especially for women with justice system involvement.

SAMMANFATTNING Bakgrund Smärta är en individuell och subjektiv upplevelse och den vanligaste orsaken till att människor uppsöker sjukvården. Att leva med långvarig smärta påverkar människans livskvalitet. Missbruk av beroendeframkallande läkemedel ökar och är idag ett globalt folkhälsoproblem. Det är sjuksköterskans professionella ansvar att bedöma, behandla och lindra smärta. Syfte Syftet var att belysa sjuksköterskans och patientens upplevelse och erfarenhet vid smärta och läkemedelsberoende inom sjukvården. Metod En icke systematisk litteraturöversikt genomfördes och baserades på 15 vetenskapliga artiklar av kvalitativ och kvantitativ design. Artiklarna eftersöktes med hjälp av relevanta sökord i databaserna PubMed och CINAHL samt manuellt för att därefter kvalitetsgranskas utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering. Vidare analyserades artiklarna med hjälp av en integrerad analysmetod, vilken resulterade i en sammanställning med två huvudkategorier och sex subkategorier. Resultat Resultatet utgjordes av två huvudkategorier och sex subkategorier. En huvudkategori var sjuksköterskans perspektiv, den andra var patientens perspektiv. De sex subkategorierna var: attityd och förhållningsätt, kunskapsbrist, etiskt dilemma, mötet med sjukvården, att bli tagen på allvar samt partnerskap. Resultatet visade att sjuksköterskor och patienter hade såväl positiva som negativa upplevelser och erfarenheter relaterat till vården av patienter med smärta och läkemedelsberoende. Slutsats Sjuksköterskans bristande kunskap kring begreppet smärta samt sjuksköterskans attityder och förhållningssätt gentemot läkemedelsberoende patienter med smärta, utgör hinder för en god och säker omvårdnad. Mer forskning och utbildning behövs för att inte riskera ett onödigt lidande för denna patientgrupp. / ABSTRACT Background Pain is an individual and subjective experience and the most common cause of people seeking healthcare. Living with chronic pain influences a person’s quality of life. The abuse of dependency developing drugs is increasing and is now a global health problem. It is the nurse’s professional responsibility to appraise, treat and relieve pain. Aim The aim of this study was to explore the patient’s and nurse’s experiences, within the healthcare system, connected to pain and substance use disorder. Method The method was a literature review based on 15 scientific articles and both qualitative and quantitative design where included. Data collection was made in a non-structured and a manual way, in the databases PubMed and CINAHL. Quality assessment was made according to the assessment basis by Sophiahemmet University, which is directed at assessing the quality and scientifically classifying studies. Furthermore, the articles were analysed using an integrated analytical method, resulting in a compilation of two main categories and six subcategories. Results The results were compiled within two main categories and six subcategories. One of the main categories was the nurse’s perspective with the subcategories attitude and approach, lack of knowledge, ethical dilemma. The second main category was the patient’s perspective, with the subcategories the meeting with healthcare, to be taken seriously and partnership. The results showed that nurses and patients both had positive and negative experiences and knowledge related to the healthcare of patients with pain and substance use. Conclusions Nurse’s lack of knowledge about the concept of pain as well as attitudes to, and approach toward patients with substance abuse and in pain, is an obstacle to develop good and safe care. Extended research and education are needed to lower the risk of unnecessary suffering for this group of patients.

This is a retrospective, population-based cohort study (extracted with VA Informatics and Computing Infrastructure; VINCI) of adult patients (age > 18) in the United States Veterans Affairs Health Care System (VA) who have received care in at least one of seven Central Appalachian VA healthcare systems between January 1, 2014 and December 31, 2017. The study is designed to assess the potential significant correlation between pertinent demographic variables (i.e., age, race, ethnicity, sex, service connection, rurality, era of service, and combat vet status) and diagnosis of Post-Traumatic Stress Disorder (PTSD) and/or Substance Use Disorder (SUD). Using statistical methods, these demographic variables will be held constant to examine the variance explained by military branch of service (i.e., Navy, Marines, Air Force, Army, National Guard) on diagnoses of PTSD and/or SUD. Veterans will be included in the data pull if they have been seen in at least one of the seven Central Appalachian VA healthcare systems and been diagnosed with PTSD and/or SUD through an inpatient or outpatient mental health clinic (verified by clinic stop code). The primary analysis will assess correlation (Pearson's r) between demographic variables and PTSD and/or SUD diagnoses; and using a general linear model (one-way ANOVA) to examine the impact of branch of military service on diagnoses of PTSD and/or SUD after controlling for other pertinent demographic variables.

Purpose The Johnson City Downtown Day Center (JCDDC) provides integrated inter-professional primary care, mental health, and social work case management services to homeless and under-served persons who have difficulty accessing traditional systems. Because of the exponential rise in substance abuse in the Appalachian region, the JCDDC providers and staff initiated SBIRT as recommended standard of care, as endorsed by SAMHSA, United States Public Health Services Task Force, and the National Institute on Alcohol Abuse and Alcoholism. The JCDDC has two mechanisms by which patients can choose to participate in substance abuse treatment: SMART Recovery, and psychiatric nurse practitioner (NP) referrals. The purpose of the project evaluates use of SBIRT at the JCDDC by determining process of (1) referral and (2) follow-up rates of those who received SBIRT; analyzing outcomes by measuring numbers of: (1) screens administered; (2) brief interventions; (3) positive screens; (4) referrals to either SMART Recovery or to the psychiatric NP; (5) participation in one follow-up. Review of Literature: Approximately 6.4 million people, or 2.4% of the U.S. population 12 years and older, currently misuse prescription medications. There is an undeniable and tangible correlation between the chronic disease of substance use disorder and unstable housing or homelessness (de Chesnay & Anderson, 2016). Similarly, substance use disorder was found to be much more common in people facing homelessness than in people who had stable housing (National Coalition for the Homeless, 2009). Substance Abuse and Mental Health Services Administration (SAMHSA) has been the most significant funding source for SBIRT proliferation in the United States. Despite a demonstrated need for substance abuse services among this vulnerable population, people who are homeless have substantially greater barriers to obtaining treatment and often go without. Summary of Innovation or Practice The current SBIRT process includes use of DAST-10 and AUDIT tools. Evaluating clinic processes and outcomes in vulnerable populations who have inconsistent erratic follow-up is challenging. However, new ways of understanding patterns and incremental outcomes is essential to addressing clinic practice that can impact outcomes in vulnerable groups. Implications for NPs The heterogeneity of the homeless population is often precipitated by a host of complicating factors including co-occurring mental illness, multiple chronic conditions, unstable income, and lack of transportation. Therefore, the importance of finding effective, cost-conscious processes that are population specific and patient-centered is essential for future research and policy. The inter-professional model of care also informs future practice by evaluating the feasibility of administering all of the elements of SBIRT in a single facility.

Bakgrund: Substansbruk av opioider förekommer och därför ses patienter med substansbrukssyndrom dyka upp i vården. Studier pekar på att sjuksköterskor upplever svårigheter med att vårda denna patientgrupp, främst i hur substansbrukare ska smärtlindras och bemötas. Patientgruppen har ofta en högre tolerans mot smärtlindring på grund av toleransutveckling och kräver därför högre doser. Vidare finns mycket stigma kring patienter med substansbrukssyndrom som kan leda till ett sämre bemötande och sämre vård för dessa patienter.   Syfte: att beskriva hur personer med känt substansbrukssyndrom upplever smärtlindring vid akut och långvarig smärta och hur de upplever att de blir bemötta av vårdpersonal i dessa situationer.     Metod: allmän litteraturstudie med en deskriptiv design baserad på tio vetenskapliga artiklar hämtade från Pubmed och Cinahl. Kvalitetsgranskning av artiklar skedde med SBU:s mall för bedömning av studier med kvalitativ metodik. Resultatanalysen gjordes utifrån Popenoe et al:s (2021) beskrivning om kodning och kategorisering.    Resultat: Tre huvudkategorier framkom: otillräcklig smärtlindring, stigmatisering och positiva möten. Substansbrukarna beskrev att de inte alltid fick adekvat smärtlindring och hade upplevelser av dåligt bemötande. Detta påverkade deras vård negativt. Samtidigt fanns de patienter som upplevt bra bemötande från bland annat sjuksköterskor som var trevliga och engagerade sig.   Slutsats: Att vårda patienter med substansbrukssyndrom och samtidig smärta förefaller vara svårt. Okunskapen kring denna patientgrupp leder till ökad ohälsa, både fysiskt och psykiskt. Ämnet är fortsatt relevant än idag och mer studier behövs för att öka kunskapen och medvetenheten hos sjuksköterskor för att kunna bryta stigmatiseringen. / Background: Substance use of opioids occurs and therefore patients with substance use disorder are seen appearing healthcare. Studies indicate that nurses experience difficulties in caring for substance users, mainly in terms of pain management and treatment. Substance users often have a higher tolerance against pain medication and require higher doses. There is a lot of stigma surrounding these patients, which can lead to poorer treatment and care for them.   Purpose: to describe how people with substance use disorder experience pain management in acute and chronic pain and their experience of the encounter with healthcare staff in these situations.    Method: literature review with a descriptive design based on 10 scientific articles retrieved from Pubmed and Cinahl. Quality review of chosen articles was done by using a template for assessment of qualitative studies, from SBU. The result analysis was done based on Popenoe et al´s (2021) description of coding and categorization.   Results: Three categories emerged: inadequate pain relief, stigmatization and positive encounters. Substance users described that they didn’t get adequate pain relief and had experience of bad encounters with staff. This affected their care negatively. There were patients who experienced good encounters from nurses who were kind and engaged in the care.   Conclusion: Caring for patients with substance use disorders and co-occurring pain appears to be difficult. The ignorance surrounding this patient group leads to increased illness. The subject is still relevant today and more studies are needed to increase the knowledge and awareness of nurses in order to break the stigma.

No description available.

BACKGROUND: Suicide is a leading but preventable cause of death and is preceded by domains of thoughts, plans, and attempts. We assessed the prevalence of suicidality domains and determined the association of suicidality domains with sexual identity, mental health disorder symptoms, and sociodemographic characteristics. METHODS: We used the 2019 National Survey on Drug Use and Health (NSDUH) data to perform weighted multivariable logistic regression and margins analyses to examine between and within-group differences in suicidality by sexual identity among adults aged ≥ 18 years. RESULTS: About 4.89%, 1.37%, and 0.56% of the population experienced suicidal thoughts, plans, and attempts, respectively. Those aged 18-25 years old had a higher odds of suicidality compared to those aged 26 years or older. Compared to those who reported having no alcohol use dependence, illicit drug use dependence, and major depressive episodes (MDEs), those who reported alcohol use dependence, illicit drug use dependence, and MDE had higher odds of suicidal thoughts, plans, and attempts. Between all sexual identity groups, bisexuals who experienced MDEs had the highest probability of having suicidal thoughts while lesbians and gays who experienced MDE showed a higher probability of suicidal plans and attempts compared to heterosexuals. Within each sexual identity group, the probability of having suicidal thoughts, suicidal plans, and suicidal attempts was higher for those who had experienced MDEs compared to those who had not experienced MDEs. CONCLUSION: Substance use disorder and MDE symptoms were associated with increased suicidality, especially among young adults and sexual minority people. This disparity underscores the need for tailored interventions and policies to enhance the provision of prompt mental health screening, diagnosis, and linkage to care for mental health services, particularly among the most vulnerable in the population.