Experiences of Frontline Nurses while Dealing with Opioid Overdose Patients
Introduction
The case of opioid overdose patients has remained a common phenomenon in the contemporary era. More and more incidences of patients presenting with complex and complicated conditions in health institutions are highlighted indicating just how serious the case is. According to Mallick-Searle & Chang (2018), the intervention of healthcare providers is critical to save the lives of such patients and ensure that they have the potential to improve their quality as well. Today, different organizations have committed significant resources to address the prevailing problem of opioid overdose across the globe.
In recent years, Canada has identified the opioid crisis as a nationwide public health disaster. Having reported an estimate of about 2500 opioid abuse deaths in the year of 2016, the nurses have taken measures and approaches that can help solve or mitigate the ongoing crisis (ConneCtion, 2018). Nurses, just like in many other health issues, take the front line in the fight against opioid abuse. They have often absorbed in the bulk of pressure that the patients exert on the healthcare systems since they are the ones that deal with them the most. Nurses interact with these individuals in different capacities such as at the health facilities during treatment, in the communities during awareness campaigns and education programs, and during advocacy campaigns (McCall, Phillips, Estafan & Caine, 2019). There are many other ways that nurses come into contact with opioid overdose patients, and this makes them very conversant and experienced with the challenges that come with this menace. Based on these aspects, this paper conducts an in-depth exploration of the experiences of frontline nurses while dealing with opioid overdose patients.
Understanding of Opioid Overdose Issues
According to a report by Barnes & Worthy (2015), nurses have raised concerns that opioid abuse cases are not always as a result of negligence. (Susan & Painter, 2017) state that there are numerous ways through which opiates are prescribed to individuals and for different purposes. The article indicates that the primary use of these drugs makes the difference in the type of opioid crisis that the nurses encounter. However, even if there are genuine ways in the use of opioids, that does not rule out the fact that these drugs are abused outside the mainstream and recommended uses. According to Mallick-Searle & Chang (2018), the increasing availability of these drugs over the counter is one of the aspects that nurses continue to grapple with since the consequences spill over and increase their burden while dealing with the victims. Unfortunately, according to studies by Giesecke, (2017), nurses agree that opioid overdose crisis whether for pain management or among the drug abusers has become a national issue of concern not only in Canada but also in many other parts of the world. As a consequence, as frontline healthcare providers, their workload continues to increase. Although this is manageable, the experiences that come with increasing morbidity and mortality rates amid psychological linkages with patients makes the case of nurses in this area rather sensitive (Dasgupta et al., 2016).
Nurses have shown their commitment to mitigating the opioids overdose crisis being experienced in Canada. Since 1999, Mallick-Searle & Chang (2018) state that the burden of this challenge across the globe has been on a constant rise. Over the years, nurses have interacted with the victims in different capacities and become aware of the dynamics that lead to overdose. For instance, in the report by (Clarke et al., 2014), they agree that there are individuals whose primary desire is to remain high, and this translates to addiction. This is something that expertise in the nursing fraternity considers as addiction and requires specialized approaches during treatment. Other than this, other patients end up being overdose as an implication of a sharp increase in opioid consumption for pain management. Nurses agree that in such a situation, the consequences of overdose are similar to those abusing the drugs (Waszak, Mitchell, Ren, & Fennimore, 2018). Since the nurses are occupied with underlying medical conditions, the probability of a patient going into severe complications is significantly higher. There are many other aspects that nurses have learned over the years about this crisis, with others comprising the mechanisms of education, treatment of the overdose patients in the emergency rooms, working in rehabs with the patients to break the addiction and community-based prevention programs. Such an understanding of the issue of opioid overdose among the nurses makes them the best experts in tackling this national challenge (Parker, 2019). Despite this, their experiences are not limited to the management, they also extend to other unsupportive systemic aspects as well.
Working with Families
In the line of healthcare, a family is a critical component in the treatment and recovery process of a patient. According to Sapp & Hooten (2019), coordinating with the caregivers or close relatives of a victim of these prescription pain relievers is a major aspect that promises breakthroughs in the efforts of tackling the crisis. Nurses, however, agree that this problem grievously impacts on the families as well. Despite this, nurses consider fostering a healthy relationship with the entire family an important approach in the management of opioid overdose patients. Sapp & Hooten (2019) found out that there is a striking connection between treatment regimes and the perspectives of the families. They report that the shared history and beliefs and values held by these extended groupings influence how patients respond to various treatment whether in the facility or the communities. Acknowledging that the family is inseparable from the patient is one of the most progressive experience that nurses in Canada have been exposed to. Considering that the nation has a wide diversity in terms of community practices, then it is their responsibility to learn about these dynamics during the assessments to ensure that treatments are tailored to all confounding factors.
According to Teixeira, Fonseca & Carvalho, 2014), considering the family context while working with individuals is an advantage that nurses have come to appreciate in Canada. The nurses have come to recognize that this is the raw material in the efforts towards eradication of the opioids overdose not only in the nation but also across the globe. To be an integral part of the system, nurses indicate that there is a need for professionals to demonstrate absolute respect and care while designing interventions in such a setting. For instance, Stuart & Melling, (2014) indicate that over the years, it has become clear that the role of nurses, in this case, is not limited to instructional or directive segments. Instead, it extends to showing concern for both the individuals and the families while taking them through the nursing interventions related to opioid overdose. When people feel that they are appreciated, empathized with, and their values and beliefs respected, they are often in a better potential to embrace and adopt change (Sapp & Hooten, 2019). Such exposure among the nurses shows that they have a duty of examining their values, biases, and beliefs, and how they relate to the families. This realization shows that their efforts can only become fruitful when a bond of trust is created and respected.
A nurse who reflects an undivided desire to stay open, objective, neutral, and value-free has made significant milestones in dealing with the opioids crisis. Based on (Norouzinia et al. 2016), this is a learning experience whose impact on treatment dynamic adherence among patients cannot be underestimated. The findings of this research show that nurses have gained an understanding of how important it is to use unbiased language while referring to individuals or describing the conditions that they are struggling with. This is because a language is a major tool that can either strengthen or weaken the relationship bond that gradually develops between the person suffering from opioid overdose and the nurses. This bond also extends to their families, and therefore, using constructive language that does not have negative connotations or profiling inclinations. Often, the appropriateness of the language has come to be known as a significant factor that nurses dealing with these patients must put into consideration to ensure that they have a lasting impact on all the patients.
Nurses Experiences and Systemic Support
Although nurses have made significant strides in the fight against opioid crisis across the globe, they continue to struggle with systemic limitations leading to the escalation of the problem (Krokmyrdal & Andenæs, 2015). The report explains that nurses are faced with challenges similar to those faced by their patients in the process of trying to manage their patient’s pain. According to Jackson & Lopez (2018), this is a complex problem that requires comprehensive interventions and corporation of different teams. Besides, success is also drawn from external support by the larger healthcare system to ensure they incorporate all related aspects to the interventions. One of the experiences raised by nurses in different contexts is that treatment for opioid use disorder remains largely inaccessible among individuals who are dependent on opioids which can be termed as opioid addiction (Volkow, & McLellan, 2016). For instance, there are systematic limitations that bar nurses from prescribing certain treatments to patients both in Canada and the U.S (Waszak, Mitchell, Ren, & Fennimore, 2018). They include limitations such as fear of the patient’s risk of misuse of the drug which may lead to them getting addicted to the drugs and fear of the disproportionate accusation that is blamed on the nurses for the opioid outbreak. Such systemic barriers often make it difficult for nurses to execute practices and approaches they feel have a high potential to address the looming crisis.
As stated by Ramacciati, Ceccagnoli, Addey & Rasero, (2018), there is an urgent need for relevant authorities to revise the limiting regulations to ensure that nurses are not subjected to practice-based limitation. Based on Jackson & Lopez (2018), the presence of these barriers has structurally stifled the nurses with the freedom to exploit all alternatives within their exposure while treating opioid overdose patients. The consequence of this is a progressive rise in the rate of morbidity and mortality rates across the globe. Canada has not been spared from this negative experience among its nurses as well. Literature shows that since their prescription rights are limited by the existing policies, they can only do what is permissible. Unfortunately, these experts report that the existing solutions are not sufficient enough considering that issues such as opioid use disorder remains largely neglected, yet it is a major contributor to the rising statistics about opioid overdose. According to Jackson & Lopez (2018), buprenorphine maintenance treatment is the primary treatment approach for dependence on opioids. Unfortunately, in many countries, regulations demand that a practitioner must have specialty training before using this approach. Moreover, he or she can only serve a limited number of patients. In fact, in other areas, the laws specify that there must be a presence of an assistive supervising physician, something that is not possible in all healthcare centers in any nation. The consequence of this is that nurses end up with restrained options when dealing with opioid overdose patients.
Attitudes Towards the Patients
While dealing with opioid overdose patients, research indicates that there are often inconsistencies and unprofessional attitudes that manifest among nurses. Morley, Briggs, and Chumbley (2015) state that this is a major issue of concern because it impacts on the overall outcome of the treatment processes. For instance, a study by Chang, & Yang (2015) reports that sometimes, nurses develop negative attitudes against these patients. It manifests in different ways including the use of phrases that appear to classify the patients in a demeaning way such as ‘drug-seeking.’ In assessments to test how the nurses interact with patients who present with substance use disorder, the results showed that the nurses had a general presumption that classified these individuals as difficult to care for. Such aspects lead to inadequate or poor services because the care providers, nurses, have compromised interest in helping such individuals.
These experiences also manifest in the form of stereotyping. It is a practice that Morley, Briggs, and Chumbley (2015) agree interferes with the level of care. For instance, nurses who considered clients as violent, scary, unhygienic, and as people with a weak character were found to have a lower quality of care. This often led to poor health outcomes among discriminated patients. Such attitudes have also been associated with the stigmatization of the patients interfering with their treatment compliance. Therefore, these experiences among the nurses’ attitudes towards patients with opioid overdose are significant predictors of the quality of care not only in Canada but also in other parts of the world.
Compassion Fatigue and Burnout in the Nurses
Hunsaker, Chen, Maughan & Heaston, (2015) define burnout as a drawn-out reaction to various types of stressors, both interpersonal and emotional that then lead to unresponsiveness and hopelessness. The interaction of nurses with the various patients elicits different reactions in varying magnitudes. This explains why most nurses report having had a feeling of burnout as shown by Horner et al. (2019). In fact, in the case of dealing with the opioid crisis, case studies conducted by Clemans-Cope et al. (2017) show that nurses have experienced emotional exhaustion. This is because this group of patients is considered as demanding and sometimes complex to understand. For instance, in Horner et al. (2019) the authors report that nurses considered fatigue to be a direct consequence of being let down by trusting them. It even becomes worse when the patient takes control leaving the nurses with no room to be compassionate to them.
Due to the constant interaction with their patients, nurses become empathetic and develop close bonds with their patients. Johansson & Wiklund-Gustin (2015) emphasize that nurses are required to execute care with dignity and caring relationships. Unfortunately, when the negative attitude described in this research emerges, it triggers disappointments and frustrations among the nurses (Chang, & Yang, 2015). The constant struggle by the nurses to understand and go beyond this veil requires an emotional connection. It is only by doing so that they are capable of recognizing the suffering of the patients, and why they use the drug substance, not for pleasure, but as a mechanism for alleviating their suffering (Foli, Reddick, Zhang & Krcelich, 2019). Conflicting reactions emerge from this perspective as it creates a loophole where the patients can become stuck and dependent on the drug as a solution. The consequence is that nurses, in return, become stuck in a cycle where they are not clear of their frustration and the conditions of their patients’ suffering. Such an outcome translates to emotional burnout in the nurses while dealing with opioid overdose patients.
Support and Resources Available for Nurses
The opioid crisis in Canada is devastating and burdensome to the nurses involved in the cases. (Taha, Maloney-Hall, and Buxton, 2019). As a result, these care providers deserve respective empowerment, support, and provision of appropriate resources (Painter, 2017). The support mechanisms would be the provision of coping skills while delivering care to these individuals in rehabs, emergencies, and in the communities. Psychologists comprise the best resource in this support system as they are best equipped to understand and help the nurses process the issues that they go through during their duties. Research indicates that constant exposure to overdosing patients is a risk factor that can easily wear a whole nursing fraternity (Horner et al. 2019). Offering the above-mentioned support in Canada would be critical to prevent the nurses from duty dropouts or turnover due to the frustrations related to constant interaction with these types of patients. As a precautionary tactic, it is recommended that debriefing be taken routinely to ease the burden from the nurses whenever they go through an overdose patient. In this way, nurses feel like part of a larger system and capable of dealing with a challenging environment.
Another right way to give support to nurses is by offering them systematic education about the opioid crisis (McCaffery & Ferrell,1995). It is important to ensure that nurses are competently aware and that they understand the complexities of dealing with patients with this major problem. This should be complemented by biweekly pulse checks to ensure that nurses do not burnout from executing their duties. Through such support, they are rendered an opportunity to share their fears with other professionals increasing the outcome of the care delivery.
Conclusion
Opioid overdose is a major issue of concern in Canada and many other parts of the world. Nurses are part of the healthcare team that absorbs most of the burden that comes with this population. Over the years, research has shown diverse experiences that these healthcare practitioners go through in their line of duty. Some of these comprise the increasing understanding of the dynamics of the crisis and the various strategies of management. Moreover, nurses have come to understand the role of working with families and how the relationships developed from this interaction impacts on the level of care. Systemic support is also highlighted as a major experience that influences the care process of nurses in the context of opioid overdose patients. Due to these conflicting experiences, nurses often suffer from compassion fatigue and burnout. That explains the need for adequate support structure and resources to address their needs as well.
