Opioids are a type of narcotic pain medication that is used to control pain. Examples include meperidine, methadone, morphine, oxycodone (OxyContin), oxycodone with acetaminophen (Percocet), and hydrocodone with acetaminophen (Vicodin). There is an increasing number of patients with pain addicted to opioids. According to the Centers for Disease Control and Prevention, opioid overdoses have quadrupled since 1999. Nurses play a vital role in preventing opioid addiction in patients with pain through nursing assessments and monitoring of their patients.
Here are 4 essential steps that nurses can take to help prevent opioid addiction.
1. Perform a comprehensive assessment of pain by using a standardized pain assessment tool.
Nurses need to assess the individual patient’s pain location, characteristics, onset, duration, frequency, intensity or severity, precipitating factors of pain, and how the individual manages his or her pain.To learn more about pain assessment tools, visit www.paincommunitycentre.org/article/pain-assessment-tools.
2. Assess the patient’s pain management and medications used.
Pain medication should be matched to the individual patient’s needs. It is important that nurses assess the patient’s detailed medical history, including a list of currently prescribed and past medications, as well as a history of substance use or substance use disorders in the patient and the patient’s family. Keep monitoring patient use of medications and opioids to avoid overdependence or potential addiction.
3. Evaluate the effectiveness of the pain management through ongoing assessment of the individual patient’s pain experience.
Proper evaluation of pain management requires that all patients have a treatment entry diagnosis that is defined, standard, and objectively determined. An ongoing assessment of the patient’s pain experience during and after treatment is vital for preventing pain medication misuse. Patients can become addicted if they take pain medications or opioids too much or for a long period of time.
4. Educate your patients about pain management.
A better patient understanding of the nature of pain, its treatment, and the side effects and complications is one of the most important steps toward improved control of pain and pain medication use. Nurses should provide written instructions about dosage, adverse effects, how long the medication should be taken, and how to store and dispose of unused medication. Opioids can be dangerous if patients take them with alcohol, or with certain drugs such as antihistamines, sleeping pills, and some antidepressants. Nurses can also introduce the use of non-pharmacological techniques (e.g., relaxation, guided imagery, music therapy, distraction, massage, lifestyle modifications, and heat and cold application) before, during, and after feeling pain to control and reduce pain.
According to the Centers for Disease Control and Prevention, shift work and a lack of sleep due to long shifts can cause a serious health burden. Shift work sleep disorders (SWSD) contribute to the development or exacerbation of various co-morbid conditions, including cardiovascular disease, diabetes, obesity, GI disorders, and depression. It can affect your work performance and quality of life.
Nurses are particularly at risk for SWSD, which can cause physiological and psychological distress and lead to errors in their work. Thus, it is important that nurses are aware of this risk and focus on their sleep hygiene. Here are 7 tips to prevent SWSD and promote your sleep hygiene.
1. Avoid consecutive shifts longer than 12 hours and avoid working an extensive amount of overtime.
After night shifts, it is recommended that you have at least 48 hours off so that your body can recover. When you have a day or two off from work, it is good idea to catch up on rest.
2. Establish a regular sleep schedule.
This will reinforce your body’s sleep-wake cycle.
3. Create a sleep-inviting environment for restorative sleep.
Keep your room a cool temperature (between 60-67 degrees), which can help aid the process of cooling your body. Keeping your bedroom dark and quiet can help promote your sleepiness.
4. Avoid large meals, spicy foods, alcohol, nicotine, caffeine, and other substances that interfere with sleep at least 4 hours before bedtime.
Also try to limit the amount of caffeine you drink during the day.
5. Reduce screen time.
Light, noise, and content from televisions, smartphones, and tablets are stimulating and can cause difficulty falling asleep.
6. Avoid exercise before bedtime.
Exercising before bedtime can cause difficulty falling asleep.
7. Avoid stressful and stimulating activities, such as doing work or discussing emotional or serious issues, before bedtime.
Physically and psychologically stressful activities can cause the body to secrete the stress hormone, cortisol, which is associated with increasing alertness. Reducing stress and unwinding from the day can help you fall asleep faster and achieve a better quality of sleep.
In the four weeks since Hurricane Maria ravaged the island of Puerto Rico, 76 people have fallen ill with suspected Leptospirosis, according to CNN, and two have died from the bacterial disease, which is spread through water, food, or soil contaminated with the urine of infected animals.
One patient, a 61-year-old bus driver from Canóvanas, a city in northeast Puerto Rico, became sick after drinking from a stream near his house one week after the storm, according to press reports. Within a few days, he developed a fever, turned yellow, and eventually died at a local hospital.
Outbreaks of Leptospirosis are common after natural disasters and floods and a number of the patients appear to have contracted the illness the same way the bus driver did—by drinking from local streams after being without running water in their homes. People may have also acquired the infection by bathing or wading in contaminated freshwater as the bacteria can easily enter blood stream through open cuts or wounds, or via mucous membranes in the eyes, nose, or mouth.
The island’s deadly Leptospirosis outbreak is just one example of the sort of health crisis that can arise in the aftermath of a hurricane. In the midst of what’s been one of the most active hurricane seasons in recorded history, here’s a look at some of the serious health hazards that can lie in a storm’s wake.
When Hurricane Harvey dumped more than 19 trillion gallons of rain on the Houston area in late August, it turned low-lying streets into rivers—but the river that ran through southeast Texas was little more than a toxic cesspool tainted by human waste, chemicals, and other contaminants, according to USA TODAY.
J.R. Atkins, a former firefighter and paramedic from Missouri City, Texas, nearly lost his arm after contracting infection from the floodwaters while helping to rescue stranded neighbors. Atkins told ABC News it all started with small bug bite on the top of his arm. Within 24 hours, the small bite turned into a raging infection that was diagnosed as necrotizing fasciitis, or flesh-eating bacteria.
After a harrowing few days in intensive care, Atkins recovered from the nasty bug, but others have not been as lucky. Nancy Reed, a 77-year-old Houston woman, developed a flesh-eating bug after she fell inside her son’s flooded home and broke her arm. She died approximately two weeks later. On October 16th, a 31-year-old man who had been repairing hurricane damaged homes in Galveston also died after developing an infection in his arm with flesh-eating bacteria.
Floodwaters are a haven for microbes. Water samples taken from one flooded Houston home contained the fecal bacteria E. coli at 135 times the upper limit of what is considered safe, according to The New York Times, which organized the testing. The testing also turned up an unspecified strain of the Vibrio, a Gram-negative bacteria that thrives in coastal waters and can cause severe and sometimes fatal illness, including necrotizing fasciitis.
While there were no reported cases of flesh-eating bacteria in Florida following Hurricane Irma, several east coast beaches, rivers, and lagoons reported high levels of enteric bacteria, indicating fecal contamination. Coming into contact with the pathogens cause upset stomach, diarrhea, eye irritation and skin rashes, according to the Florida Department of Health.
Puerto Rico, meanwhile, continues to face a critical situation with 1 million people – nearly 30% of the island’s population—still lacking access to drinkable tap water, according to Weather.com. Residents there are urged to boil water before drinking and not to drink from streams, which may be contaminated with sewage, but as the current Leptospirosis outbreak indicates, some are not heeding that advice.
Mosquitoes are the planet’s most deadly creatures, transmitting diseases that cause millions of deaths worldwide each year. Unfortunately, the conditions after a hurricane—in particular, the abundance of standing water left behind—make it ripe for mosquito breeding.
Two weeks after Irma walloped Florida, Hernando County Mosquito Control, which covers a region located about 53 miles north of Tampa on Florida’s Gulf Coast, trapped roughly 26,000 mosquitoes over the course of 16 hours. A normal catch for that time frame would be about 500 mosquitoes.
Mosquitoes can spread an array of diseases, including dengue, chikungunya, West Nile virus, and Zika. Zika can cause serious birth defects like microcephaly. There have been 40,000 cases of the disease in Puerto Rico since 2016, though in June the island declared its outbreak of the virus was over.
While there have been no reported outbreaks of mosquito-linked illnesses thus far this year, they can take some time to appear.
Researchers noted a more than two-fold increase in cases of West Nile virus in parts of Louisiana and Mississippi in 2006, one year after Hurricane Katrina devastated the region. Most individuals infected with the virus develop a fever and other symptoms that run a self-limiting course, but one out of every 150 infected individuals will develop serious illness that can be fatal.
Mold and Pollution
Mold growth can cause serious problems in the aftermath of a hurricane. In flooded homes, fungus usually develops within 24 to 48 hours and remediation is costly.
Mold exposure can be particularly harmful for individuals with lung conditions, such as asthma or chronic obstructive pulmonary disease (COPD), and evidence suggests people can develop allergy symptoms to mold in the wake of catastrophic flooding. Following Hurricane Katrina, 78% of children tested in one study had allergies to mold, compared with the typical rate of 50% in other major urban areas.
Toxic pollutants are another concern.
Damaged petrochemical refineries and other industrial facilities in and around the Houston area accidentally released millions of tons of airborne emissions after Harvey hit in Texas, according to The New York Times.
Despite reassurances from the Environmental Protection Agency that residents were not in any immediate danger, Elena Craft, a senior health scientist at the environmental Defense Fund, told the newspaper that the pollution contained “cancer-causing compounds, like benzene and butadiene” and said her group is “very concerned about people’s long-term health in the area.”
In Puerto Rico, meanwhile, thirsty and desperate residents with no access to clean drinking water have reportedly been filling up jugs with water from wells at a federally designated hazardous waste site contaminated with toxic industrial chemicals like tetrachloroethylene and trichloroethylene, a known carcinogen.
Natural disasters don’t just take a physical toll on people—they take a mental one, too.
One study found that a third of the adult survivors of Hurricane Katrina suffered from some form of storm-related mental distress, such as depression, anxiety, and post-traumatic stress disorder (PTSD), and nearly 40% of children tracked in the study were were diagnosed with a mental disorder after the storm.
It’s not just survivors who are impacted. First responders and recovery workers who are separated from their own loved ones for long periods of time can develop mental fatigue.
The psychological burden will be even greater in places like Puerto Rico, where recovery is lagging. At least nine people have died by suicide since the storm, according to the Latin Times, and residents are overwhelmed by the disaster that has left so many homeless and jobless and struggling to survive.
There have been increasing claims of nurses being sexually harassed. Some male nurses have reported being harassed; however, more than 50% are female nurses. The harasser may be male or female, and the victim may be of the opposite sex or the same sex as the harasser. Sexual harassment is not acceptable and unlawful. It can affect a person’s emotional and mental health, as well as lead to significant stress and anxiety.
The U.S. Equal Employment Opportunity Commission (EEOC) states that “harassment does not have to be of a sexual nature, however, and can include offensive remarks about a person’s sex. For example, it is illegal to harass a woman by making offensive comments about women in general.” Sexual harassment is defined as unwelcome behavior of sexual advances, a request for sexual favors, and other verbal or physical conduct of a sexual nature that explicitly or implicitly affects an individual’s employment, unreasonably interferes with an individual’s work performance, or creates an intimidating, hostile, or offensive work environment (EEOC).
Types of sexual harassment include:
- Telling lewd jokes, or sharing sexual anecdotes;
- Making inappropriate sexual gestures;
- Staring in a sexually suggestive or offensive manner, or whistling;
- Asking sexual questions, such as questions about someone’s sexual history or their sexual orientation;
- Making sexual comments about appearance, clothing, or body parts;
- Making offensive comments about someone’s sexual orientation or gender identity;
- Inappropriate touching, including pinching, patting, rubbing, or purposefully brushing up against another person.
Whatever form the sexual harassment may take, it is important that it is recognized, and that prompt action is taken against the harasser. Preventing sexual harassment and taking proactive steps to deal with harassment that does occur is especially critical.
Here are eight steps to protect yourself from being sexually harassed:
- Be informed about the definition of sexual harassment.
- Be knowledgeable about institutional policies regarding sexual harassment.
- Take an active role in fostering a work environment free from sexual harassment.
- Attend sexual harassment prevention courses or training.
- Report the harassment to your supervisor immediately, or to a higher authority if your supervisor is the harasser. Consult with your human resources office and government agency if necessary. Never be afraid to report a comment, action, or gesture by somebody that made you feel uncomfortable.
- If possible, speak with the individual directly and inform him or her that you feel the behavior is inappropriate.
- Seek support from family members, friends, colleagues, or your state nurses’ association.
- Document the harassment in writing as soon as possible.
October 10 is World Mental Health Day, and nurses are in an excellent position to notice when patients might be suffering from a mental health condition.
Nurses have the knowledge and authority to offer patients the facts about mental health, and they can normalize conditions like depression or anxiety. They can convey the important fact that, like any other medical condition that needs to be treated properly, mental health conditions are a physical and chemical imbalance and not a character flaw.
Although the general attitude toward mental health conditions is gaining more mainstream discussion and acceptance, the attitudes vary greatly. Factors like location or family culture can either normalize depression or obsessive-compulsive disorder make it a forbidden topic. Knowing a little about how your patient sees mental health conditions can help you adapt your approach.
On World Mental Health Day, nurses worldwide can spread the word by offering access to online screening tools through places like Mental Health America or the Anxiety and Depression Association of America. They can offer referrals to area mental health providers if appropriate. This year’s theme focuses on mental health in the workplace, so it’s also a good time to open up discussions in your workplace about paying attention to our own mental health and how it impacts job performance.
But nurses can also just talk about mental health issues in a nonjudgmental manner to put patients at ease. If someone is struggling with something like racing or unusual thoughts, severe anxiety in public places or about specific topics, or experiencing significant impacts to daily life because of sadness, they want to know they are not alone. Nurses can fill that role with care, compassion, and expertise. They are also there to offer hope that with treatment, the person can feel better and can begin to resume a life they are happier with.
Of course, some patients are reluctant to talk about their mental health directly, but they might bring it up in ways that are less obvious. Nurses can ask direct questions or they can listen for clues in conversations. What are your patients saying? Are they gaining or losing weight? Having trouble sleeping? Becoming more argumentative or less engaged with their family and community? Are they missing work or getting in trouble at work for being late or making errors? Are they drinking more or using recreational drugs?
It’s good to remind patients that a mental health condition doesn’t always require medication, although that is often a good option, and it isn’t always a lifelong condition. Other treatments like therapy, stress reduction, and healthy living basics like exercise, quality sleep, and a good diet also help lesson some symptoms. Sometimes problems are a result of a different condition or a side effect of a medication—factors many people don’t know. Getting to the root of the problems will help a patient find the right treatment plan.
The important message is that help is available, treatment works, and that first step can bring them enormous relief. Your positive attitude and compassion can make a big impression and can influence how people see their condition and think about treatment.
On World Mental Health Day, remain alert to what your patients are telling you. You may be able to help change their lives in a way you didn’t expect.
As the country continues to grapple with an ever-increasing opioid addiction crisis, the medical profession and patients alike struggle to treat real pain issues while managing their pain safely.
Sherry McAllister D.C., M.S (Ed)., CCSP, executive vice president of the Foundation for Chiropractic Progress recently answered some questions from Minority Nurse about how to navigate this tricky path. October happens to be National Chiropractic Health Month and is a good time to begin thinking about managing chronic pain with medication-free methods when possible and safely with medication when it is necessary.
“The human toll of prescription opioid use, abuse, dependence, overdose, and poisoning have rightfully become a national public health concern,” McAllister says, noting that opioid drug abuse was named an emergency by President Trump. “The sheer magnitude of America’s prescription opioid abuse epidemic has evoked visceral responses and calls-to-action from public and private sectors. As longtime advocates of drug-free management of acute, subacute and chronic back, neck, and neuro-musculoskeletal pain, the chiropractic profession is aligned with these important initiatives and committed to actively participate in solving the prescription opioid addiction crisis.”
What can concerned patients and health care teams do? “Begin treating pain with conservative options first,” says McAllister. Many people suffering from pain just want it to go away and often hope the pain medication will hasten that. As nurses know so well, pain medication treats the symptom, but not the underlying problem. “But the opioid emergency demonstrates that masking pain can lead to long-term persistence of both the pain and the drug use,” she says.
The necessity for finding alternatives that will help people without exposing them to the risk of addiction or dependence is clear. “Data released by the Centers for Disease Control and Prevention (CDC) revealed that ‘opioid deaths continued to surge in 2015, surpassing 30,000 for the first time in recent history,’” says McAllister. The rates continue to rise.
Often addiction starts with something as simple as dental work or as common as a back injury. McAllister cites an April 2017 report on lower back pain in the Annals of Internal Medicine that “strongly recommends non-pharmacological treatment” that suggests a long list of first-line alternatives including heat, massage, acupuncture, exercise, multidisciplinary rehabilitation, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.
If those options don’t work, moving on to medication trials of non-steroidal anti-inflammatory medications (like Aleve or ibuprofen) or muscle relaxants should be tried. Opioids are considered an option if all these other methods have failed to provide necessary relief. But they should only be prescribed after assessing each individual case and with a discussion with the patient about realistic pain management expectations and what the risks are.
Nurses can help deliver information about pain management options to their patients while not minimizing the impact chronic pain has on their lives. They can encourage therapies that don’t include medication and back it up with the proven evidence that these approaches help patients in the long term.
Opioids, in particular, can also cause a host of associated health problems, with addiction being the most well-known. But patient’s bodies can also become adjusted to the drugs and require increased does to deliver the same pain relief. McAllister recommends Chiropractic: A Key to America’s Opioid Exit Strategy or Chiropractic: A Safe and Cost-Effective Approach to Health for more information.