Nursing Bias Against Substance Abuse Patients

Circumstances Causing Ethical Conflict

1.

Sergio Cruz, SN

Colin Clark, SN

Kat Cristino, SN

Maggie Gray, SN

Megan Lyons, SN

“The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems”

Nursing Bias Against Substance Abuse Patients

(Fowler, 2010, p.1).

Ethical Decisions

and Rationales

Evaluation of Potential Options for Action

Ethical Decisions and Rationales

Routinely use outcome measurements so the patient is involved in reviewing the effectiveness of treatment

Engage in monitoring and evaluation of treatment adherence and practice competence, for example, by using video and audio tapes and external audit and scrutiny

(Alcohol-use disorders. Diagnosis, assessment and management of harmful drinking and alcohol dependence, 2011)

Nurses should...

• Consider the holistic needs of a client as integral to the success of a client's treatment.

ECG

Patients should not be denied or receive only partially effective treatment for pain because of a history of substance use.

Standard pain assessment and treatment protocols should be followed.

• Practice reflectively to maintain continued awareness of their current and evolving perceptions, attitudes and biases, values and beliefs when working with clients with addictions

• Have knowledge of the impact of the social determinants of health on addictions.

(Care of the hospitalized HIV-infected substance user, 2009)

(Supporting clients on methadone maintenance treatment, 2009)

• Healthcare professionals who care for people in acute alcohol withdrawal should be skilled in the assessment and monitoring of withdrawal symptoms and signs

"The ethical imperative is to provide the pain treatment with the best benefit-to-harm profile for the individual patient."

(VA/DoD clinical practice guideline for management of opioid therapy for chronic pain, 2010)

62

bpm

Negative Outcomes of Expressing Bias:

• People in acute alcohol withdrawal should be assessed immediately on admission to hospital by a healthcare professional skilled in the management of alcohol withdrawal.

• Targeting specific populations can make patients feel unworthy of care.

A major way to minimize nursing bias is to be self-aware and know your own biases:

• Nurse is not promoting, advocating, or providing towards the health, safety and rights of their patient.

(Alcohol-use disorders. Diagnosis and clinical management of alcohol-related physical complications, 2010)

• The nurse can:

• Hospitalized patients with addiction are sensitive to bias and can perceive a lack of staff respect; this leads to a fear that their needs will not be acknowledged.

• Remove self from the situation.

• Seek education on substance-abuse patients or the patient population in which they have a bias towards.

Thank You!

• Take time to reflect on why he/she is feeling the way they are about a certain population of patients.

• Personal experience
• Family member/friend who is a substance abuser

(Grant, Cordts, & Doberman, 2007, p.1-3 )

References

Ethical Decisions

and Rationales

When working with people who misuse alcohol:

• Build a trusting relationship and work in a supportive, empathic and non-judgmental manner.

• Take into account that stigma and discrimination are often associated with alcohol misuse and that minimizing the problem may be part of the service user's presentation.

• Make sure that discussions take place in settings in which confidentiality, privacy and dignity are respected.

• For all people who misuse alcohol, carry out a motivational intervention as part of the initial assessment.

(Alcohol-use disorders. Diagnosis, assessment and management of harmful drinking and alcohol dependence, 2011)

Motivational

Interviewing

Interventions should be delivered by appropriately trained and competent staff.

Helping to resolve ambivalence and encourage positive change and belief in the ability to change

Offer interventions to promote abstinence or moderate drinking as appropriate and prevent relapse in community-based settings.

Adopting a persuasive and supportive rather than an argumentative and confrontational position

Helping people to recognize problems or potential problems related to their drinking

(Alcohol-use disorders. Diagnosis, assessment and management of harmful drinking and alcohol dependence, 2011)

Circumstances Causing Ethical Conflict

3.

“The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient”

(Fowler, 2010, p.23).