Coffee Zhanette, Speight Chandra, Reyes-Walsh Lisa, Foreman Jennifer, Davis-Dick Lorrie, Vanderah Todd W, Gordon Judith S
College of Nursing, University of Arizona, Tucson, Arizona, USA.
Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, Arizona, USA.
J Adv Nurs. 2024 Dec 22;81(6):3405-13. doi: 10.1111/jan.16694.
We offer a literature-driven, empirically informed, and highly warranted recommendation for a multilevel approach tailored to nurse practitioners. This approach aimed to drive change at the individual level (nurse practitioner), dyadic level (nurse-patient therapeutic relationship), and systems level (organisational culture, education, and policy) to strengthen nurse practitioners' capacity to deliver optimal opioid use disorder care.
The opioid overdose epidemic is a global public health crisis, with the United States facing the most severe impact. Access to evidence-based treatment for opioid use disorder remains a significant barrier. Primary care nurse practitioners can play a crucial role in expanding access and bridging the treatment gap. Addressing factors influencing access to, quality of, and effectiveness of treatment requires urgent and careful consideration.
This position paper highlights the multilevel barriers that inhibit nurse practitioners in managing opioid use disorder, negatively impacting treatment access and opioid use disorder-related outcomes.
The Advanced Practice Provider conceptual model was adapted to guide this paper. This adapted model illustrates the interconnected layers among nurse practitioners, clinical care, education, professional development, and organisational culture and policy in caring for patients with opioid use disorder.
Equipping primary care nurse practitioners with the necessary tools to both understand opioid addiction and empower patients experiencing it can have a profound impact. This impact benefits the provider and patient and extends to addressing the opioid crisis at multiple levels. Future research should explore nurse practitioners' experiences when working with individuals with opioid use disorder, identify barriers that hinder positive interactions with patients seeking treatment, and pragmatically test and implement multilevel interventions designed to holistically benefit providers and patient outcomes.
This American-based reflection offers valuable insights to nurse practitioners worldwide as they consider effective strategies for addressing opioid use disorder in primary care settings.
我们基于文献,以实证为依据,提出一项经过充分论证的建议,即针对执业护士采用多层次方法。该方法旨在推动个体层面(执业护士)、二元层面(护患治疗关系)和系统层面(组织文化、教育和政策)的变革,以增强执业护士提供最佳阿片类物质使用障碍护理的能力。
阿片类药物过量流行是一场全球公共卫生危机,美国受到的影响最为严重。获得基于证据的阿片类物质使用障碍治疗仍然是一个重大障碍。初级保健执业护士在扩大治疗可及性和弥合治疗差距方面可以发挥关键作用。解决影响治疗可及性、质量和有效性的因素需要紧急且审慎的考虑。
本立场文件强调了阻碍执业护士管理阿片类物质使用障碍的多层次障碍,这些障碍对治疗可及性和与阿片类物质使用障碍相关的结果产生了负面影响。
采用高级实践提供者概念模型来指导本文。这个经过调整的模型阐述了执业护士、临床护理、教育、专业发展以及组织文化和政策在护理阿片类物质使用障碍患者方面的相互关联层次。
为初级保健执业护士提供必要的工具,使其既能理解阿片类药物成瘾,又能增强正在经历成瘾的患者的能力,可能会产生深远影响。这种影响有利于提供者和患者,并延伸至在多个层面应对阿片类药物危机。未来的研究应探索执业护士在与阿片类物质使用障碍患者合作时的经历,识别阻碍与寻求治疗的患者进行积极互动的障碍,并切实测试和实施旨在全面改善提供者和患者结局的多层次干预措施。
这种基于美国的思考为全球执业护士提供了宝贵的见解,有助于他们思考在初级保健环境中应对阿片类物质使用障碍的有效策略。