NUR342 Weekly Learning And Assignment Guide

Alcoholism is a type of alcohol abuse disorder in which a person engages in serious alcohol drinking resulting in mental and physical health problems for the individual. Some of the symptoms of this disorder includes persistent craving for alcohol, putting alcohol drinking above all responsibilities, experiencing blackouts after drinking and wasting huge amount of resource in drinking alcohol (Mendoza, 2018). It is the most common type of substance abuse witnessed globally and it is the reason for the occurrence of other issues like car crashes, domestic violence, crime and mental health conditions like depression. Drinking in such form lead to many health issues for people. Although alcohol withdrawal is regarded as one of the solution to address chronic drinking, however the issue is that alcohol withdrawal also lead to serious health problems. Some of the event that may accompany alcohol withdrawal includes developments of seizures, delirium, hallucination and mental confusion (Shu, Lin & Chang, 2015).

Importance to Nursing

The issue of alcohol withdrawal has been chosen as the clinical problem because many concerns has been raised regarding the effectiveness of treatment for alcohol withdrawal. Treatment of alcohol withdrawal is regarded as a challenging process because of the interplay of several other factors for the success of the therapy. Nurses also face challenges in managing such patients because of poor knowledge or preparedness to manage complexities in patients with alcohol withdrawal (Berl et al., 2015). Another issue that increases challenges for nurse is that alcohol withdrawal is a condition that has many complex presentations and morbidities. Hence, lack of knowledge related to proper assessment of patients with alcohol withdrawal can negatively influence patient outcome. Alcohol dependence is a problem that leads to 20% of hospital admissions and without knowledge of effective interventions to manage alcohol withdrawal, promoting recovery of affected patients would be difficult (Darling, 2015). Due to the above mentioned challenges, the topic of alcohol withdrawal has been chosen to identify or search for best interventions that can treat alcohol withdrawal and minimise challenges for nurse.

Personal Reflection

Reporting The issue of alcohol withdrawal is an important topic for me because of the high prevalence of alcohol abuse and the need to treat patients coming to hospitals for alcoholism related issues. The main issue in terms of nursing practice is poor outcomes found in patient undergoing treatment for alcohol withdrawal.  

Responding I wish to gain more knowledge related to management of alcohol withdrawal because I have personally witnessed the challenges faced by people when they do not received correct treatment in the right team. The research on the topic may help to provide the right treatment in the right time.

Relating I personally feel that as therapies for alcohol withdrawal have not worked for many individual, I think researching for barriers to success of therapy is essential. I also feel that client with alcohol withdrawal have complex symptoms and nurses must take the responsibility to obtain all information to identify patients at risk of withdrawal symptoms

Reasoning

My personal opinion is that challenges in treatment of alcohol withdrawal might have also emerged because treatment procedure focuses only on clinical aspects of care and not individual factors that would affect outcome of treatment. For example, motivation and willingness to quit alcohol might play a direct role in the success of the therapy.

Reconstructing Hence, as the background research on the topic shows that nurse have poor education or knowledge to correctly assess and identify patients at risk of alcohol withdrawal, the plan is to look for research evidence to find best interventions that has worked for people with alcohol withdrawal problem.

Assessment 2b

The main problem is the failure of therapies in treating alcohol withdrawal. Research has shown that many patients experience persistent changes in mood and behaviour during withdrawal thus encouraging patients to relapse to heavy drinking. Hence, poor adherence to therapy is one major issue while caring for patients with alcohol related problem. To resolve the issue, the main aim of the paper is identify best interventions that can improve treatment outcomes while caring for patients with alcohol withdrawal problem.

PICo (Qualitative)

Population Patients with alcohol withdrawal problem

Phenomenon of Interest Poor treatment outcomes

Context Alcohol abuse

Research Question

Which interventions helped to address treatment challenges while treating alcohol withdrawal in patients with alcohol abuse?

Search Strategy

To search for relevant articles related to interventions for treating alcohol withdrawal, health science and nursing databases such as CINAHL and MedLine was used. The key search terms used to extract relevant research articles included treatment/interventions, patients with alcohol withdrawal symptoms/ people with alcohol withdrawal and treatment adherence/poor adherence/adherence issues. The criteria used for searching articles was to take recently published research literature published between 2009 to 2018 and take only those articles which has patients with alcohol abuse as the sample population. Both primary and secondary research designs were used to complete the search process. The search was first done by reviewing title and abstract and then reviewing full text as per inclusion criteria.

Best Evidence

Best Practice Level of Evidence Study Design In-text Citation in CDU APA 6th Format

To treat severe alcohol withdrawal syndrome by providing adjunctive drug phenobarbital Level 2 Retrospective cohort study design done in patients with a diagnosis of alcohol withdrawal. Gashlin et al. (2015)

To provide nursing education on community hospital’s alcohol withdrawal protocol. Level 2 Retrospective study design Barrett et al. (2016)

Use of dexmedetomidine to treat alcohol withdrawal Level 2 Retrospective case series Frazee et al. (2014)

Findings

Three best practice evidences were found to deal with challenges in treatment patients with alcohol withdrawal symptoms. The study by Gashlin et al. (2015) aimed to investigate about the efficacy of Phenobarbital, a long acting barbiturate for the treatment of alcohol withdrawal compared to treatment with Benzodiazepines. As Benzodiazepines lead to delirium and over-sedation in patient, the study identified bendodiazepines as a safe and effective alternative for the treatment of patients with alcohol withdrawal. However, retrospective study design is one major limitation of the study as it can affect the reliability of the data because of selection bias. Another pharmacological intervention that is found to give promising results include the use of dexmedetomidine as it has been found to be a good alternative in place of benzodiazepines. It is a highly selective alpha alpha adrenergic agonist and it has rapid onset and short duration. It reduces the likelihood of respiratory depression (Frazee et al., 2014). Hence, the drug can be introduced earlier in the treatment for patients with alcohol withdrawal syndrome.

In contrast to the study by Gashlin et al. (2015), the evidence by Barrett et al. (2016) revealed nursing education as an effective practice to improve compliance with treatment. The main advantage of this intervention was that it helped to address challenges experienced while providing treatment such as seizures, delirium and even death. This evidence is considered as a best practice evidence because the research design has two stages. The first part focussed on initial needs assessment and the second part focussed on providing education to nurses. This two process helps to identify knowledge gap of nurses and identify the education needs of nurse. The evidence revealed that nursing education improves compliance to 1-hour assessment for patients with withdrawal syndrome. Hence, the evidence can be used to improve nursing proficiency in complying with hospital protocol related to withdrawal management.

References

Barrett, J., Jansen, M., Cooper, A., Felbinger, M., & Waters, F. (2016). Embracing a nurse-driven alcohol withdrawal protocol through quality improvement. Journal of addictions nursing, 27(4), 234-240. DOI: 10.1097/JAN.0000000000000142

Berl, K., Collins, M. L., Melson, J., Mooney, R., Muffley, C., & Wright-Glover, A. (2015). Improving Nursing Knowledge of Alcohol Withdrawal: Second Generation Education Strategies. Journal for Nurses in Professional Development, 31(6), 328–332. https://doi.org/10.1097/NND.0000000000000176

Berl, K., Collins, M.L., Melson, J., Mooney, R., Muffley, C. and Wright-Glover, A., 2015. Improving Nursing Knowledge of Alcohol Withdrawal: Second Generation Education Strategies. Journal for nurses in professional development, 31(6), p.328. doi:  10.1097/NND.0000000000000176

Darling, L. (2015). Managing Hospitalized Adults with Alcohol Dependence. Retrieved from: https://digitalcommons.ric.edu/cgi/viewcontent.cgi?article=1114&context=etd

Frazee, E. N., Personett, H. A., Leung, J. G., Nelson, S., Dierkhising, R. A., & Bauer, P. R. (2014). Influence of dexmedetomidine therapy on the management of severe alcohol withdrawal syndrome in critically ill patients. Journal of critical care, 29(2), 298-302. Doi https://dx.doi.org/10.1016/j.jcrc.2013.11.016

Gashlin, L. Z., Groth, C. M., Wiegand, T. J., & Ashley, E. D. (2015). Comparison of alcohol withdrawal outcomes in patients treated with benzodiazepines alone versus adjunctive phenobarbital: a retrospective cohort study. Asia Pacific Journal of Medical Toxicology, 4(1), 31-36. Retrieved from: https://eprints.mums.ac.ir/7875/1/APJMT_Volume%204_Issue%201_Pages%2031-36.pdf

Mendoza, R. L. (2018). Is medical treatment of Alcohol Withdrawal Syndrome a Stag Hunt? Challenges and opportunities in managing risk and uncertainty in addiction cessation. Risk Management and Healthcare Policy, 11, 1–14. https://doi.org/10.2147/RMHP.S144831

Shu, J. E., Lin, A., & Chang, G. (2015). Alcohol withdrawal treatment in the medically hospitalized patient: a pilot study assessing predictors for medical or psychiatric complications. Psychosomatics, 56(5), 547-555. https://doi.org/10.1016/j.psym.2014.12.002