Transcript presentation-01-principles communication

1: Principles and
Communication
Prepared by J. Mabbutt & C. Maynard
NaMO
September 2008
1: Principles & Communication:
Objectives

During the session the key principles of communication in the drug and
alcohol field will be outlined, with a focus on special population groups

A brief description of the important issues of poly drug use & harm
minimisation will also be covered

By the end of the session, nurses and midwives will have a better
understanding of the background and policy directive relating to these
guidelines

By the end of the session, nurses and midwives will have a better
understanding and sensitivity of these key issues and the needs of
special population groups
1: Prevalence

Drug and alcohol use is common and affects individuals, families and
communities in all sections of society

23,313 deaths in 1998 in Australia were attributed to drug use (National
Drug Strategy Household Survey, 1999). Of these:
– 19,019 deaths were associated with tobacco use
– 3271 deaths related to alcohol use with alcohol being the main cause
of deaths on Australian roads
– 1023 deaths resulted from illicit drug use

Estimated annual health and economic cost is $34.4 billion
1: Prevalence

Over 260,000 hospital separations between 1996-97 were attributable
to drug and alcohol use

40% of ED presentations and 30% of hospital admissions are attributable
to alcohol use

50% of D&A consultation and liaison activity is attributable to alcohol
(Connigrave et al 1991)

Less than one third of nurses identify alcohol disorders (Foy and Kay)
1: Policy Directive 1
NSW Health Policy, 2007 – “Nursing and Midwifery Management of
Drug and Alcohol Issues in the Delivery of Health Care” states minimum
standards of practice
Role of managers to:
– adopt nursing and midwifery management of D&A issues within their
unit(s) as a high priority
– ensure awareness and implementation of Guidelines
– ensure adequate levels of education
– monitor delivery and quality of management & education of D&A issues
1: Policy Directive 2
Roles of nurses and midwives include:
– awareness, understanding and implementation of the guidelines,
policies and protocols
– routine D&A assessment and recognition of management issues
from assessment information
– knowledge of effects of D&A dependence & psychosocial impacts
– recognition of intoxication, overdose, withdrawal and implementation
of initial management strategies
– provision of relevant patient education and specialist referral
– participation in professional development on D&A issues
1: Principles and Communication (1)

Focus on giving an equal regard to the physical, psychosocial and
cultural wellbeing of all patients: including comprehensive assessment,
interventions and harm reduction strategies for those at risk

All episodes of care offer a critical moment for intervention: includes
offering information, providing education & assessment for interventions

Access to comprehensive health care is every individual’s right
1: Principles and Communication (2)

A client-centered approach is needed to effectively care for patients
with D&A problems and when appropriate family and significant others
should be involved

Health professionals & services have a responsibility to effectively
manage and support each person presenting with substance related
problem
1: Polydrug use

Increasing use of more than one drug over the last couple of decades
– Use of just one drug is becoming rarer
– Medication, over the counter drugs, naturopathic, homeopathic,
legal and illicit drugs could potentially interact

Poly drug use should be considered when assessing someone’s
substance use
1: Principles and communication
Harm minimisation

Seeks to reduce the harms associated with drug and alcohol use to the
individual and the community

Abstinence is one of a range of strategies and not the only goal

Public health approach

Offers patients a range of treatment options aimed at minimising harm
1: Harm minimisation strategies
beneficial

Providing clean injecting equipment – disposal units, needles, syringes, swabs

Providing access to drug and alcohol withdrawal services & rehabilitation services

Introducing legislative measures – restricting tobacco advertising

Health promotion campaigns – preventing young people taking up smoking,
risks of drink spiking in pubs and clubs, promoting light beer

Methadone (opioids), Acamprosate (alcohol) and NRT (nicotine)
1: Principle and Communication

Effective, clear, non-judgmental communication assists in building
rapport & developing a sense of trust

This is the key to undertaking a quality assessment, understanding the
person’s major issues, & managing drug & alcohol-related problems

Primary service providers, nurses & midwives often provide the link
between the person, other members of the multidisciplinary team, the
person’s family, & other service providers
1: General Principles Communication (1)

Drug & alcohol use is a health issue not a moral issue

A person’s substance use history should be taken as part of the routine
clinical assessment

Confidentiality from family members and/or significant others should be
considered

Cultural & linguistic diversity can make communication difficult,
so consider the assistance of culturally appropriate interpreters
(including Aboriginal interpreters)
1: General Principles Communication (2)

Be clear and straightforward about who you are, your role, what your are
asking about and why

Attend to the person’s immediate concerns before addressing sensitive
issues that may be unimportant to the person

Build rapport and a sense of trust by listening to what the person wants,
why they may be worried, and what they believe will help them

Show your concern about the person’s drug & alcohol use problems
without prejudice
1: Improving cross-cultural
communication

Different cultural groups may misinterpret your requests for information
or have different expectation of the service

Responding requires flexibility in approach and creativity that services
are appropriate for the person and family

Complying with rigid guidelines maybe inappropriate

This flexibility will foster rapport and a greater willingness for the person
to participate and cooperate
1: Improving cross-cultural
communication: some suggestions (1)

Always use approved interpreter services

Always follow the guidelines for how to use interpreter services

Allow sufficient time to interpret the situation from the person’s
and their family’s cultural perspective

Provide ongoing evaluation of assessment and care
1: Improving cross-cultural
communication: some suggestions (2)

Be clear, concrete and specific

Respond with respect, immediacy and timeliness

Be sensitive to embarrassment

Examine your own expectations
1: Co-existing mental health disorders
and substance misuse (1)

People with a mental illness are at an increased risk of developing
problematic drug or alcohol use

30 to 80% of patients in mental health settings have drug use issues

More than 50% of people who use substances have experienced
psychiatric symptoms

The prevalence of people with co-existing mental health and drug use
problems may be increasing
1: Co-existing mental health disorders
and substance misuse (2)

These co-existing disorders are associated with:
– increased symptoms and suicide behaviours
– greater non compliance with treatment
– more hostile and aggressive behaviours
– increased risk of violence to others
– higher rates of offending, imprisonment and homelessness
– longer psychiatric admissions
1: Aboriginal and Torres Strait
Islander people and communities (1)

The use of substances is affected by the environment, access, their history,
social situations and personal choice

More Aboriginal and Torres Strait Islanders abstain from drinking

Of those who consume alcohol, 48.7% of Aboriginal and Torres Strait Islanders are
at risk of long term alcohol related harm vs 9.7% non-Indigenous

25% of Aboriginal people over 15 reported having recently used an illicit
substance

Nursing staff need to be respectful, sensitive and flexible as with any patients

A thorough non-judgmental assessment is still the key
1: Aboriginal and Torres Strait
Islander people and communities (2)
Specific factors/hints for communication are: DO

Be polite, respectful, and treat the person as equal to yourself

Enlist the help of your health facility’s Aboriginal and Torres Strait Islander
health liaison worker

Be very careful about non-verbal signals – use a friendly tone of voice, smile;
take some time to show your interest in the patient and their family or other
visitors
1: Aboriginal and Torres Strait
Islander people and communities (3)
Specific factors/hints for communication are: DO

Ensure privacy when talking about substance issues

Be aware that separation from family can be very frightening for
Aboriginal and Torres Strait Islander people

Try to accommodate the patient’s wishes for a relative or other
trusted person to be with them if they wish for it
1: Aboriginal and Torres Strait
Islander people and communities (4)
Specific factors/hints for communication are: DON’T

Don’t assume anything. Do not base your responses to a patient on any
assumptions about their illness, their Aboriginality or their behaviour.

Don’t use stereotypes. Relying on stereotypes (e.g. ‘Aborigines all have
drinking problems’) is not only offensive but dangerous – it can lead to
other health problems being ignored or misdiagnosed
1: Aboriginal and Torres Strait
Islander people and communities (5)
Specific factors/hints for communication are: DON’T

Don’t be pushy or confrontational when giving health advice

Don’t give the impression that you are too busy to talk to the patient properly

Aboriginal and Torres Strait Islander people often say they wish professionals
would get to know them a little: “I wanted to ask questions of the doctors and
I was frightened… You walk in and they say ‘What’s wrong with you?’ instead
of talking to you.” (Eckerman et al, 1995)
1: Sexual and gender diverse groups

National and international research into Lesbian Gay Bisexual & Transgender
(LGBT) health highlights a strong relationship between homophobia,
heterosexism, social exclusion & the health status of individuals

The percentages of same-sex attracted young people injecting drugs dropped
from 11% in 1998 to 4% in 2004

Nevertheless, drug use still remains substantially higher than for heterosexual
young people, for example, double the number of same-sex attracted young
people have injected drugs
1: Ageing population

The Australian community is increasing in age therefore recognition
of their needs is necessary

Drug and alcohol use in this population need more support as their age
and effects of the use make them less able to cope in the community

Studies showed that 72% of men and 54% of women over 75 drank
alcohol – 11% of men and 6% female drank at harmful levels

50% of the adult indigenous population are current daily smokers (2004)
1: People from diverse cultural
and linguistic backgrounds

Drug use can have different meanings with a range a diversity in patterns
of use in different cultural groups

For example, Europeans are more likely to use alcohol and cannabis than
those from Asian or Arabic backgrounds

People from cultural and linguistically diverse backgrounds were less likely
to drink alcohol, in the last week, 44.5%, compared to 56.5% in the wider
community
1: Rural communities

Rural NSW has higher rate of harmful drinking in males, in 14-19 yr olds
and a higher rate of road fatalities

Rural and remote populations face specific challenges in providing
comprehensive health care

Challenges include distance, travelling times, availability of clinicians,
the dispersal of the population

These factor effect the delivery of integrated Drug and Alcohol services

Telecommunications and the use of technologies can have a special
role in the delivery of services to these populations
1: Children in development stages (1)

Alcohol consumed by mothers can seriously affect the health and
development of their unborn child

Some babies will be born with foetal alcohol spectrum disorder (FASD)
and may be/have:
– Be small at birth
– Developmental disabilities
– Behavioural and learning problems
– Abnormalities in the appearance and shape of the face
– Eye problems and heart problems
1: Children in development stages (2)

FASD is more prevalent in Aboriginal & Torres Strait Islander than
non-Indigenous infants

For further information, refer to the National clinical guidelines for
the management of drug use during pregnancy, birth and the early
development years of the newborn. (March 2006)
http://www.health.nsw.gov.au/pubs/2006/ncg_druguse.html

NSW Health Neonatal Abstinence Syndrome (NAS) Guidelines, 2005
focus on care of opioid dependant women and care of the newborn from
a child protection perspective
http://www.health.nsw.gov.au/policies/pd/2005/PD2005_494.html
1: Young people with emerging
problems

Many young people do not use drugs and alcohol at dangerously high levels,
but there are harms associated with all levels of misuse

Some young people will develop chronic patterns of drug use and engage in
frequent harmful binge use

Recent tobacco and cannabis use has almost halved in the last 20 years

In 2002, 69% of NSW secondary school students reported drinking in the last
year and 45% reported in the last 4 weeks

40% of 16 to 17 year olds binge drink at least occasionally