National Healthcare Issue

Respond to your colleagues on two different days who chose a different national healthcare issue/stressor than you selected. Explain how their chosen national healthcare issue/stressor may also impact your work setting and what (if anything) is being done to address the national healthcare issue/stressor.

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Bertram
RE: Discussion – Week 1 Main Post
COLLAPSE
NURS 6053 Week 1 Main Post

National Healthcare Issue
One of the most significant issues challenging healthcare today is the national opioid crisis. This is a problem that affects all races, all socioeconomic classes, and all ages, from the unborn child to the dying elderly, and it continues to grow worse each year. According to Tsai et al. (2019), overdose from opioid use is a public health emergency as death rates tripled in numbers from 1999 to 2017. It is the leading cause of accidental death from injury, surpassing motor vehicle accidents (Gabbard et al., 2019). Opioid induced morbidity has played a significant role in the decline of overall life expectancy rates (Compton et al., 2021). Thus, the impact it has on our nations health and social outcomes is phenomenal.

Opioid Crisis Impact on Work Setting

For the last few years, I have worked for a hospice agency. The main goal of care in hospice is to increase the quality of life and provide comfort for terminally ill patients. Symptom management of pain is a primary concern for many of our patients, as eighty percent report pain at the end of life. This percentage increases as death becomes imminent. Although some patients do not require the use of opioids, it is the mainstay treatment to control pain in hospice patients (Gabbard et al., 2019). This can impact the work setting in multiple ways.

Many patients in our program already have, or have had, a substance use disorder (SUD). This can complicate their care by making it hard to get their pain managed due to tolerance and by adding stress on the patient that they will maintain compliance with the medication regimen. Sometimes the SUD does not exist with the patient, but with the caregiver or family that the patient lives with. Drug diversion is a daily problem case managers face in the hospice home setting.

Additionally, we encounter those patients and caregivers on the opposite end of the spectrum. These are the ones that are very much aware of the opioid crisis and are too afraid to take or administer the needed pain medication because they do not want addiction to become an issue. Caregivers that are close family members tend to have a harder time with this than the patients. Although they want what is best for their loved one, they are unsure if they are doing an unjust act by administering opioids. This is a form of stigma that can hinder quality care in hospice patients (Tsai et al., 2019).

Response from Work Setting

To respond to the challenges my organization faces with this crisis, we begin education with the patient and family at the beginning of their care. Upon admission, a medication management policy is discussed and signed by the patient or caregiver. Only a short supply of comfort medication is placed in the home- maximum of two weeks. Larger supplies might encourage problems with noncompliance. Medications are counted with each visit to ensure consistency with the medication policy. If issues of a SUD exist in the home, we provide a lock box and place a responsible party in charge of the medication administration. Yet, even with these measures in place, noncompliance happens. Many of our patients are on fentanyl patches to manage their pain, due to end of life dysphagia. If compliance is an issue in these homes, the nurse must visit the patient to personally deliver and change the patch, ensuring that the patient is getting the medication. Those with patient-controlled infusions in the homes have a device over the pump and bag that prevents manipulation- yet, I have still experienced the intravenous lines being tampered with. In our organization, we have a policy that addresses each episode of noncompliance and, if it persists, the patient is subject to being discharged from our service.

The opioid crisis issue can pose many challenges in hospice care. Yet we must find a way to treat terminally ill patients dealing with a SUD.

References

Compton, W., Valentino, R., & DoPont, R. (2021). Polysubstance use in the U.S. opioid crisis. Molecular Psychiatry, 26, 4150.

Gabbard, J., Jordan, A., Mitchell, J., Corbett, M., White, P., & Childers, J. (2019). Dying on hospice in the midst of an opioid crisis: what should we do now? American Journal of Hospice and Palliative Medicine, 36(4), 273281.

Tsai, A. C., Kiang, M. V., Barnett, M. L., Beletsky, L., Keyes, K. M., McGinty, E. E., Smith, L. R., Strathdee, S. A., Wakeman, S. E., & Venkataramani, A. S. (2019). Stigma as a fundamental hindrance to the united states opioid overdose crisis response. PLOS Medicine, 16(11), e1002969. https://doi.org/10.1371/journal.pmed.1002969

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