Alcohol our favourite drug the big picture can nurses and midwives make a difference
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Alcohol Our Favourite Drug: The big picture: can nurses and midwives make a difference?. Prof. Jim Rankin Ist International Alcohol, Tobacco and Other Drugs Nursing & Midwifery Conference Adelaide, April 16, 2003. Advances in Knowledge and Understanding: Alcohol - Before 1960.

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Alcohol our favourite drug the big picture can nurses and midwives make a difference

Alcohol Our Favourite Drug:The big picture: can nurses and midwives make a difference?

Prof. Jim Rankin

Ist International Alcohol, Tobacco and Other Drugs Nursing & Midwifery Conference

Adelaide, April 16, 2003


Advances in knowledge and understanding alcohol before 1960

Advances in Knowledge and Understanding: Alcohol - Before 1960

  • Alcoholism a moral problem or a manifestation of mental illness

  • Alcoholism a disease - Alcoholics Anonymous


The scene 1964 treatment services

The Scene 1964: Treatment Services

  • Completely inadequate

  • Psychiatric hospitals

  • Residential

  • Custodial care

  • Inmates:

    • Inebriates’ Act

    • Psychiatric complications

    • Temporary accommodation & support


Sister mary christina wellsford rsc

Sister Mary Christina Wellsford, RSC


Advances in knowledge and understanding of alcohol problems

Advances in knowledge and understanding of alcohol problems

  • A spectrum of drinking behaviours that may cause problems

  • A spectrum of alcohol-related problems

  • A spectrum of responses involving health promotion, prevention and intervention/treatment


Broadening the base of treatment

Broadening the base of treatment:

  • Establishment of services in general hospitals

  • Shift of resources from psychiatric hospitals to community-based services

  • Shift of resources to provide a balance of residential and non-residential services

  • Initiatives to increase the involvement of general practitioners


Responding to alcohol problems in australia potential resources

Responding to alcohol problems in Australia: potential resources

  • Medical practitioners 70,000 (est)

  • Addiction medicine specialists

    • Certified 140

    • Certification pending 60

  • Registered nurses 250,000 (est)

    • Registered midwives 67,000 (est)

  • Members of DANA200+

  • Number of D & A services 2000 (est)


Alcohol our favourite drug the big picture can nurses and midwives make a difference

VISION


The role of nursing and midwifery

The role of nursing and midwifery


A whole of profession responsibility

A whole of profession responsibility

Practitioners

  • Clinical nurses

  • Nurse educators/academics

  • Nurse managers

  • Nurse researchers

    Organisations

  • Registration bodies

  • General professional organisations

  • Academic organisations

  • Alcohol and drug


A vision of nursing and midwifery

A Vision of Nursing and Midwifery

Professions that play active roles in the development and implementation of comprehensive alcohol policies and programs for prevention and treatment


A vision of nursing and midwifery prevention and health promotion

A Vision of Nursing and Midwifery: Prevention and Health Promotion

Professions whose members incorporate into their professional activities strategies and practices that have as their objectives maintenance of abstinence and safe patterns of alcohol use, and reductions in hazardous and harmful use.


A vision of nursing and midwifery clinical care

A Vision of Nursing and Midwifery:Clinical Care

Professions whose members play a complementary role to these preventive strategies by

  • identifying and intervening with their patients whose are at risk because of their alcohol use; and

  • Identifying and responding to the health needs of their patients who already have alcohol-related damage


Topics

Topics

  • Drinking patterns in Australia and their consequences

  • Effects of alcohol on health

  • Prevention, intervention and treatment

  • Potential roles of nursing and midwifery

  • Systems’ impediments to progress


Drinking patterns in australia

Drinking Patterns in Australia

Population aged 14+ years%

  • Drinkers811

  • Hazardous/harmful drinkers 351

  • Hazardous/harmful drinkers142

    Population aged 14-19 years

  • Drinkers641

  • Hazardous/harmful drinkers671

    Aboriginal & Torres Strait Islander Peoples

  • Drinkers621

  • Hazardous/harmful drinkers821

    1 = Last 12 months

    2 = Last week


Alcohol attributable deaths and hospital bed days 1998 9

Deaths

Caused4,286

Prevented(7029)1

Total(2,744)

Note 1. 94% aged 60+ years

Hospital beddays

Caused394,417

Prevented2(255,433)

Total138,974

Note 2. 79.7% aged 60+ years

Alcohol-attributable deaths and hospital bed days, 1998-9


Potential benefits of policies designed to prevent alcohol misuse

Potential benefits of policies designed to prevent alcohol misuse

Preventable deaths4,286

Preventable hospital beddays 394,417


Social costs of drug abuse 1998 9

Social costs of drug abuse, 1998-9

$m %

Alcohol7,560.3122.0

Tobacco21,063.061.2

Illicit drugs6,075.817.6

Total34,439.8100.0

Avoidable costs of alcohol misuse $3,928.6m (62.1%)

Note 1. Costs of alcohol misuse 1.98% of GDP


Effects of alcohol on health

Effects of alcohol on health


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Factors in Acute Alcohol-related Damage

Acutealcohol consumption


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Factors in Acute Alcohol-related Damage

Acutealcohol consumption

  • CNS depression:

  • Impairment of

  • Motor function

  • Coordination

  • Judgment

  • Respiration

  • Consciousness


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Factors in Acute Alcohol-related Damage

Acutealcohol consumption

  • CNS depression:

  • Impairment of

  • Motor function

  • Coordination

  • Judgment

  • Respiration

  • Consciousness

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Factors in Acute Alcohol-related Damage

Trauma

Acutealcohol consumption

  • CNS depression:

  • Impairment of

  • Motor function

  • Coordination

  • Judgment

  • Respiration

  • Consciousness

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment

General Environment


Trauma

Trauma

  • Fall injuries

  • Road injuries

  • Occupational and machine injuries

  • Fire injuries

  • Drowning

  • Assaults

  • Suicide


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Factors in Acute Alcohol-related Damage

Acutealcohol consumption

  • CNS depression:

  • Impairment of

  • Motor function

  • Coordination

  • Judgment

  • Respiration

  • Consciousness

Overdose/poisoning

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment

General Environment


Overdose poisoning

Overdose/Poisoning

  • Acute ethanol overdose and poisoning

  • Aspiration

  • Combined alcohol and drug overdose and poisoning

  • Methanol poisoning


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Factors in Acute Alcohol-related Damage

Acutealcohol consumption

  • CNS depression:

  • Impairment of

  • Motor function

  • Coordination

  • Judgment

  • Respiration

  • Consciousness

Obstructivesleep apnoea

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Factors in Acute Alcohol-related Damage

Acutealcohol consumption

  • CNS depression:

  • Impairment of

  • Motor function

  • Coordination

  • Judgment

  • Respiration

  • Consciousness

Pregnancy

Sexual assaultChild Abuse

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Factors in Acute Alcohol-related Damage

Supportive HOME ENVIRONMENT Non-supportive

Privileged SOCIAL CLASS Under-privileged

Affluence INCOME Poverty

Very good COMMUNITY SERVICES Absent

Very good HEALTH SERVICES Absent

General Environment


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Factors in Acute Alcohol-related Damage

Trauma

Acutealcohol consumption

  • CNS depression:

  • Impairment of

  • Motor function

  • Coordination

  • Judgment

  • Respiration

  • Consciousness

Overdose/poisoning

Obstructivesleep apnoea

Pregnancy

Sexual assaultChild Abuse

Motor vehicles

Workplace

Hotels & bars

Other social venues

Sporting activities

Associated drug use

Drinking Circumstances and Environment

General Environment


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Effects of Long-term Alcohol Consumption

Long-termalcohol consumption


Relationship between alcohol consumption and cirrhosis mortality ontario 1928 1972

Relationship between alcohol consumption and cirrhosis mortality, Ontario 1928-1972


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Effects of Long-term Alcohol Consumption

Long-term

alcohol consumption

Alcohol a necessary cause of diseases


Alcohol a necessary cause of disease

Alcohol a Necessary Cause of Disease

Behavioural and Neurological

  • Alcohol dependence

  • Acute alcohol withdrawal

  • Delirium tremens

  • Acute alcoholic hallucinosis

  • Alcoholic polyneuropathy

  • Alcoholic cerebellar atrophy

  • Neuro-psychological impairment

  • Wernicke-Korsakoff syndrome


Alcohol a necessary cause of disease1

Other diseases:

Alcoholic gastritis

Alcoholic hepatitis

Alcoholic cirrhosis

Alcoholic cardiomyopathy

Foetal alcohol effects

Foetal alcohol syndrome

Alcohol a Necessary Cause of Disease


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Effects of Long-term Alcohol Consumption

Long-termalcohol consumption

Alcohol a contributing cause of disease


Alcohol a contributing cause of disease

Alcohol a Contributing Cause of Disease

Cancer

  • Oropharyngeal

  • Oesophageal

  • Laryngeal

  • Liver

  • Female breast


Alcohol a contributing cause of disease1

Alcohol a Contributing Cause of Disease

Gastro-intestinal and hepatic

  • Oesophageal varices

  • Gastro-oesophageal haemorrhage

  • Unspecified cirrhosis

  • Haemochromatosis

  • Acute pancreatitis

  • chronic pancreatitis


Alcohol a contributing cause of disease2

Alcohol a Contributing Cause of Disease

Other diseases:

  • Epilepsy

  • Hypertension (males)

  • Ischaemic stroke (males)

  • Haemorrhagic stroke (males)

  • Psoriasis

  • Depression, attempted suicide and suicide

  • Spontaneous abortion


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Effects of Long-term Alcohol Consumption

Long-termalcohol consumption

Alcohol a contributory factor to disease outcome


Alcohol a contributory factor to disease outcome

Alcohol a Contributory Factor to Disease Outcome

  • Hepatitis C

  • Pulmonary infection

  • Post-operative complications


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Effects of Long-term Alcohol Consumption

Long-termalcohol consumption

Alcohol a protector

from diseases


Alcohol a protector from disease

Alcohol a Protector from Disease

  • Ischaemic heart disease

  • Hypertension (females)

  • Supra-ventricular cardiac dysrhythmias

  • Hear failure

  • Ischaemic stroke (females)

  • Haemorrhagic stroke (females)

  • Cholelithiasis


Alcohol our favourite drug the big picture can nurses and midwives make a difference

Effects of Long-term Alcohol Consumption

Long-termalcohol consumption

Alcohol a necessary cause of diseases

Alcohol a contributory cause of diseases

Alcohol a contributory factor to disease outcome

Alcohol a protector

from diseases

General Environment


Prevention treatment of alcohol related problems a spectrum of problems and responses

Prevention & Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

The goal: Harm minimization


Advances in disease prevention health promotion

Advances in disease prevention & health promotion

  • Drinking Guidelines

  • Low alcohol content beers

  • Labelling of alcoholic beverage containers with the number of drinks

  • Drink-driving counter measures

    ▬ Random breath testing

    ▬ Zero blood alcohol levels for probationary drivers


Advances in disease prevention health promotion1

Advances in disease prevention & health promotion

  • Thiamine supplementation of flour

  • Indexation of alcohol taxes

  • Initiatives to reduce alcohol-related harm in and near licensed premises


Advances in clinical management

Advances in clinical management

  • Screening instruments (AUDIT)

  • Assessment instruments

  • Effective behavioural interventions

    • Motivational interviewing

    • Cognitive behavioural restructuring

    • Brief interventions

  • Pharmacotherapies:

    • Naltrexone

    • Acamprosate

  • Management of alcohol-related physical diseases


  • Changes in alcohol problems

    Changes in alcohol problems

    • Between 1988 and 1998 per capita consumption as fallen from 9.4 to 7.5 litres

    • Australia has fallen from 12th to 19th place internationally in per capita consumption

    • These declines associated with falls in:

      • Incidence of alcohol-related road injury and deaths

      • Total alcohol-caused mortality

      • Deaths where alcohol is the sole cause

      • Deaths where alcohol is a contributing cause


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

    Alcohol Use

    Safe

    Primary prevention

    Nil


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

    Case finding &early intervention

    Hazardous

    Alcohol Use


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

    Harmful

    Treatment

    Alcohol Use


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

    Alcohol-relatedproblems

    Alcohol Use

    Primary prevention


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

    Alcohol-relatedproblems

    Case finding &early intervention

    Alcohol Use


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

    Alcohol-relatedproblems

    Treatment

    Alcohol Use


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    Prevention and Treatment of Alcohol-related Problems:A Spectrum of Problems and Responses

    Alcohol-relatedproblems

    Harmful

    Treatment

    Case finding &early intervention

    Hazardous

    Alcohol Use

    Safe

    Primary prevention

    Nil


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    General Nurses


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    General Nurses

    Safe Drinking Practices


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    General Nurses

    Safe Drinking Practices

    Drinking History


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    General Nurses

    Safe Drinking Practices

    Drinking History

    Screening (AUDIT)


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    General Nurses

    Safe Drinking Practices

    Drinking History

    Screening (AUDIT)

    Brief intervention


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    General Nurses

    Safe Drinking Practices

    Drinking History

    Screening (AUDIT)

    Brief intervention

    Specialist referral


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    General Nurses

    Safe Drinking Practices

    Drinking History

    Screening (AUDIT)

    Brief intervention

    Specialist referral

    Treatment of withdrawal


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    SpecialtyNursing andClinical NurseSpecialists

    Public health

    Community health

    Mental health

    Emergency

    Critical care

    Gastroenterology

    Hepatology

    Neurology

    Midwifery

    Paediatrics


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    SpecialtyNursing andClinical NurseSpecialists

    Public health

    Community health

    Mental health

    Emergency

    Critical care

    Gastroenterology

    Hepatology

    Neurology

    Midwifery

    Paediatrics

    Consultation & support


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    SpecialtyNursing andClinical NurseSpecialists

    Public health

    Community health

    Mental health

    Emergency

    Critical care

    Gastroenterology

    Hepatology

    Neurology

    Midwifery

    Paediatrics

    Consultation & support

    Specialistassessment


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    SpecialtyNursing andClinical NurseSpecialists

    Public health

    Community health

    Mental health

    Emergency

    Critical care

    Gastroenterology

    Hepatology

    Neurology

    Midwifery

    Paediatrics

    Consultation & support

    Specialistassessment

    Management ofspecialty problems


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    SpecialtyNursing andClinical NurseSpecialists

    Public health

    Community health

    Mental health

    Emergency

    Critical care

    Gastroenterology

    Hepatology

    Neurology

    Midwifery

    Paediatrics

    Consultation & support

    Specialistassessment

    Management ofmedical problems

    Follow-up


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    D and A Nursing and Clinical Nurse Specialists

    General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    D and A Nursing and Clinical Nurse Specialists

    General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

    Consultation & support


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    D and A Nursing and Clinical Nurse Specialists

    General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

    Consultation & support

    Specialistassessment


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    D and A Nursing and Clinical Nurse Specialists

    General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

    Consultation & support

    Specialistassessment

    Management ofalcohol problems


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    D and A Nursing and Clinical Nurse Specialists

    General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

    Consultation & support

    Specialistassessment

    Management ofalcohol problems

    Follow-up


    Alcohol our favourite drug the big picture can nurses and midwives make a difference

    The Role of Nursing: Clinical Practice

    General Nurses

    SpecialtyNursing andClinical NurseSpecialists

    D and A Nursing and Clinical Nurse Specialists

    Safe Drinking Practices

    Drinking History

    Consultation & support

    Consultation & support

    Screening (AUDIT)

    Specialistassessment

    Specialistassessment

    Brief intervention

    Management ofmedical problems

    Management ofalcohol problems

    Specialist referral

    Follow-up

    Treatment of withdrawal

    Follow-up


    A special need services for impaired nurses

    A special need: services for impaired nurses


    Progress in australia

    Progress in Australia

    • Services in general hospitals1964

    • Appointment of assistant directors of nursing (D and A) in NSW1982

    • Establishment of clinical nurse specialists and consultants in some states

    • Establishment of DANA1986

    • NSW Nursing Project

    • Academic appointments

    • Establishment of academic programs

    • Availability of educational resources


    Systems impediments to progress

    Systems impediments to progress

    • Increasing and competing demands on nurses and nursing services

    • Deceasing availability of nurses

    • Silo organizational structures

    • Fragmentation of patient care

    • Shift of Federal government support away the concept of universal health care

    • Inadequate funding of public hospitals

    • Increasing numbers of for-profit private hospitals


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