Alcohol our favourite drug the big picture can nurses and midwives make a difference
Download
1 / 78

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


  • 108 Views
  • Uploaded on

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.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Alcohol Our Favourite Drug: The big picture: can nurses and midwives make a difference?' - jafari


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
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 1960

  • Completely inadequate

  • Psychiatric hospitals

  • Residential

  • Custodial care

  • Inmates:

    • Inebriates’ Act

    • Psychiatric complications

    • Temporary accommodation & support



Advances in knowledge and understanding of alcohol problems
Advances in knowledge and understanding of alcohol problems 1960

  • 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: 1960

  • 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 DANA 200+

  • Number of D & A services 2000 (est)


VISION resources



A whole of profession responsibility
A whole of profession responsibility resources

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 resources

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: resources 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: resourcesClinical 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 resources

  • 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 resources

Population aged 14+ years %

  • Drinkers 811

  • Hazardous/harmful drinkers 351

  • Hazardous/harmful drinkers 142

    Population aged 14-19 years

  • Drinkers 641

  • Hazardous/harmful drinkers 671

    Aboriginal & Torres Strait Islander Peoples

  • Drinkers 621

  • Hazardous/harmful drinkers 821

    1 = Last 12 months

    2 = Last week


Alcohol attributable deaths and hospital bed days 1998 9

Deaths resources

Caused 4,286

Prevented (7029)1

Total (2,744)

Note 1. 94% aged 60+ years

Hospital beddays

Caused 394,417

Prevented2 (255,433)

Total 138,974

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 deaths 4,286

Preventable hospital beddays 394,417


Social costs of drug abuse 1998 9
Social costs of drug abuse, 1998-9 misuse

$m %

Alcohol 7,560.31 22.0

Tobacco 21,063.0 61.2

Illicit drugs 6,075.8 17.6

Total 34,439.8 100.0

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

Note 1. Costs of alcohol misuse 1.98% of GDP



Factors in Acute Alcohol-related Damage misuse

Acutealcohol consumption


Factors in Acute Alcohol-related Damage misuse

Acutealcohol consumption

  • CNS depression:

  • Impairment of

  • Motor function

  • Coordination

  • Judgment

  • Respiration

  • Consciousness


Factors in Acute Alcohol-related Damage misuse

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


Factors in Acute Alcohol-related Damage misuse

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 misuse

  • Fall injuries

  • Road injuries

  • Occupational and machine injuries

  • Fire injuries

  • Drowning

  • Assaults

  • Suicide


Factors in Acute Alcohol-related Damage misuse

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 misuse

  • Acute ethanol overdose and poisoning

  • Aspiration

  • Combined alcohol and drug overdose and poisoning

  • Methanol poisoning


Factors in Acute Alcohol-related Damage misuse

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


Factors in Acute Alcohol-related Damage misuse

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


Factors in Acute Alcohol-related Damage misuse

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


Factors in Acute Alcohol-related Damage misuse

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


Effects of Long-term Alcohol Consumption misuse

Long-termalcohol consumption



Effects of Long-term Alcohol Consumption mortality, Ontario 1928-1972

Long-term

alcohol consumption

Alcohol a necessary cause of diseases


Alcohol a necessary cause of disease
Alcohol a Necessary Cause of Disease mortality, Ontario 1928-1972

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: mortality, Ontario 1928-1972

Alcoholic gastritis

Alcoholic hepatitis

Alcoholic cirrhosis

Alcoholic cardiomyopathy

Foetal alcohol effects

Foetal alcohol syndrome

Alcohol a Necessary Cause of Disease


Effects of Long-term Alcohol Consumption mortality, Ontario 1928-1972

Long-termalcohol consumption

Alcohol a contributing cause of disease


Alcohol a contributing cause of disease
Alcohol a Contributing Cause of Disease mortality, Ontario 1928-1972

Cancer

  • Oropharyngeal

  • Oesophageal

  • Laryngeal

  • Liver

  • Female breast


Alcohol a contributing cause of disease1
Alcohol a Contributing Cause of Disease mortality, Ontario 1928-1972

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 mortality, Ontario 1928-1972

Other diseases:

  • Epilepsy

  • Hypertension (males)

  • Ischaemic stroke (males)

  • Haemorrhagic stroke (males)

  • Psoriasis

  • Depression, attempted suicide and suicide

  • Spontaneous abortion


Effects of Long-term Alcohol Consumption mortality, Ontario 1928-1972

Long-termalcohol consumption

Alcohol a contributory factor to disease outcome


Alcohol a contributory factor to disease outcome
Alcohol a Contributory Factor to Disease Outcome mortality, Ontario 1928-1972

  • Hepatitis C

  • Pulmonary infection

  • Post-operative complications


Effects of Long-term Alcohol Consumption mortality, Ontario 1928-1972

Long-termalcohol consumption

Alcohol a protector

from diseases


Alcohol a protector from disease
Alcohol a Protector from Disease mortality, Ontario 1928-1972

  • Ischaemic heart disease

  • Hypertension (females)

  • Supra-ventricular cardiac dysrhythmias

  • Hear failure

  • Ischaemic stroke (females)

  • Haemorrhagic stroke (females)

  • Cholelithiasis


Effects of Long-term Alcohol Consumption mortality, Ontario 1928-1972

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 mortality, Ontario 1928-1972Alcohol-related Problems:A Spectrum of Problems and Responses

The goal: Harm minimization


Advances in disease prevention health promotion
Advances in disease prevention mortality, Ontario 1928-1972& 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 mortality, Ontario 1928-1972& 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 mortality, Ontario 1928-1972

  • 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 mortality, Ontario 1928-1972

    • 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


    Prevention and Treatment of Alcohol-related Problems: mortality, Ontario 1928-1972A Spectrum of Problems and Responses

    Alcohol Use

    Safe

    Primary prevention

    Nil


    Prevention and Treatment of Alcohol-related Problems: mortality, Ontario 1928-1972A Spectrum of Problems and Responses

    Case finding &early intervention

    Hazardous

    Alcohol Use


    Prevention and Treatment of Alcohol-related Problems: mortality, Ontario 1928-1972A Spectrum of Problems and Responses

    Harmful

    Treatment

    Alcohol Use


    Prevention and Treatment of Alcohol-related Problems: mortality, Ontario 1928-1972A Spectrum of Problems and Responses

    Alcohol-relatedproblems

    Alcohol Use

    Primary prevention


    Prevention and Treatment of Alcohol-related Problems: mortality, Ontario 1928-1972A Spectrum of Problems and Responses

    Alcohol-relatedproblems

    Case finding &early intervention

    Alcohol Use


    Prevention and Treatment of Alcohol-related Problems: mortality, Ontario 1928-1972A Spectrum of Problems and Responses

    Alcohol-relatedproblems

    Treatment

    Alcohol Use


    Prevention and Treatment of Alcohol-related Problems: mortality, Ontario 1928-1972A Spectrum of Problems and Responses

    Alcohol-relatedproblems

    Harmful

    Treatment

    Case finding &early intervention

    Hazardous

    Alcohol Use

    Safe

    Primary prevention

    Nil


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    General Nurses


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    General Nurses

    Safe Drinking Practices


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    General Nurses

    Safe Drinking Practices

    Drinking History


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    General Nurses

    Safe Drinking Practices

    Drinking History

    Screening (AUDIT)


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    General Nurses

    Safe Drinking Practices

    Drinking History

    Screening (AUDIT)

    Brief intervention


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    General Nurses

    Safe Drinking Practices

    Drinking History

    Screening (AUDIT)

    Brief intervention

    Specialist referral


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    General Nurses

    Safe Drinking Practices

    Drinking History

    Screening (AUDIT)

    Brief intervention

    Specialist referral

    Treatment of withdrawal


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    SpecialtyNursing andClinical NurseSpecialists

    Public health

    Community health

    Mental health

    Emergency

    Critical care

    Gastroenterology

    Hepatology

    Neurology

    Midwifery

    Paediatrics


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    SpecialtyNursing andClinical NurseSpecialists

    Public health

    Community health

    Mental health

    Emergency

    Critical care

    Gastroenterology

    Hepatology

    Neurology

    Midwifery

    Paediatrics

    Consultation & support


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    SpecialtyNursing andClinical NurseSpecialists

    Public health

    Community health

    Mental health

    Emergency

    Critical care

    Gastroenterology

    Hepatology

    Neurology

    Midwifery

    Paediatrics

    Consultation & support

    Specialistassessment


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    SpecialtyNursing andClinical NurseSpecialists

    Public health

    Community health

    Mental health

    Emergency

    Critical care

    Gastroenterology

    Hepatology

    Neurology

    Midwifery

    Paediatrics

    Consultation & support

    Specialistassessment

    Management ofspecialty problems


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    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


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    D and A Nursing and Clinical Nurse Specialists

    General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    D and A Nursing and Clinical Nurse Specialists

    General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

    Consultation & support


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    D and A Nursing and Clinical Nurse Specialists

    General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

    Consultation & support

    Specialistassessment


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    D and A Nursing and Clinical Nurse Specialists

    General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

    Consultation & support

    Specialistassessment

    Management ofalcohol problems


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    D and A Nursing and Clinical Nurse Specialists

    General hospitalsPsychiatric hospitalsCommunity healthDetoxification unitsOther D & A services

    Consultation & support

    Specialistassessment

    Management ofalcohol problems

    Follow-up


    The Role of Nursing: Clinical Practice mortality, Ontario 1928-1972

    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: mortality, Ontario 1928-1972services for impaired nurses


    Progress in australia
    Progress in Australia mortality, Ontario 1928-1972

    • Services in general hospitals 1964

    • Appointment of assistant directors of nursing (D and A) in NSW 1982

    • Establishment of clinical nurse specialists and consultants in some states

    • Establishment of DANA 1986

    • NSW Nursing Project

    • Academic appointments

    • Establishment of academic programs

    • Availability of educational resources


    Systems impediments to progress
    Systems impediments to progress mortality, Ontario 1928-1972

    • 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


    ad