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Managing Hospitalized Adults with Alcohol Dependence

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Managing Hospitalized Adults with Alcohol Dependence Rhode Island College Digital Commons @ RIC Master's Theses, Dissertations, Graduate Master's Theses, Dissertations, Graduate Research and Major Papers Overview Research and Major Papers 2015 Managing Hospitalized Adults with Alcohol Dependence Lisa Darling Rhode Island College Follow this and additional works at: https://digitalcommons.ric.edu/etd Part of the Nursing Commons Recommended Citation Darling, Lisa, "Managing Hospitalized Adults with Alcohol Dependence" (2015). Master's Theses, Dissertations, Graduate Research and Major Papers Overview. 113. https://digitalcommons.ric.edu/etd/113 This Major Paper is brought to you for free and open access by the Master's Theses, Dissertations, Graduate Research and Major Papers at Digital Commons @ RIC. It has been accepted for inclusion in Master's Theses, Dissertations, Graduate Research and Major Papers Overview by an authorized administrator of Digital Commons @ RIC. For more information, please contact [email protected]. MANAGING HOSPITALIZED ADULTS WITH ALCOHOL DEPENDENCE: AN EDUCATION PROGRAM FOR NURSES by Lisa Darling A Major Paper Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Science in Nursing in The School of Nursing Rhode Island College 2015 Abstract Alcohol withdrawal is a common clinical condition with a variety of presentations, complications and morbidities. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), an estimated 17 million Americans, or one in every 12 adults, have an alcohol use disorder (AUD). An unanticipated hospital admission can precipitate alcohol withdrawal syndrome that can develop six hours after the cessation of alcohol. Early assessment of potential alcohol dependence, as well as symptoms of withdrawal and utilizing the CIWA tool, is important in identifying and managing this at risk population and reducing the potential incidence of complications. The purpose of this project was to develop and implement an educational program for nurses targeted at management of hospitalized adults with alcohol withdrawal through assessment skills and utilizing the CIWA protocol. The goal was to increase the nurses’ knowledge of assessing, monitoring and treating this patient population. A needs assessment was conducted and an online education program was developed based on a review of the literature and clinical experience. The project included a pre and post survey surrounding the education module, followed by a program evaluation. Results indicated higher scores on the post-survey suggesting an increase in nurses’ knowledge, awareness and skills related to managing AWS in hospitalized adults utilizing an online education program. The APRN is in the position to improve nursing practice through evidence-based best practice, an important element in improving patient outcomes and safety. Acknowledgements I have a great sense of pride and accomplishment when I reflect back on this endeavor to acquire a master degree in nursing. I am indebted to my many colleagues who supported me and without whom completion of this project wouldn’t have been possible. I would like to thank my first reader and mentor, Dr. Meg Mock for her patience, guidance and enthusiastic support throughout this process. I would like to acknowledge my second reader, Dr. Cynthia Padula for her expertise and guidance throughout this project, and my third reader, Stanley Goodman, NP for his assistance. I have to acknowledge the most important people in my life my husband, Michael and my children, Joshua, Ethan and Abby, for their love and support of my education Table of Contents Background/Statement of the Problem……………………………………………1 Review of the Literature…………………………………………………………..6 Theoretical frameworks……..……………………………………………….…...32 Methods………………………………………………..………………………….38 Results/Outputs…………………….…………………...…………………………46 Summary and Conclusions/Outcomes………….…………………………………51 Recommendations and Implications…....................................................…………55 References……...………………………………………………………………….57 Appendices………………………………..……………………………………………...65 1 Managing Hospitalized Adults with Alcohol Dependence: An Education Program for Nurses Background/Statement of the Problem Excessive alcohol use is a prevalent problem in the United States (US) and responsible for significant health disparities and economic burden. The American Psychiatric Association (APA) issued a revision in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that combined alcohol abuse and alcohol dependence into a single disorder, alcohol use disorder (AUD). The DSM-T also outlined criteria for diagnosing mild, moderate or severe AUD (National Institute on Alcohol Abuse and Alcoholism, 2013). According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), an estimated 17 million Americans, or one in every 12 adults, have an alcohol use disorder (AUD). Alcohol use disorder includes both alcoholism and harmful alcohol intake (NIAAA, 2014). The NIAAA reported that 24.6% of people engaged in binge drinking in the past month. Binge drinking is characterized as drinking five or more alcoholic drinks on the same occasion on at least one day in the past 30 days. Statistics recorded on the NIAAA website revealed that 7.1% of binge drinkers reported that they engaged in heavy drinking in the past month. Heavy drinking is defined as five or more drinks on the same occasion on each of five or more days in the past 30 days (National Institute on Alcohol Abuse and Alcoholism, 2013). The National Center for Chronic Disease Prevention and Health Promotion (2013) reported new estimates revealing that binge drinking is a more significant problem than once thought. This data indicated that more than 38 million Americans binge drink, averaging four to 2 eight times per month, and that most of these people are not alcohol dependent or alcoholics. Many theories exist as to what causes alcohol-related disorders. Drinking alcohol is legal, widely available and an accepted social norm of American culture. Genetics, physiologic and psychologic as well as social factors contribute to the development of complications associated with alcohol abuse without consistently affecting every individual equally (APA, 2012). These social and psychological problems, that can include impulsiveness, depression, low self-esteem and/or peer pressure, seem to perpetuate excessive alcohol use (APA). There has been ongoing research on the genetic relationship; for example, one genome-wide link study has suggested that alcohol dependence has a familial association based on analysis and study of the KIAA0040 gene (Hill, Jones, Zezza, & Stiffler, 2013). The National Council on Alcoholism and Drug Dependence Inc. (NCADD, 2012) reported that more than half of all adults have a family history of alcoholism or AUD. Long-term abuse of alcohol can cause serious health illnesses and complications affecting virtually every organ in the body (NCADD, 2012). Short-term effects of alcohol abuse, usually attributed to binge drinking, include injuries, increased violent tendencies, and risky sexual behaviors; long-term effects of alcohol can include but not limited to high blood pressure, heart disease, stroke, some cancers, liver disease and digestive problems (Centers for Disease Control and Prevention [CDC], 2014). Excessive alcohol intake is the third leading cause of preventable death, responsible for 88,000 deaths in United States each year and cost the U.S. $223.5 billion in 2006 3 (National Center for Chronic Disease Prevention and Health Promotion, 2013). Higher levels of drinking have more significant alcohol-related medical problems and more significant withdrawal episodes (Schuckit, Tipp, Reich, Hesselbrock, & Bucholz, 1995). People with alcohol dependence have lost reliable control of their alcohol use and are often unable to stop drinking. When alcohol use is stopped suddenly in this population, symptoms of withdrawal from alcohol may ensue (APA, 2012). The adverse effects and symptoms of alcohol withdrawal have been well documented for centuries, as far back as the stone-age inhabitants (Carlson et al, 2012). Carlson et al. (2012) explained that Dr. Benjamin Rush (1746-1813) distinguished excessive alcohol use as a loss of control but credits Dr. William Osler (1849-1919) as describing the sequela of alcohol withdrawal that included but is not limited to incessant motion, muscular tremor and hallucinations. In 2012, Manasco, Chang, Larriviere, Hamm and Glass described alcohol withdrawal as a clinical condition with initial symptoms of mild anxiety, insomnia, and tremor that can begin within three to six hours after stopping drinking. Prolonged alcohol exposure depresses the central nervous system and with an abrupt cessation of alcohol a variety of withdrawal symptoms can ensue including tremulousness, anxiety, diaphoresis, headache can progress to delirium tremens (Manasco et al. 2012). Progression of withdrawal varies with a wide range of symptoms secondary to hyperactivity of the autonomic nervous system. Withdrawal can advance to delirium tremens, the most severe form of which was documented in a classic study of 1648 alcohol-dependent men and women (Schuckit et al., 1995). Foy, Kay and Taylor (1997) 4 conducted an observational study that examined the variability of alcohol withdrawal and its potential complications. Withdrawal was associated with episodes of progression to delirium, respiratory failure, increased length of stay and even death in two patients.
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