Download 6 - rguhs

6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Substance abuse is a symptom. A lot of times there is something
going on with a relationship and individual. People who feel unloved are going to
use drugs to soothe those hurt places.”
- Andrea Cohen
June 26 is celebrated as international day against drug abuse and illicit trafficking
every year. It is the third largest business in the world next to petroleum and arms trade
with a turnover of around $ 500 billions. About 190 million people all over the world
consume one drug or the other. Drug addiction causes immense human distress and the
illegal production and distribution of drugs have spawned crime and violence worldwide.
1
Drug abuse is a complex phenomenon which has various cultural, biological,
geographical, historical and economic aspects. The disintegration of the old joint family
system absence of parental love and care in modern families where both parents are
working, decline of old religious and moral values lead to a rise in the number of drug
addicts who take drugs to escape hard realities of life. 1
In India the numbers of drug addicts are increasing day by day.Cannabis, heroin
and Indian–produced pharmaceutical drugs are the most frequently abused drugs in India.
Cannabis products often called charas, bhang or ganga are abused throught the country
because it has attained some amount of religious sanctity because of its association with
some Hindu deities. 1
In India there are 62.5 million users of alcohol, 8.7 million users of cannabis,
and 2 million users of opiates such as heroin. A National survey released in 2004
revealed that 8% of drugs abusers are women. Often under the influence of drugs, addicts
also indulge in high-risk behaviors such as unsafe sex and needle sharing which has
contributed to the spread of infectious diseases such as HIV/AIDS and hepatitis C. 2
Alcohol and cocaine are very popular because they produce effects on the brain
within minutes after consumption. The majority of drug users are aged between 16 to 30
years. These drug users are mostly unmarried, and from the lower socioeconomic strata,
33% of them are engaged in antisocial activities. Drug abuse causes a range of health
complications from weakness, loss of body weight and respiratory distress. One of the
most important effects of drug abuse is impaired judgement and a lack of rational
thinking. Addicts develop psychological problems such as depression, anxiety and
irritability. The incidence of drug abuse is also high among people with untreated
psychiatric or emotional problems who often report taking drugs. 1
Thousands of drugs in nature and the many thousands of drugs have made in
laboratories, but only a relative handful is used regularly for their effects on our mood,
thinking or behaviour. The most commonly used drugs in the world are caffeine (found in
tea, coffee and certain soft drinks), nicotine (in tobacco), and alcohol. These drugs are
legal in most countries; other categories of drugs such as the opioids commonly used to
treat pain, are either restricted to medical use or prohibited entirely. The effects of drug
on brain and behaviour are different from one another. World Health Organization
classify the drug in to the following categories, alcohol, opioids (opium and its
derivatives, including heroin and morphine), cannoboinoids (such as marijuana),
sedatives or hypnotics, cocaine, other stimulants including caffeine, hallucinogens,
tobacco(nicotine), volatile solvents (inhalants). 3
Substance abuse among nurses has existed for at least 150 years. Historical
research condcted by church (1984) showed that intoxication on the job existed even
during mid-19th century when Florence Nightingale began her work. The problem of
nurses with substance-related disorders gained increased awareness in the 1980s when
the American Nurses Association (ANA) first addressed the issue. The ANA (1984)
defined an impaired nurse as one who “has impaired functioning which results from
alcohol or drug misuse and which interferes with professional judgement and the delivery
of safe, high quality care.” The ability to identify nurses who have early manifestations of
impairment could lead to an increased understanding of when to intervene through
counseling and education.4
6.1 NEED FOR THE STUDY
Nurses makes largest group in hospital, and they will have direct communication
with patients. Nurses should have necessary knowledge about causes of addiction to
drugs and its adverse effects because a nurse has to identify drug abusers and educate
them regarding ill effects of substance abuse. 1
Knowledge is an important aspect. There is a need for knowing more about
substance abusers and substance abuse syndrome in planning training programme for
practising nursing personnel.
Attitude play vital role in aspects of human life. Negative attitude interfere with
action and proper understanding of these attitudes are necessary. Nurses may be
suggested ways by which they may be helped to change or modify their attitudes.
Drugs may be easily available to nurses by prescription (e.g. tranquilizers) and
over-the-counter medications (e.g. analgesics). Nurses may abuse the drugs for relaxation
and to induce sleep during stressfull working condition. Drug abuse among nurses causes
impairment in their work and which will affect on patient. Substance abuse is viewed
differently depending on the substance used, the person using it and the condition in
which it is used, so nurses should be aware of these social and cultural attitudes and
recognize their impact on individual users and people close to them. 1
A study conducted on prevalence of substance abuse among nurses revealed that
10% to 20% of nurses have substance abuse problems, and that 6%to 8% of registered
nurses are impaired due to their abuse of alcohol and other drugs. Chemical dependency
is considered a disease of that requires treatment. Early identification and treatment of
chemically dependant nurse is important for the safety of the public and for the wellbeing
of the nurse and her profession.5
Drug abuse has led to a detrimental impact on the society. It has led to a increase
in crime rate. Addicts resort to crime to pay for their drugs. Drugs remove inhibitions and
impair judgement influencing one on to commit affences. Incidence of eve-teasing, group
clashes assult and impulsive murders increase with drug abuse. Apart from affecting the
financial stability addiction increases conflicts and causes untold emotional pain for
every member of the family. With most drug users being in the productive age group of
18-35 years, the loss in terms of human potential is incalculable. 1
Nurses have very important role in management and prevention of drug abuse.
Nurses who are working in various areas such as school health nurse, community health
nurse, mental health nurse and nurses in general hospitals has to give individual therapy
and family therapy to prevent occurrence and relapse of drug abuse. 6
The effects of a chemically impaired nurse on staff could cause increased
workloads, unit tension, decreased morale, guilt, anger, and a sense of betrayal or even
denying advice. Substance abuse among nurses could be caused by many issues, from
chaotic family situations to workload stress to past emotional traumas. Physical abuse,
emotional abuse and sexual abuse often lead to lowered self esteem, isolation and
impaired social skills, which are indicators of substance abuse. 1
In order to help a client to recover from substance abuse syndrome a nurse
should show a spirit of acceptance and friendliness. A substance abuse patient is often not
accepted in the society because the substance abuse has negative value in the society. If
nurses do have negative attitudes toward drug dependent clients it may interfere with
establishing a healthy and therapeutic relationship between the client and the nurse. By
knowing the attitude of nursing personnel they can be helped to overcome their negative
attitudes.
6.2 REVIEW OF LITERATURE
Review of literature is a systematic identification, location, scrutiny and summary
of written materials that contain information on research problems
(POLIT. D. F. and
B.P. HUNGLER).
The researcher presents the review of literature which helps to study the problem
in depth. It also serves as a valuable guide to understand what has been done and what is
still unknown and untested.
A study conducted tests on emergency room nurses regarding their knowledge and
beliefs about substance misusers. Study reveals that emergency room nurses regard
alcohol and drug misusers as troublesome patients and dislike caring for them.
Programmes designed to change nurses attitudes towards substance misusers are
generally ineffective, although significant gains in substance-related knowledge are
commonly reported.7
A questionnaire on nurses knowledge, attitudes, beliefs and practices regarding
substance use was distributed to 302 nurses in Victoria, Melbourne. 134 returned the
questionnaire, giving an overall response rate of 44.3%. The survey results showed that
although knowledge and skill gaps exist in assessment and management of alcohol and
drug problems, overall knowledge levels were adequate. Although positive attitudes
towards substance use were expressed, specific educational programs to enhance nurses
skills in assessment and management of substance-related disorders may be useful.8
A study conducted to assess nurses knowledge and attitude regarding substance
use and substance users. It was done on emergency room nurses because they are
frequently exposed to patients with substance use problems and are in ideal positions to
provide early diagnosis and treatment. The result showed that only 25-50% of nurses had
the knowledge to detect patients with substance abuse.9
A study to assess nurses activity in screening substance abuse among their
patients. Here nurses of department of surgery were asked to predict if the surgical
patients treated during 24-h period (n=211) had a substance abuse disorder. This was
compared to patients self-reports based on the Alcohol Use disorders Identification Test
(AUDIT) and questions about use of other substances. The nurses were also asked to
complete a questionnaire related to interventions of patients with substance abuse;
perceived knowledge, skills, attitudes and obstacles. Result showed that only 18% of
nurses reported enough knowledge to conduct intervention.10
An interview study examined the attitudes of healthcare professionals towards
drug misuse and misusers. They represented a sub-sample of a larger study of 248
professionals working with intravenous drug missusers in West Scotland. It was thought
that nurses attitudes could affect their emotional responses and the subsequent care they
gave to patients. The results suggested that staff have judgmental and punitive attitudes to
drug abusers. Most respondents felt that drugs corrupt the young and that drug misusers
should only cared in specialized units.11
A study done a survey of qualified Greek nurses, comparing smoking attitudes,
influences on smoking behaviours and desire to quit with their motivation to act as health
promoters with patients and other health professionals who smoke. A random sample
(n=402) of qualified nurses employed by hospitals in Athens was surveyed with a self
administered questionnaire in a cross- sectional survey which had a 73% response rate.
Following quality control measures, a final sample of 308 was achieved. Results showed
that almost half of the nurses in the sample were current smokers, almost a quarter were
former smoker, with just a less than a third non-smoker. Using the stages of change
model as a measure, the survey reported that 11% of the smokers in the sample expressed
a desire to stop within the next month; another 12% in the coming 6 months and 23% of
current smokers were still in the pre-contemplation stage. 12
A study conducted on 50 nurses to assess the prevalence of substance abuse in
Rajendra hospital and medical college Patiala by means of a structured self report
questionnaire. The life time prevalence of drug abuse among nurses was 55%, majority of
nurses were taking tranquilizers and sedatives for relaxation and inducing sleep.13
A study found that about 32% of the 4,438 nurses surveyed reported drinking,
smoking or using drugs. While nurses’ use of drugs and alcohol is about the same as the
general population, the study found that critical-care and emergency department nurses
are more than three times as likely to abuse narcotics as nurses in other specialties.14
A study assessed the prevalence of licit (e.g. alcohol) and illicit (e.g. cocaine)
drug use as well as prescription (ex: tranquilizer) and over-the-counter medications (e.g.
analgesics) in regional sample of female nurses. Surveys were mailed to a random sample
of 4000 nurses in Western New York. The survey focused on life time and current use of
substances, negative consequences of alcohol consumption and dependence.
Three
mailings resulted in return of 2400 (60%) surveys, of which 1951(49%) nurses were
abusing drugs.15
A study conducted on prevalence of substance abuse among 907 registered nurses
selected through stratified random sampling technique. Study reveals that prevalence of
substance use as follows, alcohol drinking (regular use-3.8%), Cigarette smoking (regular
use 0.2%), analgesics (regular use 21.1%), benzodiazepines (regular use 1.8%) and use
of narcotics (ever use 0.7%).16
A Study reveals that the prevalence of substance abuse in the nurses is parallal to
that in the general population (that is approximately 10%). Nurses with substance abuse
problem need help. They are in danger of harming patients, the facility’s reputation, the
nursing profession and themselves. The consequences of not reporting substance abuse
can be far worse than those of reporting the issue.17
10-15% of all health care professionals misusing drugs at some time in their
careers. Drug abuse by health care professionals may also be more difficult to detect than
among the general population. Those in health care will alienate their families, destroy
their finances, dropout of their usual recreation and only then have their problems show
up on their job.18
A study conducted a cross sectional surveys among 110 male medical school
faculty (MSF), 229 physicians (67% male), 1130 medical students (46% male), and 73
female nursing students. Information on tobacco use and quit attempts was collected
using structured questionnaires. Among the male respondents, current smokers were 15%
of male medical school faculty, 13% of physicians, and 14% of medical students.19
6.3 STATEMENT OF THE PROBLEM
A study to “assess the knowledge and attitude regarding substance abuse
among nurses in selected hospital, Tumkur”
6.4 OBJECTIVES

To assess the existing knowledge towards substance abuse among nurses.

To assess the existing attitude towards substance abuse among nurses.

To determine the association between knowledge and attitude towards
substance abuse among nurses.

To determine the association between knowledge and attitude regarding
substance abuse among nurses with demographic variables such as age, sex,
education, experience etc
6.5 HYPOTHESIS
H1 There will be significant relation between knowledge and attitude regarding
substance abuse among nurses.
H2 There will be significant association between knowledge and attitude in
selected demographical variables such as age, sex, religion, education,
experience, marriage and family type
.
6.6 OPERATIONAL DEFINITIONS
Knowledge
It refers to the information and facts obtained from nurses on the aspects
such as causes, effects, treatment regarding selected substances.
Attitude
A degree of positive or negative effect associated with substance abuse
among nurses.
Substance abuse
The misuse of drugs and alcohol which will produce a negative impact on
health and behavior.
Nurses
Nurses who are working in selected hospital Tumkur.
Selected Substances
The commonly used substances such as nicotine, alcohol, lysergic acid,
diethylamide, cocaine, Amphetamine, Opiate and opiods.
7. ASSUMPTION
Substance abuse is a one among the problem in the society. If it remains unaware
about knowledge on substance abuse among nurses it will lead to improper patient care.
So by assessing the knowledge of nurses about substance abuse helps to increase their
knowledge level and make them aware of ill effects of substance abuse and its
management.
7.1 MATERIALS AND METHODS
7.1.1 SOURCES OF DATA
7.1.2 Research Approach
:
Descriptive survey
7.1.3 Research Design
:
Non experimental
research design
7.1.4 Settings of the study
:
The study will be conducted
0n nurses in selected hospital
Tumkur.
7.1.5 Sample size
:
75
7.1.6 Sampling Technique
:
Simple random sampling
technique.
7.1.7 Selected variables:Independent
Demographic variables ex: age, sex, education,
experience, monthly income etc.
Dependent
Nurses knowledge on substance abuse.
7.1.8 Sample criteria
Inclusion criteria: - The study includes nurses

Who are available during data collection.

Who understand Kannada or English or Hindi.

Who are willing to participate in the study.
Exclusion criteria: - The study will not include

Nurses who are not available during data collection.

Nurses who are not able to understand Kannada or English or Hindi.

Nurses who are not willing to participate in this study.
7.2 METHODS OF DATA COLLECTION
7.2.1 Data collection technique
: Structured interview schedule
7.2.2 Tools for Data Collection
: Structured Questionnaire
7.2.3 Methods of Data Analysis
And
Interpretation
: Data will be analyzed according
to the objectives of the study
using descriptive and inferential
statistics.
7.2.4 Duration of the study
:
6 weeks.
7.3 Does the study require any investigations or interventions to be conducted on
the patient or other human beings or animal?
The study does not require any investigation and interview on patients
and other human beings or animals
7.4 Has ethical clearance been obtained from you institution?
Yes
Ethical clearance has been obtained from Institutions Ethical Committee
(IEC) and the consent.
8. LIST OF REFERENCES
1.
2.
Substance abuse problems in India. http:// www.google.com.
Donna K. MC Neese -Smith, Nirmala Gangadurai, Nirmala Thangavalu, et.al
Nurse education of the public in India about the dangers of substance abuse
2006; Vol. 7 No1.
3. Floyd E Bloom M P et.al, The DANA guide to bright condition centre
substance abuse and addiction March 2007 .
4. Margaret Mary. Journal of Nursing Scholarship. Early risk indicators of
substance abuse among nurses June 2002.
5. Griffith J. substance abuse disorders in nurses. mjv 2v @ HSC mail.
mcc.virginia.edu.1997.
6. T.P. Prema and K. F. Graicy, Principles and Practice of psychiatric nursing. 1st
edition, 2006.
7. Howard M.O, Chung S.S, Substance use misuse: Nurses attitudes towards
substance misusers Aug, 2000; 35(9): 1227-61.
8. Happel. B, Carta. B, Pinikahana. J, Nursing Health Science, Nurses knowledge
attitudes and beliefs regarding substance use: a questionnaire.
Dec 2002; (4), 193-200.
9. Kelleher S. Accident Emergency Nurses July 2007; 15(3): 161-5.
10. Lappalainen-Lehto R. Seppa. K. et. al. cutting down substance abuse: present
state and visions among surgeons and nurses. Addictive behaviors
30(5): 1013-1018, 2005.
11. Carroll. J, Nursing standard, the negative attitude of some general nurses
towards drug misusers. 9(34): 36-38, May 1995.
12. Beletsioti-Stica. R, Scriven. R. International Nursing Review. Smoking among
Greek nurses and their readiness to quit. 53(2): 150-156, 2006.
13. Gurmeeth. Sing, Jindal. K.C, Drug alcohol depend. Drug on medical campus,
drug use among nursing and paramedical personnel, 7(1), 31-37, Feb, 1981.
14. Alison Trinkoff and Carla Storr American Journal of Public Health. 1998.
15.
Collins. R.L, Gollnisch. G, et. al,drug alcohol depend, 1;55, 145-55,
June,
1999.
16. Yang M.S, Yang M. J, Pan S.M. Kaohsing Journal of medical science:
Prevalence and correlates of substance use among clinical nurses in Kaohsiung,
17(5), 261-269, May 2001.
17. Dunn. D. Substance abuse among nurses. Defining the issue. AORN. J. 82(4):
572-596, 2005.
18. Nightingale Nursing times June 2005; page 03 and 57.
19. Mohan S, Pradeepkumar, et. al, Tobacco use among medical professionals in
kerala, India : Addictive behaviors 2006; 31(12): 2313-2318.