What Service Learning Has Meant to Me

Service Learning has been an excellent opportunity to get involved with a good cause as well as open up avenues of academic experience that I had previously not considered. As I become more aware of the magnitude of substance abuse issues and all of the facets of life it effects, I find myself becoming more compassionate toward a group of people that I had previously regarded as irresponsible and unmotivated. I've learned how the intricate dimensions of this disease process can only be combated with an open mind and unbiased actions toward helping the patient find help. I have always viewed the E.R. as kind of the trenches of the hospital. A battlefield in which staff is constantly being bombarded with patient after patient in which the only goal is the stabilization of life. This generalization comes from years of watching patients with potentially life threatening issues with substance abuse be pushed aside as doctors and nurses search for a medical reason to treat these patients rather instead of taking an holistic approach to their overall health. What I have learned is that  acute care can be much more than that. A patients room does not have to be that cold impersonal trench in the battlefield.

During my time training for M.I. was voluntold to role play as a care provider in a Motivational Interview in front of several people that I had just met minutes prior to the training. That did not go so well for  me....however this video demonstrates how well it could actually go.  

Motivational Interviewing

As we continue the data collection portion for the rate of substance abuse of patients admitted to the emergency department, I have found myself experiencing a disconnect with the way patients were referred to various agencies. There was something impersonal and probably ineffective about handing a patient that has a history of substance abuse a green piece of paper with phone numbers to various clinics around Birmingham. However, these issues regarding drug and alcohol addiction would probably have never been addressed had we not been there. So I suppose this only highlights the real issue of addiction as being a medical condition that is so negatively stigmatized that it does not warrant the appropriate attention from health care professionals.
This past week Dr. Karen Ingersoll from The University of Virginia came and spoke to the interview team of the project. Dr. Ingersoll has traveled internationally speaking about Motivational Interviewing techniques for patients suffering from substance abuse issues. Here are some of the main takeaway points I learned from her lecture:

1.)Your perceived disposition on the problems being experienced by the patient are critical in developing a rapport.  Pressed speech and conveying negativity at the patient only puts a blockade that that is often times permanent.

2.)The client should have experienced some sort of sense of autonomy at the end of the interview. Having the patient state what they could do to combat issues they dislike about their condition can be actually be empowering.

3.) By providing guidance instead of making threats and attempting to strike fear in the heart of the patient, you can leave the patient with a positive experience that they will think about later on down the road. An example of this would be a doctor making the statement, "If you don't quit drinking you're gonna kill yourself or someone else!" versus "Come and see me in a few weeks if you find yourself unable to control your drinking at a level that we just discussed would be appropriate for you, and we'll get you some more help." The patient knows he could kill himself or other people....it's been drilled in his or her head since they took the D.A.R.E program in the third grade.

4.) Once an issue with addiction has been established, ask permission to pursue a route that will eventually lead the patient to better there lives. The 12-Step program and abstinence is not the most appropriate option  for everyone having difficulty with depression.

In the days to come I look forward to implementing what I've learned and following up with patients that I've spoken with in the emergency room.

What I've Seen So Far...

Since my last post I have put in a few hours conducting substance abuse history surveys for every patient that is seen in the ED at UAB. As a caveat, I also work as a Student Nurse Tech at another ED that does not have quite as much patient volume and primarily treats patients in a lower SES. Through this work opportunity I have seen a few cases of drug overdoses and catered to patients that just needed a place to sleep off the nights consumption of liquor. However, I am often times left out of any collection of prior history of substance abuse with these patients, if any is collected at all. So I like to think of my opportunity with UAB's Emergency Department as a way of refining a skill that will become valuable later on in my nursing career. It can be difficult at times to get patients comfortable enough in the hectic environment of the ER to disclose information regarding drugs and alcohol. This issue is often times compounded with concerned or worried family members that refuse to let the patient answer questions for themselves. I've learned that therapeutic communication such as asking what brings the patient to the ER and telling them about myself develops a sense of trust.
After the first few days of data collecting I've noticed in my small sample size that alcohol tends to be the most prevalent substance of abuse. Several patients (most above the age of 40) have had extensive backgrounds including many different treatment programs, broken marriages, and lost relationships with their children. Here are some statistics from the National Survey on Drug Use and Health 2010:

• 4.7 million Americans age 12 and above initiated their first use of ETOH.
• 82.4 percent of those 4.7 million Americans were under the age of 21.
• The average age of first use of alcohol in 2010 was 17.2 years.
• 17 million Americans were identified as needing specialty treatment for alcohol abuse....and did not receive any such treatment.
• In 2010 1.1 million youths were identified as needing specialty treatment for alcohol abuse and did not receive any such treatment.

The Beginning

My name is Ben Smith, and I am currently a 3rd semester honors in nursing student at UAB. I'm originally from Agawam, Massachusetts and a veteran of the U.S. Navy. I moved to Birmingham in 2008 after I was discharged from the Navy and was employed part-time at an urgent care center in the suburbs of the city. Here is where I became increasingly aware of the issue of drug seeking behavior, and other health issues related to substance abuse resulting in the over-crowding of health care facilities all over Birmingham.
When I first started my service-learning project the initial target population was the veterans using the VA health care system that had been given a diagnosis pertaining to opioid dependence. My goal was to develop an effective referral system for patients admitted to the hospital to make the transition from hospitalization to to substance abuse treatment an easier process for the veterans.  Since then, my community agency has shifted to University Hospital's emergency department where a study has been in the works since May of 2011. The overall aim of this study is to minimize emergency room visits and hospital admissions by identifying potential substance abuse behavior and pairing the patient with the appropriate treatment center. A little motivation for these patients may prove to go a long way in their path to recovery...