"The Future of Nursing: Accelerating gains made to address the continuum of substance use"

Research has shown that medications, especially opioid agonist treatments, are an effective way to treat opioid use disorder (OUD); however, negative attitudes held by health professionals contribu...

Health professionals' attitudes toward medications for opioid use disorder.

Increasing calls within the field of implementation science (IS) research seek to promote active engagement of diverse and often disenfranchised stakeholder voices to increase buy-in, fidelity, outcome relevance, and sustainment of evidence-based practices (EBPs). Including such voices requires cultural humility and the integration of multiple perspectives and values among organizations, groups, and individuals. However, the IS field lacks guidance for researchers on structuring collaborative approaches to promote a co-created process (i.e., synergistic approach to goal attainment). We contend that improved operationalization of co-created implementation collaborations is critical to sparking synergy and addressing differentials based on power, privilege, knowledge, and access to resources among stakeholders. These differentials can undermine future implementation and sustainment efforts if not addressed early in the research effort. An insufficient understanding of the guiding principles of co-created implementation collaborations may limit the scientific value of evaluation processes, and researchers' ability to replicate outcomes. We propose a perspective foregrounded in the concept of co-creation to guide the structuring of implementation collaboratives through five principles. We offer three case examples informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework to illustrate the application of these co-creation principles. Lastly, we offer recommendations for promoting co-creation in IS research moving forward.

https://www.frontiersin.org/articles/10.3389/frhs.2022.942658/pdf

Understanding implementation research collaborations from a co-creation lens: Recommendations for a path forward

Abstract Background In the United States, a national priority exists to improve access to medication treatment for opioid use disorder (MOUD). Nurses can be an essential component of that care. We examined the perceptions and evolving roles of nurses in a national Veterans Health Administration (VHA) initiative designed to improve MOUD access within general medical settings. Methods From April 15, 2021, to June 16, 2021, we recruited nurses participating in VHA's Stepped Care for Opioid Use Disorder Train the Trainer Initiative—a national program intending to implement MOUD in general medical settings—to participate in an interview about their roles, perceptions, and experiences. The respondents answered our inquiries through an interview or responded to an email solicitation with written responses, which were then recorded, transcribed, and independently coded to identify themes. Results Nurses from 10 VHA facilities participated in an interview (n = 7) or completed the questionnaire (n = 4). Inadequate staffing, high patient-to-provider ratios, and time constraints were identified as barriers to MOUD care. Mentorship activities, existing VHA informational resources, and patients' willingness to accept treatment were identified as facilitators of MOUD care. The Stepped Care for Opioid Use Disorder Train the Trainer Initiative processes were acknowledged to promote role confidence, which in turn increased job satisfaction and empowered nurses to become content experts. Respondents often identified nurses as local lead facilitators in MOUD care. Conclusions In a national initiative to implement MOUD within general medical settings, nurses identified several barriers and facilitators to MOUD implementation. Nurses play vital collaborative care roles in enhancing access to MOUD.

Roles and Perceptions of Nurses During Implementation of a Medication Treatment for Opioid Use Disorder National Initiative

In the United States, a national priority exists to improve access to medication treatment for opioid use disorder (MOUD). Nurses can be an essential component of that care. We examined the perceptions and evolving roles of nurses in a national Veterans Health Administration (VHA) initiative designed to improve MOUD access within general medical settings.From April 15, 2021, to June 16, 2021, we recruited nurses participating in VHA's Stepped Care for Opioid Use Disorder Train the Trainer Initiative-a national program intending to implement MOUD in general medical settings-to participate in an interview about their roles, perceptions, and experiences. The respondents answered our inquiries through an interview or responded to an email solicitation with written responses, which were then recorded, transcribed, and independently coded to identify themes.Nurses from 10 VHA facilities participated in an interview (n = 7) or completed the questionnaire (n = 4). Inadequate staffing, high patient-to-provider ratios, and time constraints were identified as barriers to MOUD care. Mentorship activities, existing VHA informational resources, and patients' willingness to accept treatment were identified as facilitators of MOUD care. The Stepped Care for Opioid Use Disorder Train the Trainer Initiative processes were acknowledged to promote role confidence, which in turn increased job satisfaction and empowered nurses to become content experts. Respondents often identified nurses as local lead facilitators in MOUD care.In a national initiative to implement MOUD within general medical settings, nurses identified several barriers and facilitators to MOUD implementation. Nurses play vital collaborative care roles in enhancing access to MOUD. 

Background Few veterans with opioid use disorder receive effective treatment despite the Veterans Health Administration's efforts to expand treatment by offering buprenorphine, a medication to treat opioid use disorder (MOUD). An insufficient prescribing workforce contributes to the underutilization of buprenorphine; however, nurse practitioners (NPs) can now obtain a waiver to prescribe this medication. This quality improvement project aimed to expand the prescribing workforce by educating psychiatric mental health NPs (PMHNPs) working in an emergency setting at a Veterans Affairs Health Care System about free MOUD training and empowering them to utilize buprenorphine treatment. Methods Eleven PMHNPs were asked for their perception of prescribing buprenorphine. They were asked if they had an MOUD waiver and/or were aware of the free waiver training. The PMHNPs were educated on the importance and process of obtaining the DEA-X waiver, and then a post-intervention discussion was completed to determine if they completed the waiver training. Results At baseline, all 11 PMHNPs believed offering MOUD was important, but only three had the waiver to prescribe buprenorphine. After the education, three additional PMHNPs obtained the waiver and 10 planned to have the waiver in the next year. The department is planning to trial offering buprenorphine treatment, and PMHNPs at this facility are privileged to prescribe buprenorphine. In addition, five new PMHNP residents started or completed the training. Conclusions This project shows the potential to increase veteran access to MOUD by emphasizing education and empowering PMHNPs to initiate treatment. Providing education regarding the importance of buprenorphine treatment in the emergency setting and delivering information about the free waiver training facilitated workforce preparedness.

Empowering Psychiatric Mental Health Nurse Practitioners to Expand Treatment Opportunities for Veterans With Opioid Use Disorder.

Adverse Childhood Experiences (ACEs) are defined as traumatic events occurring before age 18, such as maltreatment, life-threatening accidents, harsh migration experiences, or violence. Screening for ACEs includes asking questions about an individual's early exposure to these types of events. ACEs screenings have potential value in identifying children exposed to chronic and significant stress that produces elevated cortisol levels (i.e., toxic stress), and its associated physical and mental health conditions, such as heart disease, diabetes, depression, asthma, ADHD, anxiety, and substance dependence. However, ACEs screenings are seldom used in primary care settings. The Surgeon General of California has addressed this care gap by introducing ACEs Aware, an ACEs screening fee-for-service healthcare policy signed into law by Gov. Gavin Newsom. Since January 2020, Medi-Cal, California's Medicaid health care program, has reimbursed primary care providers for using the Pediatric ACEs and Related Life-events Screener (PEARLS) tool to screen children and adults for ACEs during wellness visits. To achieve the goals set by the ACEs Aware state policy, it is essential to develop and test implementation strategies that are informed by the values, priorities, and resources of clinical settings, healthcare professionals, and end-users. To address this need, we partnered with a system of federally qualified health centers in Southern California on a pilot study to facilitate the implementation of ACEs screenings in five community-based clinics. The health centers had broad ideas for an implementation strategy, as well as best practices to improve adoption of screenings, such as focusing on staff training to improve clinic workflow. This knowledge was incorporated into the development of an implementation strategy template, used at the outset of this study. We used the Exploration, Preparation, Implementation and Sustainment (EPIS) framework to guide the study and inform a participatory planning process called Implementation Mapping. In this paper, we describe how Implementation Mapping was used to engage diverse stakeholders and guide them through a systematic process that resulted in the development of the implementation strategy. We also detail how the EPIS framework informed each Implementation Mapping Task and provide recommendations for developing implementation strategies using EPIS and Implementation Mapping in health-care settings.

/pdf/using-implementation-mapping-to-develop-protocols-supporting-29z4n01c.pdf

Using Implementation Mapping to develop protocols supporting the implementation of a state policy on screening children for Adverse Childhood Experiences in a system of health centers in inland Southern California

BACKGROUND
The care for people with trauma- and stressor-related disorders is multidisciplinary. The place of chaplaincy care in multidisciplinary trauma care has received limited attention.


AIM
Exploration of the place of chaplaincy care in relation to psychotrauma, moral injury, grief and palliative care and in time in relation to exposure to psychotrauma as a basis for a model of multidisciplinary collaboration.


METHOD
Inventory and discussion of the position of chaplaincy care in the literature and guidelines for trauma- and stressor-related disorders.


RESULTS
Chaplaincy care may support finding meaning and reconnection in people at risk of trauma and PTSD, moral injury, and traumatic grief. Chaplaincy care is increasingly available for palliative and multicultural care recipients. Most guidelines for trauma care recommend the availability of chaplaincy care or research into the effectiveness of complementary existential, spiritual or meaning-making interventions.


CONCLUSION
Traumatic stressors represent limit experiences, whereby the quest for meaning, existential and moral orientation are pre-eminently at stake. The use of chaplaincy care supports finding meaning and reconnection and may thereby potentially contribute to the prevention of traumatic exposure to stressors, persistent symptoms after exposure, and worsening of chronic trauma- and stressor related symptoms.

Gabrielle Jacobs

Papers

Empowering Psychiatric Mental Health Nurse Practitioners to Expand Treatment Opportunities for Veterans With Opioid Use Disorder.

Using Implementation Mapping to develop protocols supporting the implementation of a state policy on screening children for Adverse Childhood Experiences in a system of health centers in inland Southern California

[Chaplaincy care in psychotrauma care: an exploration].