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| Regardless
of whether they have been through recovery, all
good chemical dependency nurses are able—
in some way—to identify with the patients
they treat, those who work in the field say. |
A few months after she started attending Alcoholics
Anonymous meetings in 1977, Mary Mitch, RN, marched
into the chemical dependency unit at St. Mary’s
Hospital—now Fairview-University Medical Center—in
Minnesota and said, “I want to work here.”
Mitch, who has been a nurse for 39 years and a chemical
dependency nurse for 26 years, wanted to learn more
about herself and her addiction. “I was having
such a struggle with my own drinking,” she said.
She was married to an alcoholic. She had drinking in
her family. She had three children to raise and wanted
to turn her life around.
“I felt [chemical dependency nursing] was an
area where I could learn,” she said. “I
sought it out mostly because I wanted to discover more
about myself.”
As a chemical dependency nurse at Fairview Recovery
Services, Mitch still is learning and sharing her experiences
when she thinks it will help her patients, especially
those who come to the center for the first time. She
sees their tears and remorse, and tells them she has
walked in their shoes and has struggled with chemical
addiction.
“It seems to break the ice,” she said.
“When people feel really bad and beaten down,
it helps to know that others have been through it, that
they’re not the only ones.”
Regardless of whether they have been through recovery,
all good chemical dependency nurses are able—in
some way—to identify with the patients they treat,
those who work in the field say. “You have to
have a heart for it,” said Jeanne Moore, RN, director
of nursing at Greenbriar Treatment Center in Washington,
Pa. “Either you understand it and want to help
them or you don’t.”
Nurses who work with chemically dependent patients
cannot be judgmental, no matter how many times they
have seen someone come through a detox unit or a recovery
program. They must combine infinite patience with an
ability to set firm boundaries. They must empathize
and listen to patients without becoming too involved
in the sad stories they hear. They must be skilled at
dispensing medications, assessing medical conditions
and catching changes in physical conditions, while at
the same time listening carefully to what patients are
saying and watching what they are doing.
“The nurse’s job is to set up the situation
so that the patients can do the work they need to do,”
said Steve Gottlieb, MA, RN, a charge nurse at Sierra
Tucson hospital in Tucson, Ariz.
Variety of services
Whether they are called rehabilitation centers, recovery
centers, chemical dependency units or treatment centers,
most places for those who go to deal with some form
of chemical addiction offer a variety of services, ranging
from a detoxification process to residential treatment
to outpatient support programs. They may be freestanding
psychiatric hospitals, part of a medical hospital or
residential treatment programs, with acute detox facilities,
subacute facilities or no detox program at all.
Chemical dependency nurses say they see patients of
all ages, social and economic backgrounds and professions.
They work with people addicted to alcohol, sedatives,
painkillers, opiates and methamphetamines. Many have
more than one addiction. Some are dually diagnosed with
mental illness.
Most chemical dependency nurses work on the detox units
with one or two others in the residential areas to dispense
medications, observe patients and monitor medical conditions,
such as high blood pressure or diabetes. Nurses also
assess new patients, process admissions and do utilization
reviews. They often work with a team that may include
physicians, therapists, psychiatrists, counselors and
dietitians.
Detox work requires a combination of psychiatric, med/surg
and critical care nursing skills, said Carol Power,
MSN, RN, nursing director at Sierra Tucson. A lengthy
and detailed admissions process, increasing amounts
of paperwork and faster turnover of beds force nurses
to work quickly and think on their feet, while dealing
with incoming patients who may be intoxicated or suffering
painful withdrawal symptoms.
“There’s a lot to do in a little bit of
time,” Moore said. “It gets very hectic.
The people aren’t dying here, but it’s more
stress than you would think.”
The most dangerous drug to come off of is alcohol,
chemical dependency nurses said. Alcohol withdrawal
can kill a patient who is not properly monitored and
medicated, they said. Detoxing alcoholics may experience
hallucinations, shakes, nausea, sweats and chills, as
well as sudden changes in blood pressure and other vital
signs.
Withdrawal from certain painkillers and sedatives also
can have serious medical consequences, including seizures.
Detoxing from opiates, such as heroin or morphine, is
not deadly but is miserable for the patient—and
often the nurse.
“Patients have been very difficult to deal with
when they’re coming off opiates,” Mitch
said. “They’re miserable. They feel like
they’ve got a bad case of the flu.”
During the first few days and sometimes during the
recovery process as well, nurses give patients medications
to help ease the pain and physical problems caused by
withdrawal. The type and amount of medicine depends
on the symptoms and the substance patients are withdrawing
from.
“The nurse is instrumental in those first two
or three days in keeping patients in treatment,”
Power said. Nurses try to keep the detox environment
calm and unthreatening, she said. The nurse’s
message to the patient is, “We’re glad you’re
here and we want you to stay.”
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