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Greater accountability
Managed care also has forced treatment centers to be
more accountable, with measurable goals, said DeLusque,
who works in utilization review for Grapevine Valley
Hope.
On the other hand, she said, stays are shorter than
they used to be, and some patients need more time to
work on their problems than insurance companies will
pay for.
In the 1970s, when Mitch started, nurses were much
more involved in counseling, she said. Now, trained
therapists and counselors run most of the group and
individual sessions and outpatient rehabilitation. Nurses
often focus their patient education on physical aspects
of chemical dependency and alternate ways of relieving
pain and stress.
They may teach classes on topics such as how drugs
and alcohol affect the body, effects of medications
and relaxation techniques. Some may offer patients massage,
forms of acupuncture, guided-image therapy or other
types of pain relief that don’t involve medications.
Although usually not directly involved in therapy,
chemical dependency nurses talk to patients constantly.
“Sometimes patients will talk more to the nurses
than to the counselors,” DeLusque said. Nurses
are the ones who see patients pacing the corridors at
night or crying and upset after a visit or phone call.
Many times, nurses said, they take a few minutes to
sit on a patient’s bed and suggest relaxation
techniques or share a cup of tea and listen to them.
But chemical dependency patients do not always see
the nurse as their advocate. Often, nurses said, they
are cast into the role of villains because they won’t
give a patient more medication or they enforce rules
such as when patients may talk on the phone.
“Pill addicts are especially difficult to deal
with because they are so used to manipulating people,”
said Teresa Zielinski, RN, an assessment-intake nurse
at Scripps McDonald Center. Pill addicts often have
gone from doctor to doctor, or bought pills over the
Internet, she said. Some are at the nurses station every
10 minutes, asking for medication. “They think
they’re going to die. They’re exaggerating
their withdrawal symptoms to get another pill.”
The patients can be self-centered, demanding medication
when the nurse is talking to a physician or dealing
with another patient in crisis.
But these frustrating moments also can be used to help
patients deal with their behavior, nurses said. Gottlieb
said he may directly share his feelings with the patients,
telling them, “When you’re at the med room
door every 15 minutes, I feel frustrated.”
Often, he said, they respond by talking about their
fears that they can’t go for more than a quarter
of an hour without knowing they are going to get a drug.
“They’ll start to be able to talk about
what’s really going on with them.”
Zielinski often tells patients that they can’t
take a pill every time someone upsets them and that
they have to learn other ways to cope with their feelings.
“A lot of times they take that as you’re
being mean to them, that you don’t like them.
I’ve been called every name in the book, but you
have to let that go. That’s part of the job.”
Dawn Gessner, RN, a nurse case manager who works with
residential patients at Scripps McDonald Center, said
patients often come to her later to apologize for things
they said during the first part of their stay. “I’m
the big bad person when they first come in, but by the
time they leave they’re kind of joking, saying,
‘I can’t believe I did that to you.’
”
Chemical dependency nurses say it hurts to see someone
relapse, especially someone who seemed to be doing well
for a long time. “You feel bad about it,”
DeLusque said, but part of chemical dependency nursing
is reassessing, trying to figure out what went wrong
and taking a fresh approach.
Zielinski has seen some of her young patients leave
treatment, return to drugs and die. “They’re
so young and they just can’t believe they can
die from this and they do,” she said. “You
feel bad, you process it and you move on. That’s
a reality with this field.”
Mitch said she gets frustrated with patients who come
through detox dozens of times and obviously plan to
return to using drugs as soon as they get out. “But
how can we judge?” she asked. “That’s
the challenge for nursing. That we don’t have
judgment and that we put on a fresh approach every time.”
These patients, she added, are a fraction of the ones
who come to her unit. Most really want to change their
lives and stop taking drugs and alcohol. Watching those
patients turn around, say chemical dependency nurses,
is what makes their work so wonderful.
“I have more hope in chemical dependency nursing,”
said Gessner, who used to work with psychiatric patients,
“because you can see changes over a month. You
can see people really getting it.”
Moore gets annual calls from a man who was a patient
in the treatment center more than 15 years ago. He went
through the program and did everything he was supposed
to do, she said, and is still clean today. “He
calls us on his anniversary,” she said.
One of the greatest rewards of chemical dependency
nursing, say nurses, is the feeling of having a direct
impact on someone else’s life. It’s not
just about dealing with vital signs and dispensing medications
and doing paperwork and making patients feel physically
comfortable, DeLusque said.
“You’re asking, where is your heart? Where
is your soul? You need to find that time to ask those
questions because that’s what you need to find
out what’s going on.
“It’s the heart and the soul that you’re
working on.”
Contact Cathryn Domrose at kaguilar@well.com.
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