Page 41 - Encyclopedia of Nursing Research

8 n ADDiCTioN CARE

of clinical error, and management of care altering substances and behaviors. over
for selected patient groups (Zwarenstein, time, the structure and the function of the
A Goldman, & Reeves, 2009). Although not spe- brain are changed (American Psychiatric
cific to geriatrics only, the data are promising Association, 2000; Angres & Bettinadi-
for improving care for hospitalized elderly Angres, 2008; Kleber et al., 2006; National
given the majority of patients in hospitals are institute on Drug Abuse [NiDA], 2010). The
older adults. individual may begin to display physical,
Historically, elders were not considered to cognitive, and behavioral symptoms. The
be “suitable candidates” for surgeries and treat- course of the disease is marked by periods of
ments that today are considered routine. in the use and abstinence with symptoms of with-
early 1970s, individuals older than 65 years drawal and the development of tolerance.
were excluded from surgical intensive care Frequently, physical and/or additional psy-
units, as it was felt that the cost benefit was not chological disorders are also present.
going to be in favor of the older patient. Today, Historically, substance abuse and sub-
individuals in their 80s and 90s undergo open stance dependence have been classified
heart surgery and require appropriate postop- as psychological disorders. Treatment has
erative care that only a surgical intensive care been typically provided in a psychiatric set-
unit can provide (Silverstein, 2010). ting, but individuals experience a variety of
Ethical issues abound regarding elders symptoms and enter care through many dif-
during a hospitalization. For example, if ferent portals. Nurses are usually the direct
there is an insufficient number of beds in an care provider at all points of entry. This
intensive care unit, should older individu- would suggest that all nurses should have at
als be sent out to the floor before younger least a basic understanding of the disease of
individuals? Are scarce resources allocated addiction. Even so, nursing has seen addic-
to younger individuals before they are used tion care as a specialty on its own or under
to care for the elderly? Further, elder abuse, mental health. There are professional nurs-
a serious and potentially fatal syndrome, is ing organizations dedicated to the specialties
frequently overlooked when elders come into of addictions and psychiatric nursing. The
the hospital with severe symptoms, such as international Nurses Society on Addictions
bilateral bruising, histories incompatible was established in 1975. Addictions nurs-
with injuries, and overt fear of caregivers. ing certifications were offered through the
These issues are a part of ACE and need to Addictions Nursing Certification Board at
be addressed with rigorous research studies. the generalist level (Certified Addictions
Studies involving younger individuals need Registered Nurse) starting in 1989 and at the
to be replicated among older adults to dis- advanced practice level (Certified Addictions
cern differences between the age cohorts. Registered Nurse–Advanced Practice) in
2000. The American Psychiatric Nurses
Terry Fulmer Association has been in existence since 1986.
Sarah Pernikoff in the past few years other nursing
specialty organizations, for example, the
Association of Nurses in AiDs Care and
the American Society of Pain Management
Addiction cAre Nurses, have been adding a focus on sub-
stance abuse disorders because of the comor-
bidity of their disorder with addiction. other
Addiction is usually defined as a chronic, specialty nursing organizations focus on
relapsing brain disease. it is characterized addiction because of the risk for substance
by the compulsive nature of the use of mood abuse or dependence that their members