Page 43 - Encyclopedia of Nursing Research

10 n ADDiCTioN CARE

health, substance abuse, and primary care. an evidence base to provide guidance in set-
Consideration is being given to understand- ting and achieving specific outcomes from
A ing the dynamics of different populations treatment approaches in all practice settings
in the development of treatment approaches has given nursing the opportunity to be rep-
and guidelines. resented in interdisciplinary networks in any
Just as the theoretical understanding of practice setting that nurses choose for their
addiction as a disease process shaped the specialty. That has led to nursing represen-
field’s understanding of addiction, so has the tation on the National Quality Forum Task
theoretical approach to treatment changed in Forces, panels established by the Agency for
an effort to increase credibility and meet the Healthcare Research and Quality (2006) and
demands of the current climate. With increas- the Center for Substance Abuse Treatment,
ing health care costs and declining quality, researchers for organizations, agencies,
the institute of Medicine (ioM) produced facilities, and government programs, and
Crossing the Quality Chasm (ioM, 2001) and as authors for educational and professional
Improving the Quality of Health Care for Mental publications.
and Substance-Use Disorders (ioM, 2006). The goals of nursing and addiction care
These two documents recommend develop- research are closely aligned because they
ing a health care system that is safe, effective, are based on clinically relevant research and
patient-centered, timely, efficient, and equita- clinical expertise guided by the unique pref-
ble and serve as the framework for a redesign erences of the patient (ioM, 2001; McCarty,
of the health care system on the basis of six 2010). According to the National Quality
goals: (1) adapting care delivery to the new Forum (2007), research to this point has
process; (2) effective use of information tech- focused on four general areas: identifying
nology; (3) workforce adaptation and man- substance use conditions, approaches for
agement; (4) effective teaming of providers initiating and engaging participation, ther-
and coordinating care according to patient apeutic interventions, and coordination of
conditions, services, and settings; (5) measur- care. Some of the changes are integrated
ing quality; and (6) quality-based payment screening; protocols for addressing posi-
(ioM, 2001; Pincus et al., 2007). one of the tive screens, brief interventions, and refer-
changes that has risen from these recommen- rals; treatments and pharmacotherapy based
dations has been evidence-based research for on empirical data; and established perfor-
evidence-based practice. Although other def- mance and outcomes measurements (Baird
initions exist, the most widely accepted nurs- & Fornili, 2008; McCarty, 2010). Federal proj-
ing definition of evidence-based practice is ects are addressing integrated treatment for
that of Porter-o’Grady. Evidence-based prac- comorbid mental health and substance abuse
tice includes the integration of best research disorders; Screening, Brief intervention and
evidence with clinical expertise and patient Referral to Treatment for primary care pro-
values (Boswell & Cannon, 2009; Malloch & viders; clinical nursing guidelines for the use
Porter-o’Grady, 2006; McCarty, 2010). of suboxone; clinical guidelines for opioid
The social changes after World War ii addiction treatment; and issues with addic-
identified the need for nursing research in the tion and criminal justice.
1950s. Priorities began to be set, and master’s The evidence-based research and the
and doctoral programs for nurses became use of evidence-based practice are in their
available. Research focused on clinical prac- infancies for nursing and the addiction
tice, quality improvement, and establishment field. Resistance comes from concerns that
of evidence-based guidelines and standards approaches are simplistic and manualized.
of care (LoBiondo-Wood & Haber, 2006). Empirically based treatment needs to be
Now in the twenty-first century, the call for able to address all issues associated with