Nursing · Mental health nursing
Nearly every avoidable death here involved somebody who was not asked a question, or who was treated badly enough that they left
In the exams: NCLEX-RN: Psychosocial Integrity (6–12%)
Tobacco and alcohol together cause far more deaths each year than all illegal drugs combined, so any nurse who thinks of this subject as being about heroin has the proportions badly wrong. Withdrawal, liver disease, overdose, injection site infection, pancreatitis, injury and confusion bring people who use substances into general hospitals constantly — and unrecognised alcohol withdrawal causes fits, delirium and death in patients admitted for something else, which makes it one of the clearest preventable hospital deaths caused by not asking a question. Attitudes then decide the rest: people who use substances are treated worse in healthcare than almost any other group, which makes them avoid or leave it, and they die of things that were treatable. That is a nursing problem because nurses are most of the contact. And most people who develop a substance problem eventually stop or moderate, which is worth holding in mind while speaking to somebody in the middle of it.
Tobacco and alcohol together cause an enormous number of deaths each year, far more than all illegal drugs combined. Any nurse who thinks of this subject as being about heroin has the proportions badly wrong.
Withdrawal, liver disease, overdose, injection site infection, chest disease, injury, pancreatitis, heart failure and confusion all bring people who use substances into general hospitals constantly. Recognising withdrawal is a general nursing competence.
Unrecognised alcohol withdrawal causes fits, delirium and death in patients admitted for something else entirely. It is one of the clearest examples of a preventable hospital death caused by not asking a question.
People who use substances are treated worse in healthcare than almost any other group, which makes them avoid or leave it, and they then die of things that were treatable. That is a nursing problem because nurses are most of the contact.
Most people who develop a substance problem eventually stop or moderate, frequently without formal treatment. Holding that in mind changes how a nurse speaks to somebody in the middle of it.
Repeated use changes the brain's reward and stress systems so that the substance becomes prioritised over things that previously mattered, and stopping produces genuine physical and emotional distress. It is not a failure of character.
Needing more for the same effect, needing the substance to avoid withdrawal, and compulsive use that continues despite harm are three separate things. Conflating them causes both unnecessary fear of medical opioids and misjudgement of patients.
Most people who drink, and most who try drugs, do not become dependent, and the minority who do differ in genetics, trauma history, mental health, poverty and circumstance. Substance exposure alone is a poor predictor.
Places, people, objects, moods and times of day trigger craving long after use stops, which is why relapse frequently happens in familiar surroundings. Understanding that makes relapse comprehensible rather than baffling.
Dependence behaves like other long-term relapsing conditions, with periods of control and periods of deterioration, and it is treated as such. Expecting a single treatment episode to be curative sets everybody up for failure.
Substances relieve pain, anxiety, trauma memories, sleeplessness, grief, boredom and hunger, and they work immediately. Asking what it does for somebody is the most useful question in the subject.
Childhood adversity, abuse, neglect and violence are strongly associated with later substance problems, and people frequently describe using as the first thing that made the feelings bearable. Treating the substance without the trauma rarely holds.
Unemployment, poor housing, chronic pain, isolation and hopelessness drive use, and people in those circumstances are then blamed for it. Addressing circumstances changes use more than exhortation does.
Anxiety, depression, psychosis and attention difficulties commonly precede substance use, which is frequently an attempt to manage them. Treating one and ignoring the other reliably fails.
People also use substances because they enjoy them, in the same way they enjoy other risky pleasures, and pretending otherwise makes the clinician sound dishonest. Acknowledging it preserves credibility for everything else.
Describing somebody as an addict, an alcoholic, a user or dirty changes how colleagues treat them, and studies show clinicians recommend more punitive responses when stigmatising language is used. This is measurable, not theoretical.
A person who uses drugs, a person with alcohol dependence, a positive test rather than a dirty one. It takes no longer and it changes the encounter.
People who use substances report being examined less thoroughly, having pain disbelieved, being discharged early, and being spoken about within earshot. Those experiences are why they present late and leave against advice.
A person who uses drugs with abdominal pain, confusion or breathlessness is assumed to be intoxicated or seeking, and their heart infection, bleed or sepsis is found late. The bias has a body count.
Whether a condition was self-inflicted is not a clinical consideration, and applying it to substance use while not applying it to diet, driving or sport reveals it as prejudice rather than principle.
Asking every patient about alcohol, tobacco and other substances, as an ordinary part of a history, finds what selective asking misses. Deciding who to ask on the basis of appearance is both inaccurate and offensive.
Quantity, frequency, what and when, in their own terms — bottles, cans, grams, how many times a day. A question about whether they drink much produces nothing usable.
Almost everybody understates, for good reasons including judgement, consequences and shame. Accepting the first figure and doubling nothing is naive; asking again later, neutrally, usually produces a truer picture.
A flat, unsurprised, non-judgemental question gets an honest answer, and a raised eyebrow does not. This is a learnable technical skill and it determines the entire clinical picture you work from.
What they take matters enormously for withdrawal, interactions and pain management, and it must be recorded, while remembering that notes are read by many people and can cause harm outside the consultation.
Alcohol causes a very large number of deaths annually and harms across almost every organ, plus injury, violence, road deaths and fetal harm. Its legality has no bearing on its toxicity.
Risk rises with amount and with pattern, and heavy episodic drinking carries particular acute risks. There is no threshold below which alcohol is known to be entirely without risk, which is worth saying plainly.
Liver, pancreas, stomach, heart, brain, nerves, bone marrow and the immune system, plus cancers of the mouth, throat, oesophagus, liver, bowel and breast. The cancer link is poorly known by the public.
There is no established safe amount in pregnancy, and exposure can cause permanent physical, learning and behavioural effects in the child. The message is clearest when it is stated without blaming women who drank before knowing.
Most people who drink too much are not dependent, and brief, non-judgemental feedback and advice measurably reduces drinking in that group. That conversation is one of the highest-value few minutes in nursing.
Fat accumulation, then inflammation, then scarring that is irreversible. The early stages are silent and reversible, which is why finding them matters, and abnormal liver blood tests in a drinker are an opportunity rather than a formality.
Jaundice, fluid in the abdomen, confusion, bleeding from swollen veins in the gullet, and infection. Each is life-threatening and each is recognised by nurses before anybody else.
A liver that cannot clear toxins causes drowsiness, confusion, reversed sleep pattern and a characteristic tremor, and it is frequently mistaken for withdrawal or intoxication. Treating it wrongly is dangerous.
Vomiting large amounts of blood from swollen veins is a catastrophic emergency in liver disease, and survival depends on immediate recognition and resuscitation. Any drinker vomiting blood is treated as this until shown otherwise.
Alcohol is a leading cause of pancreatic inflammation, which causes severe pain, vomiting and sometimes critical illness, and repeated episodes destroy the gland causing diabetes and malabsorption. The pain is genuinely extreme.
Tremor, sweating, anxiety, nausea, a fast pulse and agitation start within hours of the last drink and peak over the first day or two. A patient admitted at midnight is withdrawing by morning.
Withdrawal can progress to fits and to a severe confusional state with hallucinations, fever and cardiovascular instability that carries a real mortality. Untreated, it is one of the most dangerous conditions on a general ward.
Withdrawal seizures typically occur in the first day or two and may be the first sign anybody notices. A fit in a newly admitted patient is a reason to ask about alcohol urgently.
Appearing a couple of days after the last drink, with disorientation, vivid hallucinations, tremor, fever and a racing pulse. It requires treatment, fluids, a calm environment and close observation, and it is not managed by reassurance.
Every preventable withdrawal death began with nobody asking how much somebody drinks. The question takes ten seconds and it is the single most valuable item in this manual.
Heavy drinking, poor diet and impaired absorption deplete thiamine, and deficiency causes a brain injury with confusion, unsteadiness and abnormal eye movements. Untreated it becomes a permanent, disabling memory disorder.
The classic three features are often not all present, and confusion alone in a drinker may be the only sign. Waiting for the full picture is how the permanent form is produced.
Giving glucose to a thiamine-depleted person can precipitate the injury, which is why thiamine is given first or alongside. This is a specific, memorable and important sequence.
Thiamine replacement is cheap, safe and effective, and the disability it prevents is lifelong and expensive. Failing to give it to a drinker who is admitted is a recognised omission.
The resulting memory disorder leaves people unable to form new memories, filling gaps with invented accounts, and frequently needing lifelong care in their forties. It is entirely preventable.
Opioids relieve pain and produce a sense of wellbeing and calm, and they also suppress breathing, which is the mechanism of every opioid death. Both effects come from the same action.
Someone who has not used for a period — after prison, hospital or detoxification — loses tolerance and can die from an amount they previously took daily. That single fact explains a large share of overdose deaths.
Opioid problems arise from prescriptions as well as from illegal supply, and people move between them depending on availability and cost. Treating them as separate populations misunderstands the problem.
Extremely potent synthetic opioids appearing in the drug supply, frequently without the user's knowledge, have driven very large increases in overdose deaths. Users may have no idea what they have taken.
Opioid withdrawal is intensely unpleasant — aching, sweating, diarrhoea, vomiting, agitation, insomnia — and although rarely directly fatal in a healthy adult, it drives people to use and to leave hospital. Treating it is why people stay for treatment.
Slow or absent breathing, unrousable, small pupils, blue lips, snoring or gurgling. It is the breathing that kills, and it is the breathing that is watched.
A specific antidote reverses opioid overdose rapidly and has a shorter duration than many opioids, so somebody who woke up can stop breathing again. They are observed rather than allowed to walk away.
Airway, breathing support, oxygen and calling for help. The antidote is part of the response rather than the whole of it, and a blocked airway is not solved by a drug.
Supplying the antidote to people who use drugs, their families and hostel staff prevents deaths, because bystanders are present at most overdoses and ambulances are not. Teaching its use is a legitimate nursing intervention.
Someone is usually present, and whether they call for help — which fear of police may prevent — determines survival. Telling people plainly what to do, and that calling is what matters, is worth the conversation.
Long-acting opioid medicines given under supervision substantially reduce deaths, injecting, crime and infection, and keep people in contact with services. It is among the best-evidenced treatments in medicine and remains widely resented.
A stable, prescribed, known dose taken regularly allows somebody to work, parent and live, which an unpredictable illicit supply does not. That distinction is the entire rationale and it is frequently not understood by staff.
An admitted patient's substitution treatment must be confirmed and continued, and stopping it precipitates withdrawal, self-discharge and relapse. Confirming the dose with the prescribing service is urgent rather than routine.
People who use drugs leave hospital before treatment is complete largely because withdrawal is not managed. Treating it adequately is how an infected heart valve or a bone infection actually gets treated.
Leaving substitution treatment, particularly abruptly or on release from prison, is associated with a sharply raised risk of death. Continuity at those transitions is where lives are saved.
Repeated injection scars and closes veins, and causes abscesses, cellulitis, ulcers and deep infections. People move to more dangerous sites — groin, neck, feet — as veins fail, with correspondingly worse complications.
Infection of a heart valve, bone infection, blood poisoning, and rarely tetanus and botulism from contaminated supply. A person who injects with a fever needs serious assessment rather than assumption of withdrawal.
Access to sterile needles, syringes and other equipment substantially reduces transmission of blood-borne viruses, and it does not increase drug use. The evidence on this is settled and the political resistance is not.
Not sharing anything, using a new needle each time, hand washing, not injecting into the groin or neck, rotating sites, and not injecting alone. Giving this advice is harm reduction rather than encouragement.
Injection-related wounds are frequently treated dismissively, and people then present with advanced infection. Cleaning, dressing and assessing them properly, with adequate analgesia, is basic care that is regularly withheld.
Hepatitis C, transmitted by shared injecting equipment, can be cured with a short course of tablets in the great majority of people. Very many people who could be cured have never been offered testing.
Vaccination prevents hepatitis B, and people who inject drugs, their partners and household contacts should be offered it. It is cheap, effective and routinely not offered.
With treatment, people with HIV live normal lifespans and become unable to transmit it. Testing, and linking people to treatment, is therefore among the highest-value things a nurse can do.
Routine, matter-of-fact offering of testing to anybody who has ever injected finds infection that selective testing misses. A person who declines today may accept next time if the offer was not awkward.
People who are still using drugs can be treated successfully for hepatitis C and HIV, and requiring abstinence first excludes precisely the people who most need treatment. That requirement is not evidence-based.
Cocaine, amphetamines and related drugs produce alertness, confidence, energy and euphoria, followed by a crash with exhaustion and low mood. The crash drives repeated use.
Stimulants raise blood pressure and heart rate and can cause heart attack, abnormal rhythms, stroke and aortic tear, including in young people with healthy arteries. Chest pain in a stimulant user is taken seriously.
Severe agitation with a very high temperature, rapid pulse and confusion is a medical emergency, and cooling and sedation are needed urgently. It occurs particularly with stimulants taken while dancing in hot environments.
Stimulants can produce paranoia, hallucinations and violent agitation that resolves as the drug clears, and may also precipitate lasting psychotic illness. Distinguishing drug-induced from primary psychosis takes time rather than a single assessment.
Unlike opioids, there is no established replacement medicine for stimulant dependence, so treatment is psychological and social. That gap is significant and is worth being honest about.
Gambling disorder involves the same reward pathways as substance dependence, causes debt, relationship breakdown, suicide risk and concealment, and is almost never asked about in healthcare. A person with unexplained financial crisis and depression may be gambling, and the question is worth posing.
Cannabis is the most widely used controlled drug worldwide, is increasingly legal in some places, and its strength has risen substantially, which changes its risk profile.
Heavy use, particularly of strong preparations and particularly starting in adolescence, is associated with a raised risk of psychosis and with anxiety and low motivation. The association is strongest in the young.
Regular users can become dependent and experience withdrawal with irritability, sleep disturbance, appetite change and craving. Many people are surprised by this because cannabis is widely described as non-addictive.
Cannabis smoked with tobacco produces nicotine dependence and the respiratory harms of smoking, and people who stop cannabis frequently continue smoking. Addressing both is more useful than either alone.
Long-term heavy use can cause recurrent severe vomiting relieved by hot showers, which is frequently investigated for years before anybody asks about cannabis. It is a specific and under-recognised presentation.
Sedative medicines of the benzodiazepine group produce tolerance and dependence within weeks, which is why they are intended for short-term use. Many people have been taking them for decades.
Stopping these medicines abruptly, particularly after long-term use, can cause fits and a severe confusional state similar to alcohol withdrawal. They are reduced gradually, over months if necessary.
Taking sedatives with opioids markedly increases the risk of fatal respiratory depression, and the combination is present in a large proportion of overdose deaths. Warning people about it specifically is worthwhile.
Dependence on prescribed sedatives, painkillers and stimulants is common, frequently unrecognised, and carries shame because the person did nothing wrong. They need help rather than accusation.
Tablets bought online may contain different drugs, wrong doses or synthetic opioids, and the person believes they are taking a known medicine. That uncertainty is now a major cause of death.
Tobacco kills an enormous number of people annually and a substantial proportion of long-term smokers die of it. Nothing else a nurse can raise in a short conversation has a comparable effect.
Nicotine dependence is powerful, withdrawal causes irritability, poor concentration, low mood and craving, and most attempts to stop fail. That is a reason for support rather than for judgement.
Combining behavioural support with medication substantially increases the chance of stopping compared with willpower alone. Simply asking whether somebody wants help, and referring, is the intervention.
Very brief advice from a health professional measurably increases quit attempts, and it takes under a minute. Repeating it at each contact, without nagging, is what works over time.
Vaping is substantially less harmful than smoking and helps some people stop, and it also creates nicotine dependence in young people who would never have smoked. Both statements are true and the advice differs by who is asking.
Inhaling solvents, aerosols, gases and nitrous oxide is commonest in younger teenagers, is cheap and legal to buy, and can kill suddenly on a first occasion through heart rhythm disturbance or suffocation. Heavy nitrous oxide use also causes nerve damage with numbness and unsteadiness that is regularly investigated for months.
Reducing the harm of substance use without requiring somebody to stop, on the grounds that keeping people alive and well is the precondition for everything else. It is pragmatic rather than permissive.
Someone kept alive, uninfected and in contact with services can recover later, and someone who is dead cannot. Framing harm reduction as abandoning hope inverts the actual logic.
Sterile equipment, the overdose antidote in the community, substitution treatment, testing and treating infections, safer use advice, wound care, and treating people well enough that they come back.
Advice about pacing, eating, not swimming, not driving, thiamine, and switching from smoking to less harmful nicotine are all harm reduction, and they are uncontroversial when the substance is legal. The inconsistency is revealing.
Harm reduction and abstinence-oriented treatment are not opposed, and many people move between them over years. Insisting on one for everybody is the error.
Almost everybody who dies of an overdose was using alone or with people who did not call for help. Telling somebody to have another person present, to leave a door unlocked, to use less of an unknown supply and to test a small amount first is practical advice that keeps people alive to recover later.
Structured psychological approaches, motivational work and contingency-based approaches all have evidence, and they work better when somebody is not simultaneously homeless, unwell and untreated for withdrawal. Sequencing matters.
Medicines exist that reduce craving, block effects or make drinking unpleasant, and substitution treatment for opioids. Many people have never been told these exist.
Peer-based recovery groups help a substantial number of people, are free, and are available where formal treatment is not. Not everybody finds them helpful, and mentioning them is worth doing.
Stable housing, income and occupation predict recovery more strongly than most clinical interventions. Treatment that ignores them is treating in a vacuum.
People who recover consistently describe one person who treated them decently and did not give up on them. That is not sentimental; it is the most frequently cited factor in recovery accounts.
Most people relapse at least once, and treating it as failure produces shame, concealment and disengagement. Framing it as information about what needs changing keeps people in treatment.
Relapse after a period of abstinence carries a high risk of fatal overdose, because tolerance has fallen while the usual dose has not. Everybody leaving detoxification, hospital or prison needs telling this explicitly.
Familiar places and people, stress, pain, celebration, bereavement, and unstructured time. Identifying an individual's triggers in advance is practical work that reduces relapse.
People who relapse frequently do not return because they are ashamed, and saying in advance that they will be welcomed back is what makes returning possible. That sentence is a clinical intervention.
Periods of abstinence, even short ones, are associated with better long-term outcomes rather than being worthless. Saying so counters the belief that a relapse undoes everything.
What, how much, how recently, and whether they are on prescribed substitution treatment. Without that, withdrawal is missed, treatment is interrupted and the admission fails.
Self-discharge in this group is largely driven by untreated withdrawal and untreated pain, and the person then dies of the infection they came in with. Managing withdrawal is what makes the rest of the treatment possible.
Confusion, drowsiness, agitation or abnormal behaviour in a person who uses substances may be head injury, low glucose, sepsis, liver failure, low sodium or withdrawal. Assuming intoxication is how these are missed.
Someone with damaged veins may be extremely hard to cannulate, and repeated failed attempts are painful and humiliating. Early involvement of somebody skilled, and protecting any access obtained, is practical respect.
Housing, substitution treatment continuity, the overdose antidote, follow-up for infection, and somebody to contact. Discharging to the street without those undoes everything the admission achieved.
Someone tolerant to opioids requires higher doses for the same analgesic effect, and their usual dose or substitution treatment maintains baseline without providing any analgesia. Both facts are routinely got wrong.
Substitution treatment is continued and additional analgesia given on top for acute pain. Assuming the substitute covers a fractured femur is a common and cruel error.
Clinicians withhold analgesia to avoid being deceived, and the result is that people in genuine severe pain suffer. Occasionally being wrong about a request is a smaller harm than routinely undertreating pain.
Simple analgesia, anti-inflammatories, regional blocks, positioning and non-drug measures alongside opioids, which reduces the opioid requirement and treats the pain better. A single-agent plan is inadequate here particularly.
Explaining what analgesia will be given, how often, what happens if it is insufficient, and that their substitution treatment continues, removes the anxiety that produces conflict. Most disputes here are about uncertainty.
Mental illness and substance use coexist very commonly, each worsens the other, and services frequently refuse to treat either until the other is addressed. That gap leaves the most unwell people with nothing.
People self-medicate symptoms and substances cause symptoms, and untangling it in a crisis is neither possible nor necessary. Treating both simultaneously is the answer.
Psychosis, depression and suicidal thoughts in somebody who uses substances are treated as real, because they are. Dismissing them as drug effects is a documented route to a death.
Substance use markedly increases suicide risk, particularly with alcohol, which also removes inhibition at the moment of crisis. Asking directly about suicide in this group is essential rather than optional.
People who use substances can be treated effectively for mental illness, and withholding treatment until abstinence is achieved excludes the people who most need it. That precondition is not evidence-based.
Pregnant women who use substances avoid antenatal care because they fear having the baby removed, and late or absent antenatal care is the main cause of poor outcomes. Reducing that fear is the clinical intervention.
Accurate information about each substance's effects, what help exists, and what will and will not happen regarding their baby. Vagueness about the last point drives the avoidance.
Sudden opioid withdrawal in pregnancy carries risks to the pregnancy, which is why substitution treatment rather than detoxification is generally advised. Stopping abruptly is not the safe option people assume.
Alcohol causes permanent physical, learning and behavioural effects, with no established safe amount, and it is legal and normalised. The message is given without shaming women who drank before knowing they were pregnant.
Continuity, a named person, flexible appointments, and not punishing missed ones. Women who stay in antenatal care have far better outcomes, and every part of the system that makes attending harder costs babies.
Babies exposed to opioids and some other substances before birth develop withdrawal over the first days, with irritability, high-pitched crying, tremor, poor feeding, sweating, sneezing, diarrhoea and sometimes fits.
Withdrawal is scored systematically because the features are non-specific and the decision to treat depends on severity and trend. Consistent assessment between nurses is what makes the score meaningful.
Reduced light and noise, swaddling, holding, skin-to-skin contact, frequent small feeds and minimal handling reduce severity substantially and reduce the need for medicine. Keeping mother and baby together helps most.
Breastfeeding is generally supported for women on stable substitution treatment, reduces withdrawal severity, and is one of the few things a mother in this situation can do that is unambiguously good. Discouraging it wrongly is common.
Separation worsens withdrawal, damages feeding and bonding, and is sometimes done for convenience or as an implied punishment. Where safeguarding requires it, that is explained rather than enacted silently.
Most adolescent substance use is occasional and will not become dependence, and treating every instance as addiction destroys credibility. Identifying the minority in difficulty is the task, and function rather than substance defines it.
Earlier onset is associated with heavier use and greater harm, and developing brains are more affected by alcohol and cannabis. That is a more persuasive argument to a young person than a warning about middle age.
Alcohol and prescribed sedative problems in older people are common and almost never enquired about, presenting instead as falls, confusion, incontinence and poor nutrition. A drinking history in a confused older person finds a great deal.
Reduced body water, slower metabolism, more medicines and greater brain sensitivity mean a long-standing drinking pattern becomes harmful without changing. The person has not changed; their body has.
Late-onset drinking frequently follows loss, retirement, pain or loneliness, and it responds well to treatment when anybody notices it. Nobody expects it, which is why nobody finds it.
Partners and children of people with substance problems experience financial hardship, unpredictability, violence, neglect and constant anxiety, and they receive almost no support. They are patients too.
A clinician treating an adult should know whether children live with them and how they are, and that question is asked as a matter of course rather than as an accusation. It is frequently never asked at all.
Children in these households take on caring, cover for their parent, miss school and keep the secret, and they are rarely identified. A young person providing care for a parent needs help in their own right.
Families who are informed, supported and not blamed are better able to help, and interventions aimed at them have their own evidence. Treating relatives as an obstacle is both unkind and ineffective.
Substance use alone does not mean a child is unsafe, and assuming it does drives families away from help. Assessing the actual care the child receives is the standard, and the balance is genuinely difficult.
Substance problems, homelessness, imprisonment, mental illness and poverty compound one another, and the people affected have the worst health outcomes of any group and die decades early. Treating one element alone rarely works.
The weeks after release from prison carry a sharply raised risk of drug death, because tolerance fell inside and support outside is absent. Continuity of substitution treatment and antidote supply at release prevents deaths.
Chest disease, liver disease, infection, injury and overdose, frequently after being turned away from or leaving services. Outreach and flexible, low-threshold services reach people that appointment-based ones cannot.
No phone, no address, no transport, no money, nowhere to keep medicine, and more urgent daily problems. Non-attendance recorded as disinterest is almost always something else.
Services that do not require abstinence, punctuality or an address reach the people at highest risk. That design choice, rather than any new treatment, is what closes the mortality gap.
Drug-related deaths have risen substantially in many countries, driven by synthetic opioids, an ageing cohort with accumulated damage, and services that are hard to reach. Most of these deaths are preventable.
Substitution treatment continued without interruption, the overdose antidote in the hands of people who will be present, sterile equipment, treatment of infections, and not using alone. Every item is unglamorous and evidence-based.
Alcohol kills far more people than illegal drugs, mostly slowly and unremarked, and attracts a fraction of the attention. Liver disease deaths in young and middle-aged adults have risen markedly.
Leaving prison, leaving hospital, completing detoxification, dropping out of treatment, and a recent non-fatal overdose. Each is an identifiable moment where a specific intervention prevents a death.
Someone who has survived an overdose is at markedly raised risk of a fatal one, and that contact is one of the best opportunities in the whole subject. Discharging them without an antidote and a conversation wastes it.
The useful question is not whether you consider yourself non-judgemental, but how you actually behave when the fifth admission of the same person arrives. Honest self-examination is more useful than a stated value.
Repeated relapse, self-discharge and aggression are genuinely wearing, and the feeling is legitimate while its expression is not. Naming it among colleagues is better than leaking it at the patient.
Healthcare workers develop alcohol and drug problems at rates comparable to the general population, with additional risks from access, stress and shift work, and they are terrified to disclose because of their registration.
Covering for a colleague who is impaired endangers patients and prolongs their illness, and reporting through the proper route is the supportive action rather than the hostile one. Most professional bodies have supportive routes.
People do recover, frequently after many attempts, and they consistently name somebody who did not give up on them. Being that person occasionally is the reason this speciality retains anybody.
Recognising and preventing alcohol withdrawal; thiamine before glucose; lost tolerance after abstinence; continuing substitution treatment in hospital; pain management in opioid-tolerant patients; and overdose recognition.
Not asking about alcohol on admission; waiting for the full picture before giving thiamine; assuming confusion in a drinker is intoxication or withdrawal without excluding other causes; stopping a patient's substitution treatment; assuming substitution treatment provides analgesia; letting somebody walk away after the overdose antidote wore off; requiring abstinence before treating hepatitis C or mental illness.
Ask everybody about alcohol. Give thiamine. Continue substitution treatment and add analgesia on top. Watch the breathing in overdose and observe after the antidote. Treat withdrawal so the real treatment can happen.
Ask how much, in their own units. Ask what it does for them. Ask whether children live with them. Say they will be welcomed back. Explain the plan out loud. Tell everybody leaving abstinence that their tolerance has fallen.
Nearly every avoidable death in this manual involved somebody who was not asked a question, or who was treated badly enough that they left. Both of those are entirely within a nurse's control.
Written in plain sentences on purpose. Nursing is studied in a second language by a large share of the students who will read this, and a sentence that has to be decoded twice is a sentence that teaches less.
These are the twelve questions written with this SUNYRA nursing manual, to check what it teaches. They are not past papers and were not written to any one examination's pattern; an examination tag means only that the examination's published blueprint covers this subject. Difficulty was not graded in the source, so every question is marked medium.
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