Michelle D-J

Thanks so much for your thoughtful response!

Drug Abuse Statistics Alcohol abuse, alcoholism, and alcohol use disorder (AUD) kill over 3 million people each year, accounting for up to 6% of global deaths1 1-in-10 Americans over the age of 12 have an Alcohol Use Disorder1 140,557 Americans die from the effects of alcohol in an average year.1 Background The incidence and frequency of encounters with patients experiencing alcohol withdrawal symptoms on the Med/Surg floor were not surprising to me as a new nurse. My background includes growing up in a rural community that was once known to have the highest per capita consumption of alcohol in the state. Unfortunately, I have seen firsthand the effects of alcoholism within the family unit and the generations-long consequences. As nursing students, our class was tasked with attending an AA (Alcoholics Anonymous) meeting in order to augment our studies on alcohol and drug abuse. Polysubstance abuse is more common than not in the adult population and can be hidden behind other signs & symptoms of patients brought to the Emergency Department. Withdrawal symptoms can begin as soon as 8 hours after the last drink. It's crucial to ask when that time was while receiving a handoff report if alcohol abuse is part of the patient's known or suspected history. Thorough and frequent assessments utilizing tools such as CAGE and CIWA2 are invaluable in the nurse's "best practices" orificenal. I share my observations here to hopefully offer insight into the ongoing struggle with addiction of these patients and utilize that understanding to deliver compassionate care as RNs. Attending the Meeting The AA Group Meeting that I attended took place from 7 pm – 8 pm at a local church. The age range of the group seemed to be from the late 40s to the late 60s; there was definitely a sense of familiarity and relationship among the participants who attended. As the speakers were sharing their stories, the mention of familiar local establishments added to the sense of fellowship. When I walked into the group, I initially thought there might not be a lot of sharing. For some reason, I jumped to the conclusion that these looked like "seasoned" AA attendees who were probably just going through the motions of attendance. I was immediately made to feel welcome by almost every one of the attendees. I was offered coffee, handshakes, smiles, and deliberately attentive eye contact. The active nature of my welcome gave me my first hint that I had been wrong to make assumptions. A Common Thread The overwhelming common thread that ran through not only the opening statements of the organization but also through the individual stories was that of humility. There was an enormous acceptance of the fact that "The person is not in charge of the drinking—the drinking is in charge of the person.” They acknowledge that they cannot recover and heal on their own; between God and their "family" in the AA meetings, they take it "One day at a time." I was especially moved by one speaker who was 11 years sober. It wasn't what he shared but rather how little he was able to share as he was still obviously battling his demons. I truly did not realize before attending this meeting that someone would still absolutely crave alcohol after so many years of abstaining. He just kept repeating that he had today, he could not count on tomorrow, and he couldn't let himself even think about taking that first drink. Relationships and Collateral Damage All of the speakers who shared their stories had attended 28-day rehab programs at least twice. The realization that those programs on their own were not cure-alls led them to seek out the safe haven of AA meetings; many said they attended almost daily at some point in their lives. Relationships seemed to be the turning point---whether attending rehab because of the insistence of a loved one or reaching a point of almost turning to violence when a loved one wouldn't give in to the demands for alcohol. One woman shared that after completing a rehab program, she was staying at home with her mother and brother. She started battling with her mother to go to the store and get her some booze. When her mother refused, the woman lunged at her mom, ready to physically take her out because she wanted alcohol so badly. Her brother had to step in before it got really out of control; that's when the woman knew she had to get back into a structured program. Another woman shared how she couldn't believe how hateful alcoholism was and how hateful she was when she was using. She admitted to looking her daughter in the eye and lying over and over again just to get what she wanted. She called herself despicable and manipulative. In fact, the low self-opinion was also a common theme as each person looked back and described their behaviors with family and friends. In the end, each speaker recognized that reliance on God/higher power and their fellow program participants had carried them through to this day and that they were grateful for THIS sober day. Acceptance Although the leader did go around and ask certain members to share, they did so agreeably and without much hesitation. These attendees were not "going through the motions," as I had originally thought. I was struck again and again by the reliance on relationships displayed by the attendees; there was absolute authenticity as they consistently expressed their gratitude for the members of the group. I really came to learn how much of a safety net the group was for each other, not just locally but as part of the consistent structure of the AA program itself. One gentleman took me aside after and shared how he and two other men used to drive all over the state attending meetings and how they would quite often come across the same people in many different locations. It was definitely part of what kept them coming back—familiarity and acceptance. These factors are a crucial and valuable part of the recovery process. Insights While we had learned about the acute signs and symptoms of withdrawal, I had no idea that there was a prolonged period of time where it was almost impossible for the person to really be "present" mentally. Each speaker touched on this in their own way as they described being at the meetings but not really hearing anything; or having conversations with family members and friends but only in body, not mind. One woman shared how it was a miracle to her when she finally retained something she'd heard at a meeting and was able to remember it the next day. Another shared how she was shocked when she woke up one morning and realized that she hadn't thought about drinking at all in the past few days. I truly had no idea that even after rehab programs and months and even years of abstinence that there would still be an all-consuming desire for alcohol. Repetition and redundancy when interacting with the patients who are actively withdrawing may seem frustrating, but it is certainly the cornerstone of accurate and effective ongoing assessments and support. I was really struck by the woman who shared that growing up in an alcoholic family and then turning to alcohol herself left her unable to cope with life skills and social situations from a sober perspective. She had no idea how to deal with day-to-day life without the buffer of being drunk. She believed she was unemployable and unlovable. This type of psychosocial gap is an area that is crucial for the nurse to step in and provide educational and emotional support, as well as advocate for the patient with social services. I have always seen substance abuse as a disease, and believe that it has to be treated from a physical, mental, and spiritual perspective. I was glad to have gained more knowledge of the realities and the ongoing nature of recovery. A concept from the meeting that I already strive to incorporate is that of acknowledging God's grace in my life, which gives me a heart to serve "whosoever" He places in my path—with compassion and without judgment. References/Resources 1 Drug Abuse Statistics: National Center for Drug Abuse Statistics 2 Caring for hospitalized patients with alcohol withdrawal syndrome: Nursing 2020 Critical Care/LWW Journals/Wolters Kluwer Health, Inc.

I think you were absolutely appropriate. I have run into the same situation many times, and it does take some "dancing" to steer some patients back to themselves and the situation at hand... LOL

The EFM course was basically reviewing what we covered when we went over maternity and had the SIM lab. It didn't take as long as I thought it would.....I had really built it up in my mind as a HUGE time commitment but it wasn't. I can't wait to actually put it in practice! 2 clinical days, 3 lectures, 1 final left!!!!!! :-D

WWWOOOOOHHHHOOOOOO Can you believe it is finally HERE????!!!!!!! \0/ 11 days of lecture, 10 days of clinical, and 1 final----MAY 3rd!!!!! What a push it is now at the end....we also have a HESI we have to take, a paper to write, and two other exams before the final. I've also been squeezing in job shadow time on the L&D floor of the hospital an hour away from me, since my school didn't offer an OB rotation and that's my JAM. Last summer I took the NRP, and on January break I did the AWHONN Intro to EFM certification. Whew!!! Anyone else applying for jobs in another state? We have decided to move right after I graduate, so I can gain the maximum experience for a few years before hitting the road as a travel nurse. WE'RE ALMOST THERE!!!!! :-D ~MLDJ1970

Exactly....for example one of our exams covered adult cardiovascular, peripheral vascular disease, respiratory, neurocognitive, abused child, anxiety and crisis, substance related and addictive disorders, and depressive disorders...while at the same time prepping all of our required paperwork (med sheets, diagnostic test summaries, diagnosis sheets, and nursing care plans) for our two clinical days each week... and working on a gigantic nursing process paper that was due a week after that exam. I was just telling my husband I'd rather take 10 regular classes than keep up with the intensity of this program!! =] But I made it...and I'm amazed at how fast this first year flew by!! Just think, at this time next year I'll be doing marching practice for graduation!! (God willing) Good luck with all that you have going on during your "break"!! ~Take care, MLDJ1970

To Leanordsmom: That's a great idea!! I don't know if they have that opportunity here....Good luck on your test and GET SOME SLEEP!!! You've earned it!! =] MLDJ1970

Hello everyone! Thought I'd add my update... Took the final this morning, got an 89 which puts me at an 86 point something for the semester. Our program is not broken down into separate classes, it is all crammed into one and man is it intense!! I can't believe it's half-way done!! We have lost so many people since we all started back in August of last year, did I mention it's intense??!!! =p Anyway, I'm kind of bummed that I couldn't keep it in "A" territory this semester but I'm very grateful to still be in the program. I got good evals from clinical instructors, and I did a solid job on the end-of-semester HESI review (NCLEX prep). I hope everyone pipes up with how they're doing, I love the updates!! Good luck to all, enjoy your summer!! =] MLDJ1970

Congratulations!!! =]

Hey everyone!! IT IS OFFICIAL -- SEMESTER ONE IS DONE!!!! =] =] =] Ended with an A-, and an encouraging final clinical eval in which my instructor said she could definitely see me going on to advanced practice!! (happy dance, happy dance) Can't believe it's already over, but I'm soooooooooooooooo ready for a break!! Anybody want to share some tips they've gleaned from this first semester? I was trying to figure out pros and cons.....I guess a pro would be focus more on the content covered in class as far as parameters of general knowledge....also, don't just know the basics but think of what you'd be seeing if the patient was presenting with signs of whatever it is you're studying. (in other words, don't just study "normal" presentation) Cons? Well, we have several different professors who choose the questions for our tests, and sometimes the wording can be very ambiguous. I've learned the hard way---don't OVERthink it!! Also, keeping previous exam notes/lessons sorted by topic is a good idea for studying for the comprehensive final. Anyone else? =] Merry Christmas to everyone (says the girl who hasn't even put up a tree or anything yet!!) ~MLDJ1970

Hello all!! Glad to hear how everyone is getting into their groove!! =] My first exam is tomorrow, at our school we have four exams plus the final; and a Lab exam we have to pass in November in order to move onto Acute Care clinicals. We also have the math test that we have to get a 100 on around the same time. Friday was our first day in the hospital, to get familiar with the floor and read our assigned patient's chart. Then we got to briefly say hello to them; we will be there for the next 6 Fridays (this is our LTC rotation). There is a lot of material that gets covered, but I have to say I'm pretty impressed with the prep work our instructors go through. Every one I've met so far is very invested in our success!! =] I hope I am still feeling this good after tomorrow!! lol =p Keep posting, fellow 2017 graduates!! WE CAN DO THIS!!! =] God Bless~MLDJ1970

Join the FB group "Travel Nursing Newbies"....also, "Full-time RVers"....lots of travel nurses with RVs on both sites!! I just joined myself, as hubby and I are planning on doing the same thing as soon as I gain enough experience after graduation to feel comfortable jumping in to a new environment! God Bless~MLDJ1970

krrbrr, You're already a CNA? You most definitely have a leg up! You're already familiar with interacting with patients, and you have a familiarity with equipment and terminology that we newbies are totally jealous over!! =] So many of the students in my class are nervous about talking to a "real" person!! lol Play to your strengths, and work on your weaknesses--You'll be fine! God Bless~MLDJ1970

NursingNicole, Not sure what kind of student you are, but if they have provided any type of syllabus or pre-reading assignments that will give you a heads up on the kind of prep work they expect. Not so much in the lectures, but definitely in the lab, they expected us to have already looked at the procedure in Perry and Potter, and to have watched the videos that come with the publisher's site BEFORE stepping in to the lab. Best hint I can give is something my friend just said yesterday: "If you're working on schedule you are actually behind!" In other words, do as much prep work (reading, going over procedures, papers) as you can. Good luck!! Keep us posted! God Bless~MLDJ1970

Hello all, Week One is officially done! =] Much less stressful than I had anticipated...when they gave us the summer reading, I was definitely under the impression we were going to be tested over it right from the beginning. Not so....we have had a decent week of orientation, already some lectures but also some time to get acclimated to course expectations, scheduling, clinical groups, etc. Had our first actual lab time today in scrubs for the last half of the day; practiced hand hygiene, sterile gloves, sterile field, and PPE. Absolutely wiped after being back at it early each day after a more laid-back summer ( only three classes, two online). Still processing it all, trying to figure out how to logistically carry/manage materials, study time....Oh I should let you know I had my husband cut off the binding to my Fundamentals book, so I could 3-hole punch and carry only those chapters we needed to go over this week. Everybody was oohing and aahhing over it in class!! =] He was so nervous, he had to practice on an old cookbook first!! lol He recommends placing the book between two boards, screwing those boards together to clamp the book, then putting the whole thing through a table saw. RELAX PEOPLE---WE GOT THIS!!! =] Keep checking in, I'm looking forward to hearing about everyone's experiences!! God Bless~MLDJ1970