ensure positive outcomes after adversity. As discussed by Earvolino-Ramirez in the third wave of resilience inquiry, there is a component of resilience that is inherent to certain individuals, com- monly described in the literature as self-determination.
Self-determination is the innate belief of an individual that he or she can overcome any chal- lenge, therefore, protecting the individual from feelings of hopelessness and despair during a time of adversity (Earvolino-Ramirez, 2007). Self-determination, in isolation, is not enough to facilitate resilience. Rather, self-determination allows individuals a more positive disposition when navigat- ing an intervention program. Equally important is the presence of at least one positive relationship or meaningful social support (Earvolino-Ramirez, 2007).
Early studies of resilience in children typically noted at least one positive adult relationship (Earvolino-Ramirez, 2007). As Earvolino-Ramirez expanded research on resilience to include adults, at least one positive relationship with another person remained consistent with positive outcomes after adversity. Another common theme Earvolino-Ramirez identified in the literature was the presence of enhanced coping mechanisms. Enhanced coping mechanisms include flexibil- ity and a sense of humor (Earvolino-Ramirez, 2007).
and reintegration back into the profession (Fogger & McGuinness, 2009). Resilience also identifies the need for at least one positive relationship (Earvolino-Ramirez, 2007). Nurses are responsible for narcotic distribution to prescribed individuals under their care. Thus, the nurse in recovery from ad- diction must possess self-determination. Self-determination is the feeling that you can overcome any obstacle to succeed (Earvolino-Ramirez, 2007). Having access to narcotics is a large obstacle to recov- ery from addiction. Nurses recovering from substance abuse issues need to possess a firm belief that they will be able to overcome this temptation and persevere with help from their social support system.
The prevalence of substance use disorders among nurses has implications for the nurse prac- titioner in both the colleague and the provider role. If the nurse is working closely with the nurse practitioner, work relations and dynamics may be affected negatively. Behaviors often associated with substance use among nurses include increased mood swings, being uncooperative with staff, carelessness, complaints regarding poor patient care, and marked nervousness (Monroe & Kenaga, 2010). The nurse working while under the influence of substances could increase the risk for med- ication errors and impair nursing judgment, which would result in potential harm and poor out- comes for the patient. One researcher suggested that education and an awareness program could improve abilities of workplace peers to recognize cues such as changes in nurses’ physical or emo- tional condition, the use of pain medications documented in patients’ charts, and repeated absen- teeism and/or excessive tardiness (Cares et al., 2015).
If the nurse practitioner recognizes any of the aforementioned behaviors in a nurse colleague, it may warrant reporting. If the nurse practitioner identifies substance use behaviors in a patient or colleague, coaching on enhanced coping mechanisms could be a useful tool in conjunction with other recovery therapies. Enhanced coping mechanisms are routinely demonstrated in resilient in- dividuals (Earvolino-Ramirez, 2007).
The nurse practitioner may be either directly or indirectly impacted by these behaviors. While the work relationship may suffer, an important role of the nurse practitioner is to be aware of the risk for potential harm to patients. Nurses with substance use disorders may withhold controlled substances from the patient, including narcotic pain relievers or benzodiazepines, for their own use. As a result, patients may verbalize increasing complaints of pain or anxiety, and dissatisfac- tion with the provider.
Nurse practitioners have the unique opportunity to develop relationships with nurses as both colleagues and as patients. A positive relationship between a nurse recovering from substance abuse disorder and the nurse practitioner could promote a resilient outcome. As demonstrated through- out the literature, the presence of at least one positive relationship is needed to promote a resilient outcome (Earvolino-Ramirez, 2007). As Fogger and McGuinness (2009) discussed in the case of substance use, a positive relationship can aid recovery and reintegration of the nurse back into the nursing profession. Establishing a positive relationship and helping others develop enhanced cop- ing mechanisms are ways the nurse practitioner can promote resilience in others.
Finally, the nurse practitioner can be sensitive to nurse colleagues and patients they treat with complaints of pain that may be recovering from substance use disorders. Pain management among individuals recovering from substance use disorders can result in an ethical dilemma for nurse practitioners when evaluating the use of narcotic pain management (Cooper, 2016). Persons with a substance use disorder are less likely than others to receive effective pain treatment, as cli- nicians are concerned about opioid misuse. Cooper suggested several clinical practice interven- tions, which were guided by the ethical principles of autonomy, beneficence, nonmaleficence, and justice to address concerns about opioid misuse. The ethical principle of beneficence was recom- mended as the primary goal when treating patients in pain with a history of a substance use disor- der. Cooper recommended that the nurse practitioner screen for addiction risk appropriately and utilize pain management consultants and addiction therapy specialists as available (Cooper, 2016).
Application to Nurse Practitioner Practice 95
▸ Conclusion
There is a strong correlation between the successful rehabilitation of nurses overcoming substance abuse, and the profession’s overall characteristic of resilience. Resilient nurses display much-needed qualities such as intelligence, self-determination, self-confidence, resourcefulness, and flexibility that can assist them in difficult situations (Brennan, 2017). Nurses have among the highest rates among professionals for effective and long-lasting rehabilitation with substance abuse disorders.
Furthermore, ATD programs have been shown to yield the best results and lower levels of re- lapse. Earvolino-Ramirez’s emerging theory of resilience supports resilience-based intervention and prevention programs. When applying resilience to the successful substance abuse rehabilita- tion, Earvolino-Ramirez’s work strengthens the evidence that nurses have higher rates of success in recovery.
The association is furthered supported when examining Earvolino-Ramirez’s contention that resilience is strengthened with the presence of self-efficacy and enhanced coping mechanisms.
Hart, Brannan, and de Chesnay (2014) described nursing research conducted to understand the phenomenon of resilience in nurses. Nurses who were able to recognize and identify their own sit- uational concerns, reframe, adapt, and look forward to a time when the current situation might be altered were typically associated with higher levels of resilience (Hart et al., 2014). Additionally, Hart and colleagues stated that nurses who buffered their current situation by considering the fu- ture and using coping mechanisms to aid in moving through were described as those who exhib- ited greater resilience.
References
Brennan, E. J. (2017). Towards resilience and wellbeing in nurses. British Journal of Nursing, 26(1), 43–47. Retrieved from http://eds.a.ebscohost.com.proxy.kennesaw.edu
Cares, A., Pace, E., Denious, J., & Crane, L. A. (2015). Substance use and mental illness among nurses: Workplace warning signs and barriers to seeking assistance. Substance Abuse, 36(1), 59–66.
Cooper, L. A. (2016). Ethics of narcotic pain management in substance use disorder recovery. The Journal for Nurse Practitioners, 12(10). 415–418.
Earvolino-Ramirez, M. (2007). Resilience: A concept analysis. Nursing Forum, 42(2), 73–82.
Epstein, P. M., Burns, C., & Conlon, H. C. (2010). Substance abuse among registered nurses. AAOHN Journal, 58(12), 513–516.
Fogger, S. A., & McGuinness, T. (2009). Alabama’s nurse monitoring programs: The nurse’s experience of being monitored.
Journal of Addictions Nursing, 20(3), 142–149.
Grafton, E., Gillespie, B., & Henderson. S. (2010). Resilience: The power within. Oncology Nursing Forum, 37(6), 698–705.
Hart, P. L., Brannan, J. D., & de Chesnay, M. (2014). Resilience in nursing: An integrative review. Journal of Nursing Management, 22, 720–734.
Kunyk, D. (2015). Substance use disorders among registered nurses: Prevalence, risks and perceptions in a disciplinary jurisdiction. Journal of Nursing Management, 23(1), 54–64.
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96 Chapter 8 Resilience in Health Care and Relevance to Successful Rehabilitation
▸ Introduction
This chapter discusses one group of refugees (Afghan women) in the United States and uses the intersectionality feminist theory to explore identifiers that may lead to this population’s marginal- ization. Although other disciplines have numerous studies about refugees, the nursing literature is greatly lacking. Juliene Lipson, a nurse anthropologist, along with her colleagues, has conducted several studies focusing on the Afghan women refugees in California. Nurses may be one of the first healthcare professionals refugees encounter when they resettle in the United States. Thus, nurses
OBJECTIVES
At the end of this chapter, you will be able to:
1. Discuss briefly the history of the feminist movement in the United States.
2. Compare and contrast intersectionality and intersectionality feminist theories.
3. Explore intersectionality feminism as it relates to the Afghan women refugees in the United States.