Expanded Roles and Responsibilities for Nurses in ...

1 Expanded Roles and Responsibilities forNurses in Screening, Brief Intervention,and Referral to Treatment ( sbirt ) forAlcohol UseStephen Strobbe, PhD, RN, NP, PMHCNS-BC, CARN-APmCydne Perhats, MPHmLauren M. Broyles, PhD, RNAbstractIt is the position of the International Nurses Society onAddictions and the Emergency Nurses Association thatnurses in all practice settings be prepared to deliverscreening, brief intervention,and referral to treatment, orSBIRT, to identify and effectively respond to alcohol use andrelated disorders across the :alcohol, brief intervention, Nurses , referral totreatment, sbirt , screeningDESCRIPTIONA lcohol use disorders are primary diagnoses that contributeto illness, injury, medical complications, premature death,rising healthcare costs, and increased human suffering acrossthe lifespan.

2 In one epidemiological study in the UnitedStates, lifetime prevalence of any alcohol use disorder wasmore than 30% (Hasin, Stinson, Ogburn, & Grant, 2007),yet many patients are not screened for these disorders, andmost of those who meet criteria for specialized treatment donot seek or receive these extensive clinical recommendations, many Americansare unaware of the drinking guidelines established by the Na-tional Institute on Alcohol Abuse and Alcoholism (NIAAA)and do not receive information, feedback, or encouragementfrom healthcare providers to reach or stay within those Guidelines Recommendations&Healthy men under the age of 65 years: consume no morethan 14 standard drinks per week or four drinks perdrinking , nonpregnant women and healthy adults overthe age of 65 years: consume no more than seven standarddrinks per week or three drinks per drinking standard drink is defined as a 12-ounce glass of beer,a 5-ounce glass of table wine, or of 80-proofspirits (NIAAA, 2005).

3 Those who may be exceeding recommended drinkinglimits may not be receiving information and feedback to helpdecrease their drinking or quit altogether. In addition, thosewho choose to abstain from alcohol use, or who are drinkingwithin the recommended guidelines, may not be receiving thesupport and encouragement to help them stay within theseguidelines, potentially preventing future cooperation with the Substance Abuse and MentalHealth Services Administration (SAMHSA), The Joint Com-mission released a set of substance use measures for use byhospitals to help meet accreditation requirements, effectiveon January 1, 2012. These measures include (1) screeningfor unhealthy alcohol use among hospitalized patients ages18 years and older, (2) providing or offering brief interven-tions to those who screen positive for unhealthy alcoholuse, (3) providing or offering alcohol and other drug use dis-order treatment at discharge, and (4) assessing status afterdischarge (The Joint Commission, 2012).

4 One approach that has gained increased attention and ac-ceptance in helping patients with alcohol and other subtanceuse disorders is screening, brief intervention, and referral totreatment, or sbirt . A number of studies have shown theefficacy of SBIRTand similar approaches, both in the UnitedStephen Strobbe, PhD, RN, NP, PMHCNS-BC, CARN-AP, University ofMichigan School of Nursing, Ann Arbor, and International Nurses Societyon Addictions, Lenexa, Perhats, MPH, Institute for Emergency Nursing Research,Emergency Nurses Association, Des Plaines, M. Broyles, PhD, RN, Center for Health Equity Research andPromotion, VA Pittsburgh Healthcare System, and University of Pittsburgh, an employee of the Department of Veterans Affairs, Dr. Broyles contributions to this material were partially the result of work supportedwith resources and the use of facilities at the VA Pittsburgh HealthcareSystem, Pittsburgh, PA.

5 The views expressed in this document do not nec-essarily reflect the position or policy of the Department of Veterans Affairsor the United States the content and writing of this ,UniversityofMichigan School of Nursing, 400 North Ingalls Street, Ann Arbor, of Addictions PaperJournal of Addictions Nursing&Volume 24&Number 3, 203Y204&CopyrightB2013 International Nurses Society on AddictionsCopyright 2013 International Nurses Society on Addictions. Unauthorized reproduction of this article is and in other countries (SAMHSA, 2011). As part of afederally funded initiative in the United States, sbirt hasbeen defined asIa comprehensive, integrated, public health ap-proach to the delivery of early intervention andtreatment services for persons with substanceuse disorders, as well as those who are at risk ofdeveloping these disorders.

6 Primary care centers,hospital emergency rooms, trauma centers, andother community services provide opportunitiesfor early intervention with at-risk substance usersbefore more severe consequences quickly assesses the severity of substance useand identifies the appropriate level of intervention focuses on increasing insight andawareness regarding substance use and motivation towardbehavioral to treatment provides those identified as need-ing more extensive treatment with access to specialtycare (SAMHSA, 2012).It is the position of the International Nurses Society onAddictions and the Emergency Nurses Association (ENA) that& Nurses in all specialties and practice settings be preparedto deliver sbirt to identify and effectively respond toalcohol use and related disorders across the lifespan;&hospitals invest in training, implementation, and out-come measures related to nurse-delivered sbirt as ameans to improve the health of patients, families, andcommunities;& Nurses be involved in ongoing research to determine thefeasibility and effectiveness of sbirt in different patientpopulations, across various healthcare settings, and itspotential application related to the use of alcohol andother substances.

7 And& Expanded curricula be included in undergraduate, grad-uate, and continuing education to provide Nurses withthe requisite knowledge and competencies to deliverhigh-quality, cost-effective, comprehensive care to pa-tients with alcohol use and related Nurses represent the single largest group oflicensed healthcare professionals in the United States,numbering million, with million employed in nurs-ing, and 62% of these working in hospitals (AmericanNurse Association, 2011). Their numbers and presencethroughout the healthcare system place them in primepositions to provide care for patients with alcohol useand related the basis of education and training, Nurses practice atdifferent levels within the profession and across a varietyof healthcare settings in which the existence of alcoholuse disorders frequently emerge.

8 sbirt provides op-portunities for all nursesVgeneralists, specialists, andadvanced practice registered nursesVto screen for andconstructively address alcohol use and related specialty nursing organizations, including the ENA,have adopted the sbirt method, provide education andtraining to help improve competency, and disseminate areplicable and sustainable model (ENA, 2008).& Nurses consistently rank among the most trusted pro-fessions in the United States, including 2011, when 84%of respondents rated Nurses ethical standards and hon-esty as high or very high (Gallup, 2012), which mayserve to increase a patient s level of comfort and recep-tivity when discussing a potentially sensitive health-related recent study showed the acceptability of nurse-performed sbirt among hospitalized veterans (Broyles,Rosenberger, Hanusa, Kraemer, & Gordon, 2012), afterwhich a clarion call was made for widespread imple-mentation and sustained integration of nurse-performedSBIRT across the continuum of care (Finnell, 2012).

9 As integral members of interprofessional healthcare teamsin a variety of settings, Nurses are well positioned to facilitatecollaborative partnerships with both on-site and off-site pro-viders who can deliver high-quality, coordinated, patient-centered sbirt services across the continuum of by the International Nurses Society on Addic-tions Board of Directors: December 2012 Approved by the Emergency Nurses Association Board ofDirectors: May 2013 REFERENCESA merican Nurses Association. (2011). Fact sheet. Retrieved from , L. M., Rosenberger, E., Hanusa, B. H., Kraemer, K. L., & Gordon,A. J. (2012). Hospitalized patients acceptability of nurse-deliveredscreening, brief intervention, and referral to :Clinical and Experimental Research, 36(4), Nurses Association. (2008). sbirt alcohol screening Plaines, IL: , D.

10 S. (2012). Commentary: A clarion call for nurse-led sbirt across the continuum of : Clinical and ExperimentalResearch, 36(7), (2012). Honesty/ethics in professions. Retrieved from , D. S., Stinson, F. S., Ogburn, E., & Grant, B. F. (2007). Prevalence,correlates, disability, and comorbidity ofDSM-IValcohol abuseand dependence in the United States: Results from the NationalEpidemiologic Survey on Alcohol and Related General Psychiatry, 64(7), Institutes on Alcohol Abuse and Alcoholism. (2005).Helpingpatients who drink too much: A clinician s guide(NIH PublicationNo. 05-3769). Rockville, MD: Abuse and Mental Health Services Administration. (2011).Screening, brief intervention and referral to treatment ( sbirt ) inbehavioral healthcare. Retrieved from Abuse and Mental Health Services Administration. (2012).