An Opinion
Piece: The Consensus Conference
GERALDENE
I
N SPRING Mental
through
1989, the Alcohol, Health
the
(NIDA)
National
and Alcoholism
knowledge,
scientific
skills,
and attitudes
statement
other
drugs
dents,
general
medical
nursing
diagnosis,
Comparable
internal
students,
medicine
of consensus
that are published
The ADAMHA stitutes
of Health
(NIH)
1977,
which
conferences
(Fig 1). However, Development
has provided
the NIH
Program
consensus
the safety and efficacy of more than 80 medical nologies.
Fogle
(1990)
there is little evidence
reports
that
that consensus
since
statements critics
on tech-
believe
statements
bureaus,
institutes,
the consensus purpose seminate
ers, policymakers,
have
ganized
to evaluate
and operation.
the consensus
Among
so recommendations
of Medicine
(IOM) was or-
program’s
structure
the special committee’s
30 or
are proposals that topical sugges-
tions be solicited from both inside and outside the government; that the issues considered be broadened to incorporate economic, social, and ethical aspects
*Professor and Dean, College of Nursing, University of Iowa, Iowa City, IA. Address correspondence and reprint requests to Dr Felton: College of Nursing, University of Iowa, Iowa City, IA, 52242. Copyright 0 199 1 by W.B. Saunders Company 8755-7223/91/0703-0014$3.00/O
184
not just to dishealth care provid-
and the public.
the growth
of invitational has accelerated
problem-oriented
Some that come to mind (NCNR)
sions’ Division
National
science,
patient
care, strategies education
conference
research priorities
ble that
to improve
of
nurse recruitment,
and nursing
(AIDS) population
and huimmugroups.
aspects to the use of the con-
format.
There
is a code at work.
view that emanates
to partici-
from consen-
cannot be said to result from a pooling Modern
specialization
those who evaluate
have the relevant
expertise
make fair judgments. most likely
for
resources and the delivery
One aspect has to do with who is invited pate. The collective
Profes-
virus (HIV)/acquired
syndrome
There are paradoxical sensus
for Nursing
of Health
The topics of these con-
in nursing,
man immunodeficiency nodeficiency
years.
a series of conferCenter
nursing
nursing
nursing
in recent
include
of Nursing.
nursing doctoral
rapidly
and the Bureau
ferences have included
of ignorance.
emy of Sciences’ Institute
to scientists,
of the
and that
have the declared
practices,
conferences
sus conferences
Acad-
program
to that
To inform nurses’ thinking, consensus development conferences have been less often used. Albeit,
had much effect on medical practice or on the public. of the National
program
health
information
equal
and divisions;
development
As a result,
a special committee
centers,
to change
minor-
document;
of the consensus
to a level at the NIH
Research
In-
in the consensus
that there be the elevation status
ences held by the NIH
Max-
from the National
process; that well-reasoned
be included
pe-
and the
(West,
into the consensus
and
1984).
is separate
has had a Consensus
faculty,
At issue is the ques-
tion of the influence
& Solomon,
and resi-
obstetricians
resultant
statements
state-
for physicians, faculty
physicians,
and psychiatrists.
well, Noble,
grad-
treatment,
consensus
family medicine
emergency
gynecologists,
training,
of the use and abuse of alcohol and
(AODA).
diatricians,
a 3-day
on the min-
that baccalaureate
ments in the area have been developed including
to its con-
information,
uates need in the prevention, and management
Abuse
by organizing
EDD, RN, FAAN*
ity opinions
on Alcohol Abuse
added nursing
programs
imum
on Drug
Institute
to prepare a consensus
and
(ADAMHA),
Institute
(NIAAA),
sensus development meeting
Drug Abuse,
Administration
and the National
FELTON,
to include
makes it inevita-
complex within
Thus,
must
that profession
to
participants
are
invited
subject
subjects
matter
experts,
clini-
cian experts, academics, administrators, entrepreneurs, and others perceived to be self-aware, to have ability and experience in working in a political environment, and with the experience and clout necessary to effectively represent a specialty group or health care agency. All are prominent and busy people. Another aspect has to do with context. Some things can be said with impunity at one moment by certain people, but not at a different moment by others. It depends on who is doing the talking and under what circum-
Journal of Professional Nursing, Vol 7, No 3 (May-June),
1991: pp 184-187
CONFERENCEONALCOHOLANDOTHERDRUGABUSE
185
Department Of Health & Human Services (HHS) Secretary: LOUIS W. Sullivan, M.D. Public
d
salth SsrvlccB (PHS) #rHealth: yla he Netlond InstlMc
CentersFor Dlaease
01 Health(NH-I) (we up of 13 InstlMes, the NatlonalLlbraty of Medkkle, 5 Centers,Including the NationalCenter )I NumlngResearct and 2 dlvkions) 7
ConWForFoodWty LAppltd Nutrttlon
I I
PWMtlOn !tONkW
Figure
1.
Federal
health
components.
stances.
Thus,
generalized
pluralism
creates
an atmosphere
of
the changing
The 1989 ADAMHA Nursing Consensus Conference
essary knowledge
and skills
increase consumer
awareness
quences of AODA,
support
ciplinary The ADAMHA charged
Nursing
Consensus
to agree on educational
necessary for bachelor’s-degree uates.
Emblematic the conference
nine
other
attendees
federal agencies. mechanical consensus plenary mercial
consisted
representing
was
on AODA
conference
various
interested rules. The
were forged through
of this date,
reporting
the con-
to its essence and approved
corps of the initial conference
participants.
program
potential
to
of the causes and consethe expansion
of interdis-
to effective therapeu-
abuse within
the health care
system.
There are paradoxical aspects to the use of the consensus conference format.
a series of
and small group sessions recorded by a comeditor. Evenings were reserved for evaluation
ference was distilled
have high
efforts, and contribute
tic responses to substance
They
with the nec-
forand
It turned out that the process was not
and there were few procedural statements
of AODA.
and new grad-
of 12 participants
of the day’s work. The monograph smaller
Conference
content
students
of the consensus
mat,
realities of the situation
stated their belief that nurses prepared
tolerance.
However,
by a as
staff do not believe
the document is in the form they would like. Names of all participants and attendees were made a permanent part of the report. If truth were to be told, it probably is correct to infer that participants were personally proud of being a part of the process and believe they made an important contribution to a concept with serious purposes. They had their ideals confront
The
1989 ADAMHA
ence report signed
is divided
to showcase
Nursing into
specific
Consensus
the following content
Conferareas de-
and pedagogical
methods.
The areas decided on are: socialization;
concepts;
epidemiology;
pharmacology;
basic
pathophysiol-
ogy and psychosocial consequences; prevention; acute and long-term nursing management; ethical/legal aspects; public policy; impaired nurses; nursing research issues; and recommended resources and activities for student learning. The report concludes with a list of representative references and sources for the availability of model curriculums.
186
GERALDENE FELTON
The 19891990 HRSA National Nursing Consortium on AODA
Conference document
The Health sortium
Resources
convened
laboration ferences
with NIDA to develop
dissemination stance
and Services (HRSA)
by the Division
and NIAAA
a national
prevention
nurse educators,
a l-year
period,
agencies (Table
1) collaborated
describe the importance impact
problems,
identify
deal with
the issues,
appropriate
entities
and identify
specific
for nursing Over
of 20 professional federal
to identify
key issues, and its
resources
abuse
strategies needed
to and
to address the proposed strategies,
specific methods
of information
dissem-
ination and how nursing organizations can participate in the disseminating of such information. Of necessity, recurring
threads
the differences
there was overlap in participants in the two conferences. between
the ADAMHA
sortium
of the participants
and
Preparation
Con-
The Con-
represented
organiza-
are involved
of the ADAMHA
was the responsibility
directly
in
and
previous
report
by the staff. Based on preferences
experience
group consensus
Conference
of a series of editors with over-
sight and reediting
with
statements
its own ideas about
physician
specialty
in the area, the staff had
writing
techniques
and prefer-
ences, the design of the report, preferred language and format, the length of the document, content to be included
and what was to be excluded,
narrative. conference
The HRSA
National
with
advance
conference
participants
liberations.
Fortunately,
strengthen
the consortium
imperfect entirely
organizers
Consortium known
before completion document
accuracy, precise diction, grammatical correctness.
of the deused to
was the as yet Conference.
required
logical
a
to the
one of the documents
both reports
of
by the staff using
report of the ADAMHA appropriate,
and amount
Nursing
report was completed
draft format
Federal agencies represented included HRSA (Bureau of Health Professions’ Division of Nursing, Indian Health Service) and ADAMHA (Office for Substance Abuse Prevention [OSAP], NIAAA, NIDA, and the National Clearinghouse on Alcohol and Drug Abuse).
membership
earlier.
and some not.
However,
American Association of Colleges of Nursing American Nurses’ Association Committee on Impaired Nursing Practice American Public Health Association District of Columbia Nurses’ Association Drug and Alcohol Nursing Association Inc. Mid-Atlantic Regional Nursing Association Midwest Alliance In Nursing The Organization for Obstetric, Gynecologic and Neonatal Nurses The National Alliance of Nurse Practitioners National Association of Hospital Nurses National Association of School Nurses National Black Nurses’ Association, Inc. National Consortium of Chemical Dependency Nurses National Council of State Boards of Nursing National Federation for Specialty Nursing Organizations National League for Nursing National Nurses’ Society of Addictions National Student Nurses’ Association New England Organization for Nursing Southern Council on Collegiate Education for Nursing Western Institute of Nursing
The Consensus
the care of persons who abuse alcohol and other drugs,
Consensus
TABLE 1. Twenty Nursing Organizations Represented in the Division of Nursing National Nursing Consortium on Alcohol and Other Drug Abuse
and the
to take the content
groups.
were described
conference
the mech-
of the final report,
back to their constituent ference participants
in the topic,
participants,
tions, some of whose members
and state
with substance
measurable
identify
of the participants
the charge to the conference commitment
on sub-
of the issue to nursing
on the care of patients
and interests
Consor-
for whom the
but rather in the knowledge-
for information
and nurse clinicians.
and various
ability
was written,
anism for the preparation
programming
representatives
organizations
Conin col-
Nursing
lay not in the audience
held three con-
and treatment
students, nursing
plan
and educational
abuse
of Nursing
and the HRSA National
tium conference
As is
technical
organization,
and
The Significance There are obvious for concern
about
fects of drug include direct
dependence
increased
health
reasons
For one, the growing and addiction
criminal
consequences
on individual
and some not so obvious
AODA.
of drugs
behavior,
ef-
on society
as well as the
and long-term
and their associated
changes social bur-
dens and costs (West et al., 1984). For instance, AODA coexists with other acute and chronic health problems in a high percentage of hospitalized patients (Institute of Medicine, 1982; Mendelson, Miller, Mello, Pratt, & Schmitt, 1982; West et al., 1984), few of whom are referred for AODA treatment (Mendelson et al., 1982; West et al., 1984). Another startling concern is that attention and resources for AODA disorders and drug-taking behavior have most often been focused on treatment after addiction, rather than on effective preventive strategies. Further, the low rate of referral becomes more tragic when one
CONFERENCE ON ALCOHOL AND OTHER DRUG ABUSE
187
considers that AODA is associated with HIV infection
proponents
and AIDS,
long-term
homelessness,
mortality,
accidents,
low birth
weight,
loss of productivity,
infant
and early
Nurses spend more time with individuals ilies than
any other
American
health
it requires,
zations devoted to addictions stream nursing responsibility
education
nursing;
has not publicly
dence that characterize affirmed
the addictive
of new graduates
peutic
options
and families substance
ral, and health
quired.
The larger issue is that,
accepted its into their
the health-illness
maintenance.
for supervised
that
forcibly
into the twenty-first
to assure the . . n
continuum treatment,
Moreover, clinical
of refer-
the following
AODA
into
their
nurses are in a unique
patients,
families,
and
practices. position
sus document
communities
if an ADAMHA
with
Nursing
will ever be released.
Consen-
The Division
of
Nursing
will be issuing a report from the HRSA Con-
sortium
conference.
wished
Meanwhile,
it is to be sorely
that colleges and universities
in this country
do not dismiss statements on nursing in AODA as trivial or redundant, but will self-consciously choose to incorporate preparation
AODA
teaching
of baccalaureate
Thus,
a responsive
to move nursing
values
century.
into the educational
nursing
students.
The National
Nursing
Consortium
that
all nursing
position
conference
par-
organizations
statement:
to
problems.
It is not known
strikes
assur-
sanction
assist
progress
into action.
there is no
instruction
edge
problems
for genuine
is re-
position to assist patknts, families, and communities with AODA problems.
patients
have asked
AODA
more than
content
nurses are in a unique
ticipants
about
Much
suggested
cord. It holds special meaning
ing that all graduates are adequately informed and skilled to be able to recognize and integrate knowlNotwithstanding,
to practice.
this topic
of
into the armamen-
to occur, words must be translated it is imperative
in
state. Nor have
and support
use and abuse prevention,
good formula
of ad-
to know the range of thera-
and to intervene along
of approaches
ideas and presenting
organi-
have a
and psychic depen-
our commitment
ability
content
tarium
however, main-
to equip nurses to incorporate
awareness of the physical
we publicly
specialty
must
of drug abuse,
and in the consequences
AODA
raising
There
(ANA) standards
practice and nursing
education
in the problems
are
and fam-
professionals.
Nurses’ Association
nursing
practice
the attention
not incorporating
mortality.
diction
of undergraduate interest
The
We, as representatives of professional nursing in the United States, recognize that alcohol and substance abuse is a leading health problem in this country. We believe that education about the risk factors and outcomes of alcohol and drug use are good defenses against abuse. We acknowledge that nurses and other health professionals are themselves vulnerable to alcohoi and drug abuse. We pledge ourselves and our professional associations to work in partnership with the public and our professional colleagues to educate about drug and alcohol use, to promote healthy lifestyles, and to provide quality nursing care to persons entrapped by alcohol or drugs.
References Fogle, S. (1990). Consensus panels draw flak. TheJouraal of NIH Research, 2, 34-35. Institute of Medicine, Committee to Study the HealthRelated Effects of Cannabis and its Derivatives. (1982). Marijtuaa and health. Washington, DC: National Academy Press.
Mendelson, J. H., Miller, K. D., Mello, N. K., Pratt, H., & Schmitz, R. (1982). Hospital treatment of alcoholism: A profile of middle income Americans. Alcoholism, 6, 377-383. West, L. J., Maxwell, D. S., Noble, E. P., &Solomon, D. H. (1984). Alcoholism. Annals of Internal Medicine, 100, 405-416.
Piece: The Consensus Conference
GERALDENE
I
N SPRING Mental
through
1989, the Alcohol, Health
the
(NIDA)
National
and Alcoholism
knowledge,
scientific
skills,
and attitudes
statement
other
drugs
dents,
general
medical
nursing
diagnosis,
Comparable
internal
students,
medicine
of consensus
that are published
The ADAMHA stitutes
of Health
(NIH)
1977,
which
conferences
(Fig 1). However, Development
has provided
the NIH
Program
consensus
the safety and efficacy of more than 80 medical nologies.
Fogle
(1990)
there is little evidence
reports
that
that consensus
since
statements critics
on tech-
believe
statements
bureaus,
institutes,
the consensus purpose seminate
ers, policymakers,
have
ganized
to evaluate
and operation.
the consensus
Among
so recommendations
of Medicine
(IOM) was or-
program’s
structure
the special committee’s
30 or
are proposals that topical sugges-
tions be solicited from both inside and outside the government; that the issues considered be broadened to incorporate economic, social, and ethical aspects
*Professor and Dean, College of Nursing, University of Iowa, Iowa City, IA. Address correspondence and reprint requests to Dr Felton: College of Nursing, University of Iowa, Iowa City, IA, 52242. Copyright 0 199 1 by W.B. Saunders Company 8755-7223/91/0703-0014$3.00/O
184
not just to dishealth care provid-
and the public.
the growth
of invitational has accelerated
problem-oriented
Some that come to mind (NCNR)
sions’ Division
National
science,
patient
care, strategies education
conference
research priorities
ble that
to improve
of
nurse recruitment,
and nursing
(AIDS) population
and huimmugroups.
aspects to the use of the con-
format.
There
is a code at work.
view that emanates
to partici-
from consen-
cannot be said to result from a pooling Modern
specialization
those who evaluate
have the relevant
expertise
make fair judgments. most likely
for
resources and the delivery
One aspect has to do with who is invited pate. The collective
Profes-
virus (HIV)/acquired
syndrome
There are paradoxical sensus
for Nursing
of Health
The topics of these con-
in nursing,
man immunodeficiency nodeficiency
years.
a series of conferCenter
nursing
nursing
nursing
in recent
include
of Nursing.
nursing doctoral
rapidly
and the Bureau
ferences have included
of ignorance.
emy of Sciences’ Institute
to scientists,
of the
and that
have the declared
practices,
conferences
sus conferences
Acad-
program
to that
To inform nurses’ thinking, consensus development conferences have been less often used. Albeit,
had much effect on medical practice or on the public. of the National
program
health
information
equal
and divisions;
development
As a result,
a special committee
centers,
to change
minor-
document;
of the consensus
to a level at the NIH
Research
In-
in the consensus
that there be the elevation status
ences held by the NIH
Max-
from the National
process; that well-reasoned
be included
pe-
and the
(West,
into the consensus
and
1984).
is separate
has had a Consensus
faculty,
At issue is the ques-
tion of the influence
& Solomon,
and resi-
obstetricians
resultant
statements
state-
for physicians, faculty
physicians,
and psychiatrists.
well, Noble,
grad-
treatment,
consensus
family medicine
emergency
gynecologists,
training,
of the use and abuse of alcohol and
(AODA).
diatricians,
a 3-day
on the min-
that baccalaureate
ments in the area have been developed including
to its con-
information,
uates need in the prevention, and management
Abuse
by organizing
EDD, RN, FAAN*
ity opinions
on Alcohol Abuse
added nursing
programs
imum
on Drug
Institute
to prepare a consensus
and
(ADAMHA),
Institute
(NIAAA),
sensus development meeting
Drug Abuse,
Administration
and the National
FELTON,
to include
makes it inevita-
complex within
Thus,
must
that profession
to
participants
are
invited
subject
subjects
matter
experts,
clini-
cian experts, academics, administrators, entrepreneurs, and others perceived to be self-aware, to have ability and experience in working in a political environment, and with the experience and clout necessary to effectively represent a specialty group or health care agency. All are prominent and busy people. Another aspect has to do with context. Some things can be said with impunity at one moment by certain people, but not at a different moment by others. It depends on who is doing the talking and under what circum-
Journal of Professional Nursing, Vol 7, No 3 (May-June),
1991: pp 184-187
CONFERENCEONALCOHOLANDOTHERDRUGABUSE
185
Department Of Health & Human Services (HHS) Secretary: LOUIS W. Sullivan, M.D. Public
d
salth SsrvlccB (PHS) #rHealth: yla he Netlond InstlMc
CentersFor Dlaease
01 Health(NH-I) (we up of 13 InstlMes, the NatlonalLlbraty of Medkkle, 5 Centers,Including the NationalCenter )I NumlngResearct and 2 dlvkions) 7
ConWForFoodWty LAppltd Nutrttlon
I I
PWMtlOn !tONkW
Figure
1.
Federal
health
components.
stances.
Thus,
generalized
pluralism
creates
an atmosphere
of
the changing
The 1989 ADAMHA Nursing Consensus Conference
essary knowledge
and skills
increase consumer
awareness
quences of AODA,
support
ciplinary The ADAMHA charged
Nursing
Consensus
to agree on educational
necessary for bachelor’s-degree uates.
Emblematic the conference
nine
other
attendees
federal agencies. mechanical consensus plenary mercial
consisted
representing
was
on AODA
conference
various
interested rules. The
were forged through
of this date,
reporting
the con-
to its essence and approved
corps of the initial conference
participants.
program
potential
to
of the causes and consethe expansion
of interdis-
to effective therapeu-
abuse within
the health care
system.
There are paradoxical aspects to the use of the consensus conference format.
a series of
and small group sessions recorded by a comeditor. Evenings were reserved for evaluation
ference was distilled
have high
efforts, and contribute
tic responses to substance
They
with the nec-
forand
It turned out that the process was not
and there were few procedural statements
of AODA.
and new grad-
of 12 participants
of the day’s work. The monograph smaller
Conference
content
students
of the consensus
mat,
realities of the situation
stated their belief that nurses prepared
tolerance.
However,
by a as
staff do not believe
the document is in the form they would like. Names of all participants and attendees were made a permanent part of the report. If truth were to be told, it probably is correct to infer that participants were personally proud of being a part of the process and believe they made an important contribution to a concept with serious purposes. They had their ideals confront
The
1989 ADAMHA
ence report signed
is divided
to showcase
Nursing into
specific
Consensus
the following content
Conferareas de-
and pedagogical
methods.
The areas decided on are: socialization;
concepts;
epidemiology;
pharmacology;
basic
pathophysiol-
ogy and psychosocial consequences; prevention; acute and long-term nursing management; ethical/legal aspects; public policy; impaired nurses; nursing research issues; and recommended resources and activities for student learning. The report concludes with a list of representative references and sources for the availability of model curriculums.
186
GERALDENE FELTON
The 19891990 HRSA National Nursing Consortium on AODA
Conference document
The Health sortium
Resources
convened
laboration ferences
with NIDA to develop
dissemination stance
and Services (HRSA)
by the Division
and NIAAA
a national
prevention
nurse educators,
a l-year
period,
agencies (Table
1) collaborated
describe the importance impact
problems,
identify
deal with
the issues,
appropriate
entities
and identify
specific
for nursing Over
of 20 professional federal
to identify
key issues, and its
resources
abuse
strategies needed
to and
to address the proposed strategies,
specific methods
of information
dissem-
ination and how nursing organizations can participate in the disseminating of such information. Of necessity, recurring
threads
the differences
there was overlap in participants in the two conferences. between
the ADAMHA
sortium
of the participants
and
Preparation
Con-
The Con-
represented
organiza-
are involved
of the ADAMHA
was the responsibility
directly
in
and
previous
report
by the staff. Based on preferences
experience
group consensus
Conference
of a series of editors with over-
sight and reediting
with
statements
its own ideas about
physician
specialty
in the area, the staff had
writing
techniques
and prefer-
ences, the design of the report, preferred language and format, the length of the document, content to be included
and what was to be excluded,
narrative. conference
The HRSA
National
with
advance
conference
participants
liberations.
Fortunately,
strengthen
the consortium
imperfect entirely
organizers
Consortium known
before completion document
accuracy, precise diction, grammatical correctness.
of the deused to
was the as yet Conference.
required
logical
a
to the
one of the documents
both reports
of
by the staff using
report of the ADAMHA appropriate,
and amount
Nursing
report was completed
draft format
Federal agencies represented included HRSA (Bureau of Health Professions’ Division of Nursing, Indian Health Service) and ADAMHA (Office for Substance Abuse Prevention [OSAP], NIAAA, NIDA, and the National Clearinghouse on Alcohol and Drug Abuse).
membership
earlier.
and some not.
However,
American Association of Colleges of Nursing American Nurses’ Association Committee on Impaired Nursing Practice American Public Health Association District of Columbia Nurses’ Association Drug and Alcohol Nursing Association Inc. Mid-Atlantic Regional Nursing Association Midwest Alliance In Nursing The Organization for Obstetric, Gynecologic and Neonatal Nurses The National Alliance of Nurse Practitioners National Association of Hospital Nurses National Association of School Nurses National Black Nurses’ Association, Inc. National Consortium of Chemical Dependency Nurses National Council of State Boards of Nursing National Federation for Specialty Nursing Organizations National League for Nursing National Nurses’ Society of Addictions National Student Nurses’ Association New England Organization for Nursing Southern Council on Collegiate Education for Nursing Western Institute of Nursing
The Consensus
the care of persons who abuse alcohol and other drugs,
Consensus
TABLE 1. Twenty Nursing Organizations Represented in the Division of Nursing National Nursing Consortium on Alcohol and Other Drug Abuse
and the
to take the content
groups.
were described
conference
the mech-
of the final report,
back to their constituent ference participants
in the topic,
participants,
tions, some of whose members
and state
with substance
measurable
identify
of the participants
the charge to the conference commitment
on sub-
of the issue to nursing
on the care of patients
and interests
Consor-
for whom the
but rather in the knowledge-
for information
and nurse clinicians.
and various
ability
was written,
anism for the preparation
programming
representatives
organizations
Conin col-
Nursing
lay not in the audience
held three con-
and treatment
students, nursing
plan
and educational
abuse
of Nursing
and the HRSA National
tium conference
As is
technical
organization,
and
The Significance There are obvious for concern
about
fects of drug include direct
dependence
increased
health
reasons
For one, the growing and addiction
criminal
consequences
on individual
and some not so obvious
AODA.
of drugs
behavior,
ef-
on society
as well as the
and long-term
and their associated
changes social bur-
dens and costs (West et al., 1984). For instance, AODA coexists with other acute and chronic health problems in a high percentage of hospitalized patients (Institute of Medicine, 1982; Mendelson, Miller, Mello, Pratt, & Schmitt, 1982; West et al., 1984), few of whom are referred for AODA treatment (Mendelson et al., 1982; West et al., 1984). Another startling concern is that attention and resources for AODA disorders and drug-taking behavior have most often been focused on treatment after addiction, rather than on effective preventive strategies. Further, the low rate of referral becomes more tragic when one
CONFERENCE ON ALCOHOL AND OTHER DRUG ABUSE
187
considers that AODA is associated with HIV infection
proponents
and AIDS,
long-term
homelessness,
mortality,
accidents,
low birth
weight,
loss of productivity,
infant
and early
Nurses spend more time with individuals ilies than
any other
American
health
it requires,
zations devoted to addictions stream nursing responsibility
education
nursing;
has not publicly
dence that characterize affirmed
the addictive
of new graduates
peutic
options
and families substance
ral, and health
quired.
The larger issue is that,
accepted its into their
the health-illness
maintenance.
for supervised
that
forcibly
into the twenty-first
to assure the . . n
continuum treatment,
Moreover, clinical
of refer-
the following
AODA
into
their
nurses are in a unique
patients,
families,
and
practices. position
sus document
communities
if an ADAMHA
with
Nursing
will ever be released.
Consen-
The Division
of
Nursing
will be issuing a report from the HRSA Con-
sortium
conference.
wished
Meanwhile,
it is to be sorely
that colleges and universities
in this country
do not dismiss statements on nursing in AODA as trivial or redundant, but will self-consciously choose to incorporate preparation
AODA
teaching
of baccalaureate
Thus,
a responsive
to move nursing
values
century.
into the educational
nursing
students.
The National
Nursing
Consortium
that
all nursing
position
conference
par-
organizations
statement:
to
problems.
It is not known
strikes
assur-
sanction
assist
progress
into action.
there is no
instruction
edge
problems
for genuine
is re-
position to assist patknts, families, and communities with AODA problems.
patients
have asked
AODA
more than
content
nurses are in a unique
ticipants
about
Much
suggested
cord. It holds special meaning
ing that all graduates are adequately informed and skilled to be able to recognize and integrate knowlNotwithstanding,
to practice.
this topic
of
into the armamen-
to occur, words must be translated it is imperative
in
state. Nor have
and support
use and abuse prevention,
good formula
of ad-
to know the range of thera-
and to intervene along
of approaches
ideas and presenting
organi-
have a
and psychic depen-
our commitment
ability
content
tarium
however, main-
to equip nurses to incorporate
awareness of the physical
we publicly
specialty
must
of drug abuse,
and in the consequences
AODA
raising
There
(ANA) standards
practice and nursing
education
in the problems
are
and fam-
professionals.
Nurses’ Association
nursing
practice
the attention
not incorporating
mortality.
diction
of undergraduate interest
The
We, as representatives of professional nursing in the United States, recognize that alcohol and substance abuse is a leading health problem in this country. We believe that education about the risk factors and outcomes of alcohol and drug use are good defenses against abuse. We acknowledge that nurses and other health professionals are themselves vulnerable to alcohoi and drug abuse. We pledge ourselves and our professional associations to work in partnership with the public and our professional colleagues to educate about drug and alcohol use, to promote healthy lifestyles, and to provide quality nursing care to persons entrapped by alcohol or drugs.
References Fogle, S. (1990). Consensus panels draw flak. TheJouraal of NIH Research, 2, 34-35. Institute of Medicine, Committee to Study the HealthRelated Effects of Cannabis and its Derivatives. (1982). Marijtuaa and health. Washington, DC: National Academy Press.
Mendelson, J. H., Miller, K. D., Mello, N. K., Pratt, H., & Schmitz, R. (1982). Hospital treatment of alcoholism: A profile of middle income Americans. Alcoholism, 6, 377-383. West, L. J., Maxwell, D. S., Noble, E. P., &Solomon, D. H. (1984). Alcoholism. Annals of Internal Medicine, 100, 405-416.
