DRUG AND ALCOHOL SERVICES COUNCIL
NURSING PHILOSOPHY
DASC NURSING PHILOSOPHICAL STATEMENT
A nursing philosophy provides the basis for our model of care. It demonstrates our beliefs about ourselves as nurses and defines a framework to guide practice. A philosophy acknowledges that attitudes, knowledge and skills are inseparable attributes to providing quality nursing care in DASC.
Within the framework of the DASC Constitution the Nursing Service of DASC believes that:-
Health is a consequence of both the environment and activities of the individual. The environment in which people live and work may give little choice and support for empowering changes to lifestyles and attitudes. Through skills which enable, mediate, educate and advocate, nurses in the community are well placed to work in partnership with people/communities to facilitate change in aspects of the environment and the individual which maintains wellness and prevents ill health.
People are individuals with multiple social, economic, cultural, psychological, spiritual and physical resources and needs which impact on their level of wellness. Each person has the right to a quality service without prejudice, regardless of age, ethnicity, creed, gender, sexual preference, physical, psychosocial and economic status.
Primary health care promotes and maintains health through a system of social justice, equality, accessibility, self-responsibility and community participation. In a positive way nurses are able to initiate and apply skills and knowledge across the continuum of health care activities. This includes illness prevention, health advancement, harm minimisation and the maintenance of people with long term needs at an optimum level of wellness. The continuum represents working with people and communities who are well, at risk and who have ongoing health problems.
Nursing practice includes a client centred approach through involving the client and appropriate others in their assessment of needs, planning of care related to individuals needs, implementing nursing interventions and the continuous evaluation of process and outcomes. This also incorporates linking with other members of the health care team and the community in which the client relates/lives.
Each nurse is accountable for their own performance, standards of practice and professional development which demonstrates competence and encourages best practice. This includes providing professional support to each other facilitating a positive and cohesive professional environment within DASC.
© DASC Nursing Services 1995
MODEL OF NURSING PRACTICE IN DASC
A collaborative and integrated systems approach to client/community centred care is used. The Community Health Nurse, Drug and Alcohol Services Council (DASC) interacts with individuals and the community to facilitate a supportive environment through the provision of personal care, education, advocacy and support for community action. The nurse assists in developing and implementing healthy public policy to minimise the harmful effects of alcohol and other drugs in the community. The strategies of the Ottawa Charter for health promotion are used as the framework for illustrating the nurse's role.
This framework was chosen because of its ability to accommodate the multiplicity of the issues discussed above. Fundamental to the Ottawa Charter Strategies is the philosophy of Primary Health Care which is characterised by social justice, equality, self responsibility and broad concepts of health.
The strategies outlined in the Ottawa Charter area:-
1. Developing Personal Skills
2. Creating Supportive Environments
3. Strengthening Community Action
4. Building Healthy Public Policy
5. Reorienting Services In the Interest of Health
The scenarios which follow are brief case studies which demonstrate nursing activities in relation to the Ottawa Charter. They are not exemplars which critically analyse professional nursing practice.
1. DEVELOP PERSONAL SKILLS/INCLUDES PERSONAL CARE AND
PERSONAL SKILLS AND KNOWLEDGE
This demonstrates how the nurse can work with clients to develop personal skills and/or provide personal care by:-
• Enabling people to gain knowledge and an understanding of their alcohol and other drug use, health and environment through the provision of information, education and life skills. Increasing choices available to people to exercise more control. Acting as a cue for action.
• Increase options to family members in order to reduce the impact of alcohol and other drug issues on their lives, through counselling, providing information and referral to appropriate supports.
• Providing opportunities to the community to develop knowledge and skills to cope with alcohol and other drug problems, to seek advice when necessary and to understand the social context of alcohol and other drug use and health. Creating a climate of opinion for change.
SCENARIO:
This scenario demonstrates working with a client to increase his options and exercise more control over his drug use.
Client B is 25 years old and has been unemployed. He works casually in his family's business. He has a supportive family but stated that "they were getting fed up with him". He has a few friends, especially two male friends, who were also drug users.
Client B has had several admissions for detoxification at Warinilla and the Royal Adelaide Hospital. His withdrawals in the past have been moderate to severe. During one admission he used IV Heroin within the unit and was discharged. He did not keep appointments for follow-up counselling. He managed his drug use through abstinence for a few weeks before recommencing.
On one admission after completing another detox and discussing his options with the nursing staff, he decided to do a rehabilitation program. After completing detox he was referred to a live-in long term rehabilitation program at the Woolshed, situated at Ashbourne. He stayed there for one month but had to leave as the other members of the group did not consider that he was serious about giving up drug use. After leaving the Woolshed he remained abstinent for two months. He attended regular meetings with Narcotics Anonymous and chose to stay away from his friends who were using heroin.
At a further admission to the detoxification unit he stated that when he stopped attending NA meetings and started to meet with his friends who used heroin he found it difficult to resist. At first he was injecting $50 of Heroin every evening for about two months; this gradually increased to $100 of Heroin twice a day. He recognised that he was increasing his use and was able to prevent this from further escalating by contacting his case manager at the detoxification unit and asking for assistance.
He was abstinent for a longer period of time after this detox and decided to attend follow-up appointments as encouraged by his case-worker when in the detox unit.
He had recognised his problem more quickly this time, even though he had relapsed. He felt comfortable due to the supportive environment of the detox unit to seek professional support as he could not do it on his own.
2. CREATE SUPPORTIVE ENVIRONMENT
This strategy deals with the inextricable links between people and their environment. These environments may be physical, social and economic. This seeks to demonstrate this by:-
• working with people/communities to seek ways to provide living and working conditions that are safe, stimulating, satisfying and enjoyable;
• encouraging creativity, fostering commitment and valuing trust (Fowler 1994);
• developing and enhancing social networks (Fowler, 1994).
• collaborating with government agencies, industry, non government organisations and community groups to look at ways of addressing poverty, isolation, dangerous environments, inadequate amenities and insufficient basic necessities for people living with alcohol and other drug use.
SCENARIO:
This case study highlights the nurses role to mediate and advocate on behalf of the client to provide an environment which is safe, and satisfactory for the client's needs.
Mr B, age early 30's, used to have frequent admissions to Alcohol Detoxification Unit (AUP) for his alcohol and benzodiazepine problems. On admission it was assessed that he was experiencing psychiatric problems. This assessment was discussed with him and he was referred to Glenside Psychiatric Hospital where he was diagnosed and treated for a manic depressive disorder. It became apparent, on a subsequent admission, that Mr B was unable to function in the community by himself without support systems. He had a sister in a country town who did not want the responsibility of looking after him. He had no other family or friends. His pet dog had also just died.
The nursing staff liaised with Glenside Hospital, and arranged his discharge medication to coincide with the Glenside House Team Assessment Panel. He was then assessed by this team as suitable for their supervised hostel accommodation where his needs were to be met, ie, company and supervision of medications and meals cooked. To date the outcome has been satisfactory with no more admissions required by Mr B to the Unit.
3. STRENGTHEN COMMUNITY ACTION
The heart of this process is the empowerment of communities to enhance their health status. This includes ownership and control of their "own endeavours and destinies". (Ottawa Charter 1986)
Strengthening community action works by:-
• assisting the community to set priorities, make decisions, plan and implement strategies to achieve better health and promote appropriate alcohol and other drug use;
• empowering communities to feel ownership and control over issues which they feel are important to them;
• enhancing self esteem, social supports and increased public participation through community development activities;
• promoting and supporting community participation in health services, eg involving consumers in planning, priority setting and supporting consumer action for change.
(Fowler 1994)
SCENARIO:
This is a nurse initiated project which involved the nurse negotiating with a range of community services to provide a venue for public participation which enabled community debate and informed decision making. Through this initiative the nurse worked towards strengthening community action.
Naracoorte Mount Gambier Outreach Services involvement with a community awareness night in Penola.
Organised by Penola Police and Naracoorte Outreach Nurse. Three guest speakers.
Nurse Educator - DASC Education Unit
Discussed drugs and their effects.
Detective Sergeant - Drug Task Force
Directed his address firstly to the young people in the audience, urging them to discuss their problems with their parents, be open and honest and become involved in community activities. The second part of his speech was directed towards the parents in the audience, encouraging them to make time available for their children, to discuss topics of interest and any problems or concerns.
The Detective Sergeant also warned the community to be aware of illegal amphetamine factories that may be set up empty farmhouses and the signs to look for. Included discussion re decontamination process he brought with him a display which housed small samples of specific drugs.
Former AFL Coach (Well-known Sporting Identity)
A very motivational speech encouraging the young people in the audience to become involved in a team sport not necessary football, to stay fit and healthy. He described his own vigorous daily exercise plan and also shared stories of players he knew who had used drugs and the consequences of their drug-use.
The DASC Outreach nurse was available to discuss any issue related to alcohol and other drug use and had an extensive display of pamphlets and posters as well as an interactive program called the "drinkmeter".
The night was sponsored by local small businesses and service clubs, Lions and Apex. 130 people (broad age group) attended the night demonstrating a very positive response to a topic of public concern. It was also an indication of a small community accepting and responding to an education program when given the opportunity. The nurse instigated advertising of the program through the local television and radio.
4. BUILD PUBLIC POLICY
The involvement of all sectors of the community working together in the interest of creating an environment, which promotes appropriate use of alcohol and other drugs. The following demonstrates this by:-
• Putting alcohol and other drug problems on the agenda of policy makers, in all sectors and at all levels.
• Directing policy makers to be aware of the health consequences of their decisions and accept responsibility. (Strategic Directions for Primary Health Care in South Australia, 1993)
• Encouraging health workers to liaise across sectors of the community, (this can be defined as intersectorial communication which is an extension of the concept of healthy public policy).
SCENARIO:
By encouraging other areas and personnel to work together to raise the issues of alcohol and other drugs in the workplace, the nurse initiated local policy development in a workplace setting which will assist to change behaviours and attitudes.
Intersectorial Collaboration With Local Industry
After a multidisciplinary meeting in my area at a local industry, I undertook to present three workshops at different locations addressing drug and alcohol issues in the workplace. This was received very well by management and staff and the program was expanded to include two other presenters, the industrial nurse who addressed HIV/AIDS, heat stress and effects of UVR, and the chief of security who addressed company policy and by laws in relation to the above issues.
This has now become a twelve module training program which has been presented to well over 800 employees within that industry. All employees are required to complete the training program.
The information has been taken home by the staff and I have had anecdotal feedback from family members of staff who say that the issues have been discussed at home. Although it is difficult for me to see actual outcomes the industry has noted some change in the workplace. It was interesting and exciting working with the industry and with a multi-disciplinary team.
5. REORIENT SERVICES TO PROMOTE HEALTH
Ensures that services are accessible, acceptable and affordable and move increasingly in a health promotion direction. Services must refocus on the total needs of individuals with less emphasis on cure of illness and more on health, well being and quality of life. (This section is adapted from work with the NBSA by Cusack, Smith, Byrnes, 1995).
SCENARIO:
Nurses have a role to work with other agencies and to encourage them to shift their planning for service provision to be more acceptable and accessable, particularly for clients who are in a minority group. This scenario demonstrates a nurse taking the leadership and change agent role to work with other services through the process of networking.