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In nursing, substance misuse is a widespread problem. It is anticipated that
approximately 10% of nurses may misuse drugs or alcohol at some point throughout
their careers. Despite the fact that nurses appear to drink less than the average
population, research have found that they binge drink more than the general
population aged 35 and older (Foli et al., 2015). Some researchers have also indicated
that people with access to these prescriptions at work have greater rates of
prescription drug misuse. (Stewart & Mueller, 2018). Stress assiciated with
inadequate support and increased workloads is a major contributor to substance use
among nurses. In addition, the high prevalence is associated with lack of education
regarding substance use making nurses unware of the signs and symptoms of
addicion.

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When a nurse develops a substance misuse problem, it has far-reaching implications
for the profession. Nurses who struggle with substance misuse are more capable of
harming themselves. The same nurses are more likely to inflict harm to the patients
they are caring for since they are unable to perform at their best due to substance
misuse difficulties. Substance misuse can be exhausting on both a physical and
emotional level. A circumstance like this is more likely to have an impact on the
quality of treatment provided to patients. Thus, health care facilities need to offer
education to nurses and other health care professionals concerning drug and alcohol
use, and establish procedures, policies, and practices to promote supportive, safe,
and drug-free workplaces (Foli et al., 2019).

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Nurses must be aware of the consequences of poor nursing on the nursing profession
and the healthcare system as a whole. Because the handicapped nurse may be
unable to provide safe and appropriate care, this is the case. As a result, nurses must
be aware of the indicators of impairment and how to report any colleague nurse who
may be suffering from a substance misuse disorder. While some impaired nurses may
be able to perform normally, the majority of impaired nurses may be unable to offer
competent care, make medication errors, or divert controlled substances from the
patient to themselves. (Manthey, 2018). In addition, it would lead to poor work
performance since it has potential to damage the health of a nurse. Substance abuse
may result in mental illness among nurses, among other chronic illnesses such as
hepatitis, hypertension, liver disease, traumatic injuries, and possibly death because
of overdose.

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Policies and procedures for recognizing and responding to indications and behaviors
that may indicate impairment in the workplace should be implemented in health care
facilities. Nurses need to learn how to spot risk factors and indicators of dysfunction
in the profession. They must be aware of symptoms of possible controlled substance
diversion, as well as any hurdles to identifying colleagues who are impaired. They
must also be aware of the regulations that govern the discipline and care of
compromised nurses in their state.

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To detect medication diversion, system-wide initiatives must be established in all
clinical backgrounds, and all personnel must be made aware of the protocols in place.
Every nurse working in a health-care facility plays a vital role in preventing drug
diversion. They must be able to spot drug diversion-related trends, patterns, and
behaviors. They have a responsibility to guarantee patient safety and that the
impaired nurse receives assistance in regaining full function. Nurses who are aware
are better able to assist colleagues in finding relevant resources. They can also lobby
for necessary support, treatment, and access to fair judicial process on behalf of their
impaired colleagues.(Stewart & Mueller, 2018). .

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Several nurses are unaware of the negative effects of substance abuse in the
workplace. They do not understand the negative consequences of drug diversion.
There is need for education programs that inform nurses on the negative
consequences of the addiction process and ways of recognizing signs and symptoms
of substance abuse disorder, which remain the most profound risk factors for nurse
impairment. Broad-educational programs are necessary to understand proper ways of
responding to impaired nursing (Brummond et al., 2017). Newly hired nurses should
be taken through substance abuse as part of their orientation, and it should be part
of the yearly competency training. The facility should also hold annual addiction
conferences.

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Health facilities should put in place policies and procedures that ensure consistent
tackling of substance abuse problems in the workplace. The policies put in place
should promote safety and offer assistance to nurses and other health professionals
at high risk of substance abuse disorder. Some of these policies may include but not
limited to pre-employment drug testing, for-cause drug testing, return-to-practice
guidelines, and relapse management. In addition, putting in place surveillance
systems can be useful in detecting impairment and provide proof to establish
whether the impairment is related to diversion of controlled substances (Brummond
et al., 2017).

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Telehealth
Technology on
Patient Outcomes

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What is Telehealth
Nursing?

Telehealth nursing helps to bring healthcare, management of care, coordination, and
nursing care to patients through telecommunication measures (Bashir & Bastola,
2018). It helps to provide a service that enables those seeking care to find resources
and be linked to health centers for advanced care.

Through telehealth patient can control their health need through an electronic
system and find resources that may be needed like pharmacy refills or prescriptions
that can be requested telephonically. Patients may also talk to nurses for further
referrals for ailments.

Telehealth allows patients to communicate through a virtual setting through phone
calls, secure emails, and video which provides a safe environment during crisis like
the pandemic (Weinstein, 2020).

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Why Telehealth?

Telehealth has provided a way to provided healthcare to rural communities and
allowing care to be more accessible and convenient to the client

Anonymity allows clients to feel more comfortable in expressing their health care
needs without feeling embarrassed or exposed (Bulls et al., 2021).

Open-ended communication allows users and healthcare professionals to stay
connected with a route of communication instead of having to schedule and
reschedule clinical visits (Henry, 2021).

During a study, using 315 student, it was found the interfaces were easy to use with
well designed, intuitive systems (Bulls et al., 2021).

Images: Powerpoint Stock Images

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Telehealth Today

Telehealth has provided an alternative way for clients to receive care in another form.
Telehealth has helped reduce risk of exposure to disease and infections like COVID-19
and reduce patient volume in clinics (Ali & Khoja, 2020).

Telehealth also reached rural levels of care by providing a service to those who may
not have immediate access to healthcare.

Mental health care has also been a focus during the pandemic with many losing
family members, jobs, and facing isolation. Stress and anxiety has also been factors as
well as burnout from essential personal. Telehealth lets those who do not have time
to visit clinics or unable to have a source of care.

Images: Powerpoint Stock Images

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Telehealth Technology
Integration

Telehealth is being integrated into regular care. Health providers are able to talk to
clients about health issues and assess, route, and provide care remotely. Counseling
is implemented online and over the phone for health care workers to reach out
during crisis or when in need (Ali & Khoja, 2020).

Telehealth systems help to schedule and refer patients to advanced care settings
when needed.

Telehealth has also been used to provide education and training to those in need.
This includes what to do when exposed to COVID 19 and education on the COVID 19
pandemic.

Telehealth has also been used for contact tracing purposes for COVID 19

Images: Powerpoint Stock Images

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Problems in Telehealth

Telehealth has posed a problem with younger adults with generating costs. Students
participated in a study and found that it was more costly due cost of devices used to
connect to healthcare professionals (Bull et al., 2016).

Privacy and security has been a concern for those seeking care remotely. A study
found that 35% of users had reservations of using this method of health because of
lack in trust in the system (Bull et al., 2016). They stated that they do not feel
comfortable with releasing their information with concern it may be given to the
wrong person.

Users have also expressed concerns with impersonal communication. Interpersonal
skills have been studied and found to positively impact nursing care and patient
outcomes (Henry et al., 2021). Telehealth may lack the impersonality and
connectedness that patients receive during in person visits (Bull et al., 2016).

Errors are also a fear during telehealth. Omissions, loss of health records or lack of
access to health records, negligent credentialing, privacy breaches, and technology
failure has led to concerns about telehealth (Gajarawala & Pelkowski, 2021).

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Telehealth
Funding:
Government
Involvement

Resource
management

Reallocation
of funds

Addressing
barriers in
telehealth

Lobbying and to government provide a way to address problems that are faced with
telehealth technologies.

Government involvement and lobbying are important factors for telehealth. It is
important to gain funding for telehealth and to reallocate money that is saved from
conserving medical supplies by treating patients remotely (Ali & Khoja, 2020).

More funding to the appropriate source will help to adapt telehealth technologies
that are needed to give uninterrupted, appropriate care to patients and to address
concerns mentioned previously (Zhai, 2021). This can address lack of technologies in
rural areas, security issues that may persist, and confidentiality. Funding can also help
to link users that currently do not have service or connection suitable for telehealth
(Zhai, 2021). Finally, the money can also be used to provided training on how create a
therapeutic call with clients.

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Other Topics
addressed for
Increased Funding

Telehealth provides a means to social distance and decrease mass volumes from
flood hospitals and clinics especially during times like an outbreak. A new variant of
COVID has surfaced and patients will be turning to care. Using telehealth, we can
enable healthcare professionals from being at risk for exposure.

Telehealth offer a unique way of managing patients with limited resources and
monitoring patients that do not need immediate care. This allows to free space and
equipment for those that need attention immediately.

Images: Powerpoint Stock Images

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Impact on Clinical
Setting

Implementing telehealth technologies allows healthcare workers to be shielded from
risk of exposure to contagions like COVID (Ali & Khoja, 2020).
This is due to a decreased volume of visits to clinics and hospital with provided care
through a remote setting. Patients will be able to identify health concerns and receive
care without risking others health.

Care is now easier to obtain, and clients are able to have access wherever they are
and allow them to manage appointments easier allowing sites to control scheduling
with ease (Bull et al., 2016).

As a nurse this will allow me an option to work remotely and provide care to patients
in a unique way. In a hospital setting it will help me to keep a manageable patient to
nurse ratio as well. It also provides me with resources for my own care regarding
mental health and education.

Images: Powerpoint Stock Images

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References
• Ali, N. A., & Khoja, A. (2020). Telehealth: An Important Player During the COVID-19 Pandemic. The Ochsner journal, 20(2), 113–114. https://doi.org/10.31486/toj.20.0039

• Bashir, A., & Bastola, D. R. (2018). Perspectives of nurses toward telehealth efficacy and quality of health care: Pilot study. JMIR medical informatics, 6(2), e35.

https://doi.org/10.2196/medinform.9080

• Bull, T. P., Dewar, A. R., Malvey, D. M., & Szalma, J. L. (2016). Considerations for the telehealth systems of tomorrow: An analysis of student perceptions of telehealth

technologies. JMIR medical education, 2(2), e11. https://doi.org/10.2196/mededu.5392

• Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth Benefits and Barriers. The journal for nurse practitioners : JNP, 17(2), 218–221.

https://doi.org/10.1016/j.nurpra.2020.09.013

• Henry, B. W., Billingsly, D., Block, D. E., & Ehrmann, J. (2021). Development of the teaching interpersonal skills for telehealth checklist. Evaluation & the Health

Professions. https://doi.org/10.1177/0163278721992831

• Weinstein, B. E. (2020). Optimizing Telehealth, Communication Amid COVID-19. The Hearing Journal, 73(10), 47. https://doi.org/10.1097/01.HJ.0000719832.63281.90

• Zhai Y. (2021). A Call for Addressing Barriers to Telemedicine: Health Disparities during the COVID-19 Pandemic. Psychotherapy and psychosomatics, 90(1), 64–66.

https://doi.org/10.1159/000509000

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