Many forms of substance abuse, and its associated violence, seem to be on the rise in the United States and the globally. One of the most frequently abused substances is alcohol, which often has associated violent behavior and delirium. An example of a group of substances often abused is opioids-and more specifically and recently fentanyl. This troubling situation has been termed by the US federal government as a crisis and is one that required immediate attention. In this issue of Critical Care Nursing Quarterly, several first-time authors, students, and frontline health care workers were invited to share their work aimed at increasing the readers' knowledge related to substance abuse, violence, and delirium in the inpatient hospital setting.
In the first article, Gutierrez summarizes the literature on alcohol use disorder. Alcohol consumption in the United States, incidence of driving under the influence, deaths attributed to alcohol intake, and financial implications are discussed. The effectiveness of a screening tool to assess risk for alcohol use disorder and a model used to reduce alcohol consumption is also discussed. The article emphasizes the importance of readiness to change alcohol consumption on the patient's part and support for nonphysicians in assisting patients in decreasing their alcohol use.
Escue and colleagues, in the second article, share the original work of a performance improvement project focused on workplace violence (WPV). The A3 problem-solving methodology is reviewed, and the current state and countermeasures to decrease gaps in the current process are examined. Assaults directed toward health care workers are also highlighted. The authors' purpose was to understand what measures could be effectively implemented to decrease the incidence of WPV events, utilize and implement staff responses to improve staff perception of safety around decreasing WPV events, and review employee injuries and violent patient events. The article emphasizes the need to act on WPV events and assaults for their employees by implementing interventions that curtail those events. In addition, health care organizations, community resources, law enforcement, and law makers must join hands and create innovative evidence-based methods to decrease WPV.
In the third article, Thomas and Ullrich review literature on alternate medication infusion options that provide effective sedation for patients admitted to the intensive care unit (ICU). When medications such as lorazepam (Ativan), midazolam (Versed), diazepam (Valium), and propofol (Diprivan) were in short supply, other medications were explored for maintenance to provide adequate sedation for critically ill patients. In their review, the history, safety, pharmacokinetics, and pharmacodynamics of dexmedetomidine (Precedex) are explored. The incidence of delirium, cost, and cardiovascular and respiratory issues are also discussed.
Dechant et al describe, in the fourth article, the process of implementing the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in a quality improvement project. The process followed the Plan, Do, Study, Act (PDSA) format. The aim of the study was to reeducate nurses at the bedside and improve their knowledge of ICU delirium and the CAM-ICU tool in an ICU. ICU delirium is defined, occurrences in mechanically ventilated ICU patients are discussed, and the Richmond Agitation-Sedation Scale, a tool used to determine the patient's current level of sedation, is shared. The project highlights the importance of having CAM-ICU resources readily available to staff to ensure earlier delirium detection and improve patient outcomes.
In the fifth article, Carruthers and Sutton-Inocencio stress the reasons that all patients should be routinely evaluated for alcohol and drug abuse upon their initial entry into the health care system. They provide a thorough discussion about the policies and procedures that facilitate the identification of patients with substance abuse problems, ensuring their prompt treatment and timely referral for follow-up care.
Resnick and colleagues review factors among older adults with dementia that are associated with function-focused care. Their findings support the importance of functional state, delirium, quality-of-care interactions, and pain. Encouragement of patients with dementia to engage in activities and its usefulness in pain management is described.
In the next article, Shibley, Kim, and Ecoff explore the usefulness of an electronic rounding board and its effect on adverse patient events. Patient falls and self-harm were the adverse events utilized in this important work. In addition, they explored the realm of staff accountability related to use of the tool and adverse patient events.
Smallheer, Barstow, and Tola report the results of a nurse-driven protocol for fluid management. Their methodology included education regarding cardiac output, stroke volume variation, and other dynamic preload indicators, as well as an assessment of nurses' knowledge, confidence, and patient outcomes. This thorough report demonstrates the need to look "outside the box" in providing care utilizing novel approaches to fluid management.
In the final article, three Iranian nurses report their study about the relationship between compassion fatigue and nursing quality. This work illustrates the effects of a common problem that impacts nurses on a global scale.
As we in the health care community have endured the onslaught of the global COVID-19 pandemic (which still lingers but is being conquered), we can now turn our focus to the crisis (the "other pandemic") that started before COVID-19 and still continues-the crisis of substance abuse, violence, and delirium. Together, we will not only endure but also conquer this foe, as well as improve the health and lives of the patients and families we serve. Together, applying all of the tools at our disposal, we will triumph. It is our distinct honor to not only be a part of this health care community/team but also present this issue that is full of tools that can be used to defeat the "other pandemic" and create a better place for all the citizens of our beautiful Earth.
-Felipe Gutierrez, PhD, RN, FNP, CMSRN
-Scot Nolan, DNP, RN, CNS, PHN, CCRN, CNRN, SCRN, FCNS
Issue Editors