Contemporary philippine arts from the regions_PPT_Module_12 [Autosaved] (1).pptx
Professional impairment nova
1. Professional Impairment:
The Lived Experience of
Chemically Dependent
Nurses
Patricia Welch Dittman PhD, RN, CDE
Nova Southeastern University
2. Professional Impairment
• Professional impairment is the inability to
carry out professional responsibilities
consistent with acceptable standards set
by regulatory agencies. Professional
impairment involves mental and physical
dependency on legal and illegal chemical
substances
3. Prevalence in Nursing
• Nursing research reflects that less than 10% of
all nurses will become addicted to chemical
substances, which is comparable to the general
public (Trinkoff, Eaton & Anthony, 1991).
• The Florida Board of Nursing reported
approximately 80 to 90% of their disciplinary
cases are involving professional impairment
issues (IPN Annual Report, 2005).
4. IPN
• The Intervention Project for Nurses
Program in the State of Florida is
sponsored by the Florida Department of
Health and the Florida Board of Nursing.
The designated rehabilitation program
provides a supportive structure that assists
the nurse back to practice.
5. Gender Statistics
• Approximately 303,000 nurses make up
the total population of nurses in the State
of Florida
• Gender breakdown:
– Female 91%
– Male 9%
6. Gender Statistics for the IPN
• Active enrolled participants in the
Intervention Project for Nurses
• Female 62%
• Male 38%
7. Theoretical Underpinnings
• Kant- “Duty to Serve”
• Betty Neuman’s Systems Model -The Newman
Systems Model is based on philosophy, holism, reality, and wellness
as it pertains to the person, environment, person and the
environment, health and nursing
• Boykin and Schoenhofer Nurse as Caring -
discusses that persons are caring by virtue of their humanness.
8. Theoretical Underpinning
• Labeling Theory – Society response to
deviant behavior
• Kohlberg’s Theory of Moral Development
(moral Justice)
• Gilligan’s Theory Moral Development
– Selfishness
– Self-sacrifice
– Assumption of responsibility
9. Theory of Nursing as Caring
• The impaired nurse takes on the role of
the nursed in the nurse/nursed interaction
until his or her chemical dependency is
under control.
“The Nurse Becomes the Nursed”
10. Conceptual Framework
• Betty Neuman’s Systems Model
• Prevention as Intervention
– Primary- reduce risk factors in the
environment
– Secondary- symptoms following the reaction
to the stressor
– Tertiary-following treatment to stability
11. Human Science
• “Human (mental, social, historical)
phenomena differ from natural (physical,
chemical, behavioral) phenomena in that it
requires interpretation and understanding
where as natural science involves external
observation and explanation” (Van Manen,
2003)
12. Hermeneutic Phenomenology
• In hermeneutic phenomenology human
science the method has two purposes. It is
used to first explore or describe
(phenomenological) narrative material and
secondly to interpret (hermeneutic)
conversational relationships with the
interviewee about the meaning of the
experience (Van Manen, 1990).
13. Lived Experience
• “We grasp the fullness of lived experience
by reconstructing or reproducing the
meaning of life’s expressions found in the
products of human efforts, work and
creativity” (Dilthey, 1987).
14. Purpose of the Study
• The purpose of the study will be to
examine the lived experience of nurses in
the State of Florida’s Intervention Project
for Nurses Rehabilitation Program for
chemical dependency.
• Male nurses participate in a
disproportionate number as compared to
female nurses in the Intervention Project
for Nurses Program.
15. Purpose of the Study
• Knowing this information will offer understanding
of the pressures associated with male nurses
and professional impairment.
• The study will offer a male nurse perspective on
professional impairment in nursing which is a
female dominated profession.
16. Research Question
• What is the Lived Experience of Nurses
Who Have Successfully Rehabilitated
From Chemical Dependency Through the
State of Florida's Intervention Project for
Nurses ?
17. Literature Review
• Historical Analysis of impairment /
addiction
• Profession
• Person
• Education
• Policy
• Economics
• Pilot Study
18. Van Manen’s Method
• Orientation to the phenomenon
• Formulation of the phenomenological
question
• Explicating assumptions and pre-
understandings
• Explore the phenomenon – generate data
through personal experience
19. Van Manen’s Method (cont)
• Consulting literature
• Conducting thematic analysis
• Determining essential themes
• Attending to the speaking of language
• Varying the examples
• Writing and re-writing
20. Sample
• Nine male nurses participated
• Ages range: 42-57
• Ethnicity: 8 White, 1 Hispanic
• Educational Preparation: 2 years of college to a
doctoral candidate in Education
• Sexuality: 5 Heterosexual, 4 Homosexual
• Worked while chemically impaired 6-22 years
• No one self enrolled in IPN
21. Limitations
• Potential to restrict the truthfulness of the
study
• Vulnerable population
• Illegal actions
• Chairperson Florida Board of Nursing
• Violation of the nurse practice act
• Reporting action to authority
22. Thematic Analysis
• Van Manen’s Four major steps
– Lived Experience
– Existential Investigation
– Phenomenological Reflection
– Phenomenological Writing
23. Study Findings
• Based on phenomenological reflection:
• Two overarching theme:
– Person
– Profession
24. CARING FOR NURSES WITH PROFESSIONAL
IMPAIRMENT MODEL
PROFESSION
PERSON Masterminding
Professional Heteronomy
Predetermined Risk Getting Caught
Sensation Seeking Rehabilitation
Altered values Spirituality
Mental and
Physical Nurse Becomes the Nursed
Dependency
Professional
Intervention IPN
Inability To Carry Out
Professional
Responsibilities Spirituality -Transition from Person
to Personhood
25. Person
• The over arching theme of person is
based on how the chemically dependent
male nurse relates to himself. It is looking
at the individual to describe their personal
journey through addiction.
27. Predetermined Risk
• Family history of • Unstable lifestyle
addiction • Cyclical behavior
• Chaotic home life • Generic
• Mental / physical • Idiosyncratic
abuse • Fear of passing the
• Maltreatment, trait on to their
neglect, denial, children
enabling behavior
28. Predetermined Risk
• “I see it in my daughter as a small child. She had
surgery and was given medications “Opiates” in
the post operative period. I watch the doctor give
her a specific amount with no effect. When the
drug finally took effect instead of the sedation
effect it was to opposite. She could not stay still.”
“We are wired differently”
29. Sensation Seeking Behavior
• Start in childhood • Fast paced areas of
• No fear practice
• No filtering of • Come to the rescue
impulses • Seek unstable
• Adrenaline Rush vulnerable patients
• Decisions that are
harmful to themselves
and others
30. Sensation Seeking Behaviors
• At my highest point I was taking 100 pills
of Dilaudid a day. I remember getting 500
pills and they only lasted 5 days. I was
working at the time but no one seemed to
put it together. Addiction will take you to
places you never thought/ I am intelligent
and towards the end I would try to take
100 pills and obvious they would not
digest. So the undigested pills that would
not stay down I would try to swallow again”
31. Altered Values
• Willingness to make • Disconnect between
poor choices their actions and the
• Loss valuable affects on others
supportive • During active
relationships impairment they only
• Poor communicators, look to meet their
broken promises chemical needs
• Excuse for behaviors
32. “Altered Values”
• “The Director of Nursing calls me down to her office. I
am a staff nurse so when the DON calls you down to
speak to her most people would have that ah moment.
Not me I go be-bopping down to her office with no
concern. I am not clean at the time but this
does not even enter my head. The meeting is the
intervention. I can remember sitting there and thinking
“oh God what do I do? My outward response was to
deny and I try to turn this around. I said How Dare You;
you know I’ve had stress. I was still denying as I was
peeing in the cup.”
33. “Altered Values”
• “I was in charge and everyone looked to me for
the answers. I liked being in charge so that I
could orchestrate the situation. When the
Director of Pharmacy asked about a drug
discrepancy I was the one he involved to help
with the corrective action. I took that role right on
so that I could come to the rescue and fix it.
What they didn’t know is I was the problem. I
was the one taking the medication.” “I was a
nursing student and a nurse who used alcohol
and cocaine on a daily basis for 22 years and
none of my peer nurses were aware.”
34. Profession
• The over arching theme of profession is
based on how chemically dependent male
nurses related to the profession of nursing.
It is looking at the description of individual
decisions interacts with their professional
journey while dealing with addiction.
36. Masterminding
• Ability to manipulate • Convince others in
the people, working believing that they are
environments and not abusing or using
themselves drugs
• Denial of their effects • Convince themselves
on others that they are not
• 24 hour a day focus doing harm
on access • Exhausting
performance
37. Masterminding
• “I volunteered to be the nursing supervisor
on the night shift and every other
weekend. This was a great place because
you are on every floor and have keys to all
areas of the hospital. The hot areas for
easy access are the Operating Room,
Endoscopy and the Pharmacy. As the
nursing supervisor you have the authority
and no one questions your actions”
38. Professional Heteronomy
• Inability to connect with their profession
• No sense of Duty
• Opposite of Autonomy
• Disconnection between the practitioner
and their patient
• Lack of accountability to the code of ethics
and governance of nursing
39. Professional Heteronomy
• “The automated medication systems that are now in
place in many hospitals will make a difference. They are
worth the price that it costs to have them in your
institutions. If it prevents someone from diverting
medications from a vulnerable patient it is work it. I also
want to emphasize the important of watching nurses
really waste the unused narcotics. As nurses make sure
you know what you are signing for when it comes to
wastage records.”
40. Getting Caught
• Increased need for chemical substances
• Increased risk taking
• Exhausted façade
• Getting caught begins to become
appealing
• Actions = Call for help
41. Getting Caught
• I was a travel nurse in another state and working
in the ER on the night shift. I started to use
because the stress of the job was getting to me.
I could not shout my mind off so I took Demerol.
It escalated so fast and soon I was using 4-5
times a shift. You soon realize that you need to
move on and a new contract is the answer. I was
able to survive like that for years always taking
smallcontracts that were less than 10 weeks.
42. Rehabilitation
• Stop lying
• Set realistic goals
• Return to practice is the biggest obstacle
• IPN confirmation
• Sole searching about their actions and
their profession
43. Rehabilitation
• If any drug addict tells you they would
never do a drug again they are lying
because you never know. The only thing I
can do is to make sure that I don’t get high
today. I know that I don’t have any drugs
on my person and that I am not going to
stick a needle in my arm today. But
tomorrow…..I don’t know. The structure is
what you hold on to….
44. Spirituality
• Addictions destroy any spiritual connection
• Prayer increases as the addiction is
replaced by healthy behavior
• Connection to a power greater than
themselves
45. Spirituality
• I keep myself spiritually fit by my support
groups and believing in God. I pray
everyday that I did not hurt someone or
because of me they died. That is a heavy
burden but I know that some nurses must
carry that burden. God must have been
looking over me or using my hands.
Because of this I must thank him
everyday.
46. Nurse Becomes the Nursed
• Nursing as a caring profession
• Calls for nursing
• Nurses willingness to care for nurses
• Response to the call
• Personhood
47. Nurse Becomes the Nursed
• I describe my intervention day as the worst
and best day of my life. I still keep in
contact with the nurse who reported me for
my diversion activities. It seems funny that
we stayed in touch. I call her at least once
a year on the 22nd of June just to say
thank you for saving my life.
48. Rigor
• Credibility of the findings was validated when the
researcher returned to the participants to share the
interpretation of the findings as well as checking for
accuracy from the perspective of the meaning of the
lived experience.
• Fittingness was evaluated by peer rehabilitated nurses
who can evaluate if the human experience reported,
rings true and is useful for guiding the practice.
“Phenomenological Nod” Van Manen (2003)
49. Rigor
• Transferability / Dependability-The researcher presented
her finished study at the IPN Annual Impairment
Conference (2007)
• Conformability - The researcher used the actual study
participants to assist with keeping the study true to the
lived experience.
50. Findings
• Chemical substance use started in the formative years in
an emotional and or physical abusive family
• Lack of awareness on dependency, impairment and
rehabilitation among the nursing community
• Fellow nurses are not aware or do not want to address
their peer concerning addiction
• Work 6-22 years while impaired
• Lack of compliance with policy and procedures related to
controlling drugs access
• Nursing leaders are present during the intervention but
are absent during the return to work phase of
rehabilitation
51. Findings
• Male nurses responded differently to stress by covering
it up
• No de-escalation post stressful situation causing
professional heteronomy
• Male nurses believe that they take more risk when it
concerns accessing chemical substances irrelevant to
the environment
• 100% of the male nurses studied were using chemical
substances during their initial nursing education
program
• Chemically dependent male nurses were intelligent,
productive and thought to be clinically competent by
their peers
52. Recommendations and
Implications
• Future research using a • Since their was a common
quantitative approach to factor of family abuse a
understanding the effect of the longitudinal study to address
clinical environment that may potential screening factors for
provide opportunities for preventative education for
recidivism nursing students
• Protective measures used by • Development of a campaign to
nurses as preventative address faculty awareness
strategies to impairment and competencies related to
• Develop survey tool to signs of addiction, impairment
determine if a cause and effect and diversion
exists between the study
themes and drug dependency
53. Recommendations and
Implications
• Nursing administration needs • Annual update on rules,
to provide annual information regulations and reporting
on the S&S of addiction mechanisms based on the
• Information on the role of the their states Nurse Practice Act
staff nurse and nursing • Education on alternative to
leadership concerning re-entry discipline and disciplinary
plans rehabilitation programs
• Monitoring practice • Nationwide law to address the
environments to ensure need for nurse rehabilitation
compliance with policy and programs in all fifty states and
procedures related to narcotic territories of the United States
access • Role of the nurse leader (CNO)
is significant in the return to
practice plan
