Module 6: Chelsea Flashcards
Some of the drugs most often associated with substance use include:
-alcohol
-amphetamines
Ritalin
-barbiturates
Seconal, Nembutal, Amytal, Tuinal
-benzodiazepines
Xanax, valium, Ativan, Halcion
-cocaine
-opioids
morphine, codeine, methadone
There are different approaches or models for caring for substance-using women and each of these approaches views the problem through a different lens.
For example:
- We may see substance use as a disease and the only “cure” is abstinence.
- We may believe people with substance-use problems are weak or flawed in some way and the answer lies in enforced treatment.
- We may believe that drug use is part of our world and the goal is to reduce the harmful effects of the substances.
Harm Reduction Model
A harm reduction model of care is a public health approach that aims to reduce the harmful consequences associated with recreational drug use and other high-risk activities. “Harm reduction is a set of practical strategies that reduce negative consequences of drug use, incorporating a spectrum from safer use, to managed use to abstinence.” (BC Women’s Hospital & Health Centre, 2006, p. 50). The harm reduction model also takes into account the impact of poverty, class, racism, trauma, and social inequalities on a person’s vulnerability to and capacity for dealing with substance use (BC Women’s Hospital and Health Centre, 2006).
Some examples of harm reduction programs are:
heroin maintenance programs
safe injection sites
needle exchange programs
safer sex programs
Some of the existing programs in Canada that provide services for women who use substances during pregnancy via a women-centered harm reduction model are:
- Sheway
- Fir Square Unit
- Breaking the cycle
- Motherfirst, Kidsfirst
Sheway, Vancouver BC
Provides comprehensive health and social services to women who are either pregnant or parenting children less than 18 months old and who are experiencing current or previous issues with substance use. The program consists of prenatal, postnatal and infant health care, education and counseling for nutrition, child development, addictions, HIV and hepatitis C, housing and parenting. Sheway also assists in fulfilling basic needs, such as providing daily nutritious lunches, food coupons, food bags, nutritional supplements, formula, and clothing.
Fir Square Unit, BC Women’s Hospital
The program helps women and their newborns stabilize and withdraw from substances, keeping mothers and babies together whenever possible and continuing to provide care from antepartum to postpartum and between hospital and community. Women at Fir Square have access to counseling and instruction to enhance critical life skills, parenting techniques, and coping mechanisms. Babies receive specialized care that meets their needs, if withdrawing from prenatal substance exposure to ensure the healthiest possible start. Babies room in with their mothers on the ward.
Breaking the Cycle, Toronto
Breaking the Cycle (BTC) is an early identification and prevention program designed to reduce risk and to enhance the development for substance-exposed children (prenatal–6 years). They provide services which address maternal addiction problems and the mother-child relationship through a community-based cross-systemic model. Families receive integrated addictions counseling, health/medical services, parenting support, development screening and assessment, early childhood interventions, child care, access to FASD Diagnostic Clinic, and basic needs support in a single access setting in downtown Toronto, with home visitation and street outreach components.
MotherFirst, KidsFirst, Regina
Provides support to vulnerable expectant and new mothers. Assists families in becoming the best parents that they can be, by providing support, enhancing knowledge and building on family strengths.
What is it important for nurses to understand when working with this demographic?
What is important for nurses to understand is that women presenting with substance-use problems often are dealing with other problems such as poverty, unstable housing, abusive partners, mental health problems, social isolation, and fear of authorities. While we acknowledge that it is often difficult to care for women with substance use problems, we need to remember that the behaviors we might view as manipulative or disrespectful are behaviors they have developed in order to survive.
The 12 determinants of health that have been identified are:
Aboriginal status Early life Education Employment and working conditions Food security Health services Gender Housing Income and its distribution Social safety net Social exclusion Unemployment and employment security
Income
The Canadian Perinatal Health Report (2008) supports the fact that socioeconomic status is a determinant of perinatal health. Infant mortality is widely regarded as a general indicator of population health. Infant mortality rates among low income groups in urban Canada were two-fold higher than the rates in the highest income groups.
Zhong-Cheng et al (2006) observed higher rates of preterm birth, small for gestational age, still-birth, neonatal death and post neonatal death among mothers of poorer neighborhoods.
The level of income shapes the basic living conditions, such as safe housing, the availability of healthy food, the extent of physical activity, tobacco use and access to education (Mikkonen & Raphael, 2010).
Education and Employment
Education as a social determinant of health is often linked with other determinants such as income, employment security and working conditions. Zhong- Cheng et al (2006) identified that women with lower education levels are more vulnerable to adverse birth outcomes. This may be through lack of knowledge about antenatal care, nutrition and infant care.
Social Support and Social Exclusion
Social support/exclusion can be at the individual or societal level. Lack of social support can lead to poor mental and physical health, increased risk of depression, and pregnancy complications (WHO). In Canada, groups that are often hard to reach or who do not access prenatal care and social supports include: substance-using women, immigrant women, aboriginal women, and women who are experiencing partner violence.
Food Security and Housing
Food quality as well as quantity is influenced by economic conditions. Lower income or poorer people tend to replace healthy fresh food with processed, high fat, sugary foods. The WHO (2003) states that “the main dietary difference between social classes is the source of nutrients” (p. 26). Canada is, in global terms, a very rich country. However, more than one in five Canadian households are unable to find affordable healthy homes (Shapcott, 2009). Low-income families are often forced to live in illegal or substandard rental units.
Aboriginal Health
Within Canada, there are three aboriginal populations: First Nations, Métis, and Inuit. When reviewing the literature there is overwhelming evidence of inequality and poverty among our aboriginal population. Aboriginal people have higher unemployment rates, lower education, experience more food insecurity, and experience a disproportionate burden of illness and early death than non-aboriginal people (Smylie, 2009).
It is well recognized that prenatal care is an important aspect of promoting maternal and neonatal health. Aboriginal women are less likely to receive prenatal care and attend prenatal classes (BC’s Aboriginal Health Project, 2006). Barriers to care include: financial barriers, services that are geared towards married non-aboriginal women, fear of medical providers, and lack of providers in their community.
Gender
Neonatal nursing involves caring for women and their families. Before proceeding, let us first understand the difference between sex and gender. Sex refers to the biological differences between males and females, while gender goes beyond biology to address the social and economic context of our lives. Mikkonen and Raphael (2010) state that “women in Canada experience more adverse social determinants of health than men. The main reason for this is that women carry more responsibilities for raising children and taking care of the household. Women are also less likely to be full-time employed and are less likely to be eligible for employment benefits” (p.44). The high percentages of women living in poverty, the persistence of violence against women, and reduced federal spending on social support services are just a few of the key issues that both create and support women’s equality (Spitzer, 2009).
Gender also intersects with other factors such as race, culture and language. Aboriginal women as well as immigrant, refugee, and visible minority communities face racism as well as language and cultural barriers when seeking care.
Women’s greater exposure to poverty, discrimination, socioeconomic disadvantages and violence puts them at increased risk of health issues and substance abuse problems.
Substance use can affect the developing fetus in 3 ways:
-directly on the fetus, a teratogen
birth defects
-alter function of the placenta
intrauterine growth restriction, microcephaly
-cause muscles of the uterus to contract
spontaneous abortion, or premature delivery
After birth the newborn can be affect by the following complications:
withdrawal symptoms respiratory distress infections (HIV, hepatitis) postnatal growth delay feeding difficulties long-term cognitive delays which may not manifest until school age
Methadone
Methadone is a synthetic opioid used in the treatment of opioid dependency (heroin, morphine). When taken as prescribed in a daily dose methadone does not get a person high but it does stop opioid withdrawal. Methadone is the treatment of choice for the management of opioid dependence in pregnant women (Cleary, 2011).
Infants exposed to methadone antenatally do experience withdrawal and this can occur within 24 hours to up to 5–7 days after birth.
Neonatal Abstinence Syndrome
Neonatal Abstinence Syndrome, also known as neonatal withdrawal, is a group of problems that occur in a newborn who was exposed to addictive illegal or prescription drugs while in the mother’s womb.
