Nursing Council on Alcohol: a nursing initiative targeting harmful alcohol use

Introduction

For many years, a plethora of research has indicated that there is an identified need for education and training of nurses if there is to be any meaningful impact on the health consequences of harmful alcohol use. Over the last three decades, papers have been published and conference speeches pontificated, emphasising the need to bring about change amongst the nursing profession, and raising awareness that the nurses actions can indeed impact on the health of the harmful drinker. Yet, event though, as nurses, we live in an evidence-based world, we have still to act on the evidence that inclusion of harmful alcohol use assessment, and the provision of brief intervention, can reduce harmful alcohol use amongst ones patient or client group, and the associated health consequences.

It is acknowledged that nurses are reluctant to include screening and intervention for harmful alcohol use for three primary reasons:

• Role Legitimacy – Nurse are uncertain as to whether, or how far, harmful alcohol use comes in to their remit.
• Role Adequacy – Nurses feel that they do not have sufficient knowledge and skill to recognise and respond to harmful drinkers.
• Role Support – Nurses feel that if a harmful drinker were identified they would not have sufficient access or support from specialist alcohol services

Just over two year ago, a few individual decided that the only way to move harmful alcohol use and the identified need for nurse education, training and interventions forward was to bring about a nursing body with this specific aim. On 30 November 2000, at a conference attended by over 300 senior nurses, chief executives and nurse specialists from throughout the UK, the Nursing Council on Alcohol (NCA) was launched, a management committee of leading nurse specialist and managers in the alcohol field formed, and a membership established.

The Glasgow launch of the Nursing Council on Alcohol was important in that it commenced focused endeavours to raise the nurse awareness of the need to include assessment, identification and appropriate intervention for the patient or client experiencing alcohol related problems. It is important to mention at this point that the Council is not an anti-alcohol organisation; it is about reducing harmful alcohol use.

The Council is an A-Political body, and is dependent on it’s funding from membership fees, donations and sponsorship. The Nursing Council on Alcohol is a registered charity, established with the explicit aim and objective to raise awareness, and the identification and treatment of, harmful alcohol use in the client or patient of the nurse. Raised awareness will lead to the early identification, and the consequential provision of, adequate and appropriate intervention at the entrance point to nursing care.

The Council decided to specifically target alcohol, as opposed to substance use, in acknowledgement that whist funding has been allocated for drug treatment and support, less emphasis has been given to the impact of harmful alcohol use on the health of the individual, the family, society, and on employment/industry, and the health and social care service, even though all can often be interlinked.

According to the UK government, 1 in 25 people are dependent on alcohol; twice the number of those on illegal and prescribed drugs. The number of death from harmful use is 100 fold greater. This gives some perspective of the size of alcohol related harm that is often lost behind the illicit drugs agenda. In terms of the direct impact of harmful alcohol use on the workforce, it is estimated that excessive or inappropriate use of alcohol cost industry £2 billion per annum. People working under the influence of alcohol and or suffering the consequences of excessive consumption can affect performance and productivity. Alcohol related workplace accidents are said to account for 20-25% of workplace accidents.

As professionals, we need to be aware of the complications and effects that alcohol can have upon the individual and society. There is an identified need for an emphasis in raising the awareness of both professional and the public to the potential dangers of the ‘safe drug,’ alcohol. The inclusion of education and training relating to alcohol related harm and problems in the nurse training programmes are at present inadequate, especially in view of the importance in terms of cost to the National Health Service, industry and other public services. For there to be a change in the way one perceives those experiencing alcohol harm and the ability to correctly identify and intervene in a positive therapeutic manner, therefore reducing the risk of developing further problems, it is imperative that both pre- and post- basic training programmes dedicate more teaching hours to an important subject.

In our interactions with individuals using alcohol harmfully, the starting point must be the recognition that alcohol use forms only a small part of the problem but that identification and brief intervention for those consuming alcohol harmfully may be integral to that individual’s future health. In addition, they have substantial cost implications for the NHS. Each patient or client will present with a unique set of concerns, which may have caused, contributed to, or interacted with the development of the overall problem.

Individuals using alcohol at harmful levels often change their behaviour as a direct result of a crisis or life event, such as a change in an important relationship, hospitalisation, an accident or illness, redundancy, a birth or a death. Such procedures can curtail, neutralise or enhance the nurses endeavours and need to be taken into account in the formulation of appropriate interventions. A holistic and eclectic approach to treatment, in which all relevant professionals should intervene as necessary, is essentially the way forward.

The effects of harmful alcohol use can impact on the individuals health. One in 6 people attending casualty have alcohol related injuries/problems, 15% of acute hospital admission are misusing alcohol and 11% of case of high blood pressure in men is related to harmful levels of alcohol use. In addition, there is a recognised increase in harmful alcohol use amongst women and young people.

Taking the above into account, it becomes apparent that if there is to be a meaningful change on the health and well being of the individual, nurses must open their practice to include the role they play in reducing harmful alcohol use. This is just as important in the occupational health advisors and practice nurses role as it is to the generic or specialist nurses role. Harmful alcohol use knows no clinical or specialist boundaries. It is the business of all nurses and must be so if we are to avoid the ‘it’s not our problem,’ assumption that prevents therapeutic interventions, and the reduction of the health impact on the nurses patient or client group.

Since the Councils launch we have been overwhelmed with requests for information, advice, education and writings, as well as briefing from parliamentary candidates, and comment on policy documents. The primary problem any organisation has when dealing with alcohol related issues is that public perception of the individual with a drink related problem is often one of no hope, violence, or often ‘a waste of time.’ This is not the case; many people with alcohol related problems lead active ‘normal’ lives following brief interventions. In addition, many individual drinking at harmful levels are not aware of the consequences of harmful use or that they may be drinking harmfully. This is something the council is aiming to redress with this proactive education and training initiative.

Plans are in progress to develop a summer school where the specialist nurse can network and share his or her expertise, initiatives and service development, and the nurse new to the speciality or merely interested, can develop important links, increase his or her knowledge base and evaluate how developments impact on that individuals practice. It is anticipated that this will commence in Spring 2003.

A little sooner will be the launch of the NCA and UNISON Essay Competition 2002 initiative to be launched toward the end of 2001. The Essay Competition aims to raise awareness of the nursing profession, whilst at the same time awarding initiative. There will be three categories for this event:

• Student nurses and midwives
• Non-specialist registered nurses, midwife and health visitor
• Registered nurse, midwives and health visitors working in the alcohol field.

The Nursing Council on Alcohol is currently looking at introducing regional coordinators, and eventually local coordinators, who will take forward the work of the Council by identifying education and training initiatives and thus keeping harmful alcohol use on the regional and local agenda.

There is still a long way to go but it is certain that nurses do have an important role to play in the assessment, identification, and intervention of harmful alcohol use. When the paper that brought us the ‘Lager Lout,’ headlines, now has a website with a dedicated computerised competition, where any one of any age can time oneself against friends to drink 5 pints of beer. Yet, omits to consider that the young adult, as is the prerogative of this age group – where ‘do not’ can often be interpreted as ‘please do,’ will transpose this competition to actual practice in a public bar. No caution or acknowledgment is given to the fact that even for the established drinker, 5 pints consumed at speed, without break, could lead to alcohol poisoning and or numerous other health consequences. For the new consumer the consequence may well be death. We still have a long way to go to bring about change to harmful alcohol use to members of the public, but it can be done. The nurse is in the advantageous position of assessing harmful alcohol use and offering brief intervention that can impact on the client or patient group s/he works with daily.

We will never know all there is to know about alcohol harm and problems. Alcohol will always offer up surprises. What intervention one offers depends on the knowledge, and the ability to use ones own, other people’s, knowledge. As professionals one has a responsibility to offer the best that is known, to the best of ones ability, at that time.

Knowledge and understanding of alcohol use is constantly changing. The challenge is to remain open to the information that will help provide:

• Appropriate therapeutic intervention,
• At the appropriate level,
• At the appropriate time,
• At the appropriate cost,
• With the appropriate understanding of the individual presenting with the problem.

Anyone wanting more information on the work of the Council, membership of the council, the conference or the essay competition should contact:

Professor Hazel Watson
Secretary, NCA
Glasgow Caledonian University
City Campus
Cowcaddens Road
Glasgow
G4 0BA
T: 0141 331 3457
F: 0141 331 8312
E: NCA.UK@btinternet.com