Primary care includes providing patients with guidelines and information for maintaining good health as well as providing the screening, diagnosis, intervention, and treatment of basic health problems, including alcohol abuse and dependence. Nurses play a crucial role in the primary care setting. They assess client needs; formulate and deliver care to individuals and families; and often are responsible for detecting, addressing, and referring patients who exhibit alcohol, tobacco, and other drug-related(1) problems.
Yet basic knowledge about alcohol abuse and its related problems has not been included in general nursing education in any consistent manner. Indeed, significant gaps exist in the content of nursing curricula aimed at educating nurses about substance abuse.
This article briefly reviews the role of nurses in primary care; examines the history of alcohol abuse nursing curricula; describes some model curricula programs; considers the need for clinical placement, preceptorships, and faculty development; and discusses efforts to standardize alcohol abuse curricula.
CURRENT NURSING EDUCATION
Basic nursing education now takes place in two major degree programs. The 2-year associate degree program teaches nurses to provide direct patient care from a base of scientific knowledge and liberal arts. The 4-year baccalaureate degree program prepares nurses to implement prevention, treatment and long-term strategies, such r as conducting interviews to obtain patients' histories and taking physical assessments. Nurses with baccalaureate degrees function with more autonomy and have a greater depth of knowledge than do nurses with associate degrees.
A master's degree in a specific content area allows nurses to specialize. Primary care nurse practitioners, nurse midwives, and addictions specialist nurses have master' s degrees and are prepared and proficient at nursing diagnosis and health care management within their chosen areas.
ROLES OF NURSES IN PRIMARY CARE
Primary care activities related to alcohol abuse center on the early prevention and intervention of problems and on the identification of problems and referral to specialty care.
Such an emphasis on prevention provides opportunities for generalist(2) nurses to assume more formal roles in providing primary care. Having a basic nursing education prepares nurses to identify alcohol-related problems in patients and to refer them to treatment specialists. For nurse practitioners, the role extends beyond primary care to include secondary care of patients with alcohol abuse and dependence (primary care referring to prevention and health maintenance and secondary care to diagnosis and care of acute illnesses).
A primary care nurse addressing alcohol-related problems must have received adequate education and training to obtain routine alcohol and other drug histories; implement primary prevention strategies, including anticipatory guidance and alcohol abuse education; assess a possible problem with alcohol; formulate a diagnosis of abuse from an analysis of patient assessments and data collection (e.g., laboratory results); conduct appropriate nursing interventions (e.g., patient education and nutrition counseling); identify acute alcohol-related illness and refer patients to physicians or addictions nursing specialists; and continue care in the forms of followup, monitoring, health maintenance, or health care support during recovery.
THE EVOLUTION OF NURSING EDUCATION
Information about alcohol abuse and its related problems has not been included consistently in nursing curricula. Long-term effects of alcoholism and appropriate nursing care for this condition often were included in professional nursing curricula developed in the 1940's. Yet it was not until 1977 that a textbook--Alcoholism: Development, Consequences and Interventions, by Estes and Heinemann--consolidated existing scientific findings and clinical observations to provide specific implications about alcohol abuse to the nursing community. …