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URSING _CIENCE UARTERLY THEORY! RESEARCH ! AND PRACTICE
Volume 29
Numbe r 2 April 2016
NURSING SCIENCE QUARTERLY THEORY, RESEARCH , AND PRACTICE
Editor Rosemari e Ri zzo Parse. RN: PhD: FAAN Di stingu ished Professor Emeritus Loyo la University Chicago
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Katj a Fried. MA : MBA lanag ing Editor Editor, Writer Camarillo. CA Katj a.Fried @verizon.net
International Advisory Panel Thomas Doucet. Rt : PhD Uni versity of Moncton , ew Brunsw ick, Canada
Lina Ma. R : PhD Li ons Home for the Elders, Singapore
Emiko Endo. RN: PhD Musashino ni versity. Tokyo. Japan
Francoi se Maillard-Struby. R 1; PhD Webster U ni versity, Geneva, Switzerl and
Ok Ja Lee. RN: PhD Konyang Uni versity. Seo ul. Korea
Anthony Welch, Rl ; PhD Central Queensland Univers ity, Australia
Editorial Board Steven L. Baumann . Rl\!: PhD Professor, Hunter College, City University of New York
Kri stine L. Florczak . R ; PhD Assoc iate Professor of Nur ing, Saint Xav ier University
Sandra Schmidt Bunker , RN; PhD ; FAAN Adjunct Professo r, College of ursing South Dakota State niversity
Paul a M. Karni ck. RN: PhD Endowed Chair in Advanced Practi ce Nursing In diana Uni versity South Bend
Barbara Backer Condon, RN; PhD Professor. Bri ar Cliff Uni versity Pamela N. Cl arke . RN: PhD: FAAN Professor. University of Wyo min g
Constance L. Milton. RN ; PhD Assoc iate Dean and Professor. Azusa Pacific University Mary R. Morrow, RN : PhD Assistant Professor, College of Nursing Purdue University Calumet
About the Cover: Cover design by Alj Mary, The Iron Rose Complex. Fi nleyv ille, PA. The Nursing Science Quarterly logo i a sy mbolic representat ion of the process of expanding nur ing knowledge. The circular configurations represen t the known For SAGE Publications Production : Ayan Dhar
Mario Orti z. RN : PhD Dean and Profe sor, Col lege of Health Sciences In diana ni versity South Bend Pamela G. Reed. RN: PhD ; FAA Profe sor, College of ursing ni versity of Arizona Nan Ru ssell Yancey, RN ; PhD Dean, Office of Graduate Studi es Lewis ni vers ity
theoreti cal frameworks in their various processes of development. The dots and swirling lines depict earl y conceptualj zations of ideas and perspectives. Green represents hope, a persistent moving on with anticipation of what will be as the discipline changes.
C 0 p E
COMMITTEE ON PUBLICATION ETHI CS
NURSING SCIENCE QUARTERLY THEORY, RESEARCH , AND PRACTICE
Volume 29
Number 2 April 2016
Editorial Where Have All the Nursing Theories Gone? Rosemarie Rizzo Parse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1
Columns Theoretical Concerns I Am Community Sandra Schmidt Bunkers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Research Issues Evidence-Based Practice: What's New Is Old Kristine L. Florczak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Ethical Issues Power with Social Media: A Nursing Perspective Constance L. Milton ............. .. . . . .. . .. . .... . .. . . ....... ....... . . . ... .............. 113
Teaching-Learning Processes Community-Centered Service Learning: A Transformative Lens for Teaching-Learning in Nursing Nan Russell Yancey . .. . . . ... ................................. .. . . . ... .......... .... . . . 116
Practice Applications Sorting It Out: Cultural Competency and Healthcare Literacy in the World Today Paula M. Kamick . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Scholarly Dialogue Culture: Distinct or an Illusion? Pamela N. Clarke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Are We Really Measuring Cultural Competence? Larry Purnell. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Articles Humanbecoming Hermeneutic Sciencing: Reverence, Awe, Betrayal, and Shame in The Lives of Others Rosemarie Rizzo Parse ..... . . ......... ... .. ... .. .... .... . ................. . ... . ........ 128
Emotional Eating Mediates the Relationship Between Role Stress and Obesity in Clergy Nancy N. Manister and Eileen Gigliotti ........... . ...... .. . . ..... . ... . .. .. ........... . .... 136
Building a Middle-Range Theory of Adaptive Spirituality Marjorie C. Dobratz ................ . . ... . . ... .. .............. ... .......... . . . . . .. . .... 146
Reformulating the Common Sense Model of Self-Regulation: Toward Parent-Child Shared Regulation Jenn ifer T. Sonney and Kathl een C. Insel .. . ...... . .. . . .... .. . ... . ............ . . ... . .. . .. .. 154
Global Perspectives A Human Science View of Behavioral Health Steven L. Baumann ..... . .................. . ... . . . . ...... .... . .. . . . . ... . .. . . . . . .. . ..... 160
Nursing and Substance Use Disorders in Mexico Miguel A. Vi llegas-Pantoj a and Martha D . Mendez-Ruiz . . .. . . . . . . .. . .. .. ...... . . . . ........... 163
Leading-Following Perspectives Collaborative Partnerships: A Leading-Following Perspective Mario R. Ortiz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Academic-Practice Partnerships: The Interdependence Between Leadership and Followership Linda Q. Everett . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Essays on Nursing Science Thoughts About Social Issues: A Neuman Systems Model Perspective Teri Aronowitz and Jacqueline Fawcett .. ................... . ... . . .. . ....... . ... . . .. . .. . . .. 173
Book Reviews and New Media Transitioning .............................................................................. 177 A Review of What is Nursing? Exploring Theory and Practice, 3rd Ed. Mary Monow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Global Perspectives
Nursing and Substance Use Disorders in Mexico
Nursing Science Quarterly 2016, Vol. 29(2) 163- 166 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPerm issions.nav DOl: I 0.1177/0894318416630092 nsq.sagepub.com
®SAGE 1
Miguel A. Villegas-Pantoja, RN; BS , and Martha D. Mendez-Ruiz, RN; BS 2
Abstract The authors of this article see substance use disorders as a major public health problem in Mexico in which nursing is taking on an increasingly important role in addressing. The authors discuss some the challenges and opportunities nurse researchers, educators, and clinicians face in the prevention and treatment of substance use disorders in Mexico.
Keywords Mexico, nurses, substance use disorders
A pattern of substance use that results in significant health or other problems is now categorized as substance use disorders in the American Psychiatric Association's (2 0 13) Diagnostic and statistical manual of mental disorders, 5. This pattern of use is seen as a major public health issue in Mexico, and elsewhere. Whil e many challenges remain in the prevention and treatment of substance use disorders in Mexico, nurses are making a significant contribution to the research, education, and practice in the field. While the Mexican health authorities have been invo lved in addressing the substance use problem in Mexico since the early 1970s, the first National Survey of Addictions was not done until 1988. The more recent surveys demonstrate that the prevalence of substance use disorders continues to increase (Secretariat of Health , 20 15). Substance use disorders are now understood to be a multifactorial progressive disease, like diabetes.
Substance Use Disorders in Mexico Substance use related problems in Mexico are related to multiple social, econom ic, and political factors. Part of the reason for the increase in use is the aging and growth of the population and unemployment. Globalism and terrorism contribute to the production, transportation, and sale of drugs in Mexico (Naegle, 2002). A combination of these issues is seen as related to the availability and misuse of these substances. Between 2002 and 2011 the percentage of adolescents with substance use disorders in Mexico doubled; the percentage of alcohol use disorders increased from 2.1 % to 4.1 %, and dependence to illegal substances increased from 0.7 % to 1.5% (Secretariat of Health, 20 12). Furthermore, although males are more likely to use and abuse drugs, use by females is increasing as well. Evidence for this is seen in the increasing numbers of adolescent females who admit to
smoking tobacco, increasing from 3.8% in 2004 to 8. 1% in 2012 (Secretariat of Health, 20 12). The number of male tobacco smokers of the same age in the same time period did not significantly change. Also considered significant is the age of onset of substance use for both genders, which has decreased in the past l 0 years. The statistics of this disturbing trend, is that in 2002 , the average age of onset for using illicit substances (includes marijuana, cocaine, crack, inhalants, hallucinogens, amphetamines) was reported as 23.6 years for females and 19.8 years for males, in 201 1 the age of onset was estimated to be 20.1 years and 18 .3 years, respectively (Secretariat of Health, 2012). These public health problems pose a significant risk to the people of Mexico and the stability of the Mexican Health System and represent a challenge for all health profess ionals. Government and pri vate organizations have initiatives aimed at reducing the demand for drugs ; however, their achievements to date have been modest. Public health initiatives to reduce the rates of substance misuse in Mexico have included the creation of care facilities , such as the Centros Nueva Vida (New Life Centers) and Centros de Integraci6n Ju venil (Youth Integration Centers) , which are intended to treat and identify at risk individuals vulnerable to addictions. Also, research institutes and administrative units were established to promote research in this
' Professor, Nursing School of Nuevo Laredo, University of Tamaulipas, Mexico 2 Professor, Nursing School of Nuevo Laredo, University of Tamau lipas, Mexico Contributing Editor: Steven L. Baumann, RN , PhD , Professor, Hunter College, City University of New York, 82 Sherman Avenue, Williston Park, New York 11596. Email:
[email protected]
Nursing Science Quarterly 29(2)
164 areas, these include the Comisi6n Nacional contra las Adicciones (National Commission Against Addictions) and the Centro Nacional para Ia Prevenci6n y el Control de las Adicciones (National Center fo r Prevention and Control of Addictions). Despite these developments, the initiati ves are limited and do not provide the evidence and understanding needed to adequately guide healthcare (Marin-N avarrete, Medina-Mora, & Tena-Suck, 2014) . The limitation of the ex isting scientific knowledge and the ava il abili ty of approp riate substance use disorders treatment in Mexico remains insufficient due in part to the lack of investments in trai ni ng and deve lopment for nu rses and other healthcare workers (Secretariat of Health, 2013). Despite the limited funding and oppmtuniti es to gain the needed experti se, registered professional nurses are playing an increasingly significant role in substance use di sorders treatment in Mex ico, even while they remain underutilized and inadequately supported .
The Growing Role for Nursing According to the Pan A merican Health Organization and the Wo rld Health Organization (20 11) a feas ibl e way to increase access to appropri ate substanc e use di sorders treatment is to improve the education and trai ning of primary care providers . In countries like Mex ico, increasi ng the education and skills of nurses to wo rk effecti ve ly with persons w ith substance u e disorders is a logical step . As in other countries, nur e in Mexico are the largest health professional group, including those in primary care clinics (Secretariat of Health, 200 ) . .Yloreover, nurses generally are prevention oriented and work in close proximity to population at ri sk for substance use disorders. In Mexico, nurses are more likely to be of the same cultural background as their patients and more likely to be able to develop the rapport needed to engage persons at ri sk for substance use disorder in effective treatment, than other gro ups of health professionals. In other words, even with modest amounts of supp011 and research training nu rses are increasingly contribu ting to the countries response to sub stance use disorders. However Mexican nursing continues to face many obstacles that slow down their progress in bringing this initiative into widespread use. It is no w recognized that there is a significant nursing shortage in Mexico, which varies regionall y. Nationally, Mex ico has only 2.6 nurses per 1,000 inhabitants, which is far below the average of Organization for Economic Co-operation and Deve lopment members (8 .8 per I ,000 inhabitan ts) and significantly less that in the United States ( 11. 1 per 1,000 inhab itants; OECD , 20 14). To make matters worse, 5 1% of all nurses in Mexico work in four of the 3 1 states that compri se the Mexican Republ ic (Secretariat of Health, 2007). Thi s sh011age is clearl y a country-wide obstacle to access and treatment fo r persons with substance use disorders. In addition to the total number of nurses in the country, the preparation of these nurses is limited; there are fe w nurses in Mexico with an y graduate education. While 30% of
nurses working in the public sector have a bachelors ' degree, only 1.26% have a masters ' degree and 0.05 % have doctoral degrees. Consequently, less than 1% of all nurses emplo yed in the public sector are invo lved in research (Secretariat of Hea lth, 20 15) . The number of nursing staff with specialized training to provide bas ic care in the area of substance use di sorders is not known; but it is likely to be quite low.
Nursing and th e Inter-American Drug Abuse Control Commission (CICAD) Aware of the aforementi oned issues, during th e 1990s the Organization of A meri can States (OAS) , through the CICAD , undertook a project to help meet the Hemispheric Drug Strategy - the biggest ini tiative against drugs in the Americas . It was called The International Research BuildingCapacity Program for Health Related Professionals to Stud y the Drug Phenomenon in Latin America and the Caribbean. The goal of thi s proj ect was to prepare educators and new nurses with the kno wledge and skill s in hea lth promoti on, prevention of drug use and abuse, and socia l reintegration of drug abusers (Wright & Lujan, 20 13). Whi le Mexican nurses were not engaged in the early stages of this project, by 200 I some nurses were enro lled in CICAD's project through public uni versi ti es, such as th e University of uevo Leon (UA L), the Un iversi ty ofGuanajuato and the Uni versity of Queretaro . The nurses recei ved training at the University of Albe11a, Canada through scho larship s funde d initia lly by the Governm ent of Japan, and then by the governments of US and Canada (Wright et al. , 2005). The traini ng provided by CICAD was comprised of three basic components that provide the scientifi c basis to develop an understanding of drug issues: education activities, outreach activities and drug research stud ies (Wright & Lujan, 20 13) . Below we provide a brief summary of the ac hi evements in each component.
Education Activities Mex ican nu rses have tried to meet the project requirements, particularly in the area of education. The focu s of their eff011s has been on increasing substance use disorder content in undergraduate and graduate nursing programs . This eff011 has been hampered by a lack of agreement or nursing standards on substance use in the curriculum. FUI1hermore, when it was included the content was added to the psychiatric-mental health courses only, which fails to appreciate the holi stic nature of the problem. Fortunately, newer standards in nursing education have included competenci es for new graduates to be educated in comprehensive care in relation to substance misuse. To date, academi c institutions have adapted new nursing curricula throughou t Mex ico (Esparza, Alonso , Lopez, & Rodri guez (20 14) , mainly in schools belonging to state universities. As an examp le, in 2014 the School of ursing of the UANL had graduated more than 1,500 registered nurses under the new curricula. Standardization of CUITicula has
Villegas-Pantoja and Mendez-Ruiz I Global Perspectives been achieved in part through the establishment of organizations such as the Federaci6n Mexicana de Asociaciones de Facultades y Escue/as de Enfermeria (Mex ican Federation of Associations of Colleges and Schools of Nursing [FEMAFEE]), which concentrates 12 associations committed to improve qual ity of nursing . Supported by the Mex ican etwork of Colleges and Schools of Nursing, FEMAFEE recently organized a series of workshops highlighting teaching and research skills to improve teachers' knowledge in the field of addictions (Perez, 2011 ). Another way to promote CICAD 's education component was recruitment of leaders and change agents who have the knowledge to educate nurses and other staff members. To achieve this aim, these leaders added drug-related content to graduate cunicula, just as in undergraduate programs. The first adaptations to Master's and Doctoral programs were held in the School of:"Jursing of the UANL, where more than 130 Master of Nursing Science (from 2001 -2014) and four Doctors of ursing Science belonged to the Add ictions Line of Research (from 2008 to 2014) (Esparza et a!. , 2014). The agents of change have boosted the generation of scientific knowledge and contributed to the training of staff to detect people at risk and addicted to substances. Also change agents have improved or developed other nursing graduate programs.
Outreach Activities With regard to community outreach activities, nurses have been focused on health promotion, prevention of substance use related problems and the development of soc ial rei ntegration programs for high-risk groups. For example, nurse researchers have des igned and tested a few interventions to prevent smoking and alcoho l use in high school youth (see Alonso-Castillo, Esparza-Almanza, Frederickson, GuzmanFacundo, Lopez-Garcia, & Martinez-Ma ldonado, 2008). They have also performed outreach educati on in the commun ity. For examp le, nurses in the city of Monteney have agreements with the Min istry of Education, that require training on substance use related problems for teachers so they can identify vu lnerabl e indiv iduals and groups promote healthy li festy les. Likewise, the Grupo de Estudiantes de Enfermeria en Contra de las Adicciones GREECA (Nursing Students Group against Addiction s) seeks to improve knowledge of substance misuse. This group started in 2001 and has become national in scope, involving 17 nursing schools at this time. Its purpose is to enhance learning and lmowledge about substance use disorders and promot a culture of prevention in nursing schools. This group holds an annual convention where nurse students share drug-related cli nica l experiences and receive training by special ists (Esparza eta!., 2014).
Substance-Related Health Problems Research As for dn1g research studies, Mexican nurses have perfonned many local, national , and even multicenter studies (see Alonso,
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Musayon, David, & Gomez, 2006). Most of the cunent studies have used descriptive quantitative methods. Funding bas been provided by state univers ities, CICAD and the Nati onal Council of Science and Technology (CONACYT). The find ings of these studies have linked antisocial behaviors, depression, stressful life events, and a history of violent behavior and gang membership as risk factors for substance use di sorders . High self-efficacy, self-esteem, as well as good parentchild conununication and parenting skills have been linked with less use and misuse of substances. However, it is important to note that professors and students of graduate programs have conducted most of these studies and the involvement of clini cal staff has been limi ted. Thi s may be explained by the limited presence of research departments in hospitals and outpatient's clinics. Another ach ievement in the area of substance use research has been the recognition of nurses as members of the Mexican a tiona! System of Researchers (SNI). The SNI is the highest authority in the country for recognizing scientific work and it serves as an important bridge between Mexican Government and CONACYT to help translate research findings into education and clinical practice. Since SNI members are the main representation of academia to the Mex ican Government, the membership puts them in a strategic posi tion to contribute to the health policy advocacy as welL However, the nursing affi li ation to the SNI is conditioned by the impact of their scientific production, which in many cases is questioned by other professionals. It is expected that the engagement of more nurses with the SNI, will support nursi ng projects and influence the political sphere of promoting true health care reforms for the benefit of society.
Challenges and Opportunities Then national and international context demands specialized professionals ab le to ana lyze problems and present feasible sc ientific solutions. Mexico does not have suffic ient spec ialized staff to participate in national drug commiss ions, research centers, hospitals or academic institutions. However, nurses have made progress in addressing these chall enges. A notable examp le is the standardization of nursing education on substance misuse and treatment, which demonstrates that nurses may be able to organize their discipline for collective goa ls. There has been considerable effort and progress toward establishing and developing graduate programs and lines of research with a focus on addictions. However, the communication with private nursing schools and nursing schoo ls located in disadvantaged areas is still an issue. Moreover, it is necessary to extend the progress to include the cli nical sector, and reduce the gap between educational activities, research, and po licy. Also, nurses' contributions to improve the ep idemiologica l outcomes are not yet palpable. Most interventions that have a real impact on public health are sti ll designed by professiona ls in psychology, medicine, and anthropo logy (Alvarez, Alonso, Lopez, Esparza, Alonso, & Guzman, 20 I 0).
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In addition , nursing research is mainly perfonned by academics , limiting the di ssemination of findings and its appli cation to clinical environments -(Benavides-Torres, 2002 ), where the largest numbers of nurses practice. Training staff nurses to use theory and science to guide their work with persons with drug related health problems remains a challenge. Many problems remain, such as the shortage of nursing staff. As already stated, to exceed OECD 's nursing staff average Mexican authorities wou ld need to more than triple the number of nurses (Secretariat of Health , 20 13), even without considering that in the next 30 years the demand for nurses will be much higher. These challenges demand interventions to improve the image of nursing in order to increase the number of new recruits. A way to achi eve this goa l is to promote the strengths and progress achi eved by the nursing profession in addictions. Finally, an aspect to consider in order to improve the nurses ' experience in substance use di sorders services could be the establi shment of new co llaboration with other disciplines. As in developed countries, it is essential to take advantage of multidisciplinary teamwork in order to improve patient care, and promote nurses' capab iliti es. However, it is worth noting that nurses' presence at conferences and on government boards will not be enough to achieve disciplinespecific goals. Nurses will not be recognized as an advocacy group until they have demonstrated the ability to make a difference in the prevalence of these di sorders and related health problems. Therefore, development of meaningful so lutions agai nst substance use disorders is likely to remain critical to improving public health and welfa re in Mexico, and a key element in broadening the professional visib ility of nursing. Declaration of Conflicting Interests The authors declared no potential confl icts of interest with respect to the authorsh ip and/or publication of this rev iew.
Funding The authors received no financial support for the authorship and/or publication of th is rev iew .
References Ameri can Psychi atric Associat ion. (2 0 13). Diagnostic and statistical manual of mental disorders (5th Ed.). Washingto n, DC: Author. Alonso, M. M. , Musayon, F. Y. , David, H. M .S. , & Gomez, M . V. (2 006). Drug consumption and occupational violence in working women, a multicenter study: Mex ico, Peru, Brazil. Latin American Jo urnal of Nursing, 14, 155- 162. Alonso-Castillo, M . M., Esparza-Almanza, S. E., Frederickson, K. , Guzman-Facundo, F. R. , Lopez-Garcia, K . S. , & MartinezMaldonado, R. (2008) . Effect of an intervention to prevent alcoho l and snuff among ado lescents in secondary school s in Mo ntetTey, Mex ico. Nursing Research : Image & Development, I 0, 79-92.
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