Nursing Leadership Executive Summary: Addressing a Lack of Education Surrounding Fentanyl Use and Recovery
Our project focused on assisting a nonprofit organization who exists to serve the most vulnerable of families in the Seattle area. They offer a number of programs including a mobile outreach team that seeks to bring resources to families, a program for families which provides the opportunity for new mothers to bond with their newborn, and another program which assists families with medically fragile children to find healthcare resources, and more. Our team was made up of six students from the Lydia Green Nursing Program at Seattle Pacific University who were enrolled in the Nursing Leadership in Community Engagement class. The aim of this course was to practically apply our leadership skills in the context of public health by providing resources to a local health agency to complement their current programs. This was done by collecting data on the target population and communicating with the agency to identify an issue that could be addressed through an evidence-based project. Upon our first meeting with the staff at the community agency, we identified the issue of deficient knowledge among the staff related to fentanyl use and recovery, as evidenced by relapse occurrence, unsafe handling of the drug, and self-report from the staff. Our team in collaboration with the agency decided to create an evidence-based resource for the staff that would detail overdose and Narcan use, education on fentanyl, and safe disposal of the needles, all displayed in a concise binder that the staff can continue to use for years to come.
A King County Point-in-Time Count revealed that there were over 11,500 people experiencing homelessness, which was a five percent increase from the year prior (Constantine, 2020). Another qualitative study looking at addiction recovery of women in opioid use disorder described postpartum pain and anxiety as the primary reason for mothers to turn back to opioid substances (Rankin, 2022). These statistics informed us of the need for resources to address the issue of substance relapse in mothers. This agency was only a few years old at the time of this project and was in need of procedures and protocols to address health issues for their population, in addition to resources outside the agency. The staff of the community center were enthusiastic about the idea of educational resources for their employees. By educating the staff, our group empowered them to provide quality care to their clients.
Activities with Rationale
One of the primary resources that the community agency provides to their clients is their mobile outreach team, which strives to meet people at their place of residence to provide medical, financial, and educational support. At the time of this project, the agency was in dire need of educational resources for their outreach staff. The goal of our project was to provide access to evidence-based research through educational binders and badges for the staff. The first item we created was an educational pocket/badge card. The literature demonstrates pocket cards are effective tools for process improvement when a rapid response is needed. In one study, the use of a pocket card increased the use of narcan four-fold (Russel, et al., 2015). Because pocket cards are such an effective tool, our team created a pocket card for staff and clients around proper Narcan administration.
The second item we created was an educational binder. Each section of the binder was focused on a different topic of interest that the staff had asked for more education on. The first tab in the educational binder focused on education surrounding fentanyl use. Our goal was to educate the staff on the public health crisis surrounding fentanyl use in Seattle by discussing common drugs that can be laced with fentanyl, addressing misconceptions of how someone overdoses from fentanyl, and what an overdose looks like (Centers for Disease Control and Prevention, 2022).
A lot of our efforts also focused on naloxone (Narcan) education due to the services that the agency provides to their clients. The community center is frequently working with a population that utilizes substances, resulting in the need for their staff to be thoroughly educated and comfortable with the use of Narcan. The information in our binder covered what an overdose looks like by using the acronym “S.U.S.P.E.C.T.”, which stands for slack muscles, unresponsive, scratching, pupils constricted, emesis, and choking sounds (Illinois Department of Public Health, n.d.). Our education then shifted to proper use of naloxone, which outlined how to administer it in a safe way.
Another resource that the agency had indicated a need for was detailed information regarding needle and sharps disposal. Upon our first meeting with the community center, the executive director mentioned the lack of information their clients have on proper disposal of sharps. The population that they serve often does not have access to a proper sharps bin, which creates the need for alternative options. Our education focused on creative ways to dispose of needles through the use of everyday objects, such as an old laundry detergent bottle (What to Do With Used Sharps in Washington, 2020). We also touched on the laws in Washington State that govern disposal of needles, and where the clients can dispose of their collected needles.
The final resource we put together for the staff was information surrounding methadone and the role it has in preventing further opioid dependence. Our goal was to educate the staff on what methadone is, and the risks that come with using it. It is widely known in the literature that access to educational resources can improve work-flow, decision making, and outcomes.
The staff at the community center demonstrated the need for education surrounding the health issues that their clients face. Based on the needs assessment, we identified the nursing diagnosis to be knowledge deficit among the staff related to fentanyl use and recovery, as evidenced by relapse occurrence, unsafe handling of the drug, and self-report from the staff. Our goal was to equip their mobile outreach team and staff based out of the agency with information that would guide the interventions used for their clients, based on the evidence in the literature. Our binder of educational information was received very well by the staff. The badge resource we created was also very appreciated by the staff, and the director said it would be very useful for their mobile outreach team. The team verbalized understanding of the educational content. Pre and post outcomes were outside the scope of this project.
Each week during the development of our project, our team liaison would communicate with the agency regarding the progress of our research and project. The outreach coordinator was enthusiastic about the resources we were providing them, and frequently thanked our team for the interventions we were providing the agency. By equipping the employees, we were able to provide tangible health and nursing knowledge for their clientele.
In conclusion, our interventions on behalf of the community agency were able to address their goals of educating their staff on problems relevant to the population they serve. Our team also met our goal of providing a resource to the agency based on the nursing process, which includes assessment, diagnosis, planning and outcomes, implementation, and evaluation. Based on the needs assessment, our nursing diagnosis was a knowledge deficit surrounding fentanyl use and recovery. We met this need by providing an evidence based pocket card and educational binder. Our project ultimately has the potential to make an impact on the community that the agency serves, and should continue to make a difference as the educational binder is used for years to come. In the future we recommend further education surrounding fentanyl use and recovery, along with education in other areas where the agency shows a knowledge deficit.
Center for Disease Control and Prevention. (2022). Fentanyl facts. Department of Health and Human Services. https://www.cdc.gov/stopoverdose/fentanyl/index.html
Constantine, D. (2020). News. Executive News. https://kingcounty.gov/elected/executive/constantine/news/release/2020/July/01-homeless-count.aspx
Illinois Department of Public Health. How to use naloxone and prevent overdose. (n.d.) State of Illinois. https://dph.illinois.gov/content/dam/soi/en/web/idph/files/images/naloxone-brochure-09052017.pdf
Rankin, L., Mendoza, N. S., & Grisham, L. (2022). Unpacking perinatal experiences with opioid use disorder: Relapse risk implications. Clinical Social Work Journal. https://doi.org/10.1007/s10615-022-00847-x
Russell, C. D., Young, I., Leung, V., & Morris, K. (2015). Healthcare Workers' decision-making about transmission-based infection control precautions is improved by a guidance summary card. Journal of Hospital Infection, 90(3), 235–239. https://doi.org/10.1016/j.jhin.2014.12.025
What to Do with Used Sharps in Washington. Safe Needle Disposal. (2020, April 7). https://safeneedledisposal.org/states/washington/
Sala, Nicole; Gonzalez, Luciana; Dorvilien, Caroline; Keilwitz, Teo; Terhune, Maddy; and Forson, Portia, "Addressing a Lack of Education Surrounding Fentanyl Use and Recovery" (2023). Nursing Leadership in Community Engagement Projects. 27.
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