NHSFPX-8002_EndresTraci_Assessment 2-1

1 Demonstrating Effective Leadership Traci Endres Capella University NHSFPX-8002: Collaboration, Communication, and Case Analysis for Doctoral Learners Dr. Kathleen Zajic July 31, 2023

2 Demonstrating Effective Leadership Opioid misuse and deaths among adults have substantially increased over the past two decades with almost 72,000 deaths in 2017 alone ( Hudgins et al., 2019). The National Center for Drug Abuse Statistics (n.d.) indicates over 48,000 people experienced an opioid overdose in 2020, and nearly 4% of adults in America abuse opioids yearly. According to the Illinois Department of Public Health (n.d.) deaths related to synthetic opioid use have increased by 2,736% since 2013 which ranks Illinois as 24 th in the nation for drug overdose fatalities in 2019. The focus of this assessment is the state of Illinois, specifically Hancock County to analyze contributing factors and their impact contributing to this health concern, identifying high risk and affected groups including environmental, social, and financial factors along with forming a collaborative, interprofessional coalition to mitigate this chronic population health concern. Factors Contributing to Opioid Addiction The World Health Organization (2021) asserts that there are several risk factors for opioid misuse and overdose including using prescription medications without the supervision of a provider, using high prescribed dosages, injectable routes of administration, previous opioid addiction or disorder, and concurrent medical conditions such as chronic pain. In 2020, opioid prescription dispensing rates remained high across the country with nearly forty-four prescriptions written per one hundred people with some counties having rates up to nine times greater (Centers for Disease Control [CDC], 2021). Additionally, it has been shown those that are Caucasian without college degrees in rural areas with decreasing employment opportunities are among those with the highest mortality rates related to prescription drug overdose and misuse in recent years ( Salmond & Allread, 2019).   An

4 access to treatment, locally available treatments, gaps in care, health disparities, and community attitudes toward opioid addiction ( Salmond & Allread, 2019).   The coalition team members and their contribution are listed in the following table. Table 1 Coalition Team Members and Their Contribution Coalition Team Members Contribution Dr. E.M., Emergency Medicine-Carthage Memorial Hospital, key community member Provide insight and education on opioid misuse, addiction, and overdose cases being seen in the ED. Can provide data on outcomes and frequency of recurring visits by the same patients. J.H., CADC, BSW, Certified Alcohol & Drug Counselor-Memorial Medical Clinic, Carthage, key community member Collaborate with Dr. E.M. and C.B to provide education to coalition members regarding opioid treatment and rehabilitation best practices and formulate a strategy for addiction and prevention, recovery, and rehabilitation C.B., DNP, FPA-APRN, PMHNP-BC, CPNP-PC, MBA, Director of Behavioral Health Services- Memorial Medical Clinic Collaborate with Dr. E.M. and C.B to provide education to coalition members regarding opioid treatment and rehabilitation best practices and formulate a strategy for addiction and prevention, recovery, and rehabilitation M.C., APN-Hancock County Health Department Board Member, general practice nurse practitioner, key LaHarpe community member Provide valuable data on community and county opioid misuse and addiction from both a health department and general provider perspective. Data can also help determine areas of the county that are seeing increasing opioid trends. M.C. lives in a neighboring community and is an active member of that community Dr. L.J. Smith, Hancock County Health Department Board Member, key community member Provide valuable data on community and county opioid misuse and addiction from both a health department and general provider perspective. Data can also help determine areas of the county that are seeing increasing opioid trends to better focus to address this health concern C.W., Pharm D-Wear Pharmacy, active Carthage community member C.W can provide data on the number of opioid prescriptions being written along with any trends on specific communities, health centers, and providers to provide additional focus to address this issue J.N., Mayor of Carthage, active Carthage community member The mayor of the largest town in the county will have the greatest chance of reaching the most community members to provide information regarding the work the coalition is doing to reduce opioid addiction as well as promote community and county involvement. A.F., Hancock County Emergency Medical Service Coordinator The EMS coordinator can contribute valuable data on the trends of service calls across the county related to overdose. This can help the coalition to improve focus in those areas and determine if services related to addiction are lacking in those communities T.D., Hancock County Sheriff, key community member The county sheriff and his office have information on drug-related incidents and trends across the county. He can also provide insight on surrounding counties to determine if the data may somehow be related to increase prevention measures.

5 Issues Affecting Coalition Collaboration Interprofessional collaboration has become commonplace with adoption of collaborative care in the primary care setting. This ensures all patients receive all the care they need at the right time from the right discipline to achieve the best outcome. Multiple issues can affect the efficacy of the coalition including poor communication, ill-defined roles, and responsibilities, lingering ideas of traditional hierarchies, differing cultures, and work styles, inefficient and inaccurate data, and doubts about the effectiveness of interprofessional collaboration ( Rawlinson et al., 2021). Failure to acknowledge another profession’s perspectives, thought processes, and approach to this health concern as well as a lack of appreciation for the other profession’s knowledge base and skill set can also lead to poor performance and outcomes related to interprofessional collaboration ( Hager et al., 2018). Strategies to Optimize Collaboration Jenkins (2021) notes the effectiveness of a coalition can be enhanced when each member recognizes the unique and specific skill set, contributions, strengths, and knowledge each person brings to the team. This helps to build a culture of respect, trust, and autonomy. He further explains accountability and professionalism are two important concepts to be contemplated to improve trust and respect. According to McLaney et al. (2022) the Sunnybrook framework for interprofessional collaboration was developed at the Sunnybrook Health Sciences Centre in Toronto, Ontario to address gaps in interprofessional teamwork and collaboration. The framework consists of six core competencies that can be applied to varying types of teams. They further explain the six

7 All these principles can apply on different levels including the micro and meso levels. On a micro level, autonomy may be overridden related to the patient being unable to make healthy and appropriate decisions for themselves based on their addiction. Henden (2023) explains that autonomy is the ability to govern oneself free from interference and this decision-making is forming an intention and choosing an appropriate action to meet that goal. To do this, the person must have control over the goal or intention they are forming for effective decision-making. The coalition will need to recognize potential or actual decision-making deficits and incorporate this into treatment plans. Each member of the coalition has the duty of nonmaleficence to each patient, provide fair and equitable treatment of each person, and beneficence to advocate for the patient. Conversely, on the meso level, Santoro & Santoro (2018) found the media has a large effect on how opioid misuse and addiction is portrayed to the public with regard to different races and ethnicities. Stereotyping continues in healthcare through unconscious and/or intentional thought and this plays a role in treatment attitudes. It is important to address these issues to formulate the best treatment plan and goals for those affected by opioid addiction. Health systems are the perfect vehicle to create an interdisciplinary and interprofessional approach to treatment for opioid misuse and addiction that will emphasize the four principles of the Code of Ethics that will also focus on effective life-sustaining treatment to improve quality of life and meet state and regulatory regulations and compliance. The care model can also help healthcare and community bias and societal attitudes while raising awareness and promoting prevention of opioid misuse ( Perrone et al., 2019). With members of the coalition and their varied backgrounds and expertise, various barriers will be addressed. Factors including childhood trauma, abuse, discrimination, and engaging in high-risk behaviors have all been

8 associated with opioid misuse along with the stigma of having this disorder can present roadblocks to seeking treatment and furthering harm reduction (Hansen et al., 2022). Positive support and an encouraging environment created by the coalition can decrease stigma and negative connotations associated with opioid use and move toward treatment and prevention. Collaboration, Diversity, and Inclusion Diversity includes recognizing the differences present within each setting including ethnicity, race, gender, race, nationality, and sexual orientation while inclusion can be defined as the ongoing intentional effort that all people with varying identities can participate in all work in an organization and making sure all viewpoints are represented (Tan, 2019). Based on this, the coalition must ensure it creates and fosters a culture of diversity among the members and is inclusive of each team member’s unique background and views. Promoting diversity within addiction research and treatment is a necessary step to lessen the social determinants of health within the opioid emergency and requires an increased need for activism from a culturally diverse team (Jordan & Jegede, 2020). Promoting diversity and inclusion will boost goal achievement in the coalition and increase interactions in the community. Environments that are diverse and inclusive produce new solutions. Team members are more likely to feel comfortable sharing ideas and making inclusion and diversity a driver in performance. Diversity and inclusion also improve social and cultural awareness and improve understanding of the community and surrounding areas (Penn Liberal & Professional Studies, 2022). Collaboration and inclusion can be challenging when working with teams across multiple professions. Effective collaboration is based on trust, relationships, and communication. Teams using technology to share information and connect while being geographically separated using message boards to share ideas and make suggestions have ongoing interactions that contribute to

10 techniques along with management options including cognitive therapy, medication substitution use, and Naltrexone to block the effects of the opioid in emergent situations. This study also covers best practice strategies for a team or coalition to improve care coordination, communication, and outreach to improve patient outcomes and engagement. The coalition can use the information in this study to obtain a broader knowledge base of all aspects of the disorder and begin to understand opioid misuse is multi-faceted. The 2019 study conducted by Malta et al., provides data pertaining to the correctional system in relation to opioid use disorder. It has been shown that people with the disorder are overrepresented in the criminal justice system and findings highlight the need for jails to improve opioid agonist therapy for those with the disorder while incarcerated to lower mortality and overdose risk after release. Opioid treatment is limited and poorly administered to incarcerated people and to lessen the impact of continued overdose and misuse after release, it is essential to provide treatment and ongoing prevention strategies to beat the addiction. This study will be useful to the coalition to gain a broader understanding and perhaps provide more focus on education and treatment of the disorder not only in the school, community, or hospital settings, but for those incarcerated. This study is a great opportunity for county law enforcement to work closely with medical personnel to establish an in-jail treatment program to promote rehabilitation and lessen recurrence or relapse. Conclusion The opioid crisis has been moving into more rural areas and small communities that used to be insulated from the issue are now facing this problem. Multiple community members are needed from various backgrounds to monitor and address all areas of this crisis and treat every facet of this disease. The creation of a coalition to address opioid use will bring awareness to the

11 communities in the county and promote engagement. Providing education on multiple levels including schools, jails, health departments, and in the community at large will improve treatment, access to care, reduce stigma, and lower relapse while enhancing prevention.

13 Hudgins, J. D., Porter, J. J., Monuteaux, M. C., & Bourgeois, F. T. (2019). Prescription opioid use and misuse among adolescents and young adults in the United States: A   national survey study.   PLOS Medicine ,   16 (11), e1002922. doi:   10.1371/journal.pmed.1002922 Illinois Department of Public Health. (n.d.). IDPH data. Data and Reporting (illinois.gov) Institute for Academic Development. (2022, August 29). Literature review. University of Edinburgh. Literature review | The University of Edinburgh Jenkins, D. (2021, April 13). How nurses are enhancing interprofessional collaboration in todays healthcare marketplace. The Nurse Speak. Nurses Enhance Interprofessional Collaboration - The Nurse Speak Jordan, A. , & Jegede, O. (2020). Building outreach and diversity in the field of addictions. American Journal on Addictions, 29 , 413-417. outreach paper_395162_284_3011_v1.pdf (yale.edu) Lancet Public Health. (2022, March). Opioid overdose crisis: Time for a radical rethink.  The Lancet Public Health, 7 (3), e195-e195.  https://doi.org/10.1016/S2468-2667(22)00043-3 Malta, M., Varatharajan, T., Russell, C., Pang, M., Bonato, S., & Fischer, B. (2019). Opioid- related treatment, interventions, and outcomes among incarcerated persons: A systematic review.   PLOS Medicine ,   16 (12), e1003002. doi:   10.1371/journal.pmed.1003002 McLaney, E., Morassaei, S., Hughes, L., Davies, R., Campbell, M., & Di Prospero, L. (2022). A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviours.   Healthcare Management Forum , 35 (2), 112-117. doi: 10.1177/08404704211063584

14 National Center for Drug Abuse Statistics. (n.d.). Opioid epidemic: Addiction statistics. Opioid Crisis Statistics [2023]: Prescription Opiod Abuse (drugabusestatistics.org) Penn Liberal & Professional Studies. (2022, September 28). Why are diversity and inclusion critical in the workplace? Why are diversity and inclusion critical in the workplace? | Penn LPS Online (upenn.edu) Perrone, J., Weiner, S. G., & Nelson, L. S. (2019). Stewarding recovery from the opioid crisis through health system initiatives.   The Western Journal of Emergency Medicine ,   20 (2), 198–202. doi:   10.5811/westjem.2018.11.39013 Rawlinson, C., Carron, T., Cohidon, C., Arditi, C., Hong, Q. N., Pluye, P., Peytremann- Bridevaux, I., & Gilles, I. (2021). An overview of reviews on interprofessional collaboration in primary care: Barriers and facilitators.   International Journal of Integrated Care ,   21 (2), 32. doi:   10.5334/ijic.5589 Salmond, S., & Allread, V.   (2019).   A population health approach to America's opioid epidemic.   Orthopaedic Nursing,   38   (2),   95-108. https://oce-ovid- com.library.capella.edu/article/00006416-201903000-00004/HTML Santoro, T. N., & Santoro, J. D. (2018, December 14). Racial bias in the US opioid epidemic: A review of the history of systemic bias and implications for care. Cureus, 10 (12): e3733. 1612428354-1612428346-20210204-18268-1obujeb.pdf (cureus.com) Smith, H. J. (2020). Ethics, public health, and addressing the opioid crisis. AMA Journal of Ethics, 22 (8), 647-650. Ethics, Public Health, and Addressing the Opioid Crisis | Journal of Ethics | American Medical Association (ama-assn.org)

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