Nurse-identified problems in the management of alcoholic patients

The purpose of this exploratory study was (1) to identify and rank the patient problems of hospitalized alcoholics that medical-surgical nurses view as difficult to manage, (2) to identify the factors that contribute to the difficulty in care, (3) to identify interventions used by nurses in an attempt to resolve patient problems and (4) to describe relationships between nurses and the identified patient problems. Subjects (N=83) completed and returned an open-ended questionnaire by listing the physiological and psychosocial patient problems, factors and interventions. Selected demographic and biographic data were also collected. A nursing diagnosis classification described by others served as a basis and was adapted for the nursing diagnosis categories. Nominal data were analyzed using frequency distributions and percentages. The most difficult physiological problems in caring for alcoholic persons were categorized from subjects' responses using the nursing diagnoses of 'potential for injury,' 'alterations in nutrition-elimination' and 'fluid volume deficit.' The nursing diagnosis categories of 'ineffective individual coping,' 'ineffective family coping' and 'noncompliance' comprised the most difficult psychosocial patient problems. A majority of subjects reported having limited classroom and clinical experience with alcoholism; 80% expressed a need for additional inservice education. It is recommended that nursing educational programs include didactic and clinical content about alcoholism, focusing on problem areas identified and on family dynamics, communication, coping strategies and time-management strategies.