University of Arizona College of Nursing Doctor of Nursing Practice (DNP) student James Fiske’s DNP project has had a concrete impact on patient care for substance abuse issues. Fiske, who is currently doing his clinical rotation at Marana Health Center (MHC), researched the communication aspects of the Addiction Severity Index (ASI) test, which led to the assessment being implemented in MHC’s substance abuse treatment program. Fiske’s focus on the most effective uses of the semi-structured interview designed to address seven potential problem areas in substance-abusing patients is just one example of the exemplary impact our DNP students have on the care of patients.
The potential problem areas in substance-abusing patients that the ASI addresses include: medical status, employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status. In one hour, a skilled interviewer can gather information on recent and lifetime problems in all of the problem areas. The ASI provides an overview of problems related to substance, rather than focusing on any single area.
When he was brainstorming his dissertation, Fiske, who graduates from the DNP program in December, realized that the need for nurses to administer the ASI test would be beneficial for patients and providers alike. “The ASI is intended to establish whether the person who is walking through the door has accepted that substance use is a significant problem in their life,” explains Fiske. “It helps determine if they need treatment, and also to understand whether they have accepted that other factors are affecting their use of substance, including family or medical issues. You have to deal with those underlying issues to get to the substance problem.”
The ASI interview yields two different measures: the Interviewer Severity Ratings and the Composite Scores. The Interviewer Severity Ratings are qualitative items that provide a summary for people who want a quick general profile of a client's problem status in each section of the ASI. Composite Scores are mathematically sound measures of change in problem status. The Composite Scores were developed to provide reliable and valid measures of patient status in each area of the ASI; measures can be compared at the beginning of treatment and a subsequent evaluation points to note improvement or the lack thereof.
In addition to helping devise a treatment strategy, the ASI is also useful for psychotherapy because results indicate whether the patient would benefit from psychotherapy or chemical therapy. “For psychotherapy, you want to be able to establish what is most important for this patient and focus on that. It’s proven that if you can maintain a person in a substance abuse program for at least a year then the possibility of relapse becomes even less,” Fiske says.
Training medical providers – including nurses – to effectively administer the ASI is key to the success of the assessment tool. Fiske conducted a one-day training at Marana Health that provided training on two different levels: to train providers to understand what the scores they will be looking at mean and also to train nurses how to provide the assessment. “It’s one thing for providers to look at the score,” Fiske says. “But if the nurses who will be asking those questions are not asking them properly, they could provide wrong Composite Scores and wrong addiction severity scores.”
Marana Health Center was impressed enough with Fiske’s ASI innovations that it adopted the program for use with addiction treatment. After new patients receive a psychiatric evaluation from a physician, Fiske takes over as point person for the ASI. “I sit with then for 30 minutes and I do the ASI,” Fiske says. “Whatever the psych evaluation reveals, the ASI balances that information. If the person has a problem it shows, because the psychiatric evaluation complements the ASI. We assess for depression, anxiety, and psychosis. It’s important for psychotherapy because once the person is going for psychotherapy, then they can focus on what they need to address their problems.”
A native of West Africa, Fiske has taken a long and sometimes arduous journey to his current doctoral studies. He holds a bachelor’s degree in political science and history from the University of Ghana, and a bachelor’s of science in nursing and a master’s in professional communication from East Tennessee State University. He has worked as a war reporter and as a research analyst in Liberia’s Office of the President and spent time as a refugee from his war-torn home country. “All of those things motivated me pursue a career that would make it possible to be able to help people more significantly,” he says.
As for the future, Fiske plans on giving back to his home country. He is motivated by his desire to aid disadvantaged communities through the spread of up-to-date health care strategies. After he earns his DNP, he plans to work in the U.S., save money and ultimately build a teaching clinic in Liberia. He hopes to structure the clinic so that nurses from both Liberia and the U.S. can rotate between countries, thereby increasing their knowledge of new research and growing their capacity to deliver health care. “I’m interested in bridging this gap by having people go over, and come over and do rotations,” he says. “This is my philosophy: Everybody cannot migrate to the Unites States of America. But the United States can migrate to people in those ways. In the realm of science and medicine we can reach out – and that is truly significant.”