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P32. Nurses’ Experience of the Clinical Opioid Withdrawal Scale

P32. Nurses’ Experience of the Clinical Opioid Withdrawal Scale

Learner category:

  • Expert Level

Learning objectives:

  • Participants will further their knowledge and understanding of opioid withdrawal in the context of addiction. The presentation of this phenomenological based research contributes to a greater understanding of nurses’ experience of the Clinical Opioid Withdrawal Scale (COWS) and informs evidence based practices for opioid withdrawal patients that are safe, compassionate, competent and ethically driven. This study is timely and relevant given the ongoing opioid crisis in North America. The first learning objective helps to understand signs and symptoms of opioid withdrawal. This objective will provide rationale and discussion of the role the COWS tool plays in a comprehensive assessment of opioid withdrawal.
  • Participants will be able to discuss nurse’s role in the care of opioid withdrawal on inpatient addictions and mental health units. Nurses are well positioned to assess opioid withdrawal, design care plans and implement supportive measures in the care of opioid withdrawal patients. A final learning objective explores ramifications for patient care using the COWS scale in the care of opioid withdrawal patients. These include consistent evidence informed care, comprehensive patient assessments and universal standard of care.
  • Participants will enhance their opioid withdrawal treatment knowledge through the use of the COWS as a consistent evidence based nursing practice for quality patient care.


Opioid withdrawal is a complex medical process that can adversely affect physical and mental health, employment and finances, often resulting in strained and lost relationships. Nurses are central figures in acute and ongoing care of people who use opioids. Within inpatient contexts, nurses are responsible for the observation and assessment of patients who are experiencing opioid withdrawal. The Clinical Opioid Withdrawal Scale (COWS) is a tool that was designed to assess and document the common signs and symptoms related to the physical and psychological withdrawal from opioids. Although COWS has been validated for use in both inpatient and outpatient settings, its use by nurses is inconsistent. Using a descriptive phenomenological method, this study investigated the nurses’ experience with the COWS while caring for opioid withdrawal patients. The first theme, discusses how COWS acts as a navigator that enables nurses to make more accurate and purposeful decisions about the care they are providing. Next, the second theme, explores nurses designing patient care plans based on judgement of what would best suit the patients’ needs. The final theme deliberates how nurses informed on the COWS can implement the scale to provide continuity of care and; furthermore, engage their patient in care as an equal partner and informant. Insights gained from this study can inform possibilities for changes in practice and policy that enhance the treatment of opioid withdrawal patients on inpatient addictions and mental health units.  Keywords: opioid withdrawal, Clinical Opioid Withdrawal Scale, nursing, assessment, intervention, and scale


Carlina Jow

Carlina Jow is a registered nurse practicing in the field of addictions and mental health. Her clinical interests include health promotion and harm reduction. She is a member of the College of Registered Nurses of Alberta. Recently, she completed her Master of Nursing at the University of Calgary.

Jacqueline Smith
BN, MN, PhD, University of Calgary

Jacqueline Smith has been an assistant professor in the Faculty of Nursing at the University of Calgary since July 2017. She is passionate about education, prevention and early intervention research in the context of adolescent and young adult substance abuse. Her research promotes mental health and wellbeing for all children and families. Jacqueline teaches undergraduate level courses and supervises graduate students with interest in addiction, mental health and narrative inquiry. She is an associate member of the Mathison Centre and the Alberta Children’s Hospital Research Institute (ACHRI). She is currently serving as Vice President of the Canadian Chapter of the International Nurses Society of Addiction. Jacqueline embraces community partnerships and is a member of the Board of Directors for the Calgary Fetal Alcohol Network and sits on the Advisory Committee for Drug Free Kids Canada.  

Andrew Estefan
BN, MN, PhD University of Calgary

Dr. Andrew Estefan has been a professor in the Faculty of Nursing at the University of Calgary since 2008. Since this time he has taught undergraduate, master’s and doctoral students in the areas of philosophy, research methods, and mental health/psychiatric nursing. Between 2014 and 2016 he served in the role of Associate Dean, Teaching and Learning. Before coming to Calgary, Dr. Estefan taught in nursing, health and social care programs in Australia and the United Kingdom. Dr. Estefan’s program of research inquires at the intersections of sexuality, gender, and people’s experiences of mental health and illness. His research work in narrative inquiry and philosophical hermeneutics, alongside faculty colleagues, has been published extensively; he supervises numerous master’s and doctoral students undertaking narrative and hermeneutic studies. His teaching, research, and scholarship have been recognized with international awards from the American Educational Research Association.

Graham McCaffrey
BA, BN, PhD, University of Calgary

Dr. McCaffrey has been a professor in the Faculty of Nursing at the University of Calgary since 2012. His doctoral research was a hermeneutic study of nurses’ practices of relational care in mental health, using Buddhist perspectives as a way of opening to new understanding. He is interested in continuing to develop dialogue between Buddhist thought and contemporary nursing – for example, focusing on compassion as a way of acting. Hermeneutics as a methodology invites precisely this kind of intercultural exchange. He is an Assistant Editor for the Journal of Applied Hermeneutics and has presented his work at the Canadian Hermeneutic Institute.

Comments (4)

  1. Cheryl Rush

    I enjoyed this presentation. I like that you included the COWS tool in your presentation.

  2. Dennis Hagarty

    Thank you

  3. Virginia Singer

    Thank you

  4. Rita Hanuschock

    Very nice presentation;
    I am not an advocate of using COWS or CIWA in daily nursing assessments of w/drawal, but your research supports its use as an educational tool, which has value.

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