Reducing Student Nurse Stigmatization of the Patient Who Misuses Opioids: A Scoping Review

Testing Interventions to Address Bias About Patients with Opioid Use Disorder in the Emergency Department

INTRODUCTION

Reducing nurse bias about patients with opioid use disorder in the emergency department is critical for providing nonjudgmental care, enhancing patient outcomes, supporting effective communication, and promoting a holistic approach to care. Emergency nurses can make a positive impact on the lives of individuals diagnosed as having opioid use disorder by providing care that is free from stigma and discrimination.

METHODS

The study used an observational, pretest-posttest design to compare educational sessions addressing bias and stigma toward patients with opioid use disorder. The study population consisted of emergency nurses who self-selected into a virtual learning experience consisting of e-modules or simulation-based experience consisting of simulation-based experience consisting of simulation, discussion, and a speaker.

RESULTS

After the intervention, the simulation-based experience group showed an increase in total score postintervention from a mean of 118.6 to a mean of 127.1 (P < .001). The virtual learning experience group also showed an increase in total score postintervention from a mean of 116.3 to 120.7 (P < .001). Although both groups showed an increase in scores over time, the simulation-based experience group had a greater increase (P = .0037). Within the simulation-based experience, there was an increase in scores across all age groups (P < .05) but a significantly greater increase in scores among younger nurses (18-29 years) than the older age groups (P = .006).

DISCUSSION

Opioid use disorder is a complex condition that requires a comprehensive and holistic approach to care. Study results indicate that providing an educational experience to address stigma about patients diagnosed as having opioid use disorder can significantly affect nurse perceptions about these patients and their self-efficacy when working with them. However, investing in a simulation-based educational experience provides a stronger experience and results in greater change, particularly for younger, less experienced emergency nurses.

Integrated Education Reduces Negative Attitudes Toward Persons with Substance Use Disorders: A Pilot Study

Educational practices to reduce negative attitudes toward persons with substance use disorders (SUD) are urgently needed for undergraduate nursing students, but few studies have examined their long term effectiveness. In this pilot, consenting students completed the Drug and Drug Problems Perception Questionnaire (DDPPQ) anonymously online, before and 1 year after integrated curricular content about SUD. Pretest scores were significantly higher than posttest, indicating higher negative attitudes toward persons with SUD before the integrated content. Time main effect was statistically significant. To our knowledge, this is the first report examining long-term effects of an educational intervention with reinforcement in multiple courses over time upon the attitudes of undergraduate nursing students toward persons with SUD.

Refusal to accept emergency medical transport following opioid overdose, and conditions that may promote connections to care

BACKGROUND

Opioid overdose is a leading cause of death in the United States. Emergency medical services (EMS) encounters following overdose may serve as a critical linkage to care for people who use drugs (PWUD). However, many overdose survivors refuse EMS transport to hospitals, where they would presumably receive appropriate follow-up services and referrals. This study aims to (1) identify reasons for refusal of EMS transport after opioid overdose reversal; (2) identify conditions under which overdose survivors might be more likely to accept these services; and (3) describe solutions proposed by both PWUD and EMS providers to improve post-overdose care.

METHODS

The study comprised 20 semi-structured, qualitative in-depth interviews with PWUD, followed by two semi-structured focus groups with eight EMS providers.

RESULTS

PWUD cited intolerable withdrawal symptoms; anticipation of inadequate care upon arrival at the hospital; and stigmatizing treatment by EMS and hospital providers as main reasons for refusal to accept EMS transport. EMS providers corroborated these descriptions and offered solutions such as titration of naloxone to avoid harsh withdrawal symptoms; peer outreach or community paramedicine; and addressing provider burnout. PWUD stated they might accept EMS transport after overdose reversal if they were offered ease for withdrawal symptoms, at either a hospital or non-hospital facility, and treated with respect and empathy.

CONCLUSION

Standard of care by EMS and hospital providers following overdose reversal should include treatment for withdrawal symptoms, including buprenorphine induction; patient-centered communication; and effective linkage to prevention, treatment, and harm reduction services.