Substance Use Education in Schools of Nursing: A Systematic Review of the Literature

Integrating Evidence-Based Screening, Brief Intervention, and Referral to Treatment Into a Family Nurse Practitioner Program

PROBLEM STATEMENT

Substance use disorder (SUD)-and more specifically opioid use disorder-is a national epidemic. With the increasing amounts of people suffering from SUD, all healthcare professionals should be educated to identify substance abuse, provide a brief intervention, and refer patients for treatment when indicated.

PURPOSE

The purpose of this project is to integrate the SBIRT into the curriculum of a graduate-level family nurse practitioner (FNP) program in southeastern Pennsylvania and to determine if educating FNP students on the SBIRT process increases their knowledge of SUDs and their treatment and increases their motivation to work with patients with SUD.

MEASUREMENTS

The measurements used were as follows: shortened Alcohol and Alcohol Problems Perception Questionnaire (S-AAPPQ), shortened Drug and Drug Problems Perception Questionnaire (S-DDPPQ), a 10-question knowledge test, and demographic data.

RESULTS

All subscales of the S-DDPPQ, the S-AAPPQ, and the knowledge test showed a statistically significant change from the pretest score means and to posttest means. This evidence-based practice project supports the integration of SBIRT education into FNP programs to increase their ability to identify and treat individuals with SUDs.

Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US

BACKGROUND

Medications for opioid use disorder (OUD) are effective at preventing overdose and infectious disease but are vastly under-prescribed in the US. For decades, prescribers faced additional training and regulation to prescribe buprenorphine which stigmatized the medication and lessened support for a harm reduction approach to treating opioid use disorder. The Drug Enforcement Administration removed the X-waiver requirement for prescribing buprenorphine in late 2022, which removed stigma and lessened important barriers to prescribing but also left training at the discretion of individual organizations. Our study aimed to assess differences in knowledge, confidence, and stigma regarding buprenorphine between those who went through the X-waiver training and those who did not, among practicing primary care providers (PCPs).

METHODS

We assessed buprenorphine prescribing readiness among primary care aligned outpatient providers in Ohio, USA. Using survey data, we conducted bivariate and regression analyses predicting primary prescribing outcomes. Primary outcomes measured knowledge of and confidence in buprenorphine, as well as perceived adequacy of one's training. Secondary outcomes were attitudes toward patients with OUD, including bias toward OUD patients, stress when working with them, and empathy toward them. Participants (n = 403) included physicians, nurse practitioners, and physician assistants practicing in primary care aligned disciplines.

RESULTS

Survey data showed that PCPs who received X-waiver training were more likely to understand and have confidence in the mechanism of buprenorphine, and consider their training on treating OUD to be adequate. PCPs with an X-waiver showed more empathy, less negative bias, and experienced less stress when working with patients with OUD.

CONCLUSION

Removing restrictive policies for prescribing buprenorphine is an important step to expanding access and reducing the stigma associated with opioid use disorder treatment. Yet, our findings suggest that the training received alongside regulation may be important for improving prescribing confidence and reducing stigma. Strategies to increase buprenorphine prescribing are unlikely to be effective without also expanding access to prescribing support for primary care providers across the career course.

Closing the Opioid Treatment Gap Through Advance Practice Nursing Activation: Curricular Design and Initial Outcomes

INTRODUCTION

Buprenorphine, an effective medication for opioid use disorder (MOUD), reduces opioid-related harms including overdose, but a significant gap exists between MOUD need and treatment, especially for marginalized populations. Historically, low MOUD treatment capacity is rising, driven by advanced practice registered nurses (APRNs). A graduate nursing course was designed to increase equitable buprenorphine treatment delivery by APRNs. We report on baseline findings of a curriculum evaluation study with a pretest-posttest design.

DESIGN

Computerized surveys assessed trainee satisfaction with the course, trainee knowledge for providing MOUD, and trainee satisfaction in working with people who use drugs.

METHODS

Quantitative survey results utilizing Likert scales are presented.

RESULTS

Baseline precourse surveys revealed less than half (44%) of APRN students agreed/strongly agreed that they had a working knowledge of drugs and drug-related problems and 37% agreed/strongly agreed that they knew enough about the causes of drug problems to carry out their roles when working with people who use drugs. Approximately two thirds of APRN students agreed/strongly agreed that they want to work with people who use drugs (63%), that it is satisfying to work with people who use drugs (66%), and that it is rewarding to work with people who use drugs (63%). Nearly all students reported high satisfaction with the course.

CONCLUSION

APRN students reported high satisfaction with a novel course grounded in health equity that has potential to reduce health disparities and accelerate the closure of the MOUD treatment gap, particularly for racial/ethnic minorities, rural populations, and transition-age youth.

Is the Clinical Practicum in Addiction Treatment Facilities an Effective Educational Intervention to Improve Nursing Students' Attitudes Toward Alcohol Use Disorders?

ABSTRACT

The paucity of education and training on alcohol use disorders (AUDs) in nursing curricula is the main predictor of negative attitudes and results in limited knowledge access and delivery of health care for persons experiencing these problems. Although experts advocate increasing the time devoted to alcohol-related content in a crowded curriculum, didactic strategies for teaching about addiction in prequalifying nursing education have been discussed. This study aimed to verify the effectiveness of an educational experience that integrated clinical practicum experience in addiction treatment facilities for nursing students' attitudes. A quasi-experimental one-group study with pre-and-post 3-month follow-ups was carried out with 108 nursing students who answered the Attitudes Scale toward Alcohol, Alcohol Use Disorder, and Patients with Alcohol Use Disorders. The effect of the clinical practicum was apparent, with statistically significant changes to more positive global attitude scores in all measures. Previous educational intervention for AUDs during nursing education was a predictor of positive attitudes (OR = 7.21, p < .04). Students' self-perceived skills and professional preparation to deliver and direct care for patients with AUDs improved after the intervention, suggesting that clinical practice influenced students' skills for AUD identification across nursing practice. Previous contact with this population with lack of training in substance use disorder seems to favor negative attitude development. Clinical practicum experience in addiction treatment facilities improved nursing students' attitudes toward AUDs and patients with AUDs, and its effects were sustained 3 months later.

Improving Nurses' Attitudes Toward Substance Use Disorder: Screening, Brief Intervention, and Referral to Treatment

ABSTRACT

Patients with substance use disorder (SUD) encounter many barriers to healthcare, including negative attitudes of healthcare personnel. Compared with other healthcare professions, nurses have been reported as having less tolerant attitudes toward patients with SUD. Knowledge acquisition combined with role support has been shown to improve therapeutic attitudes of nurses toward patients with SUD. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based educational intervention aimed to improve the outcomes of patients at risk and with SUD. SBIRT education has been shown as an effective educational tool with licensed nurses. Therefore, the aim of this study was to evaluate whether a 2-hour educational session on SBIRT (Mitchell et al., 2013) improved the therapeutic attitudes of nurses toward patients with SUD. Peplau's theory of interpersonal relations guided this study with an emphasis on the nurse-patient relationship. A quasi-experimental pretest/posttest design was used to evaluate nurses' attitudes pre and post a 2-hour educational session. Participants included 65 registered nurses employed in a 247-bed teaching hospital in New England. Attitudes were measured before and after the educational session using the 20-item, five-subscale Drug and Drug Problems Perceptions Questionnaire. A paired t test was performed, showing statistically significant improvements in attitudes postintervention. Prior education on SUD significantly correlated with baseline attitudes. A standard regression model, with practice setting, family history of SUD, and prior education as dependent variables, was not predictive of baseline attitudes. The results suggest conducting SBIRT should be considered a mandatory nursing competency, both in undergraduate curriculum and among licensed nurses.

Influences on advance practice nursing education to prescribe medications for opioid use disorder

BACKGROUND

Opioid misuse is a major public health concern in the United States. Opioid agonist medications are evidence-based treatments for opioid use disorders (OUD) that can be prescribed by advance practice registered nurses (APRNs) with prescriptive authority and appropriate training.

PURPOSE

Article examines factors influencing preparation to provide medications for opioid use disorder (MOUD) in APRN education.

METHODS

Data from semi-structured interviews addressing the role of education in preparing APRNs to provide MOUD were grouped into key themes using thematic analysis. Data were collected in a mixed methods study in four states with high opioid overdose deaths whose main findings were previously published.

FINDINGS

Two overarching themes emerged: "addressing attitudes" and "curriculum change." Sub-themes include affective barriers to providing OUD treatment; motivation to respond to the OUD crisis; and attitude change through experience with MOUD.

DISCUSSION AND CONCLUSION

APRNs can play a key role in reducing the harms caused by OUD. Attention to attitudinal issues, such as stigma, toward people using opioids is important in educating APRNs about providing MOUD.

Learning that cannot come from a book: An evaluation of an undergraduate alcohol and other drugs subject co-produced with experts by experience

Alcohol and other drugs (AOD) use is a significant public health issue and is associated with high mortality and morbidity rates. Despite this, people who use drugs are often reluctant to seek care due to the lack of trauma-informed treatment and harm reduction treatment options, as well as experiences of stigma and discrimination in health services. Arguably, AOD education that is co-produced with people who use alcohol and drugs can enhance future health professionals' ability to practice in ways that support the needs of this population. This paper reports on a qualitative co-evaluation of a co-produced undergraduate nursing AOD subject. The AOD subject was co-planned, co-designed, co-delivered, and co-evaluated with experts by experience, who have a lived experience of substance dependence and work as advocates and peer workers. Following the delivery of the subject in 2021 and 2022, focus groups were undertaken with 12 nursing students. Focus group data indicate that the co-produced subject supported participants to understand and appreciate how stigma impacts on nursing care and how to recognize and undertake 'good' nursing care that was oriented to the needs of service users. Student participants noted that being co-taught by people who use drugs was particularly powerful for shifting their nursing perspectives on AOD use and nursing care and took learning beyond what could be understood from a book. Findings indicate that co-produced AOD education can shift nursing students' perceptions of AOD use by providing access to tacit knowledge and embodied equitable and collaborative relationships with people who use drugs.

Original Research: Nurses' Self-Assessed Knowledge, Attitudes, and Educational Needs Regarding Patients with Substance Use Disorder

BACKGROUND

Substance use disorder (SUD) is a chronic illness, but it's often seen as an intentional choice rather than as a disease. People with SUD are frequently stigmatized, leading to disparate care. Findings from previous studies have indicated that nurses feel inadequately prepared to care for, and tend to have negative attitudes toward, patients with SUD. But it's unknown what kind of education would better prepare nurses caring for this patient population, or whether these negative attitudes vary across practice settings.

PURPOSE AND DESIGN

This observational, cross-sectional, mixed-methods study sought to explore nurses' self-assessed knowledge of and attitudes toward caring for patients with SUD (whether formally diagnosed or not) in hospital settings across the United States. A secondary aim was to determine nurses' educational preferences and needs in this area.

METHODS

Data were collected over a three-month period in early 2020, using the online social networking platform Facebook. All participants were nurses working in hospital settings throughout the United States. Participants were surveyed using two tools: the Drug and Drug Problems Perceptions Questionnaire, and another questionnaire that included open-ended questions regarding nurses' SUD-related education and their experiences and perceived needs in caring for patients with SUD. Quantitative data were analyzed using analysis of variance and post hoc Tukey tests. Qualitative data were analyzed using thematic analysis.

RESULTS

A total of 691 nurses participated. Nurses reported having been educated in SUD but wanted additional face-to-face education from mental health specialists. The nurses working on mental health units had significantly more positive attitudes toward caring for patients with SUD than nurses on other units. Older nurses had significantly more positive attitudes toward patients with SUD than younger nurses. Qualitative analysis uncovered four themes: unmet needs, personal experiences inform care, personal beliefs inform perceptions, and judgmental attitudes.

CONCLUSIONS

Study findings indicate that, in general, hospital nurses have negative attitudes toward patients with SUD. The results further reaffirm the need for empathy-based nursing education for nurses who care for these patients. Participants expressed a preference for face-to-face training by mental health specialists experienced in SUD. Given the increasing prevalence of SUD and the expected retirement of older nurses, it is urgent that we prioritize empathy-based nursing education, particularly for newer-to-practice nurses, in order to improve nurses' attitudes and ensure best care for patients with SUD.

Assessing Student Readiness to Work with People Who Use Drugs: Development of a Multi-disciplinary Addiction Educational Survey

BACKGROUND

As health profession schools implement addiction curricula, they need survey instruments to evaluate the impact of the educational interventions. However, existing measures do not use current non-stigmatizing language and fail to capture core concepts.

OBJECTIVE

To develop a brief measure of health profession student readiness to work with people who use drugs (PWUDs) and establish its content validity.

METHODS

We conducted a literature review of existing instruments and desired clinical competencies related to providing care to PWUD and used results and expert feedback to create and revise a pool of 72 items. We conducted cognitive interviews with ten pre-clinical health profession students from various US schools of nursing, pharmacy, and medicine to ensure the items were easy to understand. Finally, we used a modified Delphi process with twenty-four health professions educators and addiction experts (eight each from nursing, pharmacy, and medicine) to select items for inclusion in the final scale. We analyzed expert ratings of individual items and interdisciplinary agreement on ratings to decide how to prioritize items. We ultimately selected 12 attitudes and 12 confidence items to include in the REadiness to Discuss Use, Common Effects, and HArm Reduction Measure (REDUCE-HARM). Experts rated their overall assessment of the final scale.

RESULTS

Twenty-two of twenty-four experts agreed or strongly agreed that the attitudes scale measures student attitudes that impact readiness to work with PWUDs. Twenty-three of twenty-four experts agreed or strongly agreed that the confidence scale measures student self-efficacy in competencies that impact readiness to work with PWUDs. Seven of 72 initial items and none of the 24 selected items had statistically significant differences between disciplines.

CONCLUSIONS

The REDUCE-HARM instrument has strong content validity and may serve as a useful tool in evaluating addiction education. Additional research is needed to establish its reliability, construct validity, and responsiveness to change.

Perceived stigma, barriers, and facilitators experienced by members of the opioid use disorder community when seeking healthcare

INTRODUCTION

Healthcare professionals, particularly nurses, have negative attitudes towards individuals with opioid use disorder (OUD) and these attitudes can contribute to suboptimal care. The aim of this study was to identify stigma, barriers and facilitators experienced by members of the OUD community when interacting with the healthcare system.

DESIGN

A qualitative exploratory design used semi-structured focus group interviews to address the study aim.

METHODS

Following IRB approval, purposive sampling was used to recruit participants with a history of OUD, family caregivers of individuals with OUD, and support group leaders from regional recovery groups to provide a broad perspective of stigmatizing issues and barriers to care. Focus group discussions were conducted, and video recorded using web-based conferencing software. Transcripts from the focus groups and field notes were analyzed and coded into themes.

RESULTS

Both structural and social determinants of health were identified by participants as stigmatizing and/or barriers to care. Thematic content analysis resulted in eight themes: stigmatizing language, being labeled, inequitable care, OUD as a chronic illness, insurance barriers, stigma associated with medications for OUD (MOUD), community resources, and nursing knowledge and care.

CONCLUSION

Members of the OUD community are challenged by both internal and external stigma when seeking healthcare. Stigma negatively affects public support for allocation of resources to treat OUD. Interventions aimed at reducing stigma are critical to support effective OUD treatment and prevent barriers to OUD care.

CLINICAL RELEVANCE

Understanding the complex relationships between stigma and structural determinants of health will allow nursing science to develop educational interventions that provide the next generation of nurses with the knowledge, skills, and attitudes needed to advance health equity for individuals with OUD.

Exploring Perinatal Nursing Care for Opioid Use Disorder: Knowledge, Stigma, and Compassion

The opioid epidemic has greatly increased the number of pregnant women with opioid use and newborns exposed to opioids in utero. Mothers with opioid use disorder can face stigma by nurses in perinatal care settings, contributing to negative care experiences. A survey was distributed to nurses caring for mothers and newborns exposed to opioids in a large urban hospital in the Pacific Northwest United States (n = 89) from March to July 2019. Survey measures included participant characteristics, attitude toward substance use in pregnancy and postpartum (stigma, compassion satisfaction, comfort, and knowledge), and open-ended questions. Relationships among variables and questionnaire items were examined using Pearson's correlations, 2-sample t tests, and simultaneous multiple linear regression. Qualitative description was used to analyze open-ended questions. Nurses' stigma was negatively correlated with compassion satisfaction (r = -0.63), feeling knowledgeable (r = -0.36), and comfortable in providing care to this population (r = -0.44). Nurses identified defensiveness, lack of trust, and inadequate social support as key challenges in this patient population. Nurses suggested more support for mothers and nurses, increased nursing education, and clinical guidelines to improve clinical practice and foster therapeutic relationships. Findings highlight potential strategies to improve nursing care for chemically dependent mothers and their infants. These strategies may offer practical approaches to reduce stigma, develop therapeutic relationships, and improve patient outcomes.

Substance use-related continuing education course objectives: Alignment with professional competencies

Background: Novel educational efforts are needed to prepare the current and future interprofessional health care workforce to address the range of substance use-related health problems. A 6-module massive open online course (MOOC) was developed to provide education to health professionals of various disciplines on the fundamentals of substance use-related treatment. The purpose of this project was to match course objectives to substance use-related competencies for 5 disciplines: nurses, pharmacists, physicians, physician assistants (PA), and social workers. Methods: Content expert raters within each discipline determined what Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) core competencies were matched to each objective for the 6 modules of the MOOC. The number of objectives across the 6 modules was summated. Results: All nursing and social work competencies were mapped to the course objectives. For physicians, PAs, and pharmacists, the proportions of knowledge-based competencies that mapped to the course objective were 58%, 76%, and 80%, respectively, and proportions of skill-based competencies that mapped to the course objective were 88%, 83%, and 75%, respectively. For those 3 groups, 100% of attitude-based competencies mapped to the course objective. Conclusions: The competency-based mapping with the MOOC objectives supports the interprofessional design of the course and discipline-specific competencies needed to promote the best outcomes for patients.

Outcomes and lessons learned from an interprofessional student training program in Screening, Brief Intervention, and Referral to Treatment (SBIRT) at an academic health sciences center

BACKGROUND AND OBJECTIVES

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a public health intervention to address overuse and risky use of alcohol and illegal substances. In order to increase SBIRT in clinical practice, training should start with future health care provider students and faculty. The main objective of this program was to improve and enhance the training of health professions students to provide competent screening, brief intervention and referral to treatment for persons who have or are at-risk for substance use disorder. This paper shares the results of an SBIRT training program at an academic health sciences center for undergraduate nursing, graduate nursing, and medical students.

DESIGN, SETTING AND PARTICIPANTS

1229 undergraduate and graduate nursing students, medical students, faculty and preceptors at an academic medical center completed SBIRT coursework integrated into their existing curriculum. Coursework utilized an online learning platform as well as in-person skills training experiences.

METHODS

An interprofessional team collaborated to create an online SBIRT curriculum consisting of 5 primary modules (total 3 h) and an SBIRT Booster module (0.5 h). The team also developed pre- and post-module quizzes and satisfaction surveys to measure changes in knowledge, confidence, and satisfaction; as well as simulations, videos, a screening tool, a provider pocket card, and an online resource library to support learning. Faculty and preceptors were trained in the program to model skills and answer student questions. A motivational interviewing specialist provided the in-person skills training sessions.

RESULTS

A sustainable interprofessional SBIRT training program demonstrated gains in knowledge, confidence, and skills across all programs. The team used clinical opportunities and simulation with education to promote clinical proficiency.

CONCLUSIONS

Interprofessional training mirrors real world clinical situations and encourages all providers to implement SBIRT in practice and decrease poor outcomes associated with substance use disorders.

Users of psychoactive substances: challenges to nursing care in the Family Health Strategy

ABSTRACT Objective to analyze the nursing care provided to users of psychoactive substances in the Family Health Strategy. Method a descriptive and qualitative study carried out with seven nurses from the Family Health Strategy of Juiz de Fora, Minas Gerais. Data was obtained through interviews guided by a semi-structured script and the Thematic Content Analysis was used for its treatment. Results the care provided by the interviewees is based on spontaneous demand, without active search strategies, with the valorization of practices guided by the medicalization of the person and the referral to specialized services. The inclusion of the family in the rehabilitation process, immediate care, and therapeutic listening were mentioned as strategies that can be adopted for an integral assistance. The challenges mentioned referred to the lack of training in mental health, the fragmentation of knowledge about the specialty, the absence of training, and the patient's desire to participate in the treatment. Final considerations and implications for the practice the nurses reported insufficient care to ensure comprehensive care permeated by a lack of knowledge and skills to deal with this public, which leads to referral to specialized services as the main intervention, reinforcing the need to train these professionals.

Usuários de substâncias psicoativas: desafios à assistência de enfermagem na Estratégia Saúde da Família

RESUMO Objetivo analisar a assistência de Enfermagem ao usuário de substâncias psicoativas na Estratégia Saúde da Família. Método estudo descritivo e qualitativo realizado com sete enfermeiros da Estratégia Saúde da Família de Juiz de Fora, Minas Gerais. Os dados foram obtidos por meio de entrevistas guiadas por um roteiro semiestruturado e a Análise Temática de Conteúdo foi utilizada para o seu tratamento. Resultados a assistência prestada pelos entrevistados é pautada na demanda espontânea, sem estratégias de busca ativa, com a valorização de práticas orientadas pela medicalização da pessoa e o encaminhamento aos serviços especializados. A inclusão da família no processo de reabilitação, o atendimento imediato e o exercício da escuta terapêutica foram mencionados como estratégias que podem ser adotadas para uma assistência integral. Os desafios mencionados referiram-se à falta de formação em saúde mental, à fragmentação do conhecimento acerca da especialidade, à ausência de capacitações e ao desejo do paciente em participar do tratamento. Considerações finais e implicações para a prática os enfermeiros referiram um cuidado insuficiente para a garantia da integralidade da assistência permeado pela falta de conhecimentos e habilidades para lidar com esse público, o que leva ao encaminhamento para serviços especializados como principal intervenção, reforçando a necessidade de capacitação desses profissionais.

Addressing Bias and Stigma in the Language We Use With Persons With Opioid Use Disorder: A Narrative Review

BACKGROUND: Despite an increase in access to medications for opioid use disorder, less than 20% of individuals with opioid use disorder (OUD) receive treatment. Stigmatizing language has been identified as a potential trigger for explicit and implicit biases that may adversely affect treatment enrollment and quality of care for persons with OUD. AIMS: To conduct a narrative review of the literature on stigmatizing language and OUD, examine how treatment outcomes are affected, and present strategies to reduce bias and promote OUD treatment. METHOD: A narrative review of the literature between 2010 and 2019 was conducted using CINAHL, PubMed, and PsycINFO. Key search terms were opioid use disorder (or substance use disorder), stigma, and language. Fifty-two articles were screened for inclusion, and 17 articles were included in this review. RESULTS: The articles reviewed provide consensus that stigmatizing language toward persons with OUD fosters explicit and implicit bias and impedes engagement in treatment. Four themes emerged: (1) stigma and language, (2) stigma and language used by health care professionals, (3) stigma and language used by the general public, and (4) stigma and language used by people with OUD. CONCLUSIONS: Stigmatizing language is dehumanizing and plays a pivotal role in bias and discrimination that may contribute to unsatisfactory treatment outcomes among persons with OUD. Health care professionals, nursing in particular, must assume an intentional stance against stigma perpetuated toward persons with OUD through advocacy in education, practice, policy, and the media.

Nursing students' attitudes towards alcohol use disorders and related issues: A comparative study in four American countries

The present study identified and compared the attitudes of nursing students from North and South American countries towards alcohol, alcohol use disorders and persons with alcohol use disorders (AUDs). A cross-sectional design and survey approach were used. The sample consisted of 327 nursing students recruited from four nursing schools in metropolitan regions of North and South America. The questionnaire contained questions about sex, age, marital status, home country and other questions about training in substance use disorders during nursing education and previous experiences with substance use disorder patients. To identify nursing students' attitudes, validated English, Spanish and Portuguese versions of the attitudes scale for alcohol, alcoholism and persons with AUDs (EAFAA) were applied. Comparison of the four groups suggested that nursing students in the United States demonstrated more positive attitudes than students from Colombia, Mexico and Brazil. Similar positive attitudes were observed towards individuals with AUDs. Results of the attitudes towards the aetiology of AUDs showed positive attitudes in all samples, suggesting a contemporary understanding of AUDs. Nursing students' attitudes were associated with home country and training in substance use disorders during nursing education. Nursing students' attitudes were generally positive across countries. Idiosyncratic cultural and educational aspects in these countries and world regions likely significantly influenced the attitudes of nursing students towards alcohol and associated issues.

Changes in Nursing Students' Attitudes and Perceptions After Receipt of Enhanced Substance Use-Related Curricular Content

BACKGROUND

Negative attitudes toward persons who use alcohol and other drugs contribute to suboptimal care. Nurses are in key roles to address the needs of this population, yet they lack the education needed to identify persons who may be at risk because of substance use and intervene accordingly. The purpose of this study was to evaluate the impact of a substance-use-related curriculum on nursing students' attitudes and therapeutic commitment for working with patients with alcohol- and drug-use-related problems.

METHODS

Data were collected for four cohorts of 169 nursing students enrolled in a Master's Entry into Nursing program. Questionnaires included the Person-Centered Alcohol and Alcohol Problems Perception Questionnaire and the Drug and Drug Problems Perception Questionnaire, completed before and after completing the curriculum. Paired samples t test were used to examine pre/post differences for each measure's subscale.

RESULTS

Four of the seven Person-Centered Alcohol and Alcohol Problems Perception Questionnaire subscales showing significant increases were role adequacy, role support, role legitimacy, and general perceptions. Four of the five Drug and Drug Problems Perception Questionnaire subscales showing significant increases were role adequacy, role support, job satisfaction, and role legitimacy; there was a significant change in role-related self-esteem, however, in a negative direction.

CONCLUSIONS

This study adds to the growing evidence of the positive impact of providing evidence-based information and skill development, which enhance alcohol- and drug-related knowledge and competence for nurses entering professional practice.

Undergraduate nursing student knowledge and attitudes of healthcare consumers with problematic alcohol and other drug use: A scoping review

Problematic alcohol and other drug use has a significant societal, personal, and financial burden. Nurses are key in responding to problematic alcohol and other drug use; however, research indicates many nurses hold negative attitudes towards people with substance and alcohol use disorders. Further, little content exists in most undergraduate degrees to address stigma held by new nurses. The objective of this scoping review, structured using Arksey and O'Malley's (International Journal of Social Research Methodology: Theory and Practice, 8 (1), 19-32, 2005) framework, is to examine studies that either explore or attempt to improve the knowledge and attitudes of undergraduate nurses caring for people who use alcohol and other drugs. Our initial search located 610 articles, and after screening, 14 articles were appraised using the Mixed Methods Appraisal Tool (MMAT) and included in this review. Most of the papers appraised were small, localized studies using evaluation methods considered low quality, but showed promising results in addressing stigma and confidence in providing care to people who use alcohol and other drugs. This review indicates that a consistent direction for improving knowledge and attitudes among undergraduate nursing students working with people who use alcohol and other drugs is urgently needed. Further studies of interventions, tested with more rigorous evaluation methodologies, are required to extend existing work in this area.

Perceptions diverge on aspects related to substance use disorder: An analysis of individuals in recovery, physicians, nurses, and medical students

Background: Interactions with healthcare workers can provide effective entrance into treatment, ensuring retention and lifelong recovery for individuals with Substance Use Disorder (SUD). Healthcare providers approach the challenges of patient management with different skills, comfort levels, and viewpoints. Individuals in recovery also provide crucial perspectives relevant to the complex aspects of the drug epidemic. The purpose of this study was to determine if perceptions of SUD diverge among individuals in recovery, physicians, nurses and medical students. Methods: A survey consisting of 29 Likert statements was deployed to physicians, nurses, medical students, and persons with SUD in recovery. Respondents were asked to rate their level of agreement on statements about SUD such as treatment, stigma, medications for opioid use disorder (MOUD), naloxone kits, safe injection sites, and methamphetamine usage. Separate Welch's analysis of variances (ANOVAs) were conducted to determine differences between the respondent groups and each statement. For any statistically significant findings, Games-Howell post-hoc analyses were employed. Results: A total of 523 individuals provided survey responses: individuals in recovery (n = 111), physicians (n = 113), nurses (n = 206), and medical students (n = 93). Survey results revealed the majority of items had statistically significant differences in respondent groups. Perceptions diverged on items related to treatment, stigma, MOUD, take-home naloxone kits, safe injection sites, needle exchange programs, and methamphetamine. Conclusion: As healthcare providers and policymakers develop treatment strategies to engage those with SUD in quality treatment, they will benefit from understanding how different viewpoints on SUD affect treatment for these individuals. These attitudes impact stigma, willingness to prescribe new treatments, and development of clinical relationships. The insight from this study allows for important discussions on the substance use health crisis and further inquiry on why these differences exist and how the diverging viewpoints may impact the lives of persons with SUD.

A Cross-Sectional Survey Exploring Nursing Students' Knowledge and Attitudes Regarding Opioids and the Opioid Epidemic

BACKGROUND

The opioid epidemic continues to be a serious public health crisis in the United States. One way to address this issue is to effectively educate future healthcare providers, especially nurses, who play a key role in managing pain and improving opioid-related outcomes.

METHODS

A 34-item electronic survey was administered to traditional baccalaureate student nurses at a large, public University School of Nursing. The survey was used to assess participant demographics, general knowledge, and attitudes regarding opioids and the opioid epidemic, and relevant personal and professional experiences. Quantitative responses were analyzed using descriptive statistics, ANOVAs, and logistic regression; free-text responses were categorized by frequency of keywords.

RESULTS

In all, 134 students (response rate 42.3%) completed the survey. Increases in student opioid knowledge and confidence scores over the 4 years were statistically significant (p< .001). General opioid attitudes were primarily negative (n = 70; 52.5%) or neutral (n = 54; 40.3%), and few students (n = 12; 9.0%) reported positive experiences caring for patients with substance use disorders. Free-text responses revealed that nursing students are eager to contribute to the conversation regarding how to address this critical public health issue and recognize they have a key role to play in safely supporting patients coping with pain.

CONCLUSIONS

Although opioid knowledge and confidence scores were higher for 4th year compared with 1st year nursing students, there is room for continued improvement. Curricula and clinical experiences must thoughtfully integrate opioid and pain management content longitudinally across all years of a nursing program to optimize care for both patients in pain and those coping with substance use disorders.

Preparing nurse practitioners to combat the opioid epidemic: A survey of nurse practitioner academic programs in the United States

ABSTRACT

Between 1999 and 2017, nearly 400,000 individuals died from opioid-related overdoses in the United States. Nurse practitioners (NPs) can be instrumental in providing care for those with opioid use disorders (OUDs) but must be adequately prepared to do so. Currently, there is limited evidence regarding how NP programs are preparing their graduates to address opioid use. The purpose of this study was to evaluate how NP programs have addressed the opioid epidemic within their curricula, and to evaluate barriers to and facilitators of curricular modifications. Electronic surveys were distributed to all 444 NP program directors in the United States. The survey consisted of 10 questions and inquired about curricular modifications made in regard to OUDs, barriers and facilitators of such modifications, and perceived importance of addressing the opioid epidemic within NP programs. A total of 130 (29.3%) of program directors responded to the survey. Of the program directors who responded, 89 (76.1%) reported that curricular modifications were made to address OUDs. Barriers to curricular modification included limited time, lack of faculty expertise or confidence, and stigma in regard to opioid use. Facilitators included faculty champions, availability of external educational resources, student interest, and financial incentives. Nurse practitioners can treat patients with OUDs, mitigating significant barriers to care reported in light of the opioid epidemic. Graduate NP programs should assure that curricula adequately cover opioid use and related management.

Substance Use Education in Canadian Nursing Programs: A Student Survey

BACKGROUND

In Canada, nursing programs have not kept pace with the growing rates and changing patterns of substance use.

METHOD

To get a sense of the current state of substance use education in nursing programs, we conducted a survey of nursing students.

RESULTS

Our findings indicate that (a) substance use education is minimal, 1 to 5 hours (43%) or none (20%); (b) students had more working knowledge of legal and prescribed substances than illegal ones; (c) of 22 content areas deemed essential for practice, only seven were covered; (d) students were able to identify statements consistent with a harm reduction philosophy despite limited substance use education; and (e) the majority of students wrongfully believed that illegal substances are more harmful than legal substances.

CONCLUSION

Our findings demonstrate that substance use education in nursing programs is largely insufficient and not keeping up with current issues. [J Nurs Educ. 2020;59(9):510-513.].

Nursing Course on Drug Addiction and its Effects on Beliefs and Intentions: A Quasi-experimental Study

Objective: To determine the impact of a course aimed at the care of persons with drug dependence on the beliefs and intentions of drug use among bachelor nursing students. Materials and methods: A quasi-experimental study conducted with a non-equivalent comparison group composed of 210 Mexican students of both sexes. Two Likert-type instruments were used to measure the beliefs and intentions of drug use, before and after a semester-long course. Results: At the end of the study, a significant interaction was found (F = 3.56, p = 0.050, η2p = 0.025), which suggests a greater decrease in beliefs in favor of drug use among students who took the course on drug addiction. Regarding drug use intentions, a general decrease was observed in the entire sample (F = 10.13, p = 0.002, η2p = 0.059). Conclusions: Courses on the care of drug addiction can have beneficial effects on nursing students by modifying beliefs and intentions to carry out unhealthy behaviors such as the use of substances. These results demand to verify if the effects remain beyond the completion of university education.

Experiences and opinions of health professional students participating in an opioid use disorder educational event

Introduction

The objectives of this study were to describe health professional students' experiences and opinions about patients with opioid-use disorder (OUD), to summarize evaluation results from an OUD educational event and to compare results by sex, discipline, and clinical experience.

Methods

The OUD educational event lasted 75 minutes and covered the epidemiology of the opioid epidemic, evidence-based prevention and treatment services, stigma, and recommendations on how to improve care. An anonymous pre-event survey collected information on attendees' experiences and opinions about patients with OUD. The postevent survey collected information on the attendees' evaluation of the event.

Results

Forty percent of students reported having a friend or family member who has/had an OUD. A minority (29.1%) reported that they would be uncomfortable working with patients with OUD or would prefer not to interact with patients with OUD (27.7%). Overall, the event evaluation results were very positive, and 85.5% reported that the information would change or influence their clinical practices. The open-ended responses found that the content was informative (n = 36); the attendees liked the inclusion of statistics (n = 19) and that the content was locally focused (n = 13).

Discussion

Health professional students participating in this event had fewer negative opinions of patients with OUD than previous research has found, and this may, in part, be explained by their personal experiences. Overall, health professional students want to learn more about patients with OUD.

A Pilot Interprofessional Course on Substance Use Disorders to Improve Students' Empathy and Counseling Skills

Objective. To implement and assess the effectiveness of an interprofessional course designed to provide pharmacy and nursing students with opportunities to improve their understanding of substance use disorders (SUDs), assess their attitudes toward patients with SUDs, receive instruction and feedback on behavior change counseling, and engage in interprofessional education. Methods. The course consisted of four interactive class sessions that focused on empathy and recognition of personal bias, behavioral change counseling, and SUD recognition, screening, and treatment. Classes were taught by an interprofessional faculty member. Students also attended a 12-step recovery meeting in the community, counseled an authentic patient using behavioral change counseling, and received feedback based on a faculty member's direct observation of their counseling. Students completed validated assessments of their attitudes toward patients with SUDs and interprofessional collaboration. A faculty member used the Behavioral Change Counseling Index (BECCI) to assess students' counseling of SUD patients. Counseled patients were asked their preference for follow-up care for their SUD. Results. Twenty-seven pharmacy and nursing students completed this course, along with 51 students from other professions. The pharmacy and nursing students demonstrated significant improvements in their attitudes toward patients with SUDs and toward interprofessional collaboration, as measured by the Substance Abuse Attitudinal Scale (SAAS) and Student Perception of Interprofessional Clinical Education (SPICE-R2). Approximately 93% of pharmacy and nursing students counseled a patient with a SUD, with 96% of counseled patients reporting their intent to receive follow-up care. Conclusion. An interprofessional SUD course enriched pharmacy and nursing students' understanding, attitudes, and behaviors toward patients with SUDs and interprofessional collaboration. Students demonstrated an ability to provide behavior change counseling to patients, and 96% of counseled patients stated a willingness for follow-up care for their SUD.