The determinants of nurses’ therapeutic attitude to patients who use illicit drugs and implications for workforce development

Evaluation of nurses' attitudes and behaviors regarding narcotic drug safety and addiction: a descriptive cross-sectional study

BACKGROUND

By evaluating nurses' attitudes and behaviors regarding narcotic drug safety and addiction, effective strategies need to be developed for combating addiction in healthcare institutions. This study, aimed at providing an insight into patient and staff safety issues through the formulation of health policies, aimed to evaluate nurses' attitudes and behaviors regarding narcotic drug safety and addiction.

METHODS

The study was conducted in a descriptive cross-sectional design. It was carried out with 191 nurses in a public hospital between March 2023 and August 2023. Data were collected through face-to-face interviews, gathering socio-demographic information and utilizing the Addictive Substance Attitude Scale. The data were analyzed using independent sample t-tests, one-way ANOVA tests, and regression analysis (P < .001 and p < .05).

RESULTS

The average age of the participants was determined to be 36.58 ± 8.40. It was reported by 85.3% of nurses that narcotic drug follow-ups in their units were conducted according to procedures. In the study, it was found that 63.9% of nurses did not know the procedure to be followed towards a healthcare professional identified as a narcotic substance addict. The total mean score of the Addictive Substance Attitude Scale of nurses participating in the study was 74.27 ± 14.70. A significant difference was found between the total scores of the scale and the level of education of nurses, the follow-up status of the drugs in the unit where they work, their status of receiving narcotic drug addiction training, and their routine use of the half-dose drug disposal form (p < .05).

CONCLUSIONS

The findings of this study underscore the importance of evaluating nurses' attitudes and behaviors regarding narcotic drug safety and addiction. These results indicate the need for nursing administrators, particularly in terms of patient and staff safety, to adopt more effective policies and strategies.

Understanding Nurse Perceptions of Caring for Patients With Alcohol Use Disorder: A Cross-Sectional Study

BACKGROUND

Alcohol use disorder (AUD), the problematic consumption of alcohol, affects 107 million people worldwide. Individuals with AUD experience high morbidity and increased mortality. Nurses practicing in acute care are ideally positioned to deliver quality interventions to patients with AUD, including screening and brief intervention; formal training and assessment of baseline knowledge, attitudes, and perceptions are necessary.

AIMS AND OBJECTIVES

The aim of this study was to explore the knowledge, attitudes, and perceptions of acute care nurses caring for patients with AUD.

DESIGN

This study used a cross-sectional survey design.

METHODS

The Survey of Attitudes and Perceptions was completed by 93 nurses working in six acute care centers (seven medicine units) across Alberta. Data were analyzed using descriptive and inferential statistics.

RESULTS

Few participants reported receiving any prior structured training on AUD, with the majority reporting limited knowledge of alcohol and the effects of alcohol consumption. Although most participants said that caring for patients with AUD was a part of their professional role, few felt satisfied or motivated to work with this group of patients. Responses to individual questions or subdomains of the survey did not significantly differ by length of time in professional role, employment status, or sex.

CONCLUSION

Our results indicate that nurses need to learn more about caring for patients with AUD. Developing tailored educational interventions that are mindful of the importance of knowledge, support, satisfaction, and motivation is necessary to improve the quality of care for patients with AUD.

AUD in perspective

Alcohol is a major cause of pre-mature death and individual suffering worldwide, and the importance of diagnosing and treating AUD cannot be overstated. Given the global burden and the high attributable factor of alcohol in a vast number of diseases, the need for additional interventions and the development of new medicines is considered a priority by the World Health Organization (WHO). As of today, AUD is severely under-treated with a treatment gap nearing 90%, strikingly higher than that for other psychiatric disorders. Patients often seek treatment late in the progress of the disease and even among those who seek treatment only a minority receive medication, mirroring the still-prevailing stigma of the disease, and a lack of access to effective treatments, as well as a reluctance to total abstinence. To increase adherence, treatment goals should focus not only on maintaining abstinence, but also on harm reduction and psychosocial functioning. A personalised approach to AUD treatment, with a holistic view, and tailored therapy has the potential to improve AUD treatment outcomes by targeting the heterogeneity in genetics and pathophysiology, as well as reason for, and reaction to drinking. Also, the psychiatric co-morbidity rates are high in AUD and dual diagnosis can worsen symptoms and influence treatment response and should be considered in the treatment strategies.

The mobilization of nurse-client therapeutic relationships in injectable opioid agonist treatment: Autonomy, advocacy and action

INTRODUCTION

Injectable opioid agonist treatment (iOAT) is an evidence-based treatment that serves an important minority of people with opioid use disorder who require specialized care. Unique to iOAT care is the consistency with which clients access treatment (up to three times daily), a condition that creates repeated opportunities for health care engagement. To date, no study has examined therapeutic relationships in this life saving, nurse-led treatment that can have lasting implications in the equitable delivery of other forms of addictions care.

METHODS

This study used grounded theory to generate a dynamic framework for therapeutic relationship building in iOAT. Researchers collected semi-structured interviews from registered nurses working in iOAT sites (n=24) form January 2020 through June 2022. The study analyzed collected data through a constant comparative analysis; explored through open, axial, and selective coding; and assessed in a conditional relationship matrix. The team reviewed key findings with stakeholders through formalized processes of engagement to confirm saturation of coding categories. Throughout data collection and analysis, researchers integrated feedback from additional knowledge users and member checking. Reported findings adhered to the COREQ1 standardized checklist.

RESULTS

We identified five interrelated categories that created a distinct culture of care for iOAT nurses: Ways of Knowing, Personal Investment, Leveraging Empathy, Finding Flexibility, and Collaborating to Overcome. Through creating a safe, nonjudgmental environment, nurses establish therapeutic relationships that build trust to identify client needs outside of medication administration. In turn, nurses participate in team-based problem solving to advocate for client needs. If nurses cannot find flexibility within and outside of the health care system to improve client engagement, tensions can arise and therapeutic relationships can be strained.

CONCLUSIONS

Therapeutic relationships are an integral part of building and maintaining trust with a population that has been precariously involved with other forms of health care. Nurses make a substantial effort to create a safe and nonjudgmental environment to manifest a culture of care that bridges client needs and program access. Without the expansion of access to iOAT programs and their embedded services, nurses are limited in their ability to provide individualized care for clients with diverse needs.

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.

Factors Associated with Nurses' Motivation to Provide Care for Patients with Alcohol Use and Alcohol Use-Related Problems

BACKGROUND

There is a high human and economic cost associated with alcohol use and alcohol use-related problems. Nurses have a pivotal role in addressing the needs of this patient population. Purpose: The study aimed to examine the correlation between nurses' demographics/background characteristics, personal attitudes, professional attitudes, and their motivation to provide care to patients with alcohol use and alcohol use-related problems.

METHODS

A descriptive, cross-sectional correlational design was utilized. Nurses were recruited from four Southwestern Pennsylvania hospitals. The study variables were examined using questionnaires that explored nurses' demographic/background characteristics, their personal and professional attitudes, and motivation to care for patients with alcohol use and alcohol use-related problems.

RESULTS

The sample included 234 nurses. Demographic/background characteristics were identified as associated with nurse's alcohol use-related motivation, including gender, primary work setting and specialization. Previous personal experience with alcohol use-related problems (nurses themselves or co-workers), familiarity, perceived dangerousness, fear, social distance, personal responsibility beliefs and disease model were also associated with nurses' alcohol use-related motivation to care for these patients. In addition, all professional attitudes were associated with nurses' motivation toward caring for patients with alcohol use and alcohol use-related problems.

CONCLUSIONS

The study revealed that certain demographic/background characteristics and personal and professional attitudes were associated with nurses' motivation to provide care to this patient population. This study provides the foundation for future studies aimed at exploring predictors of nurse's motivation to care for patients with alcohol use and alcohol use-related problems.

How well do policymakers address stigma surrounding substance use disorders: lessons from a qualitative review of Scottish Alcohol and Drug Partnerships' strategic plans

Background

Stigma is a significant barrier to the successful implementation of public health policies which aim to reduce harm from substance use disorders. Despite attention being given to stigma in the literature for at least a decade, evidence on what works to reduce it is limited and inconclusive. Without clear guidance, policymakers could be limited in their ability to develop evidence-informed strategies for reducing stigma. In response to a steep incline in drug-related deaths in Scotland since 1996, the Scottish Government has committed to tackling stigma in national drug policy. Scotland's 31 Alcohol and Drug Partnerships are responsible for developing local strategies that aim to tackle harm from substance use disorders. This qualitative review explored how well these strategies respond to stigma and identified approaches mentioned that could have implicit implications for tackling stigma.

Methods

The strategic plans of Alcohol and Drug Partnerships across Scotland were identified and thematically analysed to identify key themes relating to stigma. Content of strategic plans was initially coded under a coding scheme of four broad categories: content that explicitly mentioned stigma; identity, status and power; deservedness of support; and attribution of responsibility for SUDs.

Results

Twenty-four strategic plans were identified and analysed, with four themes emerging: (1) limited clarity and consistency on how stigma will be directly tackled by ADPs; (2) recognition of the positive contribution that people with substance use disorders can make towards decisions about treatment and support; (3) diversion of people with substance use disorders away from the criminal justice system towards quality support underpinned by human rights; and (4) recognition of the complex determinants of substance use disorders and that everyone has a role to play.

Conclusion

Alcohol and Drug Partnerships acknowledged the importance of tackling stigma in their strategic plans but provide limited clarity on how this will be done. This review calls for the inclusion of more evidence-informed strategies for tackling stigma within the Scottish local policymaking context. This requires academic, policymaking and lived experience communities to collaborate to test and evaluate innovative responses to tackling in stigma to strengthen understanding of what works in which contexts.

Nursing students' perceived knowledge, therapeutic attitudes, and interest in addictions education

BACKGROUND

Nurses care for people who use substances (SU) and have addictions across healthcare settings; however, education has been lacking about these issues. Experiences working with patients with SU paired with lack of knowledge may negatively affect attitudes.

PURPOSE

Prior to designing an addictions curriculum, we aimed to assess nursing students' perceived knowledge, attitudes, and educational interests in SU and addictions, and compare pre-licensure nursing students to registered nurses and advanced practice RNs (RN/APRNs).

METHODS

The student body at a large mid-Atlantic school of nursing was surveyed online, Fall 2019. Of 1987 students, 647 (33 %) responded; 567 complete responses were analyzed. Pre-licensure and RN/APRN student responses were compared, and comments were summarized.

RESULTS

Virtually all students agreed that it is important to be educated about SU and addictions (96 %). Students were interested in addiction courses (80 %) and a graduate certificate program (61 %), and 70 % of undergraduates were in favor of an addictions focus area as part of their BSN degree program. Perceived knowledge to address addictions was rated moderately overall. As far as learning needs, students felt they knew the least about problem gambling, communicating about SU, considering readiness to change and using community resources. RN/APRNs rated their motivation and job satisfaction in working with people with SU lower than pre-licensure students.

CONCLUSIONS

Students' responses supported and informed the development of addictions curricula, with a broad focus on addictions including substances, gambling and other addictions. Elective courses, an undergraduate focus area, and a graduate-level certificate were developed, piloted, and are now offered by the School of Nursing.

Nurses' Perception of Caring for Patients With Substance Use Disorder

ABSTRACT

The objective of this research was to explore the perceptions of nurses regarding patients with substance use disorder (SUD), healthcare provided, and desired resources to care for this population properly. This study used a cross-sectional, descriptive design. Data were collected via an anonymous 12-item survey and three open-ended questions. Data were analyzed using descriptive statistics and conventional content analysis. Nurses with less than 1 year of experience reported more significant challenges when caring for patients with SUD. These challenges included difficulties in managing pain, implementing alternative pain management techniques, and knowing who to contact when problems occur. The study revealed many needs of nurses to provide compassionate care for patients with SUD. Findings indicate a need for education for nurses, especially novice nurses, who care for patients with SUD.

The Creation of an Addiction Nursing Fellowship Program for Registered Nurses: A Unique Approach to Enhancing the Addiction-Treatment Workforce

In 2020, Boston Medical Center and the Grayken Center for Addiction launched an addiction nursing fellowship to enhance registered nurses' knowledge and skills related to the care of patients with substance use disorders and to improve patient experience and outcomes. This paper describes the development and essential components of this innovative fellowship, to our knowledge the first of its kind in the United States, with the goal of facilitating replication in other hospital settings.

An Experimental Study of the Effects of Patient Race, Sexual Orientation, and Injection Drug Use on Providers' PrEP-Related Clinical Judgments

Social biases may influence providers' judgments related to pre-exposure prophylaxis (PrEP) and patients' consequent PrEP access. US primary and HIV care providers (n = 370) completed an experimental survey. Each provider reviewed one fictitious medical record of a patient seeking PrEP. Records varied by patient race (Black or White) and risk behavior (man who has sex with men [MSM], has sex with women [MSW], or injects drugs [MID]). Providers reported clinical judgments and completed measures of prejudice. Minimal evidence of racially biased judgments emerged. Providers expressing low-to-moderate sexual prejudice judged the MSM as more likely than the MSW to adhere to PrEP, which was associated with greater PrEP prescribing intention; sexual prejudice was negatively associated with anticipated MSM adherence. Providers judged the MID to be at higher risk, less likely to adhere, less safety-conscious, and less responsible than both the MSM and MSW; adverse adherence and responsibility judgments were associated with lower prescribing intention.

Roles and Perceptions of Nurses During Implementation of a Medication Treatment for Opioid Use Disorder National Initiative

BACKGROUND

In the United States, a national priority exists to improve access to medication treatment for opioid use disorder (MOUD). Nurses can be an essential component of that care. We examined the perceptions and evolving roles of nurses in a national Veterans Health Administration (VHA) initiative designed to improve MOUD access within general medical settings.

METHODS

From April 15, 2021, to June 16, 2021, we recruited nurses participating in VHA's Stepped Care for Opioid Use Disorder Train the Trainer Initiative-a national program intending to implement MOUD in general medical settings-to participate in an interview about their roles, perceptions, and experiences. The respondents answered our inquiries through an interview or responded to an email solicitation with written responses, which were then recorded, transcribed, and independently coded to identify themes.

RESULTS

Nurses from 10 VHA facilities participated in an interview (n = 7) or completed the questionnaire (n = 4). Inadequate staffing, high patient-to-provider ratios, and time constraints were identified as barriers to MOUD care. Mentorship activities, existing VHA informational resources, and patients' willingness to accept treatment were identified as facilitators of MOUD care. The Stepped Care for Opioid Use Disorder Train the Trainer Initiative processes were acknowledged to promote role confidence, which in turn increased job satisfaction and empowered nurses to become content experts. Respondents often identified nurses as local lead facilitators in MOUD care.

CONCLUSIONS

In a national initiative to implement MOUD within general medical settings, nurses identified several barriers and facilitators to MOUD implementation. Nurses play vital collaborative care roles in enhancing access to MOUD.

The stigma system: How sociopolitical domination, scapegoating, and stigma shape public health

Stigma is a fundamental driver of adverse health outcomes. Although stigma is often studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural. This paper proposes a theoretical approach that synthesizes the literature on stigma with the literature on scapegoating and divide-and-rule as strategies that the wealthy and powerful use to maintain their power and wealth; the literatures on racial, gender, and other subordination; the literature on ideology and organization in sociopolitical systems; and the literature on resistance and rebellion against stigma, oppression and other forms of subordination. we develop a model of the "stigma system" as a dialectic of interacting and conflicting structures and processes. Understanding this system can help public health reorient stigma interventions to address the sources of stigma as well as the individual problems that stigma creates. On a broader level, this model can help those opposing stigma and its effects to develop alliances and strategies with which to oppose stigma and the processes that create it.

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.

Attitudes, perceptions, self-efficacy and knowledge levels of Israeli nurses in relation to opioid misuse: A cross-sectional survey

BACKGROUND

In an opioid epidemic that is imposing heavy health burdens on individuals, families and health systems, nurses are the main front-line caregivers in the battle against the unrelenting increase in opioid medication misuse. Yet, little research has been conducted on nurses' opinions and knowledge surrounding this issue worldwide and in Israel as well.

OBJECTIVES

To evaluate Israeli nurses' attitudes, their knowledge about opioid use and misuse, their perception of institutional support, and their perception of their role and self-efficacy in preventing and treating opioid misuse.

DESIGN

Cross-sectional study.

METHODS

The data were collected through an electronic questionnaire from 414 Israeli registered nurses using the Qualtrics platform for on-line surveys.

RESULTS

The majority of the sample perceived their role positively, held positive attitudes toward people with opioid addiction, and were willing to take care of persons who misused opioids. Nurses reported low scores on knowledge, perceived institutional support, and self-efficacy relating to the issues surrounding opioid pain medication use and misuse.

CONCLUSIONS

The results clearly indicate a lack of up-to-date knowledge among nurses concerning opioids use. This situation must be urgently corrected through revisiting the subject of opioids across undergraduate, graduate, and continuing nursing education programs. Improved knowledge, combined with a supportive organizational culture, should strengthen nursing care provided to this frequently neglected patient population.

CLINICAL RELEVANCE

Broad insight into nurses' attitudes, their level of knowledge about opioid use and misuse, and their perceptions of their own role in preventing and treating such misuse are essential for creating targeted, relevant educational interventions for nurses with the aim of providing safe and effective opioid treatment for individuals with pain.

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.

Implementation of a New Hampshire community-initiated response to the opioid crisis: A mixed-methods process evaluation of Safe Station

BACKGROUND

New Hampshire (NH) ranked first for fentanyl- and all opioid-related overdose deaths per capita from 2014 to 2016 and third in 2017 with no rate reduction from the previous year relative to all other states in the US. In response to the opioid crisis in NH, Manchester Fire Department (MFD), the state's largest city fire department, launched the Safe Station program in 2016 in partnership with other community organizations. This community-based response to the crisis-described as a connection to recovery-focuses on reducing barriers to accessing resources for people with substance use and related problems. The study aim is to characterize the multi-organizational partnerships and workflow of the Safe Station model and identify key components that are engaging, effective, replicable, and sustainable.

METHODS

A mixed-methods design included: semi-structured qualitative interviews conducted with 110 stakeholders from six groups of community partners (Safe Station clients, MFD staff and leadership, and local emergency department, ambulance, and treatment partner staff); implementation and sustainability surveys (completed by MFD stakeholders); and ethnographic observations conducted at MFD. Qualitative data were content analyzed and coded using the Consolidated Framework for Implementation Research. Survey subscales were scored and evaluated to corroborate the qualitative findings.

RESULTS

Community partners identified key program characteristics including firefighter compassion, low-threshold access, and immediacy of service linkage. Implementation and sustainability survey data corroborate the qualitative interview and observation data in these areas. All participants agreed that community partnerships are key to the program's success. There were mixed evaluations of the quality of communication among the organizations.

CONCLUSION

Safe Station is a novel response to the opioid crisis in New Hampshire that offers immediate, non-judgmental access to services for persons with opioid use disorders requiring community-wide engagement and communication. Data convergence provides guidance to the sustainability and replicability of the program.

Changing Nurse Practitioner Students' Attitudes and Beliefs About Caring for Those With Opioid Use Disorders

PURPOSE

Nurse practitioners (NPs) are in a unique position to address the problem of opioid use disorders (OUDs) because they provide a large percentage of primary care services (Agency for Healthcare Research and Quality, 2014). This study aimed to increase doctoral NP students' beliefs/attitudes about their ability to care for and about individuals with OUDs through a multifaceted educational approach, guided by social cognitive theory.

METHODS

Researchers used a quasi-experimental pre/post design. Five doctoral students attended lectures and 16 hours of direct clinical exposure to individuals with OUDs at a medication-assisted treatment center. The 22-item Drug and Drug Problems Perception Questionnaire examined students' attitudes toward individuals with OUDs before and after receiving this multifaceted education. Students completed reflective writings. Descriptive statistics and effect sizes were computed, and reflective writings were reviewed.

RESULTS

Changes in Drug and Drug Problems Perception Questionnaire scores before and after intervention showed a fairly large effect size. This suggests that the intervention may have clinical significance for practice and is likely to attain statistical significance with a larger sample size. Greatest changes occurred in students' perceptions of role adequacy and self-esteem scores, indicative of higher self-efficacy. Measured score increases correspond to increases in confidence, knowledge, and skills to therapeutically engage with this population.

CONCLUSION

Doctoral NP students had more positive attitudes and beliefs about individuals with OUDs after the multifaceted intervention. Enhancement of self-esteem and adequacy in the caregiver role for this population were promising signals that education can reduce stigma. Further study is warranted with a larger and more diverse sample.

Odnos medicinskih sester do pacienta, odvisnega od prepovedanih drog

Uvod: Odnos medicinskih sester do pacientov, odvisnih od prepovedanih drog, je dejavnik, ki vpliva tako na izid zdravljenja kot na rehabilitacijo pacientov, odvisnih od prepovedanih drog. Namen raziskave je bil raziskati odnos medicinskih sester do zdravstvene obravnave pacientov, odvisnih od prepovedanih drog.Metode: Uporabili smo analizo in sintezo pregleda dokazov iz zbirk podatkov CINAHL, ProQuest Dissertations & Theses Global, SpringerLink, WILEY in PubMed. Omejitvena kriterija iskanja sta bila: objava članka med letoma 2008 in 2018 ter dostopnost celotnega besedila članka v angleščini. Oblikovan je bil konceptualni model PICOT s ključnimi besedami: »nurses«, »substance use disorders«, »attitudes«. Ocena kakovosti dokazov je prikazana v hierarhiji dokazov. Podatki so bili obdelani s tematsko analizo.Rezultati: V končni pregled je bilo vključenih 18 izbranih ustreznih člankov, identificiranih je bilo 68 kod, ki so združene v pet vsebinskih kategorij: (1) dejavniki vpliva na negativen medosebni odnos; (2) dejavniki vpliva na pozitivnejši medosebni odnos; (3) psihopatološki, vedenjski in drugi dejavniki tveganja na strani pacienta, ki imajo pomen za kakovost medosebnega odnosa; (4) posledice neustreznega odnosa medicinskih sester za zdravstveno obravnavo pacientov; (5) ukrepi za preprečevanje predsodkov in stigmatizacije pacientov, odvisnih od prepovedanih drog.Diskusija in zaključek: Raziskava potrjuje negativni odnos medicinskih sester do pacientov, odvisnih od prepovedanih drog. Določeni dejavniki so povezani tako z negativnim kot s pozitivnim odnosom medicinskih sester do teh pacientov. Njihovo proučevanje in posledice za zdravstveno oskrbo pacientov, odvisnih od prepovedanih drog, pa zahtevajo dodatne raziskave.

Mental Health Nurses' Attitudes towards Consumers with co-Existing Mental Health and Drug and Alcohol Problems: A Scoping Review

Consumers with co-existing mental health and drug/alcohol problems are exposed to more stigma than those with any other health problems. This scoping review aimed to systematically map the available literature regarding mental health nurses' attitudes, empathy, and caring efficacy towards consumers with a dual diagnosis. Twenty studies reported outcomes regarding nurse attitudes; however, none reported nurses' empathy or caring efficacy towards consumers with a dual diagnosis. Further research is required to advance the evidence on the impact of mental health nurses' attitudes, empathy and caring effectiveness, and the outcomes should lead to improved service delivery for consumers with a dual diagnosis.

Personal and professional attitudes associated with nurses' motivation to work with patients with opioid use and opioid use-related problems

BACKGROUND

Opioid use and opioid use-related problems contribute significantly to increased morbidity rates and premature deaths as well as an increased economic burden. Nurses have key roles in providing care to this patient population; however, they often report low motivation toward working with these patients. Examining personal and professional attitudes associated with nurses' motivation to work with this population can present a valuable opportunity to enhance their willingness to intervene at an earlier stage when patients do not have a diagnosable opioid use disorder. Methods: A descriptive, correlational design was used. Nurses were recruited from four hospital settings in Southwestern Pennsylvania. Data on nurses' demographic/background characteristics, personal attitudes, professional attitudes, and motivation related to working with patients with opioid use and opioid use-related problems were collected via a paper/pencil survey and analyzed using linear regression. Results: A sample of 234 nurses were included in the final analyses. Personal attitudes associated with nurses' motivation included personal experience with a family member related to alcohol and/or other drugs, and stigma perceptions (familiarity, perceived dangerousness, fear, social distance and personal responsibility beliefs). Professional attitudes associated with nurses' motivation included working experience with substance use (SU), SU education as continuing education or other educational resources, role security, therapeutic commitment, role responsibility, and self-efficacy. Conclusions: This study's findings provide valuable information regarding the bivariate relationships between nurses' personal attitudes, professional attitudes, and motivation to work with patients with opioid use and opioid use-related problems. The study provides a base for future studies aimed at developing interventions to enhance nurses' motivation to work with this patient population particularly related to preventing the progression of opioid use to a diagnosable disorder.

Opioid Use Disorder: Treatments and Barriers

Over the last decade, opioid use around the world has risen considerably and is projected to continue to rise at an alarming rate. As opioid use rises, so too does the number of people who suffer from opioid use disorder (OUD) and opioid overdose-related deaths. As science and medicine progresses, new medications and therapies have arisen in order to help treat patients suffering from addiction. Treatment can be split into two main domains: pharmacological and non-pharmacological. Buprenorphine and methadone, currently the most prescribed medications for patients suffering from OUD, have been shown to be extremely effective in clinical trials but have significant real-world limitations. Geographical disparities between various locations, physician stigma with prescribing these medications, and training required to prescribe medication can make access to these treatments difficult for patients. Non-pharmacological interventions have also been shown to help with limited efficacy when combined with pharmacological interventions. However, the time and resources required to implement these strategies may be a difficult barrier to overcome. In this review, we assess pharmacological interventions, non-pharmacological treatments, examine barriers to treatment for patients, and propose solutions to bypass these barriers.

Impact of Substance Use Disorder on Quality of Inpatient Mental Health Services for People With Anxiety and Depression

Objective: Substance use disorders are commonly comorbid with anxiety and depressive disorders and are associated with poor treatment outcomes. The mechanisms underlying this association remain unclear-one possibility is that patients with anxiety/depressive disorders and substance use disorders receive poorer treatment. Concerns have been raised about the quality of inpatient care received by patients with substance use disorders. The purspose of this research was to examine the quality of care received by inpatients with an anxiety or depressive disorder, comparing subgroups with or without a comorbid substance use disorder. Methods: This was a retrospective case-note review of 3,795 patients admitted to inpatient psychiatric wards in England. Data were gathered on all acute admissions with anxiety/depressive illness over a 6-month period, for a number of measures of quality of care derived from national standards. Association of coexisting substance use disorders with a variety of quality of care outcomes (relating to assessment, care planning, medication management, psychological therapies, discharge, crisis planning, and follow-up) was investigated using multivariable regression analyses. Results: In all, 543 (14.3%) patients in the study had a secondary diagnosis of a substance use disorder. Patients with substance use disorders were less likely to have had care plans that were developed jointly (i.e., with input from both patient and clinician; odds ratio [OR] = 0.76, 95% confidence interval [CI] [0.55, 0.93], p = .034) and less likely to have had their medication reviewed either during the admission (OR = 0.83, 95% CI [0.69, 0.94], p = .030) or at follow-up after discharge (OR = 0.58, 95% CI [0.39, 0.86], p = .007). Carers of patients with substance use disorders were less likely to have been provided with information about available support services (OR = 0.79, 95% CI [0.57, 0.98], p = .047). Patients with substance use disorders were less likely to have received adequate (at least 24 hours) notice in advance of their discharge (OR = 0.72, 95% CI [0.54, 0.96], p = .033), as were their carers (OR = 0.63, 95% CI [0.41, 0.85], p = .007). They were less likely to have a crisis plan in place at the point of discharge (OR = 0.85, 95% CI [0.74, 0.98], p = .044). There was also strong evidence that patients with substance use disorders were less likely to have been referred for psychological therapy (OR = 0.69, 95% CI [0.55, 0.87], p = .002). Conclusions: We found evidence of poorer quality of care for inpatients with anxiety and depressive disorders with comorbid substance use disorders, highlighting the need for more to be done to support these patients. Discrepancies in care quality may be contributed to the poor treatment outcomes experienced by patients with substance use disorders, and strategies to reduce this inequality are necessary to improve the well-being of this substantial patient group.

The Care of the Patients With Alcohol Intoxication in the Emergency Department of a Central Hospital: Nurses' Skills, Knowledge, and Attitudes

AIM

The aim of the study was to describe nurses' skills, knowledge of care, and attitudes toward the care of patients with alcohol intoxication in the emergency department.

METHOD

The data were collected using theme interviews in 2016. The study participants were nurses working in the emergency department (n = 6) that has a sobering unit. The data were analyzed using inductive content analysis.

RESULTS

On the basis of the interviewees' descriptions, five main categories were formed: the skills to discuss the use of alcohol on arrival, safety skills, teamwork skills, the skills to organize follow-up care, and nurses' attitudes and ethics in patients' care. Asking about the use of alcohol as well as the use of a screening tool varied. The interviewees emphasized the skills to anticipate the risk of violence as well as ensuring the safety of the working environment. Nurses' attitudes were seen as the ability to regulate negative emotions raised by the patient. Factors related to nurses' attitudes emerged in patients' behavioral disorders and commitment to treatment. Despite some negative feelings toward patients, nurses thought that it is important to ensure ethicality in patients' care.

CONCLUSIONS

The nurses' skills and knowledge of care and attitudes toward patients with alcohol intoxication varied. There is a need for additional training on issues relating to the treatment of patients with alcohol intoxication.

Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers within the Treatment System

Even though evidence-based treatment for opioid use disorders (OUD) is effective, almost four in five Americans with OUD do not receive any form of treatment. The gap in access to evidence-based care, including treatment with medications for OUD, stems in part from barriers to change within the health care system. This paper includes nine key barriers that prevent access to evidence-based care, including stigma; inadequate clinical training; a dearth of addiction specialists; lack of integration of MOUD provision in practice; regulatory, statutory, and data sharing restrictions; and financial barriers. Action from a number of actors is urgently needed to address this crisis.

Burnout and Mental Health Stigma Among Juvenile Probation Officers: The Moderating Effect of Participatory Atmosphere

Despite high rates of mental health problems among juvenile justice-involved youth, mental health stigma among juvenile probation officers (JPOs) is under-studied. This cross-sectional study examined effects of job burnout and workplace participatory atmosphere on mental health stigma among JPOs across Indiana (n = 226). Participatory atmosphere moderated the relationship between JPO burnout-related cynicism and mental health stigma (interaction β = - 0.14, p = .04); burnout was related to greater mental health stigma at low levels of participatory atmosphere. Findings suggest participatory atmosphere mitigates effects of burnout on mental health stigma among JPOs. Organizational-level interventions might help to reduce mental health stigma and combat negative effects from burnout among JPOs.

Emergency Department Clinicians' Attitudes Toward Opioid Use Disorder and Emergency Department-initiated Buprenorphine Treatment: A Mixed-Methods Study

Introduction

Emergency department (ED) visits related to opioid use disorder (OUD) have increased nearly twofold over the last decade. Treatment with buprenorphine has been demonstrated to decrease opioid-related overdose deaths. In this study, we aimed to better understand ED clinicians’ attitudes toward the initiation of buprenorphine treatment in the ED.

Methods

We performed a mixed-methods study consisting of a survey of 174 ED clinicians (attending physicians, residents, and physician assistants) and semi-structured interviews with 17 attending emergency physicians at a tertiary-care academic hospital.

Results

A total of 93 ED clinicians (53% of those contacted) completed the survey. While 80% of respondents agreed that buprenorphine should be administered in the ED for patients requesting treatment, only 44% felt that they were prepared to discuss medication for addiction treatment. Compared to clinicians with fewer than five years of practice, those with greater experience were less likely to approve of ED-initiated buprenorphine. In our qualitative analysis, physicians had differing perspectives on the role that the ED should play in treating OUD. Most physicians felt that a buprenorphine-based intervention in the ED would be feasible with institutional support, including training opportunities, protocol support within the electronic health record, counseling and support staff, and a robust referral system for outpatient follow-up.

Conclusion

ED clinicians’ perception of buprenorphine varied by years of practice and training level. Most ED clinicians did not feel prepared to initiate buprenorphine in the ED. Qualitative interviews identified several addressable barriers to ED-initiated buprenorphine.

It is just that people treat you like a human being: The meaning of dignity for patients with substance use disorders

INTRODUCTION

Patients who suffer from substance use disorder (SUD) might receive services from different service providers in an opioid maintenance treatment programme (OMT) and have a widespread and complex need for nursing.

BACKGROUND

Literature reveals that prejudices against people with SUD exist. There is a lack of studies exploring patients with SUD experiences of preserving their dignity in the encounter with healthcare staff. The aim of the study was to gain insight into the meaning of dignity for patients with SUD.

METHODS

The research design was descriptive and interpretative. In the interpretation of qualitative in-depth interviews with six patients, a hermeneutical approach based on Gadamer (Truth and method, Sheed & Ward, London, UK, 1989) was used.

RESULTS

Analysis resulted in three mains themes about the meaning of dignity: (a) The material dimension. (b) To be respected by others. (c) The inner experience. Factors enhancing dignity in the encounters were as follows: (a) Being respected and acknowledged. (b) Being cared for. (c) Knowledge and persistent relation. Factors depriving dignity were as follows: (a) Stigma and prejudice. (b) Insufficient relations and lack of confirmation. (c) Experiencing disrespectful/patronising attitudes and lack of knowledge.

CONCLUSIONS

The material dimension of dignity containing an aesthetically aspect was important for these patients. Dignity was also experienced as strongly connected to respect. Dignity can be enhanced by treating patients with SUD with understanding and respect, and dignity can be inhibited through stigmatization of patients with SUD, as well as by caregivers' lack of knowledge.

RELEVANCE TO CLINICAL PRACTICE

The study clarifies a need for more knowledge about SUD among healthcare staff, as well as promotes ethical awareness in encounters with patients regardless of their background.

Moving from stigmatization toward competent interdisciplinary care of patients with functional neurological disorders: focus group interviews

PURPOSE

To explore facilitating and inhibiting factors in the inpatient care of patients with functional neurological disorders as experienced by interdisciplinary teams of healthcare professionals.

METHOD

Qualitative focus group interviews were conducted with 18 healthcare professionals of various professions. Data were analyzed using qualitative content analysis with inductive coding of data.

RESULTS

Two main categories were formulated: (a) Giving the diagnosis to patients - a moment of fragility and opportunities, and (b) Organization of care - ensuring the continuity and protecting patients' self-image. One overarching theme tied the two categories together: Establishing coherence in the inpatient trajectory - moving from stigmatization toward competent care. Coherence and steadiness in care was a prerequisite for transparency in goalsetting and for designating the responsibilities of individual healthcare professionals. Stigma and having clinical experience and knowledge of functional neurological disorders, as two counter-factors, influenced the extent to which this was achieved. Examples of facilitating factors for enhancing competent care were documentation of symptoms, effective ways of passing on clinical information, education, professional dialog, and organizational support.

DISCUSSION

To nurture competent care, guidelines, structured educational initiatives and other supportive actions should be promoted. We provide ideas for the next logical steps for clinical practice and research.IMPLICATIONS FOR REHABILITATIONClose collaboration between interdisciplinary healthcare professionals plays an important role for reaching optimal results in the rehabilitation of inpatients with functional neurological disorder.There is currently limited knowledge regarding the facilitating and inhibiting features encountered by interdisciplinary healthcare professionals in the provision of care for patients with a functional neurological disorder.The findings show that a working environment that endorses a skillful culture of practice and which facilitates actions to reduce problems that hamper effective teamwork needs to be promoted.Solutions that help to solve many obstacles encountered by the team of healthcare professionals in the care provision of patients with functional neurological disorders include open dialog regarding symptoms, diagnosis and treatment, effective ways of documenting and reporting symptoms, and availability of guidelines and supporting educational material.

Barriers and facilitators to office-based opioid agonist therapy prescribing and effective interventions to increase provider prescribing: protocol for a systematic review

BACKGROUND

Opiate agonist therapy (OAT) prescribing rates by family physicians are low in the context of community-based, comprehensive primary care. Understanding the factors that support and/or inhibit OAT prescribing within primary care is needed. Our study objectives are to identify and synthesize documented barriers to, and facilitators of, primary care opioid agonist prescribing, and effective strategies to inform intervention planning and support increased primary care OAT prescribing.

METHODS/DESIGN

We will systematically search EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, MEDLINE, and gray literature in three domains: primary care providers, opioid agonist therapy, and opioid abuse. We will retain and assess primary studies reporting documented participation, or self-reported willingness to participate, in OAT prescribing; and/or at least one determinant of OAT prescribing; and/or strategies to address determinants of OAT prescribing from the perspective of primary care providers in comprehensive, community-based practice settings. There will be no restrictions on study design or publication date. Studies limited to specialty clinics with specialist prescribers, lacking extractable data, or in languages other than English or French will be excluded. Two reviewers will perform abstract review and data extraction independently. We will assess the quality of included studies using the Joanna Briggs Institute Critical Appraisal Tool. We will use a framework method of analysis to deductively code barriers and facilitators and to characterize effective strategies to support prescribing using a combined, modified a priori framework comprising the Theoretical Domains Framework and the Consolidated Framework for Implementation Research.

DISCUSSION

To date, no synthesis has been undertaken of the barriers and facilitators or effective interventions promoting OAT prescribing by primary care clinicians in community-based comprehensive care settings. Enacting change in physician behaviors, community-based programming, and health services is complex and best informed by using theoretical frameworks that allow the analysis of the available data to assist in designing and implementing interventions. In light of the current opioid crisis, increasing the capacity of primary care clinicians to provide OAT is an important strategy to curb morbidity and mortality from opioid use disorder.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD86835.

Rising rates of injection drug use associated infective endocarditis in Virginia with missed opportunities for addiction treatment referral: a retrospective cohort study

BACKGROUND

Injection drug use (IDU) is a growing public health threat in Virginia, though there is limited knowledge of related morbidity. The purpose of this study was to describe the temporal, geographic and clinical trends and characteristics of infective endocarditis associated with IDU (IDU-IE) and to identify opportunities for better-quality care of people who inject drugs (PWID).

METHODS

We reviewed charts for all admissions coded for both IE and drug use disorders at the University of Virginia Medical Center (UVA) from January 2000 to July 2016. A random sample of 30 admissions coded for IE per year were reviewed to evaluate temporal trends in the proportion of IDU associated IE cases.

RESULTS

There were a total of 76 patients with IDU-IE during the study period, 7.54-fold increase (prevalence ratio: 8.54, 95% CI 3.70-19.72) from 2000 to 2016. The proportion of IE that was IDU-associated increased by nearly 10% each year (prevalence ratio of IDU per year: 1.09, 95% CI: 1.05-1.14). Patients with IDU-IE had longer hospital stays [median days (interquartile range); IDU-IE, 17 (10-29); non-IDU-IE, 10 (6-18); p-value = 0.001] with almost twice the cost of admission as those without IDU [median (interquartile range); IDU-IE, $47,899 ($24,578-78,144); non-IDU-IE, $26,460 ($10,220-60,059); p-value = 0.001]. In 52% of cases there was no documentation of any discussion regarding addiction treatment.

CONCLUSION

IDU-IE is a severe infection that leads to significant morbidity and healthcare related costs. IDU-IE rates are increasing and will likely continue to do so without targeted interventions to help PWID. The diagnosis and treatment of IDU-IE provides an opportunity for the delivery of addiction treatment, counseling, and harm reduction strategies.

Knowledge and Perceptions of Undergraduate Nurses towards the Use of Cocaine (Smoked) in a Brazilian Context

The aim of the study was to evaluate the perceptions and knowledge of nursing students on the identification and intervention care among users of cocaine (smoked) patients. A cross-sectional survey design was conducted with 164 undergraduate nursing students of two nursing school from Northeast of Brazil. A questionnaire on knowledge and attitudes and therapeutic commitment towards the use of cocaine (smoked) were used. The students stated that they received contents of substance misuse in the curriculum of nursing. Only 10% of the students reported that they had adequate knowledge on addiction to dealing with cocaine (smoked) users and wish to work with these users. There are positive perceptions on motivation, task specific self-esteem and work satisfaction among students.

The impact of educational interventions on attitudes of emergency department staff towards patients with substance-related presentations: a quantitative systematic review

BACKGROUND

Visits to emergency departments for substance use/abuse are common worldwide. However, emergency department health care providers perceive substance-using patients as a challenging group to manage which can lead to negative attitudes. Providing education or experience-based exercises may impact positively on behaviors towards this patient population. Whether staff attitudes are similarly impacted by knowledge acquired through educational interventions remains unknown.

OBJECTIVES

To synthesize available evidence on the relationship between new knowledge gained through substance use educational interventions and emergency department health care providers' attitudes towards patients with substance-related presentations.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Health care providers working in urban and rural emergency departments of healthcare facilities worldwide providing care to adult patients with substance-related presentations.

TYPE OF INTERVENTION

Quantitative papers examining the impact of substance use educational interventions on health care providers' attitudes towards substance using patients.

TYPES OF STUDIES

Experimental and non-experimental study designs.

OUTCOMES

Emergency department staff attitudes towards patients presenting with substance use/abuse.

SEARCH STRATEGY

A three-step search strategy was conducted in August 2015 with a search update in March 2017. Studies published since 1995 in English, French or Spanish were considered for inclusion.

METHODOLOGICAL QUALITY

Two reviewers assessed studies for methodological quality using critical appraisal checklists from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Reviewers agreed on JBI-MAStARI methodological criteria a study must meet in order to be included in the review (e.g. appropriate use of statistical analysis).

DATA EXTRACTION AND SYNTHESIS

The data extraction instrument from JBI-MAStARI was used. As statistical pooling of the data was not possible, the findings are presented in narrative form.

RESULTS

A total of 900 articles were identified as relevant for this review. Following abstract and full text screening, four articles were selected and assessed for methodological quality. One article met methodological criteria for inclusion in the review: use of random assignment and comparable study groups and measurement outcomes in a reliable and consistent manner. The included study was a cluster randomized controlled trial. Participants were emergency medicine residents with a mean age of 30 years. The study assessed the impact of a skills-based educational intervention on residents' attitudes, knowledge and practice towards patients with alcohol problems. While knowledge and practice behaviors improved one year following the intervention, there were no significant differences between groups on attitudinal measures.

CONCLUSIONS

Employing educational interventions to improve the attitudes of emergency department staff towards individuals with drug and alcohol related presentations is not supported by evidence.

Relationship between Provider Stigma and Predictors of Staff Turnover among Addiction Treatment Providers

To further our knowledge about feasible targets for improving quality of addiction treatment services, the current study provides preliminary assessment of the relationship between provider stigma and indicators of staff turnover. As predicted, results suggest that higher provider stigma was significantly related to lower ratings of job satisfaction and workplace climate. However, provider stigma was not significantly related to burnout. Our preliminary findings, if replicated, suggest the importance of considering provider stigma as a risk factor for future staff turnover and job dissatisfaction. Promising provider stigma interventions do exist and offer viable opportunity for improving quality of addiction treatment.

Nursing interventions for substance use during psychiatric hospital admissions: Clinical context and predictors

Empirical information about how nurses manage substance use on psychiatric wards is lacking. The aims of the study were to identify the frequency and clinical features of incidents among a sample of inpatients over a 12-month period and how nursing staff intervened. Electronic, anonymized inpatient records were searched for incidents of substance use on 17 acute psychiatric wards in four hospitals in London. Searches were conducted for all patients admitted during 2012 and details of incidents and patient characteristics were extracted for analysis. Substance use was reported for 291 patients, with 25 incidents per 100 patients admitted to hospital. Only half of the incidents were followed by a response that specifically addressed the patients' substance use behaviour. These interactions usually concerned the circumstances and reasons for use, but rarely involved specific support for patients' substance use problems. The likelihood of staff taking any form of action was increased if the patient had been formally admitted, and was reduced if the patient was subject to containment during the shift or had a history of self-harm. The results demonstrate that nurses require specific training and guidance on supporting substance using patients.

A Study of Therapeutic Attitudes Towards Working With Drug Abusers: Reliability and Validity of the Japanese Version of the Drug and Drug Problems Perception Questionnaire

Positive therapeutic attitudes from healthcare professionals are important when providing medical services. The Drug and Drug Problems Perception Questionnaire (DDPPQ) measures healthcare professionals' attitudes towards working with drug abusers. We developed a Japanese version (J-DDPPQ) and examined its reliability and validity among Japanese nurses. The J-DDPPQ showed good internal consistency (Cronbach's alpha=0.92). Using exploratory factor analysis, the five-factor structure was found to be identical to the original structure. Construct validity was supported by significant positive correlations with experience working with drug abusers, a high level of knowledge and skills, receiving education and training, and optimistic perception about people with drug dependence. The results show that the J-DDPPQ has acceptable reliability and validity and will contribute to investigating the effect of education and training on drug abuse.

Nurses' competence in pain management in patients with opioid addiction: A cross-sectional survey study

BACKGROUND

There may be up to 21 million opioid abusers in the world. Drug abuse and associated health-related problems are increasing. Opioid addiction can cause serious bacterial infection, injury and trauma, conditions that can trigger pain. Opioid abusers experience pain differently from non-addicts. There is limited research on nurses' competence to provide pain treatment to patients with opioid addiction.

OBJECTIVE

To report on a Norwegian pilot study examining nurses' knowledge about pain and competence in treating pain in patients who abuse opioids.

DESIGN

A descriptive cross-sectional survey design was employed.

PARTICIPANTS

Nurses at medical (n=64) and orthopaedic (n=34) units at two urban, public Norwegian hospitals.

METHODS

Data were collected in January 2010 using a self-administered questionnaire. Sample selection was determined by purposive sampling. The response rate was 54%.

RESULTS

Eighty-eight percent of nurses did not have sufficient knowledge about pain treatment in patients with opioid addiction. Eight-eight percent and seventy-seven percent regarded work-place experience and colleagues as the primary contributors to their knowledge about pain treatment, respectively. Work-place experience contributed most to nurses' competence. Ninety percent, 70% and 84% of nurses responded that education, literature and information technology, respectively, played a minor role in obtaining knowledge about pain management. Sixty-five percent of the respondents had basic skills for evaluating pain, although 54% could not evaluate the degree of pain. Almost 62% of nurses did not trust the pain experience self-reported by patients who were opioid abusers.

CONCLUSION

Our study shows shortcomings in the nurses' competence to evaluate and treat pain, suggesting that patients with opioid addiction may not receive adequate pain management. Nurses' competence to offer pain treatment to opioid abusers could be characterized as experience-based rather than evidence-based.

Reducing stigma towards substance users through an educational intervention: harder than it looks

OBJECTIVE

Stigma towards people with substance use disorders is pervasive and imbedded in our US culture. Prejudicial attitudes that are part of a health care practitioner's value system are a barrier to people accessing health care and substance use treatment. This study aimed to reduce stigmatizing attitudes of graduate health care professional students by implementing an innovative curriculum combining multiple teaching methods.

METHODS

Physician assistant students received a 3-h educational intervention that consisted of lecture and discussion sessions, direct interaction with a recovering substance user, viewing a film portrayal of addiction and addiction treatment, and written self-reflection. Changes in student attitudes were measured using a subscale of the Attitudes to Mental Illness Questionnaire (AMIQ) instrument and analysis of coded written reflections. A follow-up focus group resulted in additional qualitative insight into attitudes.

RESULTS

Post-intervention scores for the "heroin" AMIQ vignette significantly improved compared to pre-test scores (p<0.007), but the effect was small and the mean post-test scores still reflected very negative attitudes. Students' neutral attitude towards alcohol use did not change as a result of the intervention. Written reflections demonstrated that this sample of students continued to harbor stigma towards people with substance use following the intervention. Focus group data suggested students believed that stigma beliefs about substance use were common among health care professionals, though they believed that their own level and quality of care would not be influenced by these beliefs.

CONCLUSIONS

The persistence of negative attitudes following this and others' educational interventions suggests the need for a new approach to changing health care professionals' stigma towards substance users.

Challenges in nursing practice: nurses' perceptions in caring for hospitalized medical-surgical patients with substance abuse/dependence

OBJECTIVE

The objective of this study was to investigate nurses' perceptions of caring for hospitalized medical-surgical patients with comorbid conditions of substance abuse/dependence.

BACKGROUND

Critical to this issue of quality patient care is the rising incidence of comorbid drug and alcohol abuse among hospitalized patients. Little research exists on the perceptions of nurses providing care to substance abuse/dependent medical-surgical hospitalized patients. There exists the need to further explore nurses' perceptions regarding caring for this challenging population.

METHODS

Using a qualitative inductive approach, a convenience sample of 24 nurses completed research questions regarding their perceptions of caring for hospitalized patients with substance abuse/dependence.

RESULTS

Data analysis revealed ethical duty to care, negative perceptions toward patients with substance abuse/dependence, need for further education, sympathy, and issues with pain management. Providing quality nursing care for the hospitalized medical-surgical patient with concomitant alcohol and/or drug dependence is challenging for nursing. Nurses need additional education and professional support in caring for these individuals.

Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review

BACKGROUND

Healthcare professionals are crucial in the identification and accessibility to treatment for people with substance use disorders. Our objective was to assess health professionals' attitudes towards patients with substance use disorders and examine the consequences of these attitudes on healthcare delivery for these patients in Western countries.

METHODS

Pubmed, PsycINFO and Embase were systematically searched for articles published between 2000 and 2011. Studies evaluating health professionals' attitudes towards patients with substance use disorders and consequences of negative attitudes were included. An inclusion criterion was that studies addressed alcohol or illicit drug abuse. Reviews, commentaries and letters were excluded, as were studies originating from non-Western countries.

RESULTS

The search process yielded 1562 citations. After selection and quality assessment, 28 studies were included. Health professionals generally had a negative attitude towards patients with substance use disorders. They perceived violence, manipulation, and poor motivation as impeding factors in the healthcare delivery for these patients. Health professionals also lacked adequate education, training and support structures in working with this patient group. Negative attitudes of health professionals diminished patients' feelings of empowerment and subsequent treatment outcomes. Health professionals are less involved and have a more task-oriented approach in the delivery of healthcare, resulting in less personal engagement and diminished empathy.

CONCLUSIONS

This review indicates that negative attitudes of health professionals towards patients with substance use disorders are common and contribute to suboptimal health care for these patients. However, few studies have evaluated the consequences of health professionals' negative attitudes towards patients with substance use disorders.