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Fokuo JK, Hutman PJ, Gruber VA, Masson CL, Lum PJ, Bush DM, Naugle JA, Sorensen JL. Substance use Attitudes, Beliefs, Experience, and Knowledge Among Nursing and Nursing Assistant Students. J Psychoactive Drugs 2024:1-11. [PMID: 38646910 DOI: 10.1080/02791072.2024.2343402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/14/2024] [Indexed: 04/23/2024]
Abstract
Stigma is a public health concern. Stigmatizing attitudes toward persons with substance use disorders (SUDs) can adversely impact clinical care and outcomes. Beliefs about SUD, prior experience and familiarity to persons with SUD, and educational curricula drive attitudes among health-care workers. In 2019, nursing and nursing assistant students were recruited through an online survey platform. Participants completed an SUD knowledge test and a survey assessing education, beliefs, personal experience, and confidence in recognizing the signs and symptoms of SUD. One hundred and ten health-care students (nursing students, n = 67 and nursing assistant students, n = 43) completed the survey. Among nursing assistant students, endorsing a disease model of addiction (F(2, 40) = 5.83, p < .001, R2 = .23), and personal familiarity with SUD (F(2, 40) = 4.46, p < .001, R2 = .18), were significantly positively predictive of positive regard toward working with persons with SUD. For nursing students, endorsing a disease model of addiction, educational curricula involving persons with SUD, and personal familiarity were significantly positively predictive of positive regard toward working with persons with SUDs (F(2, 61) = 11.52, p < .001, R2 = .36). Interventions to mitigate drug-related stigma among health-care students should center students with personal familiarity, promote the disease concept of addiction, and incorporate contact-based training.
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Affiliation(s)
- J Konadu Fokuo
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Paul J Hutman
- Veterans Administration, Northern California Health Care System, Redding, CA, USA
| | - Valerie A Gruber
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Carmen L Masson
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Paula J Lum
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Dylan M Bush
- Division of Biology and Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jessica A Naugle
- San Francisco Department of Public Health, Street Medicine and Shelter Health, San Francisco, CA, USA
| | - James L Sorensen
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
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de Claudio JCM, Pereira CF, de Vargas D. Effectiveness of Clinical Practicum Experience in Drug Addiction Treatment Facilities in Nursing Students' Attitudes Toward Alcohol, Alcohol Use Disorders, and Alcoholics: Systematic Review and Meta-Analysis. J Addict Nurs 2024; 35:86-98. [PMID: 38829998 DOI: 10.1097/jan.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
ABSTRACT The aim of this study was to identify, analyze, and synthesize the best evidence on the effectiveness of clinical practicum experience in drug addiction treatment facilities on nursing students' attitudes toward alcohol, alcohol use disorder (AUD), and persons with AUD. This systematic review followed the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses and used the System for the Unified Management of the Assessment and Review of Information to assess methodological quality and extract data for meta-analysis. A comprehensive literature search of the EBSCO databases, Embase, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, PsycINFO, Scopus, Web of Science, Mednar, Coordenadoria de Aperfeiçoamento de Pessoal de Nível Superior, and ProQuest Dissertations & Theses catalog was conducted. The System for the Unified Management of the Assessment and Review of Information tool was used for the extraction and critical evaluation of the selected articles followed by a meta-analysis. After removing duplicates, 2,831 publications were identified, and eight met the inclusion criteria. More positive attitudes were observed after performing practicum experience in specialized services (-1.27, 95% confidence interval [-2.85, -0.30]), and an increase in the motivation and satisfaction among the students to care for patients with AUD was also noted. In conclusion, the review suggests that clinical practicum experience in a drug addiction treatment facility has the potential to change the attitudes of nursing students toward AUD and persons with AUD.
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Affiliation(s)
- João Carlos M de Claudio
- João Carlos M. de Claudio, MSN, Caroline F. Pereira, PhD, and Divane de Vargas, PhD, University of São Paulo, Brazil
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Magnan E, Weyrich M, Miller M, Melnikow J, Moulin A, Servis M, Chadha P, Spivack S, Henry SG. Stigma Against Patients With Substance Use Disorders Among Health Care Professionals and Trainees and Stigma-Reducing Interventions: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:221-231. [PMID: 37801599 DOI: 10.1097/acm.0000000000005467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
PURPOSE In this systematic review, the authors examine the prevalence and extent of stigmatizing attitudes among health care professionals (HCPs) and trainees against patients with substance use disorders (SUDs), including research on interventions to reduce stigma. METHOD The authors searched 7 databases for articles published from January 1, 2011, through February 15, 2023, that quantified SUD stigma among HCPs or trainees. Inclusion criteria allowed both observational and intervention studies from the United States or Canada to be included in this review. Quality assessment was applied to all included studies; studies were not excluded based on quality. RESULTS A total of 1,992 unique articles were identified of which 32 articles (17 observational studies and 15 intervention studies), all conducted in the United States, met the inclusion criteria. Half of the included studies (16 of 32) were published in 2020 or later. Most of the intervention studies (13 of 15) used a single-group pre-post design; interventions involved didactics and/or interactions with persons with SUDs. The 32 included studies used a total of 19 different measures of stigma. All 17 observational studies showed some degree of HCP or trainee stigma against patients with SUDs. Most intervention studies (12 of 15) found small but statistically significant reductions in stigma after intervention. CONCLUSIONS SUD stigma exists among HCPs and trainees. Some interventions to reduce this stigma had positive impacts, but future studies with larger, diverse participants and comparison groups are needed. Heterogeneity among studies and stigma measures limits the ability to interpret results across studies. Future rigorous research is needed to determine validated, consensus measures of SUD stigma among HCPs and trainees, identify stigma scores that are associated with clinical outcomes, and develop effective antistigma interventions for HCPs and trainees.
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Manzotti A, Avery-Desmarais S, Ducharme M, Elliott K, Misto K. Improving Nurses' Attitudes Toward Substance Use Disorder: Screening, Brief Intervention, and Referral to Treatment. J Addict Nurs 2023; 34:266-272. [PMID: 38015577 DOI: 10.1097/jan.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
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.
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Parish CL, Feaster DJ, Pollack HA, Horigian VE, Wang X, Jacobs P, Pereyra MR, Drymon C, Allen E, Gooden LK, Del Rio C, Metsch LR. Health Care Provider Stigma Toward Patients With Substance Use Disorders: Protocol for a Nationally Representative Survey. JMIR Res Protoc 2023; 12:e47548. [PMID: 37751236 PMCID: PMC10565625 DOI: 10.2196/47548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as the negative perceptions and behaviors that providers embody and enact toward patients with substance use disorders, across providers with different specialties, is critical to expanding the delivery of substance use treatment. OBJECTIVE To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers' clinical practices in caring for their patients. The survey also queried providers' stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders. METHODS Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants' views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations. RESULTS Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers. CONCLUSIONS Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47548.
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Affiliation(s)
- Carrigan Leigh Parish
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Daniel J Feaster
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Xiaoming Wang
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Petra Jacobs
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | | | - Elizabeth Allen
- National Opinion Research Center, Chicago, IL, United States
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- School of General Studies, Columbia University, New York, NY, United States
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Hagle H, Kameg B, Lindsay D, Matthews E, Mitchell A. Advanced practice nursing students' perspectives of learning screening, brief intervention, and referral to treatment in interprofessional settings. J Am Assoc Nurse Pract 2023; 35:568-574. [PMID: 37192411 DOI: 10.1097/jxx.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/14/2023] [Indexed: 05/18/2023]
Abstract
ABSTRACT Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to early intervention for substance use through universal screening. Utilization of SBIRT was taught in an interprofessional setting to nurse practitioner, nurse anesthetist, and dental hygiene students through integrated educational grant projects. A qualitative analysis was done across 10 SBIRT data sets collected over 4 years. The researchers used a nominal group consensus method to review the data, and six themes were identified. Results showed that students desired more training on motivational interviewing techniques. Furthermore, students identified that to effectively work interprofessionally, students must be exposed to such collaboration throughout their professional educational programs.
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Affiliation(s)
- Holly Hagle
- University of Missouri-Kansas City School of Nursing and Health Studies
| | | | - Dawn Lindsay
- Institute for Research, Education, and Training in Addictions
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Gomez E, Gyger M, Borene S, Klein-Cox A, Denby R, Hunt S, Sida O. Using SBIRT (Screen, Brief Intervention, and Referral Treatment) Training to Reduce the Stigmatization of Substance Use Disorders Among Students and Practitioners. Subst Abuse 2023; 17:11782218221146391. [PMID: 36685721 PMCID: PMC9850124 DOI: 10.1177/11782218221146391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/03/2022] [Indexed: 01/18/2023]
Abstract
Negative attitudes and stigmatization of substance-using patients lead to treatment avoidance and poor physical and health outcomes. Research suggests that training in substance use disorders is a vital tool to abate negative attitudes among health workers. The present longitudinal study trained students and experienced practitioners from various disciplines on the evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) model. The study found significant improvements in the attitudes of students-but not practitioners-who were trained during the program. The paper discusses policy and implementation implications to support and complement sustained impact of training on models such as SBIRT.
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Affiliation(s)
- Efren Gomez
- Ford School of Public Policy,
University of Michigan, Ann Arbor, MI, USA,Efren Gomez, Ford School of Public Policy,
University of Michigan, 735 S State Street, Ann Arbor, MI 48109, USA.
| | - Matthew Gyger
- School of Social Work, University of
Nevada Las Vegas, Las Vegas, NV, USA
| | | | - Amanda Klein-Cox
- School of Social Work, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ramona Denby
- School of Social Work, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sara Hunt
- Kirk Kerkorian School of Medicine,
University of Nevada Las Vegas, Las Vegas, NV, USA
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McAfee NW, Schumacher JA, Madson MB, Villarosa-Hurlocker MC, Williams DC. The Status of SBIRT Training in Health Professions Education: A Cross-Discipline Review and Evaluation of SBIRT Curricula and Educational Research. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1236-1246. [PMID: 35320126 DOI: 10.1097/acm.0000000000004674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To assess the quality of curricular research on the Screening Brief Intervention and Referral to Treatment (SBIRT) approach and determine the presence of useful training modalities, particularly motivational interviewing (MI) training, across health care training curricula. METHOD The authors conducted a systematic review of published, peer-reviewed studies in PubMed, ERIC, CINAHL, Ovid HealthSTAR, and PsycINFO databases through March 2021 for English-language studies describing SBIRT, a curriculum for health care trainees, and curricular intervention outcomes. After the records were independently assessed, data were extracted and 20% of the studies were double-coded for interrater reliability. RESULTS Of 1,856 studies, 95 were included in the review; 22 had overlapping samples and were consolidated into 10 nested studies, leaving 83 total. Interrater reliability ranged from moderate (κ = .74, P < .001) to strong (κ = .91, P < .001) agreement. SBIRT training was delivered to trainees across many professions, including nursing (n = 34, 41%), medical residency (n = 28, 34%), and social work (n = 24, 29%). Nearly every study described SBIRT training methods (n = 80, 96%), and most reported training in MI (n = 54, 65%). On average, studies reported 4.06 (SD = 1.64) different SBIRT training methods and 3.31 (SD = 1.59) MI training methods. Their mean design score was 1.92 (SD = 0.84) and mean measurement score was 1.89 (SD = 1.05). A minority of studies measured SBIRT/MI skill (n = 23, 28%), and 4 studies (5%) set a priori benchmarks for their curricula. CONCLUSIONS SBIRT training has been delivered to a wide range of health care trainees and often includes MI. Rigor scores for the studies were generally low due to limited research designs and infrequent use of objective skill measurement. Future work should include predefined training benchmarks and validated skills measurement.
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Affiliation(s)
- Nicholas W McAfee
- N.W. McAfee is assistant professor, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi; ORCID: 0000-0002-7992-9124
| | - Julie A Schumacher
- J.A. Schumacher is professor, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael B Madson
- M.B. Madson is professor, School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi; ORCID: 0000-0002-2025-8856
| | - Margo C Villarosa-Hurlocker
- M.C. Villarosa-Hurlocker is assistant professor, Department of Psychology, University of New Mexico, Albuquerque, New Mexico; ORCID: 0000-0002-9744-8551
| | - Daniel C Williams
- D.C. Williams is associate professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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Schmidt H, Koschinowski J, Bischof G, Schomerus G, Borgwardt S, Rumpf HJ. [Attitudes of Medical Students Towards Alcohol-Related Disorders: Dependent on Intended Medical Specialization?]. PSYCHIATRISCHE PRAXIS 2022; 49:428-435. [PMID: 35081632 DOI: 10.1055/a-1690-5902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to identify subjective attitudes of medical students towards alcohol-related disorders (ARD) compared to other mental and somatic disorders. Medical students taking part in an online survey (n = 1875) rated ARD less severe compared to other disorders (p < 0.001), had a greater wish for social distance towards those affected (p < 0.001), held them more responsible (p < 0.001), and chose ARD more often as a disorder with a potential for financial savings in the health care system. Prospective psychiatrists selectively reported an increased desire for social distance and readiness for structural discrimination in terms of ARD but not for mental disorders per se. Since these attitudes might have unfavorable effects on the medical-patient relationship, it is of importance to address this issue already during medicine studies.
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Affiliation(s)
- Hannah Schmidt
- University of Lübeck, Department of Psychiatry and Psychotherapy
| | | | - Gallus Bischof
- University of Lübeck, Department of Psychiatry and Psychotherapy
| | - Georg Schomerus
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Psychiatrie und Psychotherapie
| | - Stefan Borgwardt
- University of Lübeck, Department of Psychiatry and Psychotherapy
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Diaz Heredia LP, de Vargas D, Ramírez EGL, Naegle M. Nursing students' attitudes towards alcohol use disorders and related issues: A comparative study in four American countries. Int J Ment Health Nurs 2021; 30:1564-1574. [PMID: 34231303 DOI: 10.1111/inm.12906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
| | - Divane de Vargas
- Nursing College of University of São Paulo, São Paulo, SP, Brazil
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Smyth D, Wilson C, Searby A. Undergraduate nursing student knowledge and attitudes of healthcare consumers with problematic alcohol and other drug use: A scoping review. Int J Ment Health Nurs 2021; 30 Suppl 1:1293-1309. [PMID: 34363429 DOI: 10.1111/inm.12923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 06/20/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Darren Smyth
- Alcohol and Other Drugs Service, Northern NSW Local Health District, Lismore, New South Wales, Australia
| | - Cate Wilson
- Alcohol and Other Drugs Service, Northern NSW Local Health District, Lismore, New South Wales, Australia
| | - Adam Searby
- Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
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Bennett AS, Elliott L. Naloxone's role in the national opioid crisis-past struggles, current efforts, and future opportunities. Transl Res 2021; 234:43-57. [PMID: 33684591 PMCID: PMC8327685 DOI: 10.1016/j.trsl.2021.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023]
Abstract
Over the past 25 years, naloxone has emerged as a critical lifesaving overdose antidote. Public health advocates and community activists established early methods for naloxone distribution to people who inject drugs, but a legacy of stigmatization and opposition to universal naloxone access continues to limit the drug's full potential to reduce opioid-related mortality. The establishment of naloxone distribution programs under the umbrella of syringe exchange programs faces the same practical, ideological and financial barriers to expansion similar to those faced by syringe exchange programs themselves. The expansion of naloxone from the confines of a few syringe exchange programs to what we see today represents an enormous triumph for the grass-roots activists, service providers, and public health professionals who have fought to guarantee lay access to naloxone. Despite the extensive efforts to expand access to naloxone, naloxone continues to remains a scarce resource in many US localities. Considerable naloxone "deserts" remain and even where there is naloxone access, it does not always reach those at risk. Promising areas for expansion include the development of more robust telehealth methods for naloxone distribution, including subsidized mail delivery programs; lowering barriers to pharmacy access; working with hospitals, ambulances, and law enforcement to expand naloxone "leave behind" programs; providing naloxone co-prescription with medications for opioid use disorder; and working with prisons, shelters, and networks of people who use drugs to increase access to the lifesaving medication. Efforts to ensure over-the-counter and low- or no-cost naloxone are ongoing and stand alongside medication-assisted treatments as efficacious, readily-actionable, and cost-efficient population-level interventions available for combatting opioid-related overdose in the United States.
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Affiliation(s)
- Alex S Bennett
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York; Center for Drug Use and HIV Research (CDUHR), College of Global Public Health, New York University, New York, New York.
| | - Luther Elliott
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, New York; Center for Drug Use and HIV Research (CDUHR), College of Global Public Health, New York University, New York, New York
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Halmo RS, Sellers CM, Collin CRR, Chinamasa G, Putney JM. Changes in social work students' attitudes and knowledge following opioid overdose prevention training. Subst Abus 2021; 43:289-293. [PMID: 34214409 DOI: 10.1080/08897077.2021.1941511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Opioid use disorders are widespread, commonly occurring, and have serious impacts on individuals, families, and communities. When adequately trained, social workers play a pivotal role in treating populations impacted by opioid use through the provision of high-quality services and the shifting of negative attitudes related to opioid use. However, workforce projections indicate a growing shortage of behavioral health professionals qualified to work with such populations and, presently, social work programs are not equipped to meet these workforce needs. Emerging evidence suggests opioid overdose education is associated with improved attitudes and knowledge among health professions; however, less information exists on the outcomes of such training among social work students. Schools of social work must develop and evaluate curricular components related to opioid use prevention and management to adequately prepare students for clinical work as social work practitioners. Methods: Thirty-three advanced-year MSW students received opioid overdose training as part of a day-long seminar on substance use. Content included acute effects of opioids, withdrawal symptoms, risk factors, signs of overdose, naloxone training, and harm reduction principles. Using a single-group pretest-posttest design, students completed the Opioid Overdose Attitudes Scale (OOAS) and the Opioid Overdose Knowledge Scale (OOKS). To evaluate students' attitudes and knowledge, investigators compared overall and subscale means before and after the training via paired samples t-tests. Results: Findings indicated statistically significant improvements in the "concerns" and "competence" domains of the OOAS. Likewise, findings indicated statistically significant improvements in the "risk," "signs," "action," and "naloxone use" domains of the OOKS. Conclusion: Students reported improved opioid overdose-related knowledge and attitudes when assessed after the training as compared to before the training. Due to the nature of the study design, causality cannot be inferred from the training outcomes. Findings may help other social work programs develop curricular components related to opioid use.
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Affiliation(s)
- Rebekah S Halmo
- School of Social Work, Simmons University, Boston, Massachusetts, USA
| | - Christina M Sellers
- School of Social Work, Simmons University, Boston, Massachusetts, USA.,Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Gordon Chinamasa
- School of Social Work, Simmons University, Boston, Massachusetts, USA
| | - Jennifer M Putney
- School of Social Work, Simmons University, Boston, Massachusetts, USA
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Kameg B, Fradkin D, Lee H. Effect of Standardized Patient Simulation on Nursing Students' Attitudes Toward Psychiatric Nursing and Patients With Mental Health Problems. J Psychosoc Nurs Ment Health Serv 2021; 59:15-21. [PMID: 34142918 DOI: 10.3928/02793695-20210513-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to evaluate changes in attitudes toward psychiatric nursing and mental health problems in a sample of nursing students after exposure to high-fidelity standardized patient (SP) simulation scenarios. This study used a quasi-experimental, single-group pre-/post-survey approach. Immediately before and after exposure to SP simulation scenarios, undergraduate nursing students completed Attitudes to Mental Illness (AMI) and the Attitudes to Psychiatry (ATP) surveys. There were significant improvements in the following ATP domains: psychiatric career choice and psychiatric teaching (p = 0.046 and 0.007, respectively). There were no significant changes in the AMI survey, but items related to social stigma improved following the simulation. Findings of this study suggest a potential benefit of SP simulation on nursing students in developing their attitudes toward psychiatry and mental health problems. [Journal of Psychosocial Nursing and Mental Health Services, 59(8), 15-21.].
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Bielenberg J, Swisher G, Lembke A, Haug NA. A systematic review of stigma interventions for providers who treat patients with substance use disorders. J Subst Abuse Treat 2021; 131:108486. [PMID: 34217033 DOI: 10.1016/j.jsat.2021.108486] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Stigma surrounding substance use disorders (SUDs) is a frequently cited barrier to treatment engagement. Research consistently demonstrates that healthcare professionals' attitudes towards patients with addiction problems are often negative and may adversely impact service delivery. The current study presents a systematic review of stigma interventions for providers who treat patients with SUDs, in order to evaluate the quality of existing studies and potential for implementation in clinical settings. METHODS This systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases included PubMed, APA PsycInfo and the Cochrane Database of Systematic Reviews. Of the 1462 records identified between 2011 and 2019, 15 studies were eligible for inclusion. A narrative synthesis of stigma interventions summarized the change in stigmatizing attitudes held by providers. RESULTS Studies included heterogeneous and culturally diverse samples of providers (N = 1324), who varied by age, location, discipline, and experience, with the exception of primarily female providers (75%). Results delineated six types of provider stigma interventions with components including online education, in-person education, in-person contact with consumers in recovery, or some combination of these elements. The highest quality studies incorporated motivational interviewing or communication training interventions, and many interventions combined either in-person mentorship or contact with individuals in recovery. Positive effects on provider attitudes occurred at several levels of educational and consumer contact interventions. Interventions with consumer contact demonstrated long-term maintenance of attitudinal shifts. Despite significant methodological limitations and low-quality assessment ratings, several studies utilized real-world providers and patients, as well as practical, innovative, brief, and potentially cost-effective interventions, particularly in locations with limited technological resources. CONCLUSIONS Research on provider stigma interventions increased in recent years, indicating greater worldwide attention to the negative impact of stigma. While educational interventions alone can be helpful in attitudinal change, contact with individuals in recovery from SUDs is a vital component of provider stigma interventions, particularly for lasting effects. This review highlights the importance of including implementation outcomes, such as sustainability and cost-effectiveness, in the study of stigma interventions for providers of addiction treatment.
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Affiliation(s)
- Jennifer Bielenberg
- Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
| | - Gabrielle Swisher
- Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, USA.
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
| | - Nancy A Haug
- Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
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Mahmoud KF, Finnell DS, Sereika SM, Lindsay D, Schmitt K, Cipkala-Gaffin J, Puskar KR, Mitchell AM. Personal and professional attitudes associated with nurses' motivation to work with patients with opioid use and opioid use-related problems. Subst Abus 2021; 42:780-787. [PMID: 33617737 DOI: 10.1080/08897077.2020.1856287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Khadejah F Mahmoud
- Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Deborah S Finnell
- Emerita, School of Nursing, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Susan M Sereika
- Center for Research and Evaluation, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Dawn Lindsay
- Research and Evaluation Services, Institute for Research, Education, and Training in Addictions, Pittsburgh, PA, USA
| | - Karen Schmitt
- Nursing Department, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Janet Cipkala-Gaffin
- Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Kathryn R Puskar
- Emerita, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Ann M Mitchell
- Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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Aronowitz SV, Compton P, Schmidt HD. Innovative Approaches to Educating Future Clinicians about Opioids, Pain, Addiction and Health Policy. Pain Manag Nurs 2021; 22:11-14. [DOI: 10.1016/j.pmn.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 07/03/2020] [Indexed: 11/26/2022]
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18
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Quaye B, Alatrash M, Metoyer CE. Changes in knowledge, attitudes and beliefs in BSN students after SBIRT education and practice in home health. J Prof Nurs 2020; 36:649-658. [DOI: 10.1016/j.profnurs.2020.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/26/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022]
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Richardson GB, Smith R, Lowe L, Acquavita SP. Structure and longitudinal invariance of the Short Alcohol and Alcohol Problems Perception Questionnaire. J Subst Abuse Treat 2020; 115:108041. [PMID: 32600628 DOI: 10.1016/j.jsat.2020.108041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
Many studies have employed the Short Alcohol Attitudes Problem Perception Questionnaire (SAAPPQ) to measure professionals' attitudes toward working with people experiencing alcohol problems. However, research has not confirmed the internal structure of the SAAPPQ, leaving open the possibility that scale scores are not valid empirical proxies for underlying attitudes. It is also unclear if measurement invariance holds over time or across groups. This is an important gap in light of evidence that (a) experiences can change the structure of scales and (b) structures of some popular scales differ dramatically between groups. Thus, measurement bias may confound comparisons of composite SAAPPQ scores between measurement occasions or groups. To address these gaps in the literature, we conducted a longitudinal examination of the psychometrics of the SAAPPQ using data from 241 human services professionals-in-training. We found a four-factor structure, rather than the previously reported five factors. Configural, metric, and a strong degree of scalar invariance held longitudinally. Few factor intercorrelations were significant at time one and they strengthened over time, suggesting that the SAAPPQ should not be aggregated at higher-order levels (i.e., global scores should not be used). Findings suggest four SAAPPQ subscale scores may be used as valid proxies for attitudes toward alcohol users; however, additional confirmatory studies are needed to ensure that measurement bias does not compromise inferences based on SAAPPQ scores.
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Affiliation(s)
- George B Richardson
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America.
| | - Rachel Smith
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America
| | - Linnea Lowe
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America
| | - Shauna P Acquavita
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America
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20
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Nursing Education in the Midst of the Opioid Crisis. Pain Manag Nurs 2020; 21:35-42. [DOI: 10.1016/j.pmn.2019.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/20/2022]
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22
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Bremner MN, Maguire MBR, Keen D, Blake BJ, Santa H, Nowalk A. Implementation and evaluation of SBIRT training in a Community Health nursing course. Public Health Nurs 2019; 37:243-250. [PMID: 31867784 DOI: 10.1111/phn.12696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this paper is to report on the implementation and evaluation of a Screening, Brief Intervention and Referral to Treatment (SBIRT) educational program into an undergraduate nursing curriculum and to recommend modifications for future trainings. DESIGN AND SAMPLE A one-group pre-test/post-test design was used. The sample consisted of senior level undergraduate nursing students. MEASURES Core knowledge, perceived competency, and program satisfaction were measured. Process evaluation activities were performed to gather feedback on the training and solicit ideas and recommendations for improvement. RESULTS Of the 354 nursing students enrolled in the training, 249 (70%) participated in the research portion, with 240 (96%) completed the pre- and post-training evaluations. All four core knowledge components and 13 perceived competency indicators were statistically significant (p ≤ .001) when comparing pre- and post-t test values. Process evaluation data collected through 25 telephone interviews found that the training improved the students' confidence and ability to screen for substance misuse with patients. CONCLUSION Findings support the implementation of SBIRT training into an undergraduate nursing curriculum. Modifications for future training and research are proposed.
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Affiliation(s)
- Marie N Bremner
- School of Nursing, Kennesaw State University, Kennesaw, Georgia
| | | | - Diane Keen
- School of Nursing, Kennesaw State University, Kennesaw, Georgia
| | - Barbara J Blake
- School of Nursing, Kennesaw State University, Kennesaw, Georgia
| | - Heather Santa
- Program Evaluation & Research Unit (PERU), University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Alexandra Nowalk
- Program Evaluation & Research Unit (PERU), University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
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Smyth D, Hutchinson PhD Rn M, Searby PhD Rn A. Nursing Knowledge of Alcohol and Other Drugs (AOD) in a Regional Health District: An Exploratory Study. Issues Ment Health Nurs 2019; 40:1034-1039. [PMID: 31322971 DOI: 10.1080/01612840.2019.1630531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Nurses remain at the forefront of direct patient care due to the nature of their role; they are in a position to provide assessment, response and referral of individuals in healthcare settings with problematic alcohol and other drug (AOD) use. We aim to determine the AOD knowledge of nurses in a regional health district in Australia and the awareness of an AOD service operating in the clinical environment. We employed a cross-sectional online survey, with descriptive and correlational analysis performed to explore relations between knowledge and both assessment and referral practices for individuals with problematic AOD use. Results indicate good knowledge of the AOD service, with confidence to refer to the service associated with recent contact. Lower satisfaction levels with the AOD service were found in nurses who had no recent contact with the service. Awareness of the service was also positively associated with completion of the electronic AOD assessment. These results indicate that the presence of experienced AOD clinicians may increase familiarity with AOD services and increase screening. Given the link between familiarity and comfort with the AOD service and referral, establishing specialised AOD nursing positions remains an important strategy. We argue that the presence of specialised AOD nurses has a flow on effect in maintaining continuing screening and encouraging nurses to refer individuals with problematic AOD use for ongoing care and treatment.
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Affiliation(s)
- Darren Smyth
- Credentialed Drug and Alcohol Nurse (CDAN), President, Drug and Alcohol Nurses of Australasia (DANA), Lismore, Australia
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24
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Hamza DM, Greenshaw AJ, Hamza SM, Silverstone PH. Qualitative findings from administrators of the EMPATHY (Empowering a multimodal pathway toward healthy youth) programme using the SBIRT framework. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2019. [DOI: 10.1080/03069885.2019.1686121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Deena M. Hamza
- Department of Psychiatry, University of Alberta, Edmonton, Canada
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Abstract
Over the past two decades, there has shift from focusing on the most severe end of the substance use continuum to earlier detection of persons who are at risk given the consequences associated with alcohol and other drug use. In 2017, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) undertook the development of core competencies for specific disciplines addressing substance use in the 21st century. This article presents the core competencies for nursing in accord with the 16 standards of practice and performance for nursing. The competencies for the registered nurse and the advanced practice nurse are intended to inform and guide nursing practice with a focus on prevention, intervention, treatment, and recovery supports for persons who are affected by substance.
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Affiliation(s)
| | - Matt Tierney
- School of Nursing, University of California, San Francisco, California, USA
| | - Ann M Mitchell
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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Elliott L, Bennett AS, Wolfson-Stofko B. Life after opioid-involved overdose: survivor narratives and their implications for ER/ED interventions. Addiction 2019; 114:1379-1386. [PMID: 30851220 PMCID: PMC6626567 DOI: 10.1111/add.14608] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/30/2018] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Numerous states in the United States are working to stem opioid-involved overdose (OD) by engaging OD survivors before discharge from emergency departments (EDs). This analysis examines interactions between survivors and medical care providers that may influence opioid risk behaviors post-OD. DESIGN Qualitative stakeholder analysis involving in-depth interviews with samples from three groups. SETTING Two hospitals in high OD-mortality neighborhoods in New York City (NYC), USA. PARTICIPANTS Total N = 35: emergency medical services personnel (EMS; n = 9) and ED medical staff (EDS; n = 6) both working in high OD-mortality neighborhoods in NYC; recent opioid-involved OD survivors who had been administered naloxone and transported to a hospital ED (n = 20). MEASUREMENTS EMS and EDS interviews examined content of verbal interactions with survivors and attitudes related to people who use opioids. Survivor interviews addressed healthcare experiences, OD-related behavioral impacts and barriers to risk-reduction post-OD. FINDINGS Both EMS and EDS stakeholders described frequent efforts to influence survivors' subsequent behavior, but some acknowledged a loss of empathy, and most described burnout related to perceived ingratitude or failure to influence patients. Survivors reported being motivated to reduce opioid risk following a non-fatal OD and many described successful risk-reduction efforts post-OD. Intentions to cease opioid use or reduce risk were complicated by unmanaged, naloxone-related withdrawal, lack of social support and perceived disrespect from EMS and/or EDS. CONCLUSIONS Emergency department interventions with opioid-involved overdose (OD) survivors may benefit from training emergency medical staff to assure a continuity of non-judgmental, socially supportive remediation attempts throughout contacts with different care-givers. Brief interventions to educate emergency medical staff about current theories of addiction and evidence-based treatment may achieve this goal while reducing care-giver burnout and improving the uptake and efficacy of post-OD interventions delivered in emergency departments.
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Affiliation(s)
- Luther Elliott
- National Development and Research Institutes, Center on Community and Health Disparities Research, New York, NY, USA
- New York University College of Global Public Health, Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Alex S Bennett
- National Development and Research Institutes, Center on Community and Health Disparities Research, New York, NY, USA
- New York University College of Global Public Health, Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Brett Wolfson-Stofko
- National Development and Research Institutes, Center on Community and Health Disparities Research, New York, NY, USA
- New York University College of Global Public Health, Center for Drug Use and HIV/HCV Research, New York, NY, USA
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27
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Mahmoud KF, Finnell D, Lindsay D, MacFarland C, Marze HD, Scolieri BB, Mitchell AM. Can Screening, Brief Intervention, and Referral to Treatment Education and Clinical Exposure Affect Nursing Students' Stigma Perception Toward Alcohol and Opioid Use? J Am Psychiatr Nurses Assoc 2019; 25:467-475. [PMID: 30596312 DOI: 10.1177/1078390318811570] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Alcohol and/or opioid stigma perceptions are barriers to screening, brief intervention, and referral to treatment (SBIRT) implementation. AIM: To examine SBIRT education and clinical exposure efficacy at decreasing nursing students' stigma perceptions toward caring for patients affected by alcohol and/or opioid use problems. METHOD: A single-sample, pretest-posttest design with N = 124 nursing students. The students had a 1.5-hour SBIRT education session and a 12-week clinical experience with some patients who had alcohol and/or opioid use problems. RESULTS: The participants' stigma perceptions improved toward patients who had alcohol and/or opioid use problems. CONCLUSIONS: SBIRT education and clinical exposure may provide a basis for promoting understanding of alcohol and/or opioid use-related stigma and can be used as an intervention to decrease some of stigma's negative effects.
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Affiliation(s)
- Khadejah F Mahmoud
- Khadejah F. Mahmoud, MSN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Deborah Finnell
- Deborah Finnell, DNS, RN, FAAN, Johns Hopkins University, Baltimore, MD, USA
| | - Dawn Lindsay
- Dawn Lindsay, PhD, Institute for Research, Education and Training in Addictions, Pittsburgh, PA, USA
| | - Carolyn MacFarland
- Carolyn MacFarland, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Hannah D Marze
- Hannah D. Marze, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Britney B Scolieri
- Britney B. Scolieri, DNP, PMHNP-BC, Summit Psychological Services, Pittsburgh, PA, USA
| | - Ann M Mitchell
- Ann M. Mitchell, PhD, RN, FAAN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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Kilian Wells G, Moonie S, Pharr J. Association between alcohol screening and brief intervention during routine check-ups and alcohol consumption among adults living in California. Arch Psychiatr Nurs 2018; 32:872-877. [PMID: 30454631 DOI: 10.1016/j.apnu.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 06/15/2018] [Accepted: 07/16/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Alcohol consumption accounts for 1 in 10 deaths among U.S. adults and cost upwards of $200 billion each year due to productivity loss. Alcohol Screening and Brief Intervention and Referral to Treatment (aSBIRT) was developed as a treatment approach for use in primary care to identify and reduce substance abuse. Although aSBIRT has proven to be successful, implementation rates remain low. METHODS Using population level representative data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) conducted in California, this study utilizes logistic regression to analyze the association between self-reported drinking levels and screening and brief intervention practices during routine check-ups. RESULTS The results demonstrated that the more an individual drank, the lower the odds of receiving aSBIRT during a routine check-up. Men had reduced odds of receiving intervention compared to women (odds ratio [OR], 2.21; confidence interval [CI], 1.68-2.90, p < 0.01) and diabetics had reduced odds of receiving intervention compared to non-diabetics (OR, 0.66; CI, 0.45-0.97, p = 0.3). Finally, those with lower income had reduced odds of intervention compared to those with higher income (OR, 1.84; CI, 1.33-2.56, p < 0.01). Among those who were at risk for alcohol abuse (83%) the intervention was only administered to 39%, and men had reduced odds of receiving intervention. CONCLUSION Physicians perform alcohol screenings, but do not follow up the screening with intervention. Attention should be focused on delivering intervention to those identified as at risk for alcohol abuse through standard screening tools, specifically to men, diabetics, and lower income groups. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Affiliation(s)
- G Kilian Wells
- University of Nevada, Las Vegas, School of Community Health Sciences, 4505 South Maryland Parkway, Las Vegas, NV 89154-3064, United States of America
| | - Sheniz Moonie
- University of Nevada, Las Vegas, School of Community Health Sciences, 4505 South Maryland Parkway, Las Vegas, NV 89154-3064, United States of America.
| | - Jennifer Pharr
- University of Nevada, Las Vegas, School of Community Health Sciences, 4505 South Maryland Parkway, Las Vegas, NV 89154-3064, United States of America
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Mahon LR, Hawthorne AN, Lee J, Blue H, Palombi L. Assessing pharmacy student experience with, knowledge of and attitudes towards harm reduction: illuminating barriers to pharmacist-led harm reduction. Harm Reduct J 2018; 15:57. [PMID: 30445958 PMCID: PMC6240215 DOI: 10.1186/s12954-018-0262-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the burden from the opioid epidemic continues to increase in the state of Minnesota and across the nation, the University of Minnesota College of Pharmacy seeks to design an innovative, comprehensive harm reduction curriculum in order to better train student pharmacists to serve the varied needs of the greater community. This study examines incoming individuals' baseline knowledge of and attitudes toward harm reduction in order to better inform curriculum planning and to ultimately produce pharmacists capable of impacting the devastating effects of the opioid crisis. METHODS Incoming first-year pharmacy students took a survey focused on their knowledge of opioid overdose and the drug naloxone and also provided written reflections on their perceptions of harm reduction. Data was coded using consensual qualitative research (CQR) into appropriate domains. RESULTS Pharmacy students beginning their professional education revealed a lack of knowledge of proper response to an overdose situation, with 18.56% unfamiliar with the opioid antagonist drug naloxone. Close to 10% (9.58%) of students expressed unwillingness to do anything other than call an ambulance during an overdose event, while 8.98% were either unsure or felt that they would not feel compelled to do something to help. Qualitative coding revealed many barriers to students' becoming capable harm reductionists, including lack of knowledge of substance use, addiction, and harm reduction, in addition to the presence of bias and stigma. CONCLUSION In order to interrupt the cycle of misinformation and stigma within the larger community and the subgroup of medical providers, gaps in student knowledge must be addressed in meaningful, specific ways over the course of their pharmacy education. Evaluating baseline knowledge and beliefs informs the design of a flexible, action-oriented curriculum to produce well-trained pharmacists ready to engage in finding solutions to the opioid crisis.
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Affiliation(s)
- Lily Rowan Mahon
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN, 55812-3003, USA
| | - Amanda N Hawthorne
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN, 55812-3003, USA
| | - Julie Lee
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN, 55812-3003, USA
| | - Heather Blue
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN, 55812-3003, USA
| | - Laura Palombi
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN, 55812-3003, USA.
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