In 2012 an estimated 2.1 million people in the United States experienced substance use disorders related to prescription opioid analgesics and an estimated 467,000 were addicted to heroin (SAMHSA, 2012). In addition, 1 out of 5 patients with non-cancer pain or pain - related diagnoses are prescribed opioids (CDC, 2015). Within this environment, health care providers are vital in preventing prescription drug addiction (Hall, Hawkinberry, Moyers-Scott, 2010); West Virginia leads the nation in the rate of fatal drug overdoses (WVDHHR, 2015). Nurses are currently caring for persons with acute and chronic health issues and co-existing opioid addiction.
As a result of this opioid epidemic, acute care agencies are experiencing an increase in persons admitted with comorbid substance dependence. With frequent hospitalizations patients require complex care for the associated comorbidities such as infections, withdrawal symptoms and/or mental illnesses. Staff nurses are critical to identify, prevent and intervene in opiate addiction. Nurses in clinical settings are equipped with skills which include: health promotion; providing patient education, support and coaching within a therapeutic relationship (Clark, 2012). As a foundation of nursing practice, a therapeutic relationship addresses patient problems by creating a partnership between nurse and patient, using therapeutic communication and empathy. A therapeutic commitment flows from the therapeutic relationship measuring the degree a nurse feels prepared with knowledge, professional support and personal ownership of a patient’s condition (Nilsen, 2013).
Nurses first identify and examine values, attitudes before attempting to understand the meaning of the patient’s experience. In this process negative biases are prevented from interfering with the care provided (Nielson, 2013). Negative attitudes towards patients with illicit drug use impacts the therapeutic nurse-patient relationship and clinical outcomes (van Boekel Browers, van Weeghel, & Garretsen, 2013). This happens when health care providers with negative attitudes towards substance abusers tend to overlook their substance misuse behavior thereby failing to assess and intervene (Howard & Chung, 2000). Limited research exists on nurses’ attitudes about caring for persons with opioid addiction during this current opioid epidemic. An evidence-based educational intervention will be provided September 16, 2016 to define the epidemiology of opioid abuse, recognize addiction as a disease with consequences and apply screening brief intervention and referral to treatment (SBIRT) to clinical case scenarios. The findings of this study will provide a better understanding of student nurses’ attitudes towards persons with opioid addiction to then design changes in baccalaureate nursing (BSN) curriculums. The findings will also enable educational/practice interventions specifically directed to patients addicted to drugs.
Subject Selection
Those eligible to be participants in the study will be enrolled nursing students in Shepherd University Nursing Education Program. These BSN students will be attending an 8-hour training program on opioid addiction September 16, 2016 at Shepherd University. The Department of Nursing Education’s Academic Support Specialist will invite students to participate. The Drug and Drug Problems Perceptions Questionnaire (DDPPQ) questionnaire will be given during class time; however, students may opt out if they choose. The course instructor will not be involved in the recruitment of students or the scoring. Participation will be enlisted by asking attendees if they chose to participate in two questionnaires before and after the education conference.
Procedures
The PIs will develop packets that include pre-test questionnaire of the Drug and Drug Problems Perceptions Questionnaire (DDPPQ). Students will identify themselves only with the 6 digits of their mother’s birthdate. For instance, if their mother was born on May 28,1950, The student would assign the following number 052850. The questionnaire is proctored and a script will be read providing directions to complete the packet. The student’s participation acts as consent. This pretest questionnaire with 22 questions is completed prior to the educational training. 15 minutes are allotted. The questionnaire is attached. A demographic questionnaire will ask for the following: Age; level of education; ethnicity; training or experience with substance use; years of clinical practice and if the participant had contact (defined as at least once a week) with a person who uses opioids legally and/or illegally. In the week following the educational training the post-test questionnaire will be administered to the students using the exact procedure as the pre-test. Students will identify themselves only with the 6 digits of their mother’s birthdate. The questionnaire is proctored and a script will be read providing directions to complete the packet. The student’s participation acts as consent. The Educational Intervention Program
The educational intervention program will be conducted by a group of community leaders, persons who are experienced in addiction, a nurse practitioner with expertise in addiction nursing, a psychologist with expertise in SBIRT and a psychiatrist. The training will consist of lectures, discussions and interactive application activities with time allotted for questions and answers.
Design
A descriptive design, will examine the relationship between pre and post-test attitude scores before and after an educational intervention on opioid addiction. A convenience sample of approximately 100 participants attending an educational conference will be used for the study.
Instrumentation
The Drug and Drug Problems Perceptions Questionnaire (Watson, Maclaren, & Kerr 2006) assesses the healthcare provider’s attitude and therapeutic commitment to patients using or abusing medication or illicit substances. It is also called a therapeutic commitment survey (Nilsen et al, 2013). This questionnaire is used to assess the needs for targeted educational interventions. The Drugs and Drug Problems Perceptions Questionnaire (DDPPQ); (Watson et al, 2006) is a 20 -item instrument, which is a valid and reliable tool for measuring attitudes and therapeutic commitment in working with drug-abusing patients (Hohman, Finnegan, & Clapp, 2008; Watson et al., 2006). It was adapted from the Alcohol and Alcohol Problem Perception Questionnaire (Cartwright, 1980). The responder is asked to rate agreement on a Likert scale of 1 (strongly agree) to 7 (strongly disagree). Components of the scale reflect drug abuse and clinical treatment knowledge (role adequacy), job supervision, collegial assistance (role support), job satisfaction, motivation and professional responsibility (role legitimacy) (Watson et al., 2006). Overall, lower scores reflect more positive attitudes and a higher therapeutic commitment toward patients with drug dependency or abuse (Watson et al., 2006). A Cronbach’s alpha for the scale is 0.87 (role adequacy = 0.94, role support = 0.78, role satisfaction = 0.08, role self-esteem = 0.69, and role legitimacy = 0.89). With a larger sample an alpha of 0.95 was reported (Rodgers-Banaccorsy, 2010). Test- retest reliability by analysis of variance is 0.82 (Watson et al., 2006).
Data Collection
Data will be collected before the educational intervention and upon completion of the conference.
Analysis of Data
Through descriptive statistics paired t tests will examine group differences in the pre and post test scores to answer the research question. Pearson correlations and regression analysis will be performed on factors thought to be associated with nursing students’ attitudes and therapeutic commitment scores.
Results
To be obtained after September 16, 2016 educational intervention.