Examining Nurse Attitudes and Knowledge Gaps Related to Substance Use Disorder

Friday, 28 July 2017

Pamela Quinn, MSN, RN
Norman Knight Nursing Center for Clinical and Professional Development, Massachusetts General Hospital, Boston, MA, USA
Joanne Parhiala, BSN
Department of Nursing: Blake 11 Inpatient Psychiatry, Massachusetts General Hospital, Boston, MA, USA

Purpose:  The Substance Abuse and Mental Health Services Administration (SAMHSA) (2015) reports that in 2014, more than 21 million people over the age of 11 had a substance use disorder (SUD). Substance use and abuse contributes to more deaths (which have more than doubled since the early 1980s), illnesses, and disabilities than any other preventable health condition (NIDA, 2012). Dilonardo (2011) concluded that SUD treatment in the medical setting is imperative, reduces costs, and is an essential component of quality care delivery; however, the majority of healthcare workers including nurses are unlikely to have adequate training in addiction.

Patients with SUDs are admitted hospital-wide with complex conditions that require intense nursing care. A review of the literature related to the nursing care for the patient with SUD consistently revealed two major themes. First, negative attitudes are held by nurses toward this patient population. Foster and Onyeukwu (2003) report that nurses tend to have negative attitudes toward patients with SUD and that these attitudes directly impact not only the nurse-patient relationship, but the quality of care delivered. The World health Organization (WHO) study that found positive attitudes are essential when caring for patients with SUD. Second, there is a lack of knowledge related to providing competent care. Nurses feel ill prepared for the multifaceted sequelae of SUD due to a paucity of nursing education on SUD related care (Raistrick, Russell, Tober, & Tindale, 2008). Although this patient population is growing, nursing education on SUD and related care has not been emphasized in the curricula of undergraduate nursing programs (Pillon, Villar Luis and Laranjeira, 2003).

Pens and Couture (2002) state that the more information a person has, the less stigmatizing they tend to be. Nurses need education about the how and whys of addiction in order to appropriately, competently, and compassionately provide quality and safe care to patients who suffer with SUDs. The evidence tells us that patient outcomes should improve, costs should be reduced, and the patient experience should improve.

Cramer, et. al., (2014) tell us that certification in a clinical specialty is one way of measuring nursing excellence and expertise. Among nurses caring for patients with addictions, certification has been shown to reduce failure to rescue and associated mortality of patients with SUD as well as achieve or promote statically significant improvements in delivery of clinically competent care.

The purpose of this pilot study was two-fold: 1) to examine whether nurse attitudes and knowledge of SUD and related care were influenced by a 5-month educational intervention, and 2) whether nurses in the cohort passed the Certified Addictions Registered Nurse (CARN) exam. The cohort members understood this to be an expectation at the completion of the 5 months educational intervention.

Methods:  This pilot study employed a pre/post design to examine whether educating a heterogeneous sample of 31 volunteer nurses, recruited from non-procedural in-patient hospital units, improved attitudes and increased the nurses’ knowledge about care of the patient with SUD. This pilot study used the Drug Problems Perception Questionnaire (DPPQ), which includes 20 questions and a 7- point Likert scale, with established reliability and validity that measures attitudes of professionals working with patients with SUD. The questionnaire was administered before and after the educational intervention to determine improvement and sustainability of nurses’ attitudes. The educational intervention was conducted from May, 2016 through September, 2016, preparing the participants to sit for the Certified Addictions Registered Nurse (CARN) exam in October, 2016. The CARN exam pass rate will provide the measure of improved knowledge.

Results: Based on the primary outcome of passing the CARN exam, 17 nurses took the CARN exam in October 2016 and 14 reported passing the exam. Our pass rate was 82% compared to the average pass rate in the United States of 74%. Two nurses state they are planning on retaking the exam and 8 other nurses that indicated they will be taking the exam for the first time after January 2017. Our first bimonthly post course assessment of nurse attitudes toward patients with SUD demonstrated consistent improvement in nurse attitudes as measured by the DPPQ.


Early results reveal that this intervention achieved the primary expected outcome of improving nurses’ attitudes and knowledge of SUD.