Nurses can have an important role in addressing substance use disorders among healthcare consumers. Approximately 20.8 million people (7.8 percent of the population) met the diagnostic criteria for a substance use disorder in 2015. Unfortunately, only 2.2 million individuals (10.4 percent) received any type of treatment (Center for Behavioral Health Statistics and Quality, 2016). The latest US Surgeon General report calls for a cultural shift in thinking about addiction as a disease rather than a personal weakness (U.S. Department of Health and Human Services, 2016). Nurses work in a variety of healthcare settings and are apt to encounter individuals at risk for substance abuse. Thus, they are in an ideal situation to make a meaningful contribution in addressing this crisis.
Evidenced Based Practice
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based public health approach for providing early intervention and treatment for individuals at risk for developing substance use disorders. SBIRT incorporates motivational interviewing skills. Motivational Interviewing is a clinical approach that helps individuals make positive behavioral changes to support better health.
It respects patients’ autonomy, is patient centered, and minimizes resistance to change. This interview style is collaborative, non-judgmental and recognizes patient responsibility.
In 2015, faculty teaching in an undergraduate nursing program located in the southeastern US, implemented a SBIRT training program. One hundred twenty students enrolled in a community health-nursing course completed the self-directed six-week training. The training consisted of five on-line modules, virtual training, and a 2 ½ hour face-to-face interactive workshop. This workshop required students to interview live standardized patients (SPs). Recordings of the SPs interviews were used to enhance reflection and learning during the debriefing session held immediately after the workshop. Funds from the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment (SAMHSA CSAT) were used to implement the SBIRT training.
The Survey of Attitudes and Perceptions (SAP) instrument was used to evaluate changes in core knowledge, attitudes, and perceptions in nursing students. This survey was developed based on questions from the Alcohol and Alcohol Problem Perceptions Questionnaire (AAPPQ) and the Drug and Drug Problem Perceptions Questionnaire (DDPPQ) (Terhorst et al., 2013; Watson, Maclaren, Kerr, 2007). The SAP was administered to students prior to beginning the training and upon completion. In addition, a Training Satisfaction Survey was administered to the participants who completed the SBIRT training. The survey was given at the end of the training and again 30 days post training.
Process evaluation activities were performed upon conclusion of training and include key informant interviews with faculty and focus group discussions with students from the training. The goal of these process evaluation activities was to gather feedback on the training and solicit ideas and recommendations for improvement.
Key Findings and Recommendations
The majority of students found the SBIRT training to be very useful or useful because it provided them with the skill set to address sensitive topics such as substance use with patients. Results from the SAP indicated an increase in core knowledge and perceived competency among the students. The face to face interactive workshop was well-received, particularly the live standardized patients. Students verbalized that the workshop was valuable and simulated nursing practice in the real world. Students recommended that on-line training could be enhanced by embedding audio into the Power Point presentations and requested more detailed patient history prior to the live interview.
Nurses’ engage patients through guidance and negotiation rather than directing, which fits in well with the SBIRT approach. SBIRT is a technique nurses can use to provide effective risk reduction and intervention prior to a patient’s need for more extensive treatment.
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