Student Attitudes Toward and Empathy for Patients With Substance Use Disorder After a Mentorship Practicum

Background and Purpose: The National Institutes of Health have recognized substance use disorder (SUD) as a significant chronic illness with high rates of comorbidities, and substantial economic and social encumbrances. Studies have shown that health care professionals have negative attitudes towards patients with SUD and that these attitudes contribute to suboptimal care in part due to patients’ feelings of stigmatization and discrimination. Together these issues contribute to poorer health outcomes as patients with SUD feel discouraged and do not engage in health seeking behaviors leading to health inequities in this population. The purpose of this study was to examine the effects of a 120-hour senior mentorship practicum experience on students’ empathy and attitudes toward caring for patients with SUD. An additional aim was to examine if there were differences in student attitudes and empathy across practice settings.

Methods: A mixed method study was conducted with a quantitative comparative descriptive component and qualitative descriptive approach. In the quantitative study portion, we examined 53 nursing students’ attitudes and empathy concerning patients with SUD before and after a mentorship experience in a baccalaureate nursing program in the northeastern United States. Differences in attitudes and empathy across practice settings were explored. Quantitative measures were: the Drug and Drug Problems Perceptions Questionnaire to measure student attitudes; and the Jefferson Scale of Empathy to measure students’ empathy. Qualitative data were obtained via seven focus groups with a total of 25 students. Quantitative analysis included descriptive statistics, paired t-tests, and ANOVA. Phenomenological reduction, consisting of empirical description and reflective analysis as described by Colaizzi was used for data analysis of the qualitative data.

Results: Findings revealed that students had significantly improved empathy scores after the mentorship practicum. Overall there was also a significant improvement in student attitudes towards working with patients with SUD. However, students in maternal-child health settings had significantly poorer attitudes compared to their peers in the emergency department, telemetry unit, intensive care unit, or medical surgical units. Qualitative findings indicate that students tended to blame the person with SUD, i.e., the mother, for negative health effects on infants/children. Furthermore, students felt unprepared to work with this population despite experiences with family and friends with SUD. An additional finding was that students perceived a generational difference in nurses’ attitudes and empathy with the “older” nursing staff often using pejorative terms when describing this population, and in some cases offering only limited care.

Implications and Conclusions: Perceptions shape how nurses view, understand, and interpret clinical situations. Negative attitudes and a lack of preparation can have significant consequences for the delivery of care for patients with SUD. Moreover, nurses who mentor new nurses may model negative behaviors and influence the perceptions of new graduate nurses regarding patients with SUD. Educational implications include focusing on SUD and using academic clinical experiences to foster empathy and reduce stigma associated with SUD.