An estimated 20.2 million people in the United States had a substance use disorder (SUD) in 2014.1 Nurses, including student nurses, report feeling poorly trained and have the least tolerant attitudes towards people with SUD when compared to other health professions.2 Student nurses struggle with differences between their personal beliefs and professional expectations.3 The connection between the nurse and person with SUD affects the view on the quality of care received. Nurses have been known to stigmatize people with SUD.4,5 This is due to a common perception that drug use is under the control of the person with SUD.3 Stigma has a negative impact on the person with SUD’s emotional and overall well-being.6
The purpose of this study was to determine if a targeted anti-stigma educational intervention improved undergraduate student nurse’s attitudes and perceived stigma toward working with people with a SUD from baseline to post-intervention at 4 hours.
Methods:
One hundred and sixty first semester Bachelor of Science junior university students enrolled in a nursing program during the fall of 2018 were invited to participate. Shaw et al.’s theory of therapeutic commitment7served as the framework for this study. Therapeutic commitment is influenced by the practitioner’s feelings of role adequacy, role legitimacy, and role support.7 We used a quasi-experimental, repeated measures survey design where all students received a four-hour anti-stigma intervention that included the physiology of addiction, screening tools for SUD, intranasal naloxone training, and presentations by two individuals with a lived experience of SUD. The 20-item Drug and Drug Problems Perception Questionnaire (DDPPQ) (a= 0.79),8 8-item Perceived Stigma of Substance Abuse Scale (PSAS) (a= 0.82),9 and 13-item Marlowe-Crowne Social Desirability Scale10 were measured at baseline, and the DDPPQ and PSAS were repeated post-intervention. Pairedt tests were used to determine the mean differences in the total DDPPQ score (overall therapeutic attitudes) and in the total PSAS score. A bivariate correlation was conducted between social desirability bias and the variables of interest (stigma and attitudes).
Results:
Undergraduate student nurses (N=126) in both a traditional four-year track (40.3%) and accelerated track (59.7%) participated in our study. A majority of the sample identified as white (95%) and female (85%). More than 50% of the sample had a friend or relative with a SUD, and 53% had experience working with a person with SUD. Following the four-hour educational intervention (n=109), there was a significant improvement in overall therapeutic attitudes (M=-14.8, p< 0.001) and perceived stigma (M=-0.87, p=0.014).
Conclusion:
This intervention can serve to increase a student’s awareness of the physiology of addiction, the impact of stigma and discrimination, and the importance of screening tools to identify those at risk for SUD. It is important for educators to develop strategies to increase student nurse engagement, motivation, and work satisfaction to improve care for people with SUD. Incorporating anti-stigma educational approaches may lead to more nurse involvement, compassionate connected care, and help to build therapeutic commitment in student nurses caring for people with SUD.