Undergraduate nursing students' perceptions of substance use and misuse: a Brazilian position

Alcohol, cocaine and cannabis are the substances most commonly abused in Brazil. There is limited evidence on the perceptions of undergraduate nursing students towards substance misuse. Negative attitudes, in combination with the lack of appropriate knowledge and skills, may result in minimal care provided to substance misusers. The aims of the study are to examine the knowledge and attitudes of undergraduate nursing students towards substance misusers and consider the implications of these attitudes for nursing education. The Nurse Education in Alcohol and Drug Educational Faculty Survey (NEADA) questionnaire on knowledge and education, nursing interventions, attitudes and values was distributed to undergraduate nurses (n = 227) in the south and south-eastern part of Brazil. The findings showed that there is a lack of adequate education in drug and alcohol use and misuse, including competency skills, but the participants were positive about treatment interventions. A paradigm shift in nurse education curricula and further research studies on attitudes and values towards substance misuse should be on the educational agenda. These are challenges faced by nurses to meet the healthcare needs of substance misusers.     

Uncovering the secret: giving voice to the experiences of nurses who misuse substances

AIM OF THE STUDY: The aim of this study was to gain insight into the experience of being a nurse with a substance misuse problem. RATIONALE: Several members of the research team work in a withdrawal programme specifically designed for nurses by nurses. Gaining insight into nurses' experiences will contribute to the development of appropriate guidelines to assist with prevention, identification and intervention strategies. BACKGROUND: Published research is almost exclusively from North America. Much of it represents work completed in the 1980s, with very few research-based accounts from the perspective of nurses, highlighting that this is a poorly researched and understood problem in Australia. RESEARCH METHODS: This phenomenological study used in-depth, unstructured interviews either face to face or via the telephone with a purposive sample of 12 nurses who had experienced problem substance use. FINDINGS: Five major themes were identified: nurses' justification for using substances, the fear surrounding being 'discovered', the personal meaning for nurses, the professional impact and the turning point in their road to recovery. DISCUSSION: The five themes derived from the data are inextricably linked to the nature of nursing and of the nursing workplace. Information about potential risk factors and the experiences of nurses with substance misuse problems is critical to the development of prevention and treatment strategies. CONCLUSIONS: Issues of occupational health and safety are raised due to the increasingly demanding and often traumatic nursing work environment. Fears about stigma and loss of their nursing identity highlight nurses' perceptions that treatment programmes are often punitive in nature. Guidelines for the workplace addressing issues such as confidentiality, stress reduction and strategies for handling situations where a colleague is suspected of having a problem are beginning steps that will help address the problem of substance misuse in the nursing profession.     

Nursing and substance misuse: responding to the challenge

The widespread use and misuse of alcohol, drug and other psychoactive substances are major health and social concerns that affect the lives of many The social and health sequelae of psychoactive drugs and alcohol are preventable and manageable with minimal interventions Nurses and other health workers can effectively respond to substance misuse problems and their existing generic skills can be easily adapted in working with substance misusers This paper considers some of the issues such as the extent of the problem, attitudinal considerations, response to substance misusers and a brief outline of the role of the nurse The urgent need for education and training in substance misuse and addictive behaviour for nurse practitioners is also addressed     

Substance misuse and mental health: an overview

Patients with dual diagnosis of substance misuse and mental health problems present many challenges for nurses, as their complex needs make them difficult to manage and treat. The author provides an overview of the nature and extent of the problem and a framework for nursing interventions.     

Mental illness and substance misuse: a nursing challenge

The treatment of patients diagnosed with a coexisting psychiatric and psychoactive substance misuse disorder remains an important clinical challenge in mental health nursing. This is not only because of the complexity of the disorder, but also because an increasing number of patients are presenting both disorders (i.e. coexisting psychiatric and psychoactive substance disorder). This article will review the literature on the subject of severe mental illness and substance misuse by examining various issues, including the phenomenon of dual diagnosis and its prevalence, the nature of the relationship between substance misuse and severe mental illness, the extent of the problem of illicit substance use among the psychiatric population, treatment trends and management models.     

A New Horizon: Training the Radiology Nurse of the Future

The literature is clear regarding the gap between retiring baby boomer nurses and new nurses entering the profession. Fewer nurses, together with the growing number of minimally invasive image-guided procedures, are major challenges for meeting the future demands of radiology nursing. How do we engage students, introduce the field of radiology to students, and begin to prepare the next generation of radiology nurses? This article discusses the planning phase of a creatively designed radiology immersion experience (RIE) for undergraduate nursing students, which includes both didactic course work and phased-in clinical experiences. Developed by faculty from an undergraduate baccalaureate nursing program and administrators from a large metropolitan teaching hospital in the Midwest, RIE is aimed at providing an innovative approach to learning and generating interest in radiology nursing as a future career path.     

Educational intervention of undergraduate nursing students' confidence skills with alcohol and drug misusers

There is a paucity literature on the educational interventions and evaluation programmes in alcohol and drug with undergraduate nursing students in the United Kingdom and this study intends to add a body of knowledge to this area. The aim of the study was to assess the intervention confidence skills of undergraduate nursing students before and after an educational intervention on alcohol and drug misuse. The research study is a quasi-experimental, pre- and post-test design. The sample was made of four cohorts of undergraduate nursing students (n=110) enrolled at a course leading to a diploma or BSc in nursing from three educational institutions. A visual analogue scale was used to measure intervention confidence skills before and after the educational programme in alcohol and drug. The findings showed an improvement in the level of intervention confidence skills of undergraduate nursing students. Further research is needed to examine effectiveness of educational interventions in working with substance misusers and whether substance misuse education is the key predictor of changing in changing intervention confidence skills.     

Knowledge and Perceptions of Undergraduate Nurses towards the Use of Cocaine (Smoked) in a Brazilian Context

The aim of the study was to evaluate the perceptions and knowledge of nursing students on the identification and intervention care among users of cocaine (smoked) patients. A cross-sectional survey design was conducted with 164 undergraduate nursing students of two nursing school from Northeast of Brazil. A questionnaire on knowledge and attitudes and therapeutic commitment towards the use of cocaine (smoked) were used. The students stated that they received contents of substance misuse in the curriculum of nursing. Only 10% of the students reported that they had adequate knowledge on addiction to dealing with cocaine (smoked) users and wish to work with these users. There are positive perceptions on motivation, task specific self-esteem and work satisfaction among students.     

There is no health without mental health: Are we educating Australian nurses to care for the health consumer of the 21st century?

One in five Australians has a diagnosable mental illness and the impact of the illness on the individual, their family, and the community is significant. Since comprehensive nursing was introduced in the 1980s there have been repeated concerns raised regarding the preparedness of graduates from Australian undergraduate nursing programs to care for people who have a mental illness. In 2009, despite a recent comprehensive national review of the mental health/illness content in pre‐registration curricula, these concerns remain. The nursing profession must have a responsibility to the global community to ensure that registered nurses are educated to meet evolving health challenges and the needs of the health consumer in the 21^st Century. The purpose of this paper is to highlight the prevalence and impact of mental illness on health care outcomes in all settings and to challenge the profession to acknowledge that mental health nursing content must be a core area of all undergraduate curricula. A nationally coordinated response to address the long standing identified deficits in the educational preparation of comprehensive nurses is now a priority to ensure that nurses remain a major stakeholder group in the delivery of health care and key health informants and decision makers within the global health care arena.     

Are nurses recognised,prepared and supported to teach nursing students: Mixed methods study

BackgroundThe requirement for clinical teaching and supervision of undergraduate nursing students is a continual high volume, high impact essential requirement of registered nursing staff. Nurses are integral in facilitating the learning of nursing students in the practice environment to deliver quality safe care. However nurses engaged in teaching and supervising nursing students have unique challenges.ObjectiveTo understand how well recognised, prepared, and supported nurses perceive they are to teach and supervise undergraduate nursing students in the practice environment?MethodsNurses from 12 different wards of two hospitals were invited to participate in the study. A sequential mixed methods approach comprising hard-copy questionnaires, completed by 59 nurses, and six focus groups. Four feedback sessions verified findings.ResultsA low level of recognition and support for the amount of time available to nurses to teach and supervise was reported from both survey and focus group data. Four themes emerged from focus groups. Nurses recognised their role to teach and supervise students; The role in teaching and supervision was not recognised at a system level; Nurses could be more prepared to teach and supervise students; and Nurses required more support for their role in teaching and supervising students. A major challenge was the low level of support nurses perceived from the education sector in preparing students for placements. The nurses reported a disconnection of components of the student placement system, which was difficult to negotiate when undertaking this teaching and supervision role.ConclusionThe complex practice environment, where nursing student numbers are increasing and nurses have to navigate an often disconnected student placement system, requires a rethink of the precentorship or buddy one-to-one model of clinical placement. Addressing these challenges will be an essential step in protecting the interests of the public, nurses and nursing profession.     

The relevance of globalization to nursing: a concept analysis

GROOTJANS J. & NEWMAN S. (2013) The relevance of globalization to nursing: a concept analysis. International Nursing Review 60 , 78–85 Background: This paper emerged alongside the development of learning materials for a new unit of study on global health and nursing. The proposed unit was for inclusion in a graduate entry master of nursing course leading to registration. It became evident that there has been growing attention within the nursing literature to the demands of an increasingly globalized world and the subsequent challenges confronting nursing as a profession. At the same time, the literature is inconsistent and contains mixed messages with regard to how nurses and nursing might respond to these challenges. Aim: This paper aims to (i) present the findings of a narrative analysis of the current nursing discourse on globalization, and (ii) to identify directional cohesiveness for the nursing profession in the seemingly disparate literature. Method: Concept analysis following extensive literature review. Findings: Several nursing authors argue that nurses globally are increasingly sharing concerns expressed by nurses at a local level. Concerns such as the future sustainability of the profession and more specifically practice concerns such as the continuing failure of nurses to adequately deal with social justice issues requires careful consideration by every nurse. While strategies recommended for dealing with these concerns lack a cohesive thread, some interesting themes and innovative recommendations have emerged. For example, the need for nurses to consider replacing environmental considerations with ecological considerations and that nurses consider preventative nursing practice beyond the immediate needs of clients and from a more global perspective.     

International Perspectives The Educational Experiences and Previous Orientation of Undergraduate Nursing Students in Alcohol and Drug: The English Context

Several international and national reports have identified the need for nurses, including primary health care workers and staff in the prison health system, to receive adequate training in substance abuse education. The reports highlight the need for a systematic approach to education and training on substance abuse and the principles that underpin quality education and training. However, education about drugs and alcohol and their impact on health still find insufficient space within the nursing curriculum. The purpose of the study was to examine the previous orientation of alcohol and drug education and explore the personal and professional experiences of undergraduate nursing students. A sample of 110 undergraduate nursing students completed a questionnaire. The results showed that the majority of the participants did not receive any instruction on alcohol and other drugs. Alcohol seemed to be the major health problem, compared to other drug problems, encountered by the students in their personal life. The results of this study are congruent with previous findings of the lack of adequate educational preparation of undergraduate nursing students in alcohol and other drugs.     

Theory Z as a framework for the application of a professional practice model in increasing nursing staff retention on oncology units

Recruitment and retention of nurses is the most significant issue facing nursing administrators, educators, researchers and clinicians in the ongoing nursing shortage in the United States today. It has been cited in the literature that American nurses feel that job satisfaction is a major issue in retaining qualified nurses in hospitals. Satisfaction occurs when nurse expectations are matched with the hospital's vision and values. It is for this purpose that the authors have chosen theory Z as a hospital management model to coincide with the institution of the Marker Professional Practice Model to increase job satisfaction (autonomy) in hospital-based nurses. There are four 'hidden' challenges in health care today. They are: (a) fundamental changes occurring within the profession and practice of nursing; (b) the expanded role of women in management; (c) ethical dilemmas related to advances in medical technologies; and (d) the difficulty for health care managers in the United States to make changes related to the above three challenges. The authors feel that it is inherent to the nursing profession to combine existing theories and models to enhance the retention of nurses to the profession.     

Impact of pregnancy on psychoactive substance use among women with substance use disorders recruited in addiction specialized care centers in France

Pregnancy can be a motivation for decrease in drug abusing but may also represent a period of high vulnerability for relapse. We aimed to assess psychoactive substance use among women with substance use disorders followed in addiction care centers in France. We analyzed data from women aged 15–44 years included in the ‘Observation of illegal drugs and misuse of psychotropic medication (OPPIDUM) survey’, an annual cross‐sectional survey collecting details on psychoactive substances used. Characteristics of women included in 2005–2012 yearly surveys were compared depending on their pregnant or not pregnant status. Factors, including pregnancy, associated with illicit substance use and medication misuse were investigated through logistic regression. The study included 518 pregnant and 6345 nonpregnant women; 85.3% pregnant women were on opioid maintenance therapy (OMT) (vs. 77.1% of nonpregnant). Pregnancy was associated with lower illicit substance use (adjusted OR 0.71 [0.58–0.88]) and with lower medication misuse (0.66 [0.49–0.89]), whereas financial insecurity and living as a couple were associated with increased risk. Raising children was significantly associated with less risk of substance use. Each substance taken separately, the part of women using illicit substance or misusing medication did not differ depending on whether they were pregnant or not, except for heroin (24.5% in pregnant vs. 17.9% nonpregnant; <0.001). This nationwide study provides new insights into psychoactive substance use in a large mixed population of women with drug use disorders. Results outline the challenge of preventing drug use and initiating care strategies with a specific approach on socio‐economic environment.     

Navigating the labyrinth of Canadian undergraduate psychiatric nurse education

Historically, the education and training of psychiatric nurses in Canada have only been available within a psychiatric institutional setting or community college. This trend, however, has experienced a recent shift with the establishment of a Canadian undergraduate programme. This development is symbolic of the profession's evolution and serves three primary purposes. First, it continues to address the psychiatric nursing shortage; second, it provides additional educational and career opportunities for students; and third, it serves to advance the psychiatric nursing profession. This essay reflects on a decade of undergraduate psychiatric nurse education and discusses the salient challenges and needs of learners and educators.     

Dual diagnosis: an exploratory qualitative study of staff perceptions of substance misuse among the mentally ill in Northern India

Dual diagnosis is well recognized as a significant clinical problem. It is associated with poor outcomes, staff difficulties, and management problems. This exploratory study investigated the extent and clinical correlates of dual diagnosis and traditional substance use among the mentally ill by interviewing staff from several substance misuse and mental health services in Northern India, using a semi-structured interview schedule and focus groups. Dual diagnosis was seen as a common problem according to staff interviewed from substance misuse and mental health services, although types of substance use reported were different than in western studies. Traditional substance use (the use of substances in distinct cultural, religious, and social settings that is not prohibited, such as khat or betel nut) also was reported as common among those with dual diagnosis. Substance misuse among the mentally ill is common in Northern India. Opportunities exist for informing mental health nursing practice about "traditional" substance use.     

DUAL DIAGNOSIS: AN EXPLORATORY QUALITATIVE STUDY OF STAFF PERCEPTIONS OF SUBSTANCE MISUSE AMONG THE MENTALLY ILL IN NORTHERN INDIA

Dual diagnosis is well recognized as a significant clinical problem. It is associated with poor outcomes, staff difficulties, and management problems. This exploratory study investigated the extent and clinical correlates of dual diagnosis and traditional substance use among the mentally ill by interviewing staff from several substance misuse and mental health services in Northern India, using a semi-structured interview schedule and focus groups. Dual diagnosis was seen as a common problem according to staff interviewed from substance misuse and mental health services, although types of substance use reported were different than in western studies. Traditional substance use (the use of substances in distinct cultural, religious, and social settings that is not prohibited, such as khat or betel nut) also was reported as common among those with dual diagnosis. Substance misuse among the mentally ill is common in Northern India. Opportunities exist for informing mental health nursing practice about “traditional” substance use.