“You’re kind of at war with yourself as a nurse”: Perspectives of inpatient nurses on treating people who present with a comorbid opioid use disorder

Abstract

BackgroundIn the midst of an opioid epidemic, health care workers are encountering an increasing number of patients who have opioid use disorder in addition to complex social, behavioral and medical issues. Of all the clinicians in the hospital, nurses spend the most time with hospitalized patients who have opioid use disorder, yet there has been little research exploring their experiences in caring for this population. The objective of this study was to assess the attitudes, perceptions, and training needs of nurses in the inpatient setting when caring for patients who have opioid use disorder.MethodsOne-on-one in-depth interviews were conducted with nurses working at a large academic medical center in Boston, MA, using a semi-structured interview guide. Nurses were recruited via email notifications and subsequent snowball sampling. Interviews were recorded, transcribed and analyzed using a grounded theory approach.ResultsData from in-depth interviews with 22 nurses were grouped into six themes: (1) stigma, (2) assessing & treating pain, (3) feelings of burn out, (4) communication between providers, (5) safety & security, and (6) opportunities for change. These themes were organized within four ecological levels of the Socio-Ecological Model: I) societal context, II) hospital environment, III) interpersonal interactions, and IV) individual factors. Nurses were cognizant of the struggles that patients who have opioid use disorder confront during hospitalization such as pain, withdrawal and stigma, and elaborated on how these challenges translate to professional and emotional strain among nurses. Nurses offered recommendations by which the hospital could streamline care for this population, including expanded role support for nurses and more structured policies regarding care for patients who present with a comorbid opioid use disorder.ConclusionOur results highlight the need for the development of programs targeting both organizational culture and the inpatient nurse quality of life to ultimately enhance quality of care for patients who present with opioid use disorder.

‘We do what we can as soon as we can’ Alcohol and Other Drug workforce perspectives on preventing and responding to prenatal alcohol exposure

“…There is a significant shortage of research aiming to understand the workforce development needs of AOD staff who are responding to PAE. However, this study demonstrates some similarities with research findings in general drug treatment settings (Horner et al, 2019), and with practitioners in primary and antenatal care environments (Crawford-Williams et al, 2015a;Watkins et al, 2015). Similar factors impacting upon care included constraints on time and resources, sensitivities about stigma, and the importance of both trust and rapport in engaging clients with services and treatment.…”

“…client attributes and staff training intensity) lead the authors to conclude that the theoretical underpinnings of workforce development and treatment outcomes require greater clarity. To maximize workforce development in AOD services, research must capture the complex interactions between clinician and organizational workforce characteristics, client attributes and treatment outcomes (Horner et al, 2019;van de Ven et al, 2020;Watkins et al, 2015).…”

Opioid use disorder education for acute care nurses: An integrative review

“…Nurses working on the frontlines are requesting training that is less academic and more focused on the realities of OUD in the clinical setting (Horner et al, 2019). They would like programmes using common, spoken language (not medical terms), additional training on dosages required for chronic conditions that may be outside the "normal" range in this population (i.e.…”

“…Patients with OUD present daily to inpatient areas with complex issues often associated with drug misuse or common life experiences, such as surgery, that become complicated secondary to their OUD diagnosis (Alford, Compton, & Samet, 2006;Palepu et al, 2001;Pieper & Hooper, 2005). Caring for these patients requires additional knowledge, skills and support (Horner et al, 2019;Morgan, 2014). Lack of knowledge and necessary skills have contributed to negative attitudes and dissatisfaction among healthcare providers working with this population (Gilchrist et al, 2011;Happell & Taylor, 2001).…”

“…Experienced nurses self-report insufficient knowledge in screening, identification and care (Rosenthal, Barnes, Aagaard, Cook, & Weger, 2018;Tran, Stone, Fernandez, Griffiths, & Johnson, 2009b). Nurses on the frontlines providing care are expressing emotional distress due to lack of knowledge and experience/training (Horner et al, 2019).…”