WEBVTT 00:00:00.159 --> 00:00:04.930 position:50% align:middle - [Woman] Dr. Mahmoud has made significant contributions to the addiction field, 00:00:04.930 --> 00:00:10.180 position:50% align:middle recognizing that persons with substance use problems are among the most vulnerable 00:00:10.180 --> 00:00:12.038 position:50% align:middle and stigmatized populations. 00:00:12.390 --> 00:00:19.760 position:50% align:middle Her studies focus on the utilization of person-centered language, implementing stigma reduction and addiction 00:00:19.760 --> 00:00:26.660 position:50% align:middle curriculum-based interventions, expanding addiction workforce capacity, and conducting health services 00:00:26.660 --> 00:00:31.737 position:50% align:middle research aimed at informing nursing education and practice regulations. 00:00:31.927 --> 00:00:38.077 position:50% align:middle She is also a strong advocate for nursing practice, recognizing that nurses are in ideal positions 00:00:38.077 --> 00:00:42.138 position:50% align:middle to identify patients with at-risk substance use. 00:00:42.357 --> 00:00:46.667 position:50% align:middle Dr. Mahmoud is the recipient of the University of Pittsburgh School of Nursing, 00:00:46.667 --> 00:00:53.419 position:50% align:middle Ruth Perkins Kuehn Award for Doctoral Student, Rising Star of Research and Scholarship, as well as the 00:00:53.419 --> 00:01:00.393 position:50% align:middle Association for Multidisciplinary Education and Research in Substance Abuse Marianne Marcus Award. 00:01:00.486 --> 00:01:06.178 position:50% align:middle She is also the recipient of the 2018 Center for Regulatory Scholarship Grant Award. 00:01:06.367 --> 00:01:11.112 position:50% align:middle She currently serves as the co-chair of the AMERSA Nursing Special Interest Group 00:01:11.112 --> 00:01:15.689 position:50% align:middle and as an editorial coordinator for the Journal of Addictions Nursing. 00:01:22.880 --> 00:01:24.688 position:50% align:middle - [Dr. Mahmoud] Hello. My name is Khadejah Mahmoud. 00:01:24.688 --> 00:01:30.591 position:50% align:middle Today I'm going to talk about Nurses' Readiness and Motivation to Provide Care for Patients Who Use 00:01:30.591 --> 00:01:32.091 position:50% align:middle Alcohol and Opioid. 00:01:32.589 --> 00:01:37.994 position:50% align:middle The idea here is that we're trying to inform nursing education and practice regulations. 00:01:41.161 --> 00:01:44.380 position:50% align:middle So those are my co-investigators and mentors. 00:01:44.380 --> 00:01:52.401 position:50% align:middle The study was funded by the NCSBN Center for Regulatory Excellency and the Margaret Wilkes Scholarship Award 00:01:52.401 --> 00:01:55.388 position:50% align:middle by the University of Pittsburgh School of Nursing. 00:01:59.001 --> 00:02:02.359 position:50% align:middle For today's presentation, we have three main objective. 00:02:03.069 --> 00:02:10.144 position:50% align:middle The first, we will list the negative consequences associated with alcohol and opioid use continuum. 00:02:11.109 --> 00:02:17.899 position:50% align:middle Second, we will identify factors that influence nurses' motivation to provide care to patients with alcohol and 00:02:17.899 --> 00:02:19.430 position:50% align:middle opioid use problems. 00:02:19.649 --> 00:02:26.869 position:50% align:middle And finally, we want to propose future research and practice implications that enhance nurses' motivation 00:02:26.869 --> 00:02:33.915 position:50% align:middle and promote patients' access to care via informing nursing education and practice regulation. 00:02:37.214 --> 00:02:44.164 position:50% align:middle So when talking about consequences associated with alcohol and opioid use problem, 00:02:44.164 --> 00:02:50.474 position:50% align:middle in terms of economic burden, each year, alcohol and opioid use combined contribute 00:02:50.474 --> 00:02:58.724 position:50% align:middle to more than 327 billions in cost associated with health care, loss of productivity, addiction treatment, 00:02:58.724 --> 00:03:00.934 position:50% align:middle and criminal justice expenditure. 00:03:01.848 --> 00:03:07.359 position:50% align:middle When talking about physical and psychosocial consequence, according to the 00:03:07.359 --> 00:03:14.105 position:50% align:middle World Health Organization, substance use, namely, alcohol use, have been linked to more than 200 physical 00:03:14.105 --> 00:03:19.888 position:50% align:middle and psychosocial illness, including cardiovascular disease, liver cirrhosis, 00:03:19.888 --> 00:03:26.652 position:50% align:middle and some types of cancers as well as injuries resulting from violence and road clashes and collisions. 00:03:26.808 --> 00:03:33.692 position:50% align:middle In addition, 20% of primary care medical visits, 40% of hospital medical admissions, 00:03:33.692 --> 00:03:39.146 position:50% align:middle and 70% of emergency medical visits are associated with substance use. 00:03:40.416 --> 00:03:49.665 position:50% align:middle In term of mortality and morbidity, every day, more than 128 American die of an opioid overdose. 00:03:49.665 --> 00:03:57.186 position:50% align:middle An estimated 1.7 million Americans suffered from substance use disorders related to prescription opioid. 00:03:57.586 --> 00:04:05.086 position:50% align:middle Meanwhile, an estimated 95,000 people die from alcohol-related causes annually, 00:04:05.086 --> 00:04:10.576 position:50% align:middle making alcohol the third-leading preventable cause of death in the United States. 00:04:10.889 --> 00:04:19.618 position:50% align:middle Globally, alcohol misuse was the fifth-leading risk factor for premature death and disability in 2010. 00:04:21.015 --> 00:04:26.339 position:50% align:middle In relation to the current pandemic, although social distancing, isolation, 00:04:26.339 --> 00:04:33.036 position:50% align:middle and quarantine measures have shown success in reducing the spread of disease and subsequent morbidity 00:04:33.036 --> 00:04:38.186 position:50% align:middle and mortality, these measures are expected to have more negative effects on patients 00:04:38.186 --> 00:04:40.011 position:50% align:middle with substance use disorder. 00:04:40.326 --> 00:04:46.177 position:50% align:middle According to a recent report, more than 40 states reported significant surges in the 00:04:46.177 --> 00:04:48.427 position:50% align:middle number of opioid-related death. 00:04:49.306 --> 00:04:56.232 position:50% align:middle In addition, in March 2020, there has been a 54% increase in alcohol national sales 00:04:56.232 --> 00:05:04.149 position:50% align:middle and 262% increase in online alcohol sales compared to the same period last year. 00:05:04.753 --> 00:05:08.823 position:50% align:middle In addition to all of that, this patient population is more susceptible 00:05:08.823 --> 00:05:12.878 position:50% align:middle to contract, transmit, and suffer from severe complications, 00:05:12.878 --> 00:05:16.775 position:50% align:middle including death due to COVID-19. 00:05:19.683 --> 00:05:24.572 position:50% align:middle In terms of nurses' role, for the past two decades, and according to the most 00:05:24.572 --> 00:05:29.563 position:50% align:middle recent Gallup, nurses have been voted the most trustworthy healthcare professional. 00:05:30.279 --> 00:05:35.862 position:50% align:middle In addition, nurses are the largest group of healthcare professionals in the United States, 00:05:35.862 --> 00:05:38.279 position:50% align:middle with 4 million members and counting. 00:05:38.279 --> 00:05:43.500 position:50% align:middle Therefore, they are in an ideal position to screen for alcohol and opioid use problem, 00:05:43.500 --> 00:05:45.711 position:50% align:middle and implement preventive measures. 00:05:45.959 --> 00:05:53.029 position:50% align:middle They also can play a significant role in early recognition and interventions for individuals 00:05:53.029 --> 00:05:55.350 position:50% align:middle with alcohol and opioid use problem. 00:05:56.009 --> 00:06:01.615 position:50% align:middle The current pandemic has also highlighted the important contributions nurses have made to the general 00:06:01.615 --> 00:06:07.255 position:50% align:middle population and to vulnerable patient populations in particular including patients 00:06:07.255 --> 00:06:11.865 position:50% align:middle with substance use problems. 00:06:11.865 --> 00:06:18.735 position:50% align:middle The problem is that in term of education, pre-licensure nurses reported receiving 11.3 hours 00:06:18.735 --> 00:06:23.725 position:50% align:middle of substance use education on average, in which most of the content targeted substance 00:06:23.725 --> 00:06:25.675 position:50% align:middle use treatment modalities. 00:06:25.775 --> 00:06:31.365 position:50% align:middle The number of hours devoted to substance use education, skill development, and competency among advanced 00:06:31.365 --> 00:06:35.859 position:50% align:middle practice registered nursing program is also still inadequate. 00:06:37.075 --> 00:06:44.707 position:50% align:middle When examining patient and provider interaction, healthcare providers, including nurses, often endorse 00:06:44.707 --> 00:06:48.829 position:50% align:middle negative perceptions and attitude toward patients with substance use problems. 00:06:50.383 --> 00:06:53.875 position:50% align:middle Now this can result in negative patient outcomes. 00:06:53.875 --> 00:06:59.141 position:50% align:middle So for example, stigma prevent individuals who could benefit from treatment from seeking it. 00:06:59.645 --> 00:07:05.596 position:50% align:middle It also can result in delaying the identification of patient with substance use problems and their access 00:07:05.596 --> 00:07:10.651 position:50% align:middle to treatment while also contributing to increasing their dropout and relapse rate. 00:07:11.106 --> 00:07:17.306 position:50% align:middle Shockingly, healthcare providers were also willing to provide a lower quality of care to this patient 00:07:17.306 --> 00:07:24.866 position:50% align:middle population because they believe that these patients are overutilizing the system, taking from the time of more 00:07:24.866 --> 00:07:30.628 position:50% align:middle deserving patients, "patient who did not inflict this on themself." 00:07:31.680 --> 00:07:37.010 position:50% align:middle This also contribute to diminish therapeutic engagement, use of more avoidance, 00:07:37.010 --> 00:07:44.763 position:50% align:middle and task-oriented approaches, and shorter visit, which all resulted in poorer patient treatment outcomes. 00:07:46.780 --> 00:07:52.110 position:50% align:middle While focusing on this patient population, I developed a specific interest in examining stigma 00:07:52.110 --> 00:07:58.760 position:50% align:middle perceptions among healthcare providers, in which stigma is defined as a mark of disgrace associated with a 00:07:58.760 --> 00:08:05.621 position:50% align:middle particular circumstance, quality, person, or condition, resulting in undesirable labels, 00:08:05.621 --> 00:08:12.822 position:50% align:middle qualities, and behaviors that are assigned to a person or a population based on this stereotyping. 00:08:13.121 --> 00:08:15.871 position:50% align:middle Now there are three major types of stigma. 00:08:15.871 --> 00:08:22.511 position:50% align:middle The first is self-stigma, which is defined as what people with a disorder do to themselves when 00:08:22.511 --> 00:08:24.343 position:50% align:middle they internalize stigma. 00:08:25.401 --> 00:08:31.419 position:50% align:middle The second type is social stigma, which is also known as public stigma, which is defined as the phenomenon 00:08:31.419 --> 00:08:39.655 position:50% align:middle of large social groups endorsing stereotypes about and acting against a stigmatized group. 00:08:39.989 --> 00:08:45.668 position:50% align:middle And finally, we have the structural stigma, which is defined as the rules, policies, 00:08:45.668 --> 00:08:53.949 position:50% align:middle and procedures, including practices of institutions, that restricts the rights and opportunities for members 00:08:53.949 --> 00:08:55.849 position:50% align:middle of the stigmatized group. 00:08:56.429 --> 00:09:03.310 position:50% align:middle This often is seen in the form of public policies and laws enacted, and also in the form of public 00:09:03.310 --> 00:09:08.692 position:50% align:middle institution personnel's actions, including those of healthcare professionals. 00:09:09.230 --> 00:09:14.370 position:50% align:middle Now the idea here is that structural stigma does not only discredit the stigmatized group, 00:09:14.370 --> 00:09:21.700 position:50% align:middle but also result in a systematic process of to label, stereotype, and discriminate against them, 00:09:21.700 --> 00:09:29.040 position:50% align:middle creating unequal power dynamic, which is often re-enforced in patient-provider interactions 00:09:29.040 --> 00:09:30.632 position:50% align:middle within healthcare setting. 00:09:30.632 --> 00:09:38.227 position:50% align:middle This lead to undermining access to care and minimizing efforts for coordinated substance use response. 00:09:39.952 --> 00:09:45.982 position:50% align:middle As gatekeepers to substance use treatment and care, healthcare providers' conscious or unconscious 00:09:45.982 --> 00:09:52.382 position:50% align:middle exercising or verbalizing of prejudice and discrimination against person with substance use 00:09:52.382 --> 00:09:57.007 position:50% align:middle problem is a main barrier for substance use prevention and management. 00:09:58.742 --> 00:10:05.032 position:50% align:middle Structural stigma can also embed patients' health-seeking behaviors, engagement in care, 00:10:05.032 --> 00:10:11.822 position:50% align:middle and adherence to treatment, consequently resulting in poorer health outcomes and quality of care 00:10:11.822 --> 00:10:13.689 position:50% align:middle for this patient population. 00:10:16.972 --> 00:10:24.322 position:50% align:middle Now because words matter, using a concept analysis, we defined the term substance misuse to not only 00:10:24.322 --> 00:10:30.022 position:50% align:middle broadly support contemporary applications, but also to suggest an alternative, 00:10:30.022 --> 00:10:34.293 position:50% align:middle more appropriate terminology using the term "at-risk use." 00:10:35.917 --> 00:10:43.687 position:50% align:middle In which at-risk use, in this case, related to alcohol use is defined as any level of alcohol consumptions 00:10:43.687 --> 00:10:48.961 position:50% align:middle that increases a person's or others' risk of harm as a result of their use. 00:10:50.807 --> 00:10:56.197 position:50% align:middle Based on that, the target is not only placed on patients with substance use disorder, 00:10:56.197 --> 00:11:01.087 position:50% align:middle but also on patients who may experience harm as a result of their use 00:11:01.087 --> 00:11:05.048 position:50% align:middle but do not meet the diagnostic criteria of a substance use disorder. 00:11:07.800 --> 00:11:15.833 position:50% align:middle Now, this patient population was targeted by Screening, Brief Intervention, and Referral to Treatment, in which 00:11:15.833 --> 00:11:21.997 position:50% align:middle 74% of patient reported lowering their alcohol use after Screening, Brief Intervention, 00:11:21.997 --> 00:11:28.501 position:50% align:middle and Referral to Treatment, and 48% of patient reported completely stopping alcohol use. 00:11:28.757 --> 00:11:30.728 position:50% align:middle SBIRT is also cost-effective. 00:11:30.728 --> 00:11:36.738 position:50% align:middle So for every dollar spent on SBIRT, four dollars are saved in cost related to primary care, 00:11:36.738 --> 00:11:38.980 position:50% align:middle trauma center, and ED health. 00:11:39.628 --> 00:11:47.710 position:50% align:middle SBIRT implementation was also associated with reducing hospitalization expenditure by $1,000. 00:11:49.305 --> 00:11:55.998 position:50% align:middle Now one of the main reason for focusing on readiness and motivation to provide care, which is defined 00:11:55.998 --> 00:12:02.082 position:50% align:middle as readiness and willingness to work with this patient population, was that although nurses reported 00:12:02.082 --> 00:12:06.786 position:50% align:middle an improvement in their knowledge and skills related to Screening, Brief Intervention, 00:12:06.786 --> 00:12:12.657 position:50% align:middle and Referral to Treatment and their overall attitudes, their willingness to work with this patient population 00:12:12.657 --> 00:12:14.267 position:50% align:middle did not improve. 00:12:14.467 --> 00:12:20.713 position:50% align:middle And even in some instances, their willingness decreased after receiving education and training. 00:12:21.237 --> 00:12:27.997 position:50% align:middle So in order to promote the translation of SBIRT education and skill development into clinical practice, 00:12:27.997 --> 00:12:31.698 position:50% align:middle we decided to focus on nurses' motivation. 00:12:32.819 --> 00:12:37.221 position:50% align:middle Now based on literature, we identified potential factors that influence 00:12:37.221 --> 00:12:40.961 position:50% align:middle motivation to provide care to patient with substance use problem. 00:12:40.961 --> 00:12:45.098 position:50% align:middle In this process, three main factors were identified. 00:12:45.231 --> 00:12:48.795 position:50% align:middle First, providers' demographic and background characteristic. 00:12:48.961 --> 00:12:56.051 position:50% align:middle We also have personal attitudes, which is defined as individual's social or moral views regarding substance 00:12:56.051 --> 00:12:58.578 position:50% align:middle use and individuals who use them. 00:12:58.828 --> 00:13:03.633 position:50% align:middle And finally, professional attitudes, which is defined as individual's 00:13:03.633 --> 00:13:10.779 position:50% align:middle views about their responsibility to respond to substance use issues within the context of their work. 00:13:11.517 --> 00:13:16.316 position:50% align:middle In which we contributed...we added to the current literature by adding the 00:13:16.316 --> 00:13:18.837 position:50% align:middle factors that are highlighted in orange. 00:13:20.824 --> 00:13:27.557 position:50% align:middle Now in our study, we conducted an online nationwide study using a descriptive correlational design. 00:13:27.557 --> 00:13:32.173 position:50% align:middle The study targeted three group of nursing specialty, medical-surgical nurses, 00:13:32.173 --> 00:13:36.356 position:50% align:middle psychiatric mental health nurses, and addiction trained nurses, who were recruited 00:13:36.356 --> 00:13:40.127 position:50% align:middle for national and international nursing organization. 00:13:40.369 --> 00:13:49.284 position:50% align:middle We had a sample of 493 nurses, of which only 460 were included in the final analysis due to missing this. 00:13:49.843 --> 00:13:57.918 position:50% align:middle The study was conducted over a period of six months and occurred between November 2018 and May 2019. 00:13:59.125 --> 00:14:04.545 position:50% align:middle Now, we collected nurses' demographic and background characteristic using an investigator-developed 00:14:04.545 --> 00:14:09.981 position:50% align:middle questionnaire where we also collected information related to the participant's state. 00:14:10.945 --> 00:14:18.711 position:50% align:middle Nurses' personal attitudes included measures related to nurses' stigma perceptions associated with working 00:14:18.711 --> 00:14:20.627 position:50% align:middle with this patient population. 00:14:21.265 --> 00:14:27.106 position:50% align:middle These included measures that assess nurses' personal experience with alcohol and drug use problem, 00:14:27.106 --> 00:14:35.889 position:50% align:middle and whether these experiences was with themself, a friend, a family member, a co-worker, or others. 00:14:36.392 --> 00:14:42.042 position:50% align:middle We also measured their familiarity with this patient population and whether they perceive these patients 00:14:42.042 --> 00:14:46.971 position:50% align:middle as dangerous, were afraid of them, or wanted to maintain a distance from them. 00:14:47.992 --> 00:14:55.392 position:50% align:middle We also measured if they perceive these patients as responsible for their condition and control of their 00:14:55.392 --> 00:15:02.958 position:50% align:middle condition as well as whether they perceive substance use as a disease or attributed it cause 00:15:02.958 --> 00:15:04.665 position:50% align:middle to psychosocial factors. 00:15:06.653 --> 00:15:11.758 position:50% align:middle Finally, we measured professional attitudes, where we explored if they have worked with this 00:15:11.758 --> 00:15:17.208 position:50% align:middle patient population, if they have received any kind of education related to substance use, 00:15:17.208 --> 00:15:19.615 position:50% align:middle and what was the source of this education. 00:15:20.133 --> 00:15:26.837 position:50% align:middle We also looked at if they had adequate knowledge and skills to provide care to this patient population, 00:15:26.837 --> 00:15:32.477 position:50% align:middle which is also termed role adequacy, if they felt they had the right to ask these patients 00:15:32.477 --> 00:15:38.890 position:50% align:middle about their alcohol and opioid use, which is termed as role legitimacy, whether they felt supported, 00:15:38.890 --> 00:15:45.837 position:50% align:middle competent, and satisfied to work with this patient population, which is termed as role support, 00:15:45.837 --> 00:15:49.453 position:50% align:middle task-specific self-esteem, and work satisfaction respectfully. 00:15:49.587 --> 00:15:56.057 position:50% align:middle Finally, we examined if they thought that it is within their role responsibility to address substance use 00:15:56.057 --> 00:16:02.466 position:50% align:middle issue within the context of their work and whether they felt overall confident to take care of these patients. 00:16:04.206 --> 00:16:09.116 position:50% align:middle Since we used self-report questionnaires, we also included a measure to control 00:16:09.116 --> 00:16:11.928 position:50% align:middle for socially desirable responses. 00:16:13.176 --> 00:16:19.172 position:50% align:middle Now the sample that we had had a mean age of approximately 48.5 years. 00:16:19.966 --> 00:16:24.311 position:50% align:middle We had a median years of experience in nursing of 17 years. 00:16:24.636 --> 00:16:28.010 position:50% align:middle The sample was predominantly female and Caucasian. 00:16:28.776 --> 00:16:37.075 position:50% align:middle One third of these nurses work in hospital setting, and more than 85% of nurses had at least 4-year college 00:16:37.075 --> 00:16:38.296 position:50% align:middle degree in nursing. 00:16:39.185 --> 00:16:45.169 position:50% align:middle In addition, more than half of the nurses were specialized in non-behavior health specialization. 00:16:47.217 --> 00:16:51.698 position:50% align:middle Now using the U.S. Department of Health/ and Human Services regions, 00:16:51.698 --> 00:16:58.817 position:50% align:middle our sample included responses from all 10 regions, with the lowest responses found in Region 7 00:16:58.817 --> 00:17:00.881 position:50% align:middle with only 5 responses. 00:17:03.192 --> 00:17:08.751 position:50% align:middle In relation to demographic and background predictors of alcohol-related motivation, 00:17:08.751 --> 00:17:15.922 position:50% align:middle the adjusted model with the least number of predictors revealed that working in any setting other than the 00:17:15.922 --> 00:17:19.444 position:50% align:middle hospital setting was associated with higher motivation. 00:17:24.101 --> 00:17:30.548 position:50% align:middle Personal attitude predictors associated with alcohol-related motivation revealed that familiarity 00:17:30.548 --> 00:17:34.273 position:50% align:middle with this patient population was associated with higher motivation. 00:17:34.438 --> 00:17:39.738 position:50% align:middle Meanwhile, perceived dangerousness scores and disease model scores were associated 00:17:39.738 --> 00:17:42.984 position:50% align:middle with lower motivation, nurses' motivation. 00:17:45.338 --> 00:17:51.078 position:50% align:middle The adjusted model with the least number of predictors revealed that previous work experience with this 00:17:51.078 --> 00:17:57.778 position:50% align:middle patient population, receiving any type of substance use education, alcohol-related knowledge and skills, 00:17:57.778 --> 00:18:03.952 position:50% align:middle work satisfaction, and role-responsibility scores were associated with higher nurses' motivation. 00:18:03.952 --> 00:18:10.759 position:50% align:middle Meanwhile, receiving substance use education in nursing school was associated with lower motivation, which is 00:18:10.759 --> 00:18:16.842 position:50% align:middle kind of surprising but also expected given that the median years of experience in nursing for our 00:18:16.842 --> 00:18:21.564 position:50% align:middle population was...for our sample was 17 years. 00:18:24.727 --> 00:18:30.483 position:50% align:middle In relation to opioid prediction model, motivation prediction model, age, 00:18:30.483 --> 00:18:36.387 position:50% align:middle working in community-based setting, and specializing in addiction nursing were associated 00:18:36.387 --> 00:18:38.069 position:50% align:middle with higher motivation. 00:18:40.513 --> 00:18:47.309 position:50% align:middle Personal attitudes associated with opioid-related motivation revealed that opioid personal experience 00:18:47.309 --> 00:18:54.283 position:50% align:middle with themself or others as well as attributing the cause of opioid use problem to psychosocial factors 00:18:54.283 --> 00:18:56.675 position:50% align:middle were associated with higher motivation. 00:18:57.153 --> 00:19:03.715 position:50% align:middle Meanwhile, similar to alcohol use problem model, perceived dangerousness scores and disease model scores 00:19:03.715 --> 00:19:07.036 position:50% align:middle were associated with lower nurses' motivation. 00:19:09.805 --> 00:19:15.535 position:50% align:middle Now, professional attitude predictors that were positively associated with opioid-related motivation 00:19:15.535 --> 00:19:21.695 position:50% align:middle included previous work experience with this patient population, receiving continuing education in 00:19:21.695 --> 00:19:27.611 position:50% align:middle substance use, and nurses' task-specific self-esteem and work satisfaction scores. 00:19:31.019 --> 00:19:34.047 position:50% align:middle Now, the study had a number of strength. 00:19:35.129 --> 00:19:40.169 position:50% align:middle First, it is the first study to identify demographic and background, personal, 00:19:40.169 --> 00:19:45.960 position:50% align:middle professional predictors of nurses' motivation to provide alcohol and opioid-related care. 00:19:46.429 --> 00:19:52.274 position:50% align:middle We had a large sample size, and we also targeted three different groups of nursing specialty. 00:19:53.199 --> 00:19:59.679 position:50% align:middle On the other hand, we use a cross-sectional design, which enabled us to assess association 00:19:59.679 --> 00:20:04.566 position:50% align:middle between variables but not cause a relationship among the study variables. 00:20:05.347 --> 00:20:12.774 position:50% align:middle Because the adapted familiarity sub-scale showed poor reliability for alcohol and opioid use-related 00:20:12.774 --> 00:20:17.879 position:50% align:middle problems, the familiarity result should be interpreted with caution. 00:20:19.897 --> 00:20:26.437 position:50% align:middle As our sample was predominantly female and Caucasian, the result may not be generalized to all nurses. 00:20:26.437 --> 00:20:33.316 position:50% align:middle In addition, since we use a convenience samples, we may have also experience some sort of a response bias. 00:20:37.999 --> 00:20:42.324 position:50% align:middle Now, based on our finding, we had four major recommendation. 00:20:44.655 --> 00:20:52.031 position:50% align:middle The first is incorporate presentation from persons in recovery from alcohol and opioid use in teaching 00:20:52.031 --> 00:20:57.023 position:50% align:middle nursing students and educational forums with nurses in practice. 00:20:57.201 --> 00:21:04.118 position:50% align:middle So the idea here is that sharing the lived experiences of persons with alcohol and opioid use problems can be 00:21:04.118 --> 00:21:10.358 position:50% align:middle instrumental in nursing students developing empathy and better understanding of the journey patient 00:21:10.358 --> 00:21:16.167 position:50% align:middle with alcohol and opioid use problem go through, which can ultimately lead to greater motivation to work 00:21:16.167 --> 00:21:17.827 position:50% align:middle with this patient population. 00:21:19.398 --> 00:21:28.398 position:50% align:middle Second, provide clinical experiences wherein nursing students can experience the day-to-day work of nurses 00:21:28.398 --> 00:21:33.667 position:50% align:middle working across the continuum of care with this patient population. 00:21:33.957 --> 00:21:40.511 position:50% align:middle So the idea here is that exposure to positive role models in clinical practice can offset negative 00:21:40.511 --> 00:21:46.141 position:50% align:middle experiences students may be exposed to during their undergraduate education. 00:21:46.441 --> 00:21:53.481 position:50% align:middle Nursing students and current nurses can benefit from learning from nurses with this specialty expertise 00:21:53.481 --> 00:21:56.726 position:50% align:middle in how to manage patient with substance use problems. 00:21:58.561 --> 00:22:05.604 position:50% align:middle Third, expand opportunities for real-world experiences in which students can apply what they learn 00:22:05.604 --> 00:22:07.765 position:50% align:middle in lectures into practice. 00:22:08.104 --> 00:22:13.444 position:50% align:middle So such opportunities are valuable in fostering students' confidence in applying the skills. 00:22:13.444 --> 00:22:17.724 position:50% align:middle This application of learning can also be implemented through simulations, 00:22:17.724 --> 00:22:23.288 position:50% align:middle interaction with standardized patient, case studies, and facilitated debriefing sessions. 00:22:24.504 --> 00:22:31.238 position:50% align:middle And finally, frame the students' perceptions about substance use problem in the context 00:22:31.238 --> 00:22:32.752 position:50% align:middle of disease process. 00:22:33.098 --> 00:22:38.868 position:50% align:middle So the idea here is that the first context students have with this patient may be best with a 00:22:38.868 --> 00:22:40.703 position:50% align:middle person in recovery. 00:22:41.358 --> 00:22:48.828 position:50% align:middle Such an interaction compared with a patient in a highly acute phase may be less traumatic and less stressful 00:22:48.828 --> 00:22:53.188 position:50% align:middle context for students, and can help present a different image that is not 00:22:53.188 --> 00:22:58.857 position:50% align:middle often observed in media, leading to less stigmatizing perceptions. 00:23:00.589 --> 00:23:07.329 position:50% align:middle The whole idea of this study is that we want all nurses in all setting to provide care to all patients, 00:23:07.329 --> 00:23:10.190 position:50% align:middle including care related to substance use problem. 00:23:10.519 --> 00:23:14.005 position:50% align:middle Thank you for listening. I'll be happy to take any questions. 00:23:33.619 --> 00:23:37.304 position:50% align:middle - I see that there is one question by Paulette, Paulette. 00:23:37.304 --> 00:23:40.382 position:50% align:middle I'm hoping I'm pronouncing your name right. 00:23:40.599 --> 00:23:43.965 position:50% align:middle It says, "Are there any similar studies from other countries? 00:23:43.965 --> 00:23:47.670 position:50% align:middle If yes, how do the results differ, or do they?" 00:23:48.580 --> 00:23:55.123 position:50% align:middle So basically, when I did the study, at the time of study, there were no any kind of other studies. 00:23:55.639 --> 00:23:59.438 position:50% align:middle So that's the idea or the reason why I did the study. 00:23:59.539 --> 00:24:06.825 position:50% align:middle Basically what we had is that we wanted to look at a number of factors, not only one factor. 00:24:06.825 --> 00:24:12.453 position:50% align:middle So you'll see at previous studies, they look at either stigma perception factors, or 00:24:12.453 --> 00:24:14.713 position:50% align:middle they even look at some professional factors. 00:24:14.713 --> 00:24:22.197 position:50% align:middle So I tried to combine all this in one study, and that basically was the way that I looked at it. 00:24:22.197 --> 00:24:27.975 position:50% align:middle So there are...some of my result was similar to other studies in term of the specific factors that we're 00:24:27.975 --> 00:24:35.218 position:50% align:middle looking at, but there were some that were different that we discussed in the presentation, as I mentioned. 00:24:35.916 --> 00:24:37.907 position:50% align:middle I hope that answers your question. 00:24:38.600 --> 00:24:41.971 position:50% align:middle So there's another one by...another question by Janine. 00:24:42.465 --> 00:24:46.545 position:50% align:middle "Did you ask if the participant had substance abuse recovery personally, 00:24:46.545 --> 00:24:52.645 position:50% align:middle they themself, and if those nurses would be able to share experiences and empathy for the student nurses 00:24:52.645 --> 00:24:54.412 position:50% align:middle in their upcoming experiences?" 00:24:54.765 --> 00:24:56.825 position:50% align:middle Yes, we did ask. 00:24:57.236 --> 00:25:04.128 position:50% align:middle So the study was anonymous to ensure that the participant will be able to actually report if they had 00:25:04.128 --> 00:25:07.279 position:50% align:middle themself experience, any kind of personal experience. 00:25:07.279 --> 00:25:12.939 position:50% align:middle So one of the factors that we look at at the personal attitudes was if they had any personal experience 00:25:12.939 --> 00:25:19.283 position:50% align:middle with substance use and whether that was with themself, a family member, a friend, and co-worker, 00:25:19.283 --> 00:25:27.621 position:50% align:middle and we correlated with whether they were willing to engage in the care provided to patient 00:25:27.621 --> 00:25:29.251 position:50% align:middle with substance use problems. 00:25:29.660 --> 00:25:38.109 position:50% align:middle And in terms of sharing it, the experience, we did not ask that specifically. 00:25:38.477 --> 00:25:42.962 position:50% align:middle But we just wanted to know if that actually increased their engagement because the whole idea was that we 00:25:42.962 --> 00:25:48.296 position:50% align:middle wanted to see if that will make them more willing to provide care to patients with substance use problem. 00:25:48.907 --> 00:25:54.447 position:50% align:middle The problem that we always have is that providers may not be willing to provide care to patients 00:25:54.447 --> 00:25:59.937 position:50% align:middle with substance use problem, and we wanted to see if personal experience played a role in enhancing or not 00:25:59.937 --> 00:26:06.230 position:50% align:middle this aspect, and what type of personal experience does enhance their engagement. 00:26:07.440 --> 00:26:09.770 position:50% align:middle So we have another question by Holly. 00:26:09.770 --> 00:26:14.820 position:50% align:middle "Can you share a little bit more about the disease model having a decreased impact on motivation? 00:26:14.820 --> 00:26:16.215 position:50% align:middle Define this a little more." 00:26:16.320 --> 00:26:24.530 position:50% align:middle So one of the things that the literature always talked about is whether perceiving substance use as a disease 00:26:24.530 --> 00:26:28.446 position:50% align:middle does increase engagement or willingness to work with this patient population. 00:26:28.720 --> 00:26:32.513 position:50% align:middle So although in the literature they have found a correlation between, like, 00:26:32.513 --> 00:26:39.087 position:50% align:middle viewing substance use as a disease, it does decrease their stigma perception and 00:26:39.087 --> 00:26:44.518 position:50% align:middle personal...and decrease their stigma perception to work with this patient population. 00:26:44.518 --> 00:26:47.701 position:50% align:middle We wanted to see if it have any kind of correlation with engagement. 00:26:47.701 --> 00:26:54.526 position:50% align:middle And basically the thing that was kind of surprising but also it makes sense is that 00:26:54.526 --> 00:27:00.755 position:50% align:middle when they know there is a disease, it does increase some sort of...and that is chronic in nature, 00:27:00.755 --> 00:27:07.314 position:50% align:middle though it decreased their stigma perception, it kind of increase their feeling of helplessness 00:27:07.314 --> 00:27:10.244 position:50% align:middle and frustration because of the chronic nature of substance use, 00:27:10.244 --> 00:27:17.099 position:50% align:middle and that may result in them being more reluctant to work with this patient population. 00:27:17.099 --> 00:27:23.171 position:50% align:middle So in this case, when we want...the idea here is when we want to present substance use as a disease, 00:27:23.171 --> 00:27:28.382 position:50% align:middle we want to make sure that we are presenting it in a light that we're saying that there are 00:27:28.382 --> 00:27:34.653 position:50% align:middle so many good examples of recovery where patients actually participate actively 00:27:34.653 --> 00:27:37.119 position:50% align:middle and become an active member of the society. 00:27:37.309 --> 00:27:43.644 position:50% align:middle And this is where I emphasize in one of my recommendation the idea that we want to emphasize that 00:27:43.644 --> 00:27:49.990 position:50% align:middle there are so many successful recovery stories where their participant actually go on to become more 00:27:49.990 --> 00:27:57.510 position:50% align:middle engaged in the community and actually become a more active participant in the community. 00:27:57.868 --> 00:28:04.148 position:50% align:middle And this is where we highlight this in this study, is that how should we present the disease model in a 00:28:04.148 --> 00:28:11.291 position:50% align:middle positive light that enhance engagement while decreasing their feeling of helplessness and frustration while 00:28:11.291 --> 00:28:13.421 position:50% align:middle working with this patient population? 00:28:13.421 --> 00:28:20.488 position:50% align:middle And also to shed a different light than that always provided in media, where we only see the stories 00:28:20.488 --> 00:28:29.371 position:50% align:middle of relapse and also the stories of where the person may also go back to becoming a substance use... 00:28:29.371 --> 00:28:31.205 position:50% align:middle having substance use problem. 00:28:32.150 --> 00:28:34.276 position:50% align:middle So this is where we shed this light. 00:28:36.656 --> 00:28:38.800 position:50% align:middle Again, if there are any questions... 00:28:46.801 --> 00:28:47.334 position:50% align:middle Okay. 00:28:47.476 --> 00:28:52.531 position:50% align:middle So one of the things that we're also trying to look at is also the interaction between them. 00:28:52.531 --> 00:29:00.605 position:50% align:middle So we also looked at the two-way interactions between a lot of our variables, and that's something that because 00:29:00.605 --> 00:29:04.302 position:50% align:middle of the time for the presentation, I was not able to present that. 00:29:04.302 --> 00:29:09.672 position:50% align:middle I'm hoping that we'll be able to submit that in our publication, and you'll be able to see also this 00:29:09.672 --> 00:29:11.581 position:50% align:middle finding as well. 00:29:12.856 --> 00:29:16.022 position:50% align:middle So thank you so much for attending my presentation. 00:29:16.022 --> 00:29:20.275 position:50% align:middle I'll be more than happy to answer any question if you wanted to connect later on. 00:29:20.275 --> 00:29:22.284 position:50% align:middle Thank you so much, and have a good day.