GETTING ADDICTION INTO THE NURSING EDUCATION WATER SUPPLY
Getting Addiction
into the Nursing
Education Water
Supply
Carmel Clancy, PhD, RGN, RMN, Head of Department
Department of Mental Health, Social Work and IPL, Drug and Alcohol Research Center, School of Health and Education, Middlesex University, London, United Kingdom Riding the Wave of Change in Health Care: Interprofessional
Collaboration and Caring for Substance Use Disorders, IntNSA, Washington DC, October 2013
Outline of presentation
1. Why would we want to… 2. Where are we now.. 3. How do we know we are
doing it well… a case study example from Middlesex 4. The take home message…
Quick Poll
How many of you were exposed to training during your undergraduate nursing courses?
How many of you are practitioners? How many of you have undertaken post
graduate training in addictions?
How many of you have or currently teach undergraduate students about addiction? What was the length of exposure? e.g.
number of hours?
Why mainstreaming substance use/misuse training at undergrad level is essential
Efforts in the UK http://www.ansauk.org/
Where are we now…
How time flies..
8hrs
• In 1990 Falkowski and Ghodse surveyed UK nursing schools to establish the amount of time devoted to alcohol and drug education – over a 3 year period • The mean hours?
• ANSWER:
12hrs
• In 2013 Holloway and Webster surveyed 68 UK universities on amount of time devoted to alcohol education in pre registration nursing courses. The response rate was 26%, and the mean hours?
• ANSWER:
US is no different to UK…
• Heinemann & Hoffman in 1989 conducted a review of existing AOD education in schools of nursing and found that little attention was devoted to either the theoretical or clinical components of substance abuse education
• In 2011 – Savage, Dyehouse, Marcus & Lindell undertook a similar survey and compared it to Heinemann & Hoffman’s findings and concluded over 22 years little progress had occurred in relation to the amount of education on AOD
23 years ago… this message about getting addiction training
into the ‘water supply’ is not new! • Rassool and Oyefeso (1993) in their publication
“The need for substance misuse education in health studies curriculum; a case for nursing education.” Nurse Education Today. 13, 107-110.
Matching educational goals with problem growth
Vertical Integration Model i.e. SUD is taught alongside traditional curricula (smoking: chest medicine/surgery; impact of substance use on the fetus in midwifery etc.)
That’s not to say that no one is doing anything…..there are some excellent examples and
initiatives… 1997
2002
2013
HOWEVER…
• Its too little and not systemic • How is this connected to my title?
• The Story of Community Water fluoridation as a public policy approach to combat tooth decay. Introduced in the early 50s in the US. • If you want to really tackle a mass public
health concern…you need to get something into the ‘water supply’.
So what do we know so far…
• Addiction is a global challenge and climbing • Substance use/misuse impacts across the
lifespan
• Early intervention can save lives (and dollars!)
• Nurses interface at the level of the individual, family and community
• Are we doing it?… a case study example from Middlesex
Training for Nursing/Midwifery in the UK
• Number of programmes/pathways incl BSc, PGDip (with registration)
• Direct access to specialist field of practice at UG level (e.g. Adult; Mental Health; Child; Midwifery) • BSc – 3 year programme
• PGDip – 2 year programme (fast track – must be a graduate + APEL)
Nursing at MU (Hendon Campus)
• One of London’s biggest campuses: 35,000 students in London and overseas
• Over £200million investment in creating one of London’s biggest and best-equipped campuses
• Specialist teaching spaces, labs, studios and workshops • Key focus on environmental sustainability - development of
environmentally-friendly, flexible accommodation; educating staff and students on the benefits of its eco-buildings
Nursing/Midwifery at Middlesex University
• Framework Programme admitting approx 650 students – majority of intake is Adult, followed by Mental Health, and than Child
• Commissioned by NHS – so all students training are sponsored (full tuition paid and bursary)
• Nursing and Midwifery validated separately
Curriculum for 3 year programme
Year 1 All fields together
(Adult, Mental Health,
Child)
3 modules and 1 practice placement Foundations for field of practice; Foundations for
Nursing Practice; Foundations for Professional
Practice Year 2 Field Specific
e.g. Mental Health
3 modules and 2 practice placements Approaches to Health and Social Care Research; Developing Understanding in Mental Health; Treatment Interventions in Mental Health Practice Year 3 Field Specific
e.g Mental Health
3 modules and 2 practice placements Dissertation; Meeting Complex Care Needs in Mental Health; Treatment Interventions in Mental Health Practice
Study objectives
• 1. Explore baseline perceptions among entry nursing & midwifery students towards AOD work
• 2. Explore whether current ‘AOD education’ impacts on baseline measures over time (3 FU points end of yr 1; yr 2; yr 3 – exit point) • 3. If not… do something about it!
Study Context
• In 2011 with a colleague (Prof Michael Traynor) we set out to investigate ‘workforce preparation: the changing face of nursing and healthcare support worker education and training’.
• Longitudinal panel study, capturing data on all entrants to nursing, midwifery and allied healthcare support workers’ programs, incl. personality and empathy profiles, emotional intelligence; burnout; job satisfaction;
• These baseline data are/will be tracked against participants change scores as they progress through their course of study (mapped against progression and attrition and final career destination data).
As part of the larger study…
• We included the Short Alcohol and Alcohol Problems Perception Questionnaire(SAAPPQ) and its sister instrument Short Drug and Drug Problems Perception Questionnaire(SDDPPQ)
• Data is collected at orientation to the programme (baseline); and at the end of each subsequent year of study
• In addition to the SAAPPQ and SDDPPQ, participants are asked about their own personal and family/friends experience of AOD; their opinion of the relevance of AOD training/education to their future practice as a nurse
SAAPPQ and SDDPPQ
• A ten-item measure of attitudes of professionals towards working with substance users.
• Utilizing a Likert format of 1 . Strongly agree to 7 . Strongly disagree. Some items are reversed scored – the higher the score the more positive the attitude
The items are collapsed to measure two constructs:
• Role Security (i.e. Adequacy/Legitimacy) • Therapeutic Commitment (i.e. Motivation;
Task-specific self-esteem; and Work satisfaction)
Role Support
Role Adequacy
• Lack of Knowledge & Skills
Role Legitimacy
• Its some else’s job!
Therapeutic Commitment
Motivation
• Wants to work with addicts
Work Satisfaction
• Rewarding work • Likes working with
addicts
Task Specific Self Esteem
• Has a sense of pride in work with addicts, feels proud
Mixed Methods
• In addition to the ‘quantitative data’ we wanted to contextualize what students felt about AOD work/training in their programme • Focus groups were undertaken at the end of
the 1st year of the course; and will be repeated end of yr 2; yr 3
Study Ethics
• Participation is voluntary
• Ethics approval was granted by the relevant university ethics committee
Results
• 310 students participated (80% response rate)
• 204 (66%) captured at follow up
Demographics
• 89% female
• Mean age 27 years (SD 8.1; range 18-54) • Ethnicity Breakdown
AOD Personal History
Alcohol
• 30% had experimented; 37% drink once/twice a week; 1% drink daily; 3% preferred not to answer
Cigarettes
• 22% had experimented; 7% smoke once/twice a week; 10% smoke daily; 3% preferred not to answer
AOD Family Positive History
Alcohol
20% report problems; 1% unsure; 2% declined to answer
Drug
9% report problems; 1% unsure; 1% declined to answer
AOD Friend Positive History
Alcohol
23% report problems; 3% unsure; 2% declined to answer
Drug
15% report problems; 0.6% unsure; 1% declined to answer
How relevant is AOD training to your future practice as a nurse
Baseline
• 78% relevant/extremely relevant • 6% unsure yet
• 3% not relevant at all! Follow up
• 87% relevant/extremely relevant • 1% unsure yet
• 2.5% not relevant at all!
Baseline and 1yr FU Total Sample
0 5 10 15 20 25 30 Alcohol Role Security Alcohol Therapeutic Commitment Drug Role Security Drug Therapeutic Commitment Baseline 1 Year FU
**
**
** p = 0.000 n= 204 Field Differences• No significant differences between fields in relation to Role Security at baseline
• Therapeutic Commitment was significantly greater for Mental Field students at baseline compared to other fields (Adult p= 0.00; Midwifery p=0.00; Child p=0.01)
• No differences in the percentage change score between baseline and follow up
Focus Group Findings..
Inadequate information around substance misuse prior to placement – felt
overwhelmed, information/teaching in class room in the first year does not ‘prepare’ student’s for placements
“I cared for so many patients with some form of alcohol or drug use, and just did not have the knowledge, training to support me..I really hope that 2ndyear includes more..”
The ‘Water Supply’ is already contaminated!
• Practice experience in general reveals poor role modeling by qualified nursing colleagues
– Negative and stereotypical attitudes
– Lack of knowledge & skills (impacts on ability to mentor/teach in the clinical setting)
– Lack of interest
Exclusive: Nurses feeling under
pressure, understaffed and
undervalued
30 September, 2013 |
By Steve Ford
“Eight out of 10 nurses feel
they are under more pressure
at work than they were 12
months ago, with seven out of
10 suffering the side‐effects of
stress, a major survey by
Nursing Times has found”
Dr Donna White
Only yesterday spoke to us
about …
Compassion Fatigue
Toxic Environment
43
Availability of Specialist Practice..
• Absence or pressure on access to ‘addiction specialist placement’ experience – “you can just be lucky”
So what does this mean for us at MU..
• We appear to be doing something right about Therapeutic Commitment
• However – Role Security needs work. We need to be building up year by year – no change between entry and end of yr 1 is unacceptable
• We need to also do more work with clinical colleagues via our mentoring courses/ and updates
Map this to UG nurse education
We are in effect currently taking a Crisis Response
Clinical and Service Needs have overtaken our preparedness
So we have responded by..
• Setting up courses/training for current staff and,
• Begun discussion on developing new ways of working and organizing ourselves
An AOD Work Force
Development Framework (or getting AOD into the water supply!)
Framework Systems
Current Workers Future Workers Roach, A (2001)
In its simplest terms workforce planning is getting ‘‘the right number of people with
the right skills, experiences, and competencies in the right jobs at the right
time.’’ Current Emphasis Systems Legislation Policy Funding Resources Support Mechanisms Current Workers Training Mentoring Support Best Practices Guidelines Future Workers Undergraduate/pre-qualification education Recruitment strategies Funding to employ staff Ensuring adequate services Support
Future Workers/Systems
Urgent and pressing need to focus planning on the preparation of future providers with emphasis on • Vertical educational framework which incorporates
addiction at all levels of the curricula • Inter professional /cross sector education • Competency based (e.g. SBIRT)
Future Nurses Uniform?
Is it a dream or the impact of getting AOD training into our Schools of Nursing?
In
Summary
Role of IntNSA and Global Nursing Community???
• We need a robust evidence base that teaching at this level – impacts on nursing workforce
capabilities to address AOD (Research Please and at International Level)
• We need urgent attention to be focused on the preparation of undergraduate/pre registration nurses (at Macro (water supply) not Micro Level) (e.g. IntNSA core curriculum 2ndEdition)
• We need to filter the current water supply to remove the contaminants (No blame just support and mentoring!)
Key Reference