Abstract
Information about substance use disorders (SUDs) is commonly taught in pre-licensure nursing programs. Nurses, regardless of their work settings, undoubtedly will encounter clients who deal with SUDs, and therefore it is imperative that nurse educators prepare their students for the care of these clients. But what if the person experiencing SUDs is not a client, but a colleague? This manuscript describes an innovative approach to teaching about SUDs to a class of Bachelor of Science in Nursing students that utilized a guest speaker who was a nurse in recovery from addiction. Student reflections showed that the learning activity increased their knowledge of addiction, as well as helping them to examine their own biases about people with addiction. This teaching strategy could be replicated by other nurse educators to ensure that future nurses are prepared to work alongside a colleague experiencing SUDs.
Introduction
Information about substance use disorders, often referred to as addiction, is taught in pre-licensure nursing programs because it is on the registered nurse licensure exam (National Council of State Boards of Nursing [NCSBN], 2018). While exact statistics for the prevalence of substance use disorders, sometimes abbreviated as SUDs, are difficult to provide, the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services (SAMHSA) report that the number of people affected in the United States continues to rise (2022). Nurses, regardless of their work settings, undoubtedly will encounter clients who deal with substance use disorders, and therefore it is imperative that nurse educators prepare their students for the care of these clients. But what if the substance abuser is not a client, but a colleague? How do nurse educators prepare students for working with a colleague who may be impaired? In addition, do nurse educators prepare their students to consider the fact that they too may be at risk for substance use disorders simply because they are nurses? This manuscript describes an innovative approach to teaching about substance use disorders to a class of Bachelor of Science in Nursing students that utilized a guest speaker who was a nurse in recovery from addiction. The responses from student reflections demonstrated the benefit of this teaching strategy.
Background
According to SAMHSA, “substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinical significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school or home” (2022). While it is difficult to provide exact statistics regarding the number of Americans who are diagnosed with a substance use disorder, “the percentage [of Americans] who had both AMI (Any Mental Illness) and an SUD (Substance Use Disorder) increased from 3.3 percent (or 8.1 million people) in 2015 to 3.8 percent (or 9.5 million people) in 2019” (SAMHSA, 2022).
Do nurse educators prepare their students to consider the fact that they too may be at risk for substance use disorders simply because they are nurses?
Likewise, it is also difficult to measure the prevalence of substance abuse among practicing nurses, due to variations in incidences, inconsistencies with voluntary reporting, and differing state guidelines. However, the NCSBN's most recent RN Practice Analysis lists “Report, intervene, and/or escalate unsafe practice of health-care personnel (e.g., substance abuse, improper care, staffing practices)” as number 39 out of 146 practice activities, indicating that 78% of newly licensed registered nurses reported performing this activity in their first year of employment (NCSBN, 2022). Given this information, it is imperative to provide education to nursing students about the signs, risks, consequences, and experiences of nurses with substance use disorders in order to illustrate the importance of awareness, increase identification in the workplace among coworkers, decrease stigma, and above all, keep clients safe.
Overview of Learning Activity
A class of nursing students in an accelerated program at a small private liberal arts college participated in a study guided by Mezirow's Theory of Transformative Learning (Mezirow, 1991), examining whether students found learning activities aimed at caring for vulnerable populations meaningful, and if those learning activities led to a change in perception about that population. The university's Institutional Review Board gave approval for the study. Because of the stereotypes about people with substance use disorders, a learning activity was designed to help students examine their biases and think beyond typical nurse-patient scenarios for this topic.
Information about substance use disorder was delivered in a traditional format (lecture, readings, case study) the week before this learning activity, to introduce the topic and provide content. In the learning activity, a nurse who is in recovery was invited to share her story with the students. The class session was called “A Nurse's Story,” and students did not know what the context of the class was going to be. The story included information about the nurse's addiction and recovery, and what nurses might do if working with a colleague who has a substance use disorder.
Student Reflections
Students (n=14) were assigned eight reflective journal entries throughout the semester on four different clinical experiences assigned for the mental health course, including the one assigned for this learning activity. The assignment for this journal entry was: After you hear “A Nurse's Story,” complete a reflective journal entry addressing the following: Was this learning experience meaningful to you? Why or why not? What did you learn, if anything? Did this experience change your perceptions of people who are recovering from substance abuse?
The journals were submitted to the university's learning management system and only read by the principal investigator, who was the course instructor. After the course was completed, the journals were downloaded into one file to be coded using content analysis. The actual words of the participants were used to create the coding scheme (Creswell, 2005).
Hearing from a nurse in recovery was a meaningful learning experience for students and, for some students, led to a change in perceptions about people with substance use disorder. Their reflections indicated that their knowledge of addiction was increased, and their knowledge of policy was increased as well. One student wrote:
[The nurse's] experience of lifelong recovery was interesting, especially their journey to getting their full nursing licensure back. The number of steps necessary to work as a nurse again was unbelievable, and their fortitude and commitment to their recovery are admirable. I hope they continue to speak to future nursing students. I don't think enough people in healthcare genuinely understand addiction and how to approach someone going through the trials and tribulations that come along with it. Having [the nurse] so openly tell their story will benefit me in my practice as a nurse, and I think it will do the same for future cohorts.
Reflections also indicated that some students ‘biases towards people with addiction changed. Some described actually seeing and hearing from a nurse in recovery as “powerful.” One student wrote:
This experience was a reminder to me that looks can be deceiving. Seeing our speaker, and meeting them, I would have no idea that they are a recovering substance abuser.
Another stated:
Before [the nurse's] presentation, I did have a stigma of addicts being people on the side of the road begging for money. Now, I am more willing to assist someone with an addiction history because of [the nurse's] statement, “No one dreams of becoming an addict.”
Students also gained knowledge that they will take forward into their nursing practice, as stated by this student:
I did appreciate [the nurse's] candor because by doing so, they allowed us to be able to identify someone that needs help and what to watch for in our colleagues; for example, I will watch a nurse “waste” medication instead of just signing off.
Discussion
Hearing from a nurse who was willing to share their story of addiction and recovery was a meaningful learning activity for nursing students, and one that would be beneficial to replicate in other programs. The students recognized that it took a great deal of bravery for the nurse to share their story, and recommended that future student groups have the same opportunity.
A student said, Now, I am more willing to assist someone with an addiction history, because of the nurse's statement, “No one dreams of becoming an addict.”
For other nurse educators who want to incorporate this learning activity but are unsure how to find a nurse willing to share, there are many state-level resources that could provide assistance. For example, the Nurses Peer Support Network, originated in Minnesota, offers in-person, hybrid, and online meetings for nurses affected by substance use disorders (
Conclusion
Substance use disorder is an important topic and should continue to be a part of nursing curricula. However, updating this content to include addiction among health-care providers is also important. Hearing from a nurse who was addicted and is now in recovery was a powerful teaching strategy that proved to be meaningful to nursing students. This strategy could be replicated by other nurse educators to introduce future nurses to the possibility that one day they may be faced with reporting a colleague whom they suspect is suffering from substance use disorder.
Cite this article:
DeBrew, J. (2023). “Looks can be deceiving”: An innovative way to teach nursing students about substance use disorder. Creative Nursing 29(1), Article 11.
Footnotes
The author declares no conflict of interest.
Jacqueline DeBrew, PhD, MSN, RN, CNE, (she/her). is Associate Professor of Nursing and RN-BSN Coordinator in the Department of Nursing at Elon University in Elon, North Carolina, USA.