Literature Review: Improving attitudes of nurses when caring for

patients with drug and substance abuse issues

Sonu Scaria

Clinical Nurse Educator, Justice Health

Graduate Diploma in Acute Care Nursing

Address- 8 Waterfall Cresent,Dubbo,NSW, 2830

sonut86@yahoo.in

0469834776

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Title
Improving attitudes of nurses when caring for patients with drug and substance abuse issues.

Keywords
Training, education, attitude, institutional support, and substance abuse

Abstract
Objective: To examine some of the ways that can be used to enhance the attitude that nurses
have in reference to patients who have been identified with drug and substance abuse issues.
Setting: Clinical nursing environment where nurses deal with patients with drug and substance
abuse issues.
Subjects: The subjects in this literature review are nurses and patients with drug and substance
abuse issues.
Primary argument: Patients suffering from drug and substance issues not only have to deal with
various challenging situations but also have to face discrimination. About 78% of health
professionals refuse to work with patients facing drug and substance abuse problems. Nurses
have negative attitudes towards patients with such issues which leads to barriers in providing
optimal nursing care (Barry et al 2014). Training or education was the best approach that can be
used to change nurse attitude towards patients who have been identified with addiction problems.
The use of institutional methods such as counseling, therapy, consultation and staff support by
the seniors can also be used to change the negative stereotypes that nurses have towards drug
addicts.
Conclusion: However, it was concluded that training was the main method used by hospital
management to change the attitude of nurses against drug addicts. Despite the assistance of
literature on the topic, it was recommended that a new study needs to be undertaken and
investigate how institutional support, training/education, and experience influence nurse attitude
towards addicts using the theoretical framework as a set, conversely to how previously the
intervention/methods have been studied individually.

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Introduction

Nurse attitude towards patients who have been diagnosed with substance abuse had
become a prevalent issue in many hospitals and its consequences are far-reaching owing to
potential dangers that such perception can have on effective delivery of medical assistance to
those who are in need. The literature review will discuss some of the interventions and methods
that can be used to improve nurse attitude towards patients with substance abuse difficulties.

Discussions

Training/education

Nedenleri (2016, pp. 105) sought to examine the perception that nurses working in the
emergency unit had towards the treatment of patients with substance addiction difficulties.
Nedenleri (2016, pp. 109) adopted a descriptive study using three healthcare care facilities and, a
total of 86 nurses was used in the research as the sample size. Data were analysed using
descriptive statistics, T-Test, besides correlation analysis was applied. The results show that
approximately 49.43±19.59 of nurses generally had a negative attitude in regard to patients who
had substance abuse problem due to the constant conduct of going back to drugs after being
treated (Nedenleri 2016, pp. 105). The article established that most of the nurses who worked in
the emergency unit had developed negative perceptions concerning patients with the history of
using various forms of substance abuse. As a result, most of the nurses maintained a social
distance with the addicts (Nedenleri 2016, pp. 105). Nurses who had served for many years
strongly believed that the use of social programs to reduce substance abuse among addicts were
less effective because it failed to produce positive results in the long run, especially after the
victims reverted back to addiction conduct.

In a different study, Bartlett et al (2013, pp. 349) sought to examine how positive nurse
attitude could be used to reduce suffering among persons who have substance abuse challenges.
According to Bartlett et al (2013, pp. 349), it is the duty of the nurses to ensure that they reduce
pain among the patients without any form of prejudice as to whether they are addicts or not, and
hence the need to improve their attitude and perceptions relating to them. However, in contrast
to the findings made by Nedenleri (2016, pp. 113) regarding the negative attitudes of toward the

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substance abuse patients, Bartlett et al (2013, pp. 349) note that the main problem that compels
nurses to develop negative attitude when caring for patients with substance addiction problem
was the shortage of training to manage deviant behaviours that the victims displayed, and which
in most cases threatened the social interactions among them.

Secondly, Bartlett et al (2013, pp. 349) suggest that belligerent conducts among the
addicts made nurses to develop a fear that something bad could happen when caring for the
victims. In conclusion, whereas Nedenleri (2016, pp. 113) generally summarised the nurses’
views toward addicts, Bartlett et al (2013, pp. 349) concluded that the lack of technical
knowledge and enhanced training on how to handle victims with substance addiction difficulties
was the key factor that caused dissatisfaction among nurses, and therefore the negative attitudes
against them. As such, the article established that the only way to improve nurse attitude and
perceptions relating to patients with substance abuse problems was through intensive and
extensive training on how to handle the aggressive nature of the patients (Bartlett et al 2013, pp.
349).

A study by Meg (2014) contrasted with the findings made by Bartlett et al (2013).
Whereas Bartlett et al (2013) established that training was key in improving nurse attitudes
toward patients with substance abuse, Meg (2014, pp. 195) replied to the article written by
Bartlett et al (2013) highlighting that nurses were extremely judgmental when it comes to
persons with substance addiction compared to other workers in the health facilities. In reference
to the article, nurses had a premeditated attitude against this group and anytime they are called to
help they would not do it disappointingly due to the low regard they placed on them (Meg 2014,
pp. 195). Therefore, to improve nurses’ attitude in relation to the addicts, Meg (2014, pp. 195)
asserts that nurses should be encouraged to change the present judgmental views and consider
substance abuse victims as normal patients who need care and assistance to recover from their
addiction.

Moreover, Meg (2014, pp. 195) emphasises that the negative attitudes that the nurses
have against patients with addiction difficulties emanate from the fact that they regard the
condition as being self-induced by the victims, and therefore a waste of time to care for people
who will go back and abuse drugs again. Nevertheless, to offer quality nursing care to victims
with substance abuse, Meg (2014, pp. 195) recommends the change of the judgmental

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perceptions that nurses have in relation to such persons, and extend quality care to them just like
any other patients. Secondly, nurses should be less hypercritical on the cause of addiction among
the patients when compared to other practitioners at the hospital such as the doctors.

With the objective of examining the different ways that can be used to improve nurses’
attitudes in relation to persons with drug addiction, Pillon et al (2013) sought to survey how
undergraduate training could be used to change the perceptions that nurses had developed when
handling patients who are addicted to different drugs. According to the study, existing literature
has published extensively about the challenges that nurses encounter when giving treatment and
care to patients who are considered to be addicts, yet, little is known on what can be done to
influence the adverse approach that nurses have against them for the purposes of effective health
care (Pillon et al (2013, pp. 123). Therefore, Pillon et al (2013, pp. 119) content that the lack of
knowledge on how to handle diverse conditions resulting from drug addiction is responsible for
causing dissatisfaction among nurses and which led to the negative attitude. To change their
perceptions, Pillon et al (2013, pp. 119) suggest that nurses must be trained on how to handle
multiple conditions that are presented by the substance abuse victims. This can be achieved by
supporting the curriculum change which focuses on substance abuse and care management in the
undergraduate nursing studies. The aim is to equip the nurses with vital knowledge on how to
handle patients who are addicted to drugs.

Comparable findings were reported by Stanbrook (2012, pp. 155) and Wylie (2010, pp.
618) who established that the lack of training/knowledge among nurses on how to handle
multifaceted conditions from addicts caused dissatisfaction and hence negative attitude. Equally,
to improve nurse attitude, both Stanbrook (2012, p 155) and Wylie (2010, pp. 630) recommend
the use of training programs to adjust nurse attitudes when it comes to substance abuse patients.

In yet a different study Harling (2017, pp. 153) sought to examine how the attitude of
nurses could be improved to enhance the patient relationship and the provision of effective
service delivery to all victims who report to various health facilities. As a result, the author
examined the nature of the attitudes that nurses had when presented with substance abuse
patients. A sample of 23 nurses was recruited for the descriptive study. From the analysis made,
the findings exposed that nurses tend to have a negative attitude towards patients who were
addicts and using different drugs such as heroin.

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 The results were concurred by Pereira et al (2018, pp.349) who note that education was
the best approach through which health care management could apply to enhance nurse attitude
towards patients with addiction problems. Based on the article, the use of basic training was
significant because it helped in educating nurses about the primary care and treatment for
addicts. As a result, nurse training enhanced their confidence and knowledge and automatically
changed their negative perceptions against such patients. A different cross-sectional study was
done by Raistrick et al (2018, pp. 56) in Australia which shows that nurses who had undertaken
basic training in managing patients with addictions found it less traumatising to handle the
victims.

Crapanzano and Fisher (2014, pp. 420) also probed the change of perception among
nurses against addict patients who had therapeutic challenges. The intent of the research was to
reduce the stigma that was linked to the manner in which nurses viewed patients that were
addicted to drugs. A 3-hour lecture on intervention mechanism was given to the selected sample
where discussion and lectures were held (Crapanzano and Fisher 2014, pp. 420). Discussions and
meetings that were educative and informative in nature focused on the methods used to relate
handle addiction as well as writing, self-reflection about the experiences they gain from the
programs. The study found that by educating nurses on how to handle the different type of
addiction as well as the aggressive behaviour presented by the patients, training through
educative programs were effective in promoting a positive attitude among the nurses
(Crapanzano and Fisher. 2014, pp. 423).

Similarly, Barry et al (2014, pp. 1269) concurred with the findings made by Ford et al
(2008) when they reported that, among the 45 respondents who participated in the study, 68% of
them indicated that they faced challenges in handling different types of addictions which resulted
into frustration, and hence the negative attitude (Barry et al 2014, pp. 1269). As a result, the
surveyed nurses suggested the use of education/training to help them with practical knowledge
on how to handle the deviant behaviours that are presented by the addicts (Barry et al 2014, pp.
1270). Also, 32% of the respondents recommended the need for direct support by the senior
staffs and supervisors in handling the patients as some of them are aggressive and can easily
harm the nurses (Barry et al 2014, pp. 1271).

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 De Barros et al (2015, pp. 129) also investigated the effects education program
intervention in changing the attitudes that the nurse had towards individuals with drug abuse
difficulties. After assessing the attitude and knowledge among the nurses before and after the
intervention program, a quasi-experiment study that had 120 participants revealed that the nurses
exhibited a significant shift in how they viewed addicted persons who were seeking treatment.
De Barros et al (2015, pp.135) note that the provision of education programs among the
undergraduate nurses positively enhanced their knowledge and understanding of substance abuse
and hence improving the type of attitude they had conceptualised against the victims, especially
those who had problems with alcohol. Similar findings were reported by Monks and Newell
(2013, pp. 946) who suggest the use of training methods to change nurse perception towards
patients who have drug addiction problems.

Nevertheless, Morley et al (2015, pp. 711) differed with the findings made by Van
Boekel et al (2015, pp. 497), Newell (2013, pp. 946) and De Barros et al (2015, pp.135) about
the use of education in helping nurses to improve their attitudes in regard to patients with
drug/substance abuse. According to Morley et al (2015, pp. 710), 67% of the nurses who were
examined on the effectiveness of training and other methods used to change their attitudes in
regard to patients who had substance abuse, indicated that perception was internal and it was
determined by ethics which guide the practitioners. Those who considered it ethical to take care
of the patients would change after being trained on how to handle drug addicts (Morley et al
2015, pp. 711). Conversely, nurses who consider addiction as a self-inflicted pain could not
change their minds easily, even after being given extensive training on the care and management
of a person with substance abuse problems (Morley et al 2015, pp. 710). Similar results were
reported by Mendiola et al (2018, pp. 135) who also found that despite the fact that nurses in the
different hospital were educated and trained on how to handle addicts, the majority of them did
not show a significant change in their perceptions about the nature addicts. Mendiola et al (2018,
pp. 134) note that 35% of the respondents stated that there was no need for them to be concerned
with people who directly engage in activities that they knew would affect their lives and such
effort was diverted in treating other types of patient who had terminal illnesses.

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Institutional support methods

Despite the effectiveness of the training methods and how they can be used to mitigate on
the types that nurses have against drug addicts, Van Boekel (2013, pp.23) criticised studies like
Mendiola et al (2018, pp. 134), Morley et al (2015, pp. 711) and by Raistrick et al (2018, pp. 56)
among others of ignoring to examine the effectiveness of institutional based interventions on
how they can be used to enhance the attitude that nurses had against addicts. As such, van
Boekel (2013, pp. 27), report that nurses who receive a role and professional support of the
seniors on how to handle patients with addiction showed improved relations afterward and their
response in regard to treatment improved significantly.

Ford et al (2008, pp. 1269) surveyed the effects of therapeutic attitudes that nurses head
towards patients with illicit-drug addictions. The intent of the researchers was to establish the
determinants of therapeutic attitude that the nurse had towards the patients who had been
diagnosed with addiction problems. Ford et al (2008, pp. 2462) found that nurses discriminated
against patients who were linked to substance abuse and linked to the self-inflicted problem. As a
result, Ford et al (2008, pp. 2461) note that nurses found it difficult to provide care for them.
However, an effort to improve nurses’ perceptions, the study found that institutionally based
interventions were effective (Ford et al 2008, pp. 2462). In addition, Harling (2017, pp. 153)
established that the use of institutional support methods such as counselling, consultation and
overall support of how nurses could handle patients with drug addiction conditions, significantly
contributed to the enhanced understanding among the nurses and heightened the nature of
relations they had with drug addicts.

Neville (2014, pp. 339) investigated the perceptions that the nurses had when caring for
hospitalised patients who have been diagnosed with substance abuse. From the findings made,
nurses tend to show disparity when taking care of victims who are suffering from addiction-
related complication as they perceive it to be intentional, and there was a high chance that after
receiving medication the patients would go back to the use of different drugs. However, to
influence their attitudes and compel them to offer quality and equitable treatment, Crapanzano
and Fisher (2014, pp. 425) recommend the use of institutional support programs that are meant to
empower nurses on how to handle such patients and be ready to offer fair medication. Equally, to
reduce the negative attitudes that nurses have towards patients with substance abuse problems,

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Van Boekel et al (2015, pp. 496) advocate for the use of counselling intervention techniques to
offer the nurses with a chance to learn how to manage the different experiences they encounter
when handling drug addicts in the hospitals.

Improving nurse experience

While studies such as Crapanzano and Fisher (2014, pp. 425), Van Boekel et al (2015,
pp. 496), Ford et al (2008, pp.2462) and Harling (2017, pp. 153) and others focus on education
and institutional support to help change nurse attitude towards drug addicts, Van Boekel (2013,
pp.27) differed and criticised the studies of ignoring the central factor that can significantly
change nurse attitude. Nurses who had wide experience in handling people with addiction
problems improved their attitude significantly. The above findings are supported by Kelleher and
Cotter (2009, pp. 3), who note that the use of rich nursing experience with many years of practice
could help in change nurse attitude towards patients with substance addiction. Furthermore,
Crapanzano and Fisher (2014, pp. 424) found that nurses who had practiced for many years with
frequent interaction with drug addicts reduced the level of stereotypes that the nurses had
conceptualised about patients with substance abuse problems, and hence improving medical care
towards the addicts.

Conclusion

In summary, the literature review above sought to examine the different approaches
through which nurse attitudes toward the patient with substance abuse problems can be
improved. After critically examining the current literature, the analysis has revealed different
methods that have been proposed by different researchers in improving the attitude that nurses
have when interacting with patients experiencing substance abuse. One of the methods that have
been examined widely by previous studies is the use of training techniques to empower nurses on
how to handle different traumatising encounters presented by the drug addicts. Secondly, the use
of institutional support methods such as consulting and counselling has also been suggested as an
alternative approach that can be applied when there is a need to change nurse attitudes against
drug addicts who are seeking medical services in different health centers. Thirdly, the level of
experience that nurses have has also been linked to their ability to influence and change the
concept of negative attitudes toward the patients. Nurses who have long experience in handling

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drug addicts changed their attitude compared to newly graduated nurses who found it difficult to
handle such patients with fear of physical harm from the drug addicts.

Recommendations

There still exist insufficient researches on how the above - discussed methods in the
literature review can be used to improve nurse attitude. The publications are scanty and a new
study is required to assess a combination of how education, training, institutional support, and
experience affects nurse attitude towards patients with substance abuse using different theoretical
models.

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References

Bartlett, R., Brown, L., Shattell, M., Wright, T. and Lewallen, L. 2013. Harm reduction:
Compassionate care of persons with addictions. Medsurg nursing: official journal of the
Academy of Medical-Surgical Nurses, 22(6): 349.

Barry, C.L., McGinty, E.E., Pescosolido, B.A. and Goldman, H.H. 2014. Stigma, discrimination,
treatment effectiveness, and policy: public views about drug addiction and mental
illness. Psychiatric Services, 65 (10): 1269-1272.

Crapanzano, K., Vath, R.J. and Fisher, D. 2014. Reducing stigma towards substance users
through an educational intervention: harder than it looks. Academic Psychiatry, 38 (4): 420-425.

De Barros Junqueira, M.A., Rassool, G.H., dos Santos, M.A. and Pillon, S.C. 2015. The impact
of an educational program in brief interventions for alcohol problems on undergraduate nursing
students: a brazilian context. Journal of addictions nursing, 26 (3): 129-135.

Ford, R., Bammer, G. and Becker, N. 2008. The determinants of nurses’ therapeutic attitude to
patients who use illicit drugs and implications for workforce development. Journal of clinical
nursing, 17(18): 2452-2462.

Harling, M.R. 2017. Comparisons between the attitudes of student nurses and other health and
social care students toward illicit drug use: An attitudinal survey. Nurse education today, 48:153-
159.

Meg, D. 2014. Harm reduction: compassionate care of persons with addictions. Medsurg
Nursing, 23 (3): 195.

Mendiola, C.K., Galetto, G. and Fingerhood, M. 2018. An exploration of emergency physicians’

attitudes toward patients with substance use disorder. Journal of addiction medicine, 12 (2) :132-
135.

Monks, R., Topping, A. and Newell, R. 2013. The dissonant care management of illicit drug
users in medical wards, the views of nurses and patients: a grounded theory study. Journal of
Adv Nursing, 69(4) :935-46.

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11
Morley, G., Briggs, E. and Chumbley, G. 2015. Nurses' experiences of patients with substance-
use disorder in pain: a phenomenological study. Pain Management, Nursing, 16 (5): 701-711.

Nedenleri, A.S.Ç.H.B. 2016. Perceptions and Attitudes of Nurses Working At Emergency Unit
About the Causes and Treatment of Addiction. Journal of Psychiatric Nursing, 7(3):105-113.

Neville K. and Roan, N. 2014. Challenges in nursing practice: nurses’ perceptions in caring for
hospitalised medical-surgical patients with substance abuse/dependence. Journal of Nursing
Administration, 44 (6): 339-46.

Kelleher, S. and Cotter, P. 2009. A descriptive study on emergency department doctors’ and
nurses’ knowledge and attitudes concerning substance use and substance users. International
Emergency Nursing, 17 (1): 3-14.

Pereira, S.C.C., Andreto, L.M., Souza, A.I., da Silva Frazão, I., Rassool, G.H. and Pillon, S.C.
2018. Knowledge and perceptions of undergraduate nurses towards the use of cocaine (smoked)
in a Brazilian context. Archives of psychiatric nursing, 32 (3) :348-352.

Pillon, S.C., Luis, M.A.V. and Laranjeira, R. 2013. Nurses' training on dealing with alcohol and
drug abuse: a question of necessity. Revista do Hospital das Clínicas, 58 (2): 119-124.

Raistrick, D.S., Tober, G.W. and Unsworth, S.L. 2015. Attitudes of healthcare professionals
in a general hospital to patients with substance misuse disorders. Journal of Substance Use, 20
(1): 56-60.

Stanbrook, M.B. 2012. Addiction is a disease: We must change our attitudes toward addicts.
Canadian Medical Association Journal, 184 (2:115): 155.

Van Boekel, L.C., Brouwers, E.P., Van Weeghel, J. and Garretsen, H.F. 2013. Stigma among
health professionals towards patients with substance use disorders and its consequences for
healthcare delivery: systematic review. Drug and alcohol dependence, 131 (1-2): 23-35.

Van Boekel, L.C., Brouwers, E.P., Van Weeghel, J. and Garretsen, H.F. 2015. Comparing
stigmatising attitudes towards people with substance use disorders between the general public,
GPs, mental health and addiction specialists and clients. International Journal of Social
Psychiatry, 61(6): 539-549.

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12
Wylie, L.W. 2010. Assessing user perceptions of staff training requirements in the substance use
workforce: A review of the literature. Drugs: education, prevention and policy, 17(5):618-631.

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