10/17/2013. Getting Addiction into the Nursing Education Water. Supply

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1 Riding the Wave of Change in Health Care: Interprofessional Collaboration and Caring for Substance Use Disorders, IntNSA, Washington DC, October 2013 Getting Addiction into the Nursing Education Water GETTING ADDICTION INTO THE NURSING Supply 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 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 are practitioners? How many of you have undertaken post graduate training in addictions? How many of you were exposed to training during your undergraduate nursing courses? What was the length of exposure? e.g. number of hours? How many of you have or currently teach undergraduate students about addiction? Why mainstreaming substance use/misuse training at undergrad level is essential 1

2 Efforts in the UK Where are we now How time flies.. US is no different to UK 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: 8hrs 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: 12hrs 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, 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.) 2

3 That s not to say that no one is doing anything..there are some excellent examples and initiatives HOWEVER So what do we know so far 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. 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 Education/training is part of solution 3

4 Training for Nursing/Midwifery in the UK Are we doing it? a case study example from Middlesex 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 Year 2 Year 3 All fields together (Adult, Mental Health, Child) Field Specific e.g. Mental Health Field Specific e.g Mental Health 3 modules and 1 practice placement Foundations for field of practice; Foundations for Nursing Practice; Foundations for Professional Practice 3 modules and 2 practice placements Approaches to Health and Social Care Research; Developing Understanding in Mental Health; Treatment Interventions in Mental Health Practice 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! 4

5 Study Context As part of the larger study 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). 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 Therapeutic Commitment Role Adequacy Lack of Knowledge & Skills Role Legitimacy Its some else s job! Motivation Wants to work with addicts Task Specific Self Esteem Has a sense of pride in work with addicts, feels proud Work Satisfaction Rewarding work Likes working with addicts 5

6 Mixed Methods Study Ethics 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 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 6

7 AOD Friend Positive History How relevant is AOD training to your future practice as a nurse Alcohol 23% report problems; 3% unsure; 2% declined to answer Drug 15% report problems; 0.6% unsure; 1% declined to answer 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 ** p = n= Alcohol Role Security Alcohol Therapeutic Commitment ** ** Drug Role Security Drug Therapeutic Commitment 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 Baseline 1 Year FU Focus Group Findings.. Impact of clinical placement 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 2 nd year includes more.. 7

8 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.. So what does this mean for us at MU.. Absence or pressure on access to addiction specialist placement experience you can just be lucky 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 To take us back to Dr McLellen The Future? 8

9 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) Current Emphasis 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 Workers Training Mentoring Support Best Practices Guidelines Systems Legislation Policy Funding Resources Support Mechanisms Future Workers Undergraduate/prequalification education Recruitment strategies Funding to employ staff Ensuring adequate services Support 9

10 Future Workers/Systems Urgent and pressing need to focus planning on the preparation of future providers with emphasis on Future Nurses Uniform? Is it a dream or the impact of getting AOD training into our Schools of Nursing? Vertical educational framework which incorporates addiction at all levels of the curricula Inter professional /cross sector education Competency based (e.g. SBIRT) 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 2 nd Edition) We need to filter the current water supply to remove the contaminants (No blame just support and mentoring!) Key Reference Thank you for listening Questions???? 10

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