"It's My Secret": Shame as a Barrier to Care in Individuals With Opioid Use Disorder.

BACKGROUND: Substance use disorder (SUD) is a chronic illness impacting more than 59 million Americans last year. Opioid use disorder (OUD) is a subset of SUD. The literature supports that healthcare providers frequently stigmatize patients with OUD. Individuals with OUD often feel shame associated with their disorder. Shame has been associated with maladaptive and avoidant behaviors. AIM: The aim of this qualitative descriptive study was to examine and describe the experiences of shame and health-seeking behaviors in individuals with OUD. METHODS: A qualitative exploratory design using focus groups with individuals in treatment for OUD was used to identify the issue of shame and its relationship to health-seeking behaviors. RESULTS: A systematic content analysis of discussions with 11 participants in four focus groups revealed four major themes and associated subthemes: Avoidance of Preventive Care (belief providers are judgmental); the Hidden Disorder (keeping secrets); Constraints of Shame (justification for the continuation of drug usage); and Trust in MOUD (Medication for Opioid Use Disorder) Providers. The feeling of shame leads to a reluctance to engage in health-promoting actions, such as scheduling appointments with primary care providers and dentists. CONCLUSION: Healthcare practitioners must prioritize providing a safe, nonstigmatizing environment for patients with SUD/OUD. This includes establishing trust and rapport, providing education, collaboration with psychiatric mental health specialists and other healthcare providers, and the offering support and resources to help patients manage their condition to achieve optimal health outcomes.

Creating a Community of Nurse Educator Scholars: The QSEN Academic Task Force Success.

BACKGROUND: Engaging in scholarship is a critical component of being an effective nurse educator and can have a significant impact on the nursing profession as a whole. PROBLEM: Nurse educators are expected to teach and simultaneously engage in scholarship. Barriers include heavy workloads and lack of resources including faculty mentors. Evidence supports that organized work groups support success. APPROACH: Members of the Quality and Safety Education for Nurses (QSEN) Academic Task force were queried about scholarly activity as a result of engagement with fellow task force members. OUTCOMES: Scholarly outcomes included numerous peer-reviewed publications, teaching tips, presentations, and grants. CONCLUSION: Participating in national work groups can serve as a platform for fostering a community of scholars to make meaningful contributions to the profession.

A Labor of Love: From Cranberry Biologist to Nurse Scholar and Educator.

There are many nursing scholars who have contributed to nursing knowledge. Dr. Monika Schuler started her career as a cranberry biologist and is now a nurse scholar and educator. Her contributions to nursing knowledge include two new models that contribute to our understanding of nursing professional growth: (1) the reflection, feedback, and restructuring model for role development in nursing and (2) the substance use disorder nursing attitude model. Dr. Schuler is working with colleagues toward developing an understanding of how nursing experiences inform their role development. In this scholarly dialogue, Dr. Schuler shares her path to nursing scholarship and her recent contributions to nursing knowledge development.

Original Research: Nurses' Self-Assessed Knowledge, Attitudes, and Educational Needs Regarding Patients with Substance Use Disorder.

BACKGROUND: Substance use disorder (SUD) is a chronic illness, but it's often seen as an intentional choice rather than as a disease. People with SUD are frequently stigmatized, leading to disparate care. Findings from previous studies have indicated that nurses feel inadequately prepared to care for, and tend to have negative attitudes toward, patients with SUD. But it's unknown what kind of education would better prepare nurses caring for this patient population, or whether these negative attitudes vary across practice settings. PURPOSE AND DESIGN: This observational, cross-sectional, mixed-methods study sought to explore nurses' self-assessed knowledge of and attitudes toward caring for patients with SUD (whether formally diagnosed or not) in hospital settings across the United States. A secondary aim was to determine nurses' educational preferences and needs in this area. METHODS: Data were collected over a three-month period in early 2020, using the online social networking platform Facebook. All participants were nurses working in hospital settings throughout the United States. Participants were surveyed using two tools: the Drug and Drug Problems Perceptions Questionnaire, and another questionnaire that included open-ended questions regarding nurses' SUD-related education and their experiences and perceived needs in caring for patients with SUD. Quantitative data were analyzed using analysis of variance and post hoc Tukey tests. Qualitative data were analyzed using thematic analysis. RESULTS: A total of 691 nurses participated. Nurses reported having been educated in SUD but wanted additional face-to-face education from mental health specialists. The nurses working on mental health units had significantly more positive attitudes toward caring for patients with SUD than nurses on other units. Older nurses had significantly more positive attitudes toward patients with SUD than younger nurses. Qualitative analysis uncovered four themes: unmet needs, personal experiences inform care, personal beliefs inform perceptions, and judgmental attitudes. CONCLUSIONS: Study findings indicate that, in general, hospital nurses have negative attitudes toward patients with SUD. The results further reaffirm the need for empathy-based nursing education for nurses who care for these patients. Participants expressed a preference for face-to-face training by mental health specialists experienced in SUD. Given the increasing prevalence of SUD and the expected retirement of older nurses, it is urgent that we prioritize empathy-based nursing education, particularly for newer-to-practice nurses, in order to improve nurses' attitudes and ensure best care for patients with SUD.

Perceived stigma, barriers, and facilitators experienced by members of the opioid use disorder community when seeking healthcare.

INTRODUCTION: Healthcare professionals, particularly nurses, have negative attitudes towards individuals with opioid use disorder (OUD) and these attitudes can contribute to suboptimal care. The aim of this study was to identify stigma, barriers and facilitators experienced by members of the OUD community when interacting with the healthcare system. DESIGN: A qualitative exploratory design used semi-structured focus group interviews to address the study aim. METHODS: Following IRB approval, purposive sampling was used to recruit participants with a history of OUD, family caregivers of individuals with OUD, and support group leaders from regional recovery groups to provide a broad perspective of stigmatizing issues and barriers to care. Focus group discussions were conducted, and video recorded using web-based conferencing software. Transcripts from the focus groups and field notes were analyzed and coded into themes. RESULTS: Both structural and social determinants of health were identified by participants as stigmatizing and/or barriers to care. Thematic content analysis resulted in eight themes: stigmatizing language, being labeled, inequitable care, OUD as a chronic illness, insurance barriers, stigma associated with medications for OUD (MOUD), community resources, and nursing knowledge and care. CONCLUSION: Members of the OUD community are challenged by both internal and external stigma when seeking healthcare. Stigma negatively affects public support for allocation of resources to treat OUD. Interventions aimed at reducing stigma are critical to support effective OUD treatment and prevent barriers to OUD care. CLINICAL RELEVANCE: Understanding the complex relationships between stigma and structural determinants of health will allow nursing science to develop educational interventions that provide the next generation of nurses with the knowledge, skills, and attitudes needed to advance health equity for individuals with OUD.

A model to understand antecedents of nursing attitudes and perceptions influencing outcomes of patients with SUD.

INTRODUCTION: Substance use disorder (SUD) is a persistent and long-standing public health issue in the United States. While SUD is medically considered a chronic illness, it is also one that is viewed as self-inflicted, thereby resulting in judgmental attitudes and stigmatization from care providers, specifically from nurses. DESIGN: In 2020, the authors completed an analytical cross-sectional study that included open-ended questions to examine nurses' knowledge and attitudes toward caring for patients with SUD across practice settings. METHODS: A conceptual model was constructed by examining original study data and published literature on SUD, re-analyzing themes, determining constructs and variables, then coming to a consensus on critical aspects of the model. CONCLUSION: The resulting conceptual model highlights antecedents of nursing behaviors that directly affect patient care outcomes, providing a roadmap to improving patient outcomes. CLINICAL RELEVANCE: Understanding antecedents that affect nurses' attitudes and perceptions of patients with SUD highlights changes that can influence patient outcomes.

Nursing student perceptions of required online educational programs utilized outside the classroom.

BACKGROUND: The use of online educational programs (OEPs) such as ATI™, Kaplan™, and Course Point™, to facilitate learning is generally thought to be an innovative and complementary approach to supplement learning across many nursing programs. The rapid transition to an online learning environment, dominated by Zoom, as a result of the COVID-19 pandemic has further increased faculty and student reliance on OEPs both in and out of the classroom. The aim of this study is to examine student perceptions of faculty assigned OEPs utilized outside the classroom. METHOD: Cross-sectional, correlational survey design was used to explore the relationships between student perceptions and the use of OEPs among nursing students enrolled in a traditional baccalaureate nursing program. RESULTS: Nursing students (n = 221) spent an average of 7.85 h on OEPs and an additional 6.4 h on the Zoom platform. Sophomore students spent significantly more hours engaging in the OEPs (F(3,191) = 10.09, p = .00) and Zoom (F(3,193) = 8.89, p = .00) than the other academic levels. On average, sophomores spent a total of 20 h per week engaging in OEPs (M = 10.9, SD = 11.5) and Zoom (M = 9.18, SD = 4.3). Freshmen students had a significantly more favorable view of OEPs than senior students did (p = .02). Qualitative data analysis from open ended responses revealed four themes: Too many programs, Cost, Technological challenges, and Benefits. CONCLUSIONS: The cost, ease of use, and the number of OEPs assigned influence student perception of OEP. Faculty should be mindful of student burden related to number of OEPs assigned, time required to complete the OEPs, and cost. Furthermore, faculty should consider collaborating with other faculty to streamline the use of OEPs, enhance relevancy, and eliminate redundancy.

A Cohort Model of Mentoring as Facilitator to the Transition to an Academic Nurse Faculty Position Following Completion of a PhD.

ABSTRACT: Successful transition to an academic nurse educator role is challenging; it is necessary to identify facilitators and barriers that aide or hinder this process. This study used an autoethnographic qualitative design to explore the lived experiences of a cohort of faculty during their transition into a tenure-track role. Three facilitators (noncompetitive environment, resource sharing, and cohort approach) and two barriers (work-life balance and intrusion of old habits) emerged as themes. A cohort model can be a valuable facilitator for a successful transition. Multitiered mentoring further aided in the transition.

Description and comparison of exam wrapper learning strategy use in baccalaureate and associate degree nursing students: A descriptive study.

BACKGROUND: Exam wrapper, a structured self-regulated learning strategy, assists students to review study habits and performance on an exam with the goal of improving future study habits. Little is known about the use of this strategy in nursing students, particularly associate degree students. OBJECTIVES: To describe and compare demographic characteristics, study habits, reasons for getting content wrong on an exam and future study plans between associate degree and baccalaureate nursing students. DESIGN: A cross sectional, descriptive comparative study of exam wrapper use in associate degree and baccalaureate nursing students. SETTINGS: A medium-sized public university and small private college in the northeastern United States. PARTICIPANTS: A convenience sample 102 prelicensure baccalaureate (n = 63) and associate degree (n = 39) nursing students. Mean age of 21.9 ± 5.6, GPA of 3.46 ± 0.38, 7% male, 57% commuter students, 75% employed an average of 14 ± 11.4 h per week. METHODS: Data were collected by course faculty during an in-class exam review following a multiple-choice examination. Students completed a demographic form and exam wrapper that assessed pre-exam study habits, reasons for getting items wrong on an exam and future study habits. RESULTS: Associate degree students had lower GPAs (3.19 vs 3.57, p = .000), were older (27 vs 19.2, p = .000), more often commuted (100% vs 31%, p = .000), were employed (95% vs 65%, p < .001), were more likely to study at home (39.5% vs 13.1%, p = .000) and spent significantly longer on each study activity (p = .000) than baccalaureate students. When comparing reasons for getting a question wrong and intended study habits, baccalaureate and associate degree students did not differ. CONCLUSIONS: Use of the exam wrapper strategy allows nursing students at all levels of prelicensure education to actively reflect upon their learning with the goal of improving future learning.

The Reflection, Feedback, and Restructuring Model for Role Development in Nursing Education.

An integral component of transitioning to the nursing practice setting is in assimilating and sometimes reformulating and reconceptualizing the knowledge gained in the classroom with what is seen and experienced in practice. An inability to do so may inhibit role development and result in difficult transitions to practice. A constructivist approach was utilized in the development of a new model that describes the process of learning and role development in the clinical and simulation setting. This approach involved reviewing the literature, reanalyzing themes, development of multiple schematics, continual review, personal observations of students in the clinical and simulation settings, and feedback from peer educators. The resulting reflection, feedback, and restructuring model describes an inductive, iterative process strongly influenced by feedback. This conceptual model may be a useful tool to guide nurse educators in facilitating role development and the transition from the classroom to the clinical setting for the nursing student.

Nursing student experiences of remote learning during the COVID-19 pandemic.

BACKGROUND: The emergence of the COVID-19 pandemic resulted in a sudden transition to remote learning. These circumstances presented many challenges for higher education faculty and students around the world but especially for nursing education programs which are traditionally conducted in a face-to-face learning environment that includes hands-on experiential learning. METHODS: Guided by Meleis' Transition Theory, a qualitative descriptive design was utilized to explore prelicensure nursing students' experiences of the transition to remote learning during the Spring 2020 semester. Participants were recruited from one baccalaureate program in the Pacific Northwestern United States. Interviews were conducted and transcribed using a web conferencing platform. Data were analyzed using Colaizzi's phenomenological reduction. RESULTS: Eleven students participated. Interviews revealed four overarching themes: technological challenges, academic relationship changes, role stress and strain, and resilience. CONCLUSION: The sudden transition to remote learning resulted in a number of challenges for nursing students. Despite these challenges, students demonstrated a remarkable sense of resilience and perseverance. Faculty have an opportunity to address student stressors and design remote courses in such a way to facilitate student engagement and community building.

Leadership, Teamwork, and Collaboration: The Lived Experience of Conducting Multisite Research Focused on Quality and Safety Education for Nurses Competencies in Academia.

AIM: The aim of this study was to explore facilitators and barriers to conducting a multisite national study in nursing academia unsupported by grant funding. BACKGROUND: Scholarship focused on the Quality and Safety Education for Nurses (QSEN) competencies stimulates opportunities for research and collaboration among nurse educators and clinicians. Twelve members of the QSEN Academic Task Force collaborated on a multisite study of the effectiveness of a QSEN teaching strategy and published the findings. METHOD: A descriptive phenomenological reflective approach using Kim's critical reflective inquiry model was used to explore the lived experiences of the original study investigators. Data were analyzed using Colaizzi's phenomenological reduction. RESULTS: Findings revealed seven facilitators and one overarching barrier to conducting academic research projects of this scope. CONCLUSION: Participants found that strong leadership, a commitment to teamwork and collaboration, and a shared interest were critical to conducting a successful national study across academic settings.

Nursing Students' Attitudes Toward and Empathy for Patients With Substance Use Disorder Following Mentorship.

BACKGROUND: Previous studies have shown that nurses have negative attitudes toward caring for patients with substance use disorder (SUD); these negative attitudes also have been noted with nursing students. This study examined nursing students' attitudes toward and empathy for patients with SUD to determine whether there were differences across practice settings. METHOD: Fifty-three students were surveyed before and after a 120-hour mentor-ship practicum; 25 students participated in focus groups. RESULTS: Students' empathy scores improved significantly across all practice settings, and students' attitudes improved significantly in all settings except maternal child health. Qualitative analysis revealed themes related to perceived lack of educational preparation, observing generational differences in nursing care, transitioning from fear to empathy, familial exposure, and feelings of helplessness and blame. CONCLUSION: Findings support the need for educational interventions in both academic and professional practice settings. [J Nurs Educ. 2020;59(3):149-153.].

Changing Roles, Changing Perspectives-Vulnerability as a Patient.

As an assistant professor of nursing and nurse in an emergency department, I offer my perspective on being a patient with cancer and the element of feeling vulnerable associated with an "insiders" viewpoint of the health-care system.

Exam Wrapper Use and Metacognition in a Fundamentals Course: Perceptions and Reality.

BACKGROUND: An exam wrapper is a structured debriefing questionnaire designed to help students understand examination performance and develop improvement strategies. This mixed-methods pilot study sought to examine its impact on students' metacognitive skills in a fundamentals nursing class and to assess student perceptions of its usefulness. METHOD: Metacognition was assessed using the Metacognitive Inventory for Nursing Students. Quantitative data were analyzed using the nonparametric Friedman test. Qualitative data were taken from four focus groups. RESULTS: Students who used the exam wrapper throughout the semester demonstrated significant improvement in metacognition over time (p = .014). Focus group data revealed that students did not find the exam wrapper to be helpful. The analysis revealed three themes: Reliance on Faculty, Overlap With Established Self-Regulated Learning Strategies, and Difficulty in Answering Exam Wrapper Questions. CONCLUSION: Although students may not perceive this tool as useful, those who repeatedly used it over time had increased metacognition. [J Nurs Educ. 2019;58(7):417-421.].

Constructive Feedback Teaching Strategy: A Multisite Study of Its Effectiveness.

AIM: The study purpose was to describe students' perceptions of feedback after participating in a teaching strategy designed to foster a view of feedback as an opportunity for improvement. BACKGROUND: Although delivering and receiving constructive feedback are essential to the role of the professional nurse, feedback has been identified as a trigger for incivility in academia and practice. METHOD: Twelve nurse educators from the Quality and Safety Education for Nurses Academic Task Force, located at nine schools of nursing across the nation, implemented a presentation about giving and receiving constructive feedback in junior and senior courses. RESULTS: Five hundred twenty-three students submitted a total of 985 posts or essays in response to viewing the presentation; seven themes were identified. CONCLUSION: Viewing this teaching strategy enabled nursing students to develop an awareness of the opportunity that constructive feedback presents for professional development, self-improvement, teamwork and collaboration, and patient safety.

Shadowing in Early Baccalaureate Nursing Education and Its Influence on Professional Role Perspectives.

Nursing students often experience a discrepancy between their ideal views of nursing obtained while in school and the realities of practice. Using a phenomenological research design, sophomore-level students reflected on their perceptions of the professional nursing role before and after shadowing a nurse. Students' perceptions changed from a focus of the nurse as the primary caregiver in a hierarchy to a broader understanding of the complexity of nursing and what it means to care.